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Bronchoscopic Tissue Removal

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Design a new bronchoscopic tissue removal device to solve the most critical ... Forceps Debridement. Suctioning [6] [16] [10] Mechanical Debulking. Advantages ... – PowerPoint PPT presentation

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Title: Bronchoscopic Tissue Removal


1
Bronchoscopic Tissue Removal
  • Group 7
  • Presented by Nathan Killian
  • Partners David Jin
  • Sangita Sudharshan
  • Mentor Martin L Mayse, M.D.
  • Director, Interventional Pulmonology
  • Washington University in St. Louis

2
Lung Obstructions
  • Lung cancer is the primary cause
  • 175,000 new cases
  • 30 will develop symptomatic obstruction
  • 98 would die on a ventilator without
    bronchoscopic removal
  • Still many problems
  • 3

16
3
Project Scope
  • Design a new bronchoscopic tissue removal device
    to solve the most critical problems existing with
    current devices

4
In This Presentation…
  • Review most common bronchoscopic tissue removal
    techniques
  • (results of literature searches)
  • Discuss our design requirements based upon the
    problems we found
  • Present specifications and preliminary
    mathematical analysis for our device

5
Bronchoscopes
16
Flexible
Rigid
6
Bronchoscopic Technique
7
Types of Obstructions
3
Endoluminal Extraluminal Mixed
8
Mechanical Debulking
6
10
16
Rigid Core-out
Forceps Debridement
Suctioning
9
Mechanical Debulking
  • Advantages
  • Fine control over amount/location of tissue
    removed
  • Quick relief of airway obstruction
  • Can be used through both flexible and rigid
    bronchoscopes
  • Tissue sample can be removed

1
10
Mechanical Debulking
  • Disadvantages
  • Poor hemostasis
  • Poor limiting of local disease recurrence (short
    durability)
  • Takes a long time through a flexible bronchoscope

1
11
Electrocautery
16
12
Argon Plasma Coagulation
13
Electrocautery
  • Advantages
  • Immediate relief of airway obstruction
  • Can be used through both rigid and flexible
    bronchoscopes
  • Excellent hemostasis
  • Fine control over amount of tissue destruction
  • Slows local disease recurrence

2
14
Electrocautery
  • Disadvantages
  • Delayed collateral tissue damage is possible
  • Cannot be used for patients with pacemakers and
    automated implantable cardiac defibrillators
  • Risk for endobronchial fires, hemorrhages, and
    electrical shock to patients or operators
  • Tissue sample cannot be removed

2
15
Cryotherapy
16
16
Cryotherapy
  • Advantages
  • Can be used through both rigid and flexible
    bronchoscopes
  • Excellent hemostasis
  • Little risk of injury to neighboring healthy
    tissue
  • Slows local disease recurrence

4
17
Cryotherapy
  • Disadvantages
  • Very slow effect and clearing of airway
    obstruction
  • Tissue sample cannot be removed

4
18
LASER Resection
16
19
LASER Resection
  • Advantages
  • Fine control over amount of tissue destroyed
  • Slows local disease recurrence
  • Excellent hemostasis
  • Quick airway obstruction relief
  • Can be used through both flexible and rigid
    bronchoscopes

5
20
LASER Resection
  • Disadvantages
  • Risk of endobronchial fires if used in an
    oxygen-rich environment
  • Risk of airway perforation
  • Tissue sample cannot be removed

5
21
Brachytherapy
16
22
Brachytherapy
  • Advantages
  • Can treat deep obstructions
  • Potentially curative for inoperable, early stage
    tumors
  • Excellent hemostasis
  • Can be used through both flexible and rigid
    bronchoscopes

3
23
Brachytherapy
  • Disadvantages
  • Very slow relief of airway obstructions
  • Risk of deep tissue destruction
  • Tissue sample cannot be removed

3
24
Photodynamic Therapy
Pre-Treatment
LASER Application
Post-Treatment
16
25
Photodynamic Therapy
  • Advantages
  • Can be used through both flexible and rigid
    bronchoscopes
  • Selective destruction of tumor
  • Limits local disease recurrence
  • Excellent hemostasis

5
26
Photodynamic Therapy
  • Disadvantages
  • Patients receiving treatment must avoid direct
    sunlight for up to 6 weeks following the
    procedure
  • Tissue sample cannot be removed

5
27
Summary of Therapy Qualities
28
Design Requirements
  • Be used in either rigid or flexible bronchoscope
  • Minimize collateral damage
  • Have an immediate effect
  • Control bleeding
  • Recover specimens
  • Have a durable effect (gt 1 month)
  • Cost less than 1,000 to make

29
Design Specifications
  • Flexibility is primary consideration
  • Diameter
  • Less than 2.2 mm ideal for 5 mm scope
  • 2.2 2.8 maximum for 6 mm scope
  • Length
  • At least 60 cm working length
  • Materials
  • Biocompatible (e.g. stainless steel, silicone
    plastic, ABS plastic) 8,9,10
  • Reusable (washed and autoclaved)
  • Weight consistent with current tools

30
More Specs…
  • Suction must be less than 300 mmHg (max wall
    suction used in hospitals)
  • For electrocautery, LASER resection, cryotherapy,
    etc.
  • Device must be compatible with common OLYMPUS
    devices used in hospitals

31
Preliminary Mathematical Analysis
  • Heating of tissue with electrocautery
  • Heating of tissue with LASER resection
  • Suction pressure to displace tissue

32
Heating with Electrocautery
  • Set your Argon plasma probe to 15 W…

s
14
33
Heating with LASER Resection
  • Total absorbed power density Capacity of
    material to conduct heat away from impact site
    Heat absorbed from laser at impact
  • K thermal conductivity
  • tp duration of irradiation
  • p density
  • Cv specific heat per unit volume
  • (T1-T0) change in temperature
  • (1-R) absorption coefficient
  • Io laser intensity
  • 1460 W/cm2 needed to vaporize biological tissue

13
34
Suction Needed to Displace Tissue
  • Assume we have a 4 mm long piece of tissue that
    we want to stretch 2 mm…

15
35
Project Schedule
36
Work Distribution
  • Nathan
  • Preliminary presentation
  • Design focus electronics, energy sources
  • Literature and patent searches
  • Sangita
  • Progress presentation
  • Design focus materials
  • Safety management
  • David
  • Final presentation
  • Design focus mechanics
  • Website development

37
References
  • Prakash, U., Advances in Bronchoscopic
    Techniques., American College of Chest
    Physicians, 1999(116) 1403-1408.
  • Ernst, A., et. al., Interventional Pulmonary
    Procedures., American College of Chest
    Physicians., 2003(123) 1693-1717
  • Leh, S., Mayse, M., Role of Interventional
    Pulmonology., Washington University in St. Louis.
  • Mathur, PN, et. al., Fiberoptic bronchoscopic
    cryotherapy in the management of tracheobronchial
    obstruction, Chest, 1996(110) 718-723.
  • Simoff, Michael J., Endobronchial Management of
    Lung Cancer, Cancer Control, 2001(84)337-343.
  • http//www.tobacco-facts.info/bronchoscopy.htm
  • http//caonline.amcancersoc.org/cgi/reprint/55/1/1
    0.pdf
  • http//en.wikipedia.org/wiki/Silicone
  • http//www.sdplastics.com/abs.html
  • http//www.escomedical.com/
  • http//www.chestjournal.org/cgi/content/full/116/5
    /1403
  • http//www.medscape.com/viewarticle/455720_10
  • http//www.chestjournal.org/cgi/content/full/120/3
    /934
  • http//www.engineeringtoolbox.com/specific-heat-ca
    pacity-food-d_295.html
  • http//www.medscape.com/viewarticle/489484_print
  • Images borrowed from Dr. Mayse

38
Questions?
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