Single-Use (Disposable) Flexible Bronchoscopes: The Future of Bronchoscopy?

The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reprocessing procedure for reusable flexible bronchoscopes (RFBs) involves multiple episodes of handling of equipment that has been used during an aerosol-generating procedure and thus is a potential source of transmission. Single-use flexible bronchoscopes (SUFBs) eliminate this source. Additionally, RFBs pose a risk of nosocomial infection transmission between patients with the identification of human proteins, deoxyribonucleic acid (DNA) and pathogenic organisms on fully reprocessed bronchoscopes despite full adherence to the guidelines. Bronchoscopy units have been hugely impacted by the pandemic with restructuring of pre- and post-operative areas, altered patient protocols and the reassessment of air exchange and cleaning procedures. SUFBs can be incorporated into these protocols as a means of improving occupational safety. Most studies on the efficacy of SUFBs have occurred in an anaesthetic setting so it remains to be seen whether they will perform to an acceptable standard in complex respiratory procedures such as transbronchial biopsies and cryotherapy. Here, we outline their potential uses in a respiratory setting, both during and after the current pandemic.

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial.

BACKGROUND: A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient's airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method. METHODS: Sixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury. RESULTS: The median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries). CONCLUSIONS: Repositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IPR-15006933 , registered on 15 August 2015.

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Hallazgos fibrobroncoscópicos en pacientes estudiados por estridor en un hospital de tercer nivel / Fiberoptic bronchoscopy findings in children with stridor in a tertiary hospital

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The latest generation in flexible bronchoscopes: a description and evaluation.

BACKGROUND: Since the introduction of the flexible bronchoscope over 50 years ago, bronchoscopists have seen vast improvement in the technology available for diagnostics and therapeutics in the bronchoscopy laboratory. We set forth to evaluate the latest evolution in flexible bronchoscopes with features designed to improve imaging and airway navigation. METHODS: The BF-Q190, BF-H190, and/or BF-1TH190 bronchoscopes were evaluated prospectively in 105 patients undergoing bronchoscopy from November 2010 to August 2011 at 2 tertiary care centers in the United States. Data collected from each procedure included method of insertion, airway images, and therapeutic interventions. At the completion of the study, 10 bronchoscopists were surveyed using a 7-point Likert scale to identify the perceived benefits of the design. RESULTS: Insertion methods included nasal, oral, laryngeal mask airway or endotracheal tube, and tracheostomy. Procedures performed included bronchoalveolar lavage, endobronchial biopsy or brushing, transbronchial biopsy, transbronchial needle aspiration or injection, peripheral navigation, and large airway therapeutic interventions. Survey of bronchoscopists revealed that when compared with current bronchoscopes, the features rated as having the most significant impact on functionality are the 210-degree tip angulation (average 2.4/3) and rotational capability of the insertion tube (average 2.4/3). CONCLUSIONS: The new-generation flexible bronchoscope offers improvement in image quality, magnification options, unique insertion tube rotation, and an increased 210-degree distal tip angulation over currently available flexible bronchoscopes. The bronchoscopes are an overall improvement to the current generation of bronchoscopes. The increased tip angulation and novel rotating insertion tube add the most to improvement in functionality.

Broncoscopia pediátrica: una realidad útil y segura / Pediatric bronchoscopy: a useful and safe tool

La situación de la broncoscopia pediátrica, gracias a la miniaturización de los fibrobroncoscopios y los esfuerzos docentes de las diferentes Unidades de Neumología Pediátrica, ha experimentado una evolución fulgurante en nuestro país en los últimos años. Sin embargo, esta técnica sigue identificándose casi exclusivamente con la extracción de cuerpos extraños por lo que en este trabajo se realiza una revisión y actualización de las aplicaciones diagnóstico-terapéuticas de la broncoscopia pediátrica(AU)

With smaller miniaturized fiber bronchoscopy available and thanks to continuous research and work a number of pediatric pneumology units have carried out, a revolution in the pediatric fiber bronchoscopy field has taken place in our country in the last few years. However, and despite having a variety of uses, this technique is still strongly and almost exclusively related to foreign body removal. This paper aims to widen the scope of pediatric fiber bronchoscopy indications, by reviewing and updating all the other diagnostic and therapeutic applications this safe and useful tool has(AU)

Diagnostic bronchoscopy: state of the art.

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

Utilización de criosondas para la realización de la biopsia pulmonar transbronquial / Transbronchial lung biopsy using cryoprobes

IntroducciónLa biopsia pulmonar transbronquial (BPTB) es una técnica broncoscópica indicada en el estudio de las enfermedades pulmonares difusas, cuyo rendimiento diagnóstico es variable debido, en parte, al pequeño tamaño de las muestras obtenidas. La utilización de criosondas en la práctica de la BPTB podría permitir obtener muestras tisulares de mayor tamaño y mejor calidad. El presente trabajo tiene como objetivos describir la metodología de la técnica y su implantación en nuestro centro, así como analizar los resultados de seguridad e histológicos en los primeros pacientes.Pacientes y métodosSe incluyó a 10 pacientes tributarios de BPTB para estudio de neumopatía difusa. De un modo equiparable al método convencional, la criosonda (Erbokryo CA®, Erbe, Alemania) se introduce a través del videobroncoscopio y se dirige hacia regiones pulmonares periféricas, donde la aplicación de frío permite obtener una muestra de tejido pulmonar congelado que queda adherido al extremo de la criosonda. Se registraron la duración del procedimiento y las complicaciones durante éste, y se evaluó la calidad de las muestras obtenidas.ResultadosLa duración media (±desviación estándar) del procedimiento fue de 35±11min. Las muestras presentaban un área media de 9,5mm2 (rango: 3–25mm2), con un número medio de espacios alveolares conservados de 29,6. Ningún paciente presentó neumotórax. En 6 de los 10 pacientes se registró hemorragia tras la biopsia, que en ningún caso obligó a interrumpir el procedimiento.ConclusionesLa utilización de criosondas es viable para la realización de la BPTB y en el futuro podría mejorar el rendimiento de la técnica convencional(AU)

Background and objectivesTransbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained.Patients and methodsWe selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA®, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of −89.5°C was applied for 3s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated.ResultsThere were 10 patients (64±8 years, 6 males). Procedure length was 35min. The specimen area was 9.5mm2 (range 3 to 25mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures.ConclusionsThe use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield(AU)

Bronchoscopes of the twenty-first century.

Over the past century, bronchoscopy has become an essential tool for pulmonologists and thoracic surgeons, who for many years have employed bronchoscopy with such therapeutic modalities as laser therapy, electrocautery, cryotherapy, and stent placement. Over the past decade, advanced imaging techniques, such as autofluoresence bronchoscopy, electromagnetic navigation, narrow-band imaging, confocal fluorescence microendoscopy, and endobronchial ultrasound, have greatly expanded the diagnostic utility of bronchoscopy. This article reviews the technological advances in the field of diagnostic bronchoscopy.