Introduction

Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. Bronchoscope)is inserted into the airways
through the nose or mouth, or occasionally through a tracheostomy

Types Rigid metal tubes with attached lighting devices Flexible optical fiber instruments with realtime video equipment.

History
A German, Gustav Killian first rigid bronchoscopy in 1897- to remove a pork bone. Till 1970 rigid bronchoscope was used. A Japanese, Shigeto Ikeda - flexible bronchoscope in 1966. The flexible scope initially employed fiberoptic bundles requiring an external light source for illumination. More recently, fiberoptic scopes have been replaced by bronchoscopes with a charge coupled device (CCD) video chip located at their distal extremity.

Types
Rigid brochoscope Flexible brochoscope

Rigid bronchoscope- uses

Rigid bronchoscopy is used for retrieving foreign objects. Massive hemoptysis, defined as loss of >600 mL of blood in 24 hours( medical emergency) The larger lumen of the rigid bronchoscope versus the narrow lumen of the flexible bronchoscope allows for therapeutic approaches such as electrocautery to help control the bleeding.

Rigid bronchoscope

Flexible bronchoscope
A flexible bronchoscope is longer and thinner than a rigid bronchoscope. It contains a fiberoptic system that transmits an image from the tip of the instrument to an eyepiece or video camera at the opposite end. The tip of the instrument can be oriented, allowing the practitioner to navigate the instrument into individual lobe or segment bronchi.

Flexible bronchoscope
Most flexible bronchoscopes also include a channel for suctioning or instrumentation, but these are significantly smaller than those in a rigid bronchoscope. Flexible bronchoscopy causes less discomfort than rigid bronchoscopy and the procedure can be performed easily and safely under moderate sedation. It is the technique of choice nowadays

Flexible bronchoscope

Uses
Diagnostic
To view abnormalities of the airway To obtain tissue specimens of the lung in a variety of disorders. Specimens may be taken from inside the lungs by biopsy, bronchoalveolar lavage, or endobronchial brushing. To evaluate a person who has bleeding in the lungs, possible lung cancer, a chronic cough, sarcoidosis

Uses
Therapeutic
To remove secretions, blood, or foreign objects lodged in the airway Laser resection of tumors or benign tracheal and bronchial strictures Stent insertion to palliate extrinsic compression of the tracheobronchial lumen from either malignant or benign disease processes Tracheal intubation of patients with difficult airways is often performed using a flexible bronchoscope

Procedure Flexible Bronchoscopy

Bronchoscopy room. Antianxiety and antisecretory medications Sedatives such as midazolam or propofol may be used. A local anesthetic is often given to anesthetise the mucous membranes of the pharynx, larynx, and trachea. The patient is monitored during the procedure.

Procedure Flexible Bronchoscopy

A flexible bronchoscope is inserted with the patient in a sitting or supine position. Once the bronchoscope is inserted into the upper airway, the vocal cords are inspected. The instrument is advanced to the trachea and further down into the bronchial system and each area is inspected as the bronchoscope passes. If an abnormality is discovered, it may be sampled, using a brush, a needle, or forceps. Specimen of lung tissue (transbronchial biopsy)

Procedure Rigid Bronchoscopy

Under general anesthesia. Rigid bronchoscopes are too large to allow parallel placement of other devices in the trachea; therefore the anesthesia apparatus is connected to the bronchoscope and the patient is ventilated through the bronchoscope.

Recovery
Tolerated well. Observation is required. The patient is assessed for respiratory difficulty (stridor and dyspnea resulting from laryngeal edema, laryngospasm, or bronchospasm). If the patient has had a transbronchial biopsy post procedure is done to rule out pneumothorax

Complications
Bronchial perforation Bleeding Pneumothorax Laryngospasm Laryngeal edema