Flexible bronchoscopy guided vocal cord biopsy under conscious sedation in special situations: An option to conventional biopsy techniques

Introduction: Vocal Cord (VC) biopsies are usually performed with rigid laryngoscopy under general anesthesia (GA). In patients with comorbidities such as cardiovascular or pulmonary disease, the GA risk is high and can lead to significant complications and morbidity/mortality. We describe VC biopsy in such a high-risk cohort, done safely and successfully with flexible bronchoscopy (FB -VCB) and conscious sedation. Methods: VC biopsies were done with FB in 2 categories of patients – one estimated to be high risk for GA, or two where VC lesions were found incidentally in the course of FB done for other reasons. FB was done with local anesthesia and conscious sedation, and the VC with the lesion was identified. Bronchoscopic forceps were introduced through the working channel of the bronchoscope, and the lesions were sampled carefully. Results: FB – VCB were performed in 15 patients (14 males, 1 female) with a mean age of 60.7 ± 12.1 years. Of the 15 patients, 7 patients were poor GA candidates due to comorbidities, and 6 patients had incidental VC lesions found during bronchoscopy. A diagnosis was made in 14/15 (93.3%) patients. Complications observed were mild ooze and hoarseness of voice for few days, which did not require any significant intervention. Conclusion: We report the first series of patients with VC biopsies done with FB, without significant complications. It is safe, with the distinct advantage of conscious sedation, which is useful in patients at a high risk of GA complications, and can give good diagnostic yield.