Cervical tracheal resection without intubation

Abstract

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis tracheal resection without using an endotracheal tube.
 Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis.
 Results. The resection length ranged from 15 to 45 mm (on average, 273 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 1099 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 122 days). No restenosis was detected at long term follow-up.
 Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.