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Design and Modelling of a Continuum Robot for Distal Lung Sampling in Mechanically Ventilated Patients in Critical Care.

Front Robot AI 2021 3;8:611866. Epub 2021 May 3.

School of Informatics, University of Edinburgh, Edinburgh, United Kingdom.

In this paper, we design and develop a novel robotic bronchoscope for sampling of the distal lung in mechanically-ventilated (MV) patients in critical care units. Despite the high cost and attributable morbidity and mortality of MV patients with pneumonia which approaches 40%, sampling of the distal lung in MV patients suffering from range of lung diseases such as Covid-19 is not standardised, lacks reproducibility and requires expert operators. We propose a robotic bronchoscope that enables repeatable sampling and guidance to distal lung pathologies by overcoming significant challenges that are encountered whilst performing bronchoscopy in MV patients, namely, limited dexterity, large size of the bronchoscope obstructing ventilation, and poor anatomical registration. Read More

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Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas.

BMC Pulm Med 2021 Apr 26;21(1):137. Epub 2021 Apr 26.

Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China.

Background: Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). Read More

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The use of transbronchial cryobiopsy for diffuse parenchymal lung disease in critically ill patients with acute hypoxemic respiratory failure-A case series.

Clin Respir J 2021 Mar 18. Epub 2021 Mar 18.

Division of Pulmonary, Critical Care and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.

Objectives: Accurate diagnosis and management of undifferentiated diffuse parenchymal lung disease (DPLD) in critically ill patients is challenging. Transbronchial forceps biopsies have limited utility and surgical lung biopsies can be detrimental for critically ill patients. Transbronchial cryobiopsy (TBC) has shown increased diagnostic yield compared to conventional forceps biopsy in DPLD. Read More

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Transbronchial lung cryobiopsy by twin bronchoscopes (kissing technique).

Indian J Tuberc 2021 Jan 2;68(1):16-19. Epub 2020 Nov 2.

Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi, India.

Objective: To introduce a new & novel method of obtaining big lung tissue samples by transbronchial lung cryobiopsy by twin bronchoscopes (kissing technique) in an advanced interventional pulmonology suite.

Methods: In patients of diffuse parenchymal lung diseases, transbronchial lung cryobiopsy were taken using this novel approach using simultaneously two bronchoscopes under C- arm guidance under conscious sedation. First, a standard fibreoptic bronchoscope was inserted intranasally and fixed just above the area to be biopsied, then fogarty's catheter was introduced through FOB's suction channel and protruded it at the biopsy site. Read More

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January 2021

Diagnostic value of ultrathin bronchoscopy in peripheral pulmonary lesions: a narrative review.

J Thorac Dis 2020 Dec;12(12):7675-7682

Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.

Flexible bronchoscopes are being continuously improved, and an ultrathin bronchoscope with a working channel that allows the use of a radial-type endobronchial ultrasound (EBUS) probe is now available. The ultrathin bronchoscope has good maneuverability for passing through the small bronchi and good accessibility to peripheral lung lesions. This utility is particularly enhanced when it is used with other imaging devices, such as EBUS and navigation devices. Read More

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December 2020

Computed Tomography during Bronchoscopic Lung Splinting for Atelectasis.

Ann Thorac Surg 2021 Jan 6. Epub 2021 Jan 6.

Interventional Pulmonology, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami, Miami, Florida.

A 64-year-old man experienced persistent atelectasis of the right lung following right upper lobectomy. To simultaneously visualize the airways and lung parenchyma in real-time, chest computed tomography was performed while pneumatically splinting the lung open via insufflation through the working channel of a bronchoscope. The bronchi were patent but peripheral consolidations within the remaining right lung were visualized, representative of pneumonia. Read More

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January 2021

Catheter Injectable Hydrogel-Based Scaffolds for Tissue Engineering Applications in lung disease.

Isr Med Assoc J 2020 Dec;22(12):736-740

Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv, Israel.

Background: Chronic lung diseases, especially emphysema and pulmonary fibrosis, are the third leading cause of mortality worldwide. Their treatment includes symptom alleviation, slowing of the disease progression, and ultimately organ transplant. Regenerative medicine represents an attractive alternative. Read More

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December 2020

Apneic laryngeal oxygenation during elective fiberoptic intubation - a technical simulation.

BMC Anesthesiol 2020 12 9;20(1):300. Epub 2020 Dec 9.

University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Strasse 62, 50937, Cologne, Germany.

Background: Sedation during elective fiberoptic intubation for difficult airway can cause respiratory depression, apnea and periods of desaturation. During apneic episodes, hypoxemia can be prevented by insufflation of oxygen in the deep laryngeal space. The aim of this study was to evaluate an oropharyngeal oxygenation device (OOD) designed for deep laryngeal insufflation during fiberoptic intubation. Read More

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December 2020

Anesthetic considerations for tracheobronchial surgery.

J Thorac Dis 2020 Oct;12(10):6138-6142

Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Essen, Germany.

Tracheobronchial pathology can be related to trauma, infection, tumor, or a combination of these. Per definition, planning for tracheobronchial surgery can be complicated by the overlap of anesthesiological interests in airway management and the primary surgical field. Therefore, following a detailed description of the stenosis, management of tracheobronchial surgery requires an interdisciplinary discussion and individualized planning of the procedure. Read More

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October 2020

Utility of oxygen insufflation through working channel during fiberoptic intubation in apneic patients: a prospective randomized controlled study.

BMC Anesthesiol 2020 11 10;20(1):282. Epub 2020 Nov 10.

Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.

Background: Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Read More

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November 2020

Choice of bronchoscopic intervention working channel for benign central airway stenosis.

Intern Emerg Med 2020 Oct 23. Epub 2020 Oct 23.

Department of Respiratory Medicine, Beijing Tian Tan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.

The purpose of this study is to report our experiences over 12 years with bronchoscopic interventions in patients with benign central airway stenosis using three types of working channels (rigid bronchoscope, laryngeal mask, and endotracheal intubation), with a focus on their related advantages, disadvantages, and postoperative complications. We analyzed the clinical data from 273 patients with benign central airway stenosis who underwent a bronchoscopic intervention. The Wilcoxon rank-sum test was used to analyze the immediate results after the first bronchoscopic intervention, and the Chi-square test was used to analyze the correlation between glottic edema and operation time. Read More

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October 2020

Solitary pulmonary nodule imaging approaches and the role of optical fibre-based technologies.

Eur Respir J 2021 Mar 25;57(3). Epub 2021 Mar 25.

Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.

Solitary pulmonary nodules (SPNs) are a clinical challenge, given there is no single clinical sign or radiological feature that definitively identifies a benign from a malignant SPN. The early detection of lung cancer has a huge impact on survival outcome. Consequently, there is great interest in the prompt diagnosis, and treatment of malignant SPNs. Read More

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Spatial mapping of VOC exhalation by means of bronchoscopic sampling.

J Breath Res 2020 10 6;14(4):046012. Epub 2020 Oct 6.

Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, ROMBAT, Germany.

Breath analysis holds promise for non-invasive in vivo monitoring of disease related processes. However, physiological parameters may considerably affect profiles of exhaled volatile organic substances (VOCs). Volatile substances can be released via alveoli, bronchial mucosa or from the upper airways. Read More

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October 2020

Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure: A case report of anesthesia for rigid bronchoscopy.

Medicine (Baltimore) 2020 Jul;99(27):e20916

Department of Anesthesiology.

Introduction: Evolving techniques in the field of therapeutic bronchoscopy have led to the return of rigid bronchoscopy in the treatment of complex central airway disease. Rigid bronchoscopy is typically performed under general anesthesia because of the strong stimulation caused by metal instruments. Anesthesia for rigid bronchoscopy is challenging to administer because anesthesiologists and interventionists share the same working channel: the airway. Read More

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Pharmacological ablation of the airway smooth muscle layer-Mathematical predictions of functional improvement in asthma.

Physiol Rep 2020 06;8(11):e14451

School of Human Sciences, The University of Western Australia, Crawley, WA, Australia.

Airway smooth muscle (ASM) plays a major role in acute airway narrowing and reducing ASM thickness is expected to attenuate airway hyper-responsiveness and disease burden. There are two therapeutic approaches to reduce ASM thickness: (a) a direct approach, targeting specific airways, best exemplified by bronchial thermoplasty (BT), which delivers radiofrequency energy to the airway via bronchoscope; and (b) a pharmacological approach, targeting airways more broadly. An example of the less well-established pharmacological approach is the calcium-channel blocker gallopamil which in a clinical trial effectively reduced ASM thickness; other agents may act similarly. Read More

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Use of intrapulmonary administration of thrombin in hematological malignancy patients with alveolar haemorrhage: A case series.

Medicine (Baltimore) 2020 May;99(20):e20284

Division of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Introduction: Alveolar hemorrhage (AH) is characterized by the acute onset of alveolar bleeding and hypoxemia and can be fatal. Thrombin has been widely used to achieve coagulation and hemostasis. However, the efficacy of thrombin in patients with AH is unclear. Read More

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Feasibility study of ultrasound video bronchoscopy for sampling endobronchial lesions.

Clin Respir J 2020 Jul 22;14(7):675-682. Epub 2020 Mar 22.

Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.

Introduction: Endobronchial biopsy using forceps is generally performed with a standard bronchoscope, while a needle is used with an endobronchial ultrasound (EBUS) bronchoscope. An EBUS video bronchoscope, such as the EB-530US instrument (Fujifilm, Tokyo, Japan), provides good visibility and may, therefore, enable both forceps biopsies and needle aspirations to be performed.

Objectives: The aim of this study was to investigate the feasibility of performing forceps biopsies and needle aspirations using the EBUS video bronchoscope for diagnosing endobronchial lesions. Read More

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Technologies for targeting the peripheral pulmonary nodule including robotics.

Respirology 2020 09 26;25(9):914-923. Epub 2020 Feb 26.

Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.

Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of technical and procedural techniques have further advanced diagnostic yields. These include the use of thinner bronchoscopes with better working channel diameters, understanding the importance of peripheral transbronchial needle aspiration, and virtual bronchoscopic assistance. Read More

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September 2020

Evaluation of Efficacy of a New Cryoprobe for Transbronchial Cryobiopsy: A Randomized, Controlled in vivo Animal Study.

Respiration 2020;99(3):248-256. Epub 2020 Feb 26.

Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.

Background: Forceps biopsy (FB) is still the most popular procedure for the bronchoscopic sampling of lung tissue. However, it has limitations like inadequate sample size and crush artifacts. Cryobiopsy (CB) has been introduced to obtain bronchoscopic biopsies with improved diagnostic yield compared to FB. Read More

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Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society.

Lung India 2020 Jan-Feb;37(1):86-96

Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India.

Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma.

Methodology: An expert group formed this statement under the aegis of the Indian Chest Society. Read More

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January 2020

Airway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation.

Indian J Otolaryngol Head Neck Surg 2019 Oct 12;71(Suppl 1):453-458. Epub 2018 Apr 12.

4Department of Respiratory Medicine, MGM Medical College and Hospital, Aurangabad, India.

Tracheal and subglottic stenosis are chronic inflammatory processes which can occur as a result of several possible aetiologies, most commonly as a result of prolonged intubation. All consecutive cases of subglottic and tracheal stenosis, secondary to prolonged intubation treated endoscopically over a period of 2 years were reviewed. The surgical approach consisted of radial incision and ablation using Holmium YAG laser, balloon dilatation and topical instillation of mitomycin C through flexible fiberoptic bronchoscope. Read More

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October 2019

Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial.

Chest 2019 11 26;156(5):954-964. Epub 2019 Jul 26.

Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan. Electronic address:

Background: When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin bronchoscope (UTB) with a 1.7-mm working channel is advantageous regarding good access to the peripheral airway, whereas a 4. Read More

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November 2019

Navigation bronchoscopy: A new tool for pulmonary infections.

Med Mycol 2019 Jun;57(Supplement_3):S287-S293

Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.

Infections remain a common cause of lung nodules, masses, and cavities. Safe tissue sampling is required to establish a diagnosis, differentiate between malignant and infectious causes, and provide microbiological material for characterization and sensitivity analysis. Tissue samples could be obtained bronchoscopically, percutaneously, or through surgical biopsy. Read More

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A Pilot Study of a Novel through-the-Scope Self-Expandable Metallic Airway Stents Delivery System in Malignant Central Airway Obstruction.

Can Respir J 2019 12;2019:7828526. Epub 2019 May 12.

Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, China.

Objective: Self-expandable metallic (SEM) airway stents are an important approach to malignant central airway obstruction (CAO). SEM airway stent insertions are usually performed under fluoroscopic guidance over a guide wire placed through a flexible bronchoscope often resulting in a longer procedure time and exposure to radiation. In this pilot study, we designed a novel delivery system of the through-the-scope (TTS) SEM airway stent insertion and observed its feasibility. Read More

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A study on factors determining dose of topical lignocaine during broncho-alveolar lavage by spray-as-you-go technique: A single centre observational study.

Drug Discov Ther 2019 ;13(2):89-95

Department of Medicine, All India Institute of Medical Sciences.

Basic bronchoscopic diagnostic procedures like Broncho-alveolar lavage (BAL) are often performed without sedation, using lignocaine administered via the working channel of bronchoscope (spray-as-you-go technique) and other routes. Our aim was to evaluate the factors responsible for variation in the total dose of lignocaine administered in individual subjects. We prospectively included consecutive subjects undergoing BAL in an outpatient setting from August 2016 to November 2017 at our centre. Read More

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September 2019

A Novel Laser Fiberscope for Simultaneous Imaging and Phototherapy of Peripheral Lung Cancer.

Chest 2019 09 26;156(3):571-578. Epub 2019 Apr 26.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, ON, Canada; TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada. Electronic address:

Background: Phototherapy is an alternative treatment for patients with localized non-small cell lung cancer who are unable to undergo surgical resection. However, phototherapy is currently limited to treatment of centrally located lung cancer, with the much larger proportion of peripheral lesions remaining inaccessible. There are also concerns over the accuracy of targeted laser treatment because of the need to exchange visualization and irradiation fibers during therapy, preventing the operator from confirming the final location of the irradiation fiber. Read More

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September 2019

Flexible bronchoscopy-guided vocal cord biopsy under conscious sedation: An option to surgical biopsy in special situations.

Lung India 2019 May-Jun;36(3):199-201

Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bengaluru, Karnataka, India.

Introduction: Vocal cord (VC) biopsies are usually performed with rigid laryngoscopy under general anesthesia (GA). In patients with comorbidities such as cardiovascular or pulmonary disease, the risk of GA is high, with morbidity and potential mortality. We describe VC biopsy (VCB) in such a high-risk cohort, done safely and successfully with flexible bronchoscopy-VCB (FB-VCB) and conscious sedation. Read More

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Foreign Body Aspiration in Infants and Older Children: A Comparative Study.

Ear Nose Throat J 2020 Jan 11;99(1):47-51. Epub 2019 Apr 11.

Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel.

Background: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. Read More

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January 2020

A retrospective study comparing the ultrathin versus conventional bronchoscope for performing radial endobronchial ultrasound in the evaluation of peripheral pulmonary lesions.

Lung India 2019 Mar-Apr;36(2):102-107

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Few studies have reported on the utility of ultrathin bronchoscopes (UTBs) for performing radial probe endobronchial ultrasound (EBUS). Herein, we describe our experience with UTB and conventional bronchoscope (CB) for performing radial EBUS.

Materials And Methods: This was a retrospective study comparing the diagnostic yield of a prototype UTB (external diameter 3 mm, working channel diameter 1. Read More

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Evaluation of Novel Imaging Devices for Nanoparticle-Mediated Fluorescence-Guided Lung Tumor Therapy.

Ann Thorac Surg 2019 06 8;107(6):1613-1620. Epub 2019 Feb 8.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address:

Background: Nonsurgical and minimally invasive approaches for early-stage peripheral lung cancer are needed to avoid the known morbidity of surgical resection, particularly in high-risk patients. We previously demonstrated the utility of multifunctional porphyrin-phospholipid nanoparticles (porphysomes) for fluorescence imaging and phototherapy after preferential accumulation into tumors. The objective of this study was to demonstrate the feasibility of porphysome-mediated imaging and photothermal therapy using a newly developed fiberscope and thoracoscope. Read More

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