Bronchoscopy for thoracic surgeons
Epublication WebSurg.com, May 2016;16(05). URL: http://websurg.com/doi/lt03enamer006
The idea of this lecture originated from the fact that there is very little teaching material which described bronchoscopy as practiced by the thoracic surgeon. Chest physicians (pulmonologists) perform flexible bronchoscopy on a sedated patient, and they get up-side-down views to that obtained by the surgeons. Bronchoscopy at our department is performed under general anaesthesia, usually in the anaesthetic room just before the operation. We introduce a rigid bronchoscope first, and then a flexible fibre optic 5mm bronchoscope through the rigid scope into the trachea. This arrangement enables precise diagnosis due to excellent vision, with the ability to transform the procedure into a therapeutic session, for example, to take large biopsies, and decide to laser a lesion or to put in a central airway stent. Controlled breathing makes it safer to control significant bleeding during the procedure, and it is understandable that chest physicians shy away from biopsying carcinoid tumours. The video is divided into 6 chapters. Chapter one deals with the identification of the bronchopulmonary segments and a bit of history about the two systems of nomenclature. It describes in a simplified way the effects of the heart growing in the left chest and the results of fusion, rotation and delayed branching of bronchi. Chapter 2 deals with normal bronchoscopy and anatomy of trachea, main bronchi, and segmental bronchi. Chapter 3 deals with abnormalities of the upper airways and trachea. Chapter 4 deals with abnormalities of the right bronchial tree, and chapter 5 deals with abnormalities of the left bronchial tree. The emphasis is on surgical pathology, assessment of airway for resection and decision-making. The viewer is encouraged to take the test on chapter 6 to bolster his/her knowledge of the anatomy of the airways. 1. Objectives: a. To identify the bronchopulmonary segments in a logical and easy way to recall. b. To understand the embryological changes resulting from heart growing into left chest. c. To state what the operator should look for, what is normal and what is abnormal. d. To help decision-making at operation and in the perioperative period. 2. For whom is this video made: a. Consultants and trainees in the specialty of cardiothoracic surgery, including paediatric thoracic surgeons. b. Thoracic and general anaesthetists who are involved with single lung ventilation. c. Chest physicians who perform bronchoscopy, to understand views and capabilities of flexible over rigid bronchoscopy, and to have a gist of what goes on the mind of a thoracic surgeon when performing bronchoscopy. d. Intensivists who might perform bronchoscopy via an endotracheal tube for a ventilated patient in the intensive care unit (ICU). e. Medical students interested in the detailed anatomy of the central airways. 3. What this video is not intended to do: a. This is not a compendium of abnormalities and pathologies revealed by bronchoscopy.