Transoral trans-stomal microdebrider excision of tracheal papillomatosis.

OBJECTIVES To describe a technique for surgical removal of recurrent respiratory papilloma in the distal trachea in patients with an indwelling tracheostomy tube. METHODS A transoral trans-stomal technique for removal of distal tracheal papilloma using a modified ventilating bronchoscope setup and a microdebrider with a rotatable Skimmer blade (XOMED Products, Jacksonville, Florida, USA). RESULTS Surgical removal of papillomas in the distal trachea is a challenging procedure, involving potentially competing demands for visualization, instrumentation, and ventilation. Previously described methods for management of these challenging cases provide limited ability to deliver continuous oxygenation and ventilation during the procedure. The transoral trans-stomal technique overcomes these limitations in patients who have an existing tracheostomy. CONCLUSIONS This technique allows for precise removal of papilloma in the distal trachea, while providing for excellent visualization and continuous oxygenation and ventilation of the patient.