A Novel Technique for the Placement of Endobronchial Watanabe Spigots Into the Bronchus Side-Grasping Method

Background: Bronchial occlusion with an endobronchial Watanabe spigot (EWS) is effective for the management of persistent pulmonary air leaks; however, an optimal procedure for placing the spigot at the target bronchus remains debatable. The procedure most currently applied involves grasping the middle of the graspable part of the EWS with grasping forceps (conventional method). In this study, we assess a new technique, the side-grasping method, to maneuver the spigot into the target bronchus by using rotatable biopsy forceps to grasp the edge of the graspable part of the EWS. The aim of this study is to evaluate the effectiveness of this new technique for the simple placement of the EWS. Methods: To compare the number of bronchoscopists who were able to place the EWS correctly within 10 minutes, and the time needed to place each spigot for both methods into 4 canine bronchi. Results: More bronchoscopists correctly placed the EWS within 10 minutes using the side-grasping method compared with the conventional method (35/40 vs. 15/40, P<0.01). The total time needed to place spigots into all bronchi using the side-grasping method was 13 +/- 2.2 minutes versus 27.8 +/- 3.6 minutes using the conventional method (P<0.01). Conclusion: The side-grasping method described in this study was a simple and effective technique for correctly placing an EWS spigot into the target bronchus.