Tracheal Resection Surgeries

Tracheal Stenosis: Most cases of tracheal stenosis develop when the trachea is injured after prolonged intubation — when a breathing tube is inserted into the trachea to help maintain breathing during a medical procedure — or from atracheostomy (surgical opening of the trachea).

 

 

 

 

 

 

Tracheal resection is an operation on the windpipe – the tube which connects the voice box to the lungs. It involves a short section of the windpipe being removed and the cut ends of the windpipe are stitched back together.

 

Tracheal resection and primary anastomosis for tracheal tumors and stenosis is a well-described procedure. Postintubation lesions are the most common indication for tracheal resection and reconstruction. Malignancies including predominantly squamous cell carcinoma and adenocystic carcinoma also remain an indication for resection.  Other indications include secondary tracheal tumors, tracheoesophageal and tracheal innominate fistulas. 

 

For cervical lesions, a horizontal neck incision is used, while occasionally accompanied by a median sternotomy or mini-sternotomy. Intrathoracic lesions can be addressed via a sternotomy, which is the author’s preference, or a right thoracotomy. Right tracheal sleeve pneumonectomies are done via a right thoracotomy, while left tracheal sleeve pneumonectomies are done via a combined approach or via a thoracosternotomy (“clamshell” incision), although some have abandoned this operation.

Approximately half of the trachea can be safely removed with a low incidence of anastomotic complications.  Because of the lack of suitable replacement material for the trachea, various mobilization and release maneuvers have been demonstrated to increase the length of the tracheal resection by elevation of the carina. These include hilar, suprahyoid  andsuprathyroid laryngeal release; anterior and posterior digital tracheal dissection; and constant neck flexion.