Semi-Rigid Thoracoscopic Punch Biopsy Using a Hybrid Knife with a High-Pressure Water Jet for the Diagnosis of Pleural Effusions

Abstract

Semi-rigid thoracoscopy is an important technique in the definitive diagnosis of pleural diseases with high diagnostic sensitivity and specificity. Obtaining adequate samples from thickened pleura is the most important limitation of semi-rigid thoracoscopy with a standard flexible forceps (SFF) compared with rigid thoracoscopy, especially in patients with mesothelioma or benign fibrothorax. Developing a convenient, efficient and safe biopsy technique to obtain sufficient samples from such patients is a key topic in semi-rigid thoracoscopy. The hybrid knife (HK) is an innovative design fusing high-pressure water injection and a conventional diathermic knife that can allow for the safe resection of a larger lesion during gastrointestinal endoscopic dissection. Here, we describe 3 patients with unexplained pleural effusion who underwent pleural biopsy using an HK to investigate the potential use of the HK as a new pleural biopsy device in semi-rigid thoracoscopy when pleural lesions are difficult to biopsy using an SFF. The biopsies were obtained successfully by HK, and the diagnosis followed. The sizes of the biopsies collected by HK are larger than those collected by SFF. No complications were observed. Electrocautery biopsy using an HK during semi-rigid thoracoscopy has great potential for diagnosing consistent abnormal pleuras, which are difficult to biopsy with an SFF.

<p>Endoscopic submucosal dissection of tracheal deep benign fibrous histiocytoma using hybrid knife</p>

“…The feasibility of this new device has been assessed in animal stomach, esophagus and colon and there are quite a number of initial experiences in humans 16,17. Besides the treatment of early stage gastrointestinal tumors, the hybrid knife has been reported in en bloc transurethral resection of bladder tumour which is nonmuscle invasive,18 and treatment of primary tracheal mucosa-associated lymphoid tissue lymphoma,19 also for the diagnosis of pleural effusions 20. Based on the previous experience of using a HK via semirigid thoracoscopy for electrocautery biopsy of the pleura,20 we hypothesized that the HK could make the dissection of a tracheal lesion large and deep enough without obvious damage because of the submucosal water cushion, making APC treatment of the fully exposed base more effective.…”

Primary Tracheal Mucosa-Associated Lymphoid Tissue Lymphoma Treated with a Water-Jet Hybrid Knife: A Case Report

“…Furthermore, this technique was applied in endoscopic submucosal dissection and peroral endoscopic myotomy and achieved satisfactory outcomes [11, 12]. In 2016, Yin et al [13] successfully employed a water-jet hybrid knife technique in a pleural biopsy under a semirigid thoracoscopy, which generated higher-quality tissues and minimized severe bleeding in comparison with traditional methods. Currently, there have been no reports on the employment of a water-jet hybrid knife in bronchoscopy.…”

A Review of Medical Thoracoscopy and Its Role in Management of Malignant Pleural Effusion

“…The frozen tissue is extracted by gently pulling. The probe with the attached biopsy sample is removed through the thoracoscope [34]. Then, each biopsy sample is released from the probe by thawing in saline.…”