Breathing New Life Into Trachesotomy

A surgical team at Mediclinic Cape Town was the first to trial a revolutionary balloon procedure that limits the risks associated with traditional tracheostomy. A tracheostomy is an opening surgically created through the neck so a tube can be placed into a patient’s trachea (windpipe), allowing them to breathe. A pilot balloon port is attached to tubing that inflates the cuff at the base of the tracheostomy tube to keep it in place within the trachea. “Having a tube and a surgery in your neck can be debilitating and affects your quality of life quite significantly,” says Dr Nicholas Goncalves, an ear, nose and throat (ENT) and skull base surgeon at Mediclinic Cape Town. “You’d generally need further procedures, which would mean you have a tracheostomy for quite some time.” The procedure has traditionally come with significant risks – until now. The new and ground-breaking balloon procedure, pioneered by ENT, skull base and transorbital surgeon Professor Darlene Lubbe, Dr Goncalve’s partner, mitigates those risks significantly. “In the old days, they’d insert a balloon, which would completely block the airway, so you wouldn’t be able to get any oxygen into the lungs,” explains Dr Goncalves. “You’d have to blow up the balloon and wait. This was quite dangerous because many of these procedures happen in an emergency setting so you need to get oxygen into the lungs as soon as possible.” Professor Lubbe and a medical company developed the new balloon to address this issue. “The new balloon was designed with a central port and then nine tiny individual balloons packed around each other,” says Dr Goncalves. “In an emergency situation, you’re not stressed for time or potentially putting the patient’s life at risk as you’re able to facilitate a steady oxygen flow. This helps the patient breathe throughout the procedure, which has revolutionised the process.” Another of Dr Goncalves’ colleagues at UCT, anaesthetist Professor Ross Hofmeyr, further simplified the dilatation procedure by developing a laryngeal mask airway (LMA)

“Originally, they’d try to put a tube down into your trachea and into your lung, but the narrowing there, which necessitates the procedure, meant there was a danger it wouldn’t fit,” explains Dr Goncalves. “In an emergency situation you could actually lose the airway and the patient could potentially die.”

“The new LMA technique uses a special mask that goes into your throat just above the trachea, instead of into it. We use a camera and the new balloon to simply go through this mask. With the camera, we can see the narrowing and fit the balloon, which is quite small, into it. We can then inflate the balloon and watch the narrowing expand to its normal dimensions. This allows oxygen into the lung, significantly reducing the risk of losing the airway, especially in an emergency situation.”

The procedure is relatively pain free, generally only needs a one-night hospital stay –  as opposed to the week required by a tracheostomy – and brings noticeable improvements almost immediately.

Dr Goncalves was part of the team that first used the technique and the balloon, which is now FDA-approved. They have since trained other ENTs, pulmonologists and cardiothoracic surgeons in the technique – both nationally and internationally.

This procedure can also be used to get patients off an existing tracheostomy, allowing them to return to their normal lives. Those living with a tracheostomy tube face many challenges, including:

  • Difficulty speaking
  • Risk of recurrent chest infections
  • Being unable to swim as water goes straight into the lung
  • Concerns about appearance

“Depending on what kind of work you do, you could potentially lose your job,” adds Dr Goncalves. “It really can significantly affect your quality of life.” While full healing may take time and some patients may need repeated procedures, the aim of the new balloon procedure is to avoid, or remove, a tracheostomy so the patient can reclaim their life.