Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula

Published on 27/02/2015 by admin

Filed under Pediatrics

Last modified 27/02/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1166 times

CHAPTER 7 Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula

Mark L. Wulkan

Step 1: Surgical Anatomy

♦ The fistula usually lies in proximity to the azygos vein.
♦ A moderately stiff tube should be placed through the mouth into the upper pouch to facilitate identification.
♦ Placement in the semiprone position greatly facilitates the operation by allowing the lung to drop away from the operative field (the posterior mediastinum).

Step 2: Preoperative Considerations

♦ Consideration should be given to reserving the thoracoscopic technique for patients who weigh more than 2000 g and are clinically stable until you become comfortable with the technique.
♦ Fistula ligation alone can be undertaken thoracoscopically.

Step 3: Operative Steps

Anesthetic Induction

♦ If the anesthesiologist attempts to place the endotracheal tube past the fistula, care must be taken to avoid a right mainstem intubation, which can cause problems when the right-sided chest is insufflated and the right lung is collapsed.
♦ There is usually no need for bronchial blockers or other techniques to perform single lung ventilation.
♦ The same issues of anesthetic induction for open repair of esophageal atresia with tracheoesophageal fistula apply for thoracoscopic repair.

Positioning

♦ The patient is placed in a nearly prone position.
♦ Position the patient for success! You will have a much greater chance of completing the operation thoracoscopically if the patient is positioned for a thoracoscopic procedure, not for conversion.

Port Positioning

♦ The ports are positioned to facilitate dissection and suturing (Fig. 7-1).
♦ The “baseball diamond” should be maintained.
♦ Be careful positioning the most cephalad port site so that the patient’s arm does not interfere with mobility.
image

Figure 7-1

Establishment of Pneumothorax

♦ The chest is accessed first through the planned camera port site with a Veres needle (Fig. 7-2)
♦ Initial insufflation is with 3 to 4 mm Hg of pressure using CO2.
image

Figure 7-2

Buy Membership for Pediatrics Category to continue reading. Learn more here

Related posts:

Extracorporeal Membrane Oxygenation Cannulation Imperforate Anus Vascular Access Biliary Atresia Laparoscopic and Open Pyloromyotomy Surgical Treatment of Chest Wall Deformities: Open Repair