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Posterior tracheobrochopexy with thoracoscopic or robotic approach: technical details

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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.

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Funding

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Authors and Affiliations

  1. Pediatric Thoracic and Airway Surgery Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Michele Torre

  2. Pediatric Surgery Unit, IRCCS Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy

    Michele Torre, Vittorio Guerriero, Federica Lena, Federico Palo & Girolamo Mattioli

  3. Neonatal and Pediatric Intensive Care Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Andrea Moscatelli

  4. Anesthesiology Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Nicola Disma

  5. Pulmonology Unit, IRCCS Giannina Gaslini, Genoa, Italy

    Oliviero Sacco

  6. DINOGMI, University of Genova, Genoa, Italy

    Girolamo Mattioli

  7. General Direction, IRCCS Giannina Gaslini, Genoa, Italy

    Paolo Petralia

Authors
  1. Michele Torre
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  2. Vittorio Guerriero
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  3. Andrea Moscatelli
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  4. Nicola Disma
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  5. Federica Lena
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  6. Federico Palo
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  7. Oliviero Sacco
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  8. Girolamo Mattioli
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  9. Paolo Petralia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by VG, FL, FP. OS is the pulmonologist who evaluated bronchoscopically the patients before the surgery and during the procedure. GM and MT were the surgeons who performed the procedures, ND and AM the anesthesiologists and intensivists who took care of the patients in the peri-operative period. PP is the CEO of our Institute, who made it possible to have robot in our pediatric Institute. The first draft of the manuscript was written by MT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michele Torre.

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Conflict of interest

Authors have not conflict of interest to be disclosed.

Ethics approval

The study does not include any study on patients.

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Torre, M., Guerriero, V., Moscatelli, A. et al. Posterior tracheobrochopexy with thoracoscopic or robotic approach: technical details. J Ped Endosc Surg 2, 169–174 (2020). https://doi.org/10.1007/s42804-020-00082-6

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  • DOI: https://doi.org/10.1007/s42804-020-00082-6

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