Single Use Flexible Bronchoscopy: An ex-vivo comparison of all commercially available scopes

Title: Single Use Flexible Bronchoscopy: An ex-vivo comparison of all commercially available scopes
Author(s): KF Deasy AM Sweeney EM O'Reilly MP Kennedy
Institution: Department of Respiratory Medicine, Cork University Hospital
Poster: Click to view poster
Category: Lung Cancer and Bronchoscopy
Abstract: The development of single use flexible bronchoscopes (SUFB) has proceeded with pace over the last 2 years. Concerns regarding infection related to standard bronchoscopes with subsequent COVID-19 pandemic accelerated global uptake and development with multiple companies releasing SUFB. Some vendors are currently on fourth generation devices with improved image quality and degrees of angulation. Technical documentation does not always give a clear picture of device performance and there has been no ex-vivo comparison of SUFBs to date.

We obtained samples of all commercially available SUFBs (TSC Broncoflex©, Boston Scientific© Exhalt, Ambu© and Vathin© SteriScope, as well as the CE marked and soon to be released Pentax© prototype SUFB). We compared technical metrics from multiple vendors including turning diameter, range of movement and turning forces measured in Newtons using a custom-built bench toolkit engineered to allow standardised measurements using a clamp assembly, force meter and camera. Angulation was analysed by a force meter to ascertain the effort needed to fully flex the scopes while empty and while accessed by both a BSCI Radial Jaw 4 2.0mm forceps and Cook Medical 2.0mm cytology brush. Captured images were imported into AutoCAD and analysed with standardised CAD generated images.

The Boston Scientific Exalt© SUFB had the tightest consistent turning envelope at 64 -69mm, this resulted in the highest maximal thumb force required (13 - 37N). The Ambu© Regular SUFB had the best performance in terms of force (11.8-13.7N) to angulation (150 - 190 degrees). The SUFB from Vathin© (180 degrees - 209 degrees) and TSC Broncoflex© (148 degrees - 215 degrees) provided a compromise, with increased angulation but at the cost of higher thumb force compared to Ambu© (15.7N - 23.5N, 10.2N - 21N). The Pentax EB15-S01 had objectively less downward range of movement compared to all other SUFBs (Forceps 113 degrees vs mean 152 degrees and Empty 164 degrees vs mean 192 degrees)

This research helps to inform the practical usability of each bronchoscope when deciding which SUFB is best for the physicians intended end use. Further research should look at perceived qualitative assessment of SUFB by clinicians.