Fig. 27.1
Equipment for APC. (a) Electric current generator (VIO300D, Erbe Elektromedizin, Tuebingen, Germany). (b) The tip of the APC probe enables ablation in the tangential direction. APC argon plasma coagulation
APC is a method of applying heat to tissue using argon plasma that is ionized by high-frequency current [2, 3]. Indications are for ablation of tracheobronchial lesions that cause airway compression or obstruction and for coagulation hemostasis of airway bleeding. APC is suitable for a tangentially directed ablation. The actual procedure is a contact-free heat application at an output 30–50 W, within a 5-mm distance from the lesion, that is, repeated once every few seconds. Oxygen supplementation is reduced to less than 40 % FiO2 in order to prevent fire or combustible flames. In addition, the APC probe should have a distance of at least 1 cm from the scope tip in order to prevent breakage of the CCD of the videoscope tip. Since the depth of tissue invasion by the ablation is weaker than that of a high-power laser, APC takes more time to achieve ablation.
27.4 High-Frequency Snare (Fig. 27.2)
Fig. 27.2
High-frequency snare
This device may be applied for resection of a tracheobronchial polypoid tumor (Fig. 27.3) [4]. Check the stalk of the polyp-like tumor by bronchoscopy. Then, hook the tumor stalk with the snare, followed by application of a high-frequency current (30–50 W) to generate heat energy. Avoid prolonged application of the high-frequency current; instead, use short repeated applications every 1–3 s. After dissection, remove the tumor with the use of a grasping forceps or by suctioning with the bronchoscope. A large tumor can be easily removed with basket forceps. It is possible to reduce bleeding after resection by mechanically blocking the tumor blood vessels a few seconds before turning on the power.
