Thoracoscopic surgery of the oesophagus in rats: a training concept for the treatment of tracheo-oesophageal malformations in preterm infants.

In extremely preterm babies with type Vogt III b oesophageal atresia, the primary operative management can be restricted to a gastrostomy and ligation of the fistula. Some of these patients, however, may not even tolerate a thoracotomy or placement on the operating table. We developed a minimally invasive procedure to prepare and ligate the oesophagus thoracoscopically and perform laparoscopic gastrostomy in a rat model. In 15 operations we observed only one complication. This study implies that after adequate practice, thoracoscopic dissection of the oesophagus with ligation of a tracheo-oesophageal fistula could be performed even in every small infants.