Sergio Cavaliere

Seven-year Experience with the Dumon Prosthesis

SummaryThe Dumon stent (or Endoxane), designed in 1987, is a flexible, multisized, studded, silicone prosthesis. This report describes the combined results of Dumon stent placement in Marseille, France (J.F.D.), Brescia, Italy (S.C.), Saint-Etienne, France (J.M.V.), and Barcelona, Spain (P.O.). The

Nd: YAG Laser Therapy in Lung Cancer

ABSTRACTBetween April 1982 and March 1993, 1,585 patients with significant symptoms of malignant airway obstruction were treated with 2,253 tracheobronchial neodymium (Nd):YAG laser resections performed by the first author only: 1,274 (78%) patients had non-small cell lung cancers, 91 (6%) small cel

Operative rigid bronchoscopy: indications, basic techniques and results

Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.

Transanastomotic endobronchial migration of a pericardial flap.

A 36-year-old woman underwent left main bronchus sleeve resection for a typical carcinoid. The bronchial anastomosis was reinforced with a bovine pericardial flap fixed by fibrin glue. Six months after the surgery the patient presented with acute dyspnea. Flexible bronchoscopy disclosed an endoluminal migration of the pericardial flap through the anastomotic dehiscence and a cicatricial stenosis of the left upper bronchus. The migrated flap was successfully removed and the stenosis segment of the bronchus was dilated using a rigid bronchoscope. Two months after complete recovery from the bronchial dehiscence, the patient developed an anastomotic cicatricial stenosis, which was effectively treated by laser photoresection and mechanical dilatation. Eight months after the last procedure the patient remains symptom free.

La terapia radicale

La piu frequente indicazione alla broncoscopia terapeutica e rappresentata dai tumori ostruenti la trachea ed i grossi bronchi. Nella grande maggioranza dei casi si tratta di tumori maligni non operabili in cui la rimozione della componente endoluminale ostruente oppure il posizionamento di una protesi nelle compressioni estrinseche rappresentano una terapia palliativo-sintomatica.