Interventional bronchoscopy, together with other domains of interventional pulmonology, has experienced tremendous technological advances. Diagnostic applications include endobronchial ultrasound, which enables endoscopists to see through airway walls. White light videobronchoscopy, autofluorescence imaging, and narrow band imaging have enhanced the ability to detect early
lung cancer at a preinvasive stage. Electromagnetic navigational bronchoscopy, ultrathin bronchoscopy, and virtual bronchoscopy increase the diagnostic yield of biopsy of small peripheral lung lesions. The options that are currently available for the relief of central
airway obstruction are also numerous, with both flexible and rigid bronchoscopic applications.
Stents, although dichotomized to
silicone and
metal, come in various sizes and shapes to suit the requirements of the pathology being treated. Ablative techniques are categorized into those with an immediate effect and those with a delayed effect.
Laser,
electrocautery, and
argon plasma coagulation can immediately relieve obstruction and control
hemoptysis, whereas
cryosurgery,
brachytherapy, and
photodynamic therapy have established roles in subacute
airway obstruction and in the treatment of early
lung cancer. Microdebriders have recently been added to the armamentarium of modalities for mechanical debulking of
tumor. Distal
airway obstruction has also been targeted with
bronchial thermoplasty treatment of refractory
asthma and with
bronchoscopic lung volume reduction for the management of severe
emphysema. This array of new technology has fostered collaborative work with a wide range of other medical specialties to deliver safer, more effective, minimally invasive treatment.