Chest
Volume 117, Issue 3, March 2000, Pages 887-891
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Bronchoscopy
Tissue Effects of Bronchoscopic Electrocautery

https://doi.org/10.1378/chest.117.3.887Get rights and content

Study objectives

To study tissue effects of bronchoscopic electrocautery (BE).

Design

In six patients with non-small cell lung cancer, a BE procedure was performed immediately before surgery. After patients were placed on ventilation, normal mucosa on different carinae was treated with a cautery probe (2-mm2 surface area) at a power setting of 30 W with a variable time of application of 1 to 5 s. Bronchoscopic appearance of the treated area was documented photographically, and histologic changes of the bronchial wall were examined.

Setting

Bronchoscopy unit of a university hospital.

Measurements and results

BE resulted bronchoscopically in whitening of the bronchial mucosa with crater-shaped lesions. After longer duration of BE application, deeper craters with more profound charring were seen. Histologic changes of the lesions showed craters containing a variable amount of necrotic tissue. In one case, thin subsegmental carinae were coagulated and measurements could not be performed. In the remaining five cases, microscopic findings revealed 0.2 ± 0.1-mm necrosis after 1 s; 0.4 ± 0.2-mm necrosis after 2 s; 0.9 ± 0.5-mm necrosis after 3 s; and 1.9 ± 0.8-mm necrosis after 5 s. A variable degree of tissue damage surrounding the necrotic tissue area was found. In one case, cartilage damage appeared after 3 s of coagulation, and extensive damage of the underlying cartilage was seen in four cases after 5 s of application.

Conclusions

Superficial damage was obtained by short duration of BE (≤ 2 s), and longer duration of coagulation (3 s or 5 s) caused damage to the underlying cartilage. Bronchoscopic appearance after endobronchial electrocautery corresponded with the histologic changes.

Section snippets

Materials and Methods

Six patients (two women and four men) with non-small cell lung cancer who were selected for pulmonary resection after clinical staging procedures including mediastinoscopy were treated with BE immediately before surgery, after general anesthesia and tracheal intubation had been performed. Informed consent was given by all prior to surgery. A fiberoptic bronchoscope with a flexible monopolar electrocautery probe (2-mm2 surface area; Olympus; Tokyo, Japan) was inserted through the tracheal tube.

Results

Bronchoscopic appearance of the BE lesion after a 1-s application revealed whitening of the mucosa with a small, well-defined lesion. Electrocautery after 2 s caused the same mucosal changes with some charring. Three- and 5-s applications showed deeper crater-shaped lesions with more profound charring (Fig 1 ). Examination of histologic changes showed crater-shaped appearance of the lesions containing varying quantities of coagulation necrosis. In some cases, the crater-shaped lesion was

Discussion

In this study, BE at a power setting of 30 W caused bronchial tissue destruction with an extent that varied with the duration of application. After short duration of electrocautery (1 s or 2 s), only superficial damage was found. After BE application of 3 s, damage extended as far as the underlying cartilage layer in most cases. After 5 s of application, cartilage damage was documented in almost every case. The voltage difference between probe and tissue, and the surface area of contact in this

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