eComment: Tracheal surgery.

Dr. R. Santosham (Chennai, India): Two short questions. One is in patients who were laserized, did you find more technical difficulty, because our observation has been once laser is used, the tracheal wall gets very much thickened and the area of resection becomes much longer. The other thing is in your tracheoesophageal fistula cases that you showed, our main anxiety is leak from the esophagus. Did you use any other covering material while closing the esophagus, and what is your incidence of immediate vocal cord dysfunction after your cases? Dr. Cordos: For the first question, we perform resection in the first few hours after laser therapy, and there is no problem to do the surgery because the fibrosis is not initiated in a few hours, probably after two or three days. As you saw in the picture, we perform immediately after this, because the bronchoscopist shows us the remaining tissue, and probably it cannot heal without surgery. And the second one, tracheoesophageal fistula, we have only six cases. We put the sub-thyroid muscle between the trachea and the esophagus, and we have no problem with the laryngeal nerves in our series. Dr. Patterson: And there was a question about vocal cord dysfunction also. Dr. Cordos: No vocal cord dysfunction in our series. Dr. H-B. Ris (Lausanne, Switzerland): I have a question regarding the intrathoracic tracheal portion above the carina. I found this is a very difficult region to do circumferential resection of a certain length because you have virtually no possibility to mobilize this tracheal segment. What is your opinion? Do you have tricks? What is the length of resection you can do in the intrathoracic portion of the trachea above the carina? And the second question, you had four cases of squamous cell carcinoma. Where were they localized and were they all resected and healthy tissues? Dr. Cordos: For the first one, to perform a lower tracheal resection, as you know from the literature, we use the dissection of the pulmonary hilum, and this permits to release the anastomosis. Our length of segment of trachea resected was 2.5 cm in this area. Dr. Ris: I specifically asked for resections of the supracarinal part of the intrathoracic trachea where we found that release maneuvers do not allow for a satisfactory mobilization of the tracheal segments in order to perform a tension-free anastomosis. Dr. Cordos: No, no, above the carina. The …