Thoracoscopic Tracheoesophageal Fistula Repair: Upper Pouch Mobilization and Anastomosis

Some surgeons choose to leave the azygos vein intact during this portion of the dissection

Leaving the azygos vein intact means the gap is much larger

An endoscopic clip provides atraumatic tissue handling during dissection

Extensive dissection of the upper pouch is performed to achieve adequate length for anastomosis

This case involves a longer gap than is routine for a type 3 fistula

The back wall and corners of the anastomosis are sutured first, using 4 to 5 sutures

The nasogastric or orogastric tube is advanced by the anesthesiologist after the back wall is completed

Three anterior wall sutures are sufficient to complete the anastomosis in this case

Close coordination with the anesthesiologist is extremely important to achieve adequate visualization throughout the procedure