Name of the Procedure:

Bronchoscopy, Rigid or Flexible with Excision of Tumor, including Fluoroscopic Guidance

Summary

Bronchoscopy is a medical procedure that allows doctors to view the airways and lungs using a thin tube with a camera called a bronchoscope. The procedure can be done using either a rigid or flexible bronchoscope, depending on the specific case. This procedure includes the use of fluoroscopic (X-ray) guidance to precisely excise (remove) a tumor from the airways or lungs.

Purpose

Bronchoscopy is primarily used to diagnose, inspect, and treat conditions within the airways and lungs. The main goal of performing this procedure with tumor excision is to remove abnormal growths that may be causing obstructive symptoms or other health concerns. This can improve breathing, relieve symptoms, and help diagnose the type of growth.

Indications

• Persistent cough
• Coughing up blood
• Unexplained wheezing
• Difficulty breathing
• Suspicious lesions seen on imaging tests like X-rays or CT scans
• Tumor removal to prevent airway obstruction

Preparation

• Patients are often required to fast for 6-12 hours before the procedure.
• Medication adjustments may be necessary, including stopping blood thinners.
• Diagnostic tests such as blood work, chest X-rays, or CT scans may be performed pre-procedure.
• Consent forms and a detailed medical history will be reviewed.

Procedure Description

1. The patient is typically given local anesthesia and/or sedation. General anesthesia may be used in some cases.
2. The bronchoscope is inserted through the nose or mouth and advanced into the airways.
3. Fluoroscopic guidance is used to navigate and accurately locate the tumor.
4. Specialized tools attached to the bronchoscope are utilized to excise the tumor.
5. Removed tissue may be sent to pathology for analysis.
6. The bronchoscope is gently withdrawn, and the patient is monitored during recovery.

Duration

The procedure typically takes between 30 minutes and 2 hours, depending on the complexity.

Setting

Bronchoscopy is usually performed in a hospital operating room or a specialized outpatient clinic.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist
• Nursing staff and possibly a radiology technician

Risks and Complications

• Bleeding at the site of excision
• Infection
• Pneumothorax (collapsed lung)
• Reactions to anesthesia
• Respiratory distress

Benefits

• Relief of symptoms such as coughing, wheezing, and difficulty breathing
• Removal of obstructive tumors
• Prevention of further airway obstruction
• Diagnostic clarity for appropriate treatment planning

Recovery

• Short monitoring period post-procedure, often in a recovery room.
• Patients may experience a sore throat or cough.
• Instructions on limiting physical activity, managing discomfort, and recognizing signs of complications will be provided.
• Follow-up appointments to monitor recovery and plan further treatment if needed.

Alternatives

• Surgical removal of the tumor via thoracotomy or video-assisted thoracoscopic surgery (VATS)
• Radiation therapy
• Chemotherapy
• Laser therapy
• Pros and cons vary depending on the patient's condition, with bronchoscopy often being less invasive and having shorter recovery times compared to surgical options.

Patient Experience

During the procedure, patients may experience minimal discomfort due to anesthesia. Post-procedure, mild soreness in the throat or temporary hoarseness can occur. Pain management includes prescribed pain relievers and sore throat remedies. Ensuring the patient is comfortable and informed throughout the process is a priority.