Interventional Pulmonology and Bronchoscopy
The Interventional Pulmonology Program at Cleveland Clinic Florida was founded in 2001 by Dr. Eduardo Oliveira. It is one of the top interventional programs in the state of Florida, providing a full spectrum of diagnostic and therapeutic services for lung cancer and other benign conditions of the lung. Our academic institution is able to provide cutting edge treatment in pulmonary medicine, by highly qualified and trained professionals.
We offer primary and second opinion outpatient consultations, as well as surgical and procedural evaluations for complex chest diseases. Our patients come from all parts of Florida and surrounding states. We provide consultation to international patients from South America, the Caribbean and Central America. Appointments for international patients are arranged through our International Patient Services department. Our section works in collaboration with multiple specialists at Cleveland Clinic Florida as well as the Pulmonary and Thoracic institutes at Cleveland Clinic in Ohio.
Our multidisciplinary team includes:
- Interventional Pulmonology
- General Pulmonology
- Critical Care specialists
- Thoracic Surgery
- Oncologists
- Radiation Oncologists
- Gastroenterologists specializing in EUS
- Radiologists and interventional radiologists
- Respiratory therapists
- Outpatient Nursing team
Diagnostic and Therapeutic Procedures
The diagnostic and interventional minimally invasive procedures offered are as follows:
- Laser Bronchoscopy for tumor destruction
- Laser Bronchoscopy uses laser to destroy airway tumors or lesions as well as eliminate obstructions in the bronchial tubes that cause shortness of breath.
- Airway Stent placement for narrowing of the airway
- Stents are small cylindrical expandable tubes, very similar to the types used by cardiologists to open up arteries in the heart. They are used to open bronchial tubes that are occluded or narrowed due to infection, tumors or scar tissues.
- Electrocautery bronchoscopy for destruction of lesions and removal of polyps
- Electrocautery bronchoscopy uses electric currents to destroy benign and malignant tumors in the bronchial tubes. It also helps to open up obstructed airways and to stop bleeding.
- Argon plasma coagulation
- Argon Plasma coagulation uses mild electric currents to destroy benign and malignant tumors in bronchial tubes, open up obstructed airways, and stop bleeding.
- Balloon dilation for tracheal and bronchial stenosis
- Balloon dilation for tracheal and bronchial stenosis uses small balloons to dilate bronchial tubes. The procedure passes the balloons through small bronchoscopes. The procedure is similar to angioplasties performed by cardiologists, except that it is done on the bronchial tubes.
- Autofluorescence Bronchoscopy
- Autofluorescence Bronchoscopy is a special light that is used inside the lung through our small scope. This light is able to detect suspicious areas of possible cancer in the bronchia tubes that are not clearly seen by standard bronchoscopy.
- Endobronchial Ultrasound (EBUS)
- EBUS is a technique where a special, very small scope, with a tiny ultrasound at the tip of the scope, allows the pulmonologist to perform biopsies in multiple areas. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, since we can see that the needle is placed inside the abnormality with the ultrasound.
- Esophageal Ultrasound (EUS)
- EUS is a special technique, where a special, scope, with a tiny ultrasound at the tip of the scope allows the physician to perform biopsies in multiple areas. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, since we can see that the needle is placed inside the lesion with the ultrasound.
- Transbronchial Needle Aspiration Biopsy
- Transbronchial Needle Aspiratin Biopsy uses a small scope to go to distant areas in the lung where a small biopsy forceps is used to remove tiny pieces of lung to make the accurate diagnosis of lung conditions in the outpatient setting.
- Transtracheal Needle Aspiration Biopsy
- EUS is a technique where a special, very small-sized scope, with a tiny ultrasound at the tip of the scope, allows the pulmonologist to perform biopsies in multiple areas. The lesion is visualized by fluoroscopy (live ex-ray) or by bronchoscopy. This allows the specialist to minimize the risk of puncturing a blood vessel and allows for better accuracy, since we can see that the needle is placed inside the area of concern with the ultrasound.
- Flexible Biopsy Techniques
- Biopsy procedures are performed with very small scopes using sedation techniques that keep patients very comfortable and asleep.
- Percutaneous Needle Biopsy
- Chest radiologists perform computerized guided biopsy of tumors at multiple areas in the chest reducing the need for surgical biopsies to make a diagnosis. Those procedures are done on an outpatient basis with the patient going home the same day.
- Photodynamic therapy
- Phtodynamic therapy uses an injection of a special chemical in the blood that is absorbed by cancer cells in the lungs. After the chemical is given, special light is used to activate the chemical absorbed inside the tumor cell, destroying the tumor cell but not affecting the healthy ones. This can be very useful in early stages of cancer to prevent further growth.
- Pleuroscopy: It is a procedure similar to lararoscopy but when performed in the chest is called pleuroscopy or video thoracoscopy. It is a small instrument with a camera that is inserted into the chest cavity through a very small incision allowing the physician to do diagnostic and therapeutic procedures inside the chest.
- Ultrasound Guided Thoracentesis
- Ultrasound Guided Thoracentesis removes abnormal fluid from the pleural space between the lung and the chest wall using ultrasound.
- PleurX catheter placement: Placement of a pig-tail catheter in the pleural spare when fluid continues to re-accumulate, especially in patients with malignant pleural effusions.
- Brachytherapy:
- Brachytherapy places a small catheter in the lung so radiation can be given inside the bronchial tube. This is utilized in patients with central tumors or tumors inside the airway, as well as patients who have received large doses of external radiation.
- Cryotherapy:
- Cryotherapy uses cold energy and freezing temperatures to treat bronchial lesions.
- Foreign body aspiration or inhalation and removal
- Foreign body aspiration and removal removes accidentally inhaled foreign bodies such as food, insects and others from the airway with little baskets or other tools.
Diseases commonly diagnosed and treated by our Interventional Pulmonary Service include:
- Lung cancer
- Lung nodule and Lung Mass
- Mediastinal Adenopathy / enlarged lymph nodes
- Abnormal Chest x-ray
- Blood in sputum (hemoptysis)
- Malignant Pleural Effusion (fluid in the pleural space)
- Benign Pleural Effusion
- Tracheal stenosis
- Bronchial stenosis
- Complications of tracheostomy and intubation
- Tracheobronchomalacia
- Relapsing polychondritis
- Amyloidosis
- Wegener’s granulomatosis
Thoracic Surgery Service
At the end of 2006, Cleveland Clinic Florida launched new comprehensive Multidisciplinary Thoracic Oncology program. The multidisciplinary team is composed of a thoracic surgeon, pulmonologists, medical and radiation oncologists, radiologists, pathologists, gastroenterologists, and numerous support staff. Together they specialize in the diagnosis and treatment of lung and esophageal cancer as well as other thoracic malignancies such as chest wall tumors, thymic tumors, and lymphoma.
With a minimally-invasive approach, patients that require surgery benefit from smaller incisions, less postoperative pain, and shorter hospital stays. Patients undergoing thoracoscopic surgery better tolerate postoperative treatments such as chemotherapy compared to those having more traditional “open” surgery.
We are pleased to offer our patients new, innovative treatments such as photodynamic therapy (PDT). For patients with cancer in the main airways or in the esophagus who cannot undergo surgical resection, PDT is an endoscopic (no incisions) light-based treatment used to destroy the tumor. This typically involves a few outpatient treatments over one week and allows patients to breathe or swallow easier depending on the location of the tumor.
In conjunction with the Interventional Pulmonary service, tracheobronchial stenting can be used when there is airway obstruction from a variety of causes.
Other new thoracic surgical services include:
- Thoracoscopic lung biopsy for interstitial lung disease with an average length of stay of less than 24 hours.
- Thoracoscopic sympathectomy for hyperhidrosis. This is performed on an outpatient basis.
- Thoracoscopic decortication for empyema or parapneumonic effusion.
- Thoracoscopic first rib resection for thoracic outlet syndrome.
- Thoracoscopic resection of mediastinal masses including thymectomy for myasthenia gravis.
For patients with tumors in the major airways, a lung-sparing procedure called “sleeve lobectomy” may be utilized to preserve pulmonary function. In the past, the surgical alternative would have been a pneumonectomy—the removal of the entire lung.
In conjunction with the Division of Radiation Oncology, stereotactic radiosurgery is used to treat certain thoracic malignancies. This new modality provides great accuracy and precision in the delivery of radiation to the planned target with fewer treatment sessions than more traditional external beam radiation.
Corroborating with the Division of Interventional Radiology, radiofrequency ablation may be used to treat lung tumors in patients who are not candidates for surgery. This allows for a minimally invasive approach to the treatment of primary and metastatic lung cancers.
The Section of Thoracic Surgery is pleased to offer these latest advances in the management of chest disorders to the patients of South Florida. Approximately 90% of our procedures are performed minimally invasively with a relatively brief hospitalization.
Bronchoscopic Intubations
When the patient is in distress, at times, it is necessary to insert a tube into the airways to assist the patient with breathing. Usually this procedure is performed by direct visualization and insertion of the endotracheal tube. Our pulmonologists use special scopes to insert endotracheal tubes resulting in 100% success rate in intubation, with less trauma to the patient and decreased need for sedation.
Interstitial and Granulomatous Lung Disease
A longstanding or difficult to control cough or shortness of breath that is not responsive to commonly tried medications may be due to diseases of the lungs that are unusual and difficult to diagnose. Special expertise and technology may be required to diagnose and treat these disorders. A multidisciplinary approach is used as indicated involving pulmonologists, thoracic surgeons, radiologist and pathologists to provide state-of-the-art care of patients with unusual interstitial pneumonitis, pulmonary fibrosis, sarcoidosis, atypical mycobacteria such as M. avium or MAC and related illnesses.
Pulmonary Hypertension Clinic
The only Clinic in Broward and Palm Beach counties, the Pulmonary Hypertension Clinic provides comprehensive diagnostic and treatment services for patients with pulmonary hypertension. The hospital and the staff are familiar with pulmonary hypertension patients. Procedures that are denied in other hospitals due to lack of staff familiarity are successfully performed at Cleveland Clinic Florida. We provide expert echocardiographic testing, right heart catheterization with reversibility testing on Nitric Oxide, specialized and dedicated nursing support services and readily accept transfers from outside hospitals of patients in need of specialized care. The Pulmonary Hypertension Clinic is under the direction of Dr. Rahaghi. He is a national speaker in the field of pulmonary hypertension, with multiple ongoing research projects.
Pulmonary Education and Rehabilitation
There is clear evidence that pulmonary rehabilitation decreases complications of COPD and increases patient well being.
The pulmonary department continues to support an active rehabilitation and exercise program for patients with lung disease. In conjunction with the rehabilitation educators, we are offering a unique blend of pulmonary education services in the clinic. They include:
- Disease state teaching in COPD, Emphysema, and asthma
- Inhaler, peak flow, spacer teaching.
- Asthma action plan and COPD contingency planning
- Pulmonary rehabilitation evaluation
- Smoking cessation clinic, using state of the art techniques.
- Incentive spirometry teaching and exercise planning to decrease complications prior to cardiac surgery.
Pulmonary rehabilitation, asthma action plans and disease state teachings have all been shown to decrease morbidity of pulmonary diseases.
Smoking Cessation Clinic
Staffed by trained respiratory therapists, this comprehensive clinic, provides multiple visits, support, medication and guidance to patients- under the supervision of a pulmonary physician.
State-of-the-art techniques and the latest medications are used to end nicotine addiction. The services are billed to insurance companies
Psychotherapy and Acupuncture are also available, some on a fee basis.
State of the Art Bronchoscopy Suite
Our bronchoscopy suite is equipped with the latest technology in minimally invasive therapeutic and diagnostic techniques. Complex procedures are also performed in our state of the art surgical operating rooms.
Sleep Disorders Center
Our Sleep Disorders Center, founded in 1996 by Dr. L.A. Smolley, is one of only six fully accredited sleep disorders centers in the tri-county region. We recently expanded the lab to 6 beds and relocated our modern equipment to the Marriott Hotel in Weston. By moving to a hotel setting, we provide an extremely comfortable environment more conducive to sleep.
Our diagnostic sleep laboratory is supervised by two Sleep Board certified physicians. We use a multidisciplinary approach involving sleep specialists, pulmonologists, ear-nose-throat specialists and psychologists or psychiatrists to diagnose and treat problems related to daytime sleepiness, snoring, trouble staying asleep, headaches in the morning, difficult to treat hypertension, etc., which could be due to obstructive sleep apnea or other sleep related problems.
Pulmonary Function Laboratory
Our comprehensive Pulmonary Function lab is equipped with state-of-the-art equipment that allows more accurate lung volume measurements, and allows for flight simulation in patients with borderline respiratory status pre-flight.
Special services include:
- Flight simulation
- Complete Pulmonary function testing
- ABG
- Methacholine challenge test
- 6 min walk test/ Oxygen level assessment during walking
- Alpha-1 Antitrypsin testing
- Overnight Saturation Study
ICU
Aside from applying the latest in technology, our ICU uses the following state-of-the-art and innovative technologies and programs:
- Scientific evidence-based clinical protocols and care pathways.
- Use of ultrasound guidance in all ICU procedures, including thoracentesis and central line placement.
- Multidisciplinary rounds with the collaboration of an extensive ICU team: Board certified ICU attending, medical residents, interns, medical students, respiratory therapists, ICU nurses, nursing students, pharmacists, pharmacy students, case managers, and dietitians. This group approach improves decision-making and facilitates collaborative execution of the plans.
- The academic residency programs, in conjunction with cardiology, gastroenterology, and renal fellowships drive excellence: as repeatedly demonstrated, hospitals with academic programs have an overall decrease in mortality.
- Continuing education of the nursing staff by medical educators.
Pulmonary Education and Rehabilitation
There is clear evidence that pulmonary rehabilitation decreases complications of COPD and increases patient well being.
The pulmonary department continues to support an active rehabilitation and exercise program for patients with lung disease. In conjunction with the rehabilitation educators, we are offering a unique blend of pulmonary education services in the clinic. They include:
- Disease state teaching in COPD, Emphysema, and asthma
- Inhaler, peak flow, spacer teaching.
- Asthma action plan and COPD contingency planning
- Pulmonary rehabilitation evaluation
- Smoking cessation clinic, using state of the art techniques.
- Incentive spirometry teaching and exercise planning to decrease complications prior to cardiac surgery.
Pulmonary rehabilitation, asthma action plans and disease state teachings have all been shown to decrease morbidity of pulmonary diseases.
Pulmonary Hypertension Clinic
The only Clinic in Broward and Palm Beach counties, the Pulmonary Hypertension Clinic provides comprehensive diagnostic and treatment services for patients with pulmonary hypertension. The hospital and the staff are familiar with pulmonary hypertension patients. Procedures that are denied in other hospitals due to lack of staff familiarity are successfully performed at Cleveland Clinic Florida. We provide expert echocardiographic testing, right heart catheterization with reversibility testing on Nitric Oxide, specialized and dedicated nursing support services and readily accept transfers from outside hospitals of patients in need of specialized care. The Pulmonary Hypertension Clinic is under the direction of Dr. Rahaghi. He is a national speaker in the field of pulmonary hypertension, with multiple ongoing research projects.
Smoking Cessation Clinic
Staffed by trained respiratory therapists, this comprehensive clinic, provides multiple visits, support, medication and guidance to patients- under the supervision of a pulmonary physician.
State-of-the-art techniques and the latest medications are used to end nicotine addiction. The services are billed to insurance companies
Psychotherapy and Acupuncture are also available, some on a fee basis.
Sleep Disorders Center
Our Sleep Disorders Center, founded in 1996 by Dr. L.A. Smolley, is one of only six fully accredited sleep disorders centers in the tri-county region. We recently expanded the lab to 6 beds and relocated our modern equipment to the Marriott Hotel in Weston. By moving to a hotel setting, we provide an extremely comfortable environment more conducive to sleep.
Our diagnostic sleep laboratory is supervised by two Sleep Board certified physicians. We use a multidisciplinary approach involving sleep specialists, pulmonologists, ear-nose-throat specialists and psychologists or psychiatrists to diagnose and treat problems related to daytime sleepiness, snoring, trouble staying asleep, headaches in the morning, difficult to treat hypertension, etc., which could be due to obstructive sleep apnea or other sleep related problems.
Pulmonary Function Laboratory
Our comprehensive Pulmonary Function lab is equipped with state-of-the-art equipment that allows more accurate lung volume measurements, and allows for flight simulation in patients with borderline respiratory status pre-flight.
Special services include:
- Flight simulation
- Complete Pulmonary function testing
- ABG
- Methacholine challenge test
- 6 min walk test/ Oxygen level assessment during walking
- Alpha-1 Antitrypsin testing
- Overnight Saturation Study
ICU
Aside from applying the latest in technology, our ICU uses the following state-of-the-art and innovative technologies and programs:
- Scientific evidence-based clinical protocols and care pathways.
- Use of ultrasound guidance in all ICU procedures, including thoracentesis and central line placement.
- Multidisciplinary rounds with the collaboration of an extensive ICU team: Board certified ICU attending, medical residents, interns, medical students, respiratory therapists, ICU nurses, nursing students, pharmacists, pharmacy students, case managers, and dietitians. This group approach improves decision-making and facilitates collaborative execution of the plans.
- The academic residency programs, in conjunction with cardiology, gastroenterology, and renal fellowships drive excellence: as repeatedly demonstrated, hospitals with academic programs have an overall decrease in mortality.
- Continuing education of the nursing staff by medical educators.
