More Than 1 Way to Put in A T-Tube: A Review of Different Techniques Used in Insertion of Montgomery T-Tubes

Objective: The Montgomery T-tube is a commonly used device initially designed as a temporary airway stent, but also used as a long-term airway solution for stenosis. For patients undergoing either endoscopic or open airway procedures, proper techniques for inserting these tubes are well documented. This review compiles the techniques used for insertion of the Montgomery T-tube stent. Methods: The NCBI Pubmed database was queried using the keywords: “stent,” “Montgomery,” “T-tube,” “stenosis,” “technique.” A total of 33 papers were reviewed with 12 papers selected for the study. Papers were selected based on inclusion criteria of English language and whether the paper described a technique for insertion of a Montgomery T-tube into the airway. Papers were excluded if they did not describe the technique of insertion of Montgomery T-tubes or dealt with another aspect of T-tube management. Results: The 12 selected papers each described a different technique for insertion of a Montgomery T-tube stent. Though nearly all the selected studies described using a modified Seldinger technique for insertion of the T-tube, there were discrepancies and a wide array of different instruments used. The instrument and/or technique that was selected was often determined by the individual need of the patient. Several studies addressed the challenge of interrupting ventilation while inserting or exchanging a T-tube in the operating room. These studies described attaching the T-tube to the endotracheal tube to pass the T-tube into the airway while allowing for continuous ventilation. Yet other studies used optical forceps or rigid bronchoscopes to allow placement of the T-tube with direct visualization. Conclusion: There are many techniques used for the insertion of a Montgomery T-tube. Nearly all studies described using a modified Seldinger technique and all the studies agreed on the necessity of a team approach for placement of the Montgomery T-tube.