Robotic-assisted posterior tracheopexy (RAPT)-A minimal invasive approach to treat severe trachobroncomalacia: A...

Posterior tracheopexy has been proposed recently for the treatment of pediatric tracheobroncomalacia (TBM) Robotic approach is rarely reported. The aim of this study is to define feasibility and safety of robotic posterior tracheopexy (RAPT) and to analyze its results.

We retrospectively reviewed clinical data of pediatric (<18 y. o.) patients who underwent RAPT between 2020 and 2024. We evaluated the following data: length of surgery and hospital stay, intra- and post-operative complications, endoscopic pattern and symptoms. Endoscopic pattern and symptoms were classified according to tracheomalacia endoscopic and clinical score (TMES - TMCS) and according to ERS statements. Scores were evaluated before and after RAPT. Comparisons were realized with χ²test, Fisher's exact or Mann-Whitney test. All p-values were two-tailed, with significance at p < 0.05.

Sixteen (56 % females) patients were included 4 (25 %) patients with moderate TBM at endoscopic score, while 12 (75 %) with severe TBM. Age at surgery was 8 years (IQR4-13), with a median weight of 30 kg(IQR18-55). Pre-operative TMCS 3(IQR3-5) and TMES 3(IQR3-3) with a total TMS of 6 (IQR5-8). Median operative time was 175 min (IQR 120-235). Median number of RAPT fixating sutures of 8 (IQR 6-9) and bronchopexy was associated in 7 (43.7 %) patients. No conversion to open/thoracoscopic technique occurred. One (6.2 %) intraoperative complication was the breach and suture of the thoracic duct. Early post-operative complications occurred in 3 (18.7 %) patients, one grade II Clavien Dindo and 2 grade I. Median follow-up was 17months (IQR 6-31), the median post-operative TMS was 1 (IQR 0-2, p < 0.0001), with a median post-operative TMCS was 0 (IQR 0-1, p < 0.0001) and TMES 0 (IQR 0-1, p < 0.0001). Resolution rate was 93.7 % (15 patients out of 16 had a final TMS ≤ 2).

RAPT is a valid and safe alternative to traditional surgery in case of severe TBM. This approach shows good results also in patient who previously underwent several surgeries such as post esophageal atresia repair.