<p>Endoscopic submucosal dissection of tracheal deep benign fibrous histiocytoma using hybrid knife</p>

Abstract

Deep benign fibrous histiocytoma (FH) is an uncommon and poorly recognized tumor that arises in subcutaneous or deep soft tissue. Deep benign FH of the trachea is even more rare. Deep benign FH recurs in approximately 20% of cases, so surgical resection is the recommended treatment for FH. However, some patients are afraid of the trauma and potential complications from the resection of tracheal tumors, so they do not accept surgical resection. With the development of interventional pulmonology, bronchoscopic intervention plays a key role in the treatment of benign tracheal tumors. Novel tools have emerged in interventional pulmonology and optimized the traditional techniques. Here, we report a case of deep benign FH of the trachea with broad base relapse after electrocautery with snare, argon plasma coagulation (APC) and radiotherapy. It was treated successfully by endobronchial resection with a hybrid knife (HK) and APC. The HK is a hybrid device that combines an electrocautery knife with a water jet in one instrument. Submucosal injection and circumferential cutting and dissection of lesions as well as coagulation of bleeding can be performed only with the HK. During the 6 months follow-up, the deep benign FH of the trachea did not relapse. In the case reported herein, the HK enabled submucosal injection and circumferential cutting and dissection of lesions as well as access to submucosal lesions to gain further adequate APC treatment, thereby allowing a better clinical response than that achieved by traditional electrocautery with snare and APC. In conclusion, the HK with a water jet is a feasible and effective endoscopic method for management for benign or low-grade malignant neoplasms of the trachea, especially those with a wide base and submucosal involvement.

Endoscopic submucosal dissection of endobronchial leiomyoma with a hybrid knife in an adolescent patient: a case report

“…Pedunculated benign tumors are often effectively treated using these resection methods, although wide-based tumor recurrence has been reported in a single-institution review ( 18 ). Episodes of recurrence have also been reported in tracheobronchial leiomyomas after tumor removal, whether with laser ablation or APC ( 8 , 16 , 19 ). Limited cases and comparative studies may not conclusively prove this, but these instances highlight potential limitations in the width and depth of the current endoscopic approaches ( 20 ).…”

“…Additionally, the submucosal water cushion formed by the hybrid knife acts as a protective barrier for the surrounding tissue and reduces the perforation risk. Previous use of the hybrid knife has shown promising outcomes after the resection of recurrent lesions of benign tracheal tumors in two patients ( 16 , 22 ). This procedure involves the creation of a submucosal tunnel using a water jet, followed by circumferential dissection of the lesion.…”

“…A significant portion of the tumor was excised and collected using an electrocautery snare and cryoprobe. Subsequently, a hybrid knife (HybridKnife ® ERBE JET2 Elektromedizin, Tübingen, Germany) was employed to dissect the tumor stump, as described previously ( Figure 1B ) ( 16 ). A water jet was used to administer a 2% lidocaine solution into the submucosal layer of the tumor base under a 30-bar pressure.…”

“…The hybrid knife, with multifunctional capabilities, such as circumferential dissection, submucosal injections, dissection, and hemostasis ( 14 , 15 ), has expedited ESD procedures ( 14 ). It can also be used to treat recurrent benign tracheal tumors ( 16 ). It may represent a novel approach for completely removing benign endobronchial tumors, thereby decreasing recurrence.…”