Download PDF
Semin Respir Crit Care Med 2014; 35(06): 671-680
DOI: 10.1055/s-0034-1395500
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Rigid Bronchoscopy

Abdul Hamid Alraiyes
1   Division of Interventional Pulmonology, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
,
Michael S. Machuzak
2   Department of Pulmonary Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
02 December 2014 (online)

    Permissions and Reprints

Abstract

The purpose of this article is to provide an introduction to rigid bronchoscopy (RB). We will briefly discuss its history, evolution, and resurgence while we highlight its versatility and usefulness for today's interventional pulmonologist and thoracic surgeon. Despite being one of the earliest pulmonary procedures described, RB is still an important technique. Advances in thoracic medicine have made this skill critical for a fully functional interventional pulmonary program. If the interventional pulmonologist of this century is to be successful, he or she should be facile in this technique. Despite the availability of RB for decades, the invention of flexible bronchoscopy in 1966 led to a significant downturn in its usage. The growth of the interventional pulmonology field brought RB back into the spot light. Apart from the historic role of RB in treatment of central airway lesions and mechanical debulking of endobronchial lesions, RB is the key instrument that can adapt modern therapeutic tools such as laser, argon plasma coagulation, electrocautery, cryotherapy, and stent deployment. Performing RB requires proper preprocedure preparation, exceptional understanding of upper airway anatomy, specific hand–eye coordination, and open communication between the bronchoscopist and the anesthesiologist. These skills can be primarily learned and maintained with repetition. This article will review information relevant to this technique and lay a foundation to be built upon for years to come.

Keywords

rigid bronchoscopy - rigid intubation - endobronchial tumor - therapeutic rigid bronchoscopy - foreign body extraction - massive hemoptysis
 

  • References

  • 1 Bryce DP, Nunis DB. The American Laryngological Association, 1878–1978: A Centennial History. Washington: American Laryngological Association; 1978
    Google Scholar
  • 2 Ayers ML, Beamis Jr JF. Rigid bronchoscopy in the twenty-first century. Clin Chest Med 2001; 22 (2) 355-364
    CrossrefPubMedGoogle Scholar
  • 3 Becker HD, Marsh BR. History of the rigid bronchoscope. In: Bollinger CT, Mathur PN, , editors. Interventional bronchoscopy, vol 30. Basel (Switzerland): Karger, Prog Respir Res; 2000: 2-15
    Google Scholar
  • 4 Bolliger CT, Mathur PN. Interventional Bronchoscopy. Basel; New York: Karger; 2000
    Google Scholar
  • 5 Beamis Jr JF. Interventional pulmonology techniques for treating malignant large airway obstruction: an update. Curr Opin Pulm Med 2005; 11 (4) 292-295
    CrossrefPubMedGoogle Scholar
  • 6 Jackson C. The Life of Chevalier Jackson, An Autobiography. New York: The Macmillan Company; 1938
    Google Scholar
  • 7 Helmers RA, Sanderson DR. Rigid bronchoscopy. The forgotten art. Clin Chest Med 1995; 16 (3) 393-399
    PubMedGoogle Scholar
  • 8 Jeon K, Kim H, Yu CM , et al. Rigid bronchoscopic intervention in patients with respiratory failure caused by malignant central airway obstruction. J Thorac Oncol 2006; 1 (4) 319-323
    CrossrefPubMedGoogle Scholar
  • 9 Marel M, Pekarek Z, Spasova I , et al. Management of benign stenoses of the large airways in the university hospital in Prague, Czech Republic, in 1998-2003. Respiration 2005; 72 (6) 622-628
    PubMedGoogle Scholar
  • 10 McMahon CC, Rainey L, Fulton B, Conacher ID. Central airway compression. Anaesthetic and intensive care consequences. Anaesthesia 1997; 52 (2) 158-162
    CrossrefPubMedGoogle Scholar
  • 11 Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169 (12) 1278-1297
    CrossrefPubMedGoogle Scholar
  • 12 Hujala K, Sipilä J, Grenman R. Endotracheal and bronchial laser surgery in the treatment of malign and benign lower airway obstructions. Eur Arch Otorhinolaryngol 2003; 260 (4) 219-222
    PubMedGoogle Scholar
  • 13 Freitag L, Ernst A, Thomas M, Prenzel R, Wahlers B, Macha HN. Sequential photodynamic therapy (PDT) and high dose brachytherapy for endobronchial tumour control in patients with limited bronchogenic carcinoma. Thorax 2004; 59 (9) 790-793
    CrossrefPubMedGoogle Scholar
  • 14 Han CC, Prasetyo D, Wright GM. Endobronchial palliation using Nd:YAG laser is associated with improved survival when combined with multimodal adjuvant treatments. J Thorac Oncol 2007; 2 (1) 59-64
    CrossrefPubMedGoogle Scholar
  • 15 Gompelmann D, Eberhardt R, Schuhmann M, Heussel CP, Herth FJ. Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis. Ther Adv Respir Dis 2013; 7 (5) 255-263
    CrossrefPubMedGoogle Scholar
  • 16 Hollingsworth HM. Wheezing and stridor. Clin Chest Med 1987; 8 (2) 231-240
    PubMedGoogle Scholar
  • 17 Honings J, Gaissert HA, van der Heijden HF, Verhagen AF, Kaanders JH, Marres HA. Clinical aspects and treatment of primary tracheal malignancies. Acta Otolaryngol 2010; 130 (7) 763-772
    CrossrefPubMedGoogle Scholar
  • 18 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) 202-206
    CrossrefPubMedGoogle Scholar
  • 19 Mathisen DJ, Grillo HC. Endoscopic relief of malignant airway obstruction. Ann Thorac Surg 1989; 48 (4) 469-473 , discussion 473–475
    CrossrefPubMedGoogle Scholar
  • 20 Ost D. Photodynamic therapy in lung cancer. A review. Methods Mol Med 2003; 75: 507-526
    PubMedGoogle Scholar
  • 21 Kvale PA, Eichenhorn MS, Radke JR, Miks V. YAG laser photoresection of lesions obstructing the central airways. Chest 1985; 87 (3) 283-288
    CrossrefPubMedGoogle Scholar
  • 22 Chella A, Ambrogi MC, Ribechini A , et al. Combined Nd-YAG laser/HDR brachytherapy versus Nd-YAG laser only in malignant central airway involvement: a prospective randomized study. Lung Cancer 2000; 27 (3) 169-175
    CrossrefPubMedGoogle Scholar
  • 23 Coulter TD, Mehta AC. The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection. Chest 2000; 118 (2) 516-521
    CrossrefPubMedGoogle Scholar
  • 24 Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 2001; 119 (3) 781-787
    CrossrefPubMedGoogle Scholar
  • 25 Chhajed PN, Malouf MA, Glanville AR. Bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis. Intern Med J 2001; 31 (9) 512-516
    Google Scholar
  • 26 De Gracia J, Culebras M, Alvarez A , et al. Bronchoscopic balloon dilatation in the management of bronchial stenosis following lung transplantation. Respir Med 2007; 101 (1) 27-33
    CrossrefPubMedGoogle Scholar
  • 27 Madan K, Agarwal R, Aggarwal AN, Gupta D. Utility of rigid bronchoscopic dilatation and mitomycin C application in the management of postintubation tracheal stenosis: case series and systematic review of literature. J Bronchology Interv Pulmonol 2012; 19 (4) 304-310
    CrossrefPubMedGoogle Scholar
  • 28 Pearson FG. Technique of management of subglottic stenosis. Chest Surg Clin N Am 1996; 6 (4) 683-692
    Google Scholar
  • 29 Goto T, Akanabe K, Oyamada Y, Kato R. A new technique for T tube insertion in severe subglottic stenosis. Interact Cardiovasc Thorac Surg 2011; 12 (6) 895-898
    CrossrefPubMedGoogle Scholar
  • 30 Tedde ML, Rodrigues A, Scordamaglio PR, Monteiro JS. A new technique for T-tube insertion in patients with subglottic stenosis. Eur J Cardiothorac Surg 2011; 39 (1) 130-131
    CrossrefPubMedGoogle Scholar
  • 31 Folch E, Mehta AC. Airway interventions in the tracheobronchial tree. Semin Respir Crit Care Med 2008; 29 (4) 441-452
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Wood DE, Liu YH, Vallières E, Karmy-Jones R, Mulligan MS. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 2003; 76 (1) 167-172 , discussion 173–174
    CrossrefPubMedGoogle Scholar
  • 33 Casal RF. Update in airway stents. Curr Opin Pulm Med 2010; 16 (4) 321-328
    CrossrefPubMedGoogle Scholar
  • 34 Noppen M, Stratakos G, Amjadi K , et al. Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease. Respir Med 2007; 101 (1) 139-145
    CrossrefPubMedGoogle Scholar
  • 35 Miyazawa T, Miyazu Y, Iwamoto Y , et al. Stenting at the flow-limiting segment in tracheobronchial stenosis due to lung cancer. Am J Respir Crit Care Med 2004; 169 (10) 1096-1102
    CrossrefPubMedGoogle Scholar
  • 36 Nicolai T. Foreign body aspiration in children [in German]. MMW Fortschr Med 2013; 155 (16) 36-37
    PubMedGoogle Scholar
  • 37 Ghaffarlou M, Golzari SE, Nezami N. A large asymptomatic foreign body in larynx and trachea. Quant Imaging Med Surg 2014; 4 (3) 210-211
    PubMedGoogle Scholar
  • 38 Johns S, Sellon R, Spencer E, Tucker M. Tracheal Foreign Body and Pneumonia in a Cat: A Near Missed Diagnosis. J Am Anim Hosp Assoc 2014; 50 (4) 273-277
    CrossrefPubMedGoogle Scholar
  • 39 Rafanan AL, Mehta AC. Adult airway foreign body removal. What's new?. Clin Chest Med 2001; 22 (2) 319-330
    CrossrefPubMedGoogle Scholar
  • 40 Conlan AA, Hurwitz SS. Management of massive haemoptysis with the rigid bronchoscope and cold saline lavage. Thorax 1980; 35 (12) 901-904
    CrossrefPubMedGoogle Scholar
  • 41 Colchen A, Fischler M. Emergency interventional bronchoscopies [in French]. Rev Pneumol Clin 2011; 67 (4) 209-213
    CrossrefPubMedGoogle Scholar
  • 42 Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber OC. Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis. Chest 2005; 127 (6) 2113-2118
    CrossrefPubMedGoogle Scholar
  • 43 Reisz G. Topical hemostatic tamponade: another tool in the treatment of massive hemoptysis. Chest 2005; 127 (6) 1888-1889
    CrossrefPubMedGoogle Scholar
  • 44 Sakr L, Dutau H. Massive hemoptysis: an update on the role of bronchoscopy in diagnosis and management. Respiration 2010; 80 (1) 38-58
    CrossrefPubMedGoogle Scholar
  • 45 Solomonov A, Fruchter O, Zuckerman T, Brenner B, Yigla M. Pulmonary hemorrhage: A novel mode of therapy. Respir Med 2009; 103 (8) 1196-1200
    CrossrefPubMedGoogle Scholar
  • 46 Plummer S, Hartley M, Vaughan RS. Anaesthesia for telescopic procedures in the thorax. Br J Anaesth 1998; 80 (2) 223-234
    CrossrefPubMedGoogle Scholar
  • 47 Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc 2014; 11 (4) 628-634
    PubMedGoogle Scholar
  • 48 Biro P, Layer M, Wiedemann K, Seifert B, Spahn DR. Carbon dioxide elimination during high-frequency jet ventilation for rigid bronchoscopy. Br J Anaesth 2000; 84 (5) 635-637
    CrossrefPubMedGoogle Scholar
  • 49 Perrin G, Colt HG, Martin C, Mak MA, Dumon JF, Gouin F. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation. A prospective study. Chest 1992; 102 (5) 1526-1530
    CrossrefPubMedGoogle Scholar
  • 50 Abdelmalak B, Marcanthony N, Abdelmalak J, Machuzak MS, Gildea TR, Doyle DJ. Dexmedetomidine for anesthetic management of anterior mediastinal mass. J Anesth 2010; 24 (4) 607-610
    CrossrefPubMedGoogle Scholar
  • 51 Sarkiss M. Anesthesia for bronchoscopy and interventional pulmonology: from moderate sedation to jet ventilation. Curr Opin Pulm Med 2011; 17 (4) 274-278
    CrossrefPubMedGoogle Scholar
  • 52 Fernandez-Bustamante A, Ibañez V, Alfaro JJ , et al. High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications. J Clin Anesth 2006; 18 (5) 349-356
    CrossrefPubMedGoogle Scholar
  • 53 Eberhard P. Comparison of transcutaneous and end-tidal CO2-monitoring for rigid bronchoscopy during high-frequency jet ventilation. Acta Anaesthesiol Scand 2004; 48 (2) 260 , author reply 261
    CrossrefPubMedGoogle Scholar
  • 54 Neyman K, Sundset A, Espinoza A, Kongerud J, Fosse E. Survival and complications after interventional bronchoscopy in malignant central airway obstruction: a single-center experience. J Bronchology Interv Pulmonol 2011; 18 (3) 233-238
    CrossrefPubMedGoogle Scholar
  • 55 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) 529-535
    CrossrefPubMedGoogle Scholar
  • 56 Kim JH, Shin JH, Song HY , et al. Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance. Chest 2007; 131 (4) 1114-1117
    Google Scholar
  • 57 Gompelmann D, Eberhardt R, Herth FJ. Interventional pulmonology procedures: an update. Panminerva Med 2013; 55 (2) 121-129
    PubMedGoogle Scholar
  • 58 Caputi M, Bellissimo U, Di Matteo L, Aliberti M, Perna B, Speranza A. Complications during bronchofiberscopy and rigid bronchoscopy. Panminerva Med 1986; 28 (3) 271-277
    PubMedGoogle Scholar
  • 59 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) 316-321
    CrossrefPubMedGoogle Scholar
  • 60 Pastis NJ, Nietert PJ, Silvestri GA ; American College of Chest Physicians Interventional Chest/Diagnostic Procedures Network Steering Committee. Variation in training for interventional pulmonary procedures among US pulmonary/critical care fellowships: a survey of fellowship directors. Chest 2005; 127 (5) 1614-1621
    CrossrefPubMedGoogle Scholar
  • 61 Kennedy CC, Maldonado F, Cook DA. Simulation-based bronchoscopy training: systematic review and meta-analysis. Chest 2013; 144 (1) 183-192
    CrossrefPubMedGoogle Scholar