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Procedures


Bronchoscopic diagnostic procedures such as TBNA (Trans-Bronchial Needle Aspiration) or EBUS (Endobronchial Ultrasound) guided TBNA are done in the bronchoscopy suite under conscious or deep sedation as a same day procedure. It offers minimal risk in comparison to a surgical procedure, mediastinoscopy, which is more invasive and is done in the operating room under general anesthesia. With this technique we can sample enlarged lymph glands in the chest under direct ultrasound guidance. This procedure is valuable in diagnosing new cancer or other lung diseases such as sarcoidosis or infection.

Autofluorescence bronchoscopy and Narrow Band Imaging (NBI) is used to diagnose precancerous lesions in the airway.

With the available ablative therapies such as Nd-YAG laser, APC, Cryotherapy, balloon dilation along with rigid bronchoscopy, we can resect tumor from the airways so the patients can breathe better. Similar techniques can be used to relieve shortness of breath in patients with tracheostenosis.

Patients with cancer who have fluid build-up between the chest wall and lung (Pleural Effusion) can benefit from indwelling pleural catheters (PleurX) or pleurodesis (adhesion of lung to chest wall) to relieve their shortness of breath. We do medical thoracoscopy without general anesthesia to obtain pleural biopsies and to do pleurodesis using talc.

We can also biopsy a lung mass with a needle or biopsy forceps. Occasionally, we use fluoroscopic guidance which is available in the bronchoscopy suite. We are using Electromagnetic Navigational Bronchoscopy to obtain diagnostic tissue from hard to reach peripheral lung nodules or masses.  Cytopathology is available at bedside to determine if we obtained enough diagnostic tissue during the procedure.

We routinely use ultrasound to localize pleural fluid before draining it (thoracentesis) to minimize complications such as lung collapse. The ultrasound examination is done by the same pulmonologist who does the procedure.

Rigid bronchosopy involves placing a rigid tube in the airways (trachea or bronchi) under general anesthesia. Various indications include removal of foreign bodies, placement of stents, tumor debulking, dilation of airway obstruction. We do this procedure in the operating room.

We place all kinds of airway stents including self-expanding metallic stents such as ultraflex, Silcone stents such as Dumon stents, dynamic Rusch Y stent, Polyflex and Alveolus stents. We use both rigid and flexible bronchoscopes to place these stents. Stents can be placed in trachea or bronchus (link) when there is stenosis or if there is obstruction by malignant tumor. Before stent placement we do construct a 3-D image and also use laser and rigid bronchoscope to remove tumor before placing a stent.

We have started Bronchial Thermplasty procedure to treat asthma. Currently our site is also approved to use endobronchial valves for the treatment of continuous air leak (broncho-pleural fistula). Our center manages any complicated benign tracheal stenosis cases in close conjunction with Ear, Nose Throat and thoracic surgeons.
 
Percutaneous tracheostomy is done on patients who need long term ventilator support. We do tracheostomy on our ICU patients. Between January 2006 and January 2009 we have done more than 220 tracheostomies. With our experience and safety records we are currently doing tracheostomy on obese, coagulopathic patient and other high risk patients. We also follow patients with chronic tracheostomy and mange their complications.