Stening® Bronchial

Available dimensions

The Stening® Bronchial is manufactured in a wide range of diameters and lengths, allowing the most suitable size to be selected for each clinical case.

Insertion technique

The procedure is performed under general anaesthesia. Implantation may be carried out directly through the working channel of the tracheoscope or bronchoscope, or by using a conventional silicone prosthesis introducer. The airway is accessed with a rigid endoscope.

The length and diameter of the area to be covered with the stent must be properly established. A simple method to determine the length of the affected area is to mark the tracheoscope when its tip reaches the end of the lesion, then mark it again when withdrawn to the beginning of the lesion. The diameter of the trachea or bronchus must be estimated by comparison with the known diameter of the endoscope used.

1. Lubricate the introducer tip with lidocaine gel, preventing the lubricant from reaching the operator's fingers.
2. Fold the Stening® along its axial axis and insert it into the prosthesis introducer through the tip.
3. Remove the tip.
4. Pass beyond the affected area with the tracheoscope tube and position its distal end or bevel on healthy mucosa, exceeding the affected zone by 5 to 7 mm.
5. Place the introducer inside the tracheoscope.
6. Press the ejector while withdrawing the tracheoscope by the same amount as the ejector plunger advances: the stent-loader plunger is pressed as the endoscope is extracted.

The prosthesis is thus released. If necessary, it can be repositioned with an alligator forceps; the maneuver is simpler if the stent sits “lower” than the lesion.

Repeat steps 1, 2 and 3. Then stop the tracheoscope containing the introducer and the prosthesis 5 mm before the lesion to be treated, and slowly press the ejector plunger. The prosthesis will thus be expelled towards the affected trachea.

Some stent-loader models are not inserted inside the tracheoscope but simply attach to its proximal end, from where the stent is pushed. In this case, the endoscope will have stopped proximally or distally to the lesion as explained above, in order to push the prosthesis with the plunger supplied with the endoscopic instruments. The stent then travels through the entire tracheoscope until it reaches the trachea. At this point a sudden reduction in the resistance to the plunger pressure is perceived, indicating that the stent has begun to exit the endoscope.

The stent may require additional maneuvers to correct or adjust its final position. It is preferable to correct a stent that has been placed beyond the desired position than the other way around, since it is highly inconvenient to advance a prosthesis that has been released “before” the affected area.

To move a stent proximally, it can be grasped by the edge and pulled gently. We strongly recommend, for its precision, a maneuver consisting of grasping the stent by its edge as described, and then advancing the direct-vision optic inside the stent until its distal end is visualized. Pull the forceps and you will see the stent ascending through the airway. Stop the traction when you consider the position to be optimal.

Intubation is performed with a rigid tracheoscope or bronchoscope as appropriate. The silicone stent is easy to extract: grasp it by the edge with an alligator-tooth forceps with sufficient firmness. Rotate the forceps about 360° so that the stent folds into an omega shape and thus loses its radial resistance to compression. Then pull the forceps, extracting the prosthesis together with the tracheoscope.

The proximal end of the stent may be inserted into the tracheoscope. This maneuver protects the vocal cords during extraction. Other implantation and removal methods are possible depending on the operator's experience and preferences.

Post-implantation care

Recommendations for follow-up of patients with a bronchial stent.

• Keep secretions moist when present, by performing frequent nebulizations with warm isotonic saline solution.
• Periodic check-ups according to medical criteria.
• Treat dental caries and maintain effective oral hygiene.

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