Thoracoscopic Operation for Esophageal Atresia

Abstract

We describe primary thoracoscopic repair of type C esophageal atresia. We illustrate the procedure performed in a neonate whose birth weight was ≥2000 g who had no severe cardiac anomalies or respiratory complications. Intratracheal intubation is performed under spontaneous breathing. The patient is placed in a near-prone position with the right side slightly elevated. The surgeon and the assistant hold the camera stand on the right side of the patient. The first port is inserted into the intercostal space on the caudal side of the angulus inferior scapulae, and two working ports are inserted on the right and left sides of the first port. After identifying the azygos vein and the vagus nerve, the lower pouch is dissected and the fistula is ligated. After the upper pouch is adequately mobilized, its distal tip is resected. An anchoring suture is placed on the back wall of the upper pouch to anchor it on the caudal side of the upper pouch. Anastomosis is performed using 5-0 absorbable sutures. After anastomosis of the back wall, a transanastomotic nasogastric tube is inserted into the lower esophagus. After completing anastomosis, a chest drain is inserted through the camera port. The postoperative management after thoracoscopic repair of esophageal atresia is similar to that after conventional thoracotomy.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd, 2013, with the exception of occasional newly added figures that may appear.