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Robotically Assisted Bilateral Bronchoplasty for Tracheobronchomalacia.
Richard Lazzaro, MD, John Lazar, MD, Brian Mitzman, MD.
Lenox Hill Hospital, New York, NY, USA.

OBJECTIVE: This video documents the technique and outcome of the first totally thoracoscopic bilateral bronchoplasty for tracheobronchomalacia using the DaVinci robot (Intuitive Surgical Inc, Sunnyvale, CA.)
METHODS: CASE VIDEO SUMMARY - A 79 year old male with a past medical history of hypertension, temporal arteritis, melanoma, and GERD was seen over a year ago because of severely disabling cough and thick secretions associated with decreased appetite, weight loss, and fatigue. He was initially treated for pneumonia, but when symptoms worsened he underwent further workup. Bronchcoscopy showed severe right bronchomalacia. He underwent a palliative tracheal stent procedure in February 2013 by a thoracic surgeon after it was determined he would not tolerate lobectomy. A second opinion was sought due to the continuous decline of the patient in May. The stent was removed and cultures showed multi-drug resistant pseudomonas requiring chronic antibiotics. A decision was made in July to admit patient, start a week of TPN for his malnutrition, and attempt a minimally invasive right bronchoplasty.
A right video assisted thoracoscopic robotically assisted bilateral bronchoplasty with prolene mesh was performed without any intra or post-operative complications. The patient spent the first night in the ICU for observation. The chest tube was removed post operative day 1 and then transferred to the ward. By post operative day 2 he noticed significantly decreased secretions, was able to walk the halls and eat without difficulty. Over the next several days his clinical condition continued to rapidly improve with diminished secretions, increased deep respirations, complete resolution of his severe GERD and noticeable degree of weight gain. A repeat bronchoscopy post operative day 6 showed no airway collapse during inspiration.
RESULTS: See below
CONCLUSIONS: This is the first recorded completely minimally invasive bronchoplasty with or without an access port demonstrating that high technical tracheal repairs are feasible using the robot in high risk patients.

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