Hybrid Robotic-Assisted Tracheoesophageal Fistula Repair

Introduction 

 A 77-year-old male developed a small tracheoesophageal fistula following pill impaction, which was initially treated unsuccessfully with esophageal stents, a tracheal stent, and a gastrostomy tube with tube feeds. He was referred to the authors’ institution for further management due to ongoing cough and aspiration. A barium swallow demonstrated a persistent fistula approximately 5 cm above the carina. 
 
Methods 

Given the relatively proximal location of the fistula, the surgeons performed a hybrid repair. The operation began with open mobilization of the cervical esophagus from the left neck, followed by repositioning and completion of the procedure via a robotic approach in the right chest. Circumferential control of the esophagus proximal and distal to the fistula was obtained, and the fistula was then divided sharply. The fistula defects were closed, and the repair was buttressed with a thymic interposition flap. 
 
Results 

Postoperative barium swallow demonstrated no leak. The patient recovered without complication and returned to oral intake without further aspiration. 
 
Conclusion 

A hybrid approach facilitates safe initial esophageal control, given the proximal location of the fistula and surrounding inflammation. The authors prefer to “isolate” the fistula circumferentially and divide it sharply, taking care to stay on the esophageal side, as an esophagotomy is more easil

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