Interventional Pulmonology

Interventional pulmonology (IP) uses minimally invasive techniques to diagnose and treat lung cancer, pleural diseases, and many types of complex airway and lung disorders.

The interventional pulmonology service at Brigham and Women’s Hospital uses new technology and advanced procedures to offer less invasive options to conventional lung surgery. Our interventional pulmonologist works with our specialized teams in the Lung Center – pulmonology, thoracic surgery, otolaryngology, medical oncology, radiation oncology, thoracic radiology and thoracic anesthesiology – to provide comprehensive care to our patients.

Our service has a dedicated procedural room inside our operating room. It is fully equipped with the most advanced flexible and rigid bronchoscopic tools, fluoroscopies, cone beam CT, and on-site cytopathology support. This room is staffed by full-time thoracic surgery staff, as well as advanced nurses and a thoracic anesthesiologist. In addition, we have a highly advanced thoracic intensive care unit (ICU), which accepts high-risk patients for IP procedures.

Our interventional pulmonologist, Hisashi Tsukada, MD, PhD, is a thoracic surgeon at Brigham and Women’s Hospital and an instructor in surgery at Harvard Medical School. He is board-certified in interventional pulmonology.

Why have a minimally invasive procedure?

Minimally invasive techniques have been proven to reduce pain, blood loss and recovery time as well as minimize trauma to tissue. Patients often spend less time in the hospital, and are able to return to normal activities faster.

Services

What is flexible bronchoscopy (Diagnostic and Therapeutic)?

Flexible bronchoscopy is performed by placing a small camera attached to a flexible tube down the mouth or up the nose to examine the lungs and airways. It is used to diagnose a wide range of conditions including lung infections, airway blockages, and lung cancer, and is also used to collect samples for biopsy and to treat some types of lung conditions. The patient usually remains awake during the procedure, and the throat is sedated with anesthesia.

What is rigid bronchoscopy?

Rigid bronchoscopy is used to diagnose and treat airway diseases, including lung infections, airway blockages, and lung cancer. During a rigid bronchoscopy, a straight, hollow metal tube is inserted into the throat. High-resolution cameras and endoscopic instruments are then placed inside the tube to view the lungs and airways, take tissue samples, or assist in inserting silicone stents. The procedure is usually performed in an operating room, with the patient under general anesthesia. Rigid bronchoscopy is often combined with flexible bronchoscopy to achieve optimum airway visibility and suctioning.

What is endobronchial ultrasound (EBUS)?

Endobronchial ultrasound (EBUS) is a minimally invasive procedure that uses ultrasound and a bronchoscope to diagnose lung cancer, infections, and lesions in the lungs and airways. During EBUS, the interventional pulmonologist uses a technique called transbronchial needle aspiration (TBNA) to take tissue samples from the lungs and surrounding lymph nodes without performing surgery. EBUS is usually performed under moderate sedation or general anesthesia, and patients often go home the same day.

What is electromagnetic navigational bronchoscopy?

Electromagnetic navigational bronchoscopy (ENB) is a minimally invasive procedure that uses GPS-like navigation technology to create a 3-D map of the lungs and chest for obtaining tissue samples or targeting lung cancer treatment. It is used to access lesions (spots) in areas of the lungs that cannot be reached by traditional bronchoscopy. Using the 3-D map and a thin, flexible navigation tube, specialists can obtain precise tissue samples or insert radio fiducial markers to target radiation to lung tumors. This procedure may help find lung cancer at earlier stages. ENB is usually performed on an outpatient basis, so patients can go home the same day.

What is argon plasma coagulation (APC)?

Argon plasma coagulation (APC) is a thermal ablation technique that uses heat created from argon gas to remove tumors in the airways. It is used with bronchoscopy to treat cancerous or benign tumors in the airways or to relieve symptoms of airway obstruction. APC can be used with lesions or tumors that are bleeding.

What is electrocautery?

Electrocautery is a type of thermal ablation that uses electric current to treat benign or malignant tumors in the airways. It is also used to control symptoms caused by airway lesions. Electrocautery is performed with a bronchoscope placed down the throat or up the nose. Depending on the type of bronchoscope used, the procedure may be performed with general anesthesia or local anesthesia and conscious sedation.

What is cryosurgery laser therapy (Nd-YAG)?

Laser therapy is used to remove tumors and other growths in the airways that cause central airway obstruction. There are several types of lasers, but the Nd-YAG laser is the one used most often. Laser therapy may be performed with either flexible or rigid bronchoscopy, though rigid bronchoscopy is usually preferred. In some cases, laser therapy is used with other ablative techniques or stenting. Laser therapy may be performed with general anesthesia or local anesthesia and conscious sedation.

What is photodynamic therapy (PDT)?

Photodynamic therapy (PDT) is a minimally invasive treatment for lung cancer that uses light and drugs, called photosensitizing agents, to kill cancer cells. First, the drugs are injected into the cancer cells. A few days later, a laser light is directed to the area though a bronchoscope to destroy the tumor. PDT involves less risk than open surgery, can be precisely targeted, and has minimal side effects. It can also be used repeatedly on the same area. PDT is most often done as an outpatient procedure, though some patients need to stay overnight in the hospital.

What is endobronchial brachytherapy?

Endobronchial brachytherapy is a type of radiation therapy that uses small pellets of radiation, called high-dose rate brachytherapy, to destroy tumors in the lungs or throat. During the treatment, a bronchoscope is placed down the throat and a small catheter (tube) is placed through it. Pellets of radiation are placed into the catheter and positioned next to or into the tumor, killing the cancer cells. Once the treatment is complete, the pellets and catheter are removed. Treatment usually takes about three to ten minutes. Because the radiation is delivered directly to the tumor, higher doses can be used without damaging healthy tissue, causing fewer side effects than traditional radiation. Most patients go home the same day.

What are airway stents?

Tracheobronchial (airway) stents are tiny tubes made of silicone or metal used to keep narrowed airways open. Airway stents can be either permanent or removable. They are put into place using a bronchoscope after the doctor has opened the airway with laser therapy, balloon dilation, electrocautery, or a similar technique.

What is balloon dilation?

Balloon dilation is a procedure used to improve airway narrowing caused by tumors, inflammatory conditions, or other diseases. It is performed by using small balloons that are inflated inside the airway during a bronchoscopy, providing a gentle, even force to the airway tissue. The procedure may involve several balloon inflations. Balloon dilation may be used with either rigid or flexible bronchoscopy. It often provides an immediate improvement in airway size and reduces the chance for re-narrowing of the airway after the procedure.

What is an endobronchial valve?

An endobronchial valve is small medical device implanted in an airway to treat emphysema and other lung conditions. The valve is placed into a diseased part of the airway during a bronchoscopy. It works by helping a compartment of the lung empty itself of air.

What is thoracentesis?

Thoracentesis is a procedure used to remove excess fluid from the area between the lungs and chest wall (pleural space). It may also be used to determine what is causing the fluid to build up. To perform thoracentesis, the doctor uses imaging to guide a needle through the chest wall and into the pleural space to remove the fluid. The fluid can then be tested to diagnose its cause. Thoracentesis can help ease symptoms such as chest pain or pressure and shortness of breath. It is often a short, outpatient procedure.

What is pleuroscopy?

Pleuroscopy is a minimally invasive procedure used to examine the pleural cavity, the space between the two layers of tissue inside the lungs. During the procedure, the doctor will make a small incision in the chest wall an insert a small tube with a camera on the end, called a pleuroscope, into the pleural cavity. The doctor uses the camera to look for problem areas in the pleural cavity and may take tissue or fluid samples.

What is bronchial thermoplasty?

Bronchial thermoplasty is a treatment for severe asthma that uses gentle heat to open the airways. It is performed in an outpatient procedure and done in three separate sessions about three weeks apart. Each session focuses on a different part of the lungs. To perform the procedure, the doctor places a bronchoscope down the throat and into the lungs. A smaller tube is placed inside the bronchoscope and is used to gently heat and shrink the smooth muscles in the lungs that tighten during asthma attacks.

What is percutaneous tracheostomy?

Percutaneous dilatational tracheostomy (PDT) is a procedure that involves opening the front wall of the trachea and inserting a tube for breathing. It is used in patients who are critically ill, and often performed at the patient’s bedside. In most cases, this procedure has replaced the use of surgical tracheostomy.

What is tracheostomy management?

A tracheostomy is a surgical opening in the trachea through which a tube is placed to help a patient breathe. Tracheostomy management involves making sure the tracheostomy tube remains open and unblocked, as a blocked tube is a medical emergency.

What is a trans thoracic percutaneous lung biopsy?

A trans thoracic percutaneous lung biopsy is used to take a biopsy (tissue sample) from tumors in the lungs that cannot be reached with bronchoscopy. It is usually performed using image guidance, such as ultrasound or computed tomography (CT) to guide a needle through the chest wall and into the tumor.

Interventional Pulmonology Appointments and Locations

Call The Lung Center at 1-844-BWH-LUNG (1-844-294-5864) to make an appointment, or request an appointment online.

To refer a patient, physicians can call 1-844-BWH-LUNG (1-844-294-5864).

Interventional Pulmonology Locations

The Interventional Pulmonary Service is located at Brigham and Women’s Hospital in Boston at the 15 Francis Street entrance.

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