The Fulcrum Of The Bronchoscopic Lever Is At The Upper Thoracic Aperture

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Disregard of this rule will cause

subglottic edema and will limit the lateral motion of the tip of the

bronchoscope. It is the function of the assistant to make the head and

neck follow the direction of the proximal end of the bronchoscope and

thus avoid any pressure on the larynx (see Peroral Endoscopy, Fig.

135, p. 164).

In passing down the trachea the following two rules must be kept in


1. Before attempting to enter either main bronchus the carina must

be identified.

2. Before entering either main bronchus the orifices of both should

be identified and inspected.

The carina is identified as a sharp vertical spur (recumbent

patient) at the distal end of the trachea, on either side of which are

the openings of the main bronchi. As the carina is situated to the

left of the midline of the trachea, the lip of the bronchoscope should

be turned toward the left, and slight lateral pressure should be made

on the left tracheal wall while the head of the patient is held

slightly to the right. This will expose the left bronchial orifice and