Laser resection of non-small cell carcinoma of the trachea and right main bronchus.

A 60-year-old male patient was diagnosed with non-small cell carcinoma. The tumor process had extended to the left main bronchus and the lower third of the trachea, resulting in a critical deterioration of the patient’s clinical condition, manifested by severe dyspnea, a sensation of suffocation, and insomnia.

A decision was made to perform, for vital indications, rigid bronchoscopy with endobronchial laser resection for recanalization of the tracheobronchial tree. Under general anesthesia, a Friedel rigid bronchoscope (tube No. 13) was introduced into the trachea. Both sides of the tracheobronchial tree were inspected.

The lumen of the right main bronchus was completely occluded by a tumor mass extending to the right lateral wall of the trachea. The carina was not visualized. Initially, the tumor surface was treated with low-power diode surgical laser (7–9 W) for devascularization. This was followed by removal using rigid alligator forceps. Stepwise laser resection of the tumor was then performed using higher power settings (14–16 W), with fragmentary extraction using rigid forceps.

After recanalization, a covered metallic stent was placed in the right main bronchus. A large amount of secretions from the right bronchial tree was evacuated. Bilateral endobronchial lavage was performed using up to 140 ml of cold normal saline. Locally, 5 ml of Tranexamic acid was administered.

Histomorphological examination of the biopsy material confirmed the diagnosis of non-small cell carcinoma. The patient’s condition significantly improved on the day of the procedure, and after one inpatient day, he was discharged in improved condition under oncologic follow-up.