QUAD #10 Pt.1: History of Thoracoscopic Repair of Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg

Thoracotomy is the most morbid incision performed in pediatric surgery.

When performing thoracotomy in a newborn, infant, or small child, there is a 30 to 40% chance the child will develop some degree of shoulder girdle weakness, chest wall asymmetry, and scoliosis.

Thoracoscopic PDA ligation was first described in 1995 by Labour in Paris.

The PDA ligation procedure looks similar to ligating the fistula in a TEF repair when entering the left chest.

The first thoracoscopic pure esophageal atresia repair was performed at the 1999 IPEC meeting in Berlin.

For the Berlin case, the patient had been taken to the OR every other day with metal bougies placed in upper and lower pouches to stretch them until they overlapped on X-ray.

In the Berlin case, approximately 2 hours were spent attempting to achieve single lung anesthesia, ultimately using a Fogarty catheter placed down the endotracheal tube into the right main stem bronchus to block it.

Single-lung blockade with a Fogarty catheter is a technique no longer used or needed for thoracoscopic EA repair.

The Berlin pure EA patient developed a stricture post-operatively that was dilated a few times but went on without significant problems.

The first thoracoscopic type C esophageal atresia with TEF repair was performed in Denver four days before the 2000 IPEC meeting on a 3.2 kg full-term male with no other congenital anomalies.

The first thoracoscopic TEF repair surgery was performed in the evening after other staff had left, without prior IRB approval, following a practice of asking forgiveness afterwards rather than permission beforehand.

Connor, the first thoracoscopic TEF repair patient, never required dilation and his esophagram one week post-surgery looked great.

Connor has graduated from engineering school and is doing great.