Thoracoscopic Repair of Esophageal Atresia

Abstract

The surgical repair of esophageal atresia is one of the most difficult and challenging procedures in pediatric surgery. The operation can either be performed in a classic extrapleural open manner via a posterolateral thoracotomy or in a minimally invasive thoracoscopic manner. While good comparative studies are lacking due to the small and heterogeneous patient cohort, there is currently no good evidence for or against the thoracoscopic method. Arguments for open surgery may consist of shorter operation time, and avoidance of the intrapleural space. On the other hand, there could be fewer patients with later scoliosis, thoracic wall defects and winged scapula following thoracoscopic repair. We hereby offer a detailed and step-by-step guide to performing thoracoscopic surgery for esophageal atresia. Using two or more thoracoscopic sliding knots which are tightened one by one in small increments step by step, the two esophagus ends may be brought together, whereby the pull is distributed to different points of the esophagus. Explaining several tricks and pitfalls, this video is intended to serve as a guide for experienced pediatric surgeons to optimally and timely carry out this difficult operation.