title: Operative rigid bronchoscopy: indications, basic techniques and results.
abstract: Palliative airway treatments are essential to improve quality and length of life in lung cancer patients with central airway obstruction. Rigid bronchoscopy has proved to be an excellent tool to provide airway access and control in this cohort of patients. The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease. We routinely use negative pressure ventilation (NPV) under general anaesthesia to prevent intraoperative apnoea and respiratory acidosis. This procedure allows opioid sparing, a shorter recovery time and avoids manually assisted ventilation, thereby reducing the amount of oxygen needed, while maintaining optimal surgical conditions. The major indication for NPV rigid bronchoscopy at our institution has been airway obstruction by neoplastic tracheobronchial tissue, mainly treated by laser-assisted mechanical dissection. When strictly necessary, we use silicone stents for neoplastic or cicatricial strictures, reserving metal stents to cover tracheo-oesophageal fistulae. NPV rigid bronchoscopy is an excellent tool for the endoscopic treatment of locally advanced tumours of the lung, especially when patients have exhausted the conventional therapeutic resources. Laser-assisted mechanical resection and stent placement are the most effective procedures for preserving quality of life in patients with advanced stage cancer.
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy francesco.petrella@ieo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Petrella
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Casiraghi
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cavaliere
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Donghi
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparri
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Juliana
authors.initials: J
authors.lastname: Guarize
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pardolesi
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Adele
authors.initials: A
authors.lastname: Tessitore
authors.affiliation: Department of Anaesthesiology, European Institute of Oncology, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Venturino
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy University of Milan School of Medicine, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D001980:Bronchi / Q000473:pathology / Q000601:surgery; D020680:Bronchoscopes / Q000145:classification*; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D015607:Stents; D016896:Treatment Outcome
keywords: Airway compression; Airway infiltration; Laser; Rigid bronchoscopy; Stent