Transoral flexible laser surgery of the upper aerodigestive tract with blue laser.

PURPOSE: The introduction of fiber-guided lasers was a breakthrough in laryngology practice, opening the path for treating different pathologies with minimally invasive procedures, both in the operating room and in the office. The most recent technology in the area is the blue laser, which combines photoangiolytic and cutting properties, characteristics that make this equipment suitable for its use in upper aerodigestive tract surgery. However, there is not enough experience in this area. The authors present a case series of patients with different pharyngeal, laryngeal, and tracheal pathologies who were treated by means of transoral procedures using fiber-guided blue laser. METHODS: The surgical records of patients with different upper aerodigestive tract pathologies who were treated with fiber-guided blue laser in the operating room, under general anesthesia with jet ventilation or supraglottic ventilation using suspension laryngotracheoscopy techniques between February 2018 and March 2022 were reviewed. RESULTS: A total of 80 surgical interventions in a group of 38 patients were performed. A wide variety of procedures was executed, either using the laser alone or in combination with other techniques to treat different pathologies of the aero-digestive tract safely and effectively, with adequate functional results. CONCLUSIONS: Following all necessary precautions, blue laser is a reliable tool to perform minimally invasive surgeries in the operating room using TOFLS techniques. It can be used alone or in combination with other devices to achieve the desired goals.

Adenocarcinoma traqueal em um gato / Tracheal adenocarcinoma in a cat

Background: Primary tracheal adenocarcinoma is a rare neoplasm in cats. The clinical signs often are indicative of upper airway obstruction accompanied with dyspnea, stridor, wheezing, exercise intolerance, and cough. The severity of the clinical signs is related to the size of the mass and consequently, the proportion of the tracheal lumen that is obstructed. The diagnosis is made using thoracic radiography and tracheobronchoscopy by collecting fragments for histopathological analysis and removing the mass. The present study aimed to report the case of a cat with tracheal adenocarcinoma. Case: A 17-year-old Persian female cat presented with clinical signs of dyspnea and progressive weight loss. Emergency therapy was started with bronchodilators, antibiotics, and corticosteroids, but there was no response to treatment. Complementary blood and imaging tests were performed. Thoracic radiography revealed soft tissue opacity overlying the dorsal trachea from the third to the fourth rib, bronchial pattern, and pulmonary hyperinflation. Tracheoscopy showed an irregular intraluminal thoracic trachea mass, occluded by approximately 95% of the airway lumen. The mass was biopsied multiple times with endoscopic cup biopsy forceps, followed by removal of approximately 50% of the mass lesion with an endoscopic wire snare. The patient was in intensive care, and since her clinical condition worsened 48 h after the endoscopic procedure, euthanasia was performed. Necropsy revealed a remanescent mass located in the trachea lumen 8 x 3 mm and a nodule in the right caudal pulmonary lobe with 8 mm of diameter . Histological examination showed epitelian cuboidal neoplastic cells with acinar patterns. Only a few mitosis and moderate anysocitosis were observed. The final diagnosis was primary tracheal adenocarcinoma with pulmonary metastasis...(AU)

Adenocarcinoma traqueal em um gato / Tracheal adenocarcinoma in a cat

Background: Primary tracheal adenocarcinoma is a rare neoplasm in cats. The clinical signs often are indicative of upper airway obstruction accompanied with dyspnea, stridor, wheezing, exercise intolerance, and cough. The severity of the clinical signs is related to the size of the mass and consequently, the proportion of the tracheal lumen that is obstructed. The diagnosis is made using thoracic radiography and tracheobronchoscopy by collecting fragments for histopathological analysis and removing the mass. The present study aimed to report the case of a cat with tracheal adenocarcinoma. Case: A 17-year-old Persian female cat presented with clinical signs of dyspnea and progressive weight loss. Emergency therapy was started with bronchodilators, antibiotics, and corticosteroids, but there was no response to treatment. Complementary blood and imaging tests were performed. Thoracic radiography revealed soft tissue opacity overlying the dorsal trachea from the third to the fourth rib, bronchial pattern, and pulmonary hyperinflation. Tracheoscopy showed an irregular intraluminal thoracic trachea mass, occluded by approximately 95% of the airway lumen. The mass was biopsied multiple times with endoscopic cup biopsy forceps, followed by removal of approximately 50% of the mass lesion with an endoscopic wire snare. The patient was in intensive care, and since her clinical condition worsened 48 h after the endoscopic procedure, euthanasia was performed. Necropsy revealed a remanescent mass located in the trachea lumen 8 x 3 mm and a nodule in the right caudal pulmonary lobe with 8 mm of diameter . Histological examination showed epitelian cuboidal neoplastic cells with acinar patterns. Only a few mitosis and moderate anysocitosis were observed. The final diagnosis was primary tracheal adenocarcinoma with pulmonary metastasis...

Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction. Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confirmed the diagnosis of tracheal neoplasia, which was identified as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in significant morbidity and consequent mortality, the owner chose a palliative treatment without adjuvant therapy for adenocarcinoma until acquisition of the stent, with partial resection of the tumor performed during tracheoscopy. This procedure was performed twice at an interval of three months. After the first endoscopic examination, the patient regained weight and normal behavior. Three months after the second tracheoscopy, signs of labored breathing recurred. At this point, the obstruction was treated with implantation of an intratracheal stent. A nitinol biliary stent, 35 mm in length, 8 mm in diameter, was applied during tracheoscopy without fluoroscopy aid. The cat received postoperative treatment with dexamethasone 0.25 mg.kg­¹ SID for seven days. The patient showed immediate clinical improvement in dyspnea, but retained an episodic cough. After six months, the cat suffered a relapse of dyspnea. Radiographic examination revealed a large area of radiopacity in the region of the tracheal stent, suggesting an increase in size of the tumor, and possible metastasis in the lung parenchyma. The patient underwent repeat tracheoscopy, and almost complete obstruction of the tracheal lumen was found. The cat died during this procedure. Post-mortem examination was requested, which confirmed tracheal obstruction resulting from growth of the tumor, and pulmonary metastasis. Discussion: There are few reports of tracheal neoplasms in cats, because they are uncommon. The diagnosis was based on radiography, tracheoscopy and incisional biopsy. Treatment with surgery involves high morbidity and mortality. For this reason we chose the use of a tracheal stent, although palliative in cases of cancer. Stents are frequently used in humans with malignant tracheal obstruction, but the few reports in the veterinary literature, are focused on dogs presenting with tracheobronchomalacia. In cats, a few cases of tracheal stenosis and tumors have been treated experimentally with stents, which have shown success in reestablishing an airway. In previous reports, the technique has always been carried out with the aid of fluoroscopy. The application of the stent using tracheoscopy alone was efficient. The patient in this report suvived for one year since it diagnosed before near-total obstruction of the trachea occurred. Therefore this was a palliative measure, which allowed the patient a good quality of life while receiving adjuvant therapy when possible or necessary.

Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat / Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction.Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confi rmed the diagnosis of tracheal neoplasia, which was identifi ed as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in signifi cant morbidity and consequent mortality, the

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction.Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confi rmed the diagnosis of tracheal neoplasia, which was identifi ed as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in signifi cant morbidity and consequent mortality, the

Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat / Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction.Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confi rmed the diagnosis of tracheal neoplasia, which was identifi ed as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in signifi cant morbidity and consequent mortality, the

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction.Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confi rmed the diagnosis of tracheal neoplasia, which was identifi ed as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in signifi cant morbidity and consequent mortality, the