Prior bronchoscopic inspection of a malignant airway obstruction is important to confirm the area of invasion and the type of tumor. Since it is possible that a large bronchoscope (outer diameter, 6 mm) cannot be inserted beyond the stenosis, a thin bronchoscope (outer diameter, 4 mm) or an ultrathin bronchoscope (outer diameter, 2.8–3.5 mm) should be used. Next, determine whether the needed airway intervention (e.g., balloon, electrocautery, argon plasma coagulation, and stent) according to the extent of a lesion necessitates the use of flexible bronchoscope under local anesthesia or the rigid bronchoscope under general anesthesia.

The greatest benefit of airway dilatation and stenting using a rigid bronchoscope for central airway obstruction is that it enables application of treatment procedures under sufficient and secure airway ventilation. Since airway treatment procedures (tissue coagulation or ablation) with flexible bronchoscopy under local anesthesia may be distressful for patients, there is a risk for insufficient treatment or severe complications (bronchial damage or suffocation due to airway bleeding). Other advantages of using a rigid bronchoscope are direct hemostasis of a bleeding site and fast relief of airway obstruction by mechanical excision of a larger portion of a tumor with the use of the tip of the rigid bronchoscope (core out).