Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe.

Summary

Bronchoscopy is a medical procedure where a doctor inserts a thin tube called a bronchoscope into the airways via the nose or mouth to examine the lung passages. Rigid or flexible bronchoscopes can be used, often with the aid of fluoroscopic guidance (real-time X-ray imaging) to remove bronchial valve(s) from the initial lobe of the lung.

Purpose

This procedure primarily addresses issues such as asthma, chronic obstructive pulmonary disease (COPD), or lung infections. The main goals are to remove obstructions like bronchial valves, alleviate symptoms, improve airway function, and facilitate breathing.

Indications

• Persistent cough
• Difficulty breathing
• Abnormal chest X-rays or CT scans showing blockages or growths
• Chronic lung infections
• Suspected airway abnormalities

Preparation

Patients are typically asked to:

• Fast for 6-8 hours before the procedure.
• Adjust certain medications, especially blood thinners, as per medical advice.
• Undergo preliminary diagnostic tests such as chest X-rays, blood tests, and pulmonary function tests.

Procedure Description

1. Sedation/Anesthesia: Patients are given local anesthesia to numb the throat and/or intravenous sedatives. General anesthesia may be used for rigid bronchoscopy.
2. Insertion: The bronchoscope is inserted through the mouth or nose and guided down the throat into the airways.
3. Visualization: Fluoroscopic guidance helps visualize the airways and locate the bronchial valve(s).
4. Removal: Specialized tools are used to remove the bronchial valve(s).
5. Completion: The bronchoscope is carefully withdrawn.

Duration

The procedure typically takes about 30-60 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Pulmonologist or thoracic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse
• Radiologic technician (for fluoroscopy)

Risks and Complications

• Mild bleeding
• Infection
• Reaction to anesthesia
• Pneumothorax (collapsed lung)
• Airway injury

Benefits

• Immediate relief from airway obstruction
• Improved breathing
• Better control of underlying lung conditions
• Enhanced quality of life

Recovery

• Observation for a few hours post-procedure.
• Avoid driving or operating machinery for 24 hours if sedated.
• Follow specific dietary restrictions if instructed.
• Attend follow-up appointments to monitor lung function and recovery.

Alternatives

• Medications (e.g., bronchodilators, steroids)
• Minimally invasive treatments (e.g., laser therapy)
• Surgical procedures (e.g., lobectomy)

Each alternative has its pros and cons; medication might be less invasive but less effective, while surgery could pose higher risks but more significant benefits.

Patient Experience

During the procedure, patients might feel pressure or mild discomfort, especially during sedation or anesthesia administration. Post-procedure, they may have a sore throat, hoarseness, or mild cough, managed with over-the-counter pain relief and rest.