Flexible fiberoptic and video bronchoscopes (FOB and VB) are used for central airways examination and though the working channels clinical samples are retrieved by a variety of methods and using a number of FOB/VB instruments. Ultrathin bronchoscopes have been built to negotiate past central airways narrowing and to direct sampling of peripheral parenchymal lesions. However the 2.2mm to 3.5mm instruments either have no working channels or a small calibered channel that often preclude retrieval of diagnostic specimen. This report details utility of a new thin videobronchoscope with improved manueverability, good imaging and a 2mm working channel through which diagnostic specimens are retrievable.
Diagnostic bronchoscopy is performed sequentially with Olympus series 160 VB and when necessary with a prototype 4mm Olympus thin VB (XBF-4B140Y1)to bypass central airways (up to 3rd generation segmentations)obstruction or to direct sampling of peripheral lesions. Number of airway generations reached by the respective “normal” caliber bronchoscope (5.2 - 5.8mm) are recorded by segment, corresponding number of airway segments reached by the thin instrument is subsequently recorded. Time spent on exam and diagnostic yield are noted.
18 cases involving 10 males, 8 females ranging from ages 38 to 83 were performed. 16 cancers (11 NSCLC and 5 metastases), 1 aspergilloma and 1 tracheobronchomalacia cases included. 3 have had airway stents placed, 2 had central airways obstruction and 4 had narrowing of segmentalk airways leading to lesions. On average,the thin VB reaches 5.95 generations of airways per airway segment, versus 4.42 with standard bronchoscope. The number of segments reached is greater in the lower lobe segments (6.8 on right and 7.0 on left) than the upper and middel lobe segments (5.0 and 5.5). No thin-bronchoscope related complications noted.
A new 4mm videobronchoscope with a full sized working channel is a useful addition to the current range of diagnostic flexible bronchoscopes.
Availability and training in the use of thin bronchoscopes may enable greater diagnostic accuracy in sampling of more frequently detected peripheral lesions.
Rex Yung, Consultant fee, speaker bureau, advisory committee, etc. I am a consultant to Boston Scientific Corporation, which manufactures some of the bronchoscopy equipment used in my diagnostic procedures and that may be mentioned in the course of my presentation.; Other Olympus USA, manufacturer of the thin bronchoscope described in this abstract, has provided a prototype for our testing and use.