Article Data

  • Views 121
  • Dowloads 21


Open Access Special Issue

The role of rigid bronchoscopy in complex airway disorders

  • Alessandro Bandiera1
  • Paola Ciriaco1
  • Angelo Carretta1
  • Giampiero Negri1

1Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy

DOI: 10.22514/sv.2021.017 Vol.17,Issue 2,March 2021 pp.39-47

Published: 08 March 2021

*Corresponding Author(s): Alessandro Bandiera E-mail:


Rigid bronchoscopy is a diagnostic and therapeutic tool used to treat complex airways disorders. It plays a central role in the management of central airway obstruction caused by benign or malignant diseases; and requires close cooperation between the bronchoscopist and the anesthesiologist as they share the same operative field. Rigid bronchoscopy requires deep sedation or general anesthesia, intubation with the rigid bronchoscope and adequate oxygenation and ventilation during the procedure. The choice of ventilation techniques include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation and jet ventilation. Rigid bronchoscopy is used to relieve respiratory symptoms due to airway obstruction by dilation for a tracheal stenosis or the mechanical debulking of endoluminal tumours, and supporting the airway by the placement of an endoluminal stent. Two types of stents are currently in use: silicone stents and metal stents with different lengths, diameters and shape configurations. They can significantly improve patients symptoms and their quality of life. Therapeutic rigid bronchoscopy, performed in appropriately selected patients and by skilled operators is effective and has a low morbidity rate.


Rigid bronchoscopy; Central airway obstruction; Airway stenting; Ventilation techniques

Cite and Share

Alessandro Bandiera,Paola Ciriaco,Angelo Carretta,Giampiero Negri. The role of rigid bronchoscopy in complex airway disorders. Signa Vitae. 2021. 17(2);39-47.


[1] Kollofrath O. Entfernung eines Knochenstucks ausdem rechten Bronchus auf naturlichem Wege und unter Anwendung der directen Laryngoscopie. Munch Med Wochenschrift. 1897; 38: 1038-1039. (In German)

[2] Becker HD, Marsh BR. History of the rigid bronchoscope (pp. 2-15). Interventional bronchoscopy. Basel (Switzerland): Karger Publishers. 2000.

[3] Jackson C. Foreign bodies in the air and food passages: charted experience in cases from no. 631 to no. 1155 at the Bronchoscopic Clinic. New Bedford (MA): Reynolds. 1924.

[4] Flannery A, Daneshvar C, Dutau H, Breen D. The art of rigid bronchoscopy and airway stenting. Clinics in Chest Medicine. 2018; 39: 149-167.

[5] Semaan R, Yarmus L. Rigid bronchoscopy and silicone stents in the management of central airway obstruction. Journal of Thoracic Disease. 2015; 7: S352-S362.

[6] Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Annals of the American Thoracic Society. 2015; 11: 628-634.

[7] Dutau H, Vandemoortele T, Breen DP. Rigid bronchoscopy. Clinics in Chest Medicine. 2013; 34: 427-435.

[8] Mahmood K, Wahidi MM, Thomas S, Argento AC, Ninan NA, Smathers EC, et al. Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction. Respiration. 2015; 89: 404-413.

[9] Montgomery WW. T-tube tracheal stent. Archives of Otolaryngology. 1965; 82: 320-321.

[10] Dumon JF. A dedicated tracheobronchial stent. Chest. 1990; 97: 328-332.

[11] Yarmus L, Ernst A, Feller-Kopman D. Emerging technologies for the thorax: indications, management and complications. Respirology. 2010; 15: 208-219.

[12] José RJ, Shaefi S, Navani N. Anesthesia for bronchoscopy. Current Opinion in Anaesthesiology. 2014; 27: 453-457.

[13] Dutau H, Breen D, Bugalho A, Dalar L, Daniels J, Dooms C, et al. Current practice of airway stenting in the adult population in Europe: a survey of the European Association of Bronchology and Interventional Pulmonology (EABIP). Respiration. 2018; 95: 44-54.

[14] Frumin MJ, Epstein RM, Cohen G. Apneic oxygenation in man. Anesthesiology. 1959; 20: 789-798.

[15] Perrin G, Colt HG, Martin C, Mak MA, Dumon JF, Gouin F. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation. A prospective study. Chest. 1992; 102: 1526-1530.

[16] Puma F, Meattelli M, Kolodziejek M, Properzi MG, Capozzi R, Matricardi A, et al. An alternative method for airway management with combined tracheal intubation and rigid bronchoscope. Annals of Thoracic Surgery. 2019; 107: e435-e436.

[17] Buczkowski PW, Fombon FN, Lin ES, Russell WC, Thompson JP. Air entrainment during high-frequency jet ventilation in a model of upper tracheal stenosis. British Journal of Anaesthesia. 2007; 99: 891-897.

[18] Fernandez-Bustamante A, Ibañez V, Alfaro JJ, de Miguel E, Germán MJ, Mayo A, et al. High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications. Journal of Clinical Anesthesia. 2006; 18: 349-356.

[19] Godden DJ, Willey RF, Fergusson RJ, Wright DJ, Crompton GK, Grant IW. Rigid bronchoscopy under intravenous general anaesthesia with oxygen Venturi ventilation. Thorax. 1987; 37: 532-534.

[20] Hautmann H, Gamarra F, Henke M, Diehm S, Huber RM. High frequency jet ventilation in interventional fiberoptic bronchoscopy. Anesthesia and Analgesia. 2000; 90: 1436-1440.

[21] Conacher ID, Paes LL, McMahon CC, Morritt GN. Anesthetic manage-ment of laser surgery for central airway obstruction: a 12-year case series. Journal of Cardiothoracic and Vascular Anesthesia. 1998; 12: 153-156.

[22] Natalini G, Cavaliere S, Vitacca M, Amicucci G, Ambrosino N, Candiani A. Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy. a controlled randomised trial. Acta Anaesthesiologica Scandinavica. 1998; 42: 1063-1069.

[23] Natalini G, Cavaliere S, Seramondi V, Foccoli P, Vitacca M, Ambrosino N, et al. Negative pressure ventilation vs external high-frequency oscillation during rigid bronchoscopy. A controlled randomized trial. Chest. 2000; 118: 18-23.

[24] Batra H, Yarmus L. Indications and complications of rigid bronchoscopy. Expert Review of Respiratory Medicine. 2018; 12: 509-520.

[25] Colt HG, Harrell JH. Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airways obstruction. Chest. 1997; 112: 202-206.

[26] Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Tracheobronchial stenting in the terminal care of cancer patients with central airways obstruction. Chest. 2001; 120: 1811-1814.

[27] Chhajed PN, Baty F, Pless M, Somandin S, Tamm M, Brutsche MH. Outcome of treated advanced non-small cell lung cancer with and without central airway obstruction. Chest. 2006; 130: 1803-1807.

[28] Monnier P, Mudry A, Stanzel F, Haeussinger K, Heitz M, Probst R, et al. The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study. Chest. 1996; 110: 1161-1168.

[29] Gilmartin JJ, Veale D, Cooper BG, Keavey PM, Gibson GJ, Morritt GN. Effects of laser treatment on respiratory function in malignant narrowing of the central airways. Thorax. 1987; 42: 578-582.

[30] Zaric B, Kovacevic T, Stojsic V, Sarcev T, Kocic M, Urosevic M, et al. Neodymium yttrium-aluminium-garnet laser resection significantly improves quality of life in patients with malignant central airway obstruction due to lung cancer. European Journal of Cancer Care. 2015; 24: 560-566.

[31] Murgu S, Langer S, Colt H. Bronchoscopic intervention obviates the need for continued mechanical ventilation in patients with airway obstruction and respiratory failure from inoperable non-small-cell lung cancer. Respiration. 2012; 84: 55-61.

[32] Vishwanath G, Madan K, Bal A, Aggarwal AN, Gupta D, Agarwal R. Rigid bronchoscopy and mechanical debulking in the management of central airway tumors: an Indian experience. Journal of Bronchology & Interventional Pulmonology. 2013; 20: 127-133.

[33] Cavaliere S, Venuta F, Foccoli P, Toninelli C, La Face B. Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest. 1997; 110: 1536-1542.

[34] Cavaliere S, Foccoli P, Farina PL. Nd: YAG laser bronchoscopy. A five-year experience with 1,396 applications in 1,000 patients. Chest. 1988; 94: 15-21.

[35] Grillo HC, Donahue DM. Post intubation tracheal stenosis. Seminars in Thoracic and Cardiovascular Surgery. 1996; 8: 370-380.

[36] Wain JC. Postintubation tracheal stenosis. Chest Surgery Clinics of North America. 2003; 13: 231-246.

[37] Zycinska K, Wardyn K, Zielonka TM, Nitsch-Osuch A, Zarzycki S, Demkow U, et al. Subglottic and tracheal stenosis due to Wegener’s granulomatosis. Advances in Experimental Medicine and Biology. 2013; 755: 221-224.

[38] Rafanan AL, Mehta AC. Adult airway foreign body removal. What’s new? Clinics in Chest Medicine. 2001; 22: 319-330.

[39] Sehgal IS, Dhooria S, Ram B, Singh N, Aggarwal AN, Gupta D, et al. Foreign body inhalation in the adult population: experience of 25,998 bronchoscopies and systematic review of the literature. Respiratory Care. 2015; 60: 1438-1448.

[40] Marsico G, Guimares C, Montesi J. Management of massive hemoptysis with rigid bronchoscopy and cold saline solution. Jornal de Pneumologia. 2003; 29: 1590-600.

[41] McCollun WB, Mattox KL, Guinn GA, Beall AC. Immediate operative treatment for massive hemoptysis. Chest. 1975; 67: 152-155.

[42] Gourin A, Garzon AA. Operative treatment of massive hemoptysis. Annals of Thoracic Surgery. 1974; 18: 52-60.

[43] Garzon AA, Cerruti M, Gourin A, Karlson KE. Pulmonary resection for massive hemoptysis. Surgery. 1970; 67: 633-638.

[44] Dweik RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clinics in Chest Medicine. 1999; 20: 89-105.

[45] Bobrowitz ID, Ramakrishna S, Shim YS. Comparison of medical v surgical treatment of major hemoptysis. Archives of Internal Medicine. 1983; 143: 1343-1346.

[46] Trendelenburg F. Beitra¨ ge zu den Operationen an den Luftwegen. Langenbecks Archiv für Chirurgie. 1872; 13: 335. (In German)

[47] Bond CJ. Note on the treatment of tracheal stenosis by a new T-shaped tracheotomy tube. The Lancet. 1891; 137: 539.

[48] Panchabhai TS, Mehta AC. Historical perspectives of bronchoscopy. Connecting the dots. Annals of the American Thoracic Society. 2015; 12: 631- 641.

[49] Carretta A, Casiraghi M, Melloni G, Bandiera A, Ciriaco P, Ferla L, et al. Montgomery T-tube placement in the treatment of benign tracheal lesions. European Journal of Cardio-Thoracic Surgery. 2009; 36: 352-356.

[50] Breen DP, Dutau H. On site customization of silicone stents: towards optimal palliation of complex airway conditions. Respiration. 2009; 77: 447- 453.

[51] Tay CK, Jeong B, Kim H. Angulated stents-a novel stent improvisation to manage difficult post-tuberculosis bronchial stenosis. American Society for Artificial Internal Organs. 2018; 64: 565-569.

[52] Bolliger CT, Probst R, Tschopp K, Solèr M, Perruchoud AP. Silicone stents in the management of inoperable tracheobronchial stenoses. Indications and limitations. Chest. 1993; 104: 1653-1659.

[53] Mitsuoka M, Sakuragi T, Itoh T. Clinical benefits and complications of Dumon stent insertion for the treatment of severe central airway stenosis or airway fistula. General Thoracic and Cardiovascular Surgery. 2007; 55: 275- 280.

[54] Martinez-Ballarin JI, Diaz-Jimenez JP, Castro MJ, Moya JA. Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients. Chest. 1996; 109: 626-629.

[55] Freitag L, Eicker R, Linz B, Greschuchna D. Theoretical and experi-mental basis for the development of a dynamic airway stent. European Respiratory Journal. 1994; 7: 2038-2045.

[56] Park HY, Kim H, Koh WJ, Suh GY, Chung MP, Kwon OJ. Natural stent in the management of post-intubation tracheal stenosis. Respirology. 2009; 14: 583-588.

[57] Gaissert HA, Grillo HC, Wright CD, Donahue DM, Wain JC, Mathisen DJ. Complication of benign tracheobronchial strictures by self-expanding metal stents. Journal of Thoracic and Cardiovascular Surgery. 2003; 126: 744-747.

[58] Avasarala SK, Freitag L, Mehta AC. Metallic endobronchial stents: a contemporary resurrection. Chest. 2019; 155: 1246-1259.

[59] Fortin M, Lacasse Y, Elharrar X, Tazi-Mezalek R, Laroumagne S, Guinde J, et al. Safety and efficacy of a fully covered self-expandable metallic stent in benign airway stenosis. Respiration. 2017; 93: 430-435.

[60] Lee P, Kupeli E, Mehta AC. Airway stents. Clinics in Chest Medicine. 2010; 31: 141-150, Table of Contents.

[61] Dutau H, Musani AI, Laroumagne S, Darwiche K, Freitag L, Astoul P. Biodegradable airway stents - bench to bedside: a comprehensive review. Respiration. 2015; 90: 512-521.

[62] Freitag L, Gördes M, Zarogoulidis P, Darwiche K, Franzen D, Funke F, et al. Towards individualized tracheobronchial stents: technical, practical and legal considerations. Respiration. 2016; 94: 442-456.

[63] Cheng GZ, San Jose Estepar R, Folch E, Onieva J, Gangadharan S, Majid A. Three-dimensional printing and 3D slicer: powerful tools in understanding and treating structural lung disease. Chest. 2017; 149: 1136-1142.

[64] Freitag L, Tekolf E, Steveling H, Donovan TJ, Stamatis G. Management of malignant esophagotracheal fistulas with airway stenting and double stenting. Chest. 1996; 110: 1155-1160.

[65] Youness HA, Harris K, Awab A, Keddissi JI. Bronchoscopic advances in the management of aerodigestive fistulas. Journal of Thoracic Disease. 2018; 10: 5636-5647.

[66] Ke M, Wu X, Zeng J. The treatment strategy for tracheoesophageal fistula. Journal of Thoracic Disease. 2015; 7: S389-S397.

[67] Huang P, Lee J. Are single or dual luminal covered expandable metallic stents suitable for esophageal squamous cell carcinoma with esophago-airway fistula? Surgical Endoscopy. 2017; 31: 1148-1155.

[68] Herth FJF, Peter S, Baty F, Eberhardt R, Leuppi JD, Chhajed PN. Combined airway and oesophageal stenting in malignant airway-oesophageal fistulas: a prospective study. European Respiratory Journal. 2010; 36: 1370-1374.

[69] Agrafiotis M, Siempos II, Falagas ME. Infections related to airway stenting: a systematic review. Respiration. 2009; 78: 69-74.

[70] Dutau H, Di Palma F, Thibout Y, Febvre M, Cellerin L, Naudin F, et al. Impact of silicone stent placement in symptomatic airway obstruction due to non-small cell lung cancer - a french multicenter randomized controlled study: The SPOC Trial. Respiration. 2020; 99: 344-352.

[71] Dutau H, Dumon J. Airway Stenting Revisited: 30 Years, the Age of Reason? Journal of Bronchology & Interventional Pulmonology. 2017; 24: 257-259.

[72] Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, et al. Complications following therapeutic bronchoscopy for malignant central airway obstruction: results of the AQuIRE registry. Chest. 2015; 148: 450-471.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time