Robotic-Assisted Tracheobronchoplasty

This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented with exertional dyspnea and cough. The patient underwent awake fiberoptic bronchoscopy, which confirmed posterior malaria with >90% narrowing of the trachea and right mainstream bronchus. The patient was treated conservatively with bronchodilators for six months without symptomatic improvement. She was referred for tracheobronchoplasty via a minimally invasive approach.

A four-arm robotic-assisted approach was selected. The trachea was dissected to the level of the thoracic inlet and the carina skeletonized. The left mainstem bronchus was mobilized, allowing exposure of the entire membranous trachea. The tracheoplasty was performed using four columns of interrupted horizontal mattress 4-0 vicryl sutures to a proline mesh. The bronchoplasty was performed using three columns of sutures. Frequent intraoperative bronchoscopy was performed.

While tracheobronchoplasty for TBM has traditionally been performed via an open approach, the robotic surgical platform has offered a minimally invasive option for performing the often complex technical maneuvers required in this procedure. Early results of minimally invasive tracheobronchoplasty have been promising (1).

Reference

1. Lazzaro R, Patton B, Lee P, Karp J, Mihelis E, Vatsia S, et al. First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia. J Thorac Cardiovasc Surg. 2019 Feb;157(2):791-800.

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