Abstract
Flexible and rigid bronchoscopes are complementary tools for the evaluation and treatment of a variety of airway disorders. Each device has its unique set of advantages and drawbacks. Although there are several instruments that can be used with either apparatus, the operation of each type of bronchoscope varies significantly. In the right hands, the combination of bronchoscopes forms the foundation of comprehensive airway disease management. They have a wide range of applications in the diagnosis and treatment of both benign and malignant airway diseases. Independent of the type of bronchoscope used, the cornerstones of procedural success remain the same: expert skillset, appropriate patient selection, optimal positioning, control of the procedural environment, deliberate movements, and an in-depth understanding of local anatomy. In this chapter, we discuss the history, design, and contemporary applications within thoracic medicine of these two essential tools.
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References
Ernst A, Herth FJF. Principles and practice of interventional pulmonology. 1st ed. New York: Springer New York. Imprint: Springer.; 2013. https://doi.org/10.1007/978-1-4614-4292-9.
Alraiyes AH, Machuzak MS. Rigid bronchoscopy. Semin Respir Crit Care Med. 2014;35(6):671–80. https://doi.org/10.1055/s-0034-1395500.
Becker HD, Marsh BR. History of the rigid bronchoscope. Basel: Karger, Prog Respir Res; 2000. p. 2–15.
Bolliger CT, Mathur PN. Interventional bronchoscopy. Basel/New York: Karger; 2000.
Giddings CE, Rimmer J, Weir N. Chevalier Jackson: pioneer and protector of children. J Laryngol Otol. 2013;127(7):638–42. https://doi.org/10.1017/S0022215113001084.
Tellis GJ. Disruptive technology or visionary leadership? J Prod Innov Manag. 2006;23(1):34–8.
Toty L, Personne C, Colchen A, Vourc’H G. Bronchoscopic management of tracheal lesions using the neodymium yttrium aluminium garnet laser. Thorax. 1981;36(3):175–8. https://doi.org/10.1136/thx.36.3.175.
Panchabhai TS, Mehta AC. Historical perspectives of bronchoscopy. Connecting the dots. Ann Am Thorac Soc. 2015;12(5):631–41. https://doi.org/10.1513/annalsats.201502-089ps.
Dumon J-F. A dedicated tracheobronchial stent. Chest. 1990;97(2):328–32. https://doi.org/10.1378/chest.97.2.328.
Levin DC, Wicks AB, Ellis JH Jr. Transbronchial lung biopsy via the fiberoptic bronchoscope. Am Rev Respir Dis. 1974;110(1):4–12.
Avasarala SK, Freitag L, Mehta AC. Metallic endobronchial stents: a contemporary resurrection. Chest. 2019;155(6):1246–59. https://doi.org/10.1016/j.chest.2018.12.001.
Hsia DW, Tanner NT, Shamblin C, Mehta HJ, Silvestri GA, Musani AI. The latest generation in flexible bronchoscopes: a description and evaluation. J Bronchol Interv Pulmonol. 2013;20(4):357–62.
America O: diagnostic bronchoscope (BF-H190). 2020. https://medical.olympusamerica.com/products/bronchoscope/diagnostic-bronchoscope-bf-h190. Accessed 10/19/2020.
Batra H, Yarmus L. Indications and complications of rigid bronchoscopy. Expert Rev Respir Med. 2018;12(6):509–20. https://doi.org/10.1080/17476348.2018.1473037.
Ginsberg RJ, Vokes E, Ruben A. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. 5th ed. Philadelphia: Lippincott-Raven; 1997.
Daneshvar C, Falconer WE, Ahmed M, Sibly A, Hindle M, Nicholson TW, et al. Prevalence and outcome of central airway obstruction in patients with lung cancer. BMJ Open Respir Res. 2019;6(1):e000429. https://doi.org/10.1136/bmjresp-2019-000429.
Murgu SD, Egressy K, Laxmanan B, Doblare G, Ortiz-Comino R, Hogarth DK. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest. 2016;150(2):426–41. https://doi.org/10.1016/j.chest.2016.02.001.
Oberg CL, Holden VK, Channick CL. Benign central airway obstruction. Semin Respir Crit Care Med. 2018;39(6):731–46. https://doi.org/10.1055/s-0038-1676574.
Casas DB, Fernández-Bussy S, Folch E, Aldeyturriaga JF, Majid A. Non-malignant central airway obstruction. Arch Bronconeumol (English Edition). 2014;50(8):345–54.
Petrella F, Borri A, Casiraghi M, Cavaliere S, Donghi S, Galetta D, et al. Operative rigid bronchoscopy: indications, basic techniques and results. Multimed Man Cardiothorac Surg. 2014;2014:1–6.
DiBardino DM, Lanfranco AR, Haas AR. Bronchoscopic cryotherapy. Clinical applications of the cryoprobe, cryospray, and cryoadhesion. Ann Am Thorac Soc. 2016;13(8):1405–15. https://doi.org/10.1513/AnnalsATS.201601-062FR.
Browning R, Turner JF Jr, Parrish S. Spray cryotherapy (SCT): institutional evolution of techniques and clinical practice from early experience in the treatment of malignant airway disease. J Thorac Dis. 2015;7:S405–S14.
Colt HG, Harrell JH. Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airways obstruction. Chest. 1997;112(1):202–6. https://doi.org/10.1378/chest.112.1.202.
Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, et al. Complications following therapeutic bronchoscopy for malignant central airway obstruction: results of the AQuIRE registry. Chest. 2015;148(2):450–71. https://doi.org/10.1378/chest.14-1530.
Shepherd RW, Radchenko C. Bronchoscopic ablation techniques in the management of lung cancer. Ann Transl Med. 2019;7(15):362. https://doi.org/10.21037/atm.2019.04.47.
Chin CS, Litle V, Yun J, Weiser T, Swanson SJ. Airway stents. Ann Thorac Surg. 2008;85(2):S792–S6.
Gesthalter YB, Seeley EJ. Flexible bronchoscopic deployment of a silicone bronchial stent. J Bronchology Interv Pulmonol. 2020;27(1):e10–e2. https://doi.org/10.1097/LBR.0000000000000635.
Corporation© B: Bryan-Dumon™ Series II rigid bronchoscope and stent placement kit user manual. 2008. http://www.lymolmedical.com/images/UserManualBronchSmall8-13.pdf. Accessed 09/17/2020.
Thoracent: BONASTENT tracheal/bronchial stent. 2017. https://thoracent.com/tracheal-bronchial-stents. Accessed 09/15/2018.
Systems MM. AERO® fully covered tracheobronchial stent. 2018. http://endotek.merit.com/files/docs/401871001_D_Aero_Brochure.pdf. Accessed 09/18/2018.
Atrium: atrium iCAST™ balloon expandable covered stent. http://www.atriummed.com/en/interventional/icast.asp. Accessed 09/18/2018.
Sethi S, Gildea TR, Almeida FA, Cicenia JC, Machuzak MS. Clinical success stenting distal bronchi for “lobar salvage” in bronchial stenosis. J Bronchol Interv Pulmonol. 2018;25(1):9–16. https://doi.org/10.1097/lbr.0000000000000422.
Majid A, Kheir F, Chung J, Alape D, Husta B, Oh S, et al. Covered balloon-expanding stents in airway stenosis. J Bronchology Interv Pulmonol. 2017;24(2):174–7. https://doi.org/10.1097/lbr.0000000000000364.
Folch E, Keyes C. Airway stents. Ann Cardiothorac Surg. 2018;7(2):273–83. https://doi.org/10.21037/acs.2018.03.08.
Lunn W, Feller-Kopman D, Wahidi M, Ashiku S, Thurer R, Ernst A. Endoscopic removal of metallic airway stents. Chest. 2005;127(6):2106–12.
Murthy SC, Gildea TR, Mehta AC. Removal of self-expandable metallic stents: is it possible? Seminars in respiratory and critical care medicine: Copyright© 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001; 2004. p. 381–5.
Khemasuwan D, Gildea TR, Machuzak MS. Complex metallic stent removal: decade after deployment. J Bronchol Interv Pulmonol. 2014;21(4):358–60. https://doi.org/10.1097/lbr.0000000000000101.
Lund ME, Force S. Airway stenting for patients with benign airway disease and the Food and Drug Administration advisory: a call for restraint. Chest. 2007;132(4):1107–8. https://doi.org/10.1378/chest.07-0242.
Lee HJ, Labaki W, Yu DH, Salwen B, Gilbert C, Schneider ALC, et al. Airway stent complications: the role of follow-up bronchoscopy as a surveillance method. J Thorac Dis. 2017;9(11):4651–9. https://doi.org/10.21037/jtd.2017.09.139.
Matsuo T, Colt HG. Evidence against routine scheduling of surveillance bronchoscopy after stent insertion. Chest. 2000;118(5):1455–9. https://doi.org/10.1378/chest.118.5.1455.
Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997;112(2):440–4.
Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020;157(1):77–88. https://doi.org/10.1016/j.chest.2019.07.012.
Sakr L, Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration. 2010;80(1):38–58.
Radchenko C, Alraiyes AH, Shojaee S. A systematic approach to the management of massive hemoptysis. J Thorac Dis. 2017;9(Suppl 10):S1069–s86. https://doi.org/10.21037/jtd.2017.06.41.
Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Intervent Radiol. Thieme Medical Publishers;. 2011;28:48.
Langendijk JA, ten Velde GPM, Aaronson NK, de Jong JMA, Muller MJ, Wouters EFM. Quality of life after palliative radiotherapy in non-small cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys. 2000;47(1):149–55. https://doi.org/10.1016/S0360-3016(99)00540-4.
Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis. 2017;9(9):3398–409. https://doi.org/10.21037/jtd.2017.06.137.
Tseng CC, Hsiao TY, Hsu WC. Comparison of rigid and flexible endoscopy for removing esophageal foreign bodies in an emergency. J Formos Med Assoc/Taiwan yi zhi. 2016;115(8):639–44. https://doi.org/10.1016/j.jfma.2015.05.016.
Dikensoy O, Usalan C, Filiz A. Foreign body aspiration: clinical utility of flexible bronchoscopy. Postgrad Med J. 2002;78(921):399–403.
Swanson KL. Airway foreign bodies: what’s new? Seminars in respiratory and critical care medicine. New York: Thieme Medical Publishers, c1994;; 2004. p. 405–11.
Sehgal IS, Dhooria S, Ram B, Singh N, Aggarwal AN, Gupta D, et al. Foreign body inhalation in the adult population: experience of 25,998 bronchoscopies and systematic review of the literature. Respir Care. 2015;60(10):1438–48. https://doi.org/10.4187/respcare.03976.
Doyle DJ, Hantzakos AG. Anesthetic management of the narrowed airway. Otolaryngol Clin North Am. 2019;52(6):1127–39. https://doi.org/10.1016/j.otc.2019.08.010.
Chacon-Alves S, Perez-Vela JL, Grau-Carmona T, Dominguez-Aguado H, Marin-Mateos H, Renes-Carreno E. Veno-arterial ECMO for rescue of severe airway hemorrhage with rigid bronchoscopy after pulmonary artery thromboendarterectomy. Int J Artif Organs. 2016;39(5):242–4. https://doi.org/10.5301/ijao.5000493.
Park AH, Tunkel DE, Park E, Barnhart D, Liu E, Lee J, et al. Management of complicated airway foreign body aspiration using extracorporeal membrane oxygenation (ECMO). Int J Pediatr Otorhinolaryngol. 2014;78(12):2319–21. https://doi.org/10.1016/j.ijporl.2014.10.021.
Kim JH, Shin JH, Shim TS, Oh YM, Song HY. Deep tracheal laceration after balloon dilation for benign tracheobronchial stenosis: case reports of two patients. Br J Radiol. 2006;79(942):529–35. https://doi.org/10.1259/bjr/17839516.
Salaria ON, Suthar R, Abdelfattah S, Hoyos J. Perioperative management of an airway fire: a case report. A A Pract. 2018;10(1):5–9. https://doi.org/10.1213/xaa.0000000000000620.
Lukomsky GI, Ovchinnikov AA, Bilal A. Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia. Chest. 1981;79(3):316–21. https://doi.org/10.1378/chest.79.3.316.
Drummond M, Magalhães A, Hespanhol V, Marques A. Rigid bronchoscopy: complications in a University Hospital. Journal of Bronchology & Interventional Pulmonology. 2003;10(3):177–82.
Murgu S, Laxmanan B, Stoy S, Egressy K, Chaddha U, Farooqui F, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration. 2020;99(3):239–47. https://doi.org/10.1159/000504679.
ACGME: ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine (internal medicine). https://www.upstate.edu/pulmcc/pdf/Pulm.pdf. Accessed 09/19/2020.
Mullon JJ, Burkart KM, Silvestri G, Hogarth DK, Almeida F, Berkowitz D, et al. Interventional pulmonology fellowship accreditation standards: executive summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee. Chest. 2017;151(5):1114–21. https://doi.org/10.1016/j.chest.2017.01.024.
Aslam W, Lee HJ, Lamb CR. Standardizing education in interventional pulmonology in the midst of technological change. J Thorac Dis. 2020;12(6):3331–40. https://doi.org/10.21037/jtd.2020.03.104.
Cold KM, Konge L, Clementsen PF, Nayahangan LJ. Simulation-based mastery learning of flexible bronchoscopy: deciding factors for completion. Respiration. 2019;97(2):160–7. https://doi.org/10.1159/000493431.
Kennedy CC, Maldonado F, Cook DA. Simulation-based bronchoscopy training: systematic review and meta-analysis. Chest. 2013;144(1):183–92. https://doi.org/10.1378/chest.12-1786.
Blum MG, Powers TW, Sundaresan S. Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy. Ann Thorac Surg. 2004;78(1):287–91.
Mallow C, Shafiq M, Thiboutot J, Yu DH, Batra H, Lunz D, et al. Impact of video game cross-training on learning bronchoscopy. a pilot randomized controlled trial. ATS Scholar. 2020:ats-scholar. 2019-0015OC.
Kennedy CC, Maldonado F, Cook DA. Simulation-based bronchoscopy training. Chest. 2013;144(1):183–92. https://doi.org/10.1378/chest.12-1786.
Royds J, Buckley MA, Campbell MD, Donnelly GM, James MFM, Mhuircheartaigh RN, et al. Achieving proficiency in rigid bronchoscopy-a study in manikins. Ir J Med Sci. 2019;188(3):979–86. https://doi.org/10.1007/s11845-018-1944-5.
Mahmood K, Wahidi MM, Osann KE, Coles K, Shofer SL, Volker EE, et al. Development of a tool to assess basic competency in the performance of rigid bronchoscopy. Ann Am Thorac Soc. 2016;13(4):502–11. https://doi.org/10.1513/AnnalsATS.201509-593OC.
Gafford JB, Webster S, Dillon N, Blum E, Hendrick R, Maldonado F, et al. A concentric tube robot system for rigid bronchoscopy: a feasibility study on central airway obstruction removal. Ann Biomed Eng. 2020;48(1):181–91. https://doi.org/10.1007/s10439-019-02325-x.
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Avasarala, S.K., Gillaspie, E.A., Maldonado, F. (2021). Rigid Versus Flexible Bronchoscopy. In: Turner, Jr., J.F., Jain, P., Yasufuku, K., Mehta, A.C. (eds) From Thoracic Surgery to Interventional Pulmonology. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-80298-1_1
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