PURPOSE: Tracheobronchial superficial lesions are treated with Endobronchial procedures (Photodynamic Therapy; PDT, cryotherapy, or etc.). So we could not get the whole tissue of the tracheobronchial superficial lesion. We have reported the pre-clinical experiment of Bronchoscopic Sub-epithelial Dissection (BSD) that lift up by injection to sub-epithelial layer. On the next step, we will report the procedure and the results of BSD at the bifurcation of the tracheobronchial tree.
METHODS: BSDs were performed in canine under general anesthesia. Opegan-Hi (1.0% Hyaluronic acid, 0.4-0.8ml) was injected into the sub-epithelial tissue at the bifurcation via 25G needle through the working channel of the bronchoscope(BF-1T260, Olympus). Dual Knife, Hook Knife, and snare were employed to dissect the injected sub-epithelial layer. Histopathological findings of the resected specimen and the dissected tracheobronchial wall were compared. On histopathological findings, healing of dissected wall was evaluated.
RESULTS: In all fifteen procedures of BSD (at the bifurcation between rt. upper bronchus and the intermediate: 2, at the bifurcation between rt. middle and lower bronchus: 2, at the bifurcation between lt. upper and lower bronchus: 1, at the bifurcation between lt. superior and lingular segment: 2 at the bifurcation between B6 and basal bronchus: 4, at the bifurcation between basal segments: 3, at the bifurcation between basal sub-segments: 1), BSD was successful. Followed up 15 lesions, epithelium covered the dissected surface in 2 weeks after BSD. There was no complication after BSD.
CONCLUSIONS: BSD with Opegan-Hi were successful at the bifurcations of the tracheobronchial tree.
CLINICAL IMPLICATIONS: This study showed the possibility of a new procedure (BSD) for tracheobronchial lesions on the bronchial bifurcation.
DISCLOSURE: The following authors have nothing to disclose: Noriaki Kurimoto, Teruomi Miyazawa
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