Redo Transsternal Tracheal Resection and Reconstruction: The Use of Uncommon Release Maneuvers

The patient is a seventy-one-year-old male with a history of Hurthle cell carcinoma who initially underwent thyroidectomy and central neck dissection, follow by radioactive iodine. He developed recurrence after 10 years with tracheal invasion, which was treated by tracheal resection via partial sternotomy and mediastinal lymph node dissection. Four years later, he developed a right paratracheal mass positive for Hurthle cell carcinoma with extension into the trachea resulting in obstruction.

In this video, the authors demonstrate their approach to redo transsternal tracheal resection and reconstruction with the use of several release maneuvers. These include suprahyoid release, intrapericardial mobilization of the visceral mass, and pericardiophrenic release. The paratracheal mass, along with a 4 cm segment of trachea, was resected. The margins were negative for involvement by the tumor and the anastomosis did not show any evidence of tension. The patient did well postoperatively and had no evidence of tracheal narrowing on the follow-up CT scan.

The authors concluded that redo transsternal tracheal resection and reconstruction may be performed safely. It is important to utilize release maneuvers such as suprahyoid release, intrapericardial mobilization, and pericardiophrenic release in order to facilitate a tension free anastomosis.

References

1. Macchiarini P, Altmayer M, Go T, Walles T, Schulze K, Wildfang I, Haverich A, Hardin M; Hannover Interdisciplinary Intrathoracic Tumor Task Force Group. Technical innovations of carinal resection for nonsmall-cell lung cancer. Ann Thorac Surg. 2006 Dec;82(6):1989-97; discussion 1997. doi: 10.1016/j.athoracsur.2006.07.016. PMID: 17126096.

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