VA02.5. Robotic Repair of Esophago–Left Main Bronchial Fistula Using a Pedicled Autologous Pericardial Patch Combined With Latissimus Dorsi Muscle Flap

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ID: 326150
2026
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Ranked #205 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Video Description This video presents a novel robotic-assisted technique for repairing an esophago–left main bronchial fistula that developed after definitive chemoradiotherapy for advanced thoracic esophageal cancer. The patient was a 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus (MtUt, cT4bN2M0, Stage IVA) invading the left main bronchus, accompanied by complete obstruction of the left lung. Following cisplatin/5-fluorouracil–based chemoradiotherapy (50.4 Gy), tumor regression led to fistula formation between the esophagus and left main bronchus. After temporary airway stenting, definitive surgical repair was performed. The operation was conducted in a semi-prone position under single-lung ventilation with CO₂ pneumothorax. After removal of thoracic esophagectomy, a pedicled autologous pericardial patch based on the tracheal bifurcation was robotically designed in a horseshoe shape, flipped cranially, and sutured to close the bronchial defect. Additional reinforcement was achieved using a right latissimus dorsi muscle flap introduced into the thoracic cavity and robotically fixed over the repaired fistula. Postoperatively, the patient experienced no major respiratory or fistula-related complications, and the tracheal stent was removed three weeks after surgery. This video is unique in demonstrating, to our knowledge, the world’s first robotic repair of an esophago–bronchial fistula using a combination of a pedicled autologous pericardial patch and a latissimus dorsi muscle flap, offering a minimally invasive and reproducible option for managing complex airway fistulas after chemoradiotherapy.
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Authors Tomoki Makino, Shigeto Nakai, Kota Momose, Kotaro Yamashita, Koji Tanaka, Hidetoshi Eguchi, Yuichiro Doki
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.440
URL
https://doi.org/10.1093/dote/doag077.440
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