Tissue effects of bronchoscopic electrocautery - Bronchoscopic appearance and histologic changes of bronchial wall after electrocautery

Study objectives: To study tissue effects of bronchoscopic electrocautery ( BE). Design: In six patients with non-small cell lung cancer, a BE procedure was immediately before surgery. After patients were placed on ventilation, nor mal mucosa on different carinae was treated with a cautery probe (2-mm(2) s urface area) at a power setting of 30 W with a variable time of application of 1 to 5 s. Bronchoscopic appearance of the treated area was documented p hotographically, and histologic changes of the bronchial wall were examined . Setting: Bronchoscopy unit of a university hospital. Measurements and results: BE resulted bronchoscopically in whitening of the bronchial mucosa with crater-shaped lesions. After longer duration of BE a pplication, deeper craters with more profound charring were seen. Histologi c changes of the lesions showed craters containing a variable amount of nec rotic tissue. In one case, thin subsegmental carinae were coagulated and me asurements could not be performed, In the remaining five cases, microscopic findings revealed 0.2 +/- 0.1-mm necrosis after 1 s; 0.4 +/- 0.2-mm necros is after 2 s; 0.9 +/- 0.5-mm necrosis after 3 s; and 1.9 +/- 0.8-mm necrosi s after 5 s. A variable degree of tissue damage surrounding the necrotic ti ssue area was found. In one cast, cartilage damage appeared after 3 s of co agulation, and extensive damage of the underling cartilage was seen in four cases after 5 s of application. Conclusions: Superficial damage was obtained by short duration of BE (less than or equal to 2 s), and longer duration of coagulation (3 s or 5 s) caus ed damage to the underlying cartilage, Bronchoscopic appearance after endob ronchial electrocautery corresponded with the histologic changes.