Aero-digestive Endoscopy Dr. Vishal Sharma
History
Bozzini (1806): angled speculum with mirror using wax candle, first examined larynx Manuel Garcia (1854): Using dental mirror, hand mirror & sunlight visualized his own vocal cords Adolph Kussmaul (1868): 1 st rigid esophagoscopy Gustav Killian (1897): 1 st rigid bronchoscopy Chevalier Jackson (early 1900s): father of modern rigid endoscopy Oscar Kleinsasser (1960): suspension micro-laryngoscope Shigeto Ikeda (1966): first fiberoptic bronchoscopy & oesophagoscopy H.H. Hopkins: rigid fiberoptic telescopes
Adolph Kussmaul
Gustav Killian
Chevalier Jackson
Shigeto Ikeda
Direct Laryngoscopy
Chevalier Jackson’s Direct Laryngoscope
Anterior commissure Direct Laryngoscope
Boyce’s Endoscopy position Supine position with head elevated by 10 cm
Tongue Base visualized
Epiglottis visualized
Vocal cords visualized
Micro-laryngoscopy
Kleinsasser Microlaryngoscope
Chest Piece
Laryngoscope fixed
Microscope focused
Indications for Laryngoscopy
Diagnostic Therapeutic Biopsy of suspected malignancy Foreign body in larynx & pyriform fossa removal (larynx & pyriform fossa) Examination of hidden areas: Excision biopsy anterior commissure, laryngeal of benign ventricle, subglottis, infrahyoid laryngeal lesion epiglottis, pyriform fossa apex Dilatation of laryngeal stricture Unsuccessful indirect laryngoscopy
Micro-laryngoscopyDirect Laryngoscopy Binocular visionMonocular vision Better illuminationLess illumination MagnificationNo magnification Better precisionLess precision Both hands are free1 hand holds scope Video attachment possibleNo Can be combined with microscopic Laser No
Rigid Bronchoscopy
Rigid Bronchoscope
Close-up of proximal end
Bronchoscope introduced
At laryngeal inlet
Epiglottis identified
Vocal cords identified
Scope passed through glottis after 90 0 rotation
Scope rotated back
Tracheal rings identified
Carina identified
Bronchopulmonary segments
Endoscopy position
Scope in Right bronchus
Scope in Left bronchus
Flexible Bronchoscope
Indications for Bronchoscopy 1.Broncho-alveolar lavage for C/S, AFB, cytology 2.Biopsy of tracheo-bronchial tumours 3.Investigation of chronic cough, hemoptysis, Lt vocal cord palsy, atelectasis, obstructive emphysema, mediastinal growths 4.Removal tracheo-bronchial of foreign bodies 5.Removal of retained respiratory secretions
Rigid BronchoscopyFlexible Also functions as airwayNo Better for removal of foreign bodyNo Allows use of LaserNo Visualizes up to 3 rd bronchial division5 th division Not done under local anesthesiaDone Not done in cervical spine problemsDone More risky & traumaticSafer Not done for trans-bronchoscopic biopsyDone
Rigid Oesophagoscopy
Rigid Oesophagoscope
Jackson scopeNegus scope Distal illuminationProximal illumination No markingsMarked NarrowBroad Constant diameterTapered Single bulbDouble bulb
Epiglottis visualized
Right pyriform fossa
Cricopharyngeal sphincter
Upper Oesophagus
Middle Oesophagus
Lower Oesophagus
Indications for Oesophagoscopy 1. Investigation of dysphagia, haematemesis, GERD, neck node metastasis of unknown origin 2. Oesophageal foreign body removal 3. Excision biopsy of benign oesophageal lesions 4. Dilatation of oesophageal strictures 5. Sclerotherapy for oesophageal varices 6. Insertion of palliative oesophageal feeding tube
Rigid OesophagoscopyFlexible Better for cricopharynx examinationNo Better for removal of foreign bodyNo Allows use of LaserNo Not good for lower oesophageal examnGood Not done under local anesthesiaDone Not done in cervical spine problemsDone More risky & traumaticSafer
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