TY - JOUR
T1 - First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia
AU - Lazzaro, Richard
AU - Patton, Byron
AU - Lee, Paul
AU - Karp, Jason
AU - Mihelis, Efstathia
AU - Vatsia, Sohrab
AU - Scheinerman, Samuel Jacob
N1 - Publisher Copyright:
© 2018 The American Association for Thoracic Surgery
PY - 2019/2
Y1 - 2019/2
N2 - 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 May 2016 to December 2017. 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 =.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.
AB - 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 May 2016 to December 2017. 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 =.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.
KW - COPD
KW - TBM
KW - TBP
KW - bronchomalacia
KW - robotic
KW - tracheobronchomalacia
KW - tracheobronchoplasty
KW - tracheomalacia
UR - http://www.scopus.com/inward/record.url?scp=85053790399&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2018.07.118
DO - 10.1016/j.jtcvs.2018.07.118
M3 - Article
C2 - 30669239
AN - SCOPUS:85053790399
SN - 0022-5223
VL - 157
SP - 791
EP - 800
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -