Minimally Invasive Surgical Approach for Posterior Tracheopexy to Treat Severe Tracheomalacia: Lessons Learned from Initial Case Series

Ali Kamran, Thomas E. Hamilton, Benjamin Zendejas, Bharath Nath, Russell W. Jennings, Charles J. Smithers

Research output: Contribution to journalArticlepeer-review

Abstract

Background/Purpose: Posterior tracheopexy directly addresses membranous tracheal intrusion in severe tracheomalacia (TM). We have previously reported our experience of posterior tracheopexy through open approach in a large series of patients. This study aimed to review lessons learned from our initial series posterior tracheopexy through the video-Assisted or robotic video-Assisted thoracoscopic approach. Methods: We retrospectively reviewed our single-institution experience on all patients who underwent video-Assisted or robotic video-Assisted posterior tracheopexy for treatment of symptomatic TM between October 2016 and February 2018. Results: Ten patients underwent video-Assisted (n = 4) or robotic video-Assisted (n = 6) thoracoscopic posterior tracheopexy (age range: 8 months-19 years). One patient, the youngest in our cohort, had a type C esophageal atresia repair; none of the other patients had undergone prior thoracic operations. All had symptomatic TM; 1 patient with tracheostomy dependence also had severe distal bronchomalacia, including segmental airways. Postoperatively, patients were hospitalized 3-7 days, with 1-2 days for ICU observation. Improved respiratory symptoms were noted in 9/10 patients following the operation. The 1 patient with preexisting tracheostomy had reduced ventilator dependence but remained hospitalized with ongoing respiratory symptoms. Conclusions: The thoracoscopic approach for posterior tracheopexy, while challenging, can be applied to a select cohort of children with severe TM. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-Assisted approach by providing an easier platform for more complicated suturing angles.

Original languageEnglish (US)
Pages (from-to)1525-1530
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume28
Issue number12
DOIs
StatePublished - Dec 2018
Externally publishedYes

Keywords

  • minimally invasive surgery (MIS)
  • posterior tracheopexy
  • tracheomalacia (TM)/tracheobronchomalacia (TBM)

ASJC Scopus subject areas

  • Surgery

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