Use of a Biologically Transparent Illumination Guide during Secondary Thoracoscopic Posterior Tracheopexy for Severe Tracheomalacia after Esophageal Atresia Repair: A Case Report.

INTRODUCTION

Secondary thoracoscopic posterior tracheopexy (PT) for severe tracheomalacia (TM) following esophageal atresia (EA) repair is challenging because of postoperative adhesions and scarring. Meticulous dissection is required to separate the esophagus from the trachea, increasing the risk of iatrogenic injury. We report the first use of a biologically transparent (BT) illumination guide, Tumguide (Otsuka Pharmaceutical Factory, Tokushima, Japan), to assist in identifying the course of the esophagus during secondary thoracoscopic PT.

CASE PRESENTATION: A 5-month-old infant with a history of thoracoscopic EA repair complicated by an anastomotic leak and stricture developed severe TM requiring surgical intervention. Because dense adhesions were anticipated, the Tumguide was activated in blinking mode and inserted after induction of general anesthesia to facilitate identification of the esophagus. Intraoperatively, the normal anatomical planes within the mediastinum were completely obliterated by severe fibrosis. However, the blinking BT red light was clearly visible through the thick scar tissue, helping clarify the overall orientation of the esophagus; a bronchoscope was also used as appropriate to transilluminate the tracheal wall from within, helping delineate the tracheal course. This combined visual guidance facilitated safe adhesiolysis and craniocaudal dissection, enabling successful fixation of the posterior membranous trachea to the anterior longitudinal ligament. The patient's respiratory status improved markedly, and the patient remained stable in room air without symptoms 6 months postoperatively.

CONCLUSIONS

The use of a BT illumination guide may serve as a useful and simple adjunct during complex redo surgeries such as secondary thoracoscopic PT. By helping delineate the course of the esophagus, it may improve spatial awareness and facilitate safe dissection even when normal anatomical planes are obliterated by dense adhesions.