Robotic Tracheal Resection with Peripheral VV ECMO Support

R. Rocco, D. Wigle, S. Saddoughi
Mayo Clinic, Rochester, Minnesota

Please explain the educational or technical point that this video addresses.: This is a video that shows a robotic tracheal resection of an adenoid cystic carcinoma with peripheral VV ECMO support. We demonstrate the cannulation and airway management strategies in the context of a minimally invasive chest approach. Tips and tricks regarding the aforementioned as well as how to determine adequate margins of resection and tension on the robotic platform are delineated.

Please provide a 250 word summary of the surgical video being submitted.: This is a video that shows a robotic tracheal resection of an adenoid cystic carcinoma with peripheral VV ECMO support.
The patient was a 66 year old female that presented with an adenoid cystic carcinoma in the distal third of her trachea.
After placement of cannulas in the right femoral vein and right internal jugular vein, peripheral VV ECMO was initiated. The patient was positioned for a right sided chest approach. Five robotic port sites ( including an assistant port ) were placed. A mixture of cautery and blunt dissection was used to dissect out the distal third of the trachea. With concomitant bronchoscopic identification, we were able to resect the involved portion of the trachea using robotic scissors. While waiting for frozen margin assessment, several tension-releasing maneuvers were performed. New proximal and distal margins had to be taken due to the presence of tumor; given the diagnosis as well as already present tension, no more trachea was resected and the anastomosis was performed. The anastomosis was performed with a running 3-0 PDS and interrupted 3-0 Vicryl. Leak test was negative. The new connection was reinforced with anterior and posterior fat pads found on the patient's chest. A single chest tube was left in place and the patient was extubated after being weaned off ECMO. Bronchoscopy was performed post op as well as on post-operative day 3 and 5. The patient continues to do well on follow up.