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Novel Treatment of Bronchopleural Fistula in a Lung Transplant Recipient with Endobronchial sealant and Endobronchial Valve Placement via Robotic Assisted Bronchoscopy
Ishaq J. Wadiwala, Pankaj Garg, Sebastian Fernandez-Bussy, Neil G. Feinglass, Si M. Pham, Mathew Thomas.
Mayo Clinic Florida, Jacksonville, FL, USA.

OBJECTIVE:
Bronchopleural fistulas (BPF) are a dreaded complication that occurs following lobectomy and pneumonectomy and are linked to a high rate of morbidity and mortality. A variety of surgical and endoscopic methods are used to treat BPF. Endobronchial valves (EVs), which permit the one-way airflow implanted in the lung, in conjunction with endobronchial sealant (ES) instilled with Robotic bronchoscopy (RB) allow occlusion of BPF avoiding surgery. METHODS:
The patient was a 71-year-old woman with a history of severe COPD and bronchiectasis who had bilateral lung transplantation using lungs that had been examined using the EVLP (XPS system) and then had wedge resection of the right middle lobe and left lingula (due to the donor lungs being larger than pleural cavity). After lung reduction surgery, a BPF was discovered on postoperative day (POD) 21 (Figure 1A). Conservative measures with multiple chest tubes failed and Robotic-assisted bronchoscopy (Figure 1B) was used to reach the bronchial segment and instill endobronchial sealant and endobronchial valve. RESULTS:
The pneumothorax was completely resolved 12 days later (Figure 1C). This patient had multiple postoperative complications but was finally discharged from the hospital on POD 56. The RB procedure was successful, with no recurrence of pneumothorax or BPF symptoms after a median follow-up of POD 284. CONCLUSIONS:
Robotic endobronchial closure of BPF with EV and ES is a safe, effective, and promising postoperative BPF treatment option while avoiding more invasive options


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