A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations.

Tracheal laceration is a rare complication of endotracheal intubation. Early surgical treatment is mandatory in cases of pneumomediastinum with difficulty in ventilation to prevent mediastinitis and stricture. Surgical access to the posterior tracheal wall is via a right posterolateral thoracotomy, transcervical tracheotomy or tracheostomy, each of which is associated with specific morbidities. We developed a new optical needle holder consisting of a 12° HOPKINS telescope in a fixed attachment with an endoscopic needle holder to allow for complete intraluminal repair of posterior tracheal wall lacerations. Four patients were admitted with an iatrogenic tracheal laceration due to emergency intubation. In all cases, the repair of the tracheal laceration started with the introduction of a 14-mm rigid tracheoscope and subsequent jet-ventilation. Three of the tears were successfully repaired endotracheally with a running suture. In one case, the repair had to be converted to an open closure via posterolateral thoracotomy. Two patients were discharged extubated for further treatment of their underlying diseases. One patient died from a third cardiac infarction two days after the tracheal repair. We think that an exclusively endoluminal repair of longitudinal tracheal lacerations is feasible. This repair has convincing advantages including little surgical trauma, lack of scars and diminished postoperative pain.

A new endoscopic technique for intraluminal repair of posterior tracheal laceration.

This report describes an endoscopic repair of a tracheal tear with a newly developed optical needle holder. No surgical access was necessary. A 71-year-old woman with a 5-cm gaping iatrogenic tracheal laceration and a distinctive mediastinal and subcutaneous emphysema was successfully repaired with an endotracheal running suture through a 14-mm rigid tracheoscope. Operation time was 105 minutes, and borderline jet ventilation was used to maintain oxygen saturation. A bronchoscopy 9 days later revealed the tracheal tear had completely closed and the running suture was in place. No postoperative complications were noted.