Stening® Class LSD

Available dimensions

The Stening® Class LSD is manufactured in a range of diameters and lengths, allowing selection of the most suitable size for each clinical case.

Introduction technique

The procedure is carried out under general anesthesia. The implantation of this type of prosthesis requires the use of a conventional introducer for silicone prostheses. The airway is accessed with a rigid bronchoscope. The length and lumen of the trachea or bronchus in the segment where the stent will be placed must be estimated in order to make the correct choice of prosthesis.

1. Lubricate the introducer nozzle, avoiding that the lubricant reaches the operator’s fingers.
2. Fold the Stening® Class LSD along its axial axis and insert it into the prosthesis introducer through the nozzle, with the narrowest end of the stent in the distal position.
3. Remove the nozzle.
4. Pass beyond the lesioned area with the bronchoscope tube and place its distal end or bevel over the healthy mucosa, exceeding the affected zone by about 5 to 7 mm.
5. Place the introducer inside the bronchoscope.
6. Press the ejector while withdrawing the bronchoscope by the same amount as the plunger advances inside it.

The prosthesis is thus released. If necessary, it can be adjusted with alligator forceps, the maneuver being simpler if the stent lies more “below” the lesion.

Steps 1, 2 and 3 are repeated. Now stop the bronchoscope containing the introducer and the prosthesis 5 mm before the lesion to be treated. Then slowly press the ejector plunger. In this way the prosthesis will advance into the bronchial area to be treated.

A prosthesis loader may be used to then push it through the interior of the bronchoscope, or whatever method the operator deems preferable.

The stent may require additional maneuvers in order to correct or adjust its final position. It is preferable to correct a stent that has been placed beyond the desired position than the reverse, since it is highly inconvenient to advance a prosthesis that has been released before the lesion to be treated.

To move a stent proximally, it can be grasped by the edge and gently pulled. We strongly recommend, for its precision, a maneuver consisting of grasping the stent by its edge as mentioned. Then, introduce the direct-vision optics inside the stent and observe its end. Now pull the forceps and you will be able to verify the ascent of the stent within the bronchus. Then stop the traction when you believe the stent position is optimal.

The LSD models may require a “rotation” adjustment, so that the lateral hole of the stent faces the entrance of the right upper lobar bronchus.

Intubation is performed with a rigid bronchoscope. Easy to remove, the stent should be grasped by its edge with alligator-type forceps, firmly enough. Rotate the forceps so that the stent takes on an omega shape and loses its radial resistance to compression. Then pull the forceps, extracting the prosthesis together with the bronchoscope. If preferred, the end of the stent can be introduced inside the endoscope; with this maneuver the vocal cords are protected during removal.

Post-implantation care

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

• Maintain the moisture of secretions when present, performing frequent nebulizations with warm isotonic saline solution.
• Periodic check-up according to medical criteria.
• Treat dental cavities and maintain effective oral hygiene.

Usage warning

The Stening® Class LSD is an anatomical stent, slightly conical in shape. Therefore:

1. Remember that the stent must always be introduced inside the bronchoscope with the larger-diameter end in the proximal position, and the narrowest end in the distal position.
2. If it is necessary to shorten the stent, it is preferable to make the cut close to its distal end, that is, near the smaller-diameter end.
3. As its name indicates, the Class LSD models are only useful in the right hemi-tree. When loading the stent into the introducer or the bronchoscope, remember to orient the lateral hole of the stent toward the entrance of the right upper lobar bronchus, which is usually located at 3 o’clock. Verify this position beforehand during the bronchoscopic examination and once more after implantation.
4. The device must not be reused.