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CC BY-NC 4.0 · Arch Plast Surg 2017; 44(06): 550-553
DOI: 10.5999/aps.2017.00941
Case Report

Is Robot-Assisted Surgery Really Scarless Surgery? Immediate Reconstruction with a Jejunal Free Flap for Esophageal Rupture after Robot-Assisted Thyroidectomy

Seong Hoon Park
Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Seoul, Korea
,
Joo Hyun Kim
Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Seoul, Korea
,
Jun Won Lee
Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Seoul, Korea
,
Hii Sun Jeong
Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Seoul, Korea
,
Dong Jin Lee
Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Medical Center, Seoul, Korea
,
Byung Chun Kim
Department of Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
,
In Suck Suh
Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Seoul, Korea
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Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury. We performed a jejunal free flap repair of the 8-cm defect in the esophagus. End-to-side microvascular anastomoses were created between the right external carotid artery and the jejunal branches of the superior mesenteric artery, and end-to-end anastomosis was performed between the external jugular vein and the jejunal vein. The right recurrent laryngeal nerve injury was repaired with a 4-cm nerve graft from the right ansa cervicalis. Esophagography at 1 year after surgery confirmed that there were no leaks or structures, endoscopy at 1 year confirmed the resolution of vocal cord paralysis, and there were no residual problems with swallowing or speech at a 5-year follow-up examination. RAT requires experienced surgeons with a thorough knowledge of anatomy, as well as adequate resources to quickly and competently address potentially severe complications such as esophageal rupture.

Keywords

Jejunum - Microsurgery - Free tissue flaps

This article was presented as a poster at the Korean Society for Microsurgery on November 5, 2016 in Seoul, Korea.




Publication History

Received: 01 June 2017

Accepted: 30 July 2017

Article published online:
20 April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Piccoli M, Mullineris B, Santi D. et al. Advances in robotic transaxillary thyroidectomy in Europe. Curr Surg Rep 2017; 5: 17
    CrossrefPubMedGoogle Scholar
  • 2 Kuntscher MV, Erdmann D, Boltze WH. et al. Use of a free jejunal graft for oesophageal reconstruction following perforation after cervical spine surgery: case report and review of the literature. Spinal Cord 2003; 41: 543-8
    CrossrefPubMedGoogle Scholar
  • 3 Seidenberg B, Rosenak SS, Hurwitt ES. et al. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 149: 162-71
    CrossrefPubMedGoogle Scholar
  • 4 Doki Y, Okada K, Miyata H. et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy. Dis Esophagus 2008; 21: 132-8
    CrossrefPubMedGoogle Scholar
  • 5 Razdan SN, Albornoz CR, Matros E. et al. Free jejunal flap for pharyngoesophageal reconstruction in head and neck cancer patients: an evaluation of donor-site complications. J Reconstr Microsurg 2015; 31: 643-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Kelly MF, Spiegel J, Rizzo KA. et al. Delayed pharyngoesophageal perforation: a complication of anterior spine surgery. Ann Otol Rhinol Laryngol 1991; 100: 201-5
    CrossrefPubMedGoogle Scholar
  • 7 Ballesta-Lopez C, Vallet-Fernandez J, Catarci M. et al. Iatrogenic perforations of the esophagus. Int Surg 1993; 78: 28-31
    PubMedGoogle Scholar
  • 8 Attar S, Hankins JR, Suter CM. et al. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 1990; 50: 45-9
    CrossrefPubMedGoogle Scholar
  • 9 Pollock RA, Purvis JM, Apple Jr DF. et al. Esophageal and hypopharyngeal injuries in patients with cervical spine trauma. Ann Otol Rhinol Laryngol 1981; 90: 323-7
    CrossrefPubMedGoogle Scholar
  • 10 English GM, Hsu SF, Edgar R. et al. Oesophageal trauma in patients with spinal cord injury. Paraplegia 1992; 30: 903-12
    CrossrefPubMedGoogle Scholar
  • 11 O’Brien CJ, Lee KK, Stern HS. et al. Evaluation of 250 free flap reconstructions after resection of tumours of the head and neck. Aust N Z J Surg 1998; 68: 698-701
    CrossrefPubMedGoogle Scholar
  • 12 Cho BC, Kim M, Lee JH. et al. Pharyngoesophageal reconstruction with a tubed free radial forearm flap. J Reconstr Microsurg 1998; 14: 535-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Laing TA, Van Dam H, Rakshit K. et al. Free jejunum reconstruction of upper esophageal defects. Microsurgery 2013; 33: 3-8
    CrossrefPubMedGoogle Scholar
  • 14 Bhathena HM. Free jejunal transfer for pharyngo-esophageal reconstruction. Acta Chir Plast 2002; 44: 120-3
    PubMedGoogle Scholar
  • 15 Coleman 3rd JJ, Searles Jr JM, Hester TR. et al. Ten years experience with the free jejunal autograft. Am J Surg 1987; 154: 394-8
    CrossrefPubMedGoogle Scholar