Posterior tracheobrochopexy with thoracoscopic or robotic approach: technical details
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ORIGINAL RESEARCH
Posterior tracheobrochopexy with thoracoscopic or robotic approach: technical details Michele Torre1,2 · Vittorio Guerriero2 · Andrea Moscatelli3 · Nicola Disma4 · Federica Lena2 · Federico Palo2 · Oliviero Sacco5 · Girolamo Mattioli2,6 · Paolo Petralia7 Received: 7 June 2020 / Revised: 15 August 2020 / Accepted: 23 August 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract Purpose Posterior tracheopexy has been proposed as a novel approach to treat tracheobronchomalacia, in addition or alternative to more traditional treatments as aortopexy. Reports on this technique are still very sporadic. Our aim is to discuss technical surgical details based on our preliminary experience of thoracoscopic and robotic posterior tracheopexy. Methods Technical details on 6 patients (from 8 months to 13 years of age) operated for posterior tracheopexy with a thoracoscopic approach are presented and discussed. In two cases robotic posterior tracheopexy was performed. Results Two patients presented multiple comorbidities and had a tracheostomy previously performed. Airway obstruction evaluated at pre-operative bronchoscopy was between 70 and 100%, with posterior intrusion of pars membranacea. Operative time ranged from 110 to 320 min. In three cases aortopexy was associated, one at the same time, in the other two before or after tracheopexy. No specific complications of posterior tracheopexy were observed. Robotic approach made the esophageal dissection and the tracheobronchopexy technically easier. Conclusion Thoracoscopic approach is feasible, robotic assistance is helpful for improving visualization, esophageal dissection, and making easier and more precise the pexy of the trachea and bronchi on all its length. Both bronchi can be approached and pexied if necessary, and this is a specific advantage of tracheopexy with respect to aortopexy. Intraoperative bronchoscopy and strict collaboration between surgeons and anesthesiologists are essential. Keywords Tracheomalacia · Posterior tracheopexy · Robotic thoracoscopy · Pediatric thoracoscopy · Pediatric robotic surgery · Tracheal surgery
Introduction
* Michele Torre [email protected] 1
Pediatric Thoracic and Airway Surgery Unit, IRCCS Giannina Gaslini, Genoa, Italy
2
Pediatric Surgery Unit, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
3
Neonatal and Pediatric Intensive Care Unit, IRCCS Giannina Gaslini, Genoa, Italy
4
Anesthesiology Unit, IRCCS Giannina Gaslini, Genoa, Italy
5
Pulmonology Unit, IRCCS Giannina Gaslini, Genoa, Italy
6
DINOGMI, University of Genova, Genoa, Italy
7
General Direction, IRCCS Giannina Gaslini, Genoa, Italy
Tracheobronchomalacia (TBM) is a not uncommon congenital airway anomaly. The treatment of TBM, when required due to severe respiratory symptoms, may represent a challenge. Posterior tracheopexy (PT) has been proposed as a novel approach to treat TBM, in addition or alternative to more traditional treatments as aortopexy. During PT, the posterior pars membranacea of the trachea and
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