The Use Of Forceps In Endoscopic Foreign Body Extraction

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Two different strengths of forceps are supplied, as will be seen in the

list in Chapter 1. The regular forceps have a powerful grasp and are

used on dense foreign bodies which require considerable pressure on

the object to prevent the forceps from slipping off. For more delicate

manipulation, and particularly for friable foreign bodies, the lighter

forceps are used. Spring-opposed forceps render any delicacy of touch

impossible. Forceps are to be held in the right hand, the thumb in one

ring, and the third, or ring finger, in the other ring. These fingers

are used to open and close the forceps, while all traction is to be

made by the right index finger, which has its position on the forceps

handle near the stylet, as shown in Fig. 78. It is absolutely

essential for accurate work, that the forceps jaws be seen to close

upon the foreign body. The impulse to seize the object as soon as it

is discovered must be strongly resisted. A careful study of its size,

shape, and position and relation to surrounding structures must be

made before any attempt at extraction. The most favorable point and

position for grasping having been obtained, the closed forceps are

inserted through the bronchoscope, the light reflex obtained, the

forceps blades now opened are turned in such a position that, on

advancing, the foreign body will enter the open V, a sufficient

distance to afford a good grasp. The blades are then closed and the

foreign body is drawn against the tube mouth. Few foreign bodies are

sufficiently small to allow withdrawal through the tube, so that tube,

forceps and foreign body are usually withdrawn together.

[FIG. 78.--Proper hold of forceps. The right thumb and third fingers

are inserted into the rings while the right index finger has its place

high on the handle. All traction is made with the index finger, the

ring fingers being used only to open and close the forceps. If any

pushing is deemed safe it may be done by placing the index finger back

of the thumb-nut on the stylet.]