evropis pirveli kongresi bronqologiasa da intervenciul pulmonologiaSi

profesori kaxa vaWaraZeeq.bronqologi daviT Wyonia

marseli 10-12 marti 2011weli

kongresis Catarebis adgili faros sasaxle

monawileebi

FRANCE

GERMANY

ITALYJA

PAN

CZECH REPUBLIC

UNITED STATES

TURKEYSP

AIN

UNITED KINGDOM

BELGIU

MIN

DIA

HONG KONG

PORTUGAL

SWITZE

RLAND

NETHERLANDS

BULGARIA

ALBANIA

AUSTRIA

THAILAND

BRAZIL

NORWAY

CANADA

184

42 39 25 21 19 17 11 11 10 9 8 8 8 7 6 5 5 5 4 4 3

43 qveyana, 489 monawile

3 3 3 3 32 2 2 2 2 2 2

1 1 1 1 1 1 1 1 1

mTavari darbazi

axli meTodebis aTviseba muliaJebTan

axli meTodebis aTviseba muliaJebTan

Stefano Gasparini-s gamocdilebis gaziareba

Kazuchiro Yasufuku EBUS-is Convex zondebis Semqmneli

Yoichi Watanabe-bronqoblokatorebis Semqmneli

EWS Endobronchial Watanabe Spigots

Tracheobronxane™ Endobronchial Watanabe Spigots (EWS) were

developed by NOVATECH in close cooperation with Dr. Y.

WATANABE, Okayama, Japan. They are made of implant-grade,

radiopaque silicone. Indications for re-expansion of the lung in case of

* inoperable pneumothorax * bronchio-pleural fistula with a

continuous loss of air and collapse of the lung despite thoracic suction

drain, when surgical intervention is not indicated. A study1) performed

in Japan with 63 patients including 40 cases of intractable

pneumothorax, 12 cases of pyothorax with fistula and 7 cases of

pulmonary fistula has shown that using EWS is safer and has more

permanent results than conventional methods. After determination of

the affected bronchi with a balloon catheter (alternatively X-ray etc.),

the EWS are placed with a flexible bronchoscope and forceps guided

by the working tube of the bronchoscope. The use of EWS was

successful in 96.7% of the cases. The loss of air was stopped or

significantly reduced in 77.6% of the cases. No severe complications

ocurred.

Semra Bilaceroglu,me-2 kongresis da EABIP-is mdivani

ruseT-saqarTvelos urTierTobebis aRdgena

ZiriTadad ganxiluli Temebibronqoskopia• diagnostikuri• samkurnalo

Torakoskopia (plevroskopia)• diagnostikuri• samkurnalo

axali teqnologiebi• diagnostikuri• samkurnalo

The semirigid pleuroscope is shown.

Ernst A et al. Chest 2002;122:1530-1534

©2002 by American College of Chest Physicians

Electromagnetic Navigation Bronchoscopy (ENB)Procedure Overview

CT-Scan DICOM CD Planning Software Planned Pathway File Navigation Biopsy Treatment

Electromagnetic Navigation Bronchoscopy (ENB)Procedure Overview

Locatable Guide (LG): 360° steerability for navigation to lesions and lymph nodes

Extended Working Channel (EWC): Lock EWC in place for insertion of biopsy tools and other catheters

Patient Sensor Triplets: Placed on patient and are tracking sensors to show LG position and account for patient movement

Location Board: creates electromagnetic field

Bronchoscopic Access: LG and EWC go through mouth/nose to steer through bronchial tree to lesions and lymph nodes

Planning Screen

Image copyright of superDimension, Ltd

Access to lung targets with GPS-like navigation

Planning Phase:• Visualize lung anatomy and airways in 3D

• Mark the target nodule and plan the pathway

Procedure Phase:• Steerable catheters and electromagnetic technology provide real-time guidance and access to targets in the lung

Navigation Screen

© by CARL REINER 2010 27

Jet-Laryngoscope Jet-Bronchoscopes

The Jet-Endoscopes

© by CARL REINER 2010 28

Tubeless Jet-Ventilation

No tube in surgical field! Unlimited sight upon

surgical field on Larynx and Trachea

More space for manipulation!

Laser application without risk!

No risk of barotraumas! No Tracheostoma

necessary! No time limit! Intraveneous

Anaesthesia- easy Narkotic-handling

no exposure narcotic gas

Results endoscopic treatment

p=0,034

0%

20%

40%

60%

80%

100%

1 группа 2 группа

No restenosis

Restenosis

55,5%

45,5%

Groupe 1(dilatation)

Groupe 2(dilatation+laser)Therapeutic helium - neon laser:

- wavelength - 632 nm- quartz electrode (2,6 mm)- radiation power up to 100mW

Equipment

Restenosis after endoscopic treatment Restenosis after laser irradiation

Restenosis without laser irradiation

TB Carcinoid Cancer

Broncolith TB

TOOTH

ToBe or Not ToBe – That is the Question !

TB or Not TB

TB Cancer Granulom. Inflammation

TB Rhizopus

Types of Endobronchial TB

1. Edematous-Hyperemic2. Actively Caseating3. Fibro-Stenotic4. Tumorous5. Granular6. Ulcerative7. Non Specific Bronchitic

Bronchoscopic Assessment of the Evolution of Endobronchial Tuberculosis

Hee Soon Chung et al CHEST Feb 2000 : Vol117 No.2 385-392

Conclusion

Endobronchial Tuberculosis is a great masquerader and can mimick fungal infections, sarcoidosis, foreign bodies carcinoid or even malignancy

Biopsy confirmation is necessary in most cases to make a definitive diagnosis

There are seven types of EBTB described which actually reflect the various stages of evolution in the disease and have varying prognosis

A Bronchoscopist is often faced with the dilemma TB or not TB !

gmadlobT yuradRebisTvis!