Conclusion

The evolution of exible bronchoscopy over the last 50 years has changed the feld of diagnostic and therapeutic bronchoscopy. It started with basic diagnostic procedures that we must, as trainees and teachers, master and not forget. It continued to evolve with sophisticated, novel modalities that have proven to advance the care of our patients with thoracic and pulmonary diseases.

Today’s pulmonologist needs to understand and learn some of the advanced techniques inexible bronchoscopy. It is also vital for our interventional pulmonology trainees to utilize the current and future techniques to achieve the best possible outcomes for our patients.

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Introduction and Defnition of the Procedure

Flexible bronchoscopes allow direct visualization of the airways. Depending on the indication for bronchoscopy, standard or therapeutic bronchoscopes can be used with outer diameters ranging 5–6 mm and inner diameters ranging 2–3 mm, respectively. In adult patients, standard and therapeutic bronchoscopes can therefore be advanced up to the third– fth generation bronchi with some variation depending on both bronchoscope and airway anatomy.

Ultrathin bronchoscopy refers to the use of bronchoscopes with outer diameter of 3 mm or less, the thinness of which allows the exploration of the peripheral airways otherwise not reachable with conventional bronchoscopes and, particularly, the achievement of peripheral pulmonary lesions (PPLs). Although there is wide variation depending on the bronchial anatomy of every

patient, ultrathin bronchoscopes may allow airway visualization up to the 9th–12th bronchial generation of adult patients. A visual comparison of the thinness of therapeutic, standard, and ultrathin bronchoscopes is shown in Fig. 3.1.

M. Díez Ferrer (*)

Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

e-mail: marta.diez@bellvitgehospital.cat

A. Rosell

Thorax Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

e-mail: arosellg.germanstrias@gencat.cat

Fig. 3.1  Flexible bronchoscopes of different diameters: 2.8 mm ultrathin bronchoscope with a 1.2 mm channel, 4.9 mm standard bronchoscope with a 2.0 mm channel, and 6.0 mm therapeutic bronchoscope with a 2.8 mm channel