V-012
SUCCESSFUL SURGICAL TREATMENT OF BRONCHO-OESOPHAGEAL FISTULA WITH ROBOTIC SURGICAL SYSTEM Free

Objectives: The successful surgical treatment of a patient with broncho-oesophageal fistula after tracheal resection is reported.

Video description: A 56-year old woman with benign tracheal stenosis and tracheoesophageal fistula underwent repeatedly endoscopic treatment without positive results. Therefore tracheal resection with closure of tracheaoesophageal fistula was performed (21/05/2015). Postoperative course was complicated by tuberculous sterno-mediastinitis and bronchoesophageal fistula between left main bronchus and middle third of oesophagus. Closure of the fistula was achieved after robot-assisted thoracoscopic procedure (29/11/2015). We used a right side approach and 5 ports (2 assistant ports, 2 instrumental robotic ports and one port for the camera). The patient was positioned on the left side with a slight turning of the abdomen. The azygos vein was divided to get good access to the area of the tracheal bifurcation and fistula. Details of the procedure were isolation and closure of the fistula with endostapler. Additional stitches were placed on the wall of the oesophagus and the left main bronchus. After that, stitches were reinforced by plate, which consist of fibrinogen and thrombin. Then the stump of the azygos vein was positioned between the trachea and the oesophagus. The postoperative period was uneventful. The chest tube was removed on postoperative day 4. Tuberculous sterno-mediastinitis was successfully treated with vacuum-assisted closure therapy and reoperation. The patient is in good general conditions 12 months after surgery.

Conclusions: Robotic surgical system provides good access to the structures of the mediastinum. In this case, we were able to demonstrate a successful outcome following closure of a bronchoesophageal fistula.

Disclosure: No significant relationships.