The enigma of the Vineberg-Sewell implant operation.

CHEST, VOL. 64, NO. 2, AUGUST, 1973 The fiberscope is also useful in patients with ankylosing lesions of the cervical spine or other disorders preventing extension of the neck. In fact, in such instances, the fiberscope provides a method of inserting endotracheal tubes for the anesthesiologist. Finally, the fiberscope may be indicated in the endoscopic examination of some debilitated individuals who may not tolerate hyperextension of the neck (eg those with brain tumors or cerebral vascular lesions). In such cases, however, one should bear in mind that the fiberscope does compromise the airway and at all times an open tube bronchoscope should be available in case it is needed. It is our opinion that bronchoscopic examination, whether performed with the rigid or fiberoptic instrument or not, should be done by individuals who are fully trained in endoscopic techniques and capable of handling ally problem that may arise. We strongly recommend that residents in thoracic surgery, thoracic medicine and otolaryngology be trained in open tube bronchoscopy and be able to use both the rigid and flexible instruments. The welltrained endoscopist will learn to use both instruments skillfully and will be able to handle any emergencies that may arise. Either examination should be done with a minimum of discomfort to the patient and with all possible speed. It should be borne in mind that usually examination with the open tube bronchoscope can be accomplished much more quickly than with the fiberoptic instrument. It is also our opinion that bronchoscopic examination, whether performed with a rigid or flexible instrument, should be carried out in a facility which is equipped for endoscopy. Thus, the procedures are best done in an operating room or specially designed unit for bronchoesophagology or in an intensive care area where all available safeguards are available to the endoscopist. Except under special circumstances, we do not advocate the performance of bronchoscopy in the patient’s room or in the doctor’s office; but this does not imply that hospitalization is necessary for endoscopic examination. Many patients can be handled on an outpatient basis. Again it should be emphasized that the bronchofiberscope is a valuable addition to the armamentariunl of the endoscopist. It has its greatest usefulness in the early diagnosis of lung cancer. It should he used, however, by qualified bronchoscopists under optimum circumstances. Gabriel F. Tucker, Jr., M.D., F.C.C.P., Philadelphia; Arthur M. Olsen, M.D., F.C.C.P., Rochester, Minn.; Albert I!. Andrews, Jr., M.D., F.C.C.P., Chicago; and John L. Pool, M.D., F.C.C.P., Norwalk, Conn. The Enigma of the Vineberg-SewelI Implant Operation