Optical Forceps Research Articles

New challenge in double-bore medical thoracoscopy in Fayoum University Hospital

Abstract Background Thoracoscopy is an invasive technique. When other, less intrusive techniques are ineffective at providing a diagnosis in the case of pleural exudates, thoracoscopy should be employed. The diagnostic and therapeutic thoracoscopy methods used by the pulmonologist are divided into two techniques. In the first technique, a single entry site of a thoracoscope together with a working channel for supplementary tools and optical forceps for biopsy is often created. The alternative method employs two entrance points: one is for the examination telescope and the other is for accessory instruments, including the biopsy forceps. Aim The aim of this study is to assess the effect of the use of optical rigid bronchoscopy forceps using one entry site instead of two entry sites in double bore medical thoracoscopy. Results Thirty patients with undiagnosed pleural effusion underwent medical thoracoscopy by single entry site (procedure A) using optical rigid bronchoscopy forceps and another 30 patients undergone medical thoracoscopy with two entry sites (procedure B). all patients were subjected to history, examination, computed tomography (CT) of chest, ultrasound examination, laboratory tests. The two groups were matched regarding age, sex, smoking, and co morbidities. There were matched regarding radiology, thoracoscopic picture, and pathological diagnosis with same outcomes. The procedure A was short in duration with less postprocedure complications compared with procedure B. Conclusion The use of optical rigid bronchoscopy forceps in medical thoracoscopy as a single entry site is valuable in decreasing procedure duration and postprocedure complications in comparison with two entry sites in medical thoracoscopy.

A RETROSPECTIVE STUDY ON EVOLVING TRENDS IN LOWER AIRWAY FOREIGN BODIES IN INDIAN CHILDREN AT A TERTIARY CARE HOSPITAL

Introduction Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions.[ ] The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff . Lack of proper health education, superstitions, negligence from parents side and lack of availability of timely and expert medical help results in delayed or inadequate management. . A foreign body aspiration into the respiratory tract is a serious condition of the respiratory [2 ] system, characterised by a variability of medical history, symptoms and prognosis. Methodology This study was a retrospective conducted from Jan 2018 to Dec 2022.We selected a series of 50 patients under the age of 5 yrs conducted in the Department of ENT of M.G.M Medical College and M.Y.Hospital Indore(MP). Discussion In our study highest incidence of FB was seen in the children between the age group of 1-3years which is more common because toddlers of this age group are prone to put anything coming in their hands in mouth as they explore the world. This is clearly evident in our study that the incidence of FB is more in rural areas. Tracheobronchial metallic foreign bodies early detection and removal is necessary to avoid life threatening respiratory complication. Foreign body aspiration is Conclusion a common but largely preventable problem and every case of a respiratory distress should be suspected for foreign body. Rigid Bronchoscopy is the gold standard for the diagnosis and the most safe treatment method for foreign body removal. Use of optical forceps is advantages not only for foreign body removal but also for educational, teaching, learning, record keeping & medicolegal purpose also.

Peroral Cholangioscopy in the Diagnosis and Treatment of Biliary Strictures

Objective: To determine the role of and indications for peroral cholangioscopy using the SpyGlass system in the differential diagnosis of biliary tract lesions and in case of biliary strictures, based on the literature data analysis and our own experience.Materials and methods: Peroral cholangioscopy is mainly used for the differential diagnosis of biliary tract lesions. During peroral cholangioscopy, we carefully consider gross signs of damage to the bile duct mucosa: abnormal capillary vascular pattern, granulation tissue and other types of proliferation, palpatory characteristics of the wall. Morphology should also be verified during image-guided intraductal forceps biopsy.Results: Peroral endoscopy of the biliary tract significantly increases the effectiveness of differential diagnosis between various types of biliary strictures.Direct examination of the bile duct mucosa with optical forceps biopsy and morphological verification increases the sensitivity and specificity of stricture type determination up to 83.3%–96% and 90.9%–99%, respectively. The diagnostic value of peroral cholangioscopy in the diagnosis of malignant and benign biliary tract lesions exceeds the effectiveness of endoscopic retrograde cholangiopancreatography, even with fluoroscopy-guided verification of ducts.Conclusions: Peroral cholangioscopy with its enormous potential plays an important role in management of patients with various diseases of the bilio-pancreatoduodenal area, including biliary strictures. We formulated key indications for peroral cholangioscopy based on the literature data analysis and our own experience with this technique in patients with bile duct pathology, including nondifferentiated biliary strictures.

Use of Dormia Basket for Retrieval of Tracheobronchial Foreign body.

It is always challenging to remove a long-standing smooth spherical foreign body through standard optical forceps. These foreign bodies do not negotiate with the traditional optical forceps and the chance of dislodgement during the surgery is high. Instead, a Dormia basket can be effectively used to remove these foreign bodies. Case report: We have reported two cases of smooth spherical bronchial foreign bodies, which were failed with the standard optical forceps and later successfully retrieved with a Dormia basket. Dormia basket can be effectively used to remove smooth spherical bronchial foreign bodies in children not amenable to the standard bronchoscopic forceps and later can be added to the standard tool in the foreign body retrieval kit for the otolaryngologist who deals with rigid bronchoscopy on a routine basis.

An innovative use of PIRS technique for pediatric femoral hernia: report of 2 cases

BackgroundFemoral hernia is very rare in children. Surgical intervention is necessary for treatment. There are many different surgical methods explained before. Laparoscopic single port repair technique is not reported before.Case presentationA 2.5-year-old girl with left femoral hernia and a 5.5-year-old boy with a right femoral hernia were presented to the hospital with bulging on the groin. Using a 5-mm telescope with optical forceps, the defects of patients were repaired with percutaneous ring suturing technique via spinal needle without excision of the lipoma. No complications developed on the patients in 12 months follow-up.ConclusionLaparoscopic single port needle assisted repair is a safe and feasible method repairing femoral hernia and excision of the lipoma should be kept in mind to avoid possible recurrences.

Management of Tracheal Stent Granulations: A Novel Approach

This is a case of a 29 year old female, diagnosed with adenoid cystic carcinoma of trachea who had previously undergone bronchoscopy, de-bulking of the tumour, stenting of trachea with a metallic stent followed by a course of chemo-radiotherapy. She then presented to our hospital with complaints of breathing difficulty. On rigid telescopy of larynx, a metallic stent was visualised below the level of the vocal cords with a mass lesion over it narrowing the airway. Contrast enhanced CT scan of neck and thorax showed a tracheal stent with soft tissue thickening at proximal and distal ends. By using VV-ECMO, in this patient we were able to perform satisfactory airway evaluation, biopsy of mass at upper and lower end of tracheal stent using a rigid bronchoscope with Hopkins telescope and optical forceps and KTP laser assisted excision of granulation tissue with full endoscopic visualisation and without any complications.

Single port laparoscopic-assisted ovarian cystectomy using optical forceps in neonates: a brief technical report

BackgroundThe management of neonatal ovarian cysts is often demanding. However, offering surgery as a definitive treatment for patients who lack easy access to healthcare for follow-up is reasonable. Minimally invasive, ovary-sparing surgery provides benefits, including shorter operative times, hospital stay, and superior cosmesis. The novel modification described here renders added value because it utilizes readily available and reusable instruments, averts the need for multiple ports and large incisions, and is essentially time-saving.So, the aim of the study is to evaluate the safety and feasibility and describe the use of optical forceps during single-port laparoscopic-assisted (SPLA) ovarian cystectomy in a specific cohort of neonates with simple/complicated ovarian cysts.ResultsNeonates who required ovarian cystectomy/salpingo-oophorectomy, admitted from January 2015 to December 2019 and fulfilled the inclusion criteria, were treated with optical forceps during SPLA. After the surgery, we put in place a follow-up protocol to monitor complications and recurrences.Twenty-one neonates were included. The average gestational age was 37.2 ± 1.6 weeks, operative time was 43.2 ± 2.4 min, and length of hospital stay was 2.4 ± 0.5 days. In our experiment, there was no encounter with complications, recurrences, or ones that required conversion to laparotomy, nor did we require the use of extra ports.ConclusionSPLA procedures using optical forceps for managing neonatal cysts requiring surgery appear to be a safe and achievable option by allowing complete visualization of the cyst/lesion. It also has an excellent cosmetic result with a near-normal umbilicus scar. Further research is required to compare this method to open and laparoscopic standards.

Open safety pin in the pediatric airway

Background: Aspiration of an open safety pin in the airway is an extremely rare and critical condition that needs immediate and safe removal of the foreign body (FB). An open safety pin in the airway of the pediatric patient requires urgent recognition. Imaging will confirm the exact site of the open safety pin in the airway. Rigid bronchoscopy with optical forceps or grasping forceps is an ideal tool for the removal of the open safety pin from the airway. Objective: This study aims to evaluate the clinical details, management, and outcome of pediatric patients with an inhaled open safety pin in the laryngotracheal airway. Materials and Methods: This is a retrospective descriptive study done between November 2016 and December 2021. There were six children with inhaled open safety pins in the laryngotracheal airway. The diagnosis was done through proper history taking, clinical examination, and the X-ray of the neck and chest of the children. All children underwent rigid bronchoscopy with optical forceps to remove the open safety pin. Results: Out of the six children, four were boys and two were girls. Out of the six cases, four were in the proximal part of the airway and two were seen in the distal airway. The most common clinical presentation was coughing. In this study, open safety pins of the pediatric airway were removed successfully under general anesthesia with the help of a rigid bronchoscope. Conclusion: Open safety pin is rarely found in the laryngotracheal airway. Open safety pin may cause a life-threatening complication. During the removal of the open safety pin, the surgeon should maintain maximum care to not injure the surrounding structures by the sharp end of the open safety pin.

Utility of Optical Forceps and Tracheotomy for Tracheobronchal Foreign Body.

Tracheobronchial foreign body is a life-threatening situation where quick decisions need to be taken. The preparedness for the same can never be over emphasized. This study was undertaken to understand the preference and utility of various types of foreign body forceps. This is a retrospective study in a tertiary care center. Data over 5 years (2016-2021) was analyzed to understand the utility of the optical forceps and the conventional (standard) forceps in the current scenario. The difficult cases where tracheotomy was done were also studied. Observations: 109 bronchoscopies were done during this period. In 90 patients optical forceps was used, flexible fiberoptic bronchoscope was used in 10 situations to locate and confirm the foreign body (FB) before extraction with standard or optical forceps. In 2 adult patients flexible fiber optic bronchoscope with forceps was used to extract, peripheral lying FB (pin). Standard (conventional) forceps with size 3 bronchoscope was used in 13 patients who were below 1year. There were 2 postoperative mortalities. Tracheotomy was done in 6 patients, 4 were repaired primarily and in 2 tracheostomy tube was inserted. Conclusion: Optical forceps took care of 86% of foreign body. The Standard forceps have stood the test of time and are still useful. Having flexible fiberoptic in the armamentarium is a necessity now with newer challenges. Large swollen FB which cannot be extracted through glottis should be removed with tracheotomy rather than struggling at the glottis-sub glottis and have a complete obstruction. The optical forceps, standard forceps, ventilating rigid bronchoscope, flexible fiberoptic bronchoscope, Dormia basket, Fogarty's catheter are necessary in the armamentarium of an otolaryngologist and are not replaceable for one another.

A Novel Two Surgeons Approach to Bronchial Foreign Body Removal by Optical Instruments- An 11Years Institutional Experience.

A potentially life-threatening emergency in ENT practice is the aspiration of tracheobronchial foreign body. This commonly affects young children and requires early extraction. Successful removal provides immediate relief. However procedural complications can cause devastating morbidity like anoxic encephalopathy or instant death. The aim of this study is to describe the experience in our institution with two surgeons approach for removal of tracheobronchial foreign bodies by telescope and optical forceps. This is an observational study from the period of March 2010 to April 2021 in which 96 patients (59 males, 37 females; age range 3 months to 15 years) were diagnosed with foreign body aspiration. In all cases rigid bronchoscopy and FB removal under general anaesthesia was performed using the two surgeons technique. This technique was instituted once Storz make paediatric telescope (2.9 mm diameter 36 cm length), optical grasping forceps and optical suction were procured in March 2010. Aspirated material was inorganic or organic with varying location in right main bronchus, left main bronchus or the trachea. We highlight the OT setup, surgical algorithm and the advantages of this technique. Visual and tactile coordination between the two surgeons being the crux of this procedure; allows hands on mentoring of the next generation of budding surgeons in a real-life scenario without compromising patient safety.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12070-021-02847-8.

Foreign Body (Safety Pin) in Airway in a 2-month-old Baby

Respiratory tract foreign bodies are most dangerous emergencies in children. There are various types of foreign bodies removed from airway like-peanuts, metallic foreign bodies, sharp foreign bodies, led bulbs and different part of toys. Most commonly they present with proper history of aspiration and symptoms of respiratory distress, but not always. It should be diagnosed immediately either with the history and clinical examination or with the help of radiological investigations. High resolution computed tomography of chest gives the exact location of the foreign body. These patients should be managed promptly to reduce the morbidity and mortality. Rigid bronchoscopy with optical forceps under general anaesthesia is the procedure of choice to retrieve the foreign bodies. We are presenting a case of 2 months old child which has aspirated a safety pin into her airway accidentally. The location was confirmed by HRCT chest and it was removed using optical forceps. Child was discharged under stable conditions.

Title-Optical Forceps: The Real Boon for Surgeon, Residents and Patients with Foreign Body Aspiration.

Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1-5year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic insertion and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.

An algorithm for retrieval tools in foreign body ingestion and food impaction in children.

The aim of this study is to review the experience on managing foreign body ingestion in children with special emphasis on the endoscopic techniques and specific retrieval devices used for foreign body (FB) extraction. The charts of 341 children were reviewed retrospectively. Demographic data, ingested material, removal technique and tool, level of FB, complications, and outcomes were recorded. A total of 364 FBs were removed from 341 children. Among these, 56.5% (n: 206) were entrapped in esophagus, 39% (n: 142) were in stomach, and 4.5% (n: 16) in duodenum and intestine. The most frequently ingested items were coin (42.5%), button batteries (20.6%), and safety pins (12%). Optical forceps (37.9%) were the most commonly used tool and they were used during retrieval of esophageal FB by rigid endoscopy. Retrieval net (20.7%) was the second most common tool and the most common one during flexible endoscopy. Depending on our experience, we strongly advocate rigid endoscopy for esophageal FBs and food impaction in children because it allows both to use optical forceps with a strong grasping ability for blunt FBs and to position sharp and pointed objects inside the rigid endoscope. We recommend retrieval net as the first tool for the extraction of blunt objects and rat tooth retrieval forceps is the best tool for sharp and pointed FBs in stomach.

Bronchoscopic airway foreign body extraction without using optical forceps

Aim:Airway foreign body (FB) is a very common pediatric surgical emergency. On certain difficult occasions, the extraction of FB with optical forceps (OFs) is difficult. These conditions create a life-threatening scenario. We present some of the alternative methods of FB extraction for these situations.Patients and Methods:This is a retrospective case review of patients presenting to pediatric emergency with airway FB. All patients had a chest X-ray done before the procedure. Rigid bronchoscopy was performed in all patients for retrieval.Results:A total of 20 patients (6 females) were successfully scoped. The age ranged from 1.5 years to 12 years (mean 3.5 years). Bronchoscopic removal was aided by dormia basket (DB) in 13, Fogarty's catheter (FC) in 6, and magnet aided removal in 1. Complete removal was achieved in all patients.Conclusions:We recommend that DB, FC, and a magnet should form an indispensable part of bronchoscopy set. The use of these alternative methods is successful and allows ventilation during the removal in contrast to removal by OFs. These should be kept as an option if retrieval is difficult.

Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies

BackgroundForeign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies.Case presentationWe present a difficult to retrieve esophageal foreign body in a 3-year-old girl who ingested a 2 cm glass pebble. Intraoperatively, attempts using conventional optical forceps and retrieval baskets were unsuccessful due to the size and smooth texture of the object. A novel strategy using double Fogarty embolectomy balloon catheters for retrieval of blunt esophageal foreign bodies was devised and described.ConclusionThe double fogarty retrieval technique described appeared to be safe and efficacious, allowing for extraction of large esophageal foreign bodies under direct visualization.

Pen Cap Aspirations: Maneuvering for Successful Extraction

Aim of this study was to analyze the therapeutic approach with enhanced success of bronchoscopy. We retrospectively analyzed the results of bronchoscopic extraction of pen cap aspirations in our unit from 2000 to 2014. Out of 239 bronchoscopies performed for foreign bodies in airways, there were 8 cases of pen cap aspirations. All 8 were males and age ranged from 5 to 11 years. Seven cases had definitive history, while one patient had a history of chronic respiratory ailment. The foreign bodies were lodged in right and left bronchi in four cases each and seven had their open-end toward the proximal airways. Bronchoscopic extraction was successful in seven patients. The maneuver of rotating the optical forceps by 90 degrees so as to align the pen cap with the vocal cords resulted in success in all the cases. One patient underwent thoracotomy and bronchotomy for removal. Pen cap aspirations occur in school-going children. Aligning the optical forceps with vocal cords during extraction avoids the need for tracheostomy or thoracotomy.

Video Comment on Rath et al.

See also: In vivo real-time assessment of colorectal polyp histology using an optical biopsy forceps system based on laser-induced fluorescence spectroscopyEndoscopy 2016; 48(06): 557-562DOI: 10.1055/s-0042-102251

Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children

AimPlastic bronchitis (PB) is a rare disorder characterized by formation of bronchial casts (BC) in the tracheobronchial tree with partial or complete airway obstruction. Although lysis of casts with several fibrinolytic agents has been reported, removal of BC with bronchoscope provides better clearance of airways. A retrospective study was performed to evaluate the use of serial rigid bronchoscopy (RB) in the treatment of PB in children. Patients and methodsBetween 2011 and 2015, children with partial or complete airway obstruction with PB were evaluated for age, gender, underlying disease, clinical findings, results of bronchoscopic interventions and histopathologic findings. ResultsFive patients with 14 RB interventions were evaluated. The mean age of the patients was 7.8years (min: 3years — max: 14years) and male–female ratio was 4:1. All of the patients were diagnosed as asthma and none of them had underlying cardiac disease. Suction of mucus plaques and bronchoalveolar lavage were performed in all patients with flexible bronchoscopy. Also, aerosolized tissue plasminogen activator was used in two patients. During follow-up serial RB was indicated in patients with persistent atelectasis and severe airway obstruction. The most common localization of BC was left main stem bronchus and bilateral cast formation was detected in 7 interventions. Although, removal of BC was challenging in two patients because of cast friability and fragmentation, most of the plugs were successfully removed with optical forceps and rigid suctioning. Two patients underwent repeated RB (min: 3 — max: 8) for recurrent symptoms. Histopathologic evaluation of BC revealed Charcot–Leyden crystals with inflammatory cells in all patients. The time interval between RB interventions was one to five months. ConclusionBC are tenacious mucus plugs which are firmly wedged to the tracheobronchial tree. The use of optical forceps with rigid suction provides adequate removal of BC during RB. Because of underlying disease, it is difficult to cure cast formation. Therefore, most of the patients require serial RB when they become unresponsive to standard therapy or develop partial or complete airway obstruction.

In vivo real-time assessment of colorectal polyp histology using an optical biopsy forceps system based on laser-induced fluorescence spectroscopy.

In order to reduce time, costs, and risks associated with resection of diminutive colorectal polyps, the American Society for Gastrointestinal Endoscopy (ASGE) recently proposed performance thresholds that new technologies should meet for the accurate real-time assessment of histology of colorectal polyps. In this study, we prospectively assessed whether laser-induced fluorescence spectroscopy (LIFS), using the new WavSTAT4 optical biopsy system, can meet the ASGE criteria. 27 patients undergoing screening or surveillance colonoscopy were included. The histology of 137 diminutive colorectal polyps was predicted in real time using LIFS and findings were compared with the results of conventional histopathological examination. The accuracy of predicting polyp histology with WavSTAT4 was assessed according to the ASGE criteria. The overall accuracy of LIFS using WavSTAT4 for predicting polyp histology was 84.7 % with sensitivity, specificity, and negative predictive value (NPV) of 81.8 %, 85.2 %, and 96.1 %. When only distal colorectal diminutive polyps were considered, the NPV for excluding adenomatous histology increased to 100 % (accuracy 82.4 %, sensitivity 100 %, specificity 80.6 %). On-site, LIFS correctly predicted the recommended surveillance intervals with an accuracy of 88.9 % (24/27 patients) when compared with histology-based United States guideline recommendations; in the 3 patients for whom LIFS- and histopathology-based recommended surveillance intervals differed, LIFS predicted shorter surveillance intervals. From the data of this pilot study, LIFS using the WavSTAT4 system appears accurate enough to allow distal colorectal polyps to be left in place and nearly reaches the threshold to "resect and discard" them without pathologic assessment. WavSTAT4 therefore has the potential to reduce costs and risks associated with the removal of diminutive colorectal polyps.

Impacted button battery causing acquired tracheoesophageal fistula in a 2-month-old infant

A 2-month-old male infant was brought with fever and respiratory distress of 5-days duration. Investigations showed a round, radiopaque foreign body in the upper esophagus. The child was diagnosed to have coin ingestion and referred to our center for removal of the same. Careful review of the X-rays led us suspect button battery ingestion. Emergency rigid esophagoscopy and foreign body removal was performed under general endotracheal anesthesia. A rusted, 4 mm wide button battery was removed using optical forceps with difficulty. Postoperatively, the child was managed on a ventilator. He received supportive care. Check scopy done using ultrathin, flexible esophagoscope on day 10 showed acquired tracheoesophageal fistula. The child underwent defunctioning gastrostomy and feeding jejunostomy, but succumbed to sepsis from mediastinitis and recurrent pneumonitis 2 days later. Ingestion and impaction of the button battery in a 2-month-old infant are extremely rare and unreported in literature. Hence, the case report.