Background Information:

What are the other Names for the Procedure?

• Bronchial Endoscopy
• Endoscopy of Bronchus
• Tracheobronchial Endoscopy

What is Bronchoscopy surgical procedure?

• Bronchoscopy is a minimally invasive procedure that uses an optical instrument to examine the inner linings of the bronchial tubes
• The bronchial tubes are hollow airways that carry oxygen to the lungs and are a part of the respiratory tract
• The procedure also helps in removal of any foreign material, secretion, or blood from the airway

What part of the Body does the Procedure involve?

A Bronchoscopy procedure involves the pharynx (throat), larynx (voice box), windpipe or trachea, the bronchi, and bronchioles (bronchial tubes).

Why is the Bronchoscopy surgical procedure Performed?

There could be various reasons for performing a Bronchoscopy. Some of them are:

• To diagnose diseases of the lung
• To remove a foreign object or matter causing blockage
• To investigate bleeding in the bronchial tubes
• View abnormalities in the respiratory tract
• To investigate suspected cancer of the bronchi and bronchial tubes
• Extract tissue specimen for pathological examination

What are some Alternative Choices for the Procedure?

To study and diagnose any ailment related to the bronchial tubes, a Bronchoscopy remains the gold standard technique.

What are the Recent Advances in the Procedure?

Flexible Bronchoscopy is the recent advancement in the procedure and a preferred option for all bronchial-related diseases or disorders.

What is the Cost of performing the Bronchoscopy surgical procedure?

The cost of Bronchoscopy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Bronchoscopy and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.nhlbi.nih.gov/health/health-topics/topics/bron/show.html

http://www.mdguidelines.com/bronchoscopy/prognosis

Prior to Bronchoscopy surgical procedure:

How is the Bronchoscopy surgical procedure Performed?

• The patient is administered with a local or general anesthesia before introducing the bronchoscope; the physician usually sprays liquid medicine in the patient’s nose and mouth to prevent gagging
• Next the bronchoscope is introduced into the respiratory tract
• The bronchoscope is a thin flexible tube that transmits images from within the bronchial tube to the external end which is either connected to an eyepiece or a recording camera
• In most cases the bronchoscope is also attached with a device that helps in removing or suctioning out any foreign matter, secretion, or tissue
• Once the procedure is completed, the bronchoscope is withdrawn

Where is the Procedure Performed?

A Bronchoscopy procedure is usually performed in an out-patient surgery center facility. Normally, the patient can go home once the procedure is completed.

Who Performs the Procedure?

The procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

• An ENT (ear, nose & throat) specialist
• A pulmonologist
• An intensivist (intensive care specialist)
• A general surgeon
• A thoracic surgeon

How long will the Procedure take?

The actual procedure may take anywhere between 30-90 minutes. Considering the preparation and recovery time, the total time taken for the procedure is anywhere between 4-6 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain information about the overall health status including the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• It is advised to quit smoking and the use of any nicotine based products, at least 30 days before the surgery
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• The physician will request your consent for the Bronchoscopy procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

The physician will request your consent for the Bronchoscopy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Bronchoscopy surgical procedure?

Some blood tests may be necessary prior to the procedure; the exact type of blood tests required, shall be determined by the physician. Apart from this, the patient may also need to undergo an X-ray or CT scan of the chest, or both.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Bronchoscopy?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Bronchoscopy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia with sedation. However, in some cases, general anesthesia may also be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

Since Bronchoscopy is a minimally invasive procedure, there is little or no blood loss involved.

What are the possible Risks and Complications during the Bronchoscopy surgical procedure?

The possible risks or complications that may arise during Bronchoscopy are:

• Infection in the respiratory tract or lungs
• Accidental injury to the inner lining of the bronchial tubes
• Injury to the vocal cords
• Bleeding
• Anesthetic complications, like respiratory depression, need for mechanical ventilation, anaphylactic reactions, etc.

What Post-Operative Care is needed at the Healthcare Facility after the Bronchoscopy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Bronchoscopy surgical procedure:

What are the possible Risks and Complications after the Bronchoscopy surgical procedure?

The possible risks and complications that may arise after a Bronchoscopy are:

• Pneumothorax: A condition where there is a leakage of air from the lungs, eventually leading to collapse of the affected lung
• Heart rhythm disturbances
• Swelling of mucous membranes of the respiratory tract
• Laryngospasms; spasms of the vocal cords
• Swelling of the vocal cords
• Bronchospasms; sudden contraction in the bronchial tubes

What is the Prognosis after the Surgery?

• Bronchoscopy provides information that helps the physician to successfully diagnose and treat any diseases or disorder of the lung or bronchial tubes
• The recovery from the procedure is generally excellent
• If the procedure reveals that the patient is suffering from any serious underlying diseases; the physician may suggest further diagnostic procedures

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Excessive bleeding
• Difficulty in breathing
• Increase in cough
• Chest pain
• Fever
• Dizziness
• Muscle ache

What Post-Operative Care is needed at Home after the Bronchoscopy surgical procedure?

At home, the following post-operative care is recommended, after a Bronchoscopy procedure:

• Avoid strenuous activity
• Avoid smoking
• Use a vaporizer to help increase ‘moisture in the air’ you breathe
• Complete the course of prescribed medications
• Do not use non-prescribed medications or pain killer
• Resume regular/daily activities as soon as possible, to aid in faster recovery (under advise from the physician)

How long does it normally take to fully recover, from the Procedure?

Usually, it takes about 24 hours to completely recover from the effects of the Bronchoscopic procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Bronchoscopy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• The ENT specialist, or a pulmonologist, or a general surgeon, or a thoracic surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Bronchoscopy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA