Since the launch of the Ambu aScope in 2009, SFBs have undergone more than 10 years of continuous improvement from the original fibrescope to the electron bronchoscope. The technology of the Complementary Metal Oxide Semiconductor (CMOS), the core component of the image sensor, is also mature, which im, roves the problems such as poor image quality and low sensitivity. Currently, SFBs have been used in ICU or perioperative settings༌ and oper, tion is limited to BAL, guided tracheal intubation, tracheotomy༌ etc. In, his study, we further explored more clinical applications of SFBs, such as transbronchial biopsy, and compared the performance between SFBs and RFBs.
In routine bronchoscopy, we found no significant differences in comparing their examination times. The recovery rate of qualified BALF should be more than 30% [14]. Our study found that both SFBs and RFBs could achieve satisfactory recovery rates, which was consistent with previous studies. Zaidi et al. found that SFBs obtained more excellent recovery of BALF than RFBs, and there was no significant difference in cell number and survival rate between the two groups[13]. Furthermore, in this study, SFBs were used in transbronchoscopic biopsy for the first time. There was no significant difference in biopsy time and positivity rate between SFBs and RFBs, which confirmed that SFBs could perform more bronchoscopic operations. All of the above confirmed that SFBs are non-inferior in routine bronchoscopy, BAL, biopsy, and so on.
Compared to RFBs, SFBs eliminate the risk of bronchoscopy-related infection. In the context of the COVID-19 global pandemic, several societies, including the American Association of Bronchology and Interventional Pulmonology (AABIP) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), recommended the use of SFBs in patients with suspected or confirmed COVID-19 infection, to reduce the spread of disease and protect healthcare staff [16]. In this study, we followed up with patients for two weeks after clinical operations with SFBs [17], and none of them had infection-related symptoms.
In terms of performance comparison, Liang et al. found that the YunSendo-R(SFBs) is superior to the Ambu aScope3 (SFBs) in terms of image clarity, color contrast, and illumination[18]. And it had similar vision and operability to the Olympus bronchoscope (RFBs). By investigating operator perceptions, Liu et al. found no significant difference in operability between the Vathin H-SteriScope and RFB[19]. However, Flandes et al. argued that 54.4% of operators considered that the image quality of the SFBs was worse than the RFBs[20]. In our study, the operators were generally satisfied with the SFBs after completing clinical operations, particularly in portability and lightness. However, the shortcomings of SFB are also obvious, in the image clarity, and lighting, which the operators said needs to be improved. To reduce the cost of the SFBs, CMOS is an essential component. However, compared to the charge-coupled device (CCD) used in RFBs, CMOS still has disadvantages such as poor image quality, low resolution, and low light sensitivity, which explains why RFBs do not perform as well as RFBs. In the future, the technique of SFBs should be improved to meet the clinical needs better.
In order to better understand the clinical needs, we designed a questionnaire. We found that SFBs are not yet widely used in China, and most doctors’ knowledge about SFBs is only obtained from literature or the internet. On the basis of avoiding cross-infection effectively, doctors demanded lower prices, better manipulation, and superior image quality of SFBs. Especially in price, 77% of those surveyed only accept SFBs less than $295.80. In the aspect of cost, compared with RFBs, SFBs have low operation costs, low site requirements, and zero maintenance costs. We believed that SFBs will better meet the clinical needs with the continuous development of technology.
To summarize, our study confirmed that SFBs are non-inferior to RFBs in bronchoscopy, BAL, biopsy, and so on. It expands the new clinical application of SFBs and has certain clinical significance. This study has some limitations. Such as it is a single-center study with a small sample size. There is a potential sampling bias in this study.
In the future, more clinical applications of SFBs can be explored, such as peripheral lesion biopsy, interventional therapy, physician training, and so on. Technical requirements such as improving imaging quality and illumination are also the direction of future improvement of SFBs.