Bronchoscopy By Dr. Mohamed A. Gabr Cardiothoracic Surgeon Mansoura university hospitals 2019

1. MOHAMED
GABR
BRONCHOSCOPY
Cardiothoracic surgery specialist at Muh
Mansoura university 2019

2. History of Bronchoscopy
1885: Kirstein visualized the interior of a patient’s larynx directly with
O’Dwyer’s tube.
1897: Gustav Killian known as the ‘father of bronchoscopy’
1905: Chevalier Jackson established bronchoscopy as a standard diagnostic
tool.
1907: Inokichi Kubo was the first to practice bronchoscopy.
1967: Shigeto Ikeda introduced the first flexible FOB.

3. Types of Broncho.
1- RIGID

5. 2- FOB

6. FOBRigid Bronchoscope
Advantages
- Flexible
- Can be done at bedside
- High navigational power
- (complete airway survey)
- No need for general anesthesia
- can be used through ETT
- can be used in truama
- Cheap
- Available
- Wide lumen of working channel
- Larger size accessories
- allows larger biopsies
- Ventilating
- FOB can be done through it
Disadvantages
- Expensive
- Cann`t protect airway
- Non ventilating
- Not easily available
- Low navigational power
- Requires general anesthesia (OR)
- cann`t be used in trauma

7. Indications
1- Diagnostic indications:
- investigation of unexplained cough, localized wheeze
or stridor
- diagnosis bronchogenic carcinoma
- evaluation of tracheal stenosis
- biopsy in mediastinal, lung masses (EBUS & TBNA)
- staging of bronchogenic carcinoma
- to exclude endobronchial lesions
- evaluation lung lesion of unknown etiology on CXR
- investigation unexplained hemoptysis
- evaluation airway trauma
- obtain BAL for microbiological analysis
- evaluation suspected TOF
- evaluation suspected BPF
- evaluation unexplained pleural effusions

8. 2- Therapeutic indications:
- removal of FBs
- control of hemoptysis
- removal of retained secretions
- treatment of trachea-bronchial stenosis
- treatment of airway tumors
- difficult intubation (FOB intubation)
- closure of BPF
- treatment of emphysema
- therapeutic BAL

9. Complications:
- Hypoxia
- Pneumothorax
- Airway injury
- Bleeding
- Respiratory failure

15. Anatomy

20. Malignant & Benign Endobronchial Lesions

21. Airway Stricture LASER dilatation Recurrence Silic. Stenting

22. Electrocautary of Granulation t. distal to bronchial stent

23. Tracheal Stenosis: 0 – 50% 51-70%
71 – 99% 100% ???

24. Post-intubation Tracheal Stenosis
Stenosis Normal

25. Tracheal Stenting in Tracheomalacia

27. Questions:
1- Compare between rigid and flexible bronchoscopes
2- Indications of rigid bronchoscope
3- Diagnostic indications of bronchoscope
4- Therapeutic indications of bronchoscope

28. Thank you
