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.
The program is also the first on the West Coast to offer interventional pulmonology fellowships for pulmonary fellows. Together with Palo Alto Medical Foundation (PAMF), the program is collaborating with the University of California, San Francisco (UCSF) Fellowship Program to provide pulmonary fellows an intensive one-year educational immersion involving outpatient and inpatient treatments, from diagnosis to a range of minimally invasive procedures. Upon completion of the fellowship, physicians are qualified to treat respiratory conditions with the most current techniques and minimally invasive technologies.
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:
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.
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.
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.
Bronchial Thermoplasty for the Treatment of Severe Persistent Asthma
El Camino Hospital is one of the first hospitals to offer bronchial thermoplasty (BT). Bronchial thermoplasty (BT), a device-based asthma treatment approved by the FDA, is a novel outpatient procedure that delivers precisely controlled thermal energy to reduce excess airway smooth muscle that is associated with airway constriction in patients with asthma.
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.
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.
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).
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.
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.
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.
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.
Diseases commonly diagnosed and treated by our Interventional Pulmonary Service include:
- Abnormal chest x-ray
- Benign pleural effusion
- Benign tumors of the airways or lungs
- Bronchial stenosis
- Chronic obstructive pulmonary disease (COPD)/emphysema
- Complications of tracheostomy and intubation
- Diffuse lung diseases such as pulmonary fibrosis
- Foreign body extraction
- Hemoptysis (blood in sputum, aka coughing up blood)
- Lung cancer
- Lung nodule and lung mass
- Malignant pleural effusion (fluid in the pleural space)
- Mediastinal adenopathy/enlarged lymph nodes
- Relapsing polychondritis
- Tracheal stenosis
- Wegener’s granulomatosis
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 650-962-5813 or 800-216-5556. Our interventional pulmonologist is Dr. Ganesh Krishna, MD.