Lung-Term Learning — ​Our New Digital FAQ Series

With our new Lung-Term Learning initiative, we want to further elevate the standard of care by creating a pulmonology community and broaden our offer for education beyond our medical expert trainings.
We would like to invite you to watch our “Lung-Term Learning” videos, where renowned experts will be sharing procedure-and education-related tips and tricks on how to further improve procedural outcomes and to help in our efforts to further elevate the standard of care in lung cancer diagnosis and staging.

Further Procedures in Pulmonology

Medical Thoracoscopy

Medical thoracoscopy is a minimally invasive procedure that allows access to the pleural space using a combination of viewing and working instruments. There are two types of thoracoscope, which are “rigid” and “semirigid” types. Most common indications for Medical Thoracoscopy are the evaluation of exudative effusions of unknown cause, staging of malignant mesothelioma or lung cancer, and treatment of malignant or other recurrent effusions with talc pleurodesis. Please find here more details of this procedure.

Medical Thoracoscopy with Semirigid Pleuroscope
The world`s first Semirigid Pleuroscope LTF-240 was developed by Olympus in 2001, of which flexible tip was movable by a lever on the handle to 2-way angulation 160° up and 130° down. It also had a 2.8mm working channel which enabled sampling of pleural lesions, suctioning of pleural fluid, and talc poudrage.

  • The flexible tip of the pleuroscope allowed for the exploration of areas that had been obscured by adhesions, as the instrument could be maneuvered with the flexible tip to look around the adhesions. (A Ernst, CHEST, 2002)
  • The pleuroscope affords a view of the entire pleural cavity, allowing the physician effectively rule out malignant or granulomatous disease by obtaining visually directed biopsy specimens. All remaining pleural fluid can be suctioned while visualization continues, and talc poudrage can be performed through the already placed trocar. Even the distribution of the talc can be assured with endoscopic assessment. (A Ernst, CHEST, 2002)

State-of-the-Art Semirigid Pleuroscope LTF-H290
Almost 2 decasdes after the first launch of Semirigid Pleuroscope, we have now launched the state-of-the-Art model LTF-H290 which is equipped with HD imaging sensor, wide 180° UP angulation range, and large 3.0mm-Diameter channel. In combination with CV-1500 EVIS X1 Video System Center, several cutting-edge observation modes are also available. BAI-MAC mode is one of the special features of CV-1500, which enables you to get a lot brighter and clearer image of entire thoracic cavity.

EndoJaw Single Use Biopsy Forceps FB-420K
The LTF-H290 is compatible with EndoJaw FB-420K, a 2.8 mm diameter working channel compatible single-use biopsy forceps with swing jaw mechanism that facilitates tangential approaches by capturing the tissue from the top of the biopsy site. It also has a double-step blade that makes the edges of the cup thin and sharp.

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Bronchoscopy (NBI and AFI)

In diagnostic bronchoscopy, a flexible bronchoscope is used to visually inspect the trachea and bronchi.

Narrow Band Imaging (NBI) and Autofluorescence Imaging (AFI) are two modalities that are deservedly gaining greater interest in the medical community. To a significant degree, this is due to their ability to provide more information that can lead to faster and more accurate diagnosis of a number of conditions, particularly relating to tissue thickening. With benefits like these, the arguments for using these technologies are very persuasive.

NBI provides great potential for defining the nature of a bronchial lesion, allowing a closer, more accurate look at the angiogenic process. NBI is a promising technology as it combines good sensitivity with improved specificity. It allows superior discrimination between low- and high-risk lesions (such as CIS and severe dysplasia). NBI is available with standard videoscopes on recent Olympus video endoscopy platforms.

While NBI allows easier identification of changes in the vascular patterns, AFI identifies thickened mucosa. AFI is an interesting tool for the diagnosis of central lung cancer and premalignant lesions.

Traditionally, distinguishing inflamed areas from cancerous processes has been a common problem. To help to solve this, AFI can be used. By observing changes in fluorescence intensity, AFI may assist the early detection of a suspicious lesion, displaying normal tissue in green and abnormal tissue in magenta.

AFI is available on the dedicated Olympus autofluorescence platform, EVIS LUCERA ELITE, with one dedicated autofluorescence endoscope for bronchoscopy.

Sampling

For general diagnostic purposes or if an abnormality is discovered, sampling using Bronchoscopic Alveolar Lavage (BAL), brush, forceps, or needle might be needed.

  • Olympus offers balloon catheters in two different sizes and a washing pipe for peripheral BAL
  • Olympus offers a versatile lineup of brushes to meet the needs of specific clinical requirements. The metal tip of the brushes enables perfect visibility under fluoroscopy and leads to atraumatic brushing. Thanks to their fine micro-bristles that collect significantly more cells than standard bristles, better diagnostic results can be achieved.
  • Bronchoscopists have identified a number of advantages offered by Olympus biopsy forceps. The sharpened cups ensure superior cutting performance, which can lead to fewer artefacts and less bleeding. The high-quality stainless steel allows smooth cup operation in any situation. There are no sharp edges and the swinging-type head ensures full compliance to even angulated working channels. Some target sites are difficult to approach, but the reusable Olympus SwingJaw biopsy forceps and EndoJaw single-use swinging cup forceps allow tangential targeting of the lesion.
  • Olympus offers an extended range of needles for cytology and histology to meet a variety of clinical requirements. Olympus TBNA needles offer excellent puncture performance and their sophisticated design reduces damage inside the scope channel while ensuring the smoothest passage through the channel. There are standard, side-hole, and trocar type needles available. The unique side hole allows the drawing of more specimens from tissue in contact with the side of the needle.
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Foreign Body Removal

The removal of a foreign body using bronchoscopy can be challenging due to its size and consistency, as well as due to the limited access to its location. Objects may be removed with the help of a flexible bronchoscope and the appropriate grasping instruments.

A variety of instruments, such as grasping forceps or retrieval baskets, can be used to remove foreign bodies, depending on the type of object involved. Olympus offers a versatile product lineup of grasping forceps, baskets, and loops to extract foreign bodies:

  • Superb grasping power for reliable and safe extraction
  • Various designs to grasp different types of foreign bodies
  • Single-use and reusable devices available
  • Also for 1.2 mm biopsy channels for peripheral and pediatric foreign body removal

Grasping devices – the appropriate device for every situation

  • The X-Trac extraction bag can collect small, big, or even several pieces at one time. Perfect isolation of sharp foreign bodies.
  • Forceps with rubber tip for sharp or flat objects like needles and pins. Ideal for slippery foreign bodies.
  • Forceps with V-shape for thin and flat objects. Rat tooth allows a firm grip.
  • Forceps with rat tooth for flat objects such as coins. Rat tooth allows a firm grip.
  • Forceps with alligator jaws for holding of object to be removed. Alligator jaws prevent slipping of foreign body.
  • Removal baskets for smooth and round objects or large foreign bodies
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Electrosurgery

Confident Electrosurgical Procedures and Argon Plasma Coagulation
The Olympus portfolio of electrosurgical equipment allows physicians to cut, coagulate and resect with confidence — secure in the knowledge that they are using an established and reliable treatment option.

Electrosurgical Generator and Argon Plasma Unit
The ESG-300 supports the needs of the endoscopist by providing a simple, safe and smart source of energy. An intuitive touch screen ensures easy system setup with a choice of 29 display languages. The wireless foot switch allows safer placement in the operating room.
The Argon Plasma Unit (APU-300) can be used in combination with the ESG-300 to provide advanced, superficial hemostasis or tissue devitalization. Different modes to cut or coagulate offer a wide application range.

Video Bronchoscope BF-XT190
The BF-XT190 has a large 3.2 mm working channel. During electrosurgery interventions, fast smoke evacuation is required to keep a good view and control over the field of intervention. Fast removal of secretion is also beneficial during procedures, which is perfectly supported by the BF-XT190.
· Distal end Ø: 6.1 mm.
· Insertion tube Ø: 6.3 mm.
· Instrument channel Ø: 3.2 mm.

Coagulate, Resect and Retrieve
Olympus has designed versatile EndoTherapy devices to meet all requirements for high-frequency bronchial applications as well as argon plasma coagulation.

Argon Plasma Coagulation Probes
· Different probe designs: axial, lateral, radial.
· Precise, selective coagulation and tissue devitalization.

Hot Biopsy Forceps
· Fenestrated cups for larger biopsies and tissue resection.
· Used as coagulation electrode with closed cups.

Selected Products for This Procedure

Pediatric

Flexible bronchoscopy is widely used in the diagnosis of respiratory pathologies in children of all ages. Biopsies, bronchoscopic cytology, and foreign body removal present common challenges that can be met with the selection of the appropriate techniques and instruments.

Olympus offers a full lineup of mini-instruments for pediatric bronchoscopy which are compatible with 1.2 mm channel bronchoscopes for diagnostic and therapeutic procedures in the peripheral lung and small bronchi of children.

This range covers grasping forceps and baskets for foreign bodies of different shapes and surfaces and forceps and cytology brushes for diagnosis even from the small bronchi.

Biopsy Forceps

  • Rat tooth to aid anchorage
  • Elongated cups for deeper biopsies


Cytology Brush

  • For optimized cytological yield
  • Sheathed and unsheathed types


Grasping Baskets

  • For retrieval of smooth, rounded objects


Extraction Bags

  • For retrieval of sharp and larger round objects


Grasping Forceps

  • For retrieval of irregular objects
  • Nails bite into soft objects for improved grip


Foreign Body Removal Snare

  • For retrieval of long, thin objects

Contact & Support

If you need help or would like to learn more about Olympus products or solutions, get in touch with us. We’re more than happy to accept your inquiry.