Comparison of Slide Tracheoplasty Technique on Postoperative Anatomic Outcomes in Three‐Dimensional Printed Models

Abstract

Objectives/Hypothesis We hypothesized that the use of three‐dimensional (3D) printed tracheal models to reproducibly simulate surgical technique variations in slide tracheoplasty would demonstrate the quantitative impact of surgical variables on postoperative tracheal dimensions. Study Design Prospective analysis of three‐dimensional printed surgical simulation models. Methods Slide tracheoplasty was performed on 3D printed long segment tracheal stenosis models with combinations of tracheal transection incision angle (90°, 45° beveled superior to inferior, 45° beveled inferior to superior) and tracheal transection location relative to the stenosis (at midpoint, 2 mm each superior and inferior to midpoint). Postoperative computed tomography (CT) scans measured changes in tracheal length, volume, and cross‐sectional area compared to controls. Statistical analysis was performed using one‐way analysis of variance and unpaired two‐tailed t‐tests. Results Slide tracheoplasty yielded 27 reconstructed tracheas. On average, slide tracheoplasty reduced total tracheal length by 36%. Beveled tracheal incisions yielded 9.5% longer final tracheas than straight transection incisions (P < .0001). Cross‐sectional area at the stenosis midpoint increased from 9.0 mm2 to 45 mm2 but did not vary with technique (P > .05). Total tracheal luminal volume increased from 900 mm3 to 1378 mm3 overall and was largest with beveled incisions (P = .03). More material was discarded with straight incisions compared to beveled (89 mg vs. 19 mg, P < .0001). Conclusions Beveled tracheal transection incisions resulted in increased tracheal length, longer anastomotic segments, increased volume, and reduced tissue waste as compared to straight incisions. Offsetting the incision from the midpoint of stenosis did not significantly affect reconstructed tracheal morphology. Using 3D printed models for surgical simulation can be helpful for the quantitative study of the effect isolated surgical variables on technical outcomes. Level of Evidence 3 Laryngoscope, 132:1306–1312, 2022

Multidisciplinary Advanced Surgical Planning for Slide Tracheoplasty Using 3D‐Printed Models

“…3 CST, in particular, requires advanced technical skills, and while there are well-established surgical steps, there are still a variety of potential surgical techniques. 8,12 Due to the wide array of anatomic variations and co-morbidities in the CST patient population, it may be required to deviate from standard technique. 6,13 Practicing surgical steps ahead of time on models allows for rehearsal on realistic patient-specific anatomy prior to in vivo surgery, and if necessary, allows for testing of multiple techniques on the same pathology.…”

“…Surgical planning is a well‐documented use of 3D models for airway surgery, and has been used to refine operative techniques in a variety of pathologies 3 . CST, in particular, requires advanced technical skills, and while there are well‐established surgical steps, there are still a variety of potential surgical techniques 8,12 . Due to the wide array of anatomic variations and co‐morbidities in the CST patient population, it may be required to deviate from standard technique 6,13 .…”

“…These surgeries have high rates of morbidity and mortality, require advanced coordination of multidisciplinary teams, and have a variety of surgical techniques to choose from. 8,9 At our institution, we introduced multidisciplinary pre-operative advanced surgical planning (ASP) sessions using 3D-printed models prior to all CST cases. We hypothesized that ASP sessions would improve surgeon confidence, streamline intraoperative planning, and highlight the utility of 3D modeling for CST.…”

“…Complex airway cases like CST, however, are an application that stands to benefit the most from adjuncts such as 3D models and simulation. These surgeries have high rates of morbidity and mortality, require advanced coordination of multidisciplinary teams, and have a variety of surgical techniques to choose from 8,9 …”