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Goudie E, Tahiri M, Liberman M. Present and Future Application of Energy Devices in Thoracic Surgery. Thorac Surg Clin 2016; 26:229-36. [PMID: 27112261 DOI: 10.1016/j.thorsurg.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the last decade, many energy devices have entered day-to-day practice in thoracic surgery. Some have proven and recognized applications, whereas others still require further trials. Nevertheless, currently used devices continue to be improved on and new applications for current devices will be evaluated. Ultimately, novel applications of energy in thoracic surgery and refinement in technology will hopefully allow for safer and less invasive techniques for patients requiring thoracic surgical procedures. In this article, we review the present and future applications of energy devices in thoracic surgery.
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Affiliation(s)
- Eric Goudie
- Thoracic Surgery Laboratory, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
| | - Mehdi Tahiri
- Thoracic Surgery Laboratory, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada.
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Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
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Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
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Chawla RK, Madan A, Chawla A, Arora HN. Cryo-recanalization in a case of carcinoid tumor - An interesting case report. Lung India 2015; 32:511-4. [PMID: 26628773 PMCID: PMC4587013 DOI: 10.4103/0970-2113.164161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The term “cryotherapy” comes from the Greek cryo (κρύο) meaning cold, and therapy (θεραπεία) meaning cure. Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. Carcinoid tumors of the lung are a fascinating but uncommon group of pulmonary neoplasms. In the past, these tumors were grouped with benign or less aggressive malignant pulmonary tumors, namely bronchial adenomas. Recent studies have revealed that carcinoid lung tumors are the most indolent form of a spectrum of bronchopulmonary neuroendocrine tumors that, at its extreme, include small cell carcinoma of the lung as its most malignant member. They commonly present as endobronchial obstructions, and if complete, can be life-threatening and require immediate intervention.[1] Recently, we have treated a patient of carcinoid tumor of lung who was managed with cryo-recanalization with excellent response.
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Affiliation(s)
- Rakesh K Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, Delhi, India
| | - Arun Madan
- Department of Pulmonary Medicine, Sharda Medical College and Hospital, Sharda University, Noida, India
| | - Aditya Chawla
- Department of Pulmonary Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Harsh Nandini Arora
- Department of Internal Medicine, ESI Medical College, Faridabad, Haryana, India
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Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction. J Bronchology Interv Pulmonol 2015; 22:288-93. [DOI: 10.1097/lbr.0000000000000203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mahmood K, Wahidi MM, Thomas S, Argento AC, Ninan NA, Smathers EC, Shofer SL. Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction. Respiration 2015; 89:404-13. [DOI: 10.1159/000381103] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/10/2015] [Indexed: 11/19/2022] Open
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Musani AI, Al-Zubaidi A. Cryotherapy: a powerful tool for the warriors of the endoluminal war. J Bronchology Interv Pulmonol 2015; 22:97-8. [PMID: 25887003 DOI: 10.1097/lbr.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ali I Musani
- *National Jewish Health †University of Colorado, Denver, CO
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Fruchter O, Kramer MR. Retrieval of various aspirated foreign bodies by flexible cryoprobe:in vitrofeasibility study. CLINICAL RESPIRATORY JOURNAL 2014; 9:176-9. [DOI: 10.1111/crj.12120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/26/2014] [Accepted: 02/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Oren Fruchter
- Pulmonary Division; Rabin Medical Center; Beilinson Hospital; Petah Tiqwa Israel
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Gesierich W, Reichenberger F, Fertl A, Haeussinger K, Sroka R. Endobronchial therapy with a thulium fiber laser (1940 nm). J Thorac Cardiovasc Surg 2014; 147:1827-32. [PMID: 24521960 DOI: 10.1016/j.jtcvs.2013.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/12/2013] [Accepted: 12/31/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nd:YAG laser (1064 nm) is standard in bronchology. The thulium fiber laser (1940 nm) has a nearly 1000-fold increased absorption in water, enabling precise tissue ablation with a small margin of coagulation, whereas 1064-nm laser light penetrates deeper into tissue with less controllable effects. OBJECTIVES To assess the safety, feasibility, and versatility of endobronchial thulium laser therapy in an observational cohort study. METHODS Endobronchial treatment with the thulium fiber laser was performed in a cohort study of 187 bronchoscopies on 132 consecutive patients with 135 endobronchial lesions amenable to laser resection. RESULTS The thulium fiber laser produced superficial, precise, and rapid tissue ablation. Eighty-one lesions were completely vaporized; 82 lesions were treated by deep tissue destruction by inserting the fiber into tissue followed by mechanical resection. Tumor bleeding was coagulated with rapid and sustained hemostasis (n = 28). Nitinol stents were removed after resection of severe granulation tissue overgrowth (n = 10). Intact stents were maintained after ablation of in-stent tissue (n = 47). In 11 cases, bleeding occurred during laser treatment (n = 11 of 187). Power settings between 5 and 20 W were found to be safe. CONCLUSIONS Endobronchial therapy with the thulium laser at 1940 nm seems to be safe, feasible, and highly versatile for treatment of airway stenosis and stent obstruction caused by tissue ingrowth. Further studies are warranted.
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Affiliation(s)
- Wolfgang Gesierich
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany.
| | - Frank Reichenberger
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | | | - Karl Haeussinger
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Ronald Sroka
- Laser-Forschungslabor, Hospital of University of Munich, Muenchen, Germany
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Chen H, Hong X, He Y. Successful treatment of bronchial obstruction by flexible bronchoscopy and isoniazid: A case report. Exp Ther Med 2014; 7:397-400. [PMID: 24396413 PMCID: PMC3881032 DOI: 10.3892/etm.2013.1423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/11/2013] [Indexed: 12/24/2022] Open
Abstract
Interventional bronchology techniques have been employed as an effective first-line treatment in patients with tracheobronchial obstruction. However, recurrent stenosis produced by granulation tissue requires repeated procedures. Previous studies have indicated that isoniazid regulates collagen deposition and decreases collagen content. Thus, isoniazid has been successfully administered to patients with lesions who exhibited a delay in the healing process. A case of a left mainstem obstruction managed by interventional bronchology is described in the present study. Repeated bronchial stenosis was observed even following numerous treatment procedures, however, administration of isoniazid resulted in the inhibition of hypertrophic scar formation and prevention of repeated stenosis. The suppressive effect of isoniazid on granulation formation and further observations are reported. Few studies have been conducted with regard to the function of isoniazid in suppressing scar hyperplasia, therefore, the mechanism requires further investigation.
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Affiliation(s)
- Hengyi Chen
- Department of Respiratory Medicine, Daping Hospital, The Third Military Medical University, Chongqing 400042, P.R. China
| | - Xin Hong
- Department of Respiratory Medicine, Daping Hospital, The Third Military Medical University, Chongqing 400042, P.R. China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, The Third Military Medical University, Chongqing 400042, P.R. China
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Kim SJ, Kim J, Park JH, Lee AR, Lee JK, Kim TM, Park YS. Adjuvant treatment of proper endobronchial management in leiomyosarcoma. Tuberc Respir Dis (Seoul) 2013; 75:250-5. [PMID: 24416056 PMCID: PMC3884113 DOI: 10.4046/trd.2013.75.6.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/23/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022] Open
Abstract
Endobronchial metastasis of leiomyosarcoma is rare, but it can cause life-threatening complications, such as massive hemoptysis, respiratory failure or even death. The development of new endoscopic modalities allows for effective endobronchial management. We report three patients with endobronchial metastases from advanced leiomyosarcomas which caused bronchial obstruction. The bronchoscopic examinations revealed masses obstructing the left main bronchus in all three patients. After removing the endobronchial tumor via interventional bronchoscopy, there was symptomatic and radiologic improvement. Moreover, the patients were able to undergo additional palliative chemotherapy. Therefore, endobronchial management of endobronchial tumors should be considered in the treatment of endobronchial metastasis, even in patients with advanced malignancies.
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Affiliation(s)
- Soo Jung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ae-Ra Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Cryotechnology for staged removal of self-expandable metallic airway stents. Ann Thorac Surg 2013; 96:336-8. [PMID: 23816097 DOI: 10.1016/j.athoracsur.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/26/2013] [Accepted: 03/04/2013] [Indexed: 11/23/2022]
Abstract
Self-expandable covered metallic airway stents (SEMAS) deployed for relieving inoperable central airway obstruction frequently develop complications that require removal of the device. Current techniques for SEMAS removal also involve serious complications. We are reporting a novel two-staged endoscopic approach using cryotechnology for removal of SEMAS obstructed by exuberant granulation tissue in two patients. During the first stage, the obstructing intraluminal granulation tissue was removed with cryodebridement and residual extraluminal deposits were lysed with cryotherapy. During the second stage, performed two days later, the SEMAS was liberated by mechanical means and removed in one piece. The staged approach with cryotechnology was successful and without complications.
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Cryosurgery for the immediate treatment of acute central airway obstruction. J Bronchology Interv Pulmonol 2013; 20:45-7. [PMID: 23328143 DOI: 10.1097/lbr.0b013e31827cdb8b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Central airway obstruction commonly occurs in thoracic malignancies. Treatment is usually palliative but may be significantly challenging. Several endoscopic interventions are available to establish airway patency; however, their use is sometimes limited by certain factors like availability and high oxygen requirement. Cryosurgery has been established as a safe and effective technique for treatment of malignant airway obstruction, but its use has been limited to being adjunctive to other modalities and to low-grade stenosis. This is mainly due to the delayed effect and inability to achieve immediate airway patency. We report the successful use of this technique as stand-alone modality in a tracheal tumor with severe obstruction leading to acute respiratory failure. Immediate recanalization was achieved resulting in rapid resolution of symptoms.
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63
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von Renteln D, Quaas A, Rösch T, Denzer UW, Szyrach MN, Enderle MD, Lüth S, Haas S, Trepte C, Reutter D, Schachschal G. A novel flexible cryoprobe for EUS-guided pancreatic biopsies. Gastrointest Endosc 2013; 77:784-92. [PMID: 23453293 DOI: 10.1016/j.gie.2012.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) is an established technique for the cytologic diagnosis of pancreatic disease. Attempts to obtain adequate histologic specimens have yielded variable and mostly insufficient results. OBJECTIVE To evaluate the safety, feasibility, and quality of histologic biopsy specimens obtained by using a new cryobiopsy probe and to compare them with standard EUS-FNA and (laparoscopic) trucut biopsy specimens of pancreatic tissue. DESIGN Animal non-survival study. INTERVENTION Eighty-four pancreatic biopsy specimens (12 per group) were obtained in 4 anesthetized pigs by using one of the following the 18-gauge flexible cryoprobe; a conventional, 19-gauge, EUS-FNA needle; or a rigid, trucut biopsy device (18 gauge). The latter, used in laparoscopic surgery, was considered as the criterion standard for obtaining histology specimens. MAIN OUTCOME MEASUREMENTS Specimens were evaluated for artifacts and specimen quality by a blinded pathologist who used a 7-point Likert scale to assess histologic adequacy. Biopsy size and bleeding time after biopsy also were recorded. RESULTS The new cryoprobe was equivalent to the rigid, trucut needle and superior (P < .001) to the conventional 19-gauge FNA needles with respect to artifacts, quality of the specimen, biopsy specimen size, and bleeding. LIMITATIONS Animal model. CONCLUSION EUS-guided cryobiopsy was associated with better specimen quality for histologic analysis and a shorter bleeding time compared with a conventional 19-gauge FNA needle in the animal model. It is a promising new technique for histologic examination of pancreatic tissue.
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Affiliation(s)
- Daniel von Renteln
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Li Y, Feng H, Nie Z, Meng J, Ding X, Han Z. Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10330-012-1025-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Au JT, Carson J, Monette S, Finley DJ. Spray cryotherapy is effective for bronchoscopic, endoscopic and open ablation of thoracic tissues. Interact Cardiovasc Thorac Surg 2012; 15:580-4. [PMID: 22811511 DOI: 10.1093/icvts/ivs192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Spray cryotherapy (SCT) delivers a liquid nitrogen spray via a catheter to produce cellular death. This study seeks to determine the histological changes after bronchoscopic, endoscopic and open SCT on tissues in the thoracic cavity. METHODS Yorkshire pigs underwent flexible bronchoscopy, endoscopy and thoracotomy for SCT of the airway, oesophagus and other intrathoracic structures, respectively. Variations in the duration and number of spray cycles for the same dosimetry were compared. RESULTS Bronchoscopic SCT of the airway resulted in cellular death up to the cartilage layer. Endoscopic SCT of the oesophagus led to cell death up to the adventitial layer. Tissue necrosis was severe in the lung, of full thickness in the pleura, but very superficial in the great vessels. The extracellular matrix (ECM) of treated tissues remained well-preserved. Having shorter but more cycles of SCT decreased the depth of the cellular necrosis. One pig developed ventricular fibrillation during the surgery and expired. CONCLUSIONS SCT causes reproducible tissue injury with the preserved ECM of most tissues within the thoracic cavity, making it enticing for ablation around vital structures like the great vessels with a decreased long-term risk. Further study is warranted to investigate the adverse events during SCT.
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Affiliation(s)
- Joyce T Au
- Department of Surgery, Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Finley DJ, Dycoco J, Sarkar S, Krimsky WS, Sherwood JT, Dekeratry D, Downie G, Atwood J, Fernando HC, Rusch VW. Airway Spray Cryotherapy: Initial Outcomes From a Multiinstitutional Registry. Ann Thorac Surg 2012; 94:199-203; discussion 203-4. [DOI: 10.1016/j.athoracsur.2012.01.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 12/20/2022]
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Cryorecanalization: keys to success. Surg Endosc 2012; 26:2969-74. [DOI: 10.1007/s00464-012-2260-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 03/16/2012] [Indexed: 12/17/2022]
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Wang H, Zhou Y, Li D, Zhang N, Zou H, Li J, Liang S. [Clinical application of video-assisted rigid bronchoscopy in the treatment of airway stenoses]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:367-72. [PMID: 21496438 PMCID: PMC5999710 DOI: 10.3779/j.issn.1009-3419.2011.04.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Treatment of critical airway stenoses remains a formidable challenge to surgeons and anesthesiologists. Suffocate is a leading cause of death if the patients with airway diseases were not treated properly. The purpose of this study is to explore the feasibility, safety and efficiency using video-assisted rigid bronchoscopes (VARB) in the treatment of central airway stenoses. METHODS From August 27, 2007 to September 30, 2010, 194 patients (140 men and 54 women, mean age 57.5±1.3 years) with airway stenoses (145 with malignant and 49 with benign stenoses) were retrospectively reviewed underwent VARB treatment in our hospital. All the procedures were carried out under general anesthesia with high frequency jet ventilation. After the VARB was placed in the main trachea through the mouth, electric bronchoscope was combined to examine the lesions. Various methods for controlling the airway have been established to solve this problem, such as the electric loop, cryoprobe or argon plasma coagulation (APC) and stents. RESULTS T325 procedures were accomplished in all the 194 cases. Every patients received 1.6 procedures of VARB. VARB occupied 21.3% (325/1,525) in all bronchoscopic procedures. Among the patients, there were 76 cases with primary airway tumor and 69 with secondary malignant tumor, 49 with benign airway stenoses. Karnofsky performance status (KPS) and short breathless index were obviously improved after the first treatment of VARB. Improvement of bronchial stenoses was superior to that of tracheal stenoses. The effect of electasis treatment is better in obstruction of main bronchus than that of segment bronchus. 26 airway stents were removed and 13 stents were successfully placed under VARB. CONCLUSIONS VARB can be applied safely and effectively for the management of tracheobronchial stenoses. Quality of life was improved after the treatment of VARB.
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Affiliation(s)
- Hongwu Wang
- Minimal Invasive Tumor Therapy Center, Meitan General Hospital, Beijing, China.
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69
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Lee SH, Kim KT, Yi EJ, Son JS. Endoscopic cryosurgical resection of pulmonary hamartoma with flexible bronchoscopy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2011; 44:307-10. [PMID: 22263177 PMCID: PMC3249328 DOI: 10.5090/kjtcs.2011.44.4.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/12/2011] [Accepted: 05/31/2011] [Indexed: 11/25/2022]
Abstract
Pulmonary hamartoma is one of the most common benign lung tumors. Well-known conventional methods of treatment for lung hamartomas include VATS enucleation or wedge resection, bronchoplasty, and others. Here we present a case of endobronchial hamartoma that was successfully treated with cryosurgery by flexible bronchoscopy.
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Affiliation(s)
- Sung Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, College of Medicine, Korea University, Korea
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Gompelmann D, Eberhardt R, Herth FJF. Advanced malignant lung disease: what the specialist can offer. ACTA ACUST UNITED AC 2011; 82:111-23. [PMID: 21778793 DOI: 10.1159/000329703] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is not only the most commonly diagnosed cancer worldwide, but it is still the leading cause for cancer-related death. The 5-year survival for lung cancer in Europe and in the USA is totally 16%. Therefore, a palliative therapy regimen is required to control the disease and reduce symptoms with the objective of enhancing quality of life of lung cancer patients. In addition to chemotherapy that is still one of the most important pillars in the treatment of advanced lung cancer, further interventional strategies can be offered to improve a patient's quality of life. A locoregional tumour progression is frequently associated with malignant pleural effusion or pericardial effusion, central airway obstruction, tracheo-oesophageal fistula, severe haemoptysis or superior vena cava (SVC) syndrome threatening life and necessitating urgent palliation. Recurrent pleural effusion causing dyspnoea can be managed by pleurodesis, serial thoracocentesis or insertion of an indwelling catheter. Symptomatic malignant pericardial effusion often requires an urgent pericardiocentesis. Furthermore, surgical procedures, instillation of sclerosing agents or local chemotherapy should be considered in refractory pericardial effusion. The therapy regimen of central airway stenosis includes mechanical and thermic endoscopic procedures providing rapid relief of symptoms. To prevent recurrence of airway obstruction, the insertion of a stent or palliative brachytherapy provide re-establishment of the patency of obstructed airways. Haemoptysis can be managed by bronchoscopic interventions as well as by arterial embolization or palliative thoracic radiotherapy. The therapy of SVC syndrome is dependent of histology. In small-cell lung cancer, chemotherapy is recommended. In non-small-cell lung cancer, stent insertion and/or radiotherapy are the therapeutic pillars.
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Affiliation(s)
- Daniel Gompelmann
- Pneumology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany.
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Aktas Z, Gunay E, Hoca NT, Yilmaz A, Demirag F, Gunay S, Sipit T, Kurt EB. Endobronchial cryobiopsy or forceps biopsy for lung cancer diagnosis. Ann Thorac Med 2011; 5:242-6. [PMID: 20981186 PMCID: PMC2954380 DOI: 10.4103/1817-1737.69117] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/20/2010] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND: Invasive procedures such as bronchoscopic biopsy, bronchial washing, and bronchial brushing are widely used in diagnosis of lung cancers. The mean diagnostic rate with bronchoscopic forceps biopsy is 74% in central tumors. This study was designed to evaluate the efficacy of cryobiopsies in histopathological diagnosis. METHODS: Forty-one patients who had interventional bronchoscopy were included in this study. Three forceps biopsies and one cryobiopsy with cryorecanalization probe were obtained from each subject. Biopsies interpretations were done by one expert pathologist. RESULTS: Hemorrhage was the only complication in both procedures. There was no significant difference between these two procedures in the incidence of hemorrhage (P > 0.05). Mean diameters of samples taken with forceps biopsy and cryoprobe biopsy were 0.2 and 0.8 cm, respectively (P < 0.001). Thirty-two patients (78%) were diagnosed with forceps biopsies, and 38 patients (92.7%) were diagnosed with cryoprobe biopsies (P = 0.031). CONCLUSIONS: We concluded that cryoprobe biopsies were more successful than forceps biopsies in diagnosis. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy.
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Affiliation(s)
- Zafer Aktas
- Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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72
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Abstract
Advancements in the surgical and medical treatment of lung cancer have resulted in more favorable short-term survival outcomes. After initial treatment, lung cancer requires continued surveillance and follow-up for long-term side effects and possible recurrence. The integration of quality palliative care into routine clinical care of patients with lung cancer after surgical intervention is essential in preserving function and optimizing quality of life through survivorship. An interdisciplinary palliative care model can effectively link patients to the appropriate supportive care services in a timely fashion. This article describes the role of palliative care for patients with lung cancer.
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Affiliation(s)
- Betty Ferrell
- Department of Population Sciences, Nursing Research and Education, City of Hope, Duarte, CA 91010, USA.
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73
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Gottlieb J, Wedemeyer J. [Endoscopic palliation of esophageal and bronchial carcinomas]. Internist (Berl) 2010; 51 Suppl 1:237-45. [PMID: 20135086 DOI: 10.1007/s00108-009-2502-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Luminal obstruction from tumor growth can in relation to bronchial carcinoma lead to airway and/or esophageal obstruction in breathlessness or swallowing difficulties respectively. Self-expanding stents have become an established method of restoring luminal patency in both the esophagus and central airways, leading to significant symptomatic improvement. Due to anatomical constraints particularly in processes around the tracheal carina, stent implantation within the bronchial system often poses greater difficulty than within the esophagus. Technical difficulties do however arise in the esophagus, specifically in relation to stenotic high-cervical tumors, as well as distal stenosis. In this regard, advances in stent development have resulted in significantly improved outcomes with modern stents. In high-cervical esophageal tumors as well as locally invasive tumors with evidence of tracheobronchial fistulae a shared interdisciplinary care between the gastroenterology and pulmonary teams is necessary for a satisfactory outcome.
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Affiliation(s)
- J Gottlieb
- Klinik für Pneumologie/OE 6870, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
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