News nr. 29 | September/October 2012
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Respiratory Endoscopy Unit (REU)


Dr. Rosal Gonçalves
Respiratory Endoscopy Unit (REU) 




Bronchology has been practiced since the foundation of the service in the 1950s, at first with rigid bronchoscopy started by Thomé Villar, subsequently continued by Freitas e Costa and his colleagues. 

The advancement of technology in this area has been huge. The emergence of the bronchoscope in the late 1960s revolutionized diagnostic and therapeutic procedures in Pulmonology. The 1990s saw the appearance of interventional bronchoscopy. 

The REU was structured in January 2003 when Professor Bugalho de Almeida headed the service. It has two intervention rooms with negative pressure ventilation system – one for Bronchology and the other used for Pleural Techniques (thorascoscopy and others) – a recovery room with 3 beds equipped with patient monitoring units, the team’s working room, and an area for equipment storage and washing equipped with systems that comply with established standards. 

The REU has a care providing and a training component in the field of pulmonology endoscopic techniques. It carries out about 200 tests per year and, almost always, it has two interns training in-house. In terms of provision of health services, the work of this unit covers patients allocated to several hospitals nationwide, in addition to caring after our own patients. The level of bronchology prevention on a 24-hour basis must also be stressed, as it is the only one in Greater Lisbon and in the entire southern part of the country. 

Tests are performed three times a week, under sedation for additional tests (waked sedation), or under general anesthesia with the collaboration of the Anesthesiology Department. 

Bronchial fibroscopy and video bronchial fibroscopy have the highest percentage of tests. Rigid bronchoscopy for diagnosis and intervention, particularly laser therapy and the placement of tracheobronchial prostheses, are a very important differentiating activity performed on patients with benign and malignant pathology of the trachea and obstructive pathology of the large airways, mainly patients with lung cancer. About 50-70 patients are subjected to these procedures per year. Within the field of bronchology, we also perform paediatric rigid bronchology (removal of alien bodies). Its 15 years of experience have resulted in the publication of a paper in the “Journal of Bronchology and Interventional Pulmonology” in April 2007.
Endobronchial ultrasound, which is a very importan
t technique for the diagnosis and staging of lung cancer, started to be performed in 2007. Brachytherapy, introduced in Portugal by Salvato Feijó, is performed in collaboration with the department of Radiotherapy. Total Lung Lavage is one of the least used techniques. It is used in cases of alveolar proteinosis, a rare disease that requires close collaboration with Anaesthesiology due to the need for general anaesthesia and changes in mechanical ventilation during the performance, which takes a long time. A review article about this experiment was published in “Revista Portuguesa de Pneumologia” in February 2009. 

Thoracoscopy is the most important pleural technique performed for diagnosis and treatment. About 50/60 procedures are conducted per year. 

Among other members, REU has two assistants of the Faculty of Medicine of Lisbon, one of whom is currently conducting a PhD. In terms of postgraduate teaching, REU has contributed to the training of all interns of the pulmonology specialty in the department, as well as interns from other departments and specialties, particularly intensive care professionals studying Special Studies. 

Since the restructuring of REU in 2003, several works have been presented at the annual congresses of the Portuguese Society of Pulmonology (SPP), at the European Respiratory Society, the American Thoracic Society, and at other scientific meetings:
- 7 papers,
- 22 posters. 

Two articles have been published in the “Journal of Bronchology and Interventional Pulmonology”, in April 2007 and January 2011; two review articles have been published in “Revista Portuguesa de Pneumologia”, in July 2004 and February 2009, and two chapters in “Atlas de Pneumologia”, published in 2009 by SPP.
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Coordination:
Prof. Doutor J. Fernandes e Fernandes
Editorial Commitee: Prof. Doutor J. Fernandes e Fernandes, Prof. Doutor Alexandre Ribeiro, Prof. Doutor António Vaz Carneiro, Prof. Doutor João Ferreira, Dr. Luis Pereira
Information Officer: Ana Raquel Moreira
Editorial Team: Ana Maria Silva, Ana Raquel Moreira, André Silva, Lara Ponte, Miguel Andrade, Rui Gomes, Sónia Barroso, Susana Henriques, Tânia Simões
Collaboration: Communication and Image Office - Ana Isabel Gonçalves da Silva, Bruno Moura
Design and Technical Support: UTI 
Design and development: Spirituc
e-mail: news@fm.ul.pt