Non-intubated Robotic-Assisted Thoracic Surgery for Tracheal/Airway Resection and Reconstruction: Technique Description and Preliminary Results.

Objective We aim to report a novel surgical technique that robotic-assisted thoracoscopic surgery combined with non-intubated spontaneous ventilation to perform tracheal/airway surgery. Summary background data Our team has demonstrated video-assisted transthoracic surgery (VATS) can be used for thoracic tracheal diseases with satisfactory outcomes. Our team has also demonstrated that tracheal/ airway resection and reconstruction under spontaneous ventilation can improve the anastomosis and operating time. Recently, robotic-assisted thoracoscopic surgery (RATS) emerged as an available alternative minimally invasive approach for lung cancer, with lower perioperative mortality and conversion rate to open. Methods Five patients fulfilling the criteria for non-intubated approach underwent RATS tracheal/airway surgery. Patient 1 has a tumor in the thoracic trachea; patient 2 had involving secondary carina; patient 3 had involving trachea carina, and patient 4 had involving left main bronchus. Patient 5 had involving mid-tracheal. Results All patients had an uneventful procedure. The total operative time ranged from 5 h 5 min to 9 h 55 min. The postoperative hospital stays ranged from 4 days to 14 days. Fiber-optic bronchoscopy performed one month after the procedure showed good anastomotic healing with no stricture. Conclusion This is the first report on RATS use in tracheal/airway surgery, in combination with non-intubation spontaneous ventilation. In selected patients, this novel combined approach is feasible and safe. A patient can potentially benefit from the combined advantages of both techniques. More cases and longer-term data are required to establish its role in tracheal/airway surgery.