Evolving Trends in Tracheobronchoplasty: Longitudinal Outcomes of Open and Robotic Approaches

Tracheobronchoplasty (TBP) is an operation to treat excessive central airway collapse by stabilizing the posterior membranous wall of the central airways. We compare postoperative complications and longitudinal outcomes between the open and robotic TBP, with attention to evolving outcomes in robotic TBP.

We conducted a retrospective review of all open TBP (2018-2020) and robotic-assisted TBP (2020-2025) at a high-volume center. The primary outcomes were major complications, classified by Clavien-Dindo grade ≥3a. Secondary outcomes included quality-of-life metrics and 6-minute walk test (6MWT) at 3 and 12 months post-operatively. A subgroup analysis compared early (2020-2023) versus recent (2024-2025) robotic-assisted TBP cases.

132 patients were included: 69 open and 63 robotic TBP. There were no significant differences in the major complication rates on univariate or adjusted multivariable analysis (adjusted OR 0.70, p=0.47). Both groups demonstrated improvement in quality-of-life scores and 6MWT at 3 and 12 months post-operatively. Robotic TBP had longer operative times (475 vs. 397 minutes; p<0.01), but shorter ICU (1 vs. 3 days; p<0.01) and hospital stays (5 vs. 7 days; p<0.01). Compared to early cases, recent robotic TBP had shorter operative times (444 vs. 479 minutes; p=0.03) and ICU stays (0 vs. 1 day; p<0.01).

Robotic TBP is safe and effective when compared to the open approach in selected patients, demonstrating comparable complication rates and durable improvements in quality-of-life measures. With shorter ICU stays and decreasing operative times, ongoing experience with robotic TBP continues to yield improvements in efficiency and postoperative recovery.