Interventional pulmonology is a new field within pulmonary medicine that focuses on the use of advanced diagnostic and therapeutic techniques to treat patients with lung cancer, benign airway disorders and pleural diseases. The interventional pulmonology program at El Camino Hospital Mountain View, which was founded in 2008 is one of the top interventional programs on the West Coast, providing a diagnostic and therapeutic services and cutting-edge treatment in pulmonary medicine.

An interventional pulmonologist collaborates with doctors practicing in other medical fields, such as Radiation Oncology, Thoracic Surgery and Medical Oncology, on techniques and procedures that will benefit many types of patients. We have specialized pulmonary medicine expertise with the most sophisticated techniques and technologies available to diagnose and treat many patients that are traditionally treated with more invasive procedures.

Diagnostic and Therapeutic Procedures

The conventional bronchoscopic procedures we offer include endobronchial biopsy, transbronchial needle/forceps biopsies and bronchial alveolar lavage. Bronchoscopy involves a non-surgical minimally invasive procedure to allow the physician to look inside the lungs using a bronchoscope. This can be done on an outpatient basis because no general anesthesia is involved. Bronchoscopy is a test that can help your doctor diagnose a variety of conditions, such as lung cancer, cancer of other organs that may have spread to your lungs, many types of pneumonia, tuberculosis, pneumocystis carinii pneumonia (PCP) and many other lung diseases. In some cases, bronchoscopy may allow your doctor to make a diagnosis and avoid a surgical procedure.

In addition, our minimally invasive diagnostic and interventional procedures include:

Electromagnetic Navigational Bronchoscopy
The SuperDimension inReach system we use enables physicians to access peripheral lung lesions and mediastinal lymph nodes with a minimally invasive, image-guided technique that is suitable for patients who cannot undergo more invasive procedures, patients with multiple lesions or patients who request a diagnosis before undergoing surgery. With the inReach system, physicians can gain access to distal lesions in a minimally invasive manner.

Fiducial Marker Placement for Stereotactic Radiosurgery
This is a minimally invasive way of placing markers used to locate tumors for precise delivery of radiation for patients who plan to undergo stereotactic radiosurgery (CyberKnife, Trilogy, and others) to treat tumors that cannot be accessed with traditional forms of surgery.

Airway Stent Placement to Address Narrowing of the Airway
Stents are small, cylindrical, expandable tubes, very similar to the types used by cardiologists to open up arteries in the heart. Interventional pulmonologists use them to open bronchial tubes that are occluded or narrowed due to infection, tumors or scar tissues.

Balloon Dilatation
This involves the opening of an airway using a balloon, similar to the opening of coronary arteries by angioplasty. This is particularly useful when the airway is too narrow, as a result of scarring after a tracheotomy, for example. Depending on the location of the airway narrowing, dilation can be performed using a flexible or rigid bronchoscope.

Endobronchial Ultrasound (EBUS) and Radial Probe Ultrasound (REBUS)
EBUS is a technique wherein the pulmonologist uses a special bronchoscope with an ultrasound attachment at the tip of the scope to perform biopsies in multiple areas. This technique minimizes the risk of puncturing a blood vessel and allows for better accuracy, because the pulmonologist can see the needle as it is placed inside the abnormality. This procedure is used to biopsy lymph nodes in the middle of the chest (EBUS) or peripheral lung lesions (REBUS).

Argon Plasma Coagulation (APC)
APC is the application of heat produced by an electric current to destroy tumor tissue or stop bleeding. An accompanying argon gas jet allows heat to be applied in a non-contact method. This non contact method is useful to cover a larger surface area, thereby shortening the procedure time.

Pleuroscopy
It is a procedure similar to laparoscopy but when performed in the chest is called pleuroscopy or medical thoracoscopy. It requires the use of a small instrument with a camera that is inserted into the chest cavity through a very small incision, and it allows the physician to perform diagnostic and therapeutic procedures inside the chest.

Cryotherapy
This involves the destruction of airway tumors by freezing the tissue. Cryotherapy can be performed with rigid or flexible bronchoscopy. The tumor tissue undergoes repeated application of a probe that has been super-cooled; the probe is applied over the entire surface of the tumor. This procedure can be used in conjunction with argon plama coagulation to re-canalize airways occluded by a tumor or by granulation tissue, which forms as part of a healing process.

Endoscopic Lung Volume Reduction
The IBV Valve System is currently under investigation in the U.S. as a new treatment option for people with severe emphysema, and who do not respond well to current medical therapies, are not eligible for invasive surgery such as lung volume reduction or lung transplantation, or who elect not to undergo such surgery.

The device has received Humanitarian Device Exemption (HDE) approval from the U.S. Food and Drug Administration (FDA) to control prolonged air leaks of the lung or significant air leaks that are likely to become prolonged, following lobectomy, segmentectomy, or lung volume reduction surgery. This HDE approval is the first for a bronchial valve procedure. The effectiveness of this device for this use has not yet been confirmed.

Transbronchial Cryo Biopsy
Cryoextraction is a procedure for recanalization of obstructed airways caused by exophytic (outward-growing) tumors. Biopsy samples obtained with this method can be used for tissue diagnosis. Transbronchial cryo biopsy can be used as a substitute for surgical lung biopsy in the case of diffuse lung diseases such as pulmonary fibrosis.

Applicable Diseases

Diseases commonly diagnosed and treated by our Interventional Pulmonary Service include:

Research

Research that is focused on the indications for and outcomes of interventional procedures as well as the implementation of new medical devices is an important aspect of our program. We collaborate with many manufacturers and device developers. If you are interested in any of our ongoing trials, please e-mail us.

For More Information

For details about El Camino Hospital Mountain View’s interventional pulmonology program, or to schedule an appointment or get a referral, call 650-960-5813 or 800-216-5556. Our interventional pulmonologist is Dr. Ganesh Krishna, MD.