Endobronchial Electrocautery and Argon Plasma Coagulation: A Practical Approach

Abstract

The present review covers the technical and practical aspects of endobronchial electrocautery, including argon plasma coagulation, which have great potential for widespread use by pulmonologists around the world. The various electrocautery modes, power settings and electrode probes are described in detail, and the authors' clinical and technical approach is demonstrated with a narrative description and brief case presentations. Malignant airway obstruction, hemoptysis, web-like stenosis, stent related granulation tissue and early lung carcinomas are the most common indications for treatment. Advantages of electrocautery, such as low cost, rapid effect, safety and ease of use, are contrasted to other endobronchial therapeutic modalities. Published experience with electrocautery is reviewed.

Management of Post-intubation and/or Tracheotomy Tracheal Stenoses

“…If used in the treatment of post-intubation tracheal stenosis EC and APC can be fibro-genetic and Cryo is ineffective because of the lack of blood vessels; moreover it can be dangerous for the possible persistence of iced tissue in the airways. These methods, especially APC, may only be used in granulomas [17][18][19] (Level of evidence: III).…”

Endobronchial Argon Plasma Coagulation for the Palliation of Recurrent Tracheobronchial Adenoid Cystic Carcinoma

“…Recently, APC has been used in the treatment of benign or malignant lesions in the airway [5][6][7]. It has an excellent safety profile, is convenient and simple to use, and is relatively inexpensive.…”

“…Argon plasma coagulation (APC) has recently been widely used in tracheobronchial disease [5,6] because it allows a rapid coagulation with minimal manipulation and mechanical trauma to the target tissue [6]. A previous study reported the safety efficacy of APC for the management of airway stenosis [7].…”

Integration of interventional bronchoscopy in the management of lung cancer

“…High-frequency electric current is delivered to the malignant stenosis, using a monopolar mode, by means of a flexible or rigid probe of varying diameter and form, such as a coagulation electrode, loop [12,21] or hot biopsy forceps. New-generation generators can be set to different modes [22]. In the "soft coagulation" mode, the heat produced does not exceed 200°C and no electric arc is generated, thus preventing tissue from carbonisation and ignition or airway fire, unlike the "forced coagulation" mode.…”

“…In the "soft coagulation" mode, the heat produced does not exceed 200°C and no electric arc is generated, thus preventing tissue from carbonisation and ignition or airway fire, unlike the "forced coagulation" mode. Electrocautery equipment (generator and probes) is far less expensive than laser [22][23][24]. The symptom improvement observed is constant (96%) and results in a gain of 53% in FEV1 [25], equivalent to that obtained with [22,25].…”