Exposure and Repair of the Left Mainstem Bronchus for Robotic-Assisted Tracheobronchoplasty

This video demonstrates the most technically difficult initial steps to a minimally invasive, robotic-assisted tracheobronchoplasty, namely the exposure and repair of the left mainstem bronchus. The video details the dissection on the left mainstem from the mediastinal lymph nodes and esophagus and exemplifies the coordination of the surgeon and the anesthesiologist in the "stop, drop, and roll" technique described by Lazarro et Al. (1). 

This "stop, drop, and roll" technique involved the anesthesiologist making the patient apneic, deflating the endotracheal tube balloon, and retracting the tube out of the left mainstem to provide maximal exposure for quick and effective suturing of the mesh. The mesh chosen was a 16 mm width monofilament polypropylene material cut to the length of the patient's bronchus. Vicryl sutures on RB-1 needles were used to affix the mesh and dyed versus undyed suture material was alternated to maintain organization during suturing to allow maximal flexibility in orienting the mesh with minimal confusion. 

The tracheal repair and right mainstem bronchus repair are not demonstrated in this video, as they are similar in approach and technique to the left mainstem bronchus repair but are technically easier due to greater exposure in the surgical field.

References

1. https://www.optechtcs.com/article/S1522-2942(22)00007-1/fulltext

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