Christian Medical College (CMC) Vellore has achieved a historic milestone in global medicine by successfully performing the world’s first Robotic Slide Tracheoplasty on an 8-year-old boy supported by Extracorporeal Membrane Oxygenation (ECMO) for a condition called congenital tracheal stenosis. This seminal achievement by the Department of Paediatric Surgery marks a revolutionary advancement in minimally invasive airway reconstruction for children. The pioneering operation was a masterclass in multidisciplinary collaboration, uniting experts from Paediatric and Cardiac Anaesthesia with the Paediatric ECMO team, including PICU specialists and Paediatric Cardiothoracic surgeons. Adding a global dimension to the procedure, the surgery was live-telementored by Dr. Robert Cerfolio, a world-renowned Robotic Thoracic surgeon based in New York.

Congenital Tracheal Stenosis

CTS is a rare condition (affecting approximately one in 64,500 live births) where a child is born with an abnormally narrow trachea (windpipe). While a healthy trachea consists of C-shaped cartilage rings bridged by muscle, children with CTS possess rigid, “O-shaped” rings that severely restrict airflow. Often accompanied by heart defects, the condition can cause life-threatening breathing issues at birth, though some children may only develop symptoms as they grow. The standard treatment is a Slide Tracheoplasty to widen the airway—a procedure that traditionally requires highly invasive surgery, such as a neck incision or a sternotomy (splitting the breastbone) to reach the affected area within the chest.

The success of this landmark procedure was the result of months of meticulous preparation, including practice on cadaveric animal models and the use of patient-specific 3D-printed resin models of the trachea and ribcage. These medical-grade replicas, created from the child’s CT scans, allowed surgeons to rehearse complex robotic manipulations and optimize surgical planning, saving critical time during the actual operation. A multi-disciplinary effort was central to the mission, with the ECMO team collaborating with New York-based Paediatric ECMO specialist Dr. Susheel Kumar to manage the delicate balance of anticoagulation—a vital necessity to prevent blood from clotting in the life-support machinery while maintaining a clear, blood-free surgical field for the surgeon.

Executed with surgical precision, the four-hour procedure mirrored the team’s rigorous rehearsals, demonstrating seamless teamwork and coordination during the complex tracheal reconstruction. Utilizing the da Vinci Xi robotic platform, the CMC Vellore team was live-telementored by world-renowned surgeon Dr. Robert Cerfolio, who provided expert guidance from New York  (throughout his night and early morning hours). Following the successful reconstruction, the child was electively ventilated in the PICU for 48 hours. The patient’s recovery was exceptionally smooth, leading to a discharge on just the sixth day—a remarkable achievement compared to the weeks-long hospitalization typically required by conventional open surgery.

The robotic platform has revolutionized surgical outcomes by enabling fine dissection from the chest deep into the neck, providing the precision necessary to achieve a perfectly airtight anastomosis. This minimally invasive approach offers a dramatic improvement over the conventional slide tracheoplasty, which typically requires a sternotomy and an extended recovery period—often involving a week of intubation in the PICU and up to three weeks of ward hospitalization. In contrast, the robotic procedure has achieved a phenomenal breakthrough in patient recovery, reducing the intubation period to just two days and the subsequent ward stay to only four days, allowing for a safe discharge in less than a week.

Over the past two years, the Department of Paediatric Surgery at CMC Vellore has expanded its clinical excellence by integrating a sophisticated robotic surgery program. This addition enhances our long-standing commitment to the community, offering a comprehensive range of advanced, minimally invasive interventions for highly complex cases that were previously considered ineligible for such approaches:

Thoracic (Chest) Robotics

• Lung-Preserving Resections: Performing sleeve resections and segmental lung resections that remove only the diseased tissue while saving healthy lung parenchyma.
• Complex Tumor Removal: Excision of mediastinal tumors (located around the heart) and thoracic inlet tumors (root of the neck) that involve vital nerves and blood vessels in the neck and chest.
• Airway and Esophageal Reconstruction: Robotic repair of complex aerodigestive fistulas and resection of esophageal strictures (narrowing of the food pipe) to restore normal function.

Abdominal Robotics

• Advanced Kidney and Liver Care: Management of complex renal pathologies (including heminephrectomy and tumor excision) and reconstruction for bile duct cysts and tumors.
• Organ-Sparing Surgery: Precise pancreatic drainage procedures and partial splenectomies that preserve the child’s immune function.
• Specialized GI Procedures: Heller’s Cardiomyotomy for Achalasia cardia (treating a spastic food pipe) and the excision of tumors adherent to major blood vessels.

This monumental procedure firmly establishes CMC Vellore as a global leader in paediatric surgical innovation. By merging cutting-edge technology with its foundational commitment to compassionate care, CMC Vellore continues to fulfill its mission of excellence in education, research, and service—offering a new horizon of hope to families facing the most challenging medical conditions.

CMC Vellore gratefully acknowledges the vital contributions of Dr. Robert Cerfolio (New York) for robotic telementoring, Dr. Susheel Kumar (New York) for paediatric ECMO expertise, and Dr. S. Solaman Bobby (Alliance University, Bangalore) for the 3D-printed anatomical models.