Breathe Easy

At RWJUH, Specialists Use Minimally Invasive Techniques to Diagnose and Treat Lung Conditions

Lung conditions can be debilitating—and even deadly. Fortunately, a growing number of diagnostic techniques and treatments are helping to improve patients’ quality of life and chances of survival.

Robert Wood Johnson University Hospital (RWJUH) recently launched an Interventional Pulmonology Service. Interventional pulmonology is a relatively new area of medicine in which physicians use minimally invasive procedures to care for patients with benign and malignant lung diseases. In many cases, patients can be diagnosed or treated on an outpatient basis, and they often recover faster and experience fewer side effects.

At RWJUH, interventional pulmonologists (IPs) commonly treat patients with lung cancer, interstitial lung disease (disorders that cause lung scarring and interfere with breathing), chronic cough and advanced chronic obstructive pulmonary disease (COPD). COPD encompasses progressive lung diseases, such as emphysema, chronic bronchitis and non-reversible asthma.

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Three IPs collaborate with thoracic surgeons, medical, surgical and radiation oncologists, and traditional radiologists to provide the most advanced patient care.

“We meet once a week to review cases and create individualized treatment plans,” says Ilya Berim, MD, Director of the Interventional Pulmonology Service.

Here, Dr. Berim describes some of the cutting-edge procedures his team is using to care for patients.

New Diagnostic Tests

Patients with lung infections and interstitial lung disease often need lung biopsies, in which physicians remove small samples of tissue and analyze them.

Traditionally, biopsies are performed surgically (incisions are made in the chest) and patients stay in the hospital for several days afterward. At RWJUH, Dr. Berim and his team are are using a less invasive approach called bronchoscopic cryobiopsy. They place a probe through a bronchoscope, a thin tube that’s inserted in your nose or mouth and eased into your throat and lungs. The probe is cooled until it reaches a freezing temperature, and lung tissue sticks to the probe.

“This allows us to obtain a large enough sample to make an accurate diagnosis without damaging the surrounding tissue,” says Dr. Berim.

Since the tissue is frozen, it’s better preserved and it’s easier for physicians to make a diagnosis.

“There’s no incision, and patients can go home the same day,” says Dr. Berim. “Also, the risk of complications is lower because the chest doesn’t need to be opened.”

There are many possible causes of chronic cough, such as acid reflux, asthma, COPD and a condition called excessive dynamic airway collapse, in which the airways collapse and touch.

To determine with greater accuracy what’s behind a cough, Dr. Berim’s team uses a bronchoscope to examine a patient’s airway while he or she is sedated. The team applies mild air pressure, known as continuous positive airway pressure, through a mask to check for possible airway collapse. If the airway is under too much pressure, a stent may be placed to keep it open and improve symptoms.

Cutting-Edge Treatments

In patients with advanced COPD, the small airways in the lungs may collapse, which causes difficulty with exhalation. Traditionally, surgeons have performed lung volume reduction, in which they remove a portion of the lung that’s not functioning properly. Performing such an invasive procedure in this patient population can lead to serious complications.

Dr. Berim and his team are using a novel, less invasive solution. They identify the airways that aren’t functioning properly, then insert a special one-way valve.

“This allows air to leave the lungs but not return,” says Dr. Berim. “As a result, a portion of the lung collapses.”

The benefit to patients? This minimally invasive procedure achieves the same result as the more invasive procedure but with fewer complications.

“Patients can breathe better and walk faster,” says Dr. Berim.

The downside?

The procedure is successful with a subset of patients. They must be evaluated with breathing tests, also known as pulmonary function tests, which can be performed at RWJUH’s Pulmonary Function Test Lab to ensure they are a good candidate.

If an IP needs to visually examine your lungs, he or she will likely use a flexible bronchoscope, a thin tube with a camera that’s placed in your airways. However, sometimes a metal version, called a rigid bronchoscope, is necessary to remove a foreign body, shrink a tumor and place or remove certain types of stents.

In patients with pleural effusions — fluid that accumulates between the tissues that line the lungs and chest — physicians need to determine the cause of the condition and remove the excess fluid. (Pleural effusions can be caused by cancer, an infection or heart and/or kidney failure.)

Dr. Berim and his team perform a procedure called medical thoracoscopy to diagnose and treat a patient with this condition. They are able to drain the fluid through a single incision, or port, rather than use the traditional approach of making multiple incisions. In addition, “We can obtain pleural tissue samples, remove the fluid and check the chest cavity for evidence of cancer that may have spread,” he says.

Another benefit: With this approach, patients can be given conscious sedation rather than general anesthesia and can be discharged from the hospital the same day.

Patients with a range of lung diseases will benefit from these minimally invasive procedures.

“Our goals are to improve patients’ access to high-quality healthcare and provide the most cutting-edge, evidence-based diagnostic and treatment options,” says Dr. Berim.

For more information about the Interventional Pulmonology Service, at Robert Wood Johnson University Hospital New Brunswick, please call (732) 425-1555.