Transcript Rigid & flexible endoscopy

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): 1st rigid esophagoscopy

Gustav Killian (1897): 1st 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-laryngoscopy
Direct
Laryngoscopy
Binocular vision
Monocular vision
Better illumination
Less illumination
Magnification
No magnification
Better precision
Less precision
Both hands are free
1 hand holds scope
Video attachment possible
No
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
0
after 90 rotation
Scope rotated back
Tracheal rings identified
Carina identified
Bronchopulmonary segments
Endoscopy position
Scope in Right bronchus
Scope in Right bronchus
Scope in Right bronchus
Scope in Left bronchus
Scope in Left 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 Bronchoscopy
Flexible
Also functions as airway
No
Better for removal of foreign body
No
Allows use of Laser
No
Visualizes up to 3rd bronchial division
5th division
Not done under local anesthesia
Done
Not done in cervical spine problems
Done
More risky & traumatic
Safer
Not done for trans-bronchoscopic biopsy
Done
Rigid
Oesophagoscopy
Rigid Oesophagoscope
Jackson scope
Negus scope
Distal illumination
Proximal illumination
No markings
Marked
Narrow
Broad
Constant diameter
Tapered
Single bulb
Double 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 Oesophagoscopy
Flexible
Better for cricopharynx examination
No
Better for removal of foreign body
No
Allows use of Laser
No
Not good for lower oesophageal examn
Good
Not done under local anesthesia
Done
Not done in cervical spine problems
Done
More risky & traumatic
Safer
Thank You