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Parshin VD, Porkhanov VA, Polyakov IS, Kovalenko AL, Zhikharev VA, Parshin AV, Rusakov MA, Parshin VV. [Improving surgical technique for tracheal resection with anastomosis]. Khirurgiia (Mosk) 2024:6-20. [PMID: 38258683 DOI: 10.17116/hirurgia20240116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.
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Affiliation(s)
- V D Parshin
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - V A Porkhanov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - I S Polyakov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A L Kovalenko
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V A Zhikharev
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Gosman RE, Sicard RM, Cohen SM, Frank-Ito DO. A computational analysis on the impact of multilevel laryngotracheal stenosis on airflow and drug particle dynamics in the upper airway. EXPERIMENTAL AND COMPUTATIONAL MULTIPHASE FLOW 2023; 5:235-246. [PMID: 37305073 PMCID: PMC10024600 DOI: 10.1007/s42757-022-0151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/31/2022] [Accepted: 11/24/2022] [Indexed: 06/13/2023]
Abstract
Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the larynx and/or trachea. This study characterizes airflow dynamics and drug delivery in patients with multilevel stenosis. Two subjects with multilevel stenosis (S1 = glottis + trachea, S2 = glottis + subglottis) and one normal subject were retrospectively selected. Computed tomography scans were used to create subject-specific upper airway models. Computational fluid dynamics modeling was used to simulate airflow at inhalation pressures of 10, 25, and 40 Pa, and orally inhaled drug transport with particle velocities of 1, 5, and 10 m/s, and particle size range of 100 nm-40 µm. Subjects had increased airflow velocity and resistance at stenosis with decreased cross-sectional area (CSA): S1 had the smallest CSA at trachea (0.23 cm2) and resistance = 0.3 Pa·s/mL; S2 had the smallest CSA at glottis (0.44 cm2), and resistance = 0.16 Pa·s/mL. S1 maximal stenotic deposition was 4.15% at trachea; S2 maximal deposition was 2.28% at glottis. Particles of 11-20 µm had the greatest deposition, 13.25% (S1-trachea) and 7.81% (S2-subglottis). Results showed differences in airway resistance and drug delivery between subjects with LTS. Less than 4.2% of orally inhaled particles deposited at stenosis. Particle sizes with most stenotic deposition were 11-20 µm and may not represent typical particle sizes emitted by current-use inhalers.
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Affiliation(s)
- Raluca E. Gosman
- Duke University School of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27708 USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27708 USA
| | - Ryan M. Sicard
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27708 USA
| | - Seth M. Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27708 USA
| | - Dennis O. Frank-Ito
- Duke University School of Medicine, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27708 USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC 27708 USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC 27708 USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708 USA
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Parshin VD, Pushkin SY, Akopov AL, Parshin AV, Kovalev MG, Abashkin NY, Parshin VV. [Surgical management of tracheal anastomosis failure and risk of arterial bleeding]. Khirurgiia (Mosk) 2023:20-33. [PMID: 37707328 DOI: 10.17116/hirurgia202309120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To determine the optimal algorithm for tracheal anastomotic insufficiency and prevention of arterial bleeding. MATERIAL AND METHODS We present 2 patients with defects of tracheal anastomosis after tracheal resection and divergence of tracheal edges. We primarily analyzed appropriate emergency care and prevention of subsequent severe complications such as arterial bleeding and respiratory insufficiency. CONCLUSION Tracheostomy may be preferable for complete late tracheal anastomotic insufficiency to restore breathing. However, surgery should be accompanied by prevention of arterial bleeding. Isolation of damaged area, particularly tracheostomy tube, from the mediastinum by well-vascularized tissues can prevent bleeding from major vessels (for example, innominate artery). Follow-up is unreasonable due to worsening of clinical situation, risk of hemorrhagic complications and fatal outcomes. General satisfactory clinical status of the patient is not of matter. Repeated tracheal anastomosis is justified only for early insufficiency, i.e. within 2-3 days when postoperative inflammation is mild.
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Affiliation(s)
- V D Parshin
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | | | - A L Akopov
- Pavlov St. Petersburg First State Medical University, St. Petersburg, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M G Kovalev
- Pavlov St. Petersburg First State Medical University, St. Petersburg, Russia
| | | | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, Starostin AV. [Tracheolaryngeal resection for cicatricle stenosis]. Khirurgiia (Mosk) 2018:41-48. [PMID: 29953099 DOI: 10.17116/hirurgia2018641-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. MATERIAL AND METHODS For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. RESULTS In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Starostin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
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Cheng T, Carpenter D, Cohen S, Witsell D, Frank-Ito DO. Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics. Laryngoscope 2018; 128:E141-E149. [PMID: 29044543 PMCID: PMC5867224 DOI: 10.1002/lary.26954] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/09/2017] [Accepted: 09/10/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Very little is known about the impact of laryngotracheal stenosis (LTS) on inspiratory airflow and resistance, especially in air hunger states. This study investigates the effect of LTS on airway resistance and volumetric flow across three different inspiratory pressures. METHODS Head-and-neck computed tomography scans of 11 subjects from 2010 to 2016 were collected. Three-dimensional reconstructions of the upper airway from the nostrils to carina, including the oral cavity, were created for one subject with a normal airway and for 10 patients with LTS. Airflow simulations were conducted using computational fluid dynamics modeling at three different inspiratory pressures (10, 25, 40 pascals [Pa]) for all subjects under two scenarios: 1) inspiration through nostrils only (MC), and 2) through both nostrils and mouth (MO). RESULTS Volumetric flows in the normal subject at the three inspiratory pressures were considerably higher (MC: 11.8-26.1 L/min; MO: 17.2-36.9 L/min) compared to those in LTS (MC: 2.86-6.75 L/min; MO: 4.11-9.00 L/min). Airway resistances in the normal subject were 0.051 to 0.092 pascal seconds per milliliter (Pa.s)/mL (MC) and 0.035-0.065 Pa.s/mL (MO), which were approximately tenfold lower than those of subjects with LTS: 0.39 to 0.89 Pa.s/mL (MC) and 0.45 to 0.84 Pa.s/mL (MO). Furthermore, subjects with glottic stenosis had the greatest resistance, whereas subjects with subglottic stenosis had the greatest variability in resistance. Subjects with tracheal stenosis had the lowest resistance. CONCLUSION This pilot study demonstrates that LTS increases resistance and decreases airflow. Mouth breathing significantly improved airflow and resistance but cannot completely compensate for the effects of stenosis. Furthermore, location of stenosis appears to modulate the effect of the stenosis on resistance differentially. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E141-E149, 2018.
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Affiliation(s)
- Tracy Cheng
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - David Carpenter
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Seth Cohen
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - David Witsell
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dennis O. Frank-Ito
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
- Division of Head and Neck Surgery & Communication Sciences, Duke University MedicalCenter, Durham, NC, USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC
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Abstract
Malignant airway tumors present particular challenges for surgeons, namely: to distinguish symptoms from those of the more frequent benign airway diseases; to separate metastatic disease from the uncommon primary tumors; and to consider curative resection in appropriate candidates. Here, we present a critical review of tracheal malignant obstruction, focusing on the evaluation of a patient with malignant airway tumor, patient selection for resection and the predictors of long-term survival. The new development in primary tracheal tumors is an old story, that of making physicians aware that resection rates in epidemiologic studies remain low, mainly because opportunities for resection are missed.
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Affiliation(s)
- Maria Lucia L Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Morita K, Yokoi A, Fukuzawa H, Hisamatsu C, Endo K, Okata Y, Tamaki A, Mishima Y, Oshima Y, Maeda K. Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis. Pediatr Surg Int 2016; 32:915-9. [PMID: 27457232 DOI: 10.1007/s00383-016-3928-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to determine the appropriate surgical intervention strategies for congenital tracheal stenosis (CTS) associated with a tracheal bronchus based on the location of stenosis. METHODS The medical records of 13 pediatric patients with CTS associated with a tracheal bronchus at a single institution between January 2006 and December 2015 were retrospectively reviewed. RESULTS Type 1: tracheal stenosis above the right upper lobe bronchus (RULB) (n = 1). One patient underwent slide tracheoplasty and was successfully extubated. Type 2: tracheal stenosis below the RULB (n = 7). Tracheal end-to-end anastomosis was performed before 2014, and one patient failed to extubate. Posterior-anterior slide tracheoplasty was performed since 2014, and all three patients were successfully extubated. Type 3: tracheal stenosis above the RULB to the carina (n = 5). One patient underwent posterior-anterior slide tracheoplasty and was successfully extubated. Two patients with left-right slide tracheoplasty and another two patients with tracheal end-to-end anastomosis for the stenosis below the RULB could not be extubated. CONCLUSION Tracheal end-to-end anastomosis or slide tracheoplasty can be selected for tracheal stenosis above the RULB according to the length of stenosis. Posterior-anterior slide tracheoplasty appears feasible for tracheal stenosis below the RULB or above the RULB to the carina.
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Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Chieko Hisamatsu
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kosuke Endo
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yuichi Okata
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Akihiko Tamaki
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yasuhiko Mishima
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan
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