Background Information:

What are the other Names for the Procedure?

• Open Tube Bronchoscopy
• Straight Bronchoscopy
• Ventilating Bronchoscopy

What is Rigid Bronchoscopy procedure?

• Rigid Bronchoscopy is a therapeutic procedure that allows detailed inspection of the trachea and proximal main stem bronchial airways
• The trachea and bronchial airways are airway tubes that carry oxygen to the lungs and are a part of the respiratory tract
• The procedure is performed to treat complex airway problems, especially in lung cancer. It allows laser therapy of endobronchial cancers and placement of airway stents.
• Rigid Bronchoscopy also helps in removal of any foreign body or treatment of bleeding from the airways

What part of the Body does the Procedure involve?

A Rigid Bronchoscopy procedure involves passing a rigid scope through the mouth.  The scope is passed into the oro-pharynx (throat), larynx (voice box), and trachea (windpipe).

Why is the Rigid Bronchoscopy procedure Performed?

There could be various reasons for performing a Rigid Bronchoscopy. These include:

• To treat endobronchial cancer, tumor ablation, and relief of airway obstruction
• To perform laser therapy of endobronchial cancers
• To place endobronchial stents
• To dilate tracheal or bronchial strictures
• To laser benign growths/tumors in trachea such as papillomas
• To evaluate and treat bleeding in the airways
• To remove foreign body in the airways

What are some Alternative Choices for the Procedure?

• Once Rigid Bronchoscopy is decided upon by the healthcare provider, there are usually no better alternatives
• Sometimes, the patient may be referred directly to the thoracic surgeon for an open surgical lung procedure

What are the Recent Advances in the Procedure?

The advances in Rigid Bronchoscopy include interventions such as stenting and laser therapy. 

What is the Cost of performing the Rigid Bronchoscopy procedure?

The cost of Rigid 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 with a sudden inflow of information regarding the Rigid Bronchoscopy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://health.ucsd.edu/specialties/pulmonary/procedures/Pages/rigid-bronchoscopy.aspx (accessed on 11/11/19)

https://journal.chestnet.org/article/S0012-3692(15)33708-9/fulltext (accessed on 11/11/19)

https://mmcts.org/tutorial/47 (accessed on 11/11/19)

Prior to Rigid Bronchoscopy procedure:

How is the Rigid Bronchoscopy procedure Performed?

The Rigid Bronchoscopy is usually an outpatient procedure.

• The patient is required to be under fasting prior to procedure per the physician recommendation
• It is usually performed under general anesthesia (with oral airway)
• Oxygen and ventilation are provided through the side port of the rigid bronchoscope during this procedure
• Sometimes topical anesthesia is sprayed in the oro-pharynx (throat) as well
• Sometimes, a flexible scope is passed through the rigid bronchoscope for further evaluation and procedures that involve the distal airways
• Once the procedure is completed, the rigid bronchoscope is withdrawn

Where is the Procedure Performed?

A Rigid Bronchoscopy procedure is usually performed in a university hospital, in the endoscopy/surgical procedure suite.

Who Performs the Procedure?

The procedure is usually performed by an interventional pulmonologist who has undergone additional training in complex airway procedures.

How long will the Procedure take?

• The actual procedure may take between 60-90 minutes depending on the therapeutic procedures planned
• On considering the pre-procedure examination and post-procedure recovery time, the total time in the procedure suite is 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 procedure and helps avoid complications.

• Provide medical history such as diabetes, hypertension, heart disease, etc.
• Medication history and any allergies to medications, latex, etc.
• If the patient is under any of the following medications, it has to be promptly informed to the healthcare provider: Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), warfarin (coumadin), rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradaxa), enoxaparin (Lovenox), etc. and any other blood thinners that he/she is currently taking
• Any medical or family history of bleeding disorders or blood clots
• Any unusual effects of anesthesia from prior surgery
• History of sleep apnea and CPAP use at home
• History of rheumatoid arthritis, which can affect neck joints
• Dental problems such as loose tooth
• History of arthritis or stiffness of the neck joints
• Neck flexion/extension limitations due to any prior surgery or radiation in the neck and throat region
• History of cervical spondylosis or cervical spine discectomy surgery

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to procedure and discuss procedure details with risks for complications and obtain his/her permission (termed informed consent). 

• If anesthesia team is involved in the procedure, then they too will discuss details of anesthesia with risks for complications and obtain permission from the patient (informed consent)
• Blood work, glucose, and pregnancy tests (if applicable) will be undertaken per physician recommendations
• It is strongly advised not to use any cocaine about 7 to 14 days before procedure; and if so, it is important to discuss the same with the physician and anesthesia team
• Smoking should generally be avoided prior to procedure
• Generally, the patient is required to be on fast (no solids or liquids) for at least 8 hours prior to the procedure
• Individuals with diabetes, hypertension, or other cardiac conditions, are required to discuss these (including medications taken) with their attending physician well in advance

What is the Consent Process before the Procedure?

The physician will obtain permission for the Rigid Bronchoscopy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the 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.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Rigid Bronchoscopy procedure?

• Blood tests and pregnancy test (if applicable) may be required prior to the procedure
• The patient may have already undergone a chest X-ray or CT scan of the chest, or both
• An EKG may be needed for anesthesia evaluation.

What are some Questions for your Physician?

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

• What is a Rigid 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 Rigid Bronchoscopy procedure:

What kind of Anesthesia is given, during the Procedure?

• The procedure is usually performed with general anesthesia (with oral airway)
• Oxygen and ventilation are provided through the side port of the rigid bronchoscope during this procedure
• Sometimes, topical anesthesia is sprayed in the oro-pharynx (throat) as well

How much Blood will you lose, during the Procedure?

Rigid Bronchoscopy is a fairly invasive procedure performed on patients with complex airways with lung cancer. Although the risk of bleeding is higher compared to other bronchoscopies, the experience and advanced training of the interventional pulmonology team can help result in the procedure being done with a high level of care and safety.

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

The risks or complications that may arise during Rigid Bronchoscopy include:

• Injury to the teeth or gums
• Injury to the vocal cords
• Bleeding in the airways with biopsies
• Tearing of the airways with laser therapy and endobronchial stent placement
• Oxygen desaturations, low blood pressure, and arrhythmias (irregular heart rhythm)
• Anesthesia complications, such as respiratory depression, the need for mechanical ventilation, anaphylactic reactions, etc.

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

• The patient is usually observed by healthcare professionals (nurses) in the post-anesthesia care unit (PACU); his/her vital signs are monitored
• A chest X-ray is usually performed to confirm stent placement/position
• Nebulizer treatment may be needed after the procedure

After the Rigid Bronchoscopy procedure:

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

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

• Sore throat and cough for 6 to 24 hours after the procedure
• Low-grade fevers for 6 to 24 hours after procedure if lavage is done
• Coughing blood or blood clots following biopsies, if any performed
• Bronchospasm, which is manifested by difficulty in breathing
• Lung collapse (atelectasis)
• Delayed clearance of anesthesia medications leading to prolonged respiratory depression and need for mechanical ventilation
• Uncommonly, low oxygen saturations or cardiac arrhythmias post procedure may result in the patient being admitted for overnight observation in the hospital

What is the Prognosis after the Surgery?

• The recovery from the Rigid Bronchoscopy procedure is generally good
• The patient is usually discharged after 60 minutes to 2 hours after the procedure. Typically, there may be a follow up with the physician in 2 weeks to review the results

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Coughing fresh blood
• Shortness of breath more than usual or unexplained difficulty in breathing
• Worsening cough
• Unexplained chest pain
• High grade fevers over 101 deg. F

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

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

• Take simple analgesics, such as acetaminophen (Tylenol) or ibuprofen (Advil), if needed
• Avoid any strenuous activity for a period recommended by the physician
• Do not drive (post-procedure) for a period of 24 hours
• Avoid smoking or drinking alcohol post-procedure
• Continue prescribed medications except for aspirin or blood thinners. It is important to check with the physician on when to resume aspirin or blood thinners
• Do not sign any legal documents post-procedure for a period of 24 hours

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

Usually, it takes about 12 to 24 hours to completely recover from the effects of the anesthesia and bronchoscopy procedure.

Additional Information:

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

The samples/tissue are usually sent to the microbiology and pathology departments in the hospital and subsequently disposed, as per the standard hospital protocol.

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

• The samples/tissue 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 Rigid Bronchoscopy 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 pulmonologist or 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 Rigid Bronchoscopy procedure is performed.