There are a variety of minimally invasive pulmonary procedures which can be performed with image guidance. Most of these procedures can be performed through a small incision and are done with local anesthesia and moderate sedation as an outpatient. Some of the procedures require an overnight stay in the hospital or are performed on an inpatient basis.
Many diseases cause fluid to build up in the chest cavity (pleural space). When this occurs, the lung becomes compressed making it difficult to breath easily. For this procedure a small catheter is inserted into the fluid collection in order to suction out the fluid and improve breathing. The catheter in the removed. The fluid can then be sent for testing and either aid in the diagnosis or help guide further therapy.
Some patients have recurring fluid in the chest cavity and require intermittent drainage. For these patients, an indwelling catheter or pleurodesis can be performed. The procedure is similar to a thoracentesis, where fluid is drained through a small incision and catheter. After the fluid is drained, a chemical is then injected into the pleural space. The chemical is an irritant to the lining of the lung (which causes inflammation). After the chemical is drained, the lining of the lung becomes adherent to the chest wall preventing accumulation of the fluid.
Indwelling Pleural Catheter
For patients with recurring fluid in the chest cavity, an indwelling catheter can be used as an alternate way of improving pulmonary function. Similar to a thoracentesis, a catheter is placed in the fluid collection. The catheter is then tunneled in the skin where it remains. Using this technique, the patient can then drain the fluid at home (after receiving training) thereby improving quality of life by not requiring further hospitalization or return visits when fluid accumulates.
The indwelling catheter can also be used to treat a pneumothorax. A pneumothorax occurs when there is an air leak from the lung. The air accumulates in the pleural space and the lung collapses. By placing a catheter into the air collection it can be suctioned out and the lung can be reflated. When the catheter is placed, the patient is hospitalized until the problem has been corrected.
Lung or Chest Biopsy
Chest X-rays and CT scans often show an abnormal region of tissue, but are unable to offer an exact diagnosis. A small sample of tissue is needed to assist the medical team in directing the appropriate type of treatment. By obtaining a sample of tissue through a small incision and using a needle to sample the tissue unnecessary surgery can be avoided. Other times, biopsies are needed to stage or monitor progression of disease. This procedure is usually done with a CT scanner and comparing it to your previous study. It usually takes a few days to get the results as there is a lot of testing done on the samples.
A nonsurgical treatment for certain types of cancer can be performed with minimally invasive temperature ablation. Similar to a lung biopsy, a small incision is made in the skin in order to place a probe which can kill tumor cells while avoiding damage to healthy lung tissue. This form of treatment is sometimes easier on the patient when compared to systemic therapy.
Pulmonary Embolism (PE) Thrombolysis
A PE is the result of a blood clot obstructing blood flow to your lungs and usually originates as a blood clot in your leg (deep vein thrombosis otherwise known as a DVT). This is a very serious condition and can be life-threatening. For patients who do not qualify for surgical removal of the blood clot, there is a minimally invasive procedure called catheter-directed thrombolysis. In this procedure, a small catheter can be directed into the pulmonary artery in order to deliver clot busting medication known as thrombolytics. This procedure requires admission to the hospital and close monitoring, but has a good success rate for positive outcomes.
When this procedure is performed it is often done in conjunction with placement of a temporary IVC (Inferior vena Cava) Filter. An IVC filter is an expandable device which can be put into a patient and when released it expands to fit into a large vein. Once in position, the filter acts as a sieve blocking large clots from reaching the lungs and causing more damage. The filter placements are always tracked by patient and removed when possible (when the patient is doing better and no longer at risk for the PE.
Bronchial Artery Embolization
There are a number of conditions which cause either abnormal arterial communications or acute hemoptysis (bleeding from the lungs) including trauma. Many of these patients can be treated with a minimally invasive procedure called embolization. Through a small incision, the source of the bleeding is identified. The catheter is then selectively navigated to the abnormality and then a variety of material is at our disposal to safely block the blood flow to this region with very little risk to loss of function to the lung or surrounding tissue.