Abstract
Ensuring proper placement of one-way endobronchial valves is a vital step in achieving successful bronchoscopic lung volume reduction. The ability to navigate into sharply angled airways may be limited by the maximal flexion capability of bronchoscopes. We sometimes encounter difficult anatomical situations, causing a challenging, or sometimes even impossible placement of the EBV in the appropriate position due to steep bronchial bifurcation angles, particularly in the apical segments. A 56-year-old woman with severe emphysema was referred to our hospital after an incomplete EBV treatment due to a very sharp bronchial bifurcation angle in the right upper lobe apical segment (RB1). We were able to easily solve the problem by placing the final RB1 valve using a single-use therapeutic bronchoscope with a greater angulation range than conventional reusable bronchoscopes. The use of single-use therapeutic bronchoscopes with greater flexibility than conventional reusable therapeutic bronchoscopes may be a valuable approach for achieving successful EBV placement in anatomically challenging cases with sharp bronchial branching angles.