The term tracheotomy refers to a surgical procedure of an incision in the trachea to provide an alternative method of breathing, which was first recorded in 1649. The practice had been in use long before this, however, previously known as pharyngotomy, laryngotomy or bronchotomy.
Tracheotomy in Ancient History
Tracheotomy is one of the oldest operations known, with ancient Egyptian artifacts engraved with depictions of tracheostomy that date back to 3600BC. Written references to a surgical procedure of an incision in the trachea also appeared in a Hindu text written circa 2000BC. Alexander the Great was reported to save a soldier’s life from suffocation in circa 1000BC, by way of an incision of the trachea using his sword tip.
Hippocrates (460-377BC), who knew what laceration or ligation of carotid vessels could cause death, criticized the tracheotomy procedure on the fear that it would damage carotid vessels. Aretaeus of Cappadocia in the first century AD did not advocate for the use of tracheotomy when patients faced possible suffocation caused by infection, as the operative site was likely to lead to complications of dyspnea, cough and death.
In the following ages, tracheotomy was widely known of by physicians but rarely performed as there was a high degree of risk associated with the procedure.
Acceptance of Tracheotomy
From the 16th century to the 19th century, tracheotomy was genreally regarded by surgeons as dangerous with low chance of success and, as a result, few surgeons were willing to perform the procedure. Tracheotomies were reserved as an option for emergency treatment for obstruction of the upper airways, although the success rate of the procedure was not favorable.
The Italian physician, Antonio Musa Brasavola, performed a successful tracheotomy on a patient suffering from obstruction of the tonsils in 1546 and described the surgical method he used in a report that became the first successful documented case.
Habicot performed the first documented pediatric tracheotomy in 1630, on a teenaged boy that had swallowed gold that became lodged in his esophagus and caused obstruction of the airway.
In 1718, Lorenz Heister, a German surgeon, introduced the term tracheotomy to common practice and it remains the most widely used term today.
Late in the 18th century, President George Washington died of supraglottis, a condition involving the obstruction of the upper respiratory tract. Although his physician was familiar with the surgical technique, he did not perform the procedure as its futility was not certain.
In the 19th century, tracheotomies became a surgical procedure that was performed more commonly, despite the continued high mortality and morbidity rates associated with the procedure.
Chevalier Jackson standardized the surgical procedure in the early 1900s by showing that lower mortality rates were evident when proper techniques and adequate post-operative care were employed. The technique he advocated involved a low tracheal incision to the second or third tracheal rings.
Rise of Tracheotomy
More recently in history, the surgical tracheotomy procedure has become a viable option with more successful materials and techniques used in practice. This increase in use was due to the introduction of intubation and respiratory support for neonatal patients in 1965, which revolutionized neonatal care and led to the survival of many children.
Synthetic materials and low-pressure cuffs with high-volume have improved the composition of the tracheotomy tubes and reduced the incidence of related complications.
Current mortality rates of tracheotomy are between 0.5 and 3%, which is often preferable to a blockage of the upper airways that could prove fatal. This reduction in mortality is largely as a result of percutaneous tracheotomy procedure development, which is less complicated to perform.