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Peer-reviewedCC BY 4.0Esophagus

Robotic repair of an esophago–left main bronchial fistula using a pedicled autologous pericardial patch and latissimus dorsi muscle flap: a novel technique after chemoradiotherapy for cT4b esophageal cancer

  • Tomoki Makino1
  • Shigeto Nakai1
  • Tomohira Takeoka2
  • Kotaro Yamashita1
  • Kazuya Kuroda3
  • Koji Tanaka1
  • Takashi Kanou4
  • Tateki Kubo3
  • Yasushi Shintani4
  • Shigeru Miyagawa5
  • Hidetoshi Eguchi1
  • Yuichiro Doki1,6
6 affiliations
  1. 1Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2-E2, Yamada-Oka, Suita, Osaka 565-0871 Japan
  2. 2Department of Gastroenterological Surgery, Sakai City Medical Center, Osaka, Japan
  3. 3Department of Plastic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka Japan
  4. 4Department of General Thoracic Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka Japan
  5. 5Department of Cardiovascular Surgery, The University of Osaka Graduate School of Medicine, Suita, Osaka Japan
  6. 6Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
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Abstract

Once an esophago–airway fistula develops during chemoradiotherapy for cT4b esophageal cancer, further curative treatment is often precluded. We describe a robotic technique for closure of a large esophago–left main bronchial fistula using a pedicled autologous pericardial patch reinforced with a latissimus dorsi muscle flap. A 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus invading the left main bronchus developed a fistula after definitive chemoradiotherapy. After temporary airway stenting, salvage surgery was performed in the semi-prone position under single-lung ventilation and CO₂ pneumothorax. Following thoracic esophagectomy, a horseshoe-shaped pedicled pericardial patch was created robotically, flipped cranially, and sutured to the bronchial defect. A right latissimus dorsi muscle flap was then introduced into the right thoracic cavity through a second intercostal opening and robotically fixed over the repair. To our knowledge, this is the first report of this robotic technique.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01235-x.

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Cite

BibTeXRIS
BibTeX
@article{makino2026robotic,
  title = {{Robotic repair of an esophago–left main bronchial fistula using a pedicled autologous pericardial patch and latissimus dorsi muscle flap: a novel technique after chemoradiotherapy for cT4b esophageal cancer}},
  author = {Tomoki Makino and Shigeto Nakai and Tomohira Takeoka and Kotaro Yamashita and Kazuya Kuroda and Koji Tanaka and Takashi Kanou and Tateki Kubo and Yasushi Shintani and Shigeru Miyagawa and Hidetoshi Eguchi and Yuichiro Doki},
  journal = {Esophagus},
  year = {2026},
  month = aug,
  doi = {10.1007/s10388-026-01235-x},
  url = {https://doi.org/10.1007/s10388-026-01235-x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Robotic repair of an esophago–left main bronchial fistula using a pedicled autologous pericardial patch and latissimus dorsi muscle flap: a novel technique after chemoradiotherapy for cT4b esophageal cancer
AU  - Tomoki Makino
AU  - Shigeto Nakai
AU  - Tomohira Takeoka
AU  - Kotaro Yamashita
AU  - Kazuya Kuroda
AU  - Koji Tanaka
AU  - Takashi Kanou
AU  - Tateki Kubo
AU  - Yasushi Shintani
AU  - Shigeru Miyagawa
AU  - Hidetoshi Eguchi
AU  - Yuichiro Doki
PY  - 2026
DA  - 2026/08/28
JO  - Esophagus
DO  - 10.1007/s10388-026-01235-x
UR  - https://doi.org/10.1007/s10388-026-01235-x
AB  - Once an esophago–airway fistula develops during chemoradiotherapy for cT4b esophageal cancer, further curative treatment is often precluded. We describe a robotic technique for closure of a large esophago–left main bronchial fistula using a pedicled autologous pericardial patch reinforced with a latissimus dorsi muscle flap. A 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus invading the left main bronchus developed a fistula after definitive chemoradiotherapy. After temporary airway stenting, salvage surgery was performed in the semi-prone position under single-lung ventilation and CO₂ pneumothorax. Following thoracic esophagectomy, a horseshoe-shaped pedicled pericardial patch was created robotically, flipped cranially, and sutured to the bronchial defect. A right latissimus dorsi muscle flap was then introduced into the right thoracic cavity through a second intercostal opening and robotically fixed over the repair. To our knowledge, this is the first report of this robotic technique.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01235-x.
SN  - 1612-9059
SN  - 1612-9067
ER  -