Posterior tracheobrochopexy with thoracoscopic or robotic approach: technical details

Posterior tracheopexy has been proposed as a novel approach to treat tracheobronchomalacia, in addition or alternative to more traditional treatments as aortopexy. Reports on this technique are still very sporadic. Our aim is to discuss technical surgical details based on our preliminary experience of thoracoscopic and robotic posterior tracheopexy. Technical details on 6 patients (from 8 months to 13 years of age) operated for posterior tracheopexy with a thoracoscopic approach are presented and discussed. In two cases robotic posterior tracheopexy was performed. Two patients presented multiple comorbidities and had a tracheostomy previously performed. Airway obstruction evaluated at pre-operative bronchoscopy was between 70 and 100%, with posterior intrusion of pars membranacea. Operative time ranged from 110 to 320 min. In three cases aortopexy was associated, one at the same time, in the other two before or after tracheopexy. No specific complications of posterior tracheopexy were observed. Robotic approach made the esophageal dissection and the tracheobronchopexy technically easier. Thoracoscopic approach is feasible, robotic assistance is helpful for improving visualization, esophageal dissection, and making easier and more precise the pexy of the trachea and bronchi on all its length. Both bronchi can be approached and pexied if necessary, and this is a specific advantage of tracheopexy with respect to aortopexy. Intraoperative bronchoscopy and strict collaboration between surgeons and anesthesiologists are essential.