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Tracheobronchoplasty for tracheobronchomalacia

Bakhos, Charles T.
; 
Magarinos, Jessica
; 
Bent, Daniel
; ; 
Abbas, Abbas E.
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Genre
Journal article
Date
2022-04-20
Advisor
Committee member
Group
Temple University. Hospital
Fox Chase Cancer Center (Temple University)
Department
Thoracic Medicine and Surgery
Subject
Splinting
 Airway
 Collapse
 Thoracotomy
 Robotic
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http://hdl.handle.net/20.500.12613/9611
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BakhosEtAl-JournalArticle-2022-04-20.pdf
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DOI
http://dx.doi.org/10.21037/jovs-21-56
Abstract
Tracheobronchoplasty (TBP) consists of splinting of the posterior membranous wall of the central airways with the goal of restoring a normal configuration and preventing excessive collapse in patients with tracheobronchomalacia (TBM). Despite some variation in technique, it consists of sewing a mesh on the posterior membranous wall of the trachea and both main stem bronchi. Traditionally performed through a right posterolateral thoracotomy, it should be reserved for cases of severe TBM. Surgical exposure necessitates dissection of the trachea from the thoracic inlet to the carina, as well the right main stem bronchus, bronchus intermedius and left main stem bronchus. Airway management in the operating room requires manipulation of the endotracheal tube (ETT) to allow safe placement of the sutures without puncturing the balloon. Other key technical considerations include downsizing of the airway with the mesh, and appropriate spacing of the sutures to ensure a plicating effect of the posterior membranous wall. More recently, the robotic platform was used to perform TBP surgery. Its fine precise wristed motion and excellent visualization offer potential advantages over a thoracotomy, and early outcomes of robotic-assisted TBP are encouraging. Longitudinal follow-up is still necessary to ensure the durability of repair in a patient population with significant underlying respiratory co-morbidities.
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Citation
Bakhos CT, Magarinos J, Bent D, Petrov R, Abbas AE. Tracheobronchoplasty for tracheobronchomalacia. J Vis Surg 2022;8:15.
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AME Publishing Company
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Journal of Visualized Surgery, Vol. 8
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