Percutaneous Trans-Tracheal Endoscopic Approach: A Novel Technique for the Excision of Benign Lesions of Thoracic Trachea.

INTRODUCTION:Currently, neoplasms of the trachea and lower airway demand open transcervical approach with or without thoracotomy. We describe here a novel, minimally invasive approach for an intraluminal lesion of the thoracic trachea, called percutaneous trans-tracheal endoscopic approach (PTEA). Apart from obvious advantages over potentially morbid open procedures, this technique has certain peculiar benefits over rigid or flexible bronchoscopic approach.MATERIALS AND METHODS:A 43-year-old male patient had glomus tumor of thoracic trachea. After detailed workup and informed written consent, he was taken up for percutaneous trans-tracheal excision under general anesthesia. The foremost step of the procedure is awake fiberoptic guided intubation, using the microlaryngeal tracheal tube, followed by elective tracheotomy. Subsequently, the lower end of the microlaryngeal tube was carefully pushed further inside the trachea so that the cuff of the tube lies distal to the tumor. The cuff is then inflated so that the operating area is sealed off from lower airway to aid continuous inhalational anesthesia and to prevent aspiration of blood. The surgeon sitting at the head end removed the tumor through tracheotomy under endoscopic guidance. After achieving absolute hemostasis, neck wound was closed.RESULTS:Patient had complete removal of the tumor without any aspiration intraoperatively or in the postoperative period. The anesthetic agent could be delivered uninterrupted through the secured airway, below the operative area separated by sealed cuff of the microlaryngeal tube.CONCLUSIONS:For excision of benign luminal lesions of the lower trachea, the novel approach of PTEA has many distinct and fool proof advantages in comparison to the transoral laryngoscopic/bronchoscopic and the transcervical approaches.