# Robotic-Assisted Thoracoscopic Repair of Chronic Bronchoesophageal Fistula Using Omental Flap Interposition: A Case Report

## TL;DR

A rare chronic bronchoesophageal fistula was successfully repaired using robotic-assisted thoracoscopic surgery and an omental flap, offering a new minimally invasive approach.

## Contribution

The novel use of robotic-assisted thoracoscopy combined with laparoscopic omental flap interposition for repairing complex BEFs is presented.

## Key findings

- Robotic-assisted thoracoscopic surgery enabled precise repair of a chronic BEF.
- Omental flap interposition provided a successful alternative to traditional thoracic muscle flaps.
- The patient had an uneventful recovery with no recurrence at follow-up.

## Abstract

Bronchoesophageal fistulas (BEFs) are rare and challenging conditions caused by congenital or acquired factors, often requiring innovative surgical solutions. This report describes the successful management of a chronic, postsurgical BEF in a 44-year-old male using a combination of robotic-assisted thoracoscopic surgery and laparoscopic omental flap interposition. The patient’s complex history of failed esophageal stenting and dense pleural adhesions highlighted the need for a minimally invasive yet precise approach. Preoperative optimization, intraoperative technical considerations, and the use of the da Vinci Xi robotic system facilitated successful fistula closure and omental flap placement. Postoperative recovery was uneventful, with no recurrence at follow-up. This case highlights the value of robotic-assisted thoracoscopy and omental flap interposition in managing challenging BEFs, offering a promising alternative to traditional thoracic muscle flaps. This novel application demonstrates the potential to enhance surgical precision, minimize morbidity, and improve patient outcomes for complex fistulas.