P014

I. Matus*a (Dr), V. Krishna Mattab (Dr)

a Thoracic Surgery and Interventional Pulmonology Service, Helen F. Graham Cancer Center and Research Institute, Christiana Care, Newark, De, UNITED STATES ; b Department of Medicine, Christiana Care, Newark, De, UNITED STATES

* imatusmd@gmail.com

Background: Silicone stent removal involves rigid bronchoscopy and use of rigid forceps. Inability to intubate the rigid bronchoscope represents a rare challenge for stent removal. To our knowledge, published techniques for silicone tubular stent removal via tracheostomy stoma do not exist.

Case Report:

Fifty two year old obese female with complex idiopathic subglottic stenosis, non-surgical candidate for tracheal resection and re-anastomosis, required a 14 x 40 mm hourglass silicone stent insertion after multiple prior endoscopic treatments.Twenty four hours later developed respiratory insufficiency, requiring emergent cricothyrotomy and distal stent dislodgement.

Elective open tracheostomy later performed but stent retrieval not feasible due to inability to advance any bronchoscope beyond the glottic anatomy. Multifactorial respiratory insufficiency ensued secondary to MRSA pneumonia and the tracheal stent's partial obstruction of the left mainstem bronchus takeoff. Subsequent formation of stent-induced main carinal granulation tissue complicated ventilatory support secondary to a very severe refractory cough. Stent removal was considered imperative to patient's recovery.

Three weeks later under general anesthesia, bronchoscopic intubation failed again due to persistent glottic and subglottic obstruction. As the tracheostomy's stoma was now mature, the decision to attempt stent removal via the stoma was made.

Herein we will describe and graphically illustrate our successful stepwise technique for creating loops along multiple longitudinal axes of the tracheal stent with the use of 2-0 silk sutures at different clock positions (ie. 3 and 9 o’clock). These suture loops will be used in conjunction with Kelly clamps to facilitate the safe removal of the tubular silicone stent via the tracheostomy's stoma.

Conclusion: A novel technique based on creating suture loops along multiple longitudinal axes in different clock positions of tubular stents, can safely facilitate stent removal via mature tracheostomy stomas in rare instances wherein rigid bronchoscopy is not feasible.

Disclosure of funding source(s): none