Stair-step tracheal repair: Surgical technique

Area of Science:

• Otolaryngology
• Surgical Oncology
• Thoracic Surgery

Background:

• Invasive thyroid carcinoma surgery near the cricoid cartilage risks recurrent laryngeal nerve (RLN) damage and reduces cartilaginous support.
• Standard surgical approaches necessitate extensive resection, potentially compromising airway integrity and vocal function.

Observation:

• A novel stair-step tracheal reconstructive technique was employed in a 72-year-old patient with recurrent invasive thyroid carcinoma.
• The procedure involved left hemitracheal and hemicricoid resection with contralateral tracheal resection (rings 3 and 4) for a sliding tracheoplasty.

Findings:

• This stair-step method facilitated airway reconstruction by closing the defect without dissecting the functioning recurrent laryngeal nerve (RLN) on the right side.
• The trachea was superiorly advanced and reanastomosed to the cricoid margin, successfully establishing a patent airway.

Implications:

• The stair-step approach minimizes the risk of contralateral recurrent laryngeal nerve (RLN) injury during cricotracheal resection.
• This technique offers a viable alternative for airway reconstruction in complex thyroid cancer cases, preserving vocal function and airway patency.