Robotic Management of a Right Mainstem Bronchus to Esophageal Fistula

C. Crisafi. Yongue¹, R. Cerfolio^2
1NYU Langone, New York, New York ²New York Langone Health, New York, New York

Please explain the educational or technical point that this video addresses.: This video addresses the robotic management of a broncho-esopheageal fistula from benign etiology in an otherwise young healthy patient.

Please provide a 250 word summary of the surgical video being submitted.: This patient is a 30 year old female who presented with broncholithiasis. She was found to have a right mainstem broncho-esophageal fistula on CT with oral contrast and esophragram. She was scheduled for elective robotic repair of the fistula. On intra-operative bronchoscopy the fistula orifice was a pinhole defect at 5 oclock in the right mainstem bronchus. Intra-operative EGD re-demonstrated the fistula orifice. The fistula was approached robotically from the right chest. Calcified lymph nodes were removed from the posterior mediastinum, they were densely adherent to the esophagus and right mainstem bronchus. A complete lymphadenectomy of stations 2, 4, 7, 8 and 9 was performed in order to limit the possibility of future fistula formation, strictures or SVC syndrome from the pathologic nodes. After dissection of the subcarinal space with clear delineation of the fistula neck confirmed with EGD, we divided the fistula with a robotic stapler. We then harvested a thymic pedicle to interpose between the two structures and sutured this in place. We removed the chest tube at the end of the case and the patient had an esophagram that evening which demonstrated no leak. The patient was discharged on a clear liquid diet post operative day one.