Laser-assisted endoscopic transoral surgery in apnoeic phase—management strategy for acquired supracarinal tracheal stenosis

Acquired supracarinal tracheal stenosis can be defined as postintubation tracheal stenosis of the lower third of the trachea that cannot be bypassed by standard or adjustable flange tracheostomy tubes. Owing to difficulty of access in the deep trachea, the transoral laser-assisted endoscopic surgical management of such stenoses is a challenge both for the surgeon and the anaesthetist alike. It requires good rapport and efficient cooperation between the teams to ensure appropriate oxygenation and carbon-dioxide washout while providing intermittent apnoeic phases to the surgeon for clear visualisation of the target area and use of Diode laser which is otherwise hazardous in an oxygen/nitrous oxide rich environment. From our tertiary care referral centre with strong work load for such pathologies, we report one such case of acquired tracheal stenosis successfully managed with transoral Diode laser-assisted surgery.