Flexible Bronchial Surgery

Aug 3, 2018 in Medicine

Lung cancer is a quite common disease, which is characterized by uncontrolled growth of lung tissues. If tumors are left untreated, they can spread into nearby tissue beyond the lung through the process called metastasis. Then, eventually, they will reach other parts of the body. Carcinomas that develop from epithelial cells start in lung and are known as primary lung cancers. Patient survival depends on overall health, stage of the disease, timely help and other factors. The average statistics for the U.S. patients is that fifteen percent of people diagnosed with lung cancer will live five years after the diagnosis is made. As of 2008, almost 1.4 million people die of lung cancer worldwide. It is the most common cause of death related to cancer both in men and women. There are four main histological types of cancer: squamous-cell lung carcinoma, adenocarcinoma, large-cell lung carcinoma, and small-cell lung carcinoma). Some cancers may have a combination of different types. There are also rare types, which include carcinoid tumors, glandular tumors, and undifferentiated carcinomas. While the four main types are treated through surgery and chemotherapy, other tumors may be removed with the help of flexible bronchial treatment.

In adults, bronchial carcinoids make less than 5% of all primary lung tumors.  Nearly 20% of all carcinoids are polyp-like bronchial lesions, which are not involved with the lung and bronchial wall. Bronchial carcinoids are differentiated as “atypical” or “typical” and that has a therapeutic and clinical significance. Atypical carcinoids are more metastatic and aggressive with a ten-year survival rate of less than 60%, while typical carcinoids tend to have a promising prognosis with a ten-year survival rate of more than 90%. Atypical carcinoids have to be regarded as malignant tumors and must be surgically resected. However, the option of bronchoscopic resection may also be considered as a safe and effective alternative to surgery. Carcinoid tumors can be removed through flexible bronchoscopy with the help of conscious sedation.

Flexible bronchoscopy is a procedure, which involves introduction of a flexible tube through the mouth or nose of a patient. It enables to view and explore the bronchial tree in order to find tumors. The procedure should be carried out on the advice of a specialist doctor. It requires local anesthetic in the area through which the bronchoscope is introduced (bronchi, nose, pharynx, or larynx). If the doctor who carries out the procedure thinks it necessary, an intravenous sedative can be used (Flexible Bronchoscopy). Normally, the patient is placed in the prone position. After anesthetic is administered to the point of entry, a bronchoscope is inserted. Following the examination of the bronchi and identifying the problem, a specialist doctor begins the resection procedure. 

Leonardo Fuks from Rabin Medical Center, Israel gave the following analysis of the endobronchial treatment that was conducted under his guidance (Fuks). It included photoresection  performed with the help of Nd-YAG-laser (30-40 W) using flexible bronchoscopy. The operation was carried out under conscious sedation. After the resection procedure, the tumor base was treated by low power setting (15-20 W) in order to prevent recurrence. In case of bleeding, additional safety measures were used alongside a balloon tamponade catheter, which included a rigid bronchoscope. Ambulatory day-care setting was used to perform all the necessary procedures. Repeated bronchoscopic examination was administered to all patients at three, six, and twelve months following the first session. To ensure that there were no recurrences biopsies were taken after each follow-up examination. Surgery was recommended if the tumor remained after four bronchoscopic sessions. Bronchoscopy was repeated every six months for one year and then performed once a year.

Some of the devices that are used in flexible bronchoscopy include:

  • Bronchoscope
  • Olympus EvisExera II cv 160 (superior video imaging technology)
  • Pyxis Anesthesia system
  • DragerFabius GS Anesthesia Machine

A bronchoscope is an instrument that is used for bronchoscopy. It is introduced through the nose or mouth into the large lung airways to diagnose and sometimes treat lung cancer. A flexible bronchoscope is a lighted, flexible, and narrow tube, which is attached to a camera. In case a flexible bronchoscope is used, patient is usually awake. The doctor sprays an anesthetic in the throat and mouth. If the procedure is performed through the nose, numbing drug will be applied to one nostril. During the process of inserting the bronchoscope patients cough at first. However, they stop coughing when the anesthetic (numbing drug) begins to work (Bronchoscopy). And it gets numb enough when the area feels thick. A rigid bronchoscope is a rigid narrow (about 1 cm) tube. Rigid bronchoscopes are used less than flexible bronchoscopes and require general anesthesia in the operating room. Use of a bronchoscope helps doctors to examine large lung airways in order to remove foreign objects, detect abnormalities, and treat cancers.

Bronchoscopes go together with video systems that use modern technologies in order to provide accurate images and record the results in the digital format. Olympus 160 system is an example of such system, which is made of Olympus CV-160 video processor, Olympus CLV-160 light source, pigtail, and keyboard. CV-160 was designed for the EVIS EXERA 160 Series and includes a video signal-processing technology, which is configured to special frequency components. They are designed for obtaining endoscopic images, which makes it possible to enhance details. That results in a more detailed image enabling to notice subtle color variations and minute tissue textures on the mucous membrane. The versatility of the CV-160 video system also allows accommodation of video bronchoscopes so that the same system could be used for bronchoscopy. To ensure accurate observation, special frequencies are used to obtain endoscopic images. The device has a digital image terminal, which makes it possible to transfer endoscopic images to PCs for storage (Olympus CV-160 Evis Exera Video Processor).

Bronchoscopy always requires use of some type of medication. Pyxis Anesthesia system 4000 provides automatic management of medication in procedural areas or operation rooms. This system assists in maximizing distribution capacity and, at the same time, enables convenient access to medications. Anesthesia system grants visibility of medication inventory. The system helps to obtain maximum medication storage capacity providing a number of drawers. Pyxis Anesthesia system provides assistance in distribution of medication eliminating the system of carts and trays. The system stores electronically transferred information to help with the documentation work. Pyxis Anesthesia system also protects against unauthorized access to restricted substances (Pyxis Anesthesia system 4000).

And ventilation machines are necessary when performing procedures in lungs. DragerFabius GS Anesthesia Machine is a device that includes a high contrast, integrated monitor, virtual flow tubes, and a mechanical tube. The monitor displays important ventilation curves and parameters in real time, virtual tubes show individual gas flows, and a mechanical tube reflects the total flow of gas. The system is mounted on a highly maneuverable trolley and has a central brake for easy positioning of workstation. The system has the following features: high performance ventilation that is more economical than conventional gas-driven ventilators, and a compact breathing system designed for optimal positioning. The monitoring solution allows simultaneous viewing of clinical data and patient. It is ready for IT-integration and integration into existing system of hospital information. It provides continuous monitoring during transport (Drager Fabius GS Anesthesia Machine).  

Some types of lung cancer like carcinoid tumors can be removed through flexible bronchoscopy with the help of conscious sedation. This procedure requires use of such machines as a Bronchoscope, Olympus EvisExera II cv 160 (superior video imaging technology), Pyxis Anesthesia system, and DragerFabius GS Anesthesia Machine.

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