Perioperative Outcomes of 43 Robotic Tracheobronchoplasties for Excessive Dynamic Airway Collapse

<h2>Abstract</h2><h3>Background</h3> Excessive central airway collapse involves increased collapsibility of the central airways. The definitive treatment is surgical stabilization of the airway, or tracheobronchoplasty. In 2020, our institution (Beth Israel Deaconess Medical Center, Boston, MA) began offering the robotic approach to select patients. Here, we describe perioperative outcomes for the first 43 consecutive patients to undergo robotic tracheobronchoplasty (rTBP). <h3>Methods</h3> A retrospective review of all patients who underwent rTBP from February 2020 to May 2023 was conducted. <h3>Results</h3> A total of 43 patients underwent rTBP during the study period. Most patients were female (60%), the median age was 61 years (interquartile range [IQR], 50-69 years), and the most common comorbidity was gastroesophageal reflux disease (95%). Median operative time was 8.4 hours (IQR, 7.2-9.6 hours), and there were 4 intraoperative complications (9%). Postoperatively, 25 (58%) patients experienced at least 1 complication, and 6 patients had a new respiratory infection (14%). Nine patients (21%) experienced a major postoperative complication (Clavien Dindo ≥IIIa). There were no fatalities within 30 days. The median intensive care unit and hospital lengths of stay were 1 day (IQR, 1-3.5 days) and 5 days (IQR, 4-8 days), respectively. Most patients (88%) were discharged to home. There were significant improvements in quality of life scores at 3 months. <h3>Conclusions</h3> Overall, rTBP is safe, although it is associated with a high number of complications. Continued evaluation of perioperative and long-term outcomes is needed to ensure that the minimally invasive approach is appropriately offered to this complex patient population.