Flexible and rigid bronchoscopy are two different methods of gaining access to and visualizing the airways.
When flexible bronchoscopy is performed?
A flexible fibreoptic bronchoscope is used to examine the bronchial tree and vocal cords (to exclude a recurrent laryngeal nerve palsy) prior to surgery. It is also utilized for the diagnosis of endobronchial lesions. Additional techniques such as endobronchial biopsy can be performed to obtain specimens of endobronchial lung tumours or to sample abnormal respiratory epithelium. Bronchial brushings may increase the diagnostic yield.
Bronchial washings may be used to obtain cytology in cases of suspected malignancy and are also useful in the diagnosis of suspected infections, notably tuberculosis and Pneumocystis carinii. Bronchial lavage and cell counts may be useful for the differential diagnosis of parenchymal lung disease (transbronchial biopsies can be performed to diagnose parenchymal lung disease). In addition, transbronchial lymph node aspiration may be performed to stage lung cancer. Fibreoptic bronchoscopy also allows for the aspiration of pus and impacted secretions and retrieval of selected foreign bodies.
How Flexible bronchoscopy is performed?
Informed consent is obtained and patients should be fasted for 4 hours prior to the procedure (in case of any complications that may arise requiring general anaesthesia). Oxygen saturation monitoring and anesthesia facility is essential.
Procedure of Flexible bronchoscopy:
Intravenous sedation is normally offered. The choice of drug varies with the operator but a typical sedative could be midazolam. Topical lidocaine is sprayed into the nasal passage and sufficient time allowed for anaesthesia. The fibreoptic scope is introduced into the nose and further lidocaine administered through the side arm of the scope to progressively anaesthetize the hypopharynx, larynx and vocal cords. Progressing from the trachea, the entire tracheobronchial tree is visualized.
What can be the complications of Flexible bronchoscopy?
Major complications are few, occurring in 1.7%. These include mortality (0.1%), respiratory arrest, pneumonia and airway obstruction. Minor complications include vasovagal reactions, fever, cardiac arrhythmias, bleeding, nausea and vomiting, and aphonia in 6.5%. Supplemental procedures such as transbronchial biopsy carry additional risks of pneumothorax (10%).
What is done after the operation?
Post procedure, patients are observed for up to 4 hours before returning to a ward or being discharged home.
When rigid bronchoscopy is done?
A wider range of therapeutic procedures can be performed with rigid bronchoscopy, however general anaesthesia is required. The range of indications includes massive haemoptysis, airway obstruction, and local therapy for tumours that invade the airways and strictures (e.g. stenting).
Procedure of rigid bronchosopy
Informed consent is required. Patients should be fasted overnight as general anaesthesia is required.
After general anaesthesia is administered, the patient is ventilated with a high inspired concentration of oxygen. The eyes are taped and the neck extended. The rigid bronchoscope is introduced under direct vision through the mouth (taking care not to injure the gums or teeth), past the epiglottis and vocal cords and into the trachea. Intermittent jet ventilation (through the bronchoscope) is required to maintain gas exchange during the procedure. The entire tracheobronchial tree can be visualized and a wide variety of diagnostic and therapeutic procedures undertaken.
What are the complications of rigid bronchosopy
Injuries to the lips, gums and teeth can occur but pharyngeal lacerations are rare. Bleeding can occur from trauma to the airway during this procedure but major haemorrhage is rare and is usually associated with biopsies of vascular tumours. Barotrauma from jet ventilation can produce surgical emphysema and/or pneumothorax.
What is done after the operation?
Patients are recovered on a high-dependency unit for 4 hours, and a chest X-ray is usually performed to screen for complications.
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