Introduction
Rigid bronchoscopy is a technique that visualizes the trachea and proximal bronchi. It is usually performed in the operating room under general anesthesia. Rigid bronchoscopy is most commonly used to manage patients who have obstruction of either their trachea or a proximal bronchus, since the rigid bronchoscope’s large lumen facilitates suctioning and the removal of debris, or for interventional procedures such as insertion of airway stents [1,2]. (See “Diagnosis and management of central airway obstruction” and “Airway stents”.)
Rigid bronchoscopes, equipment for visualization, and accessory instruments are reviewed here. Techniques of rigid bronchoscopic intubation are described separately. (See “Rigid bronchoscopy: Intubation techniques”.)
Rigid Bronchoscopes
The rigid bronchoscope is also known as an open tube bronchoscope, open tube, straight bronchoscope, or ventilating bronchoscope. It is a rigid, straight, hollow metal tube that is available in several sizes. Its purpose is to provide access to the airways.
The external diameter of a rigid bronchoscope varies from 2 to 14 mm, wall thickness ranges from 2 to 3 mm, and length varies from a very short tube (for pediatric cases) to a long or extra long tube (for adults). Tubes with an extra large diameter have been developed for exceptional cases of tracheobronchomalacia, but they are not readily available.
Most rigid bronchoscopes are the same diameter from the proximal to the distal end, although some have a beveled or tapered tip to lift the epiglottis during intubation. (See “Rigid bronchoscopy: Intubation techniques”.) Variations in the tip design also facilitate the dilation of airway strictures. Most rigid bronchoscopes are round when visualized in cross-section, with external side ports that permit the introduction of suction catheters, laser fibers, and ventilation (picture 1). A few are almost oval. A small internal channel exists in some rigid bronchoscopes, through which the rigid telescope passes. Others are simply an empty tube. Some rigid bronchoscopes can analyze exhaled gases.