Use Of Rigid Bronchoscopy Research Articles

Percutaneous dilatational tracheostomy guided by rigid bronchoscopy in patients with cervical mass

Herein, we proposed the PDT guided by rigid bronchoscope in intubated patients with airway obstruction. The presence of cervical mass discouraged us to perform an open tracheostomy as it could result in more blood loss than PDT, while the use of rigid bronchoscopy rather flexible bronchoscopy could facilitate the execution of PDT due to better visibility and suction capacity. This strategy was successfully applied in three consecutive intubated patients with airway obstruction due to cervical mass.

The use of rigid bronchoscopy in foreign body aspiration

The use of rigid bronchoscopy in foreign body aspiration

How risky is it to remove an airway stent?

BackgroundAirway stent removal has traditionally been associated with a high complication rate. Most studies on stent removal are over a decade old, prior to newer anti-cancer therapies, and by including non-contemporary and uncovered metal stents, may not reflect the current practices. We review our experience at Mount Sinai Hospital to report outcomes of stent removal with more contemporary practices. MethodsA retrospective review was carried out of all the airway stent removals performed between 2018 to 2022, in adult patients with benign or malignant airway diseases. Stents inserted and removal for stent trials for tracheobronchomalacia were excluded from the final analysis. ResultsForty-three airway stents removals in 25 patients were included. Twenty-five (58%) stents were removed in 10 patients with benign diseases, and 18 (42%) stents were removed in the remaining 15 patients with malignant diseases. Patients with benign disease were more likely to have their stent removed (OR 3.88). 63% of the stents removed were silicone. The most common reasons for stent removal were migration (n = 14, 31.1%) and treatment response (n = 13, 28.9%). Rigid bronchoscopy was used in 86% of cases. Ninety-eight percent of removals were accomplished in a single procedure. The median time to removal of stents was 32.5 days. Three complications were noted: hemorrhage (n = 1, 2.3%) and stridor (n = 2, 4.6%); one not directly related to the stent removal. ConclusionsCovered metal or silicone airway stents, in the era of contemporary stents, better cancer-directed therapies and surveillance bronchoscopies, can be removed safely with the use of rigid bronchoscopy.

Trends and an Online Survey on the Use of Rigid Bronchoscopy in Korea.

Although almost all interventional pulmonologists agree that rigid bronchoscopy is irreplaceable in the field of interventional pulmonology, less is known about the types of diseases that the procedure is used for and what difficulties the operators face during the procedure. The purpose of this study is to evaluate what diseases rigid bronchoscopy is used for, whether it is widely used, and what challenges the operators face in Korea. We enrolled 14 hospitals in this retrospective cohort of patients who underwent rigid bronchoscopy between 2003 and 2020. An online survey was conducted with 14 operators to investigate the difficulties associated with the procedure. While the number of new patients at Samsung Medical Center (SMC) increased from 189 in 2003-2005 to 468 in 2018-2020, that of other institutions increased from 0 to 238. The proportion of SMC patients in the total started at 100% and steadily decreased to 59.2%. The proportion of malignancy as the indication for the procedure steadily increased from 29.1% to 43.0%, whereas post-tuberculous stenosis (25.4% to 12.9%) and post-intubation stenosis (19.0% to 10.9%) steadily decreased (all P for trends < 0.001). In the online survey, half of the respondents stated that over the past year they performed less than one procedure per month. The fewer the procedures performed within the last year, the more likely collaboration with other departments was viewed as a recent obstacle (Spearman correlation coefficient, rs = -0.740, P = 0.003) and recent administrative difficulties were encountered (rs = -0.616, P = 0.019). This study demonstrated that the number of patients undergoing rigid bronchoscopy has been increasing, especially among cancer patients. For this procedure to be used more widely, it will be important for beginners to systematically learn about the procedure itself as well as to achieve multidisciplinary consultation.

Unusual inhalation of a tissue piece in an infant

Foreign body inhalation is a major problem in children and is one of the most serious accidents in early childhood. It is considered a common cause of childhood morbidity and mortality. We present a unique and unusual case of inhalation of a piece of tissue in a 10-month-old infant admitted to the Pediatric Emergency Department of the Mohamed VI Teaching University Hospital in Marrakech in 2021. The patient was initially seen with acute dyspnea, persistent dry cough, and signs of respiratory distress. The auscultation revealed decreased vesicular murmurs in the right lung field. Chest radiography did not reveal the presence of the foreign body, justifying the use of rigid bronchoscopy for diagnostic and therapeutic purposes, and revealing the presence of a tissue in the bronchial area. Our case report is distinguished by the strange and atypical nature of the foreign body not reported in the literature. Prevention especially parental education is recommended to reduce the morbidity and mortality associated with this domestic accident. Keywords: foreign body; aspiration; choking; bronchoscopy.

Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees

Background: Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings. Objectives: The aim of the study was to evaluate a previously developed assessment tool – Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) – for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees. Methods: IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves. Results: Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6–21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of <60 s. Conclusions: Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.

Rescue Tracheostomy for Patients With Unresectable Large Growing Neck Masses

Most patients with undifferentiated thyroid cancer have unresectable disease with a very high rate of airway compromise. Tracheostomy typically entails technical issues in these cases. In fact, it can be very difficult to expose or simply locate the trachea beneath the mass, and the extensive soft tissue involvement can force the surgeon to cut the tumor to place the tracheostomy tube. The combined use of rigid bronchoscopy and percutaneous tracheostomy techniques, applied in an open surgical procedure, can greatly simplify the procedure. Furthermore, by this method, the airways are quickly secured and the risk of intraoperative bleeding is reduced.

The Role of Rigid Bronchoscopic Intervention for Bronchial Carcinoid.

Bronchial carcinoid is a rare malignant tumor that is categorized as a typical carcinoid or atypical carcinoid. Many institutions use flexible bronchoscopy for diagnosis. However, due to the hemorrhagic nature of the tumor, the amount of specimen obtained is often small, making it difficult to obtain an accurate diagnosis. The use of rigid bronchoscopy may not only contribute to obtaining a diagnosis but also be beneficial in the treatment plan. The aim of this study was to evaluate the efficacy of rigid bronchoscopic interventions for the diagnosis and treatment of bronchial carcinoids. All patients with bronchial carcinoids who underwent rigid bronchoscopic intervention under general anesthesia at our institution between June 2006 and August 2018 were analyzed retrospectively. Eight patients [3 men and 5 women; median age, 71 years (range 45-82 years)] were eligible for the analysis. None of the cases had accurate subtyping preoperatively before intervention. In contrast, all cases were diagnosed as carcinoid with subtypes (5 patients had typical carcinoid and 3 had atypical carcinoid) following rigid bronchoscopic intervention. All respiratory symptoms improved immediately after the procedure. One instance of bleeding occurred, and was easily controlled by argon plasma coagulation and intraluminal administration of epinephrine under flexible and rigid bronchoscopy. Four patients (3 with typical carcinoid and 1 with atypical carcinoid) underwent radical surgery sequentially, and no recurrences were observed. We conclude that rigid bronchoscopic intervention is safe and effective for accurate diagnosis and improvement of respiratory symptoms in patients with bronchial carcinoids.

TRACHEAL LIPOMA CAUSING NEAR COMPLETE OBSTRUCTION: A MULTI-MODAL TECHNIQUE FOR MANAGEMENT

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Tracheal lipomas are a rare cause of major airway obstruction and account only for 0.1% to 0.5% of all lung tumors (1). Management of these has involved flexible or rigid bronchoscopy guided resection (1,2). Here we report a multi-modal approach to resection of a tracheal lipoma causing 80% obstruction of the distal trachea. CASE PRESENTATION: A 70-year-old male with 40 pack year cigarette smoking history and chronic obstructive pulmonary disease (COPD), had presented with progressively worsening dyspnea and wheezing. He had been using his prescribed budesonide/formoterol inhaler without significant relief. A CT-Chest without contrast showed a lesion in the distal trachea. An endobronchial tumor was suspected and evaluation with rigid bronchoscopy was planned. He was first intubated in an atraumatic fashion with the 12mm rigid bronchoscope. A vascular appearing polypoid tumor was protruding from the posterior membrane of the trachea and obstructed 80% of the lumen. Endobronchial ultrasound (EBUS) was used to examine the tumor further and it appeared solid without significant vascularity within the lesion. Rigid forceps were used for biopsy and the specimen was sent for frozen section analysis. Then electrocautery snare was used to remove the largest component of the tumor. Subsequently, Nd:YAG laser was used while holding ventilation to destroy the base of the tumor and left a crater like appearance. This was done with the intention to facilitate healing of the mucosa. The final pathology was consistent with a benign tracheal lipoma. DISCUSSION: Tracheal lipomas are 1.4–13.0% of benign tumors of the lung (1). Multiple cases in the literature report use of electrocautery or endobronchial lasers (1,2). Our approach involved using EBUS, which allowed us to examine the lesion to assess its margins and vascularity. Hemorrhage could prove to be fatal in a patient with high risk obstructive lesion. This method allowed a safe excision without significant bleeding. Furthermore, use of Nd:YAG laser achieved superior destruction of the tumor base which allowed for better healing of the mucosa. We do recommend using the laser at a low energy setting to avoid rare complications such as fire when used in high fat content lesions. A surveillance bronchoscopy 5 months following the procedure showed a completely healed posterior tracheal membrane with no evidence of recurrence. CONCLUSIONS: Combined use of rigid bronchoscopy, EBUS and Nd:YAG laser as a multi-modal approach to maximize safety while minimizing chances of recurrence should be considered. Reference #1: Stevic R, Milenkovic B. Tracheobronchial tumors. J Thorac Dis. 2016;8(11):3401-3413. doi:10.21037/jtd.2016.11.24 Reference #2: Pollefliet C, Peters K, Janssens A, et al. Endobronchial lipomas: rare benign lung tumors, two case reports. J Thorac Oncol. 2009;4(5):658-660. doi:10.1097/JTO.0b013e31819c9a59 DISCLOSURES: No relevant relationships by Brian Cody Adkinson, source=Web Response No relevant relationships by Sisir Akkineni, source=Web Response No relevant relationships by Sixto Arias, source=Web Response No relevant relationships by Jose Garcia Blanco, source=Web Response

Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries.

Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.

Competence in operative bronchoscopy.

We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central airway disorders. Rigid bronchoscopy has a history of over 100 years. The use of rigid bronchoscopy was abandoned upon the introduction of the fiberoptic bronchoscope but has made a reappearance with the development of interventional pulmonology in the late nineteenth and early twentieth century. The advantages of rigid bronchoscopy include allowing simultaneous procedures, such as ablation, debulking and suctioning, without limiting ventilation but at the moment there are no standard approaches to perform the procedure. Rigid bronchoscopy also plays a vital role in stent placement, repositioning, maintenance and removal. An interventional pulmonology practice should only be developed when there is a locoregional unmet medical need and when a dedicated interventional pulmonology unit can be guaranteed. These departments should be available 7 days a week and should provide a fast and appropriate response to referrals in emergency cases. There is a clear need to define a competency-based training program for rigid bronchoscopy, including stent placement. An optimal, multimodality training program for bronchoscopy should include didactic lectures, web-based learning, case-based reviews and hands-on training.

Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker.

Cryoprobe transbronchial lung biopsy (TBLB)/transbronchial lung cryobiopsy (TBLC) is increasingly being described as an alternative to surgical lung biopsy and provides larger lung biopsy samples as compared with conventional TBLB in patients with diffuse parenchymal lung diseases. The technique for cryoprobe TBLB procedure has not yet been standardized, and various authors describe different modalities. However, the use of an artificial airway (rigid bronchoscope or endotracheal tube) is preferred for airway protection. In addition, the use of an occlusion balloon provides safety to prevent excessive bleeding. The exclusive use of rigid bronchoscopy may limit the widespread adoption of this diagnostic modality. We describe a method to perform cryoprobe TBLB with exclusive use of a flexible bronchoscope and utilization of Arndt endobronchial blocker as an occlusion balloon. The procedure was performed in two patients under moderate conscious sedation. Adequate lung biopsies were obtained in both the cases without any complications. This modality may allow safe performance of cryoprobe TBLB with a flexible bronchoscope. Herein, we describe the technical and procedural considerations of this modality.

AB002. Tracheal surgery

AB002. Tracheal surgery

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry

There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications. We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality. Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement. Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.

The efficacy of fiberoptic bronchoscopy through laryngeal mask airway in pediatric foreign body extraction

BackgroundThe use of fiberoptic bronchoscopy (FOB) through laryngeal mask airway (LMA) in children allows the use of an adult-size bronchoscope with its grasping tools; thus, it may aid in foreign body (FB) extraction.AimWe aimed to evaluate the efficacy of FOB through LMA in pediatric FB extraction.Patients and methodsWe prospectively recruited all children (≤16 years) who presented to or were referred to the Department of Pulmonary Medicine, Ain Shams University Hospital, with a clinical suspicion of FB inhalation between June 2012 and June 2013. All the patients were subjected to FOB through LMA under general anesthesia. Rigid bronchoscopy (RB) was available to extract any FB that could not be removed.ResultsOf the 49 children suspected to have FBs, 41 FBs were identified in 28 boys and 13 girls, mean age 5.9 years (9 months to 16 years). FBs were more often lodged in the right side than in the left one (48 vs. 38%) and with predominance of organic FBs (75.6%), mainly seeds (60.9%). Successful extraction by the current technique was achieved in 34 of 41 (82.9%) FBs identified. Extraction of six of seven FBs that could not be removed was successful with the use of RB and open thoracotomy was required in one case. Noncritical complications related to FOB through LMA included laryngeal edema, transient hypoxia, gastric distension, mild hemoptysis, and fever, which occurred in five, five, four, three, and two patients, respectively. One critical complication (stridor) occurred that was related to RB.ConclusionIn conclusion, FOB through LMA is safe and effective in pediatric FB retrieval under general anesthesia with RB backup. Egypt J Broncho 2014 8:57–63

Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

Background and Aim:Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure.Materials and Methods:A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India.Results:Thirty-eight rigid bronchoscopies (50 procedures) were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65) min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal.Conclusions:Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Objectives Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives. Methods We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy. Results Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB. Conclusions Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.

RIGID BRONCHOSCOPY

Objectives: To evaluate foreign bodies in tracheobronchial tree and effectiveness of the therapeutic use of rigid bronchoscopy in a tertiary care setting. Study Design: Descriptive study. Place and duration of study. This study was carried out at Department of ENT and Head and Neck Surgery, Combined Military Hospital, Rawalpindi from June 2006 to June 2010. Patients and methods: This descriptive study was designed to evaluate the foreign bodies in tracheobronchial tree &amp; effectiveness of the use of rigid bronchoscopy in a tertiary care setting. Sixty two patients underwent initial evaluation by ENT consultants and senior registrars followed by management with rigid bronchoscopy. Results: The most commonly affected age group was under 4 years. Male to female ratio was 3:1. Right main bronchus was affected in 51.61% cases. Most of the foreign bodies removed were organic in nature in 90.32% cases. The success rate for removal with rigid bronchoscopy was achieved in 98.39% cases, with fewer complications and no mortality Conclusions: It may be concluded from this study that early diagnosis &amp; management is essential to prevent morbidity &amp; mortality associated with foreign bodies. Rigid bronchoscopy is the most effective procedure for the removal of foreign bodies in tracheobronchial tree.

Foreign body extraction through the rigid bronchoscopy

Foreign body aspiration into tracheobronchial tree represents an urgent condition at high level of risk. Etiology is different, and this condition is typical for all ages with highest incidence in pediatric population. A successful foreign body removal (partial denture) in a 34-year old man was presented. Radiography and computerized tomography of the chest showed a foreign body localized at the level of the right bronchus including the right middle lobe bronchus. By the use of rigid bronchoscopy, a foreign body was visualized and mobilized from the segmental bronchus in the first act, and then completely extracted. Efficient diagnostics and extraction are imperative for the aspirated foreign body preventing life-threatening complications.

Removal of metallic tracheobronchial stents in lung transplantation with flexible bronchoscopy

BackgroundAirway complications are among the most challenging problems after lung transplantation, and Self-Expandable Metallic Stents (SEMS) are used to treat airway complications such as stenosis or malacia at the bronchial anastomosis sites. Several transplantation centers are reluctant to use SEMS since their removal is sometimes needed and usually requires the use of rigid bronchoscopy under general anesthesia. The objective of the current report is to describe our experience in SEMS retrieval by flexible bronchoscopy under conscious sedation.MethodsA retrospective review was done of patients requiring tracheobronchial stent placement after lung transplantation in which the SEMS had to be removed. The retrieval procedure was done by flexible bronchoscopy on a day-care ambulatory basis.ResultsBetween January 2004 and January 2010, out of 305 lung transplantation patients, 24 (7.8%) underwent SEMS placement. Indications included bronchial stenosis in 20 and bronchomalacia in 4. In six patients (25%) the SEMS had to be removed due to excessive granulation tissue formation and stent obstruction. The average time from SEMS placement to retrieval was 30 months (range 16-48 months). The stent was completely removed in five patients and partially removed in one patient; no major complications were encountered, and all patients were discharged within 3 hours of the procedure. In all procedures, new SEMS was successfully re-inserted thereafter.ConclusionsThe retrieval of SEMS in patients that underwent lung transplantation can be effectively and safely done under conscious sedation using flexible bronchoscopy on a day-care basis, this observation should encourage increasing usage of SEMS in highly selected patients.