Congenital tracheal stenosis - Patient-tailored simulation
Dra. Karina Patané
Hospital de Rehabilitación Respiratoria María Ferrer - Buenos Aires, Argentina
✔ Practice and optimisation of the surgical plan
✔ Improved interaction between the surgical team
✔ Improved safety at the time of surgery
✔ Improved post-operative care and patient quality of life
A 37-year-old woman consulted for dyspnoea and stridor at night.
CT scan showed that the diameter of the trachea was very narrow along its entire length. Transverse and anteroposterior measurements on the medical images indicate a diameter of just over 5 mm, which was corroborated by endoscopy. From these studies, a diagnosis of congenital tracheal stenosis is concluded.
It is extremely rare for a patient to reach adulthood with this diagnosis untreated as it usually manifests in childhood. For this reason, the surgeons in charge of the case did not have a great deal of experience in the area. They requested a 3D model to reproduce the anatomical features of the airway to train the surgical practice and thus obtain better results.
3D anatomical model
The biomodel obtained was made of a flexible siliconised polymer, with high tenacity and flexibility, from 3D printed moulds designed with the computed tomography images.
Surgical plan and results in operating room
Surgical treatment consisted of a sliding tracheoplasty in which tracheal length is sacrificed to increase the diameter of the trachea. For this, the trachea is incised transversely down the middle, followed by an anterior incision over the upper segment and a posterior incision over the lower segment. Finally, the lower segment is slid over the upper segment and the anastomosis is performed.
"We performed several tests reproducing the surgery, which proved to be very enlightening," said Dr. Karina Patané.
In the first test, you can see that they make the incisions followed by the posterior suture with the placement of the angular stitches in the same place. Then, the suture of the anterior wall with separate stitches and the control endoscopy. The lower posterior suture should be very close to the carina. In this first test, the model was left with an "arthrosed" suture, probably because a continuous suture was made and affected by the material used.
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From the tests performed, they noted two important things to keep in mind for the actual surgery:
Advisable to perform the angular stitches before starting the posterior suture.
Replace the continuous suture with separate stitches, as the important thing in these cases is that the edges of the cartilage are correctly faced with the cartilage.