Pulmonary Procedures |

The Utility of Backward Grabbing “Inverted V” Rigid Forceps FREE TO VIEW

Sonali Sethi, MD; Michael Machuzak, MD; Francisco Almeida, MD; Joseph Cicenia, MD; Thomas Gildea, MD
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Cleveland Clinic, Cleveland, OH

Chest. 2013;144(4_MeetingAbstracts):794A. doi:10.1378/chest.1703834
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: The last decade has seen an increasing application of bronchoscopy with expansion mostly revolving around the role of flexible bronchoscopy. There have been relatively few technological advances with rigid bronchoscopy and its instruments. We describe a new modified rigid forceps involving moving the pivotal connection to the distal end of the forceps; allowing the movable jaw to open facing proximally, thus creating an “inverted V” shape when opened.

METHODS: The rigid backward forceps design was granted a US Patent on 7/14/09 with a prototype built for clinical evaluation. From 8/2012-3/2013, eight patients undergoing rigid bronchoscopy for malignant or benign airway obstruction requiring the placement of either a silicone or metal stent were managed with the backward forceps for stent manipulation to achieve ideal stent position.

RESULTS: Eight patients were treated for a total of nine procedures. Six patients suffered from benign airway disease (75%); two patients (25%) had malignant airway obstructions. A total of twelve stents in eight patients were deployed in which the backward rigid forceps were used. Ten stents were silicone (83.3%) and two were metallic (16.7%). Of the silicone stents, six (60%) involved the manipulation of a limb of a Y-stent, two involved Montgomery T-tubes (20%), and two involved bronchial silicone stents (20%). Of the two metal stents, one was used for a malignant airway obstruction, and the other for a tracheoesophageal fistula. Three procedures (33.3%) required telescoped stents in order to achieve desired result over differing airway diameters. The forceps were used to tunnel one stent into the other. In all cases, the backward rigid forceps was considered successful in manipulating stents. None of the cases required removing the stent for re-deployment. There were no procedure related complications.

CONCLUSIONS: The advantage of the backward rigid forceps include the ability to 1) rapidly reposition proximally deployed airway stents, 2) save cost if a metal stent cannot be pushed distally and is removed, and 3) limit the amount of anesthesia administered during a case when stents are removed and redeployed.

CLINICAL IMPLICATIONS: The backward rigid forceps is a new tool which is simple and effective. We believe these forceps increases the ease of rigid bronchoscopy procedures and is especially useful to interventional pulmonologist and thoracic surgeons who are technically skilled at rigid bronchoscopy and stent deployment.

DISCLOSURE: The following authors have nothing to disclose: Sonali Sethi, Michael Machuzak, Francisco Almeida, Joseph Cicenia, Thomas Gildea

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