Diagnostic Bronchoscopy
Bronchoscopy is a procedure performed with an endoscope in order to inspect the airways of the lungs. The domain of interest for the bronchoscopist is that area of the respiratory tract found below the vocal cords.
Bronchoscopy is often performed for diagnostic purposes. The most common reasons that bronchoscopy is performed are to establish the diagnosis of a mass or tumor, identify the site or cause of bleeding (also known as Hemoptysis), evaluate or help treat a pneumonia, or determine the consequences of trauma. The diagnostic procedures of bronchoalveolar lavage, transbronchial needle aspiration (TBNA), and transbronchial biopsy can be performed during a bronchoscopy.
Therapeutic Bronchoscopy
Bronchoscopy can also play a therapeutic role. For example, bronchoscopy can be used in the treatment of airway obstruction by tumors or foreign bodies, during the removal of secretions and as an assistive technique during a difficult intubation of the trachea (i.e. insertion of an endotracheal tube to permit mechanical ventilation).
Rigid and Flexible Bronchoscopes
There are two types of bronchoscopes: flexible fiberoptic and rigid. Flexible bronchoscopy is often performed under local anesthesia in association with conscious sedation while the patient is sleepy. Local anesthesia often includes medicines like Lidocaine that are used to numb your mouth and throat. Conscious sedation refers to those medicines (e.g. Versed, Valium, Fentanyl, Demerol, propofol or a combination of a few of these) that are typically injected into a patient via an intravenous catheter inserted into an arm or hand. Rigid bronchoscopes are hollow and not flexible. Rigid bronchoscopes are most often employed by a physician trying to remove a foreign body through their large channel, permit the insertion of additional equipment into the lower airways such as ultrasound probes or laser lights, and placement of airway stents. Rigid bronchoscopy is routinely done under general anesthesia in the surgical operating room.
History of Bronchoscopy
Bronchoscopy was first performed in 1897 by the German physician Gustav Killian. Dr. Killian performed rigid bronchoscopy. Rigid bronchoscopy was the only available technique for bronchoscopy until the late 1970's when fiber optic technology was applied successfully to bronchoscopy. With the advent of "interventional pulmonology" as a sub-specialty of medicine rigid bronchoscopy is being performed frequently although still far less often than flexible bronchoscopy.
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