A New Silicone Elastomer Tube for Use during Microsurgery on the Larynx

A new special endotracheal tube for ventilating patients during microlaryngeal surgery is described. It is 6.25 cm long, made of silicone elastomer and has a “soft” cuff built onto it. It is placed below the patient's cords and the cuff blown up while the patient is paralyzed, and under anesthesia. The patient's lungs can be ventilated by jetting oxygen from the jet tube which is built into it. While the oxygen is not flowing the patient can passively exhale through the tube and cords. Obstruction to the surgical field is minimal and consists of the cuff inflating tube .08 cm in diameter and the jet tube .25 cm in diameter which will be in the posterior commissure out of the way. The tube is designed in such a way that both during inflation and exhalation gas is blown out through the cords to help to blow blood and debris away from the operating field.

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Modern devices for treatment of the surgeon’s hands and the surgical field (literature review)

Disinfection affairs ◽

10.35411/2076-457x-2020-4-41-50 ◽

2020 ◽

pp. 41-50

Author(s):

Artem Mikhailovich Morozov ◽

◽

Alexey Nikolaevich Sergeev ◽

Gennady Alexandrovich Dubatolov ◽

Nikolay Alexandrovich Sergeev ◽

...

Keyword(s):

Cost Effective ◽

Surgical Infection ◽

Operating Field ◽

Functional Additives ◽

Literary Sources ◽

Film Forming ◽

Key Points ◽

Surgical Field ◽

Ammonium Compounds ◽

Active Substances

The aim – analyze modern Russian and foreign literary sources in order to determine modern means for treating the hands of the surgeon and the operating field. Results. One of the key points in the prevention of surgical infection is the treatment of the surgeon’s hands and the operating field with effective skin antiseptics in order to destroy pathogenic and opportunistic microorganisms that colonize intact skin. In modern practice, skin antiseptics are predominantly used containing alcohols as active substances, in particular ethyl, propyl and isopropyl, halogenated substances such as iodine and iodophores, guanidines, which include chlorhexidine digluconate, as well as quaternary ammonium compounds. Moreover, the most widespread are combined preparations containing several active substances and functional additives, which makes it possible to neutralize the negative properties of various active substances. Also, an interesting and promising direction is the use of polymer operating films or film-forming antiseptics. Currently, research is being actively carried out aimed at finding and developing modern highly effective antiseptic agents and their rational combinations that meet the necessary requirements, are optimal in their properties, cost-effective and comfortable to use.

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A Complication of Use of a Microlaryngeal Surgery Endotracheal Tube

Anesthesiology ◽

10.1097/00000542-198010000-00026 ◽

1980 ◽

Vol 53 (4) ◽

pp. 355-355 ◽

Cited By ~ 3

Author(s):

Luis E. Torres G ◽

Robert C. Reynolds

Keyword(s):

Endotracheal Tube ◽

Microlaryngeal Surgery

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Setup and initial testing of an endoscope manipulator system for assistance in transoral endoscopic surgery

Biomedical Engineering / Biomedizinische Technik ◽

10.1515/bmt-2017-0109 ◽

2019 ◽

Vol 64 (3) ◽

pp. 347-356

Author(s):

Axel Boese ◽

Philipp Hündorf ◽

Christoph Arens ◽

Daniel T. Friedrich ◽

Michael Friebe

Keyword(s):

General Concept ◽

Single Type ◽

Transoral Surgery ◽

Prototype System ◽

Clinical Workflow ◽

Posterior Commissure ◽

Vocal Cords ◽

Quick Release ◽

Special Cases ◽

Microlaryngeal Surgery

Abstract Purpose For the treatment of malignant diseases of the oral cavity and the larynx, a total or partial resection is the standard therapy, while in special cases chemo- and/or external radiation therapy is considered. Transoral access reduces trauma and hospitalization time. Transoral surgery is usually executed using external microscopic imaging. Therefore, the microscope is placed in the visual line of the opening of the mouth and throat. However, specific anatomical structures like the posterior commissure (dorsal end of the vocal cords) are not visible in these procedures. An endoscopic approach can improve this problem. We introduce a new prototype system for endoscopic assisted transoral surgery. Methods Based on clinical observation and discussions with professional users and surgeons, the clinical need was identified and specified. A general concept or an endoscopic manipulator to assist microlaryngeal surgery was designed. For that a steerable rigid endoscope was combined with an actuator that allows translational and rotational movement. A quick release fastener was designed allowing for fast change of the endoscope and independence from its shape and type. The actuator was fixed on a commercially available, semi-active medical holding arm for easy positioning. The holder can be fixed to the standard rails of the surgical table. The piezoelectric drives integrated in the actuator are activated with a foot pedal. This allows easy and fast fine positioning, while the hands are free to perform the surgery with standard instruments for microlaryngeal surgery. Results A prototype of the system for endoscopic assisted transoral surgery was developed. The entire technical setup was tested in terms of usability and performance in a simulated surgical scenario. A basic phantom, representing the throat and vocal cords was created and placed on a surgical table. The system was installed on the table and the clinical workflow of a simulated endoscopic assisted surgery on the vocal cords was performed. The performance of the setup and the procedure success was evaluated by clinical users. Conclusion Fixture of the system on the surgical table is fast and easy due to its low weight and compact design. The medical holder allows a fast initial positioning of the system in front of the phantom patient. An easy insertion and removal of the endoscope was realized using the quick release fastener. The developed endoscope fixation is universally adaptable and not limited to a single type of endoscope. The piezoelectric drives, combined with the foot pedal, allow a precise placement and readjustment of the endoscope during surgery. The use of a multi view endoscope enables a variable view on the surgical situs. The size and shape of the whole setup offer excellent access to the targeted structures. The development was classified beneficial by the clinical users.

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Experiences with a New Endotracheal Tube for Microlaryngeal Surgery

Anesthesiology ◽

10.1097/00000542-198004000-00016 ◽

1980 ◽

Vol 52 (4) ◽

pp. 357-359 ◽

Cited By ~ 2

Author(s):

LUIS E. TORRES ◽

ROBERT C. REYNOLDS

Keyword(s):

Endotracheal Tube ◽

Microlaryngeal Surgery

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Injuries to the Neonatal Larynx from Long-Term Endotracheal Tube Intubation and Suggested Tube Modification for Prevention

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947508400606 ◽

1975 ◽

Vol 84 (6) ◽

pp. 764-770 ◽

Cited By ~ 19

Author(s):

Arthur S. Hengerer ◽

Marshall Strome ◽

Burton F. Jaffe

Keyword(s):

Endotracheal Tube ◽

Positive Pressure Ventilation ◽

Positive Pressure ◽

Long Term Effects ◽

Posterior Commissure ◽

Long Term Follow Up ◽

Initial Injury ◽

Cartilage Erosion

Since the early 1960's nasotracheal tubes have been used for neonates with primary respiratory diseases which necessitated positive pressure ventilation. This therapy may be required for extended periods of weeks to months meaning prolonged trauma to the neonatal larynx. The initial injury and long-term effects of the endotracheal tube in this age group have not been adequately investigated. The acute findings can be arytenoid and posterior commissure ulcerations and, in some cases, cartilage erosion. Long-term follow-up in these children to age 3.5 years showed a persistent arytenoid defect with chronic hoarseness. The consideration of a change in the structure of the endotracheal tube is suggested as a possible means of avoiding these injuries.

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Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

Journal of International Medical Research ◽

10.1177/0300060519845782 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2740-2745

Author(s):

Seung Youp Baek ◽

Jin Hwan Kim ◽

Goo Kim ◽

Jin Ho Choi ◽

Chang Young Jeong ◽

...

Keyword(s):

Endotracheal Tube ◽

Main Bronchus ◽

Left Lung ◽

Lung Ventilation ◽

Surgical Excision ◽

One Lung Ventilation ◽

Lower Lung ◽

Endobronchial Blocker ◽

Surgical Field ◽

The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

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Endotracheal tube complication during extubation following surgical repair of a traumatic tracheal laceration

Veterinary Record Case Reports ◽

10.1136/vetreccr-2020-001087 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001087

Author(s):

Lucy Miller ◽

Sam Pryke ◽

Ambra Panti ◽

Miguel Gozalo Marcilla

Keyword(s):

Airway Management ◽

Endotracheal Tube ◽

General Anaesthesia ◽

Surgical Repair ◽

Maxillofacial Surgery ◽

Tracheal Extubation ◽

Special Consideration ◽

Tracheal Surgery ◽

Surgical Field ◽

Tracheal Laceration

Difficult or impossible tracheal extubation has previously been reported in the veterinary literature as a result of endotracheal tube (ETT) faults or due to their entanglement with oesophagostomy tubes. Inadvertent transfixation of the ETT to the trachea during oral–maxillofacial surgery is a reported cause of extubation complications in the human literature. In this case, an incident of accidental ETT cuff transfixation to the trachea of a dog undergoing surgical repair of a traumatic tracheal laceration is reported. General anaesthesia for tracheal surgery requires special consideration of airway management to reduce complications. While precautions can be taken to avoid ETT placement within the surgical field, this cannot always be avoided and measures should be implemented for detection of transfixation. If tracheal extubation complications do arise, it is important to consider the differential causes and act quickly to resolve the problem and ensure minimal distress to the animal.

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Modified Endotracheal Tube for Prevention of Posterior Commissure Stenosis in Long-Term Endotracheal Intubation: A Preliminary Canine Study

Otolaryngology ◽

10.1177/019459988709700616 ◽

1987 ◽

Vol 97 (6) ◽

pp. 594-599

Author(s):

Isaac Eliachar ◽

Jay Roberts ◽

Eric Olsen ◽

Hector Munoz-Ramirez ◽

Bruce Sebek ◽

...

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Posterior Commissure ◽

Canine Study

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Solitary vallecular neurofibroma presenting with respiratory obstruction: an unusual presentation

BMJ Case Reports ◽

10.1136/bcr-2018-225330 ◽

2018 ◽

pp. bcr-2018-225330

Author(s):

Pradeep Pradhan ◽

Manaswini Mallick ◽

Swagatika Samal ◽

Susama Patra

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Surgical Procedure ◽

Unmet Need ◽

Unusual Presentation ◽

Respiratory Obstruction ◽

Cold Knife ◽

Surgical Field ◽

Microlaryngeal Surgery

An occurrence of vallecular neurofibroma with airway obstruction is extremely rare and to the best of our knowledge, no case report has been documented in the literature to date. Although microlaryngeal surgery with cold knife excision is the standard surgical procedure offered to patients of vallecular lesions, it can be successfully managed with the help of endoscopic coblation as later can provide a bloodless surgical field preventing the unmet need for the tracheostomy and reducing the postoperative morbidities.

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