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Modified Robotic-Assisted Tracheobronchoplasty in a Patient With Severe Calcific Mediastinal Lymphadenopathy
Thomas M. Modified Robotic-Assisted Tracheobronchoplasty in a Patient With Severe Calcific Mediastinal Lymphadenopathy. May 2025. doi:10.25373/ctsnet.29052254
Many challenges are present when using the open tracheobronchoplasty technique for the robot-assisted minimally invasive approach. One major challenge is suture management, specifically identifying the individual sutures and tying them after completing each row. This process can be very frustrating and takes a long time to master. Another challenge is that the long pieces of mesh can make it difficult to visualize the needle passing behind the mesh, increasing the risk of tearing the tracheal membrane and the previously placed sutures.
This video presentation shows several modifications to the traditional technique that make it easier to perform robotic tracheobronchoplasty. These modifications include the division of the azygous vein with the robotic vessel sealer to improve exposure and avoid staple entanglement with the sutures, the use of multiple smaller strips of dual-layered mesh for the trachea, the use of running barbed permanent sutures to anchor the dual-layered mesh, and the placement of a reverse Y-shaped mesh for the right main stem bronchus to reinforce the bronchus intermedius and upper lobe bronchi as a routine step.
References
- Lazzaro, Richard et al. .Just breathe: 12-step robotic tracheobronchoplasty. JTCVS Techniques, 2023. Volume 21, 239 - 243.
- Richard S. Lazzaro, Donna Bahroloomi, Gregory A. Wasserman, Byron D. Patton, Robotic Tracheobronchoplasty: Technique, Operative Techniques in Thoracic and Cardiovascular Surgery, 2022, Volume 27, Issue 2, Pages 218-226.
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