Tracheal resection and reconstruction

Tracheal resection and reconstruction is a challenging surgical procedure that most of the time is due to restore patients’ spontaneous breathing and phonation. Rarely this kind of surgery is performed to treat neoplastic disease. Patient selection based on radiologic study and bronchoscopic evaluation is pivotal in order to reduce the risk of postoperative adverse events as well as to obtain the most satisfactory functional outcome. A constant cooperation with the anesthetist is required for the entire duration of surgery with the aim of assuring the best ventilatory support to the patient. At the same time, the postoperative course should be managed with the support of dedicated intensivists, physiotherapists, phoniatrics and speech pathologists. The present paper is focused on describing the surgical steps of a standard tracheal resection and reconstruction with a tracheal anastomosis. Not infrequently this surgical procedure becomes more complex than expected and auxiliary maneuvers should be promptly considered and performed to preserve the integrity of the final reconstruction.