Endoluminal therapy of trachea and bronchus

The application of endoscopic techniques is common in the treatment of trac heal and bronchial diseases today. Bronchoscopic interventions are used in both elective and emergency situations. Laser therapy for malignant tumors is purely palliative in most cases and should only be performed in nonsurgi cal patients. However, 30 % of lung cancers cause obstruction in the trache a and main bronchi. Benign tumors and tracheal stenoses could require laser recanalization or the implantation of stents, if surgery will be the secon d step or will not be possible. In patients with foreign body aspiration, m assive hemoptysis, or severe obstruction of the trachea, emergency bronchos copy is necessary. A more recent type of bronchoscopic intervention is the treatment of bronchial stump or anastomosis insufficiency as well as minima l iatrogenic injuries using spongiotic fillings or stent implantation. The use of therapeutic bronchoscopy requires great experience in rigid and flex ible bronchoscopy, the possibility of high-frequency jet ventilation as wel l as laser and argon application, and the possibility to implant different types of stents. More advanced bronchoscopic interventions should only be d one if a department of thoracic surgery exists, in view of the potential ne ed to control complications or perform further treatment. Especially the br onchoscopic treatment of tracheal stenosis should be performed by the thora cic surgeon himself or in close contact with a thoracic surgeon who is expe rienced in tracheal resections.