8. Thoracic Surgery

Background:Excessive dynamic airway collapse (EDAC) is a subtype of excessive central airway collapse characterized by anterior bulging of the posterior membranous wall during expiration.In severe symptomatic cases, surgical stabilization via tracheobronchoplasty (TBP) can restore airway rigidity and improve respiratory function.The vertical mattress suture technique, used to anchor a polypropylene mesh to the posterior membranous wall, has been proposed to optimize tension distribution and preserve airway geometry.We report the short-term results of a patient treated with robotic TBP using this approach. Material and methods:We report the short-term results of a patient treated with robotic TBP using this approach. Results:A 62-year-old woman with severe EDAC presented with progressive dyspnea and chronic cough refractory to medical therapy.Preoperative lung function showed FEV 0.94 L (27% predicted) and FVC 1.63 L (39% predicted).Dynamic bronchoscopy and computed tomography revealed >80% expiratory collapse of the distal trachea and main bronchi.The patient underwent robotic right-side approach tracheobronchoplasty with vertical mattress sutures securing a tailored polypropylene mesh to the posterior membranous wall.The intraoperative course was uneventful, and the patient was extubated in the operating room.She was discharged on postoperative day 7.At 3 months follow-up, she reported marked improvement in dyspnea, cough, and exercise tolerance.Bronchoscopy demonstrated nearcomplete abolition of dynamic collapse.Spirometry showed FEV 2.43 L (71% predicted) and FVC 3.23 L (77% predicted), confirming significant functional recovery.Postoperative CT demonstrated stable airway patency and correct mesh positioning without complications. Conclusion:Robotic tracheobronchoplasty using vertical mattress sutures appears to be a safe and effective technique for severe EDAC, providing excellent short-term anatomical and functional outcomes.This case supports the role of the vertical mattress configuration in achieving optimal posterior membranous stabilization and airway remodeling.