Thoracoscopic Repair Of Tracheoesophageal Fistula Research Articles

Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon's experience.

This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis. Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated. The learning curves were compared with the effect of accumulation based on case experience. For 33 consecutive cases, the mean operative and anastomosis times were 139 ± 39min and 3137 ± 1110s, respectively. Significant transitions beyond the learning phase for total operating and anastomosis times were observed at cases 13 and 17. Both the total operating time and anastomosis time were significantly faster in the proficiency improvement phase than in the initial learning phase. Postoperative complications significantly decreased after the initial anastomosis learning phase but not after the initial total operating learning phase. Thoracoscopic repair of TEF is considered safe and feasible after 13 cases, where the surgeon can improve their proficiency with the total operation procedure, and 17 cases, which will enable the surgeon to achieve proficiency in anastomosis. Postoperative complications significantly decreased after gaining familiarity with the anastomosis procedure through the learning phase.

Thoracoscopic repair of congenital isolated H-type tracheoesophageal fistula

Background/purposeThe available literature on congenital isolated H-type tracheoesophageal fistula (TEF) is limited, and preferred approach varies among centers (cervicotomy, thoracotomy, thoracoscopy). We aimed to present one of the biggest case series of thoracoscopic approach for congenital isolated TEF and to assess the method's feasibility and outcomes. MethodsRetrospective review of thoracoscopic TEF repair experiences at 2 European university pediatric surgery centers. Results9 boys and 3 girls were involved in the study (age 5 days–4 years), 8 of them were newborns (mean birth weight 3013 g, mean gestational age 39 weeks). The most common presenting symptoms were desaturations on feeding in neonates and recurrent respiratory tract infections in older children. The diagnoses were established on contrast study and confirmed with rigid bronchoscopy. The fistulas were located at or below the thoracic inlet; the fistulas were 2 cm above the carina to half the height of the trachea. All patients underwent successful thoracoscopic TEF repair. There were no conversions. The postoperative course was uneventful in all but one who had rethoracoscopy for prolonged postoperative chylothorax. All patients had satisfactory vocal cord function. One patient required reoperation for fistula recurrence 8 months after primary surgery. ConclusionThoracoscopic approach for isolated H-type TEF seems to be possible as a procedure of choice with satisfactory results and all benefits of minimally invasive procedure. Level of evidenceIV (case series).

Tracheoesophageal fistula

Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification.

First thoracoscopic repair of tracheoesophageal fistula in the UAE

Repair of esophageal atresia/tracheoesophageal fistula (EA/TEF) with open thoracotomy is associated with significant chest wall deformity. However, with the advancement made in minimally invasive instruments, thoracoscopic repair of this anomaly is achievable. We report our first successful case of thoracoscopic repair of EA/TEF. The surgical steps followed have been enumerated, as well as the postoperative management protocol. Thoracoscopic repair of EA/TEF is a real advantage for affected babies. Keywords : esophageal atresia, thoracoscopy, tracheoesophageal fistula

Design and development of a novel thoracoscopic tracheoesophageal fistula repair simulator.

Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) is a technically challenging surgical procedure. This congenital anomaly is rare; therefore, training opportunities for surgical trainees are limited. There are currently no validated simulation tools available to help train pediatric surgery trainees. The simulator that was developed is a low-cost, reusable model. It simulates the right side of a term neonate chest and contains a tissue block that has been surgically modified to replicate the anatomy of EA/TEF.

Left Mainstem Bronchial Tear Manifesting as Sudden Upsurge in End-Tidal CO2 During Thoracoscopic Tracheoesophageal Fistula Repair

THE CAUSES OF INCREASES in end-tidal carbon dioxide (EtCO2) during surgery are well known, but an abrupt upsurge in EtCO2 during thoracic surgery in which 1 lung has been collapsed partially using CO2 insufflation into the pleural space could only mean a direct communication between the pleural cavity/mediastinum and the airway.

Thoracoscopic repair of tracheoesophageal fistula in newborns

Background: Advancements in minimally invasive surgery in neonates have allowed even the most complex neonatal procedures to be approached using these techniques. Methods: During a period of 15 months, 8 patients born with a proximal esophageal atresia and a distal tracheoesophageal fistula underwent repair thoracoscopically. Weights ranged from 2.1 to 3.4 kg and operating times ranged from 55 to 120 minutes. Results: All procedures were completed successfully thoracoscopically, and there were no operative complications. One patient had a small leak on day 4 that resolved spontaneously on day 8. All other patients were shown to have a patent anastomosis with no leak by Barium swallow on day 5. Conclusion: This initial report shows that esophageal repair in the neonate is technically feasible and may provide advantages in terms of exposure and esophageal length, as well as the recognized advantages of avoiding a thoracotomy. J Pediatr Surg 37:869-872. Copyright 2002, Elsevier Science (USA). All rights reserved.