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Procedures

Procedural Experience

  • Dr Herath is an interventional bronchoscopist with formal international training and a post specialist fellowship in interventional bronchoscopy in thoracic malignancy, completed at McGill University Montreal Canada in 2013.
  • She is one of the very few interventional bronchoscopists who have completed formal training in a North American Centre.
  • Dr Herath started up new services for minimally invasive Radial EBUS and Cryobiopsy in Middlemore Hospital Auckland and New Zealand as well as Westmead Hospital, Sydney Australia.
  • She has completed over 1500 bronchoscopies with over a 1000 EBUS procedures with excellent published success rates.
  • Dr Herath frequently performs the following procedures

Cryobiopsy

What is Cryobiopsy or “cold biopsy” for lung cancer and lung nodules?

  • Cryobiopsy is a game-changing, minimally invasive procedure used during a lung biopsy for suspected lung cancer.
  • This is used in combination with Radial EBUS bronchoscopy (see above)
  • Instead of traditional biopsy, a cold biopsy probe is deployed through the bronchoscope and placed exactly in the lesion.
  • The probe is cooled for 4 seconds, freezing and causing the lung tissue around it to stick to the probe and pulled back.
  • This procedure requires advanced skills in both Radial EBUS biopsy as well as using Cryobiopsy probes.
  • Therefore, experience and skill level are required to identify suitable patients, perform the procedure safely and obtain a suitable biopsy as well.
  • Once you are asleep you will need an endotracheal tube or a rigid type of bronchoscopy to keep your airway safe.

What conditions is Cryobiopsy used for?

  • Cryobiopsy is the preferred method for lung cancer diagnosis and treatment by Dr Herath.
  • This enables a larger biopsy sample which can be used for multitude of immunological testing and preservation for future testing.
  • If a large airway is blocked, Cryobiopsy can be used to unblock this.
  • Dr Herath will carefully assess your medical condition and perform navigation mapping using the GPS software system and inform you of this procedure only if you are suitable for the procedure and Dr Herath is sure that she can get a sample with minimal side effects for you.

Am I asleep for the procedure? Where can I have it done?

  • This procedure is only performed by me at Macquarie University Hospital.
  • This procedure requires specially trained staff and equipment that is specially set up at Macquarie University Hospital.
  • This procedure is performed under general anaesthetic; therefore, you will not be aware of the procedure.

What is the wait period to get a Cryobiopsy?

  • Dr Herath is a an advanced bronchoscopist and thereby has her own lists in both public and private sector
  • The procedure will be done as urgently as possible as per the medical condition of the patient.
  • You do not need to be referred to another doctor to do your procedure which reduces the wait times and cost to you as the patient markedly.
  • If you were referred by another respiratory physician and your respiratory physician has already discussed the procedure with you and has taken your consent, you will be given a booking immediately and Dr Herath will discuss this procedure with you on the day of the procedure. However, if you are anxious about the procedure, we will organise a clinic appointment with Dr Herath to discuss your concerns and meet Dr Herath beforehand.

How long does it take? How long will I stay in Hospital?

  • It takes 30-45 minutes for the procedure.
  • This is a day procedure and you can go home 1-2 hours after the procedure.
  • You will be monitored for two hours after your procedure.
  • You will be given a sip of water in 1 hour after the procedure called a “sip test”.
  • This is to check that the local anaesthetic effect on your mouth has worn off and you can swallow without a risk of aspiration.
  • If you pass the test you will be given a light snack and discharged home.

What is the item number for this procedure?

  • The MBS item number for your health fund for this procedure is 30710

What should I do in preparation for Cryobiopsy/Radial EBUS bronchoscopy?

  • Fasting for 6 hours prior to the procedure for both food and fluid
  • If you are undergoing a biopsy stop blood-thinning tablet agents for 5 days pre procedure.
  • Dr Herath will discuss this with you. These include but not limited to Xeralto, Eliquis, Warfarin, Clopidogrel, Ticaglore
  • You may continue aspirin even if you have a biopsy.
  • Dr Herath will contact your cardiologist or your referring respiratory physician to discuss if it is OK for you to stop blood thinners or if you require a “bridging agent” called Clexane or Heparin leading up to the procedure.
  • You should not take diabetic medication the morning of the procedure.
  • You should take all other medications with a sip of clear water.
  • You need someone to drive you home and stay with you for one night.

What are the side effects of a CryoBiopsy-radial EBUS bronchsocpy?

  • Radial EBUS is a non-complicated advanced but safe procedure. Cryobiopsy is a biopsy technique used via the hollow radial EBUS GS.
  • We do these procedures on weekly basis and are prepared for types of adverse events during procedure and equipped to handle emergencies. Most side effects occur whilst you are in hospital and will be attended to with monitoring.
  • The rare side effects that may occur after discharge are listed so that you can watch out for them and take immediate action.
  • The success of the procedure relies excessively on the training of the proceduralist.
Common side effects during or immediately after the procedure What to Do Rare side effects Once you leave the hospital What to Do
Cough post procedure
Coughing blood mixed with sputum
Self-resolve over 24h Infection and fever post procedure Occurs 2-4 hours post procedure in 3% patients
If you have fever >38.5 or feel unwell, you will need IV antibiotics and fluids.
Please return to emergency department of the nearest hospital.
Tiredness Self-resolve in 24h Shortness of breath/chest pain after going home Shortness of breath is also a sign of pneumothorax or air leak outside the lung. If this occurs, please report to the nearest hospital emergency department.
Sore throat Difflam lozenges or throat spray for 48h Coughing up frank blood more than a tablespoon However, coughing up frank blood more than a tablespoon is not normal.
This is a sign of a larger bleed inside the lung. Please report to the nearest emergency department.
Feeling as if you have flu (30% of patients after a wash/lavage) Take paracetamol
Take your temperature
This should be below 38.5 C
Bleeding during procedure We are prepared for a bleed specially during a biopsy.
Air leak outside the lung If we anticipate an air leak, we will perform an USS or a Chest X ray to find out if this had occurred prior to discharge
Common side effects during or immediately after the procedure What to Do
Rare side effects Once you leave the hospital What to Do
Cough post procedure
Coughing blood mixed with sputum
Self-resolve over 24h
Infection and fever post procedure Occurs 2-4 hours post procedure in 3% patients
If you have fever >38.5 or feel unwell, you will need IV antibiotics and fluids.
Please return to emergency department of the nearest hospital.
Tiredness Self-resolve in 24h
Shortness of breath/chest pain after going home Shortness of breath is also a sign of pneumothorax or air leak outside the lung. If this occurs, please report to the nearest hospital emergency department.
Sore throat Difflam lozenges or throat spray for 48h
Coughing up frank blood more than a tablespoon However, coughing up frank blood more than a tablespoon is not normal.
This is a sign of a larger bleed inside the lung. Please report to the nearest emergency department.
Feeling as if you have flu (30% of patients after a wash/lavage) Take paracetamol
Take your temperature
This should be below 38.5 C
Bleeding during procedure We are prepared for a bleed specially during a biopsy.
Air leak outside the lung If we anticipate an air leak, we will perform an USS or a Chest X ray to find out if this had occurred prior to discharge
  • Although not mentioned above in the chart due to extreme rarity, adverse events due to anaesthesia, drug allergies, heart attacks, asthma exacerbations and even death can occur post procedures.
  • The more medical issues you have the higher the chance of an adverse events the above chart is a general guide only.
  • If you have multiple medical issues Dr Herath will discuss your individual risk and you will be referred to the pre-admission clinic for an anaesthetist to view your medical history and decide on the best level of anaesthesia for you.
  • We will take extra precautions like booking an Intensive Care bed post procedure if you have underlying medical issues.

When can you return to work?

You can return to work and start all your normal medications including blood thinners the next day.

When will the results be available?

  • Preliminary results will be available as soon as the procedure is completed on the same day.
  • There is a cytologist working with Dr Herath during the procedure who will look at the samples as they are being taken to give a diagnosis and feedback to see if more tissue is required. You will have a preliminary result at the end of the procedure.
  • Please book an appointment with Dr Herath one week after your procedure to discuss management and obtain referrals.
  • On some occasions when the diagnosis is an aggressive tumour you may be sent to the oncologist on the same day.
  • If you were referred to Dr Herath by your respiratory physician or other specialist, please make an appointment with your specialist only. The results will be copied to the referring specialist.