TY - JOUR
T1 - Operative rigid bronchoscopy
T2 - indications, basic techniques and results
AU - Petrella, Francesco
AU - Borri, Alessandro
AU - Casiraghi, Monica
AU - Cavaliere, Sergio
AU - Donghi, Stefano
AU - Galetta, Domenico
AU - Gasparri, Roberto
AU - Guarize, Juliana
AU - Pardolesi, Alessandro
AU - Solli, Piergiorgio
AU - Tessitore, Adele
AU - Venturino, Marco
AU - Veronesi, Giulia
AU - Spaggiari, Lorenzo
PY - 2014
Y1 - 2014
N2 - Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.
AB - Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.
KW - Airway compression
KW - Airway infiltration
KW - Laser
KW - Rigid bronchoscopy
KW - Stent
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U2 - 10.1093/mmcts/mmu006
DO - 10.1093/mmcts/mmu006
M3 - Article
C2 - 25133397
AN - SCOPUS:84929161825
VL - 2014
JO - Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery
JF - Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery
SN - 1813-9175
ER -