gms | German Medical Science

Introduction: Tracheostomy is one of the oldest surgical procedures reported for over a millennium. The principles of the “surgical tracheostomy” were described at the beginning of the 20th century and these have remained to the present day without any significant technical change. Classically, "surgical tracheostomy” is performed with incisions ranging from 3 to 5cm, with wide exposure and traction of pre-tracheal muscles. In the era of minimally invasive surgery, we proposed a new approach to perform a tracheostomy.

Methods: Between May 2006 and September 2009 were performed 73 consecutive tracheostomies by the same Head and Neck surgeon. Fifty two patients were operated on an elective basis, while 21 were operated under urgency conditions. Local anesthesia was used in all cases of urgency and in 32 elective cases. The technique used consisted of incision size equal to the tube to be used (internal tube diameter between 7.0 and 8.0mm) and vertical dissection direct toward the trachea, without the classic dissection of pre-tracheal muscles. The trachea was opened without the need for tracheal ring resection or suture, also not used skin sutures.

Results: All cases were performed with the proposed incision. There were no cases of bleeding, infection, or tracheal stenosis. Two patients developed subcutaneous emphysema of the neck and superior chest, without any clinical compromise, regressing spontaneously.

Conclusions: The technique proved to be safe, with less tissue dissection than the classical technique. As minimally invasive thyroidectomy, a more complex procedure that can be done on 1.5cm incision, we believe that tracheostomy must be performed in a less invasive way.