Uniportal VATS for Iatrogenic Tracheal Injury

The authors present a case of uniportal VATS for repair of an iatrogenic tracheal injury. The patient was a 90-year-old woman who developed progressive subcutaneous emphysema after laparoscopic cholecystectomy. A double-lumen tube was immediately inserted to control subcutaneous emphysema. Then she was transferred to the authors’ unit for further evaluation and treatment. A bronchoscopy was performed under general anesthesia and a tracheal injury was detected in the distal part of the trachea extending to the right main bronchus. A decision was made to perform a surgical repair, and she was re-intubated with a left double lumen tube and taken to the operation room. Uniportal VATS was performed through a 4 cm incision in the 5th intercostal space in the mid-axillary line. The azygos vein was divided using an endo-stapler to reveal the tracheobronchial angle. A tracheal injury 5 cm long was identified on the right side of the distal trachea extending to the right main bronchus. Stay sutures were placed on both edges to expose meticulously the proximal and distal end of the injury. The tracheal injury was repaired with 4-0 polypropylene suture using a continuous suture technique. The suture line was covered with paratracheal fatty tissue and the operation was completed after inserting a chest tube. 

On the postoperative bronchoscopy, the trachea with visible suture lines was intact and healthy. She was extubated immediately after surgery and discharged home on the fourth postoperative day. After that, on routine follow-up, the patient was examined periodically. She did not have any complaints in this period and no evidence for stricture was observed. Three months after the surgery, the trachea was considered intact and healthy again, indicating that no complications have occurred.

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