Flexible Tracheoscopy - Indications, Risks, Procedure and Complications

Introduction:

Tracheoscopy with bronchoscopy is a procedure that helps to look at the windpipe (trachea) and lower airway. A thin, flexible tube (endoscope) is used to view. This endoscope has a camera and a light for better viewing. Tracheoscopy and bronchoscopy are used along with other diagnostic tools to examine tracheal, bronchial, and lower airway diseases.

What Is Flexible Tracheoscopy?

Flexible tracheoscopy is a diagnostic procedure in which a flexible tube is inserted to view the trachea and lower airway. To this tube is an attachment of a camera and a light for viewing. This procedure takes only a minute, and family members can also view it on a video monitor. It gives information about the present trachea’s fit and size and lower airway condition.

Tracheoscopy is needed to know the laceration of the trachea. Tracheoscopy may be done as a part of an endoscopy or flexible bronchoscopy (done to have a look at the airway and lungs).

What Are the Indications of Tracheoscopy?

This method is performed to examine, diagnose and treat many airway-related problems. Due to advances in technology, and previously used methods, rigid endoscopy, which always needed general anesthesia, was replaced by recent advancements like flexible tracheoscopy, which does not need general anesthesia and can be performed by using sedation or even topical anesthesia, avoiding some of the disadvantages of old methods. Indications of tracheoscopy include

• To Identify the Airway Pathology: This method is used to identify the pathologies like airway stenosis or any other obstructions or pathologies.

• To Plan for Surgery: This method has been chosen to plan for ant surgery in the trachea or lower airway. To know about the length, size, location, and degree of the pathology before conducting the surgery. This procedure can be repeated to see the minute details as it is performed in the office setup.

• To Monitor After the Surgical Procedure: This method can be used to know how the progress is going on after the procedure. After performing the procedures like tracheal resection, cricotracheal resection, laryngotracheal reconstruction, glottic stenosis repair, and endoscopic balloon dilation of airway stenosis, to monitor the condition of these, this method can be used.

• To Evaluate Before Decannulation of Tracheal Tube: To examine the airway before removal of the tracheal tube during decannulation, this method can be used.

Conditions: This procedure is used to examine, diagnose, and treat the diseases like stridor, particularly inspiratory, sometimes biphasic or expiratory, hemoptysis, chronic cough, extrinsic airway compression, small mass lesion, and stenosis of the airway.

It is done to collect samples of mucus or tissue, remove foreign bodies from the lungs, and give treatments for lung diseases.

Procedures: The procedures like biopsy are done to remove the tissue, removal of mucus, and foreign bodies from the lungs, place a stent (small tube to hold and open an airway), treat lung problems like bleeding, stricture (an abnormal narrowing of the airway), and collapsed lung.

What Are the Risks Involved in Flexible Tracheoscopy?

Some risks can be faced while using flexible tracheoscopy. They are

• Pain.

• Epistaxis (bleeding from the nose).

• Gagging.

• Emesis (the process of vomiting)

• Vasovagal episode (sudden drop in heart rate and blood pressure resulting in fainting due to stress).

• Temporary dysphonia (neurologic disorder affecting voice and speech).

• Difficulty in breathing.

• Bleeding of the airway.

• Cough.

• Dysphagia (difficulty in swallowing)

• Loss of airway or need to go to the operating room.

What Is the Procedure For Using Flexible Tracheoscopy?

Instruments used are

• Distal chip video laryngoscope.

• Channeled scope.

• Associated tower or video monitor.

• Suction (to attach to channeled scope).

• Biopsy forceps and injection needles (flexible or curved but rigid).

• Nebulizer machine.

Medications used are lidocaine, oxymetazoline, and steroids.

What Are the Arrangements Made for the Procedure?

Arrangements made for the procedure include

The airway should be topically anesthetized with Lidocaine. Lidocaine is dripped onto vocal folds when an individual phonates. Also injected percutaneously into the trachea.

Operating Procedure:

• The nose should be sprayed with Oxymetazoline or Lidocaine.

• The individual is made to sit forward in a sniffing position (a combination of flexion of the neck and extension of the head).

• Topical anesthesia is applied to the larynx and trachea.

• Photo or video documentation should start. The telescope is inserted through the glottis, subglottis, and trachea to the carina, then the right mainstem bronchus and segmental bronchi.

• Then withdrawn slightly and insured to the left side.

• Length of abnormality, lumen size, and distance from the glottis should be measured.

• Biopsy or injections can be given at this point in time.

• All instrumentation should be removed.

• An individual should be observed for 15 min after the procedure and instructed not to take anything orally till the swallowing gets back to normal.

Special devices like tools for biopsy, electrocautery to control bleeding, and laser to reduce the size of the airway tumor are used in this procedure. In the case of lung cancer, a built-in ultrasound probe may be used with a bronchoscope to look at the lymph nodes in the chest. This is called the endobronchial ultrasound (EBUS).

What Are the Complications of Flexible Tracheoscopy?

Bleeding can be more in case of biopsy is done. If bleeding is less, then it is controlled without treatment.

• The lung may get injured during the procedure. When the lung gets injured, air collects in the lungs and can cause the lung to collapse. It can be treated easily, but admission to the hospital may be necessary.

• Generally, fever is observed after the procedure, but it does not indicate infection. It can be treated easily.

• Infection.

• Swelling may occur in the throat.

• Difficulty in breathing.

• Vomiting.

• Food or fluid may enter the airway.

• Vocal cord trauma.

Conclusion:

The airway is very important for life. Any slight changes in the airway may cause discomfort and affect the quality of life. Hence it is very essential to take special care of one’s airway and lungs. Knowing in detail about the organ and procedures related to its diagnosis, examination, and treatment helps one to identify the problem at the earliest. Early diagnosis helps in getting effective treatment. This, in turn, provides one to lead a good quality of life.