A Novel Endoscopic Anterior Cricoid Rib Grafting: A Feasibility Study in An Animal Model.

Objective: The objective of our study was to document the feasibility of a novel endoscopic anterior cricoid split and rib grafting technique in a goat airway model.

Study design: Feasibility pilot animal study.

Setting: Animal surgical laboratory at a tertiary hospital and research center.

Methods: Three Ardhi goats were utilized. After harvesting and shaping the rib graft, 2 sutures were inserted transversely into the graft. An endoscopic midline anterior cricoid split was performed and extended down through the first tracheal ring, followed by a balloon dilation of the site. Next, the 2 lower and upper graft suture ends were sequentially passed as endo-extra laryngeal sutures and tied on the anterior neck skin. Laryngeal stent was utilized in 1 goat following graft placement.

Results: The surgery was successful in all included animals and bronchoscopy performed 7 days after surgery, revealed that the anterior graft was in good position. One goat developed surgical site infection leading to partial graft resorption.

Conclusion: This study demonstrated the feasibility of this novel procedure which is potentially useful for patients who are candidates for a single-stage reconstruction. Future studies should investigate the safety and validity of this technique in a model with subglottic stenosis.

Level of evidence: NA.