This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.

Lung metastasectomy is an accepted procedure in selected patients and demonstrates good survival, depending on the primary tumor histology, disease-free interval, and number and location of the metastases. 1 The aim of metastasectomy is radical tumor resection, saving as much healthy lung tissue as possible: Wedge resection, segmentectomy, and nodule excision are the most common surgical techniques for this procedure. 2 Pulmonary nodule excision, the most parenchyma-sparing procedure, is indicated for small and central nodules not suitable for wedge resections because of their central location and theoretically requiring an anatomic segmentectomy or lobectomy. Lung nodule excision is usually performed by exposing the nodule with a pair of lung forceps, trying to further improve nodule exposure by a tampon mounted on another forceps and pushing behind the nodule.This procedure can be difficult because the nodule is slippery and deeply embedded within the parenchyma, and lung tissue incision results in profuse bleeding even at a high coagulation level using an electric scalpel or laser devices. In addition, there is a risk of tumor cell seeding in case of accidental nodule opening or incision.We have devised a new technique of lung nodule excision using custom-built forceps (Figure 1) designed to block and expose the nodule, and to clamp the lung tissue containing the nodule, thereby avoiding bleeding during the incision and allowing accurate suturing after the excision. CLINICAL SUMMARY Surgical TechniqueAfter gently palpating the whole deflated lung parenchyma and locating the nodules to be resected, the forceps are placed on the parenchyma so that the target nodule is in the center of the empty upper ring (Figure 2, A).