Additional Information
Book Details
Abstract
This issue of Thoracic Surgery Clinics is devoted to "Tracheal Surgery" and is edited by Drs. Frank Detterbeck and Erich Hecker. Articles in this outstanding issue include: Anatomy and Physiology; Pathology of Tracheal Tumors; Anesthesia for Tracheal Surgery; Endoscopic Techniques for Tracheal Diseases; Repair of Tracheobronchial Injuries; Tracheomalacia; Surgery of Benign Stenosis; Laryngo-tracheal Resection and Reconstruction; Treatment Approaches to Primary Tracheal Cancer; Carinal Resection and Sleeve Pneumonectomy; Extended Tracheal Resections; Airway Transplantation; Management of Postoperative Complications; and Treatment of Trachea-esophageal Fistula.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Tracheal Surgery | Cover | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | v | ||
| Thoracic Surgery Clinics\r | ix | ||
| Preface | xi | ||
| Trachea | 1 | ||
| Key points | 1 | ||
| Anatomic overview of the trachea | 1 | ||
| Morphogenesis of the trachea | 1 | ||
| Recent histologic findings | 2 | ||
| Tracheal stem cells | 2 | ||
| Physiologic overview of the trachea | 3 | ||
| Air transport in the trachea | 3 | ||
| Air conditioning | 3 | ||
| Removal of inspired debris and aspirated microorganisms | 4 | ||
| Acknowledgments | 4 | ||
| References | 5 | ||
| Pathology of Tracheal Tumors | 7 | ||
| Key points | 7 | ||
| Epidemiology | 7 | ||
| World Health Organization classification | 7 | ||
| TNM classification | 8 | ||
| Premalignant lesions | 8 | ||
| Squamous cell carcinoma | 9 | ||
| Malignant salivary gland–type tumors | 9 | ||
| Adenoid Cystic Carcinoma | 9 | ||
| Secondary Tumors | 9 | ||
| Prognosis | 10 | ||
| References | 10 | ||
| Anesthesia and Gas Exchange in Tracheal Surgery | 13 | ||
| Key points | 13 | ||
| Introduction | 13 | ||
| Techniques of gas exchange during TBS | 13 | ||
| Jet Ventilation | 13 | ||
| Definition | 13 | ||
| Respiratory physiology in HFJV | 14 | ||
| Parameters | 14 | ||
| Pressures | 14 | ||
| Volumes | 14 | ||
| Concerns with jet ventilation | 14 | ||
| Barotrauma | 14 | ||
| Hypothermia and exsiccation | 14 | ||
| Apneic Oxygenation | 15 | ||
| Definition | 15 | ||
| Physiologic considerations | 15 | ||
| Oxygen | 15 | ||
| Carbon dioxide and respiratory acidosis | 15 | ||
| Hypercapnia and effects on circulation | 15 | ||
| Clinical aspects of AO | 15 | ||
| Airway Surgery in the Awake Patient | 15 | ||
| General aspects of CEA | 15 | ||
| Physiologic effects of CEA | 16 | ||
| Experience in CEA for extrathoracic tracheal surgery | 16 | ||
| Extracorporeal Gas Exchange in TBS | 16 | ||
| Cardiopulmonary bypass | 16 | ||
| Extracorporeal membrane oxygenation | 16 | ||
| Pumpless interventional lung assist | 16 | ||
| Clinical procedures in anesthesia for TBS | 16 | ||
| General Aspects of Anesthesia and Gas Exchange in Tracheobronchial Surgery | 16 | ||
| Diagnostics | 16 | ||
| Conduct of anesthesia | 17 | ||
| Total intravenous anesthesia | 17 | ||
| Inhalational anesthetics | 17 | ||
| Anesthetic induction in critical airway stenosis | 17 | ||
| Pain therapy | 17 | ||
| Monitoring and equipment | 17 | ||
| FOB | 18 | ||
| Airway management provisions | 18 | ||
| Anesthesia and Ventilation in Extrathoracic Tracheal Resection | 18 | ||
| General considerations | 18 | ||
| Indications | 18 | ||
| HFJV | 18 | ||
| HFJV and alternatives | 18 | ||
| HFJV: technical considerations | 18 | ||
| LMA | 18 | ||
| ETT | 19 | ||
| Tracheostomy cannula | 19 | ||
| Sequence of ventilation techniques | 19 | ||
| HFJV: settings and handling | 19 | ||
| Limitations of HFJV in tracheal surgery | 20 | ||
| CFI-V | 20 | ||
| Termination of surgery and emergence from anesthesia | 20 | ||
| Emergence phase | 20 | ||
| Acute postoperative respiratory compromise | 20 | ||
| Postoperative care | 20 | ||
| Anesthesia and Ventilation for Sleeve Pneumonectomy and Carinal Resection | 20 | ||
| Surgical essentials | 20 | ||
| General aspects of anesthesia, pain therapy, and monitoring | 21 | ||
| Management of airways and gas exchange | 21 | ||
| Ventilation techniques | 21 | ||
| Dissection phase | 21 | ||
| Sleeve pneumonectomy and anastomosis | 21 | ||
| Complications of special importance to the anesthetist | 22 | ||
| Anesthesia and Ventilation for Tracheobronchomalacia | 23 | ||
| General aspects | 23 | ||
| Conduct of anesthesia | 23 | ||
| Management of airways and gas exchange | 23 | ||
| Emergence and postoperative phase | 23 | ||
| Summary | 23 | ||
| References | 23 | ||
| Endoscopic Treatment of Tracheal Stenosis | 27 | ||
| Key points | 27 | ||
| Malignant stenoses | 27 | ||
| Obstructing malignant tumors | 28 | ||
| Nonobstructing intraluminal tumors | 30 | ||
| Extrinsic tumor compression and wall destruction | 31 | ||
| Benign tracheal tumors | 31 | ||
| Benign tracheal strictures | 31 | ||
| Web stenoses | 33 | ||
| Strictures | 33 | ||
| Dilatation | 34 | ||
| Stents in benign strictures | 35 | ||
| References | 39 | ||
| Repair of Tracheobronchial Injuries | 41 | ||
| Key points | 41 | ||
| Introduction | 41 | ||
| Noniatrogenic TBI | 41 | ||
| Statistics | 41 | ||
| Mechanisms of Noniatrogenic Tracheobronchial Injury and Pathology | 42 | ||
| Diagnostics | 42 | ||
| Management | 43 | ||
| Operative Repair | 43 | ||
| Penetrating Injuries | 44 | ||
| Operative Access | 45 | ||
| Discussion | 45 | ||
| Iatrogenic TML | 46 | ||
| Introduction | 46 | ||
| Classification | 46 | ||
| Symptoms | 46 | ||
| Diagnostics | 46 | ||
| Treatment | 46 | ||
| Conservative treatment | 46 | ||
| Operative treatment | 47 | ||
| Treatment Decision | 47 | ||
| Discussion | 47 | ||
| Summary | 49 | ||
| Supplementary data | 49 | ||
| References | 49 | ||
| Tracheomalacia | 51 | ||
| Key points | 51 | ||
| Tracheomalacia in general | 51 | ||
| Classification of tracheomalacia | 51 | ||
| Diagnosis of airway malacia | 52 | ||
| Therapy | 54 | ||
| Endoscopic Treatment | 54 | ||
| Surgical Treatment | 54 | ||
| Surgical treatment in adults | 55 | ||
| Extrinsic Compression | 55 | ||
| After Tracheal Stoma or Intubation | 55 | ||
| In COPD | 56 | ||
| Surgical treatment in children | 57 | ||
| References | 57 | ||
| Benign Stenosis of the Trachea | 59 | ||
| Key points | 59 | ||
| History | 59 | ||
| Causes and pathomechanisms of benign stenosis | 59 | ||
| Stenosis After Tracheotomy | 59 | ||
| Cuff-Induced Stenosis | 60 | ||
| Idiopathic Inflammation and Stenosis | 61 | ||
| Symptoms and diagnostics | 61 | ||
| Clinical Signs | 61 | ||
| Lung Function Testing | 61 | ||
| Bronchoscopy | 61 | ||
| Computed Tomography Scan with Reconstruction | 61 | ||
| Indication for treatment | 62 | ||
| Treatment | 62 | ||
| Access for Tracheal Surgery | 62 | ||
| Trachea Resection with Anastomosis | 62 | ||
| Extension into the larynx | 63 | ||
| Postoperative care | 63 | ||
| Results | 64 | ||
| References | 64 | ||
| Laryngotracheal Resection and Reconstruction | 67 | ||
| Key points | 67 | ||
| Introduction | 67 | ||
| Presentation and diagnosis | 67 | ||
| Anesthesia for tracheal resection | 67 | ||
| Surgical technique | 68 | ||
| Incision and Exposure | 68 | ||
| Tracheal Resection | 68 | ||
| Cricotracheal Resection | 69 | ||
| Anastomotic technique | 69 | ||
| Postoperative care | 70 | ||
| Management of complications | 71 | ||
| Summary | 71 | ||
| References | 71 | ||
| Treatment Approaches to Primary Tracheal Cancer | 73 | ||
| Key points | 73 | ||
| Introduction | 73 | ||
| Surgery | 73 | ||
| RT | 74 | ||
| Combined Modality Approaches | 75 | ||
| Specific Approach for Locally Advanced Cystic Adenocarcinoma | 75 | ||
| Systemic Palliative Chemotherapy | 76 | ||
| Summary | 76 | ||
| References | 76 | ||
| Carinal Resection and Sleeve Pneumonectomy | 77 | ||
| Key points | 77 | ||
| Introduction | 77 | ||
| History | 77 | ||
| Patient selection | 78 | ||
| Indications and Contraindications | 78 | ||
| Anesthesia | 78 | ||
| Surgical technique | 79 | ||
| Right Sleeve Pneumonectomy | 79 | ||
| Left Sleeve Pneumonectomy | 80 | ||
| Carina Resection Without Pulmonary Resection | 80 | ||
| Special technical considerations in extensive resections | 80 | ||
| Postoperative care | 80 | ||
| Morbidity, mortality, and survival | 81 | ||
| References | 82 | ||
| Airway Transplantation | 97 | ||
| Key points | 97 | ||
| Types of transplantations | 97 | ||
| Tracheal allotransplantation | 98 | ||
| Fresh Cadaveric Trachea | 98 | ||
| In Situ Processed Fresh Cadaveric Trachea | 99 | ||
| Cryopreserved, Irradiated, or Chemically Preserved Trachea | 99 | ||
| Fresh or Cryopreserved Cadaveric Aorta | 99 | ||
| TE | 99 | ||
| The Scaffold | 100 | ||
| The biologic scaffold | 100 | ||
| The artificial scaffold | 100 | ||
| Why artificial? | 100 | ||
| Composite scaffolds | 101 | ||
| Scaffold-free | 101 | ||
| Cells | 101 | ||
| Stem cells | 101 | ||
| Pluripotent stem cells | 101 | ||
| Multipotent stem cells | 101 | ||
| Terminally differentiated cells | 102 | ||
| Autologous versus allogenic cells | 102 | ||
| Bioreactor | 102 | ||
| Pharmaceutical Intervention | 103 | ||
| Summary | 104 | ||
| References | 105 | ||
| Management of Tracheal Surgery Complications | 107 | ||
| Key points | 107 | ||
| Introduction | 107 | ||
| Prevalence of postoperative complications in tracheal surgery | 107 | ||
| Prevention of complications in tracheal surgery | 108 | ||
| Exact Planning of Operative Procedure | 108 | ||
| Knowledge of Patient’s History | 109 | ||
| Knowledge of Radiological Findings | 109 | ||
| Bronchoscopy by the Surgeon | 109 | ||
| Treatment of Mucosal Inflammation or Tracheobronchial Infection | 110 | ||
| Intraoperative Measures for Prevention of Complications | 110 | ||
| Postoperative Care | 110 | ||
| Complication management during the tracheal resection | 110 | ||
| Problems with Ventilation | 110 | ||
| Tension of Anastomosis | 111 | ||
| Bleeding | 111 | ||
| Resection of Wrong Trachea Level | 111 | ||
| Level of Stenosis is Higher than Expected | 111 | ||
| Management of postoperative complications | 111 | ||
| Bleeding Caused by Tracheo-innominate Artery Fistula | 111 | ||
| Operative Management | 112 | ||
| Granuloma Formation at the Anastomotic Site | 114 | ||
| Dehiscence of the Anastomosis | 114 | ||
| Restenosis | 115 | ||
| Conclusion | 115 | ||
| References | 115 | ||
| Treatment of Malignant Tracheoesophageal Fistula | 117 | ||
| Key points | 117 | ||
| Introduction | 117 | ||
| Epidemiology of mTEF | 117 | ||
| Symptoms and diagnosis | 118 | ||
| Treatment | 118 | ||
| Esophageal Stenting | 119 | ||
| Tracheobronchoscopic Stenting | 121 | ||
| Anesthesiologic peri-interventional management | 121 | ||
| Choosing the correct tracheal stent | 122 | ||
| Stenting technique | 123 | ||
| The “Unstentable” Fistula | 123 | ||
| Typical Problems After Double Stenting of Trachea and Esophagus | 125 | ||
| Postinterventional management and home care | 125 | ||
| Results of TEF stenting | 125 | ||
| Complications and Mortality | 125 | ||
| Survival After TEF Stenting | 126 | ||
| References | 126 | ||
| Index | 129 |