Bronchoscopic Technique: A Comprehensive Exploration

Valentina Luzzi^*
*Correspondence: Valentina Luzzi, Department of Interventional Pneumology, University of Florence, Florence, Italy, Email:

Introduction

Bronchoscopy is a vital diagnostic and therapeutic tool in the field of pulmonary medicine, providing invaluable insights into the respiratory system's anatomy, pathology and the opportunity for various interventions. This versatile procedure allows healthcare professionals to visualize, sample and treat the airways and lung parenchyma. Over the years, bronchoscopic techniques have evolved significantly, enabling precise diagnosis and minimally invasive treatment of various respiratory conditions. This article delves into the world of bronchoscopic techniques, shedding light on its history, equipment, procedural aspects and the latest advancements [1].

Description

Bronchoscopy has a rich history, dating back to the early 20^th century when rigid bronchoscopy was first introduced by Gustav Killian and Chevalier Jackson. However, it was not until the mid-20^th century that the flexible bronchoscope, invented by Shigeto Ikeda, revolutionized the field. Flexible bronchoscopy allowed for easier maneuverability, better patient comfort and access to distal airways. Today, both rigid and flexible bronchoscopy techniques coexist, each with its own set of advantages and indications. Typically used for therapeutic procedures and in managing central airway obstruction. A versatile tool, primarily employed for diagnostic purposes, but also allows for therapeutic interventions when necessary. It consists of a flexible, fiber-optic or video scope that can navigate the intricate bronchial tree. Both types of bronchoscopes require a light source to illuminate the airways, enabling clear visualization. Modern bronchoscopes often utilize advanced LED or xenon light sources [2].

For flexible bronchoscopy, a video system is crucial, allowing real-time visualization and recording for documentation and educational purposes. These include various instruments like biopsy forceps, brushes, needles, electrocautery devices, cryoprobes and stents, which enable tissue sampling and therapeutic interventions. Suction is necessary to clear secretions and maintain a clear view of the airways during the procedure. Local anesthesia is often applied to the patient's upper airway, while general anesthesia or conscious sedation may be used in certain cases. The choice depends on patient preference, the operator's expertise and the clinical situation. Ensure informed consent and assess the patient's medical history, allergies and coagulation status. If conscious sedation or general anesthesia is required, a thorough preoperative evaluation is crucial. The patient is usually placed in a semi-recumbent or lateral decubitus position, depending on the route of bronchoscopy [3].

Topical anesthesia is applied to the upper airway using lidocaine spray or a nebulized solution. This step minimizes discomfort and suppresses the gag reflex. The bronchoscope is inserted through the oral or nasal route, guided gently into the airways. The operator must navigate the scope carefully to prevent trauma. Once the bronchoscope is in the desired location, a systematic inspection of the airways is performed. This includes assessing the vocal cords, trachea and bronchial tree. Any abnormalities, such as tumors, strictures, or foreign bodies, are noted. Various diagnostic techniques can be employed, including Bronchoalveolar Lavage (BAL), brushings, biopsies and Transbronchial Needle Aspiration (TBNA). These methods aid in the evaluation of lung diseases like infections, malignancies and interstitial lung diseases. In cases of airway obstruction or other conditions requiring intervention, bronchoscopy allows for procedures like airway stenting, tumor debulking, laser therapy and cryotherapy. Real-time video recording and capturing of images are essential for documenting findings and assisting with clinical decision-making. Therapeutic bronchoscopy can also relieve airway obstruction due to various causes. Bronchoscopy can be employed to assess and biopsy peripheral pulmonary nodules, particularly when other diagnostic modalities are inconclusive. The source of bleeding can be identified and treated through bronchoscopy, which is essential in managing hemoptysis of undetermined origin [4].

The bronchoscopist must be prepared to manage potential complications, such as bleeding, bronchospasm and hypoxia. Bronchoscopy has witnessed significant technological advancements in recent years, enhancing its diagnostic and therapeutic capabilities. EBUS combines bronchoscopy with ultrasound, enabling real-time imaging of mediastinal and hilar lymph nodes. It is invaluable in the staging of lung cancer. This technology uses electromagnetic or virtual guidance to reach peripheral lung lesions, facilitating biopsy in hard-to-reach areas. AFB utilizes fluorescent light to identify abnormal areas in the airways, aiding in early detection of pre-malignant and malignant lesions. CLE allows real-time microscopic imaging during bronchoscopy, aiding in the evaluation of cellular and tissue structures in vivo. Roboticassisted bronchoscopy systems offer enhanced maneuverability and dexterity for reaching challenging peripheral lesions. It is instrumental in diagnosing infectious conditions like tuberculosis, fungal infections and opportunistic infections in immunocompromised patients. Bronchoscopy can help identify the underlying causes of ILD, such as sarcoidosis or hypersensitivity pneumonitis. It is used in the evaluation of chronic cough, unexplained hemoptysis and bronchiectasis [5].

Conclusion

Bronchoscopic techniques have come a long way since their inception, evolving into a multifaceted tool for diagnosing and managing various pulmonary disorders. The integration of advanced technology, improved instrumentation and a better understanding of the airway anatomy has made bronchoscopy an essential component of modern respiratory medicine. As research and innovation continue, we can expect further enhancements in this field, ultimately leading to improved patient care and outcomes.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. McKay, Leanne C., Wiktor A. Janczewski and Jack L. Feldman. "Sleep-disordered breathing after targeted ablation of preBötzinger complex neurons." Nat Neurosci 8 (2005): 1142-1144.

Google Scholar, Crossref, Indexed at

2. Javaheri, Shahrokh, Nicholas Harris, Joseph Howard and Eugene Chung. "Adaptive servoventilation for treatment of opioid-associated central sleep apnea." J Clin Sleep Med 10 (2014): 637-643.

Google Scholar, Crossref, Indexed at

3. Blain, Gregory M., Curtis A. Smith, Kathleen S. Henderson and Jerome A. Dempsey. "Peripheral chemoreceptors determine the respiratory sensitivity of central chemoreceptors to CO2." J Physiol 588 (2010): 2455-2471.

Google Scholar, Crossref, Indexed at

4. Giannoni, Alberto, Michele Emdin, Francesca Bramanti and Giovanni Iudice, et al. "Combined increased chemosensitivity to hypoxia and hypercapnia as a prognosticator in heart failure." J Am Coll Cardiol 53 (2009): 1975-1980.

Google Scholar, Crossref, Indexed at

5. Ponikowski, Piotr, Tuan Peng Chua, Stefan D. Anker and Darrel P. Francis, et al. "Peripheral chemoreceptor hypersensitivity: An ominous sign in patients with chronic heart failure." Circulation 104 (2001): 544-549.

Google Scholar, Crossref, Indexed at