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About Thoracic Surgery, Surgical procedures

Ultra-fast open tracheostomy

“Ultrafast open tracheotomy”

Currently tracheostomy procedures are performed one of two ways; using the traditional surgical (open) method and a percutaneous method.

Both methods have benefits and drawbacks.  In open tracheostomy, the primary drawback is the need to transport the patient in the operating room at most hospital facilities. Postoperative bleeding is less frequent in open method. However, postoperative wound infection and poor healing of the stoma in some cases may be troublesome.

As a bedside procedure, percutaneous tracheostomy is rapidly gaining in popularity due to the fast, and relative ease of the procedure.  However, it comes with its own set of risks and potential complications such as pneumothorax.  As a minimally invasive procedure, the risk of bleeding is minimized, but cases of severe hemorrhage have been reported.   The cause of this massive and severe bleeding in percutaneous method is partly due to the lack of delicate dissection of pre-tracheal soft tissues, which led the injury of isthmus of thyroid gland, esophagus, and major vessels in the neck.

In summary, percutaneous method provided a faster approach and less wound infection while having the possibility of severe bleeding complication. Open method takes more time to complete the procedure and risk of wound infection is slightly higher. But open dissection method can minimize unnecessary injury and bleeding.

Several studies comparing the two methods have demonstrated fairly equivalent outcomes.  However, ultra-fast open tracheostomy offers another option for patients who may need long-term mechanical ventilation.

The method designed by Dr. Chin-Hao Chen is called “ultra-fast open tracheostomy “.

The procedure usually takes around 4-6 minutes.  Dr. Chen reports that he has performed the procedure in over 250 cases (253 cases to date).  There have been no bleeding complications; (acute or delayed ). We did have a few minor wound infections.  We did have one patient, who had a more severe infection (but the patient’s underlying diagnosis was sepsis and organ failure.)

Dr. Chen states, “I invented the procedure about ten years too late.  Prior to that, it might have been very popular.  But now that the percutaneous puncture method has been developed, it is not so valuable.”

Dr. Chen previously presented, “A Modified Open Method for Sutureless Tracheostomy” at a conference in Taiwan last year.  At that time, he discussed his experiences and outcomes performing the procedure on 108 cases.  He reported his average operating time as 5.0 minutes.

Dr. Chen has also provided video clips to demonstrate his procedure, which is simple and fast.

References and Resources

Aaron’s tracheostomy page – site about tracheostomies and tracheostomy care by a nurse, Cynthia Bissell.  Good reference information for patients and their families.

Mayo Clinic site – all about surgical tracheostomies.  (“Minimally-invasive” aka percutaneous)

Cho YJ. (2012). Percutaneous dilatational tracheostomy.  Tuberc Respir Dis (Seoul). 2012 Mar;72(3):261-74. doi: 10.4046/trd.2012.72.3.261. Epub 2012 Mar 31

Durban, C. (2005). Types of tracheostomiesRespiratory Care, 50(4): 488 – 496.  Excellent article with historical review of techeostomy techniques.

Richter T, Gottschlich B, Sutarski S, Müller R, Ragaller M. (2011).   Late life-threatening hemorrhage after percutaneous tracheostomy.  Int J Otolaryngol. 2011;2011:890380. doi: 10.1155/2011/890380. Epub 2011 Apr 14.

Susanto, Irawan (2002) Comparing percutaneous tracheostomy with open surgical tracheostomy.  BMJ. 2002 January 5; 324(7328): 3–4.

Youssef TF, Ahmed MR, Saber A. (2011).  Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients.  N Am J Med Sci. 2011 Nov;3(11):508-12. doi: 10.4297/najms.2011.3508.

Long term complications of tracheostomy:

Epstein, S. (2005) Late term complications of tracheostomy.  Respiratory care, 2005, ;50(4):542–549.

This article was co-authored by Dr. Chin-Hao Chen and K. Eckland

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About K Eckland

World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. It includes case studies, [sometimes] dry research, interviews with thoracic surgeons along with patient perspectives, and feedback.

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