A new endoscopic hand drill for management of tracheal stenosis

Abstract

Tracheal resection and primary anastomosis is the treatment of choice for the management of benign tracheal stenoses. Rigid endoscopy with laser-assisted mechanical dilatation is an alternative to surgery and helps to improve symptoms and quality of life in patients unfit for surgery. Here, we describe the treatment of a simple web-like stenosis, using a new endoscopic hand drill that was assembled by sharpening the blunt tip of a standard endoscopic cotton applicator. The bronchoscopy was positioned proximally to the stenotic lesion and radial holes were made at 12, 3 and 9 o'clock. The tip of instrument touched the target area of the stenotic scar. The proximal end was handily rotated and the force, applied on the instrument's tip, and the hole was drilled. Next, endoscopic scissors was placed in the drill holes and the stenotic scar was cut. Mechanical dilatation with rigid bronchoscopes of increasing diameters completed the procedure. This procedure was successfully applied in 5 patients with simple benign tracheal stenosis and unfit for surgery. No intraoperative and/or postoperative complications occurred. No recurrence of stenosis was detected after a mean follow-up of 26 ± 2 months.

Endobronchial Ultrasound for Benign Tracheal Stenosis

“…To resect the stenosis, we preferred to use cold scissors instead of laser to avoid any thermal damage of airway mucosa that was likely to promote further fibrotic scar and predisposed to restenosis. 4 Furthermore, we performed a gentle balloon dilation by a uniform radial pressure on the stenosis, avoiding overenthusiastic dilation that could injure the mucosa with subsequent scarring or tracheal rupture. A significant increase in airway patency was obtained after treatment and maintained during the follow-up, but it was associated with a small improvement in MRC value.…”