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Flexible bronchoscopy is a medical procedure where a specialized long flexible endoscope, called a bronchoscope is used to examine the lungs under anaesthetic. The bronchoscope is inserted through the through the nose or mouth into the trachea and branches of the airways to look for abnormalities. Specialised tools can be delivered through the bronchoscope to perform a bronchial wash, broncho-alveolar lavage (BAL), brushings and various type of biopsies that procures specimens which can be examined in the laboratory.
Flexible bronchoscopy is used to investigate persistent cough, shortness of breath, pneumonia and other lung infections among other lung conditions.
EBUS is short for endobronchial ultrasound. EBUS technology adapted bronchoscopes have allowed us to take biopsies from deep within the lungs under anaesthetic with high degree of precision and safety. There are two types of EBUS bronchoscopies. Linear EBUS bronchoscopy is performed with a specialised bronchoscope and is used to biopsy central lung lesions and lymph nodes. It is also used to deliver fiducial markers to guide radiation therapy. Radial EBUS is a specialized ultrasound probe which fits within a normal bronchoscope and can be used to find small peripheral lung lesions so that biopsies can be performed safely. Its applications are growing and include targetting site to biopsy for interstitial lung diseases.
The pleura is the lining of the lungs and the inside of the chest wall. There are many dieases of the pleura that result in build up of fluid within the chest cavity (Pleural effusion) and requires intervention for diagnosis and treatment. Thoracentesis is sampling pleural fluid as a liquid biopsy to narrow a diagnosis and also to drain off fluid to relieve symptoms. Intercostal chest tube can be placed within the chest cavity to drain fluid or air in the case of a punctured lung (Pneumothorax). Talc pleurodesis is the introduction of talc powder into the chest cavity to cause the lung to stick to the chest wall and is used to treat the effusion. Permanent chest drains called indwelling pleural catheters (IPC) are placed to treat cancer related pleural fluid build up in specific situations. These procedures are performed under local anaesthetic.
Cryo means to freeze. A bronchoscopy guided cryobiopsy of the lung is performed by delivering a specialized cryoprobe to the target site and the biopsy is performed by freezing the tissue. Traditional forceps biopsies are small and tissue is crushed by the forcep bite hence making it difficult to interpret. This technique procures a much larger biopsies and preserves the tissue architecture making it easier for the pathologist to make a diagnosis.
Cryobiopsies can be used for centrally situated lung lesions, interstitial lung disease and peripheral lung nodules.
Rigid bronchoscopy is the principal interventional procedure developed over a century ago but has been refined and revived with improved understanding of lung diseases and availability of new innovative technologies. Rigid bronchoscope allows the bronchoscopist to secure the airway. This allows the anaesthetist to provide oxygen to the patient and at the same time the bronchoscopist can deliver larger instruments into the lungs. Rigid bronchoscopy is used to manage large tumours blocking the wind pipe, control bleeding, take biopsies of the lung and remove foreign bodies aspirated into the lungs.
Lung volume reduction
Advanced severe emphysema patients have lungs full of air which disrupts the diaphragm function and results in breathlessness. Tiny one way valves are delivered into the lungs by bronchoscopy under anaesthetic that allow the excess air to be exhaled out of the lung making the it easier to breath. The procedure can result in a collapsed lung however this means that the patient will benefit the most from the procedure. This procedure can be used to help patients waiting for a lung transplant.