Conversion to Open, Intraoperative Complications and Management During TREAT (Vascular Injury/Tracheal Injury)

Conversion to open during thoracoscopic repair of esophageal atresia can be multifactorial. There is a complex interplay between the surgeon, the camera assistant, and the anesthetist. The camera assistant and the anesthetist play a crucial role in the procedure’s success. Surgeon should be aware of all the possible reasons for conversion so that he can prepare to avoid those reasons. If the need arises, surgeon should covert in time so that the safety of the neonate is not compromised. Loss of working space due to ventilating lung, difficult anatomy, and injuries to the trachea or any surrounding blood vessels can cause intraoperative complications and can be reasons for conversion. The chapter describes these causes of conversion and how to avoid and manage them. Management of tracheal injury and vascular injury during TREAT is also discussed. There is included video supplementary material showing a difficult case which was converted to open due to loss of working space.