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Robotic Tracheobronchoplasty Performed For Post Pneumonectomy Tracheobronchomalacia Induced Cough
Ky Ngo, MD1, Mark Dylewski, MD2, Erik Sylvin, MD1.
1University of Miami Miller School of Medicine - Holy Cross Health, Miami, FL, USA, 2Baptist Health South Florida – Miami Cancer Institute, Miami, FL, USA.
BackgroundTracheobronchomalacia is an uncommon but debilitating cause of dynamic airway obstruction. Symptoms can include cough, wheezing, and dyspnea, and the condition is often underreported, especially after lung resection. Surgical tracheobronchoplasty is a complex airway operation, in which the robot approach has gained popularity in recent years. To the best of our knowledge, we report the first successful case of a robotically performed tracheobronchoplasty following right pneumonectomy for a chief complaint of recalcitrant cough.
MethodsA 75-year-old woman developed progressive dyspnea, cough, and expiratory airway collapse eight months after right pneumonectomy. Extensive workup for post pneumonectomy cough was pursued. Dynamic imaging and bronchoscopy demonstrated severe tracheobronchomalacia with greater than 75 percent collapse of the intrathoracic trachea and left main bronchus without extrinsic compression. After failure of conservative management, robotic tracheobronchoplasty was performed through a reoperative thoracic approach. The posterior membranous airway was reinforced from the thoracic inlet to the distal left main bronchus using tailored mesh and extensive interrupted suturing to restore airway rigidity while preserving luminal diameter. Intraoperative bronchoscopy confirmed airway patency.
ResultsRobotic dissection and reconstruction were completed successfully in a right post pneumonectomy chest without intraoperative complications. The patient was extubated in the operating room and had an uncomplicated postoperative course. At eight-month follow up, the patient reported marked improvement in dyspnea, exercise tolerance, and quality of life, with resolution of cough. Interval imaging and bronchoscopy demonstrated a stable airway without dynamic collapse or stenosis.
ConclusionsThis case demonstrates the feasibility of robotic tracheobronchoplasty for severe tracheobronchomalacia in a post right pneumonectomy patient. A minimally invasive robotic approach allowed precise dissection and extensive airway reconstruction in a complex reoperative setting, resulting in durable symptomatic and anatomic improvement. Tracheobronchomalcia should be considered as an etiology for recalcitrant cough in post lung resection patients. Robotic tracheobronchoplasty following lung resection, even pneumonectomy, can safely be performed with excellent results.
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