Initial Experience with Thoracoscopic Esophageal Atresia and Tracheoesophageal Fistula Repair: Lessons Learned and Technical Considerations to Achieve Success

摘要

The minimally invasive surgical (MIS) repair of esophageal atresia/tracheoesophageal fistula (EA/ TEF) is challenging and requires advanced endoscopic skills. The purpose of this study was to provide insight in successfully introducing the MIS repair based on the initial cases performed by a single pediatric surgeon and review of the experience of others. A retrospective review of all MIS TEF repairs performed by a single surgeon was conducted. Data gathered included patient demographics, technical details of repair including operative time, short- and long-term postoperative morbidity, length of stay, and follow-up. Eight cases (seven Type C, one Type D) were selected for MIS repair based on the judgment of the surgeon with consideration of adequate patient size, stability, type of associated anomalies, and expected length of esophageal gap. Operative time was an average of 207 minutes and there was one conversion to open for successful repair. There were no leaks and only one patient required a single anastomotic dilation at 19 months of age. There were two postoperative pneumothoraces of which one required broncho-scopic laser fistula ablation. Length of stay was an average of 16 days and length of follow-up is a median of 219 days. MIS repair of EA/TEF can be done successfully but requires careful patient selection, advanced MIS skills and meticulous attention to operative technique. TRACHEOESOPHAGEAL ANOMALIES of which proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF), known as the Type C pattern is most common and, affects one in 2500 to 3000 live births.1 This operation has traditionally been done open through a posterior lateral thoracotomy. However, with the advances in minimally invasive surgery (MIS), specifically the availability of smaller instruments and more prevalent advanced MIS skills among surgeons, an increasing number of these operations are being done thoracoscopically. This later approach is widely considered the most advanced procedure in neonatal MIS and requires a high level of precision in both suturing and knot-tying. Van der Zee et al.2 discussed the learning curve required in performing this difficult procedure and recommended the involvement of experienced surgeons in all cases and offered some guidance in suturing technique.