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.

Tools of the Trade: A Novel Bronchoscope With a Built-in Miniature Video Screen, Camera, and Light Source.

OBJECTIVE: To evaluate the performance of a mobile bronchoscope with miniature video screen, light source, and a digital camera. DESIGN: Prospective study. SETTING: Inpatient and outpatient tertiary care center. INTERVENTIONS: None. PATIENTS: Twenty patients who were undergoing diagnostic or therapeutic bronchoscopy from May 2009 to July 2009. MEASUREMENTS AND MAIN RESULTS: Thirteen patients underwent bronchoscopy via the oral and nasal approach, 2 via a tracheostomy, and 5 via an endotracheal tube or laryngeal mask airway. The scope was also used in the placement of a percutaneous tracheostomy tube and in the operating room for 3 procedural endotracheal intubations. The overall performance of mobile bronchoscope was satisfactory. The majority of difficulties encountered by the bronchoscopists came from the performance of the monitor. The main issue was the need to turn the screen to view the image in an upright position. CONCLUSIONS: The Airway Mobile Scope is well suited for airway examination and interventions often needed in emergency rooms, intensive care units, operating rooms, and office settings. The ease of use of the bronchoscope could be enhanced with small changes to the display of the image on the LCD screen.

Short-term Placement of Multiple Self-expandable Metallic Stents for the Treatment of Bilateral Bronchial Dehiscences Complicating Lung Transplantation.

Bronchial dehiscence after lung transplantation is a rare complication yet has high morbidity and mortality. The majority of the patients are not surgical candidates. We present the case of a 59-year-old man with bilateral lung transplantation for interstitial pulmonary fibrosis who was readmitted with symptoms of acute rejection and severe hypoxemic respiratory failure on day 14. Bronchoscopy showed bilateral bronchial anastomotic dehiscences. A computerized tomography scan showed evidence of significant peribronchial air collection in the pleural space and the mediastinum. Owing to a high predictive operative mortality, endobronchial management was planned, and 3 uncovered self-expanding metallic stents (Ultraflex, Boston Scientific Corp) were placed (in the left main stem bronchus, the anterior segment of the right upper lobe, and the right intermediate bronchus). At 5 weeks bronchoscopy showed complete healing of the dehiscences with granulation. The stents were then removed by rigid bronchoscopy. Three weeks after the stent removal a bronchoscopic examination showed a normal tracheobronchial tree except for a slightly narrowed right anastomosis. We conclude that short-term placement of uncovered self-expanding metallic stents provides a safe and minimally invasive option in the management of bilateral dehiscences.