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Mechanical debridement

Mechanical debridement is often preferable to laser resection. It is usually carried out following laser coagulation, although poorly vasularized tumors can be mechanically resected without using the laser for any other purpose than to coagulate the base of the tumor. Mechanical resection can be carried out while ventilating the patient without difficulty, even while employing closed circuit jet ventilation.

Mechanical resection is carried out under direct visualization. The telescope is retracted well into the bronchoscope in order to keep the lens free of blood and secretions. The beveled tip of the rigid bronchoscope is then placed against the airway wall and large fragments of tissue are resected by turning the bronchoscope in a cork-screw motion. The airway cartilage is held as a constant reference within the airway wall providing tactile feedback to the endoscopist who must avoid perforating the airway. The tumor fragments are removed from the bronchoscope by means of a specially designed forceps, or simply by aspirating them with the suction catheter via the bronchoscope’s side-port. Use of the suction catheter is particularly useful when removing large fragments which can be sheared by the forceps. Overall, mechanical debridement can be safer than blind laser vaporization of a large tumor mass when the loss of anatomical landmarks makes it impossible to identify the airway’s central axis.

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