Flexible Forceps Research Articles

Effect of seasons on the decomposition by necrophagous insects of pig (Sus scrofa domesticus L.) carcasses exposed to the open air in the Sudano-guinean and Sub-sudanese zones of Côte d'Ivoire

Determining the post-mortem interval (PMI) of a corpse discovered 72 hours after death is becoming complex and imprecise in forensic medicine. It is necessary to use other investigative methods to determine the date of death. The aim of this research was to determine the impact of the seasons on the decomposition of pig corpses exposed to the open air by necrophagous insects. The research was carried out in the North (at the Botanical Garden of the Peleforo Gon Coulibaly University in Korhogo) and in the Centre (in the Bouaké region). Insects were collected directly from decomposing carcasses using a mowing net and flexible forceps for larvae and Coleoptera. Pitfall-traps were also used for collection. Diptera and Coleoptera were collected during the dry and rainy seasons in the Sudano-guinean and Sub-Sudanese zones. Chrysomya albiceps, belonging to the Calliphoridae, was the majority species. Because of its plethora of species in the two study areas, C. albiceps could be one of the main species for determining the minimum MPI in Côte d'Ivoire. Five stages of decomposition were observed in the two study zones, although a sixth stage (dry putrefaction) was observed in the Sub-sudanese zone during the harmattan period. Stratiomyidae and Piophilidae contributed to the total decomposition of carcasses during the rainy season. The Histeridae family was the richest in species. Dermestes maculatus was the richest in individuals. Carcasses in the rainy and dry seasons were respectively decomposed by an average of 97.18% in the rainy season and 84.32% in the dry season in the two study areas.

Construction of MXene interlayer conductive ion transport channel by polypyrrole-coated cellulose nanofibers for ultralow voltage high-performance ionic soft actuators

Ionic soft actuators are extensively utilized in soft robotics and intelligent flexible devices due to their low-voltage actuation capability. MXene(Ti3C2Tx) has potential value as an electrode material for ionic soft actuators owing to its high conductivity and large specific surface area. However, the actuation performance of its ionic soft actuator is limited by poor extensibility and low capacitance caused by the stacking effect. Here, a high-performance ionic soft actuator with MXene\\polypyrrole-coated cellulose nanofibers (CNF@PPy) is reported. While gaining high flexibility of the electrode due to the great mechanical property of CNF, the fast conductive transport channel is constructed by doping CNF@PPy between MXene layers, which not only effectively reduces the loss of conductive properties and drastically improves the ion migration rate, but also prevents MXene from stacking and has additional chemical active sites, significantly increasing its ion storage capacity. Consequently, the actuator exhibits excellent actuation performance at the 0.5 V ultralow voltage: 0.79 % bending strain, 6 s rapid response, and 91.03 % high durability after 5 hours. Additionally, the potential for the actuating core of advanced flexible electronic devices is demonstrated by the application of flexible forceps and the flexible electronic eye.

Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

Abstract Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy.

Endoscopic third ventriculostomy and biopsy of a tectal lesion using flexible neuroendoscopy and urological cup forceps: illustrative case.

Tectal region tumors often clinically present as obstructive hydrocephalus due to mass effect on the outflow of the third ventricle and cerebral aqueduct. Pathology in this region varies; thus, biopsy can be of great value in the management decision making. Appropriate instrumentation remains an area of interest to further advance flexible neuroendoscopic techniques and applications. The authors report an illustrative case using flexible neuroendoscopy through a single burr hole for simultaneous endoscopic third ventriculostomy (ETV) and tectal tumor biopsy using urological cup forceps in a 13-year-old boy who had presented with obstructive hydrocephalus. The authors demonstrate the feasibility of simultaneous ETV and tectal lesion biopsy via flexible neuroendoscopy to address obstructive hydrocephalus and obtain a tissue biopsy in a single-site procedure. They found that the use of flexible cup forceps designed for uroscopy is an important complement to flexible neuroendoscopy. Given the evolving applications of flexible neuroendoscopy, this has implications for instrumentation adaptation and future design.

Response Evaluation Criteria in Tumors of the Bladder (RECIT-Bladder) for future window of opportunity trials as a platform to accelerate drug development.

571 Background: There are abundant potential permutations of novel or combination therapeutics that could be tested in non-muscle invasive bladder cancer (NMIBC), but the ability to study these therapies is limited. Window of opportunity trials (WOOT) may accelerate otherwise costly and slow drug evaluation by testing response to treatment during the time between the surveillance office cystoscopy that diagnoses a recurrent tumor and removal by transurethral resection (TURBT), but the accuracy of endoscopic tumor measurement is unknown. Through an iterative process modifying the RECIST criteria used for metastatic cancer response assessment; we developed RECIT-Bladder as a short-term endpoint for NMIBC WOOTs. Here, we report the feasibility and reproducibility of paired tumor measurement at office cystoscopy and TURBT in “untreated” patients as the development cohort for RECIT-Bladder. Methods: Bladder tumors were measured at office cystoscopy and again at formal TURBT in a standardized fashion compared to a calibrated object (flexible biopsy forceps). If multiple tumors were present, the two largest, measurable, representative tumors were measured. Patients were excluded if tumor location did not allow for accurate measurement (e.g., bladder neck) or if the lesion was not amenable to measurement (e.g., diffuse CIS or papillary carpeting). Results: We characterized 69 papillary tumors from 34 patients (4 patients with recurrent tumors included ≥2 times). 38% (13/34) had LGTa and the remainder had high grade (HG) bladder cancer (1 CIS, 15 HGTa, 2 HGT1, and 1 HGT2). 98.6% (68/69) were measurable at TURBT. There was a median 23 (16-37 IQR) days between cystoscopy and TURBT during which lesion size increased by a median 0.25 mm (0-0.1mm IQR, p=0.4). Measurements on cystoscopy and at TURBT were highly correlated (correlation coefficient 1.04, p<0.01, r2 = 0.88). There was no correlation between tumor growth and time between cystoscopy and TURBT (correlation coefficient 0.00, p=0.5, r2 = 0.00). MSK-IMPACT targeted exome sequencing was available in 62% of patients (21/34) of whom 71% (15/21) had an FGFR3 mutation (median growth 1 mm over median 23 days). Conclusions: Using a standardized protocol (RECIT-Bladder), tumor measurement at office cystoscopy and follow-up TURBT appears precise and reproducible. RECIT-Bladder may offer a practical short-term clinical trial endpoint for evaluating progression, stable disease, or response to therapy. If validated, RECIT-Bladder offers a pathway to rapidly discover novel therapeutic agents. We have begun a prospective multi-surgeon protocol to validate these results and evaluate potential pharmacodynamic endpoints. RECIT-Bladder is also currently being assessed in the context of an ongoing investigator-initiated WOOT testing oral erdafitinib in FGFR3 altered recurrent NMIBC (NCT04917809).

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

ROLE OF DEBULKING FOR BENIGN ENDOBRONCHIAL LESIONS: A CASE OF CHRONICALLY ASPIRATED FOREIGN BODY PRESENTING AS NECROTIZING PNEUMONIA

Use of Flexible Bronchoscopy in Foreign Body Aspiration.

Objective:Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic.Methods:We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis.Results:Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients.Conclusion:Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children.

A Novel Oral Endoscopic Biopsy Procedure to Obtain Rumen Epithelial Samples.

Most in vivo studies related to ruminal development in calves use invasive techniques involving rumen-fistulated or euthanized animals. In consideration of animal welfare, we developed an oral endoscopic biopsy procedure to allow the obtaining of rumen epithelial samples, thus serving as an alternative for measuring the height and width of rumen papillae in calves in a safe, quick, and efficient manner that allows the slaughtering of calves to be avoided. This procedure was tested on 12 Brangus crossbred calves randomly distributed in two groups, with one fed a meal starter and the other an extruded starter feed. Calves underwent a 12-h fasting period, were restrained in a squeeze chute, administered a dose of atropine, and sedated with xylazine before the oral endoscopic biopsy procedure. A 120 cm long Olympus® oral flexible video endoscope and forceps were used to collect cranial–dorsal sac rumen epithelial tissue samples of approximately 0.5 mm. Endoscopy was successful in all 12 calves and the collected tissue samples were placed in formalin (10%) for further processing for obtaining rumen papillae measurements. Consumption of the extruded starter feed resulted in the increased (p = 0.035) width of rumen papillae. The oral endoscopic biopsy procedure implemented in this study was demonstrated to be successful and is thus an alternative technique for studying rumen epithelial development and morphometric alterations in calf rumen tissue.

Transforaminal Percutaneous Endoscopic Lumbar Discectomy (TPELD) in Caudal Migrated Lumbar Disc Herniations: A Case Series and Literature Review

Background Data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely utilized in various degenerative spine pathologies, due to the presence of high-speed drills, flexible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis.

Rotation angle evaluation of a rotation mechanism including crown gear for controlling the posture around the axis of a flexible surgical tool

In this study, we proposed a rotation mechanism for controlling the posture around the axis of a flexible surgical tool for treatment deep inside the body. The mechanism includes crown gears and is driven by wire. In this method, the flexible forceps are fixed to the crown gear rotating mechanism placed at the tip of a sheath device, and the crown gear rotating mechanism is driven by the wire. The rotation mechanism can rotate infinitely. We designed and prototyped a crown gear push-up mechanism and a wire pulling mechanism, and evaluated the rotation angle of the crown gear rotation mechanism. The wire pulling mechanism was actuated by a motor and the rotation angle was measured a rotary potentiometer. As the result of the rotation angle evaluation experiment, 324° rotation was confirmed clockwise and 90° rotation was confirmed counterclockwise. In this paper, we confirmed that the rotation around the axis of a flexible surgical tool is possible within the range of ±90°.

IMPROVING PLEURAL BIOPSY YIELD THROUGH THE INTEGRATION OF ELECTROCAUTERY INTO SEMI-RIGID MEDICAL THORACOSCOPY

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Medical thoracoscopy is a minimally invasive method of obtaining pleural tissue for pathologic testing. While the use of a semi-rigid thoracoscope provides greater maneuverability over a rigid thoracoscope, the smaller working channel may limit the ability to obtain an adequate specimen using standard flexible forceps. CASE PRESENTATION: A 58-year-old male with a history of well-controlled HIV and sarcoidosis presented with a recurrent right pleural effusion. He underwent serial thoracenteses, which revealed a lymphocytic-predominant exudative effusion with triglycerides of 1,300 mg/dL consistent with chylothorax. However, cytology, pleural fluid and serologic testing, as well as lymphangiography failed to provide an underlying diagnosis. Given the uncertain etiology, the patient was consented for medical thoracoscopy. After being prepped and draped in the usual sterile fashion, the pleural space was entered with a semi-rigid thoracoscope. Visual inspection of the thoracic cavity did not reveal an obvious etiology of the pleural effusion or evidence of pleural metastases. Initially, large capacity flexible forceps (2.8mm - Boston Scientific) were used to obtain several specimens averaging 2mm x 4mm (Figure 1). Next, a section of parietal pleura was identified and using an electrocautery knife (HookKnife – Olympus), a 4mm by 10mm full-thickness section was dissected and removed en bloc. This piece was then retrieved with forceps and sent for pathologic testing. The site of the electrocautery biopsy was observed and did not show any evidence of active bleeding (Figure 2). A chest tube was left in place for ongoing management of the patient's pleural effusion. The patient tolerated the procedure well without complications and is awaiting final pathologic diagnosis. DISCUSSION: We describe the integration of a flexible electrocautery knife into semi-rigid medical thoracoscopy. This technique allows for larger specimens of intact pleural tissue to be obtained than would otherwise be possible with a standard flexible forceps biopsy. CONCLUSIONS: The use of electrocautery as a biopsy tool during semi-rigid thoracoscopy provides an effective means of acquiring full-thickness pleural samples and helps to mitigate the disadvantages of a smaller working channel when compared to rigid thoracoscopy. REFERENCE #1: Canto A, et al. Points to consider when choosing a biopsy method in cases of pleurisy of unknown origin. Chest. 1983 Aug;84(2):176-9. doi: 10.1378/chest.84.2.176. PMID: 6872597. DISCLOSURES: Consultant relationship with medtronic Please note: 2019-2021 Added 04/27/2021 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with boston scientific Please note: 2019-2021 Added 04/27/2021 by George Cheng, source=Web Response, value=Consulting fee Consultant relationship with pinnicle biologics Please note: 2019-2021 Added 04/28/2021 by George Cheng, source=Web Response, value=Consulting Owner/Founder relationship with restor3D Please note: 2016-present Added 04/28/2021 by George Cheng, source=Web Response, value=Ownership interest Consultant relationship with Intuitive Surgical Please note: 2019-2021 Added 04/28/2021 by George Cheng, source=Web Response, value=Consulting fee No relevant relationships by Russell Miller, source=Web Response No relevant relationships by Matthew Nobari, source=Web Response No relevant relationships by Alex Pearce, source=Web Response No relevant relationships by Grant Senyei, source=Web Response

Development of Multi Degrees-of-Freedom Haptic Forceps Robot with Three Actuated Fingers

Surgical robots have been studied and developed to assist surgeons. Master-slave flexible forceps robots that are components of a flexible endoscopic surgical robot are useful to realize novel minimally invasive surgical procedures that are difficult for conventional rigid medical devices. Although driving force for the tip portion of a flexible forceps robot is mechanically transmitted by wires through the flexible portion, friction and backlash changed by the posture of the flexible portion make it difficult to realize precise end effector control. Furthermore, transmission of haptic sensation is necessary to realize safer operation. In this study, a multi degrees-of-freedom (DoF) haptic forceps robot with three fingers is presented as an end effector of a flexible forceps robot. Transmission of driving force in flexible structure that causes performance deterioration is eliminated by arranging motors near the end effector. To transmit haptic sensation to operators, bilateral control is implemented to a master-slave system composed of the haptic forceps robot and a multi DoF input device. Additionally, control on modal space is implemented to verify finger dexterity. The utility of the haptic forceps robot is experimentally validated.

Diagnostic Yield and Safety of Pleural Cryobiopsy during Medical Thoracoscopy to Diagnose Pleural Effusion. A Systematic Review and Meta-Analysis

ObjectiveCurrent evidence on the diagnostic yield and safety of pleural cryobiopsy (CB) is based on a series of heterogeneous studies with limited cohorts. A pooled analysis of these studies could improve the evidence and contribute to a better understanding of this new technique. MethodologyWe performed a systematic review and meta-analysis of published studies that included data on the yield and diagnostic safety of pleural CB compared with procedures performed using conventional flexible forceps. The heterogeneity of the analysis was evaluated by determining the I2 index, while study quality was measured with the QUADAS-2 tool. ResultsSeven studies involving 356 patients were used for the final evaluation. In 55.6%, the etiology of the pleural effusion was malignant, 61.1% of which were lung cancer. The diagnostic yield of pleural CB was 95% (95% CI 92-97) vs. 91% (95% CI 87-94) with conventional flexible forceps (P = .019). Mild bleeding was reported in 67% of CB procedures (95% CI 62-72) compared with 85% of conventional flexible forceps procedures (95% CI 79-90) (P < .001). CB specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, although the quality of the studies was acceptable. ConclusionsPleural CB is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.

Cryobiopsy In Flexi-Rigid Pleuroscopy in a Region with Low Mesothelioma Prevalence

Background: The use of conventional flexible forceps during flex-rigid pleuroscopy can be challenging when sampling hard and thickened pleura. Pleuroscopic cryobiopsy is an emerging field, with various early studies demonstrating good yield and minimal complications. Objectives: To review the authors’ early experience of pleuroscopic cryobiopsy in their centre and highlight its utility in the diagnosis of mesothelioma. Method: Six cases of undiagnosed pleural effusion that underwent pleuroscopic cryobiopsy via flexi-rigid pleuroscopy between July 2017 and June 2019 were retrospectively analysed. Results: The cohort had a median age of 59 years, consisting of two females and four males with a median age of 57 years. Mean (aggregate) tissue sample diameter was 9.2±1.9 mm. Cryobiopsy established a definitive diagnosis in all six cases: one case of malignant mesothelioma, one pleural tuberculosis, two small cell carcinomas, and two adenocarcinomas. Immunohistochemical staining was performed in all five of the malignant samples (100%). There were no major complications reported. Conclusions: Based on the case series, pleuroscopic cryobiopsy is a feasible adjunct to conventional forceps biopsy, a safe procedure in the authors’ setting, gives high diagnostic yield, and enables differentiation between the different causes of exudative pleural effusion. A large, prospective study is required to validate this retrospective series.

Flexible Bronchoscopic Removal of Push-Pin from Right Lower Lobe Bronchus: a Case Report

Foreign body aspiration is common in children and adolescents. Foreign body aspiration is often unnoticed and diagnosis may be delayed in children, as many fail to provide a history. Although rigid bronchoscopy is preferred modality, flexible bronchoscopy is also a useful tool for foreign body extraction from the distal airways in selected cases. An eleven-year-old boy presented with a history of fever and dry cough of one month's duration. A chest x-ray showed a linear radiopaque foreign body along the course of the right bronchus. Flexible bronchoscopy revealed a metallic nail-like structure in right lower lobe bronchus which was successfully grasped with the flexible forceps and extracted via the oral route with the bronchoscope. Upon extraction aspirated foreign body was found to be a push-pin.

Development of small‐diameter haptic flexible gripping forceps robot

AbstractRobotic technologies are being increasingly utilized for medical treatments to support surgeons and reduce the burden on patients. Flexible endoscopic surgical systems with an endoscope and flexible forceps robots are state‐of‐the‐art devices that are expected to realize more difficult and less invasive surgery. Surgeons teleoperate these flexible forceps robots as their own hands and conduct various medical tasks. The wire‐driven mechanism is applied to many flexible forceps robots to transmit the driving force to the tip of the robots in a narrow space. However, the flexible structure makes it difficult to control the wire‐driven robots and implement the haptic technologies to realize safer surgery. In this paper, a force sensor‐less, small‐diameter flexible forceps robot with the ability to transmit haptic sensation is presented. The driving part at the tip of the flexible part, composed of a small actuator with a reduction mechanism, realizes the miniaturization of the robot. Haptic information is estimated by low‐resolution position information. The bending of the flexible part with electric wires does not deteriorate the performance of the end effector. The performance of the haptic flexible forceps robot is evaluated through experiments.

Contribution of usage to endoscope working channel damage and bacterial contamination

Biofilm formation has been shown to be associated with damaged areas of endoscope channels. It was hypothesized that the passage of instruments and brushes through endoscope channels during procedures and cleaning contributes to channel damage, bacterial attachment and biofilm formation. To compare surface roughness and bacterial attachment in used and new endoscope channels invivo and invitro. Surface roughness of 10 clinically used (retired) and seven new colonoscope biopsy channels was analysed by a surface profiler. For the in-vitro study, a flexible endoscope biopsy forceps was passed repeatedly through a curved 3.0-mm-diameter Teflon tube 100, 200 and 500 times. Atomic force microscopy was used to determine the degree of inner surface damage. The number of Escherichia coli or Enterococcus faecium attached to the inner surface of the new Teflon tube and the tube with 500 forceps passes in 1 h at 37oC was determined by culture. The average surface roughness of the used biopsy channels was found to be 1.5 times greater than that of the new biopsy channels (P=0.03). Surface roughness of Teflon tubes with 100, 200 and 500 forceps passes was 1.05-, 1.12- and 3.2-fold (P=0.025) greater than the roughness of the new Teflon tubes, respectively. The number of E.coli and E.faecium attached to Teflon tubes with 500 forceps passes was 2.9-fold (P=0.021) and 4.3-fold (P=0.004) higher compared with the number of E.coli and E.faecium attached to the new Teflon tubes, respectively. An association was found between endoscope usage with damage to the biopsy channel and increased bacterial attachment.

Rentabilidad diagnóstica y seguridad de la criobiopsia pleural durante la toracoscopia médica en el estudio del derrame pleural. Una revisión sistemática y metaanálisis

ObjectiveCurrent evidence on the diagnostic yield and safety of pleural cryobiopsy (CB) is based on a series of heterogeneous studies with limited cohorts. A pooled analysis of these studies could improve the evidence and contribute to a better understanding of this new technique. MethodologyWe performed a systematic review and meta-analysis of published studies that included data on the yield and diagnostic safety of pleural CB compared with procedures performed using conventional flexible forceps. The heterogeneity of the analysis was evaluated by determining the I2 index, while study quality was measured with the QUADAS-2 tool. ResultsSeven studies involving 356 patients were used for the final evaluation. In 55.6%, the etiology of the pleural effusion was malignant, 61.1% of which were lung cancer. The diagnostic yield of pleural CB was 95% (95% CI 92-97) vs. 91% (95% CI 87-94) with conventional flexible forceps (P=.019). Mild bleeding was reported in 67% of CB procedures (95% CI 62-72) compared with 85% of conventional flexible forceps procedures (95% CI 79-90) (P<.001). CB specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, although the quality of the studies was acceptable. ConclusionsPleural CB is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.

Transbronchial cryobiopsy as a new tool for lung biopsies in diagnosis of diffuse parenchymal lung diseases

Rationale and background The use of flexible forceps for transbronchial lung biopsy is the most commonly applied technique in the approach of diagnosis of diseases diffusely involving the lung parenchyma. Using a flexible cryoprobe for transbronchial lung biopsy has been also recently reported. Objective The aim was to study the diagnostic yield and to assess the feasibility of flexible cryoprobe in obtaining lung biopsies using flexible bronchoscopy. Patients and methods A total of 23 patients showing diffuse parenchymal lung affection in their radiology were included. They were recruited for transbronchial lung cryobiopsy. The flexible cryoprobe was directed into the preselected bronchus from the previously studied radiology. After the probe was brought into position, it was cooled and then retracted containing a frozen lung tissue attached to its tip. Then the obtained tissue was processed and sent for histopathology. Results Flexible probe lung cryobiopsy achieved overall diagnostic yield of 95.6% (22/23 patients). The most frequent diagnosis was hypersensitivity pneumonitis and idiopathic interstitial pneumonias. Each was diagnosed in 26.08% of the studied patients. Sarcoidosis and malignancy were the second frequent diagnoses obtained (each was diagnosed in 21.74% of patients). Pneumothorax (8.69%) and bleeding (4.35%) were recorded as the complications of cryotransbronchial lung biopsy in the study. Conclusion Lung cryobiopsy is a newly introduced technique that allows obtaining large biopsies of the lung parenchyma, which exceed the results of forceps biopsy in quality and size.

Pleural Cryobiopsy: A Systematic Review and Meta-Analysis

Pleural biopsy using either video-assisted thoracoscopic surgery or medical pleuroscopy is the current diagnostic criterion standard for pleural pathology with a high, yet imperfect, diagnostic yield. Cryobiopsy may provide greater tissue, increase depth of sampled tissue, and/or reduce crush artifact. However, its impact on diagnostic yield remains uncertain, and there are potential concerns regarding its safety too. We performed a systematic review and meta-analysis to investigate the same. We performed a systematic search of MEDLINE, Embase, and Google Scholar for studies evaluating the performance of pleural cryobiopsy, assessing the quality of each study using the Quality Assessment, Data Abstraction and Synthesis-2 tool. Using inverse variance weighting, we performed a meta-analysis of diagnostic yield estimations. We also reviewed specimen characteristics and complications related to the procedure. Seven observational studies involving 586 pleural biopsies (311 cryobiopsies and 275 flexible forceps biopsies) were evaluated. All but one study used a semi-rigid thoracoscope. Meta-analysis generated a diagnostic yield of 96.5%for cryobiopsy and 93.1%for forceps biopsy with an inverse variance-weighted OR of 1.61 (95%CI, 0.71-3.66) and an I2 of 16%. No instances of moderate to severe bleeding were reported with cryobiopsy. A funnel plot illustrated no major publication bias. Based on analysis of relatively homogenous observational data, pleural cryobiopsy is safe but does not increase diagnostic yield over flexible forceps biopsy. Adequately powered multicenter randomized trials are needed for further investigation.