Tracheostomy & SCOOP Procedure  ( Surgery)
Description:  Tracheostomy with skin flaps and SCOOP procedure FastTract.  Oxygen dependency of approximately 5 liters nasal cannula at home and chronic obstructive pulmonary disease. 

PREOPERATIVE DIAGNOSES:,1.  Oxygen dependency.,2.  Chronic obstructive pulmonary disease.,POSTOPERATIVE DIAGNOSES:,1.  Oxygen dependency.,2.  Chronic obstructive pulmonary disease.,PROCEDURES PERFORMED:,1.  Tracheostomy with skin flaps.,2.  SCOOP procedure FastTract.,ANESTHESIA: , Total IV anesthesia.,ESTIMATED BLOOD LOSS: , Minimal.,COMPLICATIONS:  ,None.,INDICATIONS FOR PROCEDURE: , The patient is a 55-year-old Caucasian male with a history of chronic obstructive pulmonary disease and O2 dependency of approximately 5 liters nasal cannula at home.  The patient with extensive smoking history who presents after risks, complications, and consequences of the SCOOP FastTract procedure were explained.,PROCEDURE:,  The patient was brought to operating suite by Anesthesia and placed on the operating table in the supine position.  After this, the patient was then placed under total IV anesthesia and the operating bed was then placed in reverse Trendelenburg.  The patient's sternal notch along with cricoid and thyroid cartilages were noted and palpated and a sternal marker was utilized to mark the cricoid cartilage in the sternal notch.  The midline was also marked and 1% lidocaine with epinephrine 1:100,000 at approximately 4 cc total was then utilized to localize the neck.  After this, the patient was then prepped and draped with Hibiclens.  A skin incision was then made in the midline with a #15 Bard-Parker in a vertical fashion.  After this, the skin was retracted laterally and a small anterior jugular branch was clamped and cross clamped and tied with #2-0 undyed Vicryl ties.  Further bleeding was controlled with monopolar cauterization and attention was then drawn down on to the strap muscles.  The patient's sternohyoid muscle was identified and grasped on either side and the midline raphe was identified.  Cauterization was then utilized to take down the midline raphe and further dissection was utilized with the skin hook and stat clamps.  The anterior aspect of the thyroid isthmus was identified and palpation on the cricoid cartilage was performed.  The cricoid cauterization over the cricoid cartilage was obtained with the monopolar cauterization and blunt dissection then was carried along the posterior aspect of the thyroid isthmus.  Stats were then placed on either side of the thyroid isthmus and the mid portion was bisected with the monopolar cauterization.  After this, the patient's anterior trachea was then identified and cleaned with pusher.  After this, the cricoid cartilage along the first and second tracheal rings was identified.  The cricoid hook was placed and the trachea was brought more anteriorly and superiorly.  After this, the patient's head incision was placed below the second tracheal ring with a #15 Bard-Parker.  After this, the patient had a tracheal punch with the SCOOP FastTract kit to create a small 4 mm punch within the tracheal cartilage.  After this, the patient then had a tracheal stent placed within the tracheal punched lumen and the patient was then had the tracheal stent secured to the neck with a Vicryl strap.  After this, the cricoid hook was removed and the patient then had FiO2 on the monitor noted with pulse oximetry of 100%.  The patient was then turned back to the anesthesia and transferred to the recovery room in stable condition.  The patient tolerated the procedure well and will stay in the hospital for approximately 23 hours.  The patient will have the stent guidewire removed with a scoop catheter 11 cm placed.