Interventional Pulmonology
Diagnostic and Therapeutic Procedures
Bronchoscopy is a nonsurgical minimally invasive procedure that enables a physician to look inside your lungs using a bronchoscope. Bronchoscopy can help your doctor diagnose lung cancer, many types of pneumonia and tuberculosis. In some cases, bronchoscopy allows your doctor to make a diagnosis without doing a surgical procedure.
The conventional bronchoscopic procedures we offer include endobronchial biopsy, transbronchial needle/forceps biopsies and bronchial alveolar lavage. The conventional bronchoscopies are done under moderate sedation on an outpatient basis. The interventional procedures are done either under deep sedation or anesthesia and mostly as outpatient procedures. We offer 22 separate minimally invasive diagnostic and interventional procedures, including:
- Bronchial Thermoplasty
- Electromagnetic Navigational Bronchoscopy
- Fiducial Marker Placement for Stereotactic Radiosurgery
- Airway Stent Placement
- Balloon Dilatation
- Endobronchial Ultrasound (EBUS) and Radial Probe Ultrasound (REBUS)
- Argon Plasma Coagulation (APC)
- Pleuroscopy
- Cryotherapy
- Endoscopic Lung Volume Reduction
- Transbronchial Cryo Biopsy
Bronchial Thermoplasty
Bronchial thermoplasty (BT) is a new, FDA-approved technique to treat adult (18 years and older) asthma patients who suffer from severe persistent asthma that is not well controlled with inhaled corticosteroids and long-acting beta agonists, the current standard-of-care treatments. PAMF is one of the only centers in Northern California currently offering this procedure.
Bronchial thermoplasty uses radiofrequency energy to relieve asthma symptoms. During an asthma attack, the smooth muscles of the airways contract. Bronchial thermoplasty is a noninvasive procedure that uses radiofrequency energy to heat the smooth muscle walls of the airway, which thins the smooth airway wall muscles without scarring or damaging them. Because bronchial thermoplasty thins the muscle walls, they cannot narrow as much when irritants trigger asthma attacks, resulting in lessening of symptoms and asthma relief.
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Electromagnetic Navigational Bronchoscopy
We use the SuperDimension inReach system, which gives doctors access to peripheral lung lesions and mediastinal lymph nodes using a minimally invasive, image-guided technique. This is suitable for:
- Patients who cannot undergo more invasive procedures
- Patients with multiple lesions
- Patients who request a diagnosis before undergoing surgery
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Fiducial Marker Placement for Stereotactic Radiosurgery
Some tumors are not accessible through traditional surgery, but are excellent candidates for stereotactic radiosurgery (CyberKnife, Trilogy, and others). To facilitate stereotactic radiosurgery, fiducial markers are placed in or near a tumor, so radiation can be delivered precisely and exactly.
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Airway Stent Placement
Stents are small, cylindrical, expandable tubes, very similar to those cardiologists use to open up arteries in the heart. Interventional pulmonologists use them to open bronchial tubes (airways) that are occluded or narrowed due to infection, tumors or scar tissues.
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Balloon Dilatation
Similar to how coronary arteries are opened through angioplasty, in this procedure a balloon is used to open an airway. This is particularly useful when the airway is too narrow, as a result of scarring after a tracheotomy, for example. Depending on the location of the airway narrowing, dilation can be performed using a flexible or rigid bronchoscope.
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Endobronchial Ultrasound (EBUS) and Radial Probe Ultrasound (REBUS)
With EBUS, the pulmonologist uses a special bronchoscope with an ultrasound attachment at the tip of the scope. This technique can be used to perform biopsies in multiple areas, with greater accuracy. Because the pulmonologist can see the needle as it is placed inside the abnormality, the risk of puncturing a blood vessel is minimized. This procedure is used to biopsy lymph nodes in the middle of the chest (EBUS) or peripheral lung lesions (REBUS).
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Argon Plasma Coagulation (APC)
With APC, heat from an electric current is used to destroy tumors or stop bleeding. An accompanying argon gas jet allows heat to be applied without making direct contact. This noncontact method is useful to cover a larger surface area, thereby shortening the procedure time.
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Pleuroscopy
When a laparoscopy is performed in the chest it is called pleuroscopy or medical thoracoscopy. A small instrument with a camera is inserted into the chest cavity through a very small incision, enabling the physician to perform diagnostic and therapeutic procedures inside the chest.
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Cryotherapy
Using either a rigid or flexible bronchoscopy, cryotherapy destroys airway tumors by freezing the tissue. A probe that has been super-cooled is applied repeatedly over the entire surface of the tumor tissue. This procedure can be used in conjunction with argon plasma coagulation to recanalize airways occluded by a tumor or by granulation tissue, which forms as part of a healing process.
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Endoscopic Lung Volume Reduction
The IBV Valve System is currently under investigation in the United States as a new treatment option for people:
- With severe emphysema
- Who do not respond well to current medical therapies
- Are not eligible for invasive surgery such as lung volume reduction or lung transplantation, or who elect not to undergo such surgery
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Transbronchial Cryo Biopsy
Cryoextraction is a procedure for recanalizing obstructed airways caused by exophytic (outward-growing) tumors. Biopsy samples obtained with this method can be used for tissue diagnosis. Transbronchial cryo biopsy can be used as a substitute for surgical lung biopsy in the case of diffuse lung diseases such as pulmonary fibrosis.
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