13th February 2000
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Your Health 

Now, replacing your windpipe

by Dr. Sanjiva Wijesinha
It was the first time in the world that such an operation had been done.

At St. Vincent's Hospital in Sydney last December, Australian surgeons removed a woman's cancerous windpipe and replaced it with one constructed out of skin cut from her own arm.

The patient, 43-year-old Margaret Reiss from rural New South Wales, had developed a rare form of cancer in the wall of her trachea (windpipe), which gradually enlarged inside her windpipe and was starting to block her breathing. Although the obstruction was removed by laser surgery, there was no guarantee that the cancer wouldn't recur. Her surgeons therefore decided that the best option for cure lay in replacing it with an artificial one.

Says thoracic surgeon Dr. Michael Wilson, one of the surgeons involved in the team of specialists that performed the fifteen-hour operation, "The various stages of this procedure have been done previously at St. Vincent's - but this was the first time that all the procedures were combined at the single operation, to actually remove a patient's trachea and replace it with another on the one occasion."

Mrs. Reiss became short of breath earlier last year, and for several weeks her own doctor had been treating her with asthma-relieving drugs. But when she was found to be not responding to these medications, a CAT scan was done which revealed the cancer inside the windpipe.

She was transferred to Sydney two days after her scan and the tumour was destroyed by laser surgery. As this operation weakened the wall of the windpipe from which the cancer originated, a plastic tube called a stent was inserted into her trachea to keep it from collapsing.

Three weeks later, after several meetings to plan the new operation, the team of thoracic surgeons, plastic surgeons and anaesthetists decided to go ahead. 

While Mrs. Reiss' windpipe (with its temporary stent) was being removed from her neck, plastic surgeon David Craminer fashioned her new windpipe by sewing skin and tissue taken from her forearm into a roll around a flexible, sterile mesh stent. This stent would keep the windpipe rigid - a task which in a real trachea is performed by rings of cartilage.

After the newly created windpipe was inserted and sewn into her neck, a second skin graft from her thigh was then taken and used to cover the raw area on her forearm from which the tissue to fashion the artificial trachea was removed.

Says respiratory physician Dr. Allan Glanville, "Margaret was incredibly focused on being cured. Her new trachea is now working in the same way as a natural windpipe."

Mrs. Reiss recovered rapidly from the surgery, and was able to get home in time for Christmas to her home town of Orange, 125 miles west of Sydney. She returned to Sydney at the end of January to undergo a course of radiotherapy, which focused on the area around the windpipe to ensure that any residual cancer cells were destroyed.

Observed Mrs. Reiss, back home for Christmas with her husband and three daughters, "I am getting braver every day. I feel fantastic now - it is as though nothing has happened!"

Dr. Sanjiva Wijesinha who writes regularly for The Sunday Times on health issues is currently in Australia.

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