1. Aero-digestive Endoscopy Dr. Vishal Sharma

2. History

3. 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

4. Adolph Kussmaul

5. Gustav Killian

6. Chevalier Jackson

7. Shigeto Ikeda

8. Direct Laryngoscopy

9. Chevalier Jackson’s Direct Laryngoscope

10. Anterior commissure Direct Laryngoscope

11. Boyce’s Endoscopy position Supine position with head elevated by 10 cm

12. Tongue Base visualized

13. Epiglottis visualized

14. Vocal cords visualized

15. Micro-laryngoscopy

16. Kleinsasser Microlaryngoscope

17. Chest Piece

18. Laryngoscope fixed

19. Microscope focused

20. Indications for Laryngoscopy

21. 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

22. 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

23. Rigid Bronchoscopy

24. Rigid Bronchoscope

25. Close-up of proximal end

26. Bronchoscope introduced

27. At laryngeal inlet

28. Epiglottis identified

29. Vocal cords identified

30. Scope passed through glottis after 90 0 rotation

31. Scope rotated back

32. Tracheal rings identified

33. Carina identified

34. Bronchopulmonary segments

35. Endoscopy position

36. Scope in Right bronchus

39. Scope in Left bronchus

42. Flexible Bronchoscope

43. 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

44. 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

45. Rigid Oesophagoscopy

46. Rigid Oesophagoscope

47. Jackson scopeNegus scope Distal illuminationProximal illumination No markingsMarked NarrowBroad Constant diameterTapered Single bulbDouble bulb

48. Epiglottis visualized

49. Right pyriform fossa

50. Cricopharyngeal sphincter

51. Upper Oesophagus

52. Middle Oesophagus

53. Lower Oesophagus

54. 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

55. 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

56. Thank You