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Cryosurgery of respiratory structures. I. Cryonecrosis of trachea and bronchus
Author(s) -
Neel H. Bryan,
Farrell Kenneth H.,
Desanto Lawrence W.,
Payne W. Spencer,
Sanderson David R.
Publication year - 1973
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1288/00005537-197307000-00007
Subject(s) - cryosurgery , medicine , anatomy , right main bronchus , bronchus , surgery , lung , respiratory disease
Although extirpative surgery is the mainstay of treatment of tumors of the trachea and bronchial tree, other methods for cure or palliation of neoplasms in these structures should be explored. The present study was designed to assess, in dogs, 1. the pathophysiologic effects of complete circumferential cryonecrosis of a segment of trachea, and 2. the feasibility of performing cryosurgery within the distal tracheobronchial tree through a bronchoscope. Eleven mongrel dogs weighing 16 to 20.5 kg were used. Each dog was anesthetized with intravenous pentobarbital. Under clean conditions, a segment of cervical trachea consisting of 10 rings (two through 12) was exposed and completely mobilized through a midline incision in eight dogs. A segment of trachea consisting of five to six tracheal rings was frozen by applying the probe tip to the anterior and lateral surfaces of the trachea and by suspending the posterior wall on the shaft of the cryoprobe tip. Each probe application lasted two minutes. This effected cryonecrosis of the entire circumference of a 15 to 18 mm segment of trachea. The probe was applied to the same site three times (repetitive freezing) and complete thawing was allowed between freezes. Copper constantan needle thermocouples embedded in 25‐gauge needles were inserted into the tracheal wall, and recordings of temperature changes within the target areas were made continuously with a penline recorder during freezing and thawing. A probe 0.6 cm in diameter and 55 cm long was developed for transbronchoscopic cryosurgery. In three dogs, several focal areas including the anterior and posterior trachea, carina, main stem, and segmental bronchi were frozen. Each site was frozen repetitively (three times for two minutes each). All 11 dogs survived the procedures and resumed normal activity within 12 hours of operation. Necrosis was localized, reproducible, and followed by prompt regeneration of mucosa. The gross architecture of the trachea and bronchus was not permanently altered, and there was no local or regional infection, except in one dog in which a tracheal stricture developed. This was attributed to persistent infection around a permanent suture placed at operation for the endoscopic identification of the target area. The study indicates that trachea and bronchi may be safely frozen by application of a cryoprobe either to the external surface or to the mucosal surface.