One of the technologies frequently used by interventional pulmonologists is a bronchoscope – a device that uses specialized scopes to look into the lungs.
At Cooper University Health Care, two kinds of bronchoscopes – rigid and flexible – are available, so physicians can choose the device that is the safest and most effective for each patient’s needs.
Flexible bronchoscopes have delicate fingertip controls that allow the physicians to navigate through the airways. Using a flexible bronchoscope, pulmonary specialists are able to move through the airways in the lungs to view abnormalities such as tumors, bleeding, or inflammation, and can perform advanced diagnostic and treatment procedures using special tools that can be passed through the bronchoscope. Flexible bronchoscopy is a minimally invasive procedure and can be done on an outpatient basis. No general anesthesia is necessary.
Rigid bronchoscopes are straight and made of stainless steel. Generally, patients have to be well sedated for a rigid brochoscopic procedure. The advantage of rigid bronchoscopy is that it allows the passage of larger tools into the lungs.
Procedures Performed Through Bronchoscopy
Endobronchial Ultrasound (EBUS) and Radial Bronchial Ultrasound (REBUS)
Endobronchial Ultrasound or EBUS is a technique in which an interventional pulmonologist uses a flexible bronchoscope with a special ultrasound device attached at the tip of the scope to visualize and precisely locate abnormalities in the chest and lungs. The ultrasound images are used to guide a thin needle to the site of the abnormality, so the physician can collect tissue samples for biopsy. This minimally invasive procedure enables physicians to safely, accurately and quickly biopsy previously difficult-to-reach lymph nodes and chest abnormalities. EBUS is a safe and effective alternative to traditional mediastinoscopy.
Radial Ultrasound Bronchoscopy or REBUS allows physicians to localize peripheral nodules or mass inside the lung tissue and away from the main airways. Once localized, the abnormality is biopsied, in order to obtain tissue specimens. REBUS is a safe and effective alternative to CAT Scan-guided biopsy, which has a significantly higher risk of a resulting in a collapsed lung.
Cooper is the only South Jersey hospital performing endobronchial ultrasound-guided bronchoscopy.
Transtracheal and Transbronchial Needle Aspiration
Transtrachial and transbronchial needle aspiration are methods of collecting samples from lung tissue and lymph nodes in the lung and chest. Through this procedure interventional pulmonologists use a bronchoscope (with or without ultrasound guidance) to identify the area of abnormality and guide a fine needle to the suspicious area to gather a tissue sample. The tissue is then studied by pathologists to diagnose and stage cancer, or diagnose other benign conditions.
Advanced Techniques to Open Blocked Airways
Sometimes the airways in the lung can get blocked with abnormal tissue. If this happens in a small airway, the patient will not feel much. If it happens in the trachea (the upper airway) or a main airway to one of the lungs, the blockage can cause symptoms and compromise breathing and quality of life. Cancer is the most common cause of large airway blockages, although some inflammation and scarring conditions can also cause blockage. Interventional pulmonologists at Cooper have several tools which allow the opening of blocked airways.
- Argon Beam Ablation
Argon is a gas which can carry an electrical current. In this technique, a bronchoscope is inserted into the lungs to reveal the area of blockage. A small tube is then passed through the scope. The physician can aim the tube at areas of tissue that need to be destroyed, allow the argon gas to flow through the tube and emit an electrical current. The result is a beam of electricity that can burn away tissue without having to have direct contact with the tissue. This technique is similar to the use of a laser, but is safer.
With electrocautery an electrical current heats and destroys tissues, but with this treatment option direct tissue contact is required. After the airway is examined with a bronchoscope, a catheter is passed through the scope. Different “tips” can be used - a small round probe and a thin blade or “knife.” Physicians are able to destroy the obstructing tissue by touching the tissue with the tip tool and applying a controlled electrical current.
Cryotherapy uses intense cold to destroy obstructing tissue. The procedure begins with the passage of a bronchoscope into the airway to visualize the obstruction. A treatment probe is passed through the bronchoscope and a gas is sent through the tube. As the gas expands as it hits the metallic tip of the tube. This expansion causes supercooling of the metallic tip. Temperatures go well below freezing. The tip is allowed to touch tissues that need to be destroyed and several freeze-thaw cycles are performed. This process destroys the tissues, and they slowly break down and “dissolve.”
- Foreign Body Removal
Sometimes materials such as a broken tooth or a piece of food fall into the airway and get stuck. These “foreign bodies” can be very difficult to remove and sometimes patients have to go to surgery. However, sometime the foreign body can be removed using a brochoscopic procedure.
- Airway Stenting
Blockage of an airway can cause shortness of breath, low oxygen, and infection. The most common cause of blockage is cancer, although sometimes another process such as infection or a foreign body can cause blockage. In many cases, cryotherapy, electrocautery, or argon beam ablation can be used to open up airways, but in many cases (especially cancer) the airway will shut down again. In these situations, patients can be helped by the insertion of a stent. A stent is a small tube which fits into the airway to keep it open. Stents are passed down into the airway in a collapsed configuration and then are allowed to expand and push the airway walls open. Airway stenting is a very specialized procedure performed only by interventional pulmonologists.
- One-Way Endobronchial Valve Placement
Normally, lungs easily expand and contract with breathing. But for patients with emphysema and some other lung conditions, air sacs in the lungs lose elasticity and become hyper-inflated, resulting in decreased function and a feeling of breathlessness. The one-way endobronchial valve is typically implanted such that when a patient exhales, air is able to flow through the valve and out of the lung compartment that is fed by that airway, but when the patient inhales, the valve closes and blocks air from entering that lung compartment. Thus, an implanted endobronchial valve typically helps a lung compartment to empty itself of air - improving overall function. Endobronchial valves have also been shown to be beneficial in treatment of persistent air leaks in the lungs that are likely to become prolonged following lobectomy, segmentectomy, or lung volume reduction surgery.