Other alternative approaches: endoscopic techniques and approaches

Introduction

Bronchoscopy can be a diagnostic test or a treatment procedure. In both situations, doctors will enter into your airway (trachea and bronchi) through the nose or the mouth using specific instruments (bronchoscope) to look, evaluate, take biopsies, reduce the size of a tumor, extract a foreign body or to dilate a tracheal or bronchial stenosis, among others.

There are two different types of bronchoscopies: flexible and rigid.

Flexible bronchoscopy involves the introduction of a thin and flexible tube inside your airways. It allows us to obtain samples of tumors, as well as to suction secretions, remove foreign bodies, etc.

However, some conditions cannot be managed through flexible bronchoscopy and a rigid bronchoscope may be needed. It includes removal of stocked objects, airway dilatation and stent placement and any other situation not accurately managed with a flexible bronchoscope. Rigid bronchoscopy is performed using metallic rigid bronchoscopes passed through the mouth. These tubes allow the surgeon to work while the patient receives oxygen from the ventilator thought the bronchoscope. In this procedure close cooperation and coordination between surgeons and anesthesiologists is mandatory.

Preparing for the procedure

Some flexible bronchoscopic procedures and all rigid ones are performed in the OR under deep sedation or general anesthesia. For that reason, it is important to be adequately prepared.

During the outpatient consultation your thoracic surgeon will explain you the procedure. Be aware that you should inform your doctor about:

• Head or neck problems, such as stiffness.
• Dental problems. Non-fixed dental prosthesis should be removed before the procedure.
• Surgery or radiation on your head or neck, for instance, surgery for cervical hernias, radiation for ORL tumors, etc.
• Rheumatoid arthritis (a disorder that causes swollen and painful joints).
• Oral intake of antiplatelet or anticoagulant medication (It would need to be discontinued before the procedure)
• Intubation difficulties in previous surgical procedures. If it is the case, probably you would have a medical report containing all the details.

Because this is a surgical procedure, your doctor will ask you a complete preoperative work out before proceeding. Adjusting medications and knowing your general condition/past medical history will improve the safety of the procedure. Take time to review your medication with your doctor and clarify when and how to stop/change or modify it according to the day of the surgery.

For this type of intervention, admission normally takes place the same day of the procedure. Your doctor will confirm or not this information according to each institution’s protocols. If this is the case, you should prepare for the procedure as to any other intervention. Please, visit Preparation for admission and Admission the same day of the surgery. Depending on the performed procedure it would be same day surgery or you will stay overnight. Your doctor will provide you this information.

What to expect after the procedure

After the procedure, and depending of the type of anesthesia it has been performed with, you may experience:

• Numbness in your throat: This is especially important because if you take any liquid of solid food in the 4 hours after the procedure, you will be under an increased risk of them going into your airways, or what it is called ‘aspiration’
• Pain in your throat or mouth discomfort: This is especially relevant after rigid bronchoscopies. This feeling should improve in a couple of days. If it does not, contact your doctor.
• Blood stained secretions: Depending on the type of intervention performed, it may be expected some blood in your secretions that should improve in a short time. If you cough up frank blood, do not hesitate to tell your doctor.

After the procedure, your doctor would reconcile your medication, don't forget to ask him when you should be able to reintroduce your antiplatelet or anticoagulant medications.

If you experience fever, worsened cough, difficulty breathing or purulent or blood stained sputum contact your doctor’s office and follow their indications