Tracheal release maneuvers

Broussard, Brett L.; Mathisen, Douglas J.

doi:10.21037/acs.2018.01.14

Cited by 29 publications

(26 citation statements)

References 11 publications

(15 reference statements)

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“…5 The most common sequelae of suprahyoid release are related to dysphagia and aspiration. 25 It was assumed that preventing laryngeal elevation during swallowing might cause dysphagia. Yet, Grillo 26 noted that dysphagia was significantly less often encountered after suprahyoid release in comparison with thyrohyoid release.…”

Section: Discussionmentioning

confidence: 99%

Revision cricotracheal resection: our experience

2021

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Objective The incidence of recurrent stenosis after cricotracheal resection is 3–9.5 per cent. Management of such patients is challenging. This study aimed to review our experience in revision cricotracheal resection. Methods The study was conducted in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, on nine patients with recurrent stenosis following cricotracheal resection. Revision cricotracheal resection was performed in all patients. Surgiflo was applied on the site of anastomosis to enhance healing. Results No intra-operative complications were recorded. Minor post-operative complications occurred in two patients (surgical emphysema and temporary choking); no major complications were reported. Re-stenosis occurred in one patient. Successful decannulation was achieved in eight of the nine patients. Conclusion Revision cricotracheal resection is the definitive curative treatment for recurrent stenosis after previous unsuccessful resection. It has high success rates, provided that careful pre-operative assessment and meticulous operative technique are performed.

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Section: Discussionmentioning

confidence: 99%

Revision cricotracheal resection: our experience

2021

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“…It should be noted that laryngeal release brings with it the risk of aspiration and dysphagia, which is why most institutions use the suprahyoid technique described by Montgomery in 1974, resulting in a decreased incidence of laryngeal dysfunction. Dissection of the pretracheal plane should routinely be performed to enhance the mobility of the trachea [39]. This procedure alone was enough to provide tension-free anastomosis for cervical resections in our series.…”

Section: Commentmentioning

confidence: 91%

Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis

et al. 2020

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BACKGROUND: Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and only a few centres have reported their experience. Therefore, more clinical reports on this topic are needed.METHODS: We performed a retrospective analysis of all patients who underwent tracheal or cricotracheal resection for malignant or benign tracheal stenosis in our institution between 2001 and 2016. Fisher's exact test was used for analysis of complications and recurrence. P-value <0.05 was considered statistically significant. RESULTS: 37 patients, aged 19-74, underwent tracheal (n = 21, 56.8%) or cricotracheal (n = 16, 43.2%) resection for idiopathic (n = 15, 40.5%), neoplasm-related (n = 11, 29.7%), postintubation/-tracheotomy (n = 10, 27%), and congenital (n = 1, 2.7%) stenosis. Cervical incision was applied in 28 patients (75.7%), and an extended access (5 thoracotomy, 3 hemiclamshell, 1 partial-sternotomy) was required in 9 patients (24.3%). Mediastinal lymphadenectomy was done in 7 patients (18.9%), all with neoplasm-related stenosis. Median resection length was 2.8 cm (range 1.0-6.0), and longer than 4.0 cm in 6 cases (16.2%). Release manoeuvre was performed in 7 patients (18.9%). All patients were extubated immediately after surgery and median hospital stay was 5 days (range 3-15). Median follow-up was 6 months (range, 1-93). There was no 30-day mortality, and no dehiscence or fistula occurred at the suture line. Complications were seen in 11 patients (29.7%), significantly correlating to malignant stenosis (p = 0.011) and surgical procedure, meaning extended access (p = 0.011), mediastinal lymphadenectomy (p = 0.016), and release manoeuvres (p = 0.016). Temporary hoarseness was the most common complication (n = 5, 13.5%), but remained persistent in only one patient (n = 1, 2.7%). Recurrence was seen only in patients with idiopathic stenosis (n = 5, 13.5%). CONCLUSIONS: Our results confirm good efficacy for surgical resection of tracheal stenosis. The complication rate is relatively low in comparison to the literature, suggesting the importance of managing tracheal stenosis in a tertiary referral centre.

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“…The infiltration of the bronchus intermedius was not indicated by the preoperative chest CT. The inferior pulmonary ligament was released before the reconstruction, however after the reconstruction there was a need to further relieve the tension of the anastomosis and a typical intrapericardial release was performed (29).…”

Section: Case 1: Carinal Resection and Right Upper Lobectomymentioning

confidence: 99%

Uniportal video-assisted thoracoscopic lung sparing tracheo-bronchial and carinal sleeve resections

González-Rivas¹,

Soultanis²,

García³

et al. 2020

J Thorac Dis

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Pathology arising from the intrathoracic portion of the trachea (distal trachea), the carina and the main bronchi is usually neoplastic and is mainly treated with surgery. Resection of the intrathoracic portion of the trachea, the carina and the main bronchi for neoplastic lesions does not necessitate lung resection and is traditionally being conducted via open surgery. Video-assisted thoracic surgery (VATS) is witnessing an exponential growth and is the treatment of choice for early-stage non-small cell lung cancer (NSCLC). The experience accumulated over the past two decades along with the introduction of reliable and ergonomic technology, has led to the expansion of its indications. In this article we provide a detailed description of lung sparing distal tracheal, carinal and main bronchi resection for primary neoplasms of the airway, without involvement of the lung, with the uniportal video-assisted technique. The chest is entered through the fourth intercostal space, mid-axillary line. Dissection of the paratracheal space anteriorly, the tracheoesophageal groove posteriorly and the subcarinal space and division of the azygos arch are essential to mobilize the distal trachea and carina. Lateral dissection should be avoided beyond the points of division of the airway, as it may hinder the blood supply to the anastomosis. Any tension to the anastomosis should be relieved by release maneuvers. Ventilation is achieved through an endobronchial catheter, inserted into the left main bronchus through which a high-frequency jet ventilation catheter can be also inserted through it. The rationale of applying a minimally invasive technique for the conduction of tracheal and carinal resections, is to exploit its advantages, namely less pain, earlier mobilization and lower morbidity. Uniportal video-assisted resections of the distal trachea, carina and the main bronchi, are safe when conducted by experienced surgical and anesthetic teams.

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Tracheal release maneuvers

Cited by 29 publications

References 11 publications

Revision cricotracheal resection: our experience

Revision cricotracheal resection: our experience

Postoperative outcome of tracheal resection in benign and malignant tracheal stenosis

Uniportal video-assisted thoracoscopic lung sparing tracheo-bronchial and carinal sleeve resections

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