(1)
Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
(2)
Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
Abstract
When severe tracheomalacia is not controlled by conservative measures, minimally invasive aortopexy may be a treatment option. The procedure involves suturing the aortic arch to the posterior aspect of the sternum via a left-sided approach, with left lobe thymectomy to achieve adequate exposure. The risks of aortic injury, nerve damage, and haemomediastinum are minimised by performing the procedure under thoracoscopic guidance, though concerns remain about the rate of recurrence using this approach.
Keywords
Severe tracheomalaciaMinimally invasive aortopexyInsufflation11.1 General Information
When severe tracheomalacia is not controlled by conservative measures, minimally invasive aortopexy may be a treatment option. The procedure involves suturing the aortic arch to the posterior aspect of the sternum via a left-sided approach, with left lobe thymectomy to achieve adequate exposure. The risks of aortic injury, nerve damage, and haemomediastinum are minimised by performing the procedure under thoracoscopic guidance, though concerns remain about the rate of recurrence using this approach.
11.2 Working Instruments
5-mm camera port and 0° thoracoscope
One 5-mm port, one 3-mm port
Monopolar hook diathermy
14-gauge cannula × 3
Prolene sutures
11.3 Positioning, Port Siting, and Ergonomic Considerations
The patient is positioned as shown in Fig. 11.1, and three ports are inserted.
Fig. 11.1
The patient is positioned supine, with arms outstretched and secured. Under general anaesthesia, three ports are inserted in the 3rd, 4th, and 5th intercostal spaces on the left side
The surgeon and thoracoscopist stand to the left, with the scrub nurse to the right of the patient. Thoracic insufflation using a pressure of 8 mmHg and low flow of 1 L/min provides a good view of the left thoracic cavity (Fig. 11.2).
Fig. 11.2
With the left lung deflated, the superior mediastinum can clearly be seen thoracoscopically
11.4 Relevant Anatomy
Figures 11.3 and 11.4 show the anatomy encountered in the procedure.
