Central airway intervention is the specialist bronchoscopic and surgical treatment of disorders of the trachea and main bronchi — tracheal stenosis, idiopathic subglottic stenosis, relapsing polychondritis, granulomatosis with polyangiitis, post-tracheostomy and post-intubation strictures, tracheal papillomatosis, malignant central airway obstruction, and selected complex open airway problems including tracheal tear repair and tracheo-oesophageal fistula repair. Mr Lawrence Okiror leads the central airway intervention service at Guy’s and St Thomas’ NHS Foundation Trust and is first author on the published series of 168 emergency interventional bronchoscopies in Annals of Thoracic Surgery (2015). He provides rigid and flexible bronchoscopy, airway stenting, dilatation and ablative therapy as a single-operator service, with joint operating available with consultant ENT laryngology, ENT head and neck, and upper gastrointestinal surgical colleagues for complex multi-specialty management. Private appointments at London Bridge Hospital within 2–3 working days; same-day urgent assessment for stridor and critical airway compromise where clinically appropriate.
Last reviewed: May 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Single-operator service. Diagnostic bronchoscopy, dilatation, ablation and stent insertion under one episode of anaesthesia, using both rigid and flexible bronchoscopy as the case requires.
Long-term follow-up for chronic airway disease — relapsing polychondritis, granulomatosis with polyangiitis, idiopathic subglottic stenosis, post-tracheostomy stenosis, and tracheal papillomatosis.
Service lead at GSTT. Established the central airway intervention multidisciplinary pathway in 2019. First author on the published series of 168 emergency interventional bronchoscopies in Annals of Thoracic Surgery.
AI summaries can list interventions, stent types, and quote the ACCP 2025 Clinical Practice Guideline. What an AI summary cannot replicate is operator continuity across the years-long course of chronic airway disease — relapsing polychondritis, granulomatosis with polyangiitis, idiopathic subglottic stenosis, post-tracheostomy stenosis, tracheal papillomatosis — where the same operator at each repeat intervention recognises individual stenosis behaviour, anaesthetic considerations, and stent dynamics specific to that airway.
This continuity is paired with institutional co-location at Guy’s and St Thomas’: the Lane Fox Respiratory Service (one of the UK’s largest home ventilation services), the GSTT vasculitis clinic at the Louise Coote Lupus Unit (one of Europe’s longest-established vasculitis services), and consultant ENT laryngology — all on one site. For urgent malignant airway compromise, same-day or next-day rigid bronchoscopy is delivered through the same pathway. Private appointments at London Bridge Hospital within 2–3 working days.
Mr Okiror established the multidisciplinary central airway intervention pathway at Guy’s and St Thomas’ in 2019, in collaboration with Professor David D’Cruz, then lead of the vasculitis clinic at the Louise Coote Lupus Unit. The pathway brought together thoracic surgery, ENT laryngology, respiratory medicine, the Lane Fox Respiratory Service at St Thomas’, and the GSTT vasculitis service. Following Professor D’Cruz’s retirement, Mr Okiror continues to manage many of the patients originally referred through the vasculitis service and to coordinate care across the same multidisciplinary teams.
Several institutional features of Guy’s and St Thomas’ make it well placed to host a central airway intervention service. The Lane Fox Respiratory Service at St Thomas’ is one of the UK’s largest home ventilation and weaning services, supporting over seven hundred patients on home ventilation through a national referral remit. Patients with tracheostomy-related airway complications, post-intensive-care airway stenosis, and complex respiratory failure are routinely managed across the same site, generating a population in which central airway disease is over-represented relative to most acute hospitals.
The GSTT rheumatology department is one of the largest in the UK, and the Louise Coote Lupus Unit houses one of the longest-established vasculitis services in Europe [11]. Patients with airway involvement from granulomatosis with polyangiitis, relapsing polychondritis, and other autoimmune conditions are routinely co-managed with the rheumatology service. The co-location of these populations with thoracic surgical capability is the structural reason a central airway intervention service is sustainable at GSTT.
Private appointments are available at London Bridge Hospital within two to three working days. The full scope of bronchoscopic and surgical airway intervention available at Guy’s and St Thomas’ through the NHS is also delivered privately at London Bridge Hospital, including joint operating with consultant ENT laryngology colleagues where complex upper airway involvement requires combined expertise. The same operator, the same operative philosophy, and the same approach to longitudinal follow-up apply across both settings.
Mr Okiror’s central airway intervention practice covers both benign and malignant disease. The conditions below are listed together for completeness; clinical management of each is detailed in the relevant sections that follow.
Idiopathic subglottic stenosis (iSGS) — rare progressive narrowing just below the vocal cords, occurring almost exclusively in adult women. Relapsing polychondritis with airway involvement — inflammatory cartilage disease producing focal stenosis or diffuse tracheomalacia and bronchomalacia. Granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), where airway involvement causes subglottic stenosis in approximately one quarter of patients [10, 11]. Post-intubation tracheal stenosis and post-tracheostomy stenosis, the most common causes of benign tracheal narrowing in adult practice. Stenosis in patients with established permanent tracheostomies. Tracheomalacia and tracheobronchomalacia. Recurrent respiratory papillomatosis (tracheal papillomatosis). Post-tuberculous strictures. Stricture at the site of previous airway surgery, including following childhood slide tracheoplasty. Tracheal tear and laceration, post-intubation or post-traumatic. Tracheo-oesophageal fistula, traumatic and post-treatment.
Primary tracheal tumours. Endobronchial lung cancer with central airway obstruction. Oesophageal cancer with airway compression or fistula. Head and neck cancer with airway involvement. Mediastinal compression from lymphoma, thymic tumours, or other mediastinal malignancy. Metastatic disease involving the central airways — from breast, colorectal, renal, melanoma and other primaries.
Patients with central airway disease are often initially treated for asthma or chronic bronchitis without improvement [4]. The combination of breathlessness that does not respond to inhalers, noisy breathing on inspiration (stridor), voice change, or a history of prolonged intubation should prompt assessment for a structural airway cause. Central airway obstruction is associated with a poor prognosis if untreated [2]. Early specialist assessment is always advisable.
The clinical reason is that the rigid bronchoscope maintains a controlled airway throughout the procedure. It allows jet ventilation, accommodates larger instruments for tumour debulking and stent insertion, and provides immediate access for haemostatic intervention if bleeding occurs [1]. Flexible bronchoscopy is also used routinely — for diagnostic assessment, distal airway evaluation, and procedures where rigid access is not required — but for therapeutic intervention in the central airways, rigid bronchoscopy is the operative standard.
Mr Okiror provides therapeutic central airway intervention as a single-operator service. Diagnostic bronchoscopy, dilatation, ablation, cryotherapy and stent insertion are performed by him under one episode of anaesthesia, using both rigid and flexible bronchoscopy as the case requires. For patients who often need repeated procedures over years — relapsing polychondritis, granulomatosis with polyangiitis, idiopathic subglottic stenosis, post-tracheostomy stenosis, tracheal papillomatosis — this continuity matters. For urgent malignant airway obstruction, same-session intervention can be the difference between immediate symptomatic relief and a coordinated second procedure days later.
Mr Okiror uses laser, cryotherapy, electrocautery and argon plasma coagulation as appropriate for tumour debulking, granulation tissue removal, and selected benign airway lesions. Cryotherapy is particularly useful for tracheal papillomatosis and for selected vascular tumours. The choice of ablative modality depends on the underlying pathology, lesion characteristics, and operator preference, with multimodality therapy combining ablation, dilatation and stenting often appropriate [3].
For massive haemoptysis, interventional radiology with bronchial artery embolisation is usually the appropriate first-line intervention. Mr Okiror manages cases where embolisation has failed, is contraindicated, or where the underlying lesion requires surgical resection — situations in which rigid bronchoscopy provides definitive airway control and access for haemostatic intervention.
Airway stenting is used to restore and maintain patency in patients with central airway obstruction, malignant or benign, where the underlying disease cannot be resected or where stenting bridges the patient to definitive treatment. Stent insertion in the central airways requires careful patient selection and detailed knowledge of airway anatomy and stent characteristics [3].
Mr Okiror uses the full range of contemporary airway stents:
Silicone stents — including Dumon-type tracheal and bronchial stents and silicone Y-stents for carinal lesions. Silicone stents can be repositioned and removed and are the standard for benign disease where temporary stenting is appropriate. Self-expanding metallic stents — including covered and uncovered designs, used predominantly for malignant airway obstruction where longer-term patency is required. Y-stents — including silicone and hybrid Y-stents for lesions involving the carina or both main bronchi. Fistula stents — covered stents for tracheo-oesophageal and broncho-oesophageal fistulas, often as part of combined airway and oesophageal management. Temporary stents — for selected benign disease where time-limited support is appropriate.
The published evidence is clear that no single stent type is superior across all indications, and the decision must reflect the underlying pathology, the stricture characteristics, and the patient’s prognosis and treatment trajectory [3, 5]. Stent selection is made by the operator on the basis of bronchoscopic assessment, imaging, and the patient’s broader clinical context.
Patients requiring airway stenting for chronic disease are followed long-term in Mr Okiror’s outpatient practice. Stents are reassessed bronchoscopically at intervals appropriate to the underlying disease, with timely intervention for granulation, migration, or stent fracture. Continuity of operator across the lifetime of an airway stent is part of the rationale for the single-operator approach described in section 3.
Idiopathic subglottic stenosis is a rare progressive narrowing of the airway just below the vocal cords, occurring almost exclusively in adult women. It is rare, often misdiagnosed as asthma, and characterised by recurrent symptomatic narrowing that requires repeated airway intervention over years [9].
Patients typically present with breathlessness on exertion, a brassy or rough voice, and noisy breathing during exercise. Symptoms commonly progress over months to years before the correct diagnosis is made. Pulmonary function testing shows a fixed extra-thoracic obstruction pattern that is recognisable when specifically looked for.
The North American Airway Collaborative published prospective cohort data comparing the three primary surgical techniques used for idiopathic subglottic stenosis — endoscopic dilatation, endoscopic resection with adjuvant medical therapy, and open cricotracheal resection [8]. Each approach has trade-offs between symptom-free interval, voice outcome, and risk of operative complication. The choice of approach in any individual patient depends on stenosis characteristics, patient preference, and the balance between procedure interval and intervention magnitude.
Mr Okiror manages idiopathic subglottic stenosis in collaboration with consultant ENT laryngology colleagues at Guy’s and St Thomas’ and at London Bridge Hospital. Endoscopic management — balloon dilatation, laser excision of stenotic tissue, intralesional steroid injection — is performed jointly where laryngology input is required. The longitudinal nature of this disease means most patients are followed for years, with intervention at intervals individualised to disease behaviour.
Two systemic autoimmune conditions cause airway disease that is frequently managed in Mr Okiror’s practice. Both produce a chronic, relapsing course in which medical control of the underlying inflammation must be combined with airway-directed intervention to maintain patency and quality of life.
Relapsing polychondritis is a rare disease in which inflammation affects cartilaginous structures including the tracheobronchial tree. Airway involvement occurs in a substantial proportion of patients and is associated with significant morbidity and mortality [7]. Patterns include focal subglottic stenosis, diffuse tracheomalacia, and bronchomalacia. Symptoms range from chronic breathlessness to acute respiratory failure requiring urgent intervention. The published series from Beth Israel Deaconess reported that around forty per cent of patients with relapsing polychondritis and airway involvement required intervention including dilatation, stent placement, tracheostomy, or a combination, with most experiencing symptomatic improvement [7].
Granulomatosis with polyangiitis (GPA, formerly known as Wegener’s granulomatosis) causes subglottic stenosis in approximately one quarter of patients [10, 11]. The diagnosis can be challenging when airway involvement is the presenting feature. Treatment is multidisciplinary, combining systemic immunosuppression with airway intervention. Endoscopic management — dilatation, intralesional steroid injection, and selective stenting — is the primary treatment for most patients, with surgical resection reserved for highly selected cases [10].
The central airway intervention multidisciplinary pathway at GSTT was established in 2019 by Mr Okiror and Professor David D’Cruz, then lead of the vasculitis clinic at the Louise Coote Lupus Unit. The vasculitis service at GSTT, embedded within Europe’s longest-established lupus unit, accumulated more than two decades of GPA experience under Professor D’Cruz’s leadership [11].
Mr Okiror continues to manage many of the patients originally referred through the vasculitis service. Joint working with the rheumatology service is the operational principle of the pathway: continuity of operator and continuity of medical management together produce the best outcomes in these chronic conditions.
Malignant central airway obstruction is most commonly caused by primary lung cancer, oesophageal cancer with extrinsic airway compression, head and neck cancer with airway involvement, or mediastinal compression from lymphoma and thymic tumours. Metastatic disease involving the central airways — from breast, colorectal, renal, melanoma and other primaries — is also encountered, and overlaps with the practice in pulmonary metastasectomy for selected patients with limited metastatic disease.
The American College of Chest Physicians AQuIRE registry reported outcomes from over one thousand therapeutic bronchoscopies for malignant central airway obstruction across fifteen centres. Therapeutic bronchoscopy improved dyspnoea and quality of life in the majority of patients, with the magnitude of benefit greatest in those with the most severe baseline obstruction [5]. The same registry’s safety data established benchmarks for procedural complications — bleeding, hypoxaemia, respiratory failure, and thirty-day mortality — that inform contemporary practice [6].
In Mr Okiror’s published first-author series of 168 emergency interventional bronchoscopies for symptomatic airway stenosis [1], around forty per cent of patients with malignant airway obstruction were able to proceed to palliative chemotherapy after airway intervention. Receipt of post-procedure chemotherapy was an independent prognostic factor for survival on multivariate analysis (hazard ratio 2.05, 95% CI 1.156–3.636, P = 0.014).
The clinical implication is that timely airway intervention is not only palliative but can also enable further oncological treatment that improves overall survival. Patients with critical airway compromise from cancer should be considered for urgent assessment by a centre that can deliver same-session diagnostic bronchoscopy, intervention, and onward referral for systemic treatment.
For patients with primary lung cancer where surgical resection of the airway lesion is feasible, Mr Okiror performs bronchial sleeve resection, with or without lung resection, as a lung-preserving alternative to pneumonectomy. For patients with advanced disease or where the location of the lesion makes resection infeasible, therapeutic bronchoscopy with stenting and ablation provides effective palliation.
Bronchial sleeve resection is a lung-preserving operation in which a segment of the bronchus, with or without the associated lung lobe, is removed and the airway is reconstructed by direct end-to-end anastomosis. The operation is used for selected centrally located lung tumours where pneumonectomy would otherwise be required, and for benign bronchial lesions including post-traumatic and post-treatment strictures.
The advantage of sleeve resection over pneumonectomy is preservation of lung parenchyma, with substantially better long-term respiratory function, reduced perioperative mortality, and improved quality of life. In high-volume centres, sleeve resection is increasingly substituted for pneumonectomy as precise hilar dissection has extended the reach of lobectomy.
Mr Okiror performs bronchial sleeve resection at Guy’s and St Thomas’ and at London Bridge Hospital. Where the case requires combined airway and oesophageal management, or where the lesion involves the carina or distal trachea, the operation is planned in collaboration with consultant ENT head and neck colleagues.
For further information on lung-preserving surgery for lung cancer, see Lung Cancer Surgery in 2026. For patients told elsewhere they are not fit enough for major resection, see fitness for lung surgery — structured re-assessment sometimes changes the answer.
Tracheal tear is a thoracic surgical emergency. The most common causes are intubation injury, blunt or penetrating chest trauma, and iatrogenic injury during airway procedures. Presentation can be sudden and severe, with subcutaneous emphysema, pneumomediastinum, respiratory compromise, and risk of mediastinitis if the tear communicates with the gastrointestinal tract. Open repair requires thoracic surgical access, direct closure of the airway defect, and where appropriate the interposition of vascularised tissue to protect the repair.
Mr Okiror has operative experience in tracheal tear repair, having managed a small number of these rare and complex cases at Guy’s and St Thomas’.
Acquired tracheo-oesophageal fistula in adults is rare and technically demanding. Causes include penetrating trauma, foreign body erosion, malignancy, and post-treatment complications. Repair requires control of both the airway and the oesophagus, often with concurrent oesophageal resection or reconstruction, and frequently requires interposed tissue to separate the airway and oesophageal repairs and prevent recurrence.
Mr Okiror has performed traumatic tracheo-oesophageal fistula repair jointly with consultant upper gastrointestinal surgical colleagues at Guy’s and St Thomas’, with concurrent oesophagectomy as part of the same operation. Joint operating with upper gastrointestinal surgery is also available where the underlying pathology requires combined airway and oesophageal management.
For patients in whom segmental tracheal resection is the appropriate definitive treatment, Mr Okiror works as part of multidisciplinary surgical teams. These cases are planned with consultant ENT head and neck colleagues at Guy’s and St Thomas’ and, for the most complex cases, may involve cardiac surgical input and cross-institutional thoracic surgical colleagues.
Tracheal resection is a low-volume operation requiring careful patient selection and team assembly. Indications include short-segment tracheal stenosis where endoscopic management has failed or is unlikely to provide durable control, primary tracheal tumours in fit patients, and selected cases of complex post-childhood-surgery airway disease. Many patients benefit from initial endoscopic management to optimise the airway before definitive resection [3].
These cases are typically patients with long-segment congenital airway disease presenting in adulthood, complex post-surgical complications, or critical airway compromise requiring extracorporeal support to enable safe intervention.
Where appropriate, international consultation has been undertaken with senior thoracic surgical colleagues at major centres in Toronto and Boston to ensure no options are missed before locally-led intervention.
These cases are rare and highly individualised. Patients reach this pathway through tertiary referral from respiratory physicians, ENT colleagues, rheumatologists, and other thoracic surgeons. Independent second opinion is offered for patients seeking certainty before intervention or where multiple options have been proposed and a co-ordinating clinical lead is needed. See independent second opinion for more information.
London Bridge Hospital is the primary private centre for Mr Okiror’s central airway intervention practice. The full scope of bronchoscopic and surgical airway intervention available at Guy’s and St Thomas’ through the NHS is delivered privately at London Bridge Hospital, including rigid and flexible bronchoscopy, the full range of airway stents, ablative therapy, and joint operating with consultant ENT laryngology colleagues. Most outpatient clinics, day-case bronchoscopy, and inpatient airway intervention for private patients takes place here.
The Lister Hospital Chelsea is also available for selected straightforward cases where patient convenience favours west London.
Guy’s and St Thomas’ is where Mr Okiror’s NHS practice is based and where the central airway intervention multidisciplinary pathway is run. Complex cases, ECMO-supported intervention, and joint cardiothoracic operating take place at St Thomas’ Hospital. Multidisciplinary planning involves the GSTT vasculitis clinic, ENT laryngology, the Lane Fox Respiratory Service, and respiratory medicine.
Newsweek’s World’s Best Hospitals 2026 ranked St Thomas’ Hospital first in the UK, Guy’s Hospital second in the UK, and London Bridge Hospital tenth in the UK.
What is central airway intervention?
Central airway intervention is the specialist bronchoscopic and surgical treatment of disorders affecting the trachea (windpipe) and main bronchi. It includes diagnostic bronchoscopy, dilatation of narrowed airway segments, ablative therapy for tumours and granulation tissue, insertion of airway stents, and surgical resection where appropriate. The term covers both benign airway disease (such as scarring after intubation, autoimmune airway involvement, and idiopathic narrowing) and malignant airway obstruction from cancer.
How is rigid bronchoscopy different from flexible bronchoscopy?
Flexible bronchoscopy uses a thin steerable instrument and is performed under sedation. It is used for diagnosis, biopsy, and most routine airway examinations. Rigid bronchoscopy uses a straight metal instrument under general anaesthesia, with jet ventilation through the bronchoscope. Rigid bronchoscopy provides greater airway control, accommodates larger instruments for tumour removal and stent insertion, and allows immediate management of bleeding. The American College of Chest Physicians 2025 Clinical Practice Guideline recommends rigid bronchoscopy as the standard for therapeutic intervention in the central airways. Mr Okiror uses both, choosing the appropriate technique for each case.
What are the signs that breathlessness might be caused by a central airway problem rather than asthma?
Key features that should prompt assessment for a central airway cause include breathlessness that does not improve with inhalers, noisy breathing especially when breathing in (stridor), voice change, and a history of prolonged intubation, tracheostomy, or autoimmune disease. If breathlessness has developed or worsened after a prolonged intensive care admission, or if a person diagnosed with asthma is not improving on standard treatment, a central airway cause should be actively excluded.
What conditions does Mr Okiror treat?
Mr Okiror manages benign airway conditions including idiopathic subglottic stenosis, relapsing polychondritis, granulomatosis with polyangiitis, post-intubation and post-tracheostomy stenosis, tracheomalacia, tracheal papillomatosis, tracheal tear and tracheo-oesophageal fistula. He also manages malignant central airway obstruction from primary lung, oesophageal, head and neck, mediastinal, and metastatic disease. Bronchial sleeve resection, with or without lung resection, is performed for selected airway tumours.
Will I need ongoing follow-up?
Many central airway conditions, particularly autoimmune disease and idiopathic subglottic stenosis, require repeat intervention over months and years. Mr Okiror provides longitudinal follow-up for patients with chronic airway disease, with bronchoscopic reassessment at intervals appropriate to the underlying condition. Continuity of operator is one of the principles of his practice in this area.
How quickly can I be seen privately?
Private appointments are available at London Bridge Hospital within two to three working days. Referral can be made by your GP, by a respiratory physician, by another specialist, or directly. Urgent referrals — including patients with stridor, rapidly progressive breathlessness, or critical airway compromise — are accommodated on a same-day or next-day basis where clinically appropriate.
Mr Okiror sees private patients within 2–3 working days at London Bridge Hospital. NHS referrals through Guy’s and St Thomas’. Urgent referrals for stridor, rapidly progressive breathlessness, or critical airway compromise are accommodated same-day where clinically appropriate.
Request a consultation →Disclosures
This guide describes Mr Lawrence Okiror’s clinical practice in central airway intervention as of May 2026. It is intended as patient and referrer information, not as medical advice for any individual case. Mr Okiror is a Consultant Thoracic and Robotic Surgeon at Guy’s and St Thomas’ NHS Foundation Trust, with private practising privileges at London Bridge Hospital and The Lister Hospital Chelsea. He has no commercial relationships with manufacturers of airway stents, ablation equipment, or bronchoscopy systems. He is first author on the published series cited as reference 1. Decisions about airway intervention should always be made on a case-by-case basis after appropriate clinical evaluation.
Diagnostic precision for peripheral lung nodules — the sister cluster to therapeutic central airway intervention
Lung Cancer Surgery in 2026Robotic lobectomy, segmentectomy, and bronchial sleeve resection for primary lung cancer
Emphysema Surgery in 2026Endobronchial valves and lung volume reduction surgery
Coughing up blood (haemoptysis)When to seek specialist assessment for blood in the sputum
Persistent coughWhat a persistent cough may indicate — including central airway disease
Specialist Second OpinionIndependent review for patients seen elsewhere — within 2–3 days
Fitness for Lung SurgeryStructured fitness re-assessment for patients told elsewhere they are not well enough for surgery
Pulmonary MetastasectomySurgery for cancer that has spread to the lungs — with selected airway involvement