The following is a summary of “Modified Blade: An Interventional Option in rigid bronchoscopy for non-resectable benign tracheal stenosis,” published in the February 2024 issue of Surgery by Messina et al.

Benign tracheobronchial stenosis presents a critical challenge characterized by abnormal narrowing of the tracheal lumen, often leading to progressive dyspnea and severe hypoxemia. The optimal treatment approach, whether endoscopic or surgical, remains uncertain. This study aims to evaluate the efficacy of bronchoscopic dilatation using a specialized device equipped with a blade for cutting dense fibrotic lesions in benign tracheal stenosis.

The procedures were conducted in a controlled operating room environment under general anesthesia. Patients were intubated with a Rigid Bronchoscope (RB) positioned just above the stenosis. Utilizing the RB, radial incisions were made in the mucosal stenosis at 4, 8, and 12 o’clock positions using a blade, followed by gentle back-and-forth movements. 

Subsequently, the stenotic area was further dilated with the RB and balloon dilatation. The study involved an observational, retrospective analysis conducted at the Thoracic Surgery Unit of the University of ‘Luigi Vanvitelli’ of Naples from November 2011 to September 2021. A total of 113 consecutive patients with inoperable benign tracheal stenosis were included, with 61 patients treated using the blade technique. During follow-up, the recurrence of stenosis was monitored, with 8 cases observed within the first month and 4 cases in the third month post-treatment. Among patients treated with laser (52 patients), recurrence was noted in 16 patients within the first month and 6 patients in the third month, with no relapses reported after 6 months or 1 year. Long-term successful management with the blade technique achieved a success rate of 99% in simple and 93% in mixed and complex stenosis types.

The findings underscore the efficacy of the blade technique in bronchoscopic treatment as a conservative management option for patients with inoperable benign tracheal stenosis. This approach, offering an alternative to laser therapy, demonstrates promising outcomes by mitigating abnormal inflammatory reactions and reducing the risk of stenosis recurrence.

Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-02576-3