Double Lumen Endobronchial Tube Placement for Lung Separation via a Tracheostomy Stoma in a Patient Status-Post Laryngectomy

A 63-year-old male with a history of chronic obstructive pulmonary disease and squamous cell carcinoma of the larynx status-post laryngectomy and tracheostomy presented for a robotic-assisted right upper lobectomy for neoplasm excision. On physical examination, he was noted to have moderate hypoxia with an SpO(2 )of 93% on room air. In order to facilitate potential apneic oxygen insufflation and continuous positive airway pressure in the operative lung, a traditional left-sided 35-French double-lumen endobronchial tube was placed through his tracheostomy, and utilized to facilitate lung separation and to improve surgical manipulation. The patient tolerated the procedure well and was extubated to a tracheostomy collar with a 100% fraction of inspired oxygen delivered with 15 liters per minute of flow.