Inward Rotation Method

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

When the point is found to be buried in the

mucosa, the best and usually successful method is to grasp the pin as

near the point as possible with the side-grasping forceps, then with a

spiral motion to push the pin downward while rotating the forceps

about ninety degrees. The point is thus disengaged, and the shaft of

the pin is brought parallel with that of the forceps, after which the

point may be drawn into the tube mouth. The lips added to the

side-curved forceps by my assistant Dr. Gabriel Tucker I now use

exclusively for this inward rotation method. They are invaluable in

preventing the escape of the pin during the manipulation. A hook is

sometimes useful in disengaging a buried point. The method of its use

is illustrated in Fig. 82.

[FIG. 82.--Mechanical problem of pin, needle, tack or nail with

embedded point. If the forceps are pulled upon the pin point will be

buried still deeper. The side curved forceps grasp the pin as near the

point as possible then with a corkscrew motion the pin is pushed

downward and rotated to the right when the pin will be found to be

parallel with the shaft of the forceps and can be drawn into the tube.

If the pin is prevented by its head from being pushed downward the

point may be extracted by the hook as shown above The side curved

forceps may be used instead of the hook for freeing the point, the

author's inward rotation method. The very best instrument for the

purpose is the forceps devised by my assistant, Dr. Gabriel Tucker

(Fig. 21). The lips prevent all risk of losing the pin from the grasp,

and at the same time bring the long axis of the pin parallel to that

of the bronchoscope.]

Pins are very prone to drop into the smaller bronchi and disappear

completely from the ordinary field of endoscopic exploration. At other

times, pins not dropping so deeply may show the point only during

expiration or cough, at which times the bronchi are shortened. In such

instances the invaded bronchial orifice should be clearly exposed as

near the axis of its lumen as possible; the forceps are now inserted,

opened, and the next emergence watched for, the point being grasped as

soon as seen.