Nonintubated Robotic-assisted Thoracic Surgery for Tracheal/Airway Resection and Reconstruction: Technique Description and Preliminary Results

Abstract

Objective: We aim to report a novel surgical technique that RATS combined with nonintubated spontaneous ventilation to perform tracheal/airway surgery.

Summary of background data: Our team has demonstrated video-assisted transthoracic surgery can be used for thoracic tracheal diseases with satisfactory outcomes. Our team has also demonstrated that tracheal/airway resection and reconstruction under spontaneous ventilation can improve the anastomosis and operating time. Recently, RATS emerged as an available alternative minimally invasive approach for lung cancer, with lower perioperative mortality and conversion rate to open.

Methods: Five patients fulfilling the criteria for nonintubated approach underwent RATS tracheal/airway surgery. Patient 1 has a tumor in the thoracic trachea; patient 2 had involving secondary carina; patient 3 had involving trachea carina, and patient 4 had involving left main bronchus. Patient 5 had involving mid-tracheal.

Results: All patients had an uneventful procedure. The total operative time ranged from 5 hours 5 minutes to 9 hours 55 minutes. The postoperative hospital stays ranged from 4 days to 14 days. Fiber-optic bronchoscopy performed 1 month after the procedure showed good anastomotic healing with no stricture.

Conclusion: This is the first report on RATS use in tracheal/airway surgery, in combination with nonintubation spontaneous ventilation. In selected patients, this novel combined approach is feasible and safe. A patient can potentially benefit from the combined advantages of both techniques. More cases and longer-term data are required to establish its role in tracheal/airway surgery.

FIGURE 1

Preoperative imagines and surgical pictures. A, Preoperational CT image (patient 1); a 1.3 cm tumor located in the thoracic trachea causing a significant obstruction. B, A drawing of the tracheobronchial tree with all tumors located, Patient 1 has a tumor in the thoracic trachea. Others tumor location was at the left secondary carina (patient 2), trachea carina (patient 3), left main bronchus (patient 4), and mid-tracheal (patient 5). C, Second carinal reconstruction surgical approach (patient 2); the patient was placed in a right lateral decubitus position. The robotic thoracoscope port (1 cm) was made in the sixth intercostal space in the anterior axillary line. The main operation port (3 cm) was placed in the fourth intercostal space on the midaxillary line; the auxiliary operation port (1 cm) was made in the seventh intercostal space posterior axillary line. D, Full exposure of tumor site trachea (patient 3); the tumor was excised with a clearance margin of at least 0.5 cm from the tumor. E, Suturing the trachea and reconstruction carinal (patient 3); the airway was anastomosed using a continuous prolene suture. F, Suturing the posterior wall of the trachea and reconstructed carinal (patient 3). CT indicates computerized tomography; LMB, left main bronchus; RMB, right main bronchus.