The Emergence of Interventional Pulmonology

Introduction

Interventional pulmonology focuses on the diagnosis and treatment of both malignant and non-malignant illnesses of the lungs and airways and is credited with having a significant impact on pulmonary (lung- and breathing-related) medicine. Interventional pulmonology is a subspecialty of pulmonology that focuses on the detection and treatment of lung cancer, thoracic cancer, tracheal cancer, and other disorders that affect the respiratory system by the use of non-surgical, minimally invasive techniques. Endoscopic operations, in which an instrument is inserted into the patient's body so that internal organs and tissues can be viewed and other procedures can be performed, are necessary for this method. Interventional pulmonary medicine is also used to treat related symptoms that may cause discomfort, such as shortness of breath, coughing, and chest pain. These symptoms can all be caused by the same underlying condition. A variety of lung conditions, including:

• Cancer of the lung.

• Cancers that have spread to the lungs through metastasis.

• Due to abnormal growth, there is a blockage in the airway.

• Adenopathy (lymph glands that are enlarged or swollen in size) of the mediastinum and hilar region.

• Lung nodules and masses that have not been diagnosed.

• Diseases of the pleura (the lungs are enveloped by a delicate layer of tissue known as the pleura, which also lines the inner surface of the chest cavity.), including effusions (the pleural cavity, which refers to the collection of fluid in the space between the pleura.) or disease that has not yet been diagnosed.

• Fistulas of the bronchopleural (a sinus tract that connects the primary airway, lobar, or segmental bronchi to the pleural space).

• Pneumothoraces (a gathering of air that is located outside of the lungs but inside the pleural cavity).

What Do Interventional Pulmonology Procedures Entail?

An interventional pulmonologist possesses significant expertise in conducting sophisticated, minimally invasive interventional procedures on the respiratory passages and thoracic cavity. These procedures encompass advanced bronchoscopic and fluoroscopic techniques.

• Bronchoscope - The bronchoscope is a slender, cylindrical device equipped with an illuminating component and an optical system designed for the purpose of visual examination. Additionally, it may possess a specialized instrument intended for the extraction of tissue, which can subsequently undergo an examination to detect indications of pathological conditions. The bronchoscope is introduced through the nasal or oral cavity to facilitate the examination of the internal structures of the trachea, bronchi, and lungs.

• Pleuroscope- The insertion of a pleuroscope into the thoracic cavity is facilitated by creating a small incision in the chest wall. Subsequently, the pleuroscope is guided along the chest wall and pleura on a single side of the body.

What Are the Various Types of Pulmonology Interventions?

Interventional pulmonology procedures and techniques encompass a range of medical interventions that are employed in the field, such as the following:

• Endobronchial Ultrasound- The endobronchial ultrasound (EBUS) procedure involves the insertion of a flexible bronchoscope under the guidance of an ultrasound probe in order to locate lymph nodes and masses located outside of the airways. This scope facilitates the performance of biopsies on lymph nodes or masses.

The process of placing fiducial markers (a medical gadget or another small object that is inserted into or placed on the body in order to mark a region for the purposes of surgery or radiation treatment.) involves the strategic positioning of markers either within or in close proximity to a tumor, with the aim of establishing a reliable point of reference during the administration of highly accurate and targeted stereotactic radiation therapy.

• Airway Stent Placement- The airway stent placement procedure involves the insertion of a stent into the airway with the purpose of facilitating improved respiratory function for patients.

• APC - Argon plasma coagulation (APC) is a medical procedure employed to achieve hemostasis by cauterizing blood vessels, thereby, arresting bleeding in patients experiencing hemoptysis.

• Method for Pleural Effusion - Pleurodesis and thoracentesis are medical interventions intended to alleviate pleural effusion, a condition characterized by the accumulation of excessive fluid in the pleural space surrounding the lungs. These procedures may involve the utilization of a pleural catheter as a means of fluid drainage.

• PDT - Photodynamic therapy (PDT) is a therapeutic modality that involves the utilization of photosensitive medication in combination with a light-emitting source to effectively eliminate malignant cells.

• HAST - The Hypoxia Altitude Simulation Test (HAST) is a diagnostic procedure employed to assess the necessity of supplemental oxygen for individuals experiencing respiratory difficulties during air travel.

• VATS- Certain interventional pulmonology procedures possess corresponding surgical equivalents. Video-assisted thoracic surgery (VATS) is a surgical procedure that shares similarities with medical pleuroscopy, and it is typically conducted by a thoracic surgeon.

What Are the Advantages of Interventional Pulmonology?

Interventional pulmonology addresses a basic essential patient requirement, which is the capacity to breathe normally.

• Interventional pulmonologists employ imaging technologies to identify the underlying symptoms. Interventional pulmonology is a subspecialty of pulmonology that concentrates on the use of less invasive techniques and procedures for the diagnosis and treatment of respiratory malignancies as well as the removal of blockages in the airway.

• Interventional techniques are employed to help open the airway quickly without having to wait for chemotherapy or radiation therapy to shrink tumors. This eliminates the need to wait for the airway to be opened. In order to assist patients in breathing more comfortably, the treatments may also remove extra fluid from around the lungs, which is a condition known as pleural effusion. Additionally, the procedures may relieve symptoms that cause discomfort.

• Patients may have less trauma, fewer problems, and quicker recovery times because of the less intrusive procedures used by interventional pulmonologists.

What Are the Different Types of Interventional Pulmonary Procedures?

• Bronchoscopy: The vast majority of interventional pulmonology operations use some kind of bronchoscopy, which makes it possible to perform minimally invasive procedures by utilizing very small cameras or other surgical instruments that are passed through a bronchoscope. With the help of the bronchoscope, it is able to diagnose and treat conditions such as tumors, bleeding, inflammation, or obstructions in the lungs or airways; acquire fluid samples or tissue biopsies for testing; dilate areas; and implant stents; all of these procedures can be performed on the patient without the need for surgery, hospitalization, or a protracted period of recovery.

What Are the Additional Interventional Pulmonology Procedures?

• Airway Ablation - It is a medical procedure aimed at alleviating airway obstructions and restoring patency in individuals with obstructed or scarred airways.

• Balloon Dilation - It is a medical procedure that involves the expansion of constricted airways using a balloon that is inserted through a bronchoscope.

• Bronchial Thermoplasty (BT) - It is a medical procedure that involves the targeted application of thermal energy to the airways through a bronchoscope. This therapeutic intervention aims to mitigate the constriction of the airways in individuals suffering from severe asthma by reducing the quantity of smooth muscle present.

• Bronchoscopic fiducial placement and lung tattooing are sophisticated bronchoscopic techniques that are employed, including the utilization of robotic bronchoscopy, to identify lesions and insert fiducial seeds and ink in order to reduce the extent of tissue resection performed by our thoracic surgeons.

• The utilization of a robotic bronchoscope enables the possibility of performing biopsies on lung nodules that exhibit suspicious characteristics. The utilization of this sophisticated technological apparatus enables medical practitioners to extract samples from peripheral lung lesions in an outpatient setting, resulting in enhanced efficacy and safety. In the event that malignancy is detected, concurrent tissue sampling of lymph nodes is conducted.

• Stent Placement - Stent placement involves the utilization of silicone, metal, or hybrid (silicone-covered metal) stents, which are inserted through bronchoscopy procedures to address airway obstruction in patients.

• Zephyr Endobronchial Valve - It is a medical device that consists of small valves that are inserted into the airways of the lungs using a bronchoscope. This device is specifically designed to provide treatment for patients suffering from chronic obstructive pulmonary disease (COPD) and emphysema. This mechanism facilitates the expansion of the lungs' healthy portions, thereby promoting improved respiratory function.

What Are the Complications?

Even though there is only a small chance of complications, interventional pulmonology techniques are not completely risk-free. Interventional pulmonology procedures carry a low risk of the following uncommon complications:

• Pneumothorax, sometimes known as a collapsed lung.

• Bleeding.

• An excessive amount of sedation may result in pneumonia or the requirement of emergency life support.

Conclusion

In summary, the addition of new modalities to the field of interventional pulmonology. Even though it is invasive, interventional bronchoscopy is a safe and effective treatment in certain situations. It is an effective therapy option for both life-threatening disorders as well as airway blockages that arise owing to malignancies, notably lung cancer. Interventional pulmonology techniques tend to be associated with a speedier recovery period. Surgical procedures are still often the most effective means of diagnosis and therapy for a wide variety of lung disorders.