PURPOSE: Obstructive lesions of the tracheobronchial tree can cause acute or chronic respiratory distress manifesting as cough, dyspnea or other pulmonary symptoms. Treatment has focused previously on surgical resection although laser resection has been employed with good or very good results. A case report using electrocautery for endobronchial fibroma was first described by our institution, as was the combined use of electrosurgery and laser for hamartomas. We now describe the simultaneous diagnosis and resection of various large tracheobronchial benign lesions using primarily electrocautery snare performed during rigid and flexible bronchoscopy.
METHODS: This series of cases includes patients over the past six months presenting to our institution with obstruction of either the trachea or the bronchial tree. Preoperative radiology demonstrated endobronchial tumor without extraluminal extent. All patients were brought to the operating room with informed consent and standard OR protocols applied. The patients were first examined with a flexible fiberoptic scope demonstrating at least some separation of the lesion from the tracheobronchial membrane. Rigid intubation was performed and the flexible bronchoscope was passed through the rigid scope. Electrocautery snare was used to wrap around the lesion to a visualized or non-visualized stalk. Lesions were removed entirely or in segments without complications. The mucosa from which the stalk arose was treated with laser or cautery following resection.
RESULTS: The pathology of these lesions demonstrated hamartomas (4), benign fibrous tumor (angiofibroma or schwannoma), and spindle cell lipoma. No patients experienced significant bleeding or other complications during electrosurgical resection and all were treated as outpatients.
CONCLUSION: The traditional treatment of large airway lesions has been surgical resection. With the advance of interventional pulmonary procedures, endoscopic modalities provide a relatively simple, effective, non-surgical approach for benign obstructive central lesions.
CLINICAL IMPLICATIONS: We propose that electrocautery snare, possibly augmented by Nd-YAG laser therapy, should be the primary treatment for benign occluding tracheobronchial tumors.
DISCLOSURE: Jonathan Puchalski, No Financial Disclosure Information; No Product/Research Disclosure Information