Respiratory system is one of the organs that is not accessed easily any body. Even surgeons have their own reasons for not accessing it. Coronary by pass surgery, valvular replacements are more glamorous and sought after while surgery on lungs and mediastinum is not. This is probably because of the technical problems and the lack of people trained in this area. Physicians would not think of bronchoscopy as that involved a scope going in to an important organ and the patient also would think the same. In the process many treatable diseases were missed. Thanks to the awareness this scenario has changed. The last decade has seen many surgeons willing to go towards this field of lung surgery which is no longer considered unsafe.
Another area that is not approached by physicians and chest physicians is mediastinum. Mediastinum is a cavity between the two lungs. Mediastinum contains all the principal organs of the chest except the lungs. It extends from the sternum or breast bone to the vertebral column and is bound laterally by pleura the layer that covers the lungs, pericardium the layer that covers the heart . Mediastinum is an imaginary part that houses heart, thymus. oesophagus, trachea ,bronchi, major blood vessels and nerves.
To have look into the mediastinum is only by means of chest xray, CT scans. But to get a tissue out of the chest diagnostic purpose was considered a difficult task. Only thoracic surgeons who were interested in this field used to do mediastiniscopy or mediastinotomy to get the lymph nodes, thymus and thyroid for diagnostic tissue. With the advent of interventional radiology the task became bit easier as these procedures did not involve any admission in to the hospital and were relatively safe day care procedures. The only concern about these radiological interventional were when the lesions were in mediastinum and were close to major blood vessels. In these situations there was no other option but to open and get the tissue for diagnosis.
Endobronchial Ultrasound also called EBUS can be used to aspirate the lymph nodes for diagnostic purpose, aspirate masses in the mediastinum and lungs that are close to airways and most importantly in lung cancer staging that would prevent unnecessary lung surgeries. This is done as a office procedure without any need for admission. This is just an extension of the bronchoscopy that has lots of potential not only to diagnose lung cancer but also stage the same that would help the physicians inplanning treatment strategies. This tool has been used across the world in many cancer centres to stage the lung cancer and in many centres this has become the first diagnostic step if one suspects cancer.
Dr.R.Narasimhan is one of the first persons to perform EBUS in the country and has trained many pulmonologists in this field