First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia Richard Lazzaro, MD, Byron Patton,

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Presentation transcript:

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia Richard Lazzaro, MD, Byron Patton, MD, Paul Lee, MD, Jason Karp, MD, Efstathia Mihelis, PA-C, Sohrab Vatsia, MS, Samuel Jacob Scheinerman, MD The Journal of Thoracic and Cardiovascular Surgery Volume 157, Issue 2, Pages 791-800 (February 2019) DOI: 10.1016/j.jtcvs.2018.07.118 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Evaluation and management of patients suspected of having tracheobronchomalacia (TBM). Patients with clinical suspicion of TBM are referred for dynamic computed tomography (CT) scan according to established Northwell Health Imaging protocol. Patients who exhibit collapse of the tracheobronchial tree ≥50% on CT are evaluated by a member of the thoracic surgery team. Surgical candidates for robot-assisted tracheobronchoplasty (TBP) who demonstrate persistent, severe symptoms are offered bronchoscopy. If bronchoscopic findings confirm >90% collapse of the airway, and if the airway is deemed operable for relief of intractable symptoms, patients undergo robot-assisted TBP. If patients do not meet any of these surgical inclusion criteria, they are treated by medical management. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Lenox Hill Northwell Health tracheobronchomalacia (TBM) program. Four hundred thirty-five patients underwent dynamic computed tomography (CT) scan for clinical suspicion of TBM. Of this group, 183 had >50% collapsed, as observed by CT. One hundred forty-five patients were evaluated by members of the thoracic surgery team and 42 consecutive patients underwent robot-assisted tracheobronchoplasty (TBP) for severe symptomatic TBM. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Median percent predicted lung function before and after robot-assisted tracheobronchoplasty. A, Forced expiratory volume in 1 second (FEV1). B, Forced vital capacity (FVC). C, Peak expiratory flow rate (PEFR). The median preoperative percent predicted FEV1 was 62.50% (interquartile range [IQR], 51.25%-82.00%) and was 76.00% (IQR, 55.25%-91.75%) after surgery (P = .01). The median preoperative percent predicted FVC was 69.50% (IQR, 59.25%-82.25%) and improved to 84.00% (IQR, 70.50%-96.25%) following operation (P < .0001). The median preoperative percent predicted PEFR was 60.00% (IQR, 52.00%-73.25%) and rose to 81.00% (IQR, 67.25%-101.75%) after surgery (P < .0001). The boxes indicate the IQR, with the upper boarder and lower boarder of the box indicating the upper and lower quartiles, respectively. Whiskers represent the minimum and maximum values. The central line demonstrates the median (n = 40 patients per group). The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Percent change in percent predicted forced vital capacity (FVC), peak expiratory flow rate (PEFR), and forced expiratory volume in 1 second (FEV1) by patient. Forty patients had complete sets of preoperative and postoperative PFTs. Percent predicted FEV1 (green bars), FVC (blue bars), and PEFR (red bars) were collected at a median of 4 months (interquartile range, 2-6 months) postoperatively. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Improvement of pulmonary function tests following robot-assisted tracheobronchoplasty. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Robotic tracheobronchoplasty technique. Video available at: https://www.jtcvs.org/article/S0022-5223(18)32935-0/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2019 157, 791-800DOI: (10.1016/j.jtcvs.2018.07.118) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions