Safety of Laser and Thermal Therapy During Rigid Bronchoscopy Using Manual Hand Jet Ventilation

2021 ◽  
Vol 39 ◽  
Author(s):  
Amit Mahajan ◽  
◽  
Priya Patel ◽  
Radhika Garg ◽  
Christopher Manley ◽  
...  
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Thermal Therapy ◽  
Breath Hold ◽  
Jet Ventilation ◽  
Study Objective ◽  
Ablative Therapies ◽  
Thermal Therapies ◽  
Airway Obstructions

Introduction: Thermal ablative therapies (laser, radiofrequency ablation, electrocautery, argon plasma coagulation) are often used during rigid bronchoscopy for the treatment of central airway obstructions (CAO). An airway fire is a feared complication that can occur during endobronchial thermal ablation. Materials and Methods: This was a single-center, retrospective, observational study. A total of 175 patients were reviewed undergoing rigid bronchoscopy in the operating room and bronchoscopy suite requiring manual hand jet ventilation and thermal therapy between September 2014 and September 2018. The study objective was to determine the safety of manual hand jet ventilation during endobronchial thermal therapies with rigid bronchoscopy. Results: Over a five-year period, 175 patients underwent endobronchial thermal therapy during rigid bronchoscopy with manual hand jet ventilation for the treatment CAOs. Immediately prior to thermal therapy activation, jet ventilation was paused. No incidences (0/175) of airway fires occurred despite immediate delivery of thermal energy following a jet ventilation hold. Conclusions: Results of our study show that performing thermal ablative therapy during rigid bronchoscopy with jet ventilation using a breath-hold technique is safe.

Different effects of bronchoscopic interventions on children and adults with tracheobronchial mucoepidermoid carcinoma

2021 ◽  
pp. 030089162199589
Author(s):  
Zhang Jieli ◽  
Zhou Yunzhi ◽  
Zhang Nan ◽  
Zou Heng ◽  
Wang Hongwu ◽  
...  
Keyword(s):  
Mucoepidermoid Carcinoma ◽  
Argon Plasma Coagulation ◽  
Survival Rates ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Low Grade ◽  
High Grade ◽  
Adult Group ◽  
Histologic Grading ◽  
Comprehensive Therapy

Aims: To investigate the efficacy and safety of minimally invasive bronchoscopic interventions for patients with tracheobronchial mucoepidermoid carcinoma (MEC). Methods: Patients with tracheobronchial MEC were included in this retrospective study, and the clinical features, histologic grading, treatments, and cumulative survival rates were calculated. Patients were categorized into child (n = 16) and adult (n = 19) group according to their ages. Histologic grading, treatments, and survival status were compared between the two groups. Results: In pathology, high-grade MEC counts for 6.77% and 42.10% in the child and adult group, respectively. As tumor growth pattern was concerned, 93.33% and 21.05% tumors in the child and adult group present intratracheal type. Multiple bronchoscopic interventions were conducted, including rigid bronchoscopy, argon plasma coagulation (APC), dioxide carbon cryotherapy, and electric loop. Tumors could be removed by multiple bronchoscopic interventions. Bronchoscopy-associated complications were rare, including an oral mucosa injury and a glottis edema. In the child group, one patient underwent left upper lung lobectomy. In the adult group, lobectomy and/or chemotherapy and/or radiotherapy were conducted in seven patients. The 5-year survival rate was 100% and 68.90% in the child and the adult group, respectively. Conclusions: Almost all children have low-grade and intratracheal MEC; 2/5 adults have invasive high-grade MEC. Multiple bronchoscopic interventions are effective in erasing low-grade intratracheal MEC without severe complications. For high-grade invasive MEC, aggressive and comprehensive therapy should be considered.

scholarly journals Primary intratracheal schwannoma resected during bronchoscopy using argon plasma coagulation

2018 ◽  
pp. bcr-2018-225140
Author(s):  
Purva V Sharma ◽  
Yash B Jobanputra ◽  
Tatiana Perdomo Miquel ◽  
J Ryan Schroeder ◽  
Adam Wellikoff
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Cost Effective ◽  
Rigid Bronchoscopy ◽  
Vascular Lesions ◽  
Interventional Bronchoscopy ◽  
Plasma Coagulation ◽  
Nd:Yag Lasers ◽  
Initial Work ◽  
Contrast Ct

A 63-year-old man presented with intermittent, progressively worsening dyspnoea associated with cough and blood-tinged sputum. Initial work-up showed left axis deviation on ECG, chest X-ray with an elevated left hemidiaphragm and a non-contrast CT chest that showed a multilobulated mass in the proximal trachea. Bronchoscopy showed a whitish-appearing lesion, which was then sampled and partially resected with pathology showing a schwannoma with no malignant cells. He felt partial relief post procedure; however, he presented a month later with similar symptoms of dyspnoea and a repeat CT scan showed enlargement of the mass in the same location. The patient underwent another flexible bronchoscopy and resection with argon plasma coagulation (APC)/electrocautery snare. APC/electrocautery is an effective interventional bronchoscopy technique that can be used to resect endoluminal lesions or extraluminal lesions that have infiltrated into the airway using flexible/rigid bronchoscopy. It is more cost-effective, safe, works well with vascular lesions and achieves excellent haemostasis as compared with Nd:YAG lasers.

scholarly journals Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

2015 ◽  
Vol 3 (9) ◽  
pp. 14
Author(s):  
Audra Fuller ◽  
Mark Sigler ◽  
Shrinivas Kambali ◽  
Raed Alalawi
Keyword(s):  
Mitomycin C ◽  
Topical Application ◽  
Tracheal Stenosis ◽  
Argon Plasma Coagulation ◽  
Balloon Dilation ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Definitive Treatment ◽  
Plasma Coagulation ◽  
Post Intubation

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures.  Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.

scholarly journals Therapeutic bronchoscopy for central airway diseases

2020 ◽  
Vol 29 (158) ◽  
pp. 190178
Author(s):  
Antoni Rosell ◽  
Grigoris Stratakos
Keyword(s):  
Argon Plasma Coagulation ◽  
Three Dimensional ◽  
Argon Plasma ◽  
Massive Bleeding ◽  
Rigid Bronchoscopy ◽  
Metal Stents ◽  
Past Century ◽  
Airway Diseases ◽  
Dedicated Team ◽  
Central Airway

Over the past century rigid bronchoscopy has been established as the main therapeutic means for central airway diseases of both benign and malignant aetiology. Its use requires general anaesthesia and mechanical ventilation usually in the form of manual or high-frequency jet ventilation. Techniques applied to regain patency of the central airways include mechanical debulking, thermal ablation (laser, electrocautery and argon plasma coagulation) and cryo-surgery. Each of these techniques have their advantages and limitations and best results can be attained by combining different modalities according to the type, location and extent of the airway blockage. If needed, deployment of airway endoprostheses (stents), as either fixed-diameter silicone or self-expandable metal stents, may preserve the airways patency often at the cost of several complications. Newer generation of customised stents either three-dimensional printed or drug-eluting stents constitute a promise for improved safety and efficacy results in the near future. Treating central disease of benign or malignant aetiology, foreign body aspiration or massive bleeding in the airways requires a structured approach with combined techniques, a dedicated team of professionals and experience to treat eventual complications. Specific training and fellowships in interventional pulmonology should therefore be offered to those who wish to specialise in this field.

scholarly journals Endobronchial Schwannoma Treated by Rigid Bronchoscopy with Argon Plasma Coagulation

2012 ◽  
Vol 73 (3) ◽  
pp. 174 ◽  
Author(s):  
Bo Ram Lee ◽  
Yoo Duk Choi ◽  
Yu Il Kim ◽  
Sung Chul Lim ◽  
Yong Soo Kwon
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Plasma Coagulation

scholarly journals Placement of self-expandable bifurcated metallic stents without use of fluoroscopic and guidewire guidance to palliate central airway lesions

2016 ◽  
Vol 11 ◽  
Author(s):  
Cengiz Özdemir ◽  
Sinem Nedime Sökücü ◽  
Levent Karasulu ◽  
Seda Tural Önür ◽  
Levent Dalar
Keyword(s):  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Cost Effective ◽  
Metallic Stents ◽  
Rigid Bronchoscope ◽  
Airway Obstructions ◽  
Thyroid Papillary ◽  
Procedural Complications ◽  
Expandable Metallic Stents

Background: Self-expandable metallic stents (SEMS) can be used to treat malignant obstructions and fistulas of the central airways. SEMS can be placed using different methods. Recently, a rigid bronchoscope has been used for stent placement without the need for fluoroscopy. We retrospectively evaluated patients for whom SEMS were placed using a rigid bronchoscope, without employing guidewires or fluoroscopy. We describe the intra- and post-procedural complications of the method. Methods: Data collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records. Results: The mean patient age was 58.14 ± 8.48 years (44–72 years) and 13 out of the 14 patients were male. Twelve had lung cancer, one a thyroid papillary carcinoma with a bronchomediastinal fistula, and one an esophageal carcinoma with a tracheoesophageal fistula. Covered metallic Y-shaped stents were placed in all patients. Before placement, argon plasma coagulation was performed on two patients, diode laser treatment on four, and de-obstruction on nine. No procedure-related mortality was noted. Only two patients required follow-up in the intensive care unit; they were moved to a regular ward after two days. No patient required stent replacement or repositioning. The most common early complication was mucus plugs. Conclusion: Endobronchial placement of covered self-expandable metallic stents was safe and readily performed in patients with airway obstructions. Neither fluoroscopic nor guidewire guidance was required. Neither patients nor staff were exposed to radiation, and costly guidewire guidance was not necessary. The procedure is cost-effective.

scholarly journals Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Elif Tanrıverdi ◽  
Mehmet Akif Özgül ◽  
Oğuz Uzun ◽  
Şule Gül ◽  
Mustafa Çörtük ◽  
...  
Keyword(s):  
Argon Plasma Coagulation ◽  
Amorphous Material ◽  
Argon Plasma ◽  
Rigid Bronchoscopy ◽  
Benign Tumors ◽  
Rare Presentation ◽  
Tracheal Tumor ◽  
Persistent Symptoms ◽  
Neoplastic Lesion ◽  
Tracheobronchial Amyloidosis

Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

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