The first rigid bronchoscopy was performed by Dr Gustav Killian in the late 1800 s, and provided physicians with a new glimpse into human anatomy, thereby sparking the growth of pulmonary medicine. Although its application has declined with the introduction of flexible fiberoptic bronchoscopy by Shigeto Ikeda, it is still an invaluable tool in the diagnosis and management of pulmonary diseases. In a 1999 survey, 4% of responders were performing rigid bronchoscopy. Apart from the historic role of rigid bronchoscopy in the treatment of central airway lesions and mechanical debulking of endobronchial lesions, recognition of certain advantages of rigid bronchoscopy over flexible bronchoscopy (such as airway control and ventilation during intervention as well as the ability to simultaneously use larger forceps, suction catheters and tumor excision techniques) has led to an increase in the number of rigid bronchoscopies being performed currently.A multitude of other instruments are now also available to pass down the working channel of rigid scopes, including rigid and flexible suction catheters, different types and sizes of forceps, scissors, rigid and balloon dilators, multiple types of lasers, electrocautery, argon plasma coagulation and cryotherapy catheters, snares, loops, baskets, microdebriders, and stent deployment devices. With advances in flexible bronchoscopy, ablative technologies, and stenting over the past 2 decades, rigid bronchoscopy has become an integral tool in the management of central airway disease.Rigid bronchoscopy remains an important procedure for removing foreign bodies in the trachea.
The rigid bronchoscope is a simple piece of equipment that has not significantly changed since its invention. Rigid bronchoscopes generally come in two forms; rigid tracheal scopes and rigid bronchoscopes. Both are hollow metal tubes with beveled distal edges available in several different diameters. The rigid bronchoscope is longer allowing access into the right and left bronchial trees as well as having distal fenestrations to allow ventilation of the contralateral bronchial tree. All scopes come with a built in or attachable port for jet or conventional ventilation. The light source can either be attached to the barrel, or more commonly directly to the camera. Scopes come in various sizes and length depending on the manufacturer, but all have an inner and outer diameter varying from 7-13 mm and 8-14 mm respectively.
Although there have not been significant advances in the rigid bronchoscope itself, countless types of instruments have been developed to use through the working channel. The first and most commonly used being the flexible bronchoscope. Once the airway has been secured with the rigid scope a flexible scope is often passed through the working channel and into segmental airways to lavage, suction secretions or blood as well as cannulate past smaller obstructions prior to coring, excising or stenting. A multitude of other instruments are now also available to pass down the working channel of rigid scopes including rigid and flexible suction catheters, different types and sizes of forceps, scissors, rigid and balloon dilators, multiple types of lasers, electrocautery, argon plasma coagulation and cryotherapy catheters, snares, loops, baskets, microdebriders, and stent deployment devices (14). Finally, a manual or automated jet ventilator is needed for oxygenation and ventilation during cases. If preferred or necessary the patient can also be ventilated by packing the mouth, placing silicone caps on the end of the rigid bronchoscope and using conventional positive pressure ventilation through a ventilator circuit adaptor placed on the proximal end of the rigid scope.
We have facility of Rigid Bronchoscopy And Stent Placement at:
Haridaya Superspeciality Centre
Dr. Ahish Tandon
16/28, Stanley Road, Civil Lines,
Near Police Line Helicopter Landing Site,
Allahabad, Uttar Pradesh 211001,India
+91 9792456999, +91 9336281819, +91 8004915141
info@chestspecialistallahabad.com
