Case report of successful management of intraoperative tracheal rupture during thoracoscopic esophageal resection in patient with esophageal cancer

Abstract

HighlightsIntraoperative ruptures of trachea during thoracoscopic esophageal resection are very serious complications.A 52-year-old woman had cancer of middle third of esophagus T3N1M0, stage IIIB.The woman underwent thoracoscopic esophageal resection with gastric tube plasty.Successful management of intraoperative tracheal and bronchial rupture with use of the intracorporeal suture.The patient had an uneventful, standard recovery and was discharged 12 days after the surgery.

Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy

“…To the best of our knowledge, only 1 case has been reported of intraoperative primary repair of 2 defects of the tracheobronchial tree with thoracoscopic intracorporeal suture during esophageal resection in a patient with ESCC [6]. In the current case, robotic primary repair of tracheal and left-bronchial branch tears during a McKeown esophagectomy proved safe and feasible in experienced hands and in the absence of difficulties with patient ventilation.…”

Management of an intraoperative tracheal injury during a Mckeown oesophagectomy: A case report

“…There exists the controversy of balancing out increased complications of primary repair and conservative management [11] . The need for thoracotomy in more distal injuries and subsequent post-operative sequela have contributed to increased mortality following surgically managed airway injuries in a few studies [11] , some studies stating a mortality of 2.2 % [13] . The modes vary depending on the site, surgical expertise, and the extent of the injury [8] , [11] , [12] .…”

Thoracoscopic treatment of iatrogenic injuries of the tracheobronchial tree: a retrospective analysis of 5 cases and review of the literature.

“…The incidences of iatrogenic tracheal rupture presented in research literature are as follows: 0.05-0.37% cases took place during endotracheal intubation [1], 0.4% -during thoracoscopic and transhiatal resection of the oesophagus, and 0-0.2% cases during open oesophageal surgery [3]. The ITR incidence is related to objective conditions of instrumentation, associated illnesses in patients and their morphology, the medical staff's experience and skills, etc.…”

“…During its historical evolution, ITR surgical treatment has evolved from open surgical approaches to all cases (preferably by thoracotomy) through varying transcervical-transtracheal approaches [16], using a fibreoptic bronchoscope [17] and other mini-optic instruments as guiding tools [18] to full minimally invasive techniques based on VATS [15]. However, for no clear reason, the use of the latter in the treatment of intraoperative [3] and postintubation [15] injuries has received little coverage in research literature. We were unable to find any descriptions of intraoperative injury to the trachea in the course of subtotal VATS oesophagectomy for the treatment of achalasia (P4), or the same aetiology injury with a postoperative 24-hour diagnostic delay (P5), which were treated by full minimally invasive VATS repair, when the rupture of the trachea may have occurred due to the damage of its thin, inflammatorily changed membranous wall by an electrocauter during an oesophageal dissection.…”

“…Iatrogenic injuries of the tracheobronchial tree are rare but dramatic and potentially lethal complications of some procedures such as orotracheal intubation, percutaneous dilational tracheostomies, mediastinoscopy, and excision of advanced tumours with mediastinal involvement [1][2][3]. The membranous tracheobronchial damage can sometimes be caused by compression of the trachea with oesophageal prostheses [4] and intratracheal stent insertion [5].…”