The authors present a case of uniportal VATS for repair of an iatrogenic
tracheal injury. The patient was a 90-year-old woman who developed
progressive subcutaneous emphysema after laparoscopic cholecystectomy. A
double-lumen tube was immediately inserted to control subcutaneous
emphysema. Then she was transferred to the authors’ unit for further
evaluation and treatment. A bronchoscopy was performed under general
anesthesia and a tracheal injury was detected in the distal part of the
trachea extending to the right main bronchus. A decision was made to
perform a surgical repair, and she was re-intubated with a left double
lumen tube and taken to the operation room. Uniportal VATS was performed
through a 4 cm incision in the 5th intercostal space in the
mid-axillary line. The azygos vein was divided using an endo-stapler to
reveal the tracheobronchial angle. A tracheal injury 5 cm long was
identified on the right side of the distal trachea extending to the
right main bronchus. Stay sutures were placed on both edges to expose
meticulously the proximal and distal end of the injury. The tracheal
injury was repaired with 4-0 polypropylene suture using a continuous
suture technique. The suture line was covered with paratracheal fatty
tissue and the operation was completed after inserting a chest tube.
On the postoperative bronchoscopy, the trachea with visible suture lines
was intact and healthy. She was extubated immediately after surgery and
discharged home on the fourth postoperative day. After that, on routine
follow-up, the patient was examined periodically. She did not have any
complaints in this period and no evidence for stricture was observed.
Three months after the surgery, the trachea was considered intact and
healthy again, indicating that no complications have occurred.