Tracheobronchopathia osteochondroplastica and difficult airway management in robot-assisted radical prostatectomy: two case reports

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by the proliferation and accumulation of diffuse cartilaginous and osseous nodules that protrude into the walls of the trachea and bronchus. Herein, we present two cases of 78- and 71-year-old patients with TO scheduled for robotic-assisted radical prostatectomy. In the first patient, airway access was successfully secured through the placement of a 6.5 mm endotracheal tube (ETT), and no ventilation issues were observed. In contrast, in the second patient, successful placement of a 6.5 mm ETT was achieved after five attempts over a 25-minute period, utilizing bronchofibroscopy; ultimately, the ETT cuff barely passed the vocal cords. Although the precarious placement of the tube posed a risk of dislodgement, ventilation remained adequate throughout the procedure, and the operation was completed without complications. These cases highlight the need for meticulous preoperative planning in patients with TO, not only during robot-assisted radical prostatectomy but also across a broader range of laparoscopic or robot-assisted abdominal procedures characterized by elevated airway pressures, steep Trendelenburg positioning, and pneumoperitoneum. Early implementation of bronchoscopic guidance and individualized airway management strategies are essential for ensuring safe and effective ventilation in this patient population.