Interventional pulmonology is a relatively new speciality in pulmonary medicine which uses minimally invasive endoscopic procedures for diagnosis and treatment of diseases of the airways, lungs, and pleura. Procedures for interventional pulmonology include Airway stenting, Rigid Bronchoscopy, Thoracoscopy, Bronchial Thermoplasty, Endobronchial Ultrasound System (EBUS), Cryobiopsy.
Cryosurgery is an advanced interventional pulmonology procedure which uses the cryoprobe. The cryoprobe is an advanced instrument which can freeze the target tissue to a very low temperature. This frozen tissue can then be sampled or removed easily. Cryobiopsy is very useful for sampling of lung tissue (biopsy) or complete removal of tumour mass obstructing the airway. It is a minimally invasive technique and helps in obtaining bigger samples thus giving higher accuracy and avoiding repeat procedures.
In cryobiopsy, a probe is deployed through the bronchoscope and placed near the target tissue. The probe is cooled for a few seconds, freezing and causing the lung tissue around it to stick to the probe. The scope and probe are removed, and bleeding is controlled using a balloon occlusion catheter. Navigation to the target tissue is assisted by Fluroscopy or Radial-EBUS. The procedure is mostly performed under general anesthesia and the patient can go home the same day or next morning after over-night observation.
Cryobiopsy has been proven to be a useful tool for diagnosis of lung cancer and interstitial lung diseases. Unlike traditional biopsy which involves samples less than 2mm, a cryoprobe can obtain lung tissue more than 1cm and in its intact form without any crush artefacts. Also, it has less risk involved when compared to Surgical Lung Biopsy (SLB). With Radial-EBUS and Fluroscopy, it has comparable yield to CT-guided trans-thoracic biopsy without the risk of pneumothorax. When in expert hands, cryobiopsy has no or minimal complications.
Cryobiopsy work at KRIMS Hospitals –
Around 100+ cryobiopsy procedures were performed at KRIMS Hospitals, Superspeciality Ramdaspeth, Nagpur. Cryobiopsy tool was used for Lung Biopsy in cases of Diffuse Parenchymal Lung Diseases(DPLD) or ILD, Peripheral Lung Nodules, for Biopsy and Debulking in Endobronchial Airway Tumors as well as Thoracoscopic Pleural Cryobiopsies.
Dr Sameer Arbat was Awarded the Indian Chest Society Travel Grant for presenting his work on Cryobiopsy at the European Respiratory Society ERS Congress 2018 held at Paris, France. Department of Pulmonology at KRIMS Hospitals, Nagpur has been a pioneer department in the country and has been offering advanced Interventional care since past 30 years. This is the first department in Central India to have both the Cryotherapy and EBUS Unit. Dr Sameer Arbat has performed more than 500 Interventional Pulmonology procedures in the past 3 years including thoracoscopies, cryobiopsy and EBUS. The team comprises of 5 dedicated pulmonologists with a fully equipped ICU and critical care team.