title: Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: lessons learned.
abstract: OBJECTIVE
  Repair of esophageal atresia and tracheoesophageal fistula has traditionally been performed via thoracotomy. This study aims to evaluate the feasibility and pitfalls of the thoracoscopic approach.
  
  
  METHODS
  Six consecutive patients with type C tracheoesophageal fistulae underwent thoracoscopic repair. The operation was approached through the right chest using a three-trocar technique (two 5-mm and one 3-mm) with the patient placed in a three-quarter prone position. Patient characteristics, operative time, duration of narcotic usage, conversion factors, postoperative complications, and long-term follow-up were recorded.
  
  
  RESULTS
  Five of six patients were successfully operated on thoracoscopically. The average operative time was 143 minutes (range, 75-215 minutes) with repair of long-gap defects requiring significantly longer times than short-gap defects (200 vs. 129 minutes, P < 0.05). There were no intraoperative complications. Mean duration of narcotic use was 52 hours (range, 24-72 hours). There were no anastomotic leaks. One patient developed an anastomotic stricture at the third postoperative week, which resolved with two dilations. One patient died on the first postoperative day from respiratory failure.
  
  
  CONCLUSIONS
  Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula is feasible, but is technically challenging. Long-gap defects require more extensive dissection and difficult anastomosis, and are therefore associated with longer operative times. More data are needed for further evaluation of this approach.
authors.affiliation: Department of Surgery, University of California at Irvine, Orange, California, USA.
authors.forename: Thang
authors.initials: T
authors.lastname: Nguyen
authors.forename: Kambiz
authors.initials: K
authors.lastname: Zainabadi
authors.forename: Trung
authors.initials: T
authors.lastname: Bui
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
authors.forename: Dmitri
authors.initials: D
authors.lastname: Gelfand
authors.forename: Nam
authors.initials: N
authors.lastname: Nguyen
mesh_terms: D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D013906:Thoracoscopy / Q000379:methods*; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome