G Friedrich1, G Mausser, E Nemeth. 1. Klinische Abteilung für Phoniatrie, Hals-Nasen-Ohren-Universitätsklinik, Auenbruggerplatz 26/28, 8036 Graz, Osterreich. gerhard.friedrich@uni-graz.at
Abstract
BACKGROUND AND OBJECTIVE: Tubeless jet-ventilation offers the surgeon an unimpaired surgical field and is therefore widely used in endolaryngeal surgery. In order to permit endotracheal surgery using the same devices and instruments as those used for the larynx, we have developed special jet-tracheoscopes. Here, we report on our experience with superimposed high-frequency jet-ventilation (SHFJV) together with total intravenous anaesthesia (TIVA) in endolaryngeal and especially endotracheal surgery. PATIENTS AND METHODS: The medical reports of 172 patients (91 females, 81 males) who had undergone endolaryngeal or endotracheal surgery in SHFJV were analysed retrospectively. RESULTS: Sufficient ventilation was possible in all cases and no vitally critical situation occurred. The main indication was laryngotracheal stenosis of different origins. No significant advantages could be observed in phonosurgery. There was no difficulty in exposing the endolarynx and subglottis with the currently available laryngoscopes (five sizes). The newly developed jet-tracheoscopes (two sizes) allowed a quick and safe extension of the operating field onto the tracheal bifurcation. CONCLUSIONS: SHFJV together with TIVA enlarges the diagnostic and therapeutic options in endoscopic surgery of the respiratory tract and is in many cases the precondition for endoscopic treatment without tracheotomy. In particular, the newly developed jet-tracheoscopes widen the spectrum of endoscopic surgery and allow the use of the micromanipulator guided CO2-laser in the trachea.
BACKGROUND AND OBJECTIVE: Tubeless jet-ventilation offers the surgeon an unimpaired surgical field and is therefore widely used in endolaryngeal surgery. In order to permit endotracheal surgery using the same devices and instruments as those used for the larynx, we have developed special jet-tracheoscopes. Here, we report on our experience with superimposed high-frequency jet-ventilation (SHFJV) together with total intravenous anaesthesia (TIVA) in endolaryngeal and especially endotracheal surgery. PATIENTS AND METHODS: The medical reports of 172 patients (91 females, 81 males) who had undergone endolaryngeal or endotracheal surgery in SHFJV were analysed retrospectively. RESULTS: Sufficient ventilation was possible in all cases and no vitally critical situation occurred. The main indication was laryngotracheal stenosis of different origins. No significant advantages could be observed in phonosurgery. There was no difficulty in exposing the endolarynx and subglottis with the currently available laryngoscopes (five sizes). The newly developed jet-tracheoscopes (two sizes) allowed a quick and safe extension of the operating field onto the tracheal bifurcation. CONCLUSIONS: SHFJV together with TIVA enlarges the diagnostic and therapeutic options in endoscopic surgery of the respiratory tract and is in many cases the precondition for endoscopic treatment without tracheotomy. In particular, the newly developed jet-tracheoscopes widen the spectrum of endoscopic surgery and allow the use of the micromanipulator guided CO2-laser in the trachea.