Initial experience of medical pleuroscopy via the peel-away introducer of the indwelling pleural catheter using a thin bronchoscope

Abstract

We present a case series describing a modified technique of combining medical Pleuroscopy (MP) and indwelling pleural catheter (IPC) placement for obtaining pleural biopsies and managing recurrent pleural effusions. The unique feature of this technique is the introduction of a thin bronchoscope through the peel-away introducer of IPC to obtain pleural biopsies thus avoiding a bigger incision followed by placement of IPC. This procedure was performed on nine patients in an outpatient setting. A regular flexible bronchoscopy forceps was used to obtain pleural biopsies in eight out of nine patients and only one patient could not tolerate the procedure due to marginal respiratory status. A diagnosis of malignancy was successfully obtained in six patients, one patient had biopsy findings of chronic inflammation and one patient had necrotic debris and rare atypical cells despite having visible pleural lesions. No procedure related patient complications were noted.

Flexible Bedside Bronchoscopy Using Closed Sheath System and COVID-19 Patients

“…7 These methods required blunt dissection for pleural access. Harris et al 3 were the first to report the introduction of a flexible bronchoscope through the peel-away TPC sheath in 9 patients. However, the ability to adequately sterilize a flexible bronchoscope and its working channel such that it can be safely used in the pleural space is questionable.…”

“…Through this sheath, a standard flexible bronchoscope is introduced into the pleural space. 3 This technique allows for a simple procedure with a minimal incision and few equipment requirements. One noted limitation is the difficulty associated with sterilizing reprocessed bronchoscopes.…”

Keep it Clean

“…7 These methods required blunt dissection for pleural access. Harris et al 3 were the first to report the introduction of a flexible bronchoscope through the peel-away TPC sheath in 9 patients. However, the ability to adequately sterilize a flexible bronchoscope and its working channel such that it can be safely used in the pleural space is questionable.…”

“…Recently, a technique was described combining pleuroscopy with TPC placement using a peel-away sheath introduced through the Seldinger technique. Through this sheath, a standard flexible bronchoscope is introduced into the pleural space 3. This technique allows for a simple procedure with a minimal incision and few equipment requirements.…”