Video mediastinoscopically assisted tracheal release in treatment of long tracheal stenosis.
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ABSTRACT:
SUBMITTER: Kirschbaum A
PROVIDER: S-EPMC4176060 | biostudies-other | 2013 Dec
REPOSITORIES: biostudies-other
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Project description:Long-segment tracheal resection is technically challenging due to its high tension during reconstruction. Therefore, tracheal release maneuvers, including pulmonary hilar release and pericardial dissection, were required to reduce the anastomotic tension. Traditional hilar release is performed via thoracotomy; however, this approach is invasive. We report a case of bilateral hilar and pericardial release via a video-assisted thoracoscopic surgery (VATS) approach in resecting a long segment tracheal adenoid cystic carcinoma that spanned 50% of the trachea. The bilateral hilar and pericardial releases were performed under general anesthesia through biportal VATS, which contributed to a total of 2.5 cm of additional mobility to the trachea, and the infrahyoid release was then performed through a cervical collar incision. The tumor-involved tracheal segments were removed via median sternotomy, totaling 6.0 cm in length, and the remaining trachea could be successfully reconstructed with a tension-free anastomosis. The total operative duration was 4.5 hours. The patient suffered a transient swallowing dysfunction during the postoperative course, with a good luminal patency in the trachea after 1 month postoperatively. Therefore, bilateral hilar release via VATS can be considered to be a less invasive, avoiding the potential complications related to a thoracotomy, but similarly effective release maneuver for long-segment tracheal resections.
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Project description:Tracheal stenosis is a rare but life-threatening disease in preterm infants. Misdiagnosis as congenital tracheal stenosis is common, making surgical management challenging. This report presents a case of a preterm infant with tracheal stenosis and congenital heart malformation treated with ECMO-assisted tracheal resection and end-to-end anastomosis. A male infant was born at 30 weeks of gestation with severe asphyxia, cardiac insufficiency, and pneumonia. Following failed medical treatment, fiberoptic bronchoscopy confirmed mid-tracheal to carinal stenosis. After a 2-week treatment course, ECMO-assisted tracheal resection and end-to-end anastomosis were performed successfully. This case confirms the feasibility of tracheal resection and end-to-end anastomosis in low-weight, preterm infants with tracheal stenosis born at 30 weeks gestation. The utilization of ECMO for oxygenation during surgery provides a clear surgical field and shorter operating time. Surgical intervention may be necessary for neonatal tracheal stenosis depending on the clinical presentation.
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Project description:BackgroundEndoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.MethodsWe conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.ResultsThe technical success rate of stent removal was 98.9 and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1 ± 25.9 days in the TF group, and at 89.9 ± 15.0 day in the TS group. The total incidence of complications was 21.1 and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3, 59.6, and 36.1% for TF group, and 80.4, 75.7, 75.7% for TS group.ConclusionsFluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Clinicians should pay attention to the risk of hemoptysis for patients with malignant tumors and a combination with endoscopic hemostasis may help improve its safety.
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Project description:Background Cross-field endotracheal intubation is typically performed during tracheal anastomosis to maintain single-lung ventilation. To minimize obstruction of the surgical field by the cross-field tube, special equipment such as high-frequency jet ventilation (HFJV) and extracorporeal membrane oxygenation (ECMO) or advanced techniques such as non-intubated ventilation have been proposed. Here, we describe a simple and practical airway management strategy that requires only conventional ventilators and techniques. Our operation is completed under uniportal video-assisted thoracoscopic surgery (VATS). Case Description We report a case of tracheal adenoid cystic carcinoma (ACC) presenting with cough with bloody sputum in a 53-year-old man. Computed tomography (CT) and flexible bronchoscopy revealed an irregular polypoid neoplasm attached to the right wall of the distal trachea, which almost completely blocked the tracheal lumen. To relieve the symptoms, transbronchoscopic resection of the tumor, followed by curative resection via uniportal VATS under general anesthesia was performed. To maintain single-lung ventilation during tracheal reconstruction, we took advantage of a thin suction tube [internal diameter (ID) 3 mm; external diameter (ED) 4 mm], which was connected to a conventional ventilator. Specifically, by introducing the suction tube into the distal left main bronchus through the endotracheal tube and blowing 100% oxygen, we achieved satisfactory oxygenation throughout the anastomotic process; and the blood CO2 partial pressure was also acceptable. The view of the anastomotic site was far less obstructed owing to the small diameter of the suction tube, and the anastomotic process was smooth and accurate. Postoperative recovery was good, and no stenosis of the reconstructed trachea was observed at the 3-month follow-up. Conclusions Our technique proves to be safe and feasible for selected patients with tracheal tumors, and can be a practical choice for medical centers that are not equipped with HFJV or ECMO.
| S-EPMC9347034 | biostudies-literature
Project description:The optimal way to treat severe thoracic scoliosis remains controversial. Compared with conventional procedures, the uniportal video-assisted thoracoscopic surgery (UniVATS) rises in popularity in thoracic surgery because of less pain and faster recovery. This retrospective study aimed to apply UniVATS to treat severe thoracic scoliosis. Between October 2013 and March 2018, eight scoliotic patients with extremely large Cobb angle and profoundly limited flexibility underwent UniVATS for anterior release, followed by posterior instrumentation and fusion. The mean age at the time of surgery was 14.8?±?2.4 years and the mean follow-up was 2.2?±?1.3 years. The average levels of anterior thoracic discectomy and posterior fusion were 3.6?±?0.7 and 11.5?±?1.2, respectively. The mean coronal and sagittal correction rates were 70?±?19% and 71?±?23%, respectively. UniVATS contributed to minor access trauma (3-cm incision) with minimal blood loss, shorter operation time (75?±?13?mins), less requirement of stay in the intensive care unit (0.3?±?0.5 day) or chest tube placement (0.3?±?0.7 day), speedier and narcotic-free recovery, and earlier ambulation within one day. This is the first study to assess the safety and efficacy of UniVATS in the treatment of severely stiff thoracic scoliosis, providing comparable surgical outcomes, less pain, faster recovery and superior cosmetic results without significant complications.
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Project description:BACKGROUND:In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa. METHODS:The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed. RESULTS:All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05). CONCLUSIONS:Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.
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Project description:PurposeUpper airway stenosis is one of the most formidable situations in medicine and is frequently encountered in the ENT clinic. We introduce here our method of emergency endonasal endotracheal intubation under videoendoscopic observation.MethodsTransnasal endoscopic observation was done, and the region of airway stenosis was detected. Then, the endotracheal tube was prepared and the endoscope was inserted into the tube. The endoscope with tube was inserted up to the larynx. Immediately after the administration of lidocaine to the larynx, the endoscope with tube was inserted to the endolarynx and then to the trachea. The endotracheal tube was tightly held in the nostril, and the endoscope was removed.ResultsWe have encountered four cases this year. The primary disease developing airway stenosis was acute epiglottitis due to pharyngeal and deep neck abscesses in three cases and laryngeal edema due to Ludwig's angina. All patients underwent uneventful intubation, and dyspnea was immediately ceased.ConclusionIn cases showing severe suffocation, the clinician should perform airway maintenance even in an outpatient setting apart from a more monitored setting like the operation room. This technique resembles the usual nasal endoscopic laryngeal observation and is done even in the usual ENT office and/or emergency room. The supine position tends to worsen airway stenosis in patients with upper airway stenosis; however, this technique can be performed in a sitting or semi-sitting position. This method is less invasive for patients and also reduces the risk to the medical staff, especially in this COVID-19 era.
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Project description:Several conventional treatments are used to manage tracheal stenosis after intubation and surgical procedures; however, patients are at risk of restenosis because of the absence of effective preventative therapy. In this study, we evaluate the biomodulatory effect of PT-combined blue light (BL) PBM in tracheostomal stenosis-induced animal models. The PT-combined BL group showed a significant decrease in the fibrotic protein synthesis by downregulating the release of stenosis-triggering fibrotic signals, without cytotoxicity or thermal damage. Moreover, the combined treatment ameliorated excessive granulation and collagen formation, and consequently preserved the opening of the tracheostoma ten days after fenestration. The current study demonstrated the biomodulatory effect of PT-combined BL on human tracheal fibroblasts and tracheal fenestration rodent models. Hence, PT-combined BL has the potential to be an effective preventative treatment for tracheal stenosis but also as an alternative option for fibrotic disorders.
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