INTERVENTIONAL PULMONOLOGY PROCEDURES

INTERVENTIONAL PULMONOLOGY (IP) is a subspeciality of pulmonary medicine in which minimally invasive endoscopic techniques are used to diagnose, treat and manage complex diseases of AIRWAYS, LUNGS, PLEURA, MEDIASTINUM. IP procedures are NON SURGICAL alternatives and SAFE, improving not only the functions of breathing by lungs and oxygenation but also in diagnosing and treating tumours. These procedures are used in conditions like airway obstruction due to tumours, foreign bodies, mucous plugs, pleural effusions, COPD and Lung Cancer. The instruments are mostly BRONCHOSCOPE or THORACOSCOPE. These are thin flexible tubes equipped with cameras as tools to access the respiratory organs via mouth or nose (Bronchoscope) or via chest wall (Thoracoscope). The commonly associated risks with surgeries like incisions, bleeding, scars and risks associated with anaesthesia are absent in IP procedures and time to recovery is also fast. The common IP procedures can be divided into DIAGNOSTIC and THERAPEUTIC procedures.

DIAGNOSTIC PROCEDURES:

These help in identifying the disease by visualising the inside of respiratory structures and sampling from abnormal areas.

1. FLEXIBLE BRONCHOSCOPY : It is the cornerstone procedure. It visualises airways from nostrils to sixth generation of airways.

   The popular Endo Bronchial Ultra Sounds (EBUS) are:

   1. Linear or Convex EBUS: It combines ultrasound with bronchoscope to guide needles to aspirate lymphnodes or masses.

   2. Radial EBUS: This procedure is usedfor a peripheral lung leision particularly small ones. It uses a 360 degrees rotating ultra sound passed through the bronchoscope.

   

   2.ELECTRO MAGNETIC NAVIGATION BRONCHOSCOPY ( ENB) :

   It is an advanced GPS like system useful in targetting deeply positioned pheripheral lung nodules invisible on standard scopes. It improves biopsy yield for early lung cancers.

   

   ELECTROMAGNATIC NAVIGATION BRONCHOSCOPY

   3. MEDICAL THORACOSCOPY (pluroscopy):

   In this procedure a scope is inserted into the pleural space to inspect the surfaces for any abnormal lesion and take a tissue biopsy. It is very useful in 'difficult to diagnose' pleural diseases or mesothiliomas.

   
   

THERAPEUTIC PROCEDURES:

AIRWAY INTERVENTIONS: done in diseases like airway tumours, strictures, foreign body aspirations.

AIRWAY STENOSIS OR STRICTURES:

STENTING: In order to open up the airways, silicon or self expanding metal or hybrid stents are deployed.

BALLOON DIALATATION: It helps in widening the narrowed airways.

TUMOR ABLATION: Tumour is destroyed by LASER therapy (NDYAG, Carbondioxide or Diode laser therapy). Argon Plasma Coagulation (APC) is useful in superficial bleeding or tumour ablation with precise control of depth.

CRYOTHERAPY: It freezes the tissue and helps in clearing the tumours/ masses, removing the foreign bodies or thick mucous plugs.

RIGID BRONCHOSCOPY: It is a larger scope which is used mainly for Core cut debulking, Stent placement or Control of massive hemorrhage. It is done under General Anesthesia.

OTHER AIRWAY THERAPEUTIC PROCEDURES ARE:

ENDOBRONCHIAL VALVES (EBV): One way valves which block airways and prevent airtrap and useful in COPD.

BRONCHIAL THERMOPLASTY (BT): in which Radio Frequency Energy is delivered to the hypertrophied smooth muscle in the airways and by reducing the muscle mass reduces the hyperinflation in Asthma.

PLEURAL THERAPEUTIC PROCEDURES:

1. THORACENTESIS OR PLEURAL ASPIRATION is pleural fluid aspiration in which needle drinage of excess fluid accumilated in the pleural cavity is done. It is done for both diagnostic and theraputic purposes.

2. IPC (INDWELLING PLEURAL CATHETER) placement : The catheter drainage is done in recurrent pleural effusions due to malignancies which need long term drainage or home drainage.

   

   INDWELLING PLEURAL CATHETER

   ADVANCED AND EMERGING TECHNIQUES IN IP

   CONE BEAM CT and RADIOFREQUENCY ABLATION (CBCT &RFA) :

   This is a special procedure which combines enhanced PRECISION DIAGNOSIS and TARGETTED TUMOR ABLATION.

   CBCT: It is a rotational imaging technology that generates High Resolution 3D lung images aiding navigation to pheripheral leisions.

   RFA: In this, heat is used to ablate lung tumour via a needle electrode inserted percutaneously.

   
   

   CBCT AND OTHER INTEGRATED PROCEDURES:

   CBCT can be integrated with RAB and Radial EBUS and FLUOROSCOPY for biopsy of high risk nodules.

   CBCT and RAB: ROBOTIC ASSISTED BRONCHOSCOPY or RAB navigates airways using preloaded CT maps and live visualization. After TOOL IN LESION confirmation, lesion is targetted. This procedure has advantage of reduced risk of pneumothorax and increased diagnostic yeald of 85 to 95%.

   AUGMENTED FLUOROSCOPY overlays CBCT derived 3D nodule hologram on live 2D fluoroscopy for continuous guidance, minimizing CT- to- body divergence.

   

   ADVANTAGES OF IP PROCEDURES OVER CONVENTIONAL SURGICAL PROCEDURES:

   Advantages:1. IP procedures are MINIMALLY INVASIVE, usually avoid large incisions resulting in less pain and no scar.

   2. Rapid recovery: It is often performed as an outpatient proceedure under local anaesthesia, enabling faster return to daily activities.

   3.High precision: Integration with advanced imaging techniques improves diagnositic accuracy of cancer in early stages.

   MODERN LUNG CARE IS MORE PRECISE AND PATIENT-FRIENDLY THAN EVER BEFORE. WHETHER ITS A DEFINITE DIAGNOSIS OR SYMPTOM RELIEF, OUR INTERVENTIONAL TEAM IS HERE TO PROVIDE EXPERT CARE YOU NEED.

   CONTACT US TODAY TO BOOK AN APPOINTMENT ANT START BREATHING WITH CONFIDENCE AGAIN !