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TÜRKÇE
Oral Presentation - 1
Posterior Tracheopexy for the treatment of tracheomalacia: is robotic assisted thoracoscopy an advantage?
M Torre, F Lena, F Palo, G Mattioli
IRCCS Istituto Giannina Gaslini, Genova, Italy
Purpose: Posterior tracheopexy (PT) for tracheomalacia can be performed through open, pure thoracoscopic or robotic assisted (RAT) approach. One of the keys of the success is the number of PT stitches, which is variable, and can be limited by technical difficulties. Our aim was to evaluate the role of RAT.
Method: We performed 22 PT since 2019, excluding patients undergoing primary PT during esophageal atresia repair. Group A included 16 RAT, Group B 4 pure thoracoscopy and Group C 2 open cases. We evaluated: preoperative symptoms; endoscopic findings (according to European Respiratory Society (ERS) classification); surgical details (including number of stitches); complications; results (both endoscopic and clinical).
Results: All patients, affected by severe chronic respiratory symptoms, had a tracheomalacia grade 2 or 3 at bronchoscopy (ERS). Ten (45%) had comorbidities (mostly esophageal atresia), 7 were previously submitted to aortopexy. Patients of group B and C were significantly smaller than those of group A. In the latter, the smaller patient was 3 year-old (15 Kg). Average operative time did not differ between groups. In none of the groups intraoperative complications were registered. Robotic assisted PT allowed an easier placement of more PT stitches than pure thoracoscopic PT. Post-operative chylothorax (treated conservatively) and esophageal perforation (treated with a stent) were observed in one case each of group A; another patient of the same group complained of transient dysphagia. Improvement in respiratory outcome (both endoscopic and clinical) were observed in 95% of cases: in group A, 12 (75%) had a complete resolution and 4 (25%) an improvement of symptoms. In the other groups, we observed no symptom resolution, improvement in 5 cases and stable symptoms in 1.
Conclusion: PT is an effective approach for the treatment of tracheomalacia in children. RAT PT is an advantageous approach in patients over 15 Kg