Figure 7.

Removal of bronchi and distal trachea. The remaining mainstem bronchi and distal trachea are now excised. The mainstem bronchi are grasped with Allis clamps to assist with the dissection. Placing a stay suture on the more proximal trachea is often helpful for exposure during the tracheal anastomosis. Avoid dissection along the lateral portion of the trachea as much as possible to maintain adequate blood supply to this area. The trachea is divided as distally as possible, remaining cephalad to the mainstem bronchi. Once the anterior wall of the trachea is incised it is obvious from the bleeding that the blood supply is excellent. The remaining portion of the trachea is incised and the distal segment is dissected away from the mediastinum, leaving an open trachea in the mediastinum prepared for the anastomosis (12).