Bronchoscopy is a procedure that visualizes the tracheobronchial tree by placing an instrument inside the airways. The types of bronchoscopy are reviewed here. The equipment, technique, and complications of flexible bronchoscopy are also discussed. The indications and contraindications of flexible bronchoscopy are described separately. (See "Flexible bronchoscopy: Indications and contraindications".)
TYPES OF BRONCHOSCOPY
There are two main types of bronchoscopy: rigid and flexible. Virtual bronchoscopy is also available, but it is not common (table 1).
Rigid bronchoscopy — Rigid bronchoscopy is a procedure in which a straight metal tube with a beveled distal end is inserted into the trachea through the mouth (or the tracheostomy stoma) (picture 1 and picture 2), which facilitates the debulking of large tracheal or endobronchial tumors, the management of massive hemoptysis, and the insertion or removal of airway stents (table 2). The rigid bronchoscopy system consists of the rigid bronchoscope, a telescope, a light source, and a monitor to view the images (picture 3). Rigid bronchoscopy is reviewed separately. (See "Rigid bronchoscopy: Instrumentation".)
Flexible bronchoscopy — Flexible bronchoscopy is the most common type of bronchoscopy. The flexible bronchoscope is an instrument that is inserted through the mouth, a nasal orifice, an endotracheal tube, a tracheostomy tube, or a tracheostomy stoma and then used to visualize the vocal cords, tracheobronchial tree, and segmental airways out to the third generation of airways. It can also be used to sample lesions within the airways, adjacent to the airways, or in the lung parenchyma. Various endoluminal interventions to ablate tracheobronchial lesions can be administered via flexible bronchoscopy. Flexible bronchoscopy is generally performed in a procedure room (ie, a bronchoscopy suite) using conscious sedation. The flexible bronchoscope has a mechanism to flex or extend its distal end, which facilitates insertion through the curved airways. It also contains optical fibers to transmit images, a working channel, and a light source (figure 1 and figure 2) .
Several variants of traditional flexible bronchoscopy exist :
- Endobronchial ultrasound (EBUS) involves a flexible bronchoscope that has an ultrasound probe built into its distal end. It provides real-time ultrasound images of the tissue adjacent to the airway, facilitating transbronchial needle aspiration of enlarged lymph nodes or masses.
- Electromagnetic navigation bronchoscopy (ENB) uses a special catheter with a sensor probe that is inserted through the working channel of a regular flexible bronchoscope. The probe is then steered through the distal airways beyond the third generation of airways, guided by an electromagnetic guidance system. This allows peripheral lung masses or abnormal areas to be sampled even if they cannot be accessed by regular bronchoscope directly.
- Ultrathin bronchoscopy is performed with a bronchoscope that has an external diameter of only 2.8 mm, allowing examination beyond the third generation of airways.
- Fluorescence bronchoscopy facilitates the identification of precancerous or abnormal airway lesions and is reviewed separately. (See "Endobronchial ultrasound: Indications, advantages, and complications" and "Endobronchial ultrasound: Technical aspects" and "Fluorescence bronchoscopy" and "Transbronchial needle aspiration".)