aero-digestive endoscopy dr. vishal sharma. history
TRANSCRIPT
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Aero-digestive Endoscopy
Dr. Vishal Sharma
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History
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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
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Adolph Kussmaul
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Gustav Killian
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Chevalier Jackson
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Shigeto Ikeda
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Direct Laryngoscopy
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Chevalier Jackson’s Direct Laryngoscope
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Anterior commissure Direct Laryngoscope
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Boyce’s Endoscopy position
Supine position with head elevated by 10 cm
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Tongue Base visualized
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Epiglottis visualized
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Vocal cords visualized
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Micro-laryngoscopy
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Kleinsasser Microlaryngoscope
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Chest Piece
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Laryngoscope fixed
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Microscope focused
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Indications for Laryngoscopy
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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
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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
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Rigid Bronchoscopy
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Rigid Bronchoscope
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Close-up of proximal end
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Bronchoscope introduced
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At laryngeal inlet
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Epiglottis identified
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Vocal cords identified
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Scope passed through glottis after 900 rotation
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Scope rotated back
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Tracheal rings identified
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Carina identified
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Bronchopulmonary segments
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Endoscopy position
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Scope in Right bronchus
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Scope in Right bronchus
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Scope in Right bronchus
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Scope in Left bronchus
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Scope in Left bronchus
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Scope in Left bronchus
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Flexible Bronchoscope
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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
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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
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Rigid Oesophagoscopy
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Rigid Oesophagoscope
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Jackson scope Negus scope
Distal illumination Proximal illumination
No markings Marked
Narrow Broad
Constant diameter Tapered
Single bulb Double bulb
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Epiglottis visualized
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Right pyriform fossa
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Cricopharyngeal sphincter
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Upper Oesophagus
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Middle Oesophagus
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Lower Oesophagus
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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
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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
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Thank You