Role of Percutaneous Trans-Tracheal Endoscopic Approach in Managing Thoracic Tracheal Pathologies: A Step Back for Better Outcomes

Thoracic tracheal tumors are relatively rare in routine clinical practice. Though surgery is the preferred management choice, acute presentation is challenging for the surgeon and the anesthetist. In this study, we discuss the role of the percutaneous trans-tracheal endoscopic approach (PTTEA) in the modern era of minimally invasive surgery. Its indications, advantages, complications, and anesthetic options are enumerated. A retrospective review was performed of patients with thoracic tracheal lesions treated in our department between 2015 and 2022. A total of 16 patients underwent PTTEA in an emergency after a failed fiberoptic or transoral approach and were included in the review. Twelve patients were ventilated by intermittent apnea, and four had a Cardiopulmonary bypass. Amongst the 16 patients, nine had benign, and seven had malignant pathologies. All the benign lesions were excised completely, and patients were de-cannulated, except for one case with disseminated respiratory papillomatosis. Malignant lesions underwent debulking of the lesions for acute respiratory distress, followed by initiation of adjuvant therapy. PTTEA is an effective alternative to traditional fiberoptic or rigid bronchoscopy techniques for selected patients for whom minimally invasive techniques fail. The advantages of the approach include better surgical access, hemostasis, and airway control, resulting in reduced operative time and minimal complications.