Rigid Bronchoscopy & its advantages
Critical Bronchoscopy performed to remove Bitter Gourd Seed
The 10 rigid bronchoscopies were performed on the patient with a forgotten foreign body in the right lung. She had presented with a chronic cough for the last 3 months. Flexible bronchoscopy showed a foreign body impacted in the lower lobe of the right lung associated with narrowing, oedema (swelling) and pus discharge. Our Pulmonary and Critical Care Team along with Dr Prasanna (Respiratory Medicine) utilised the rigid bronchoscope to extract the foreign body (bitter gourd seed). The patient went home symptom-free.
We once had a little girl who has aspirated a sharp pin. The pin was in her windpipe. We were partially successful in recovering it via a flexible bronchoscope however in process of retrieval the pin slipped into her throat and she swallowed it. Finally, an endoscopy had to be done to remove the pin. If we had the rigid bronchoscopy back then the little girl would not have had to undergo an additional endoscopy.
On another occasion, we had a patient with a malignant tumour in the trachea who was on the ventilator. She needed urgent tracheal debulking. We worked untiringly to figure out the logistics, arranged demo scopes, had them shipped to the hospital from New Delhi and managed to save her. Looking at this effort and the fact that lives can be saved using rigid bronchoscopy, our administrators were quick to act and within weeks we procured the equipment required. We are indebted to our hospital leaders and administrators for their foresight and trust in our team.
The availability of rigid bronchoscopy has expanded the horizon. We have been able to manage several such challenging cases. Rigid bronchoscopy has given us the freedom to explore and perform highly complex airway interventions without compromising on the patient’s hemodynamic status and stability. Clearing tumours from the windpipe or large airways and stent insertions, foreign body removals, and diagnoses of malignancies. and interstitial lung disease has now become routine and we are proud to now say that we are now on par with other specialised centres across the country in handling complex pulmonary cases.
What is a rigid bronchoscopy and what are the advantages over conventional flexible bronchoscopy?
Rigid bronchoscopy involves the insertion of a wide metal barrel into the airway. By means of a larger lumen and a separate port for ventilation, it offers advantages over flexible bronchoscope in terms of better control of the airway, and better management of bleeding. Also, all procedures can be performed while the patient breathes comfortably on the anaesthesia machine. In fact, all procedures performed using flexible broncho-scopes can be performed with a rigid bronchoscope as a conduit and inserting the flexible scope through the rigid lumen.
Rigid bronchoscopy cannot be performed by an individual alone. We are extremely grateful to our team. We would like to take this opportunity to thank everyone involved in the management of patients requiring rigid bronchoscopy, especially the anaesthesia team. The procedures are being performed in the neuro OT of the memorial hospital at the moment. The staff and technicians of both neuro OT and bronchoscopy teams have exceptionally enthusiastic and motivated to learn these techniques. Their passion is infectious and we are equally driven to continue serving our patients, teaching and innovating.
Dr Bharath Chhabria and Dr Harshith Rao MD
(Internal Medicine – PGI) DM (Pulmonary & Critical Care -PGI) Assistant Professor and Consultants Department of Pulmonary and Critical Care Medicine Ramaiah Medical College and Memorial Hospitals