Method
This paper follows the SQUIRE 2.0 guidelines (Revised Standards for
Quality Improvement Reporting Excellence) (4).
Other papers outlining the use of a boogie as a guide were searched for
for using
MEDLINE and EMBASE using the search terms; “laryngoscopy; biopsy;
exposure; bougie”. No other papers were found explaining this
technique.
The patients were positioned with the neck flexed and head extended. The
laryngoscope was inserted. The operator could then direct a 30 degree
Hopkins rod, or attach the laryngoscope handle to the suspension arm if
microlaryngoscopy was required.
If an area of the hypopharynx or larynx is difficult to access with the
standard biopsy forceps available on the laryngoscopy set, then a
flexible 2.0mm gauge, 100cm pulmonary biopsy forceps, with a 1.8mm jaw,
can be used. (figure 2). The distal tip of the bougie is cut to expose
the lumen. The assistant then loads the flexible biopsy forceps down the
bougie lumen, which can be manipulated into position to access the
difficult area (figure 3). The lesion is approached with an open jaw
biopsy forceps, pushed deep into the lesion and closed, feeling for
resistance. The biopsy forcep handle is controlled by the assistant,
whilst the operator holds the Hopkins rod and laryngoscope; or in
microlaryngoscopy, the bougie can be further guided by the operator.