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Practice On The Rubber-tube Manikin

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

This must be carried out in

two ways.

1. General practice with all sorts of objects for the education of

the eye and the fingers.

2. Before undertaking a foreign body case, practice should be had

with a duplicate of the foreign body.

It is not possible to have a cadaver for daily practice, but

fortunately the eye and fingers may be trained quite as effectually by

simulating f
reign body conditions in a small red rubber tube and

solving these mechanical problems with the bronchoscope and forceps.

The tubing may be placed on the desk and held by a small vise (Fig.

72) so that at odd moments during the day or evening the fascinating

work may be picked up and put aside without loss of time. Complicated

rubber manikins are of no value in the practice of introduction, and

foreign body problems can be equally well studied in a piece of rubber

tubing about 10 inches long. No endoscopist has enough practice on the

living subject, because the cases are too infrequent and furthermore

the tube is inserted for too short a space of time. Practice on the

rubber tube trains the eye to recognize objects and to gauge distance;

it develops the tactile sense so that a knowledge of the character of

the object grasped or the nature of the tissues palpated may be

acquired. Before attempting the removal of a particular foreign body

from a living patient, the anticipated problem should be simulated

with a duplicate of the foreign body in a rubber tube. In this way the

endoscopist may precede each case with a practical experience

equivalent to any number of cases of precisely the same kind of

foreign body. If the object cannot be removed from the rubber tube

without violence, it is obvious that no attempt should be made on the

patient until further practice has shown a definite method of harmless

removal. During practice work the value of the beveled lip of the

bronchoscope and esophagoscope in solving mechanical problems will be

evidenced. With it alone, a foreign body may be turned into favorable

positions for extraction, and folds can always be held out of the way.

Sufficient combined practice with the bronchoscope and the forceps

enable the endoscopist easily to do things that at first seem

impossible. It is to be remembered that lateral motion of the long

slender tube-forceps cannot be controlled accurately by the handle,

this is obtained by a change in position of the endoscopic tube, the

object being so centered that it is grasped without side motion of the

forceps. When necessary, the distal end of the forceps may be pushed

laterally by the manipulation of the bronchoscope.

[FIG. 72.--A simple manikin. The weight of the small vise serves to

steady the rubber tubing. By the use of tubing of the size of the

invaded bronchus and a duplicate of the foreign body, any mechanical

problem can he simulated for solution or for practice, study of all

possible presentations, etc.]