Summary
Introduction
In this article, we evaluated our case who underwent tracheal resection and reconstruction with video-assisted thoracoscopic surgery (VATS), which is a rare approach in distal tracheal stenosis, based on the literature.
Case Presentation
){kind=link}
){kind=link}
){kind=link}
 Click Here to Zoom |
Figure 1: Axial (A), and coronal (B) CT images showing tracheal stenosis (arrows). |
 Click Here to Zoom |
Figure 2: Fiberoptic bronchoscopy images showing; 70% stenosis at the distal end of the trachea, approximately 2 cm from the carina. |
 Click Here to Zoom |
Figure 3: Intraoperative pictures showing; resection of the trachea (A), and reconstruction with continued sutures (B). |
Discussion
The largest series in the literature is the series performed by Jiang et al [3] through VATS on a patient with 12 tracheal distal end stenosis with spontaneous breathing. The authors suggested that mobilization of the trachea is easier when the endotracheal tube is not used, and therefore spontaneous ventilation is effective. In our case, we preferred ventilation with an endotracheal tube, the most important reasons for this are to avoid potential intraoperative hypoxia and to minimize intraoperative complications.
During the operation anastomosis is much more challenging compared to open surgery because the intubation tube advances to the surgical site during intraoperative ventilation. Specifically, jet ventilation or extracorporeal support (ECMO-Extracorporeal Membrane Oxygenation) can be preferred to prevent this situation. Ko et al and Hoetzenecker et al have also stated that ECMO is much safer in airway surgery [4,5]. We preferred cross-field intubation at the onset of anastomosis in our case. Towards the end of the anastomosis, we performed selective lung ventilation using a right endobronchial blocker through the endotracheal tube. We think that through selective intubation, the tension of the anastomosis was adjusted more easily, and we have protected the patient from hypoxia. We did not prefer to use invasive surgical methods such as ECMO, since ventilation can be performed easily from the intraoperative surgical site and anastomosis can be performed rapidly by using endobronchial blockers when suturing is about to be completed.
Besides, one of the most important problems in sleeve resections and tracheal resections is the adjustment of anastomotic tension. Some authors use “interrupted sutures” for easier adjustment of the tension in the anastomosis and to avoid mixing of sutures [6]. On the other hand, Diego et al prefer “continue sutures” in sleeve resections [7]. We often prefer to continue sutures in our tracheal resection surgeries [8]. Thus, the anastomosis is completed not only in a shorter time but also the tension can be adjusted comfortably in the anterior part.
In conclusion, with the improving technological opportunities, major surgical procedures can be easily performed through minimally invasive techniques. We think that tracheal resection with VATS can be safely performed in distal stenosis of the trachea, instead of major incisions such as posterolateral thoracotomy.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
Funding
The authors received no financial support.
Authors’ contributions
SE, CBS, GT, YS,VE, MM: conceived and designed the current case report, co-wrote the paper, collected the clinical data. The authors discussed the case under the literature data together and constituted the final manuscript.