Robotically Assisted Bilateral Bronchoplasty for Tracheobronchomalacia

Lazar, John F.; Posner, David; Palka, Wojciech; Spier, Laurence N.; Lazzaro, Richard

doi:10.1177/155698451501000612

Cited by 4 publications

(4 citation statements)

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“…Most surgeons offered RVATS to clinical stage I or II non small cell lung cancer: Veronesi et al limited the maximum size to five centimeters, Cerfolio et al extended the indications to include larger size or preoperative chemoradiation and other surgeons allowed more advanced cases (28). Recent reports showed that more complicated cases needing bronchoplastic surgery were feasible for robotic surgery (29,30). In this series most of the patients with a lung cancer diagnosis had stage I disease and we also report more complex surgical procedures such as two bronchoplasties with adequate perioperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Buitrago¹,

Restrepo²

2019

Ann. Cardiothorac. Surg.

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Background: Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. Methods: This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. Results: Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). Conclusions: This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Buitrago¹,

Restrepo²

2019

Ann. Cardiothorac. Surg.

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“…Robotically assisted bilateral bronchoplasty, bioresorbable 3D airway stents, and tracheal cartilage regeneration techniques are also under investigation. [35][36][37] Conclusion ECAC is characterized by nonspecific symptom profile that may overlap with other more common diseases such as COPD and asthma. This often lead to delayed or misdiagnosis.…”

Section: Novel Therapiesmentioning

confidence: 99%

Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment

Kheir

Majid

2018

Semin Respir Crit Care Med

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Excessive central airway collapse (ECAC) is characterized by excessive narrowing of the airway lumen during exhalation leading to dyspnea, cough, mucostasis, recurrent respiratory infections, and poor quality of life. Tracheobronchomalacia and excessive dynamic airway collapse are heterogeneous entities of ECAC and are characterized by a diverse nonspecific symptom profile. Although the pathophysiology of airway mechanics as well as morphology in both entities is different, current evidence so far shows no practical benefit in making such distinction since both have similar symptoms and the diagnostic and therapeutic work-ups are the same. The diagnosis of ECAC should be based on dynamic flexible bronchoscopy and/or dynamic computed tomography scan as well as clinical symptoms that are not fully explained by other lung diseases. Initial treatment of symptomatic ECAC includes treatment of coexisting conditions (such as chronic obstructive pulmonary disease, asthma, gastroesophageal reflux disease, and vocal cord dysfunction) and supportive treatment of dynamic central airway collapse (antibiotics for respiratory infections, aggressive therapy, pulmonary physiotherapy, pulmonary rehabilitation, and continuous positive airway pressure). A short-term stent trial in selected patients with severe symptomatic ECAC is needed to assess whether patients will have improvement in symptoms and thus identify patients who will benefit from surgical central airway stabilization. A multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population is essential for optimal outcomes.

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“…Multiple studies show low morbidity and mortality for other robot-assisted thoracic procedures such as lobectomy. 12,13 In 2015, Lazar and colleagues 14 substantiated the feasibility of robotic-assisted bilateral bronchoplasty for the treatment of TBM. The benefits (eg, decreased morbidity) of minimally invasive surgery have been elucidated over the past decades through numerous publications.…”

Section: Perspectivementioning

confidence: 99%

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia

Lazzaro

Patton

Lee

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Tracheobronchomalacia is a progressive, debilitating disease with limited treatment options. Open tracheobronchoplasty (TBP) is an accepted surgical option for management of severe tracheobronchomalacia. This study examined the outcomes of the first reported series of robot-assisted TBP (R-TBP). Methods:We retrospectively reviewed the records of patients with clinical suspicion for tracheobronchomalacia who had dynamic computed tomography scan and subsequent R-TBP from Results: Four hundred thirty-five patients underwent dynamic computed tomography scan for suspicion of tracheobronchomalacia. Of this group, 42 patients underwent R-TBP. In the surgery group, the median age was 66 years (interquartile range, 39-72 years) and there were 30 women (71%). Respiratory comorbidities included asthma (88%) and chronic obstructive pulmonary disease (52%). The median operative time was 249 minutes (interquartile range, 266-277 minutes). Median hospital length of stay was 3 days (interquartile range, 2-4.75 days), and there were 19 postoperative complications (11 minor and 8 major). There were no mortalities at 90 days. Comparison of preoperative and postoperative pulmonary function testing demonstrated improvement in forced expiratory volume at 1 second by 13.5% (P ¼ .01), forced vital capacity by 14.5% (P<.0001), and peak expiratory flow rate by 21.0% (P<.0001). Quality of life questionnaires also showed improvement with 82% reporting overall satisfaction with the procedure. Conclusions: R-TBP can be performed with low morbidity and mortality. Early follow-up reveals significant improvement in pulmonary function testing and high patient satisfaction when compared with preoperative baseline. Long-term follow-up is needed to demonstrate the durability of R-TBP and substantiate its role in the management of patients with symptomatic, severe tracheobronchomalacia. (J Thorac Cardiovasc Surg 2019;157:791-800) Preop Postop PEFR P < .0001 Percent Predicted 0 25 50 75 100 125 From the

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Robotically Assisted Bilateral Bronchoplasty for Tracheobronchomalacia

Cited by 4 publications

References 1 publication

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia

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