Detailed Explanation of Three Operator Positions in Bronchoscopy

How to individually select the optimal position for patients with different conditions and arrange the doctor's standing position is an important skill that every respiratory physician needs to master. Below are the clinical applications and standing position specifications of three common positions in bronchoscopy.

The patient needs to lie flat on the examination table, with a pillow placed above the shoulders to allow the head to tilt back moderately, and the hands placed naturally on both sides of the body. This position design is to keep the airway in the best condition and facilitate the smooth insertion of the endoscope.

For doctors, the main operating doctor should stand directly in front of the patient's head, so that they can operate directly facing the patient with an ideal line of sight and operating angle. The endoscopy assistant or nurse should preferably stand on the left side of the operator to conveniently pass instruments and provide necessary assistance. The anesthesiologist is positioned on the right side of the operator to monitor the patient's vital signs at any time and ensure surgical safety.

The supine position is the most basic and commonly used position in bronchoscopy, and it can be said to be the "standard equipment" for respiratory endoscopists. This position is not only suitable for most bronchoscopy diagnosis and treatment operations, including rigid bronchoscopy, but also effective in both elective and emergency endoscopy. Whether it is a routine examination or emergency treatment, the supine position is the first choice.

The advantage of this position is that it is very much in line with ergonomic principles, making it particularly easy for doctors to operate. Patients can fully relax their muscles in this position and feel relatively comfortable. From the perspective of standing layout, everyone performs their own duties, and the entire operation process is smooth and orderly. Especially for elderly patients, weak patients, or mentally tense patients, the supine position can make the surgical process smoother.

When a patient needs to take the lateral decubitus position, it is usually the left lateral decubitus position. The patient should place a pillow at the same level as the shoulders, bend the legs moderately to maintain a comfortable posture, and wear a special mouth guard to prevent accidental biting of the endoscope.

In this case, the main operating doctor should stand on the left side of the patient. The endoscopy assistant or nurse still stands on the left side of the operator, maintaining a cooperative relationship similar to that in the supine position. The anesthesiologist needs to adjust their position and stand at the head side of the patient, so that they can monitor the patient without hindering the operation.

The lateral decubitus position is particularly suitable for cases requiring simultaneous combined bronchoscopy and gastroscopy. For example, in the treatment of esophagotracheal fistula, this position allows operations on both the respiratory and digestive tracts without moving the patient, greatly improving surgical efficiency.

The biggest advantage of this position is that it avoids position conversion during the operation. Imagine that if the patient is under anesthesia, turning the body back and forth is not only time-consuming but also increases the risk. After adopting the lateral decubitus position, the operation time is significantly shortened, the amount of anesthetic drugs can be reduced, and the overall risk of the patient is naturally reduced. However, this standing layout requires doctors to have more flexible operating skills, because the perspective and operating angle are different from the conventional position, which requires a certain amount of adaptation and training. The entire team also needs to adjust the cooperation method to ensure tacit coordination.

For patients who can only sit, we need to adopt the sitting position. The patient should sit upright on a high-back chair in a conscious state, with the back close to the backrest, and wear a fixed mouth guard. This posture requires the patient to remain stable and not move randomly.

At this time, the main operating doctor needs to stand directly opposite the patient and operate face-to-face with the patient. The nurse should stand behind the patient, use both hands to assist in fixing the patient's head, and at the same time help the doctor fix the endoscope body to ensure stable operation. The endoscopist's assistant stands on the right side of the operator to provide necessary assistance.

The sitting position is mainly suitable for patients who cannot lie flat, such as patients with severe dyspnea, patients with thoracic deformities (such as hunchback), or patients with other special conditions. In such cases, the sitting position becomes a feasible solution.

To be honest, the sitting position operation has quite high technical requirements for doctors because it breaks the conventional operating habits. Doctors have to face the patient directly, and the operating angle is completely different. However, mastering this technique is very valuable for solving special clinical problems. It is crucial for the nurse to fix the head and the endoscope body from behind, which is directly related to the stability of the operation. According to research, some hospitals have accumulated successful experience in thousands of sitting position examinations, proving that this method does have unique advantages. Especially for obese patients, elderly patients, and patients with obvious dyspnea, sitting position examination can avoid gastric juice reflux, and it is relatively less labor-intensive for doctors to operate.

In actual operation, the arrangement of doctors' standing positions needs to follow several core principles:

First, ergonomics should be considered. The standing position should allow doctors to maintain a natural and relaxed posture, avoid bending over or twisting for a long time, and reduce occupational injuries. Operational convenience is also important. The standing position should facilitate doctors to observe the screen, operate instruments, and communicate with assistants.

The team cooperation principle requires that the standing positions of each member form a reasonable working triangle, so that instrument delivery and information exchange will be smoother, and emergency situations can be handled quickly. Finally, the safety monitoring principle: the anesthesiologist's standing position must be able to clearly observe the patient's vital signs and be ready to intervene at any time.

In practical work, various factors need to be considered when selecting a position and arranging a standing position:

The patient's specific conditions are very important, including age, physical condition, presence of dyspnea, presence of cervical and thoracic deformities, etc. Different physical conditions require individualized arrangements. The type of surgery also affects the selection: is it a simple examination or a therapeutic operation? Is it necessary to combine other endoscopic operations?

Different anesthesia methods have different requirements. The requirements for position and standing position are quite different between local anesthesia and general anesthesia. For example, the sitting position is usually not suitable for patients under general anesthesia. In addition, the experience of the surgical team: different positions and standing positions require the team to have corresponding proficiency, especially operations in special positions, which require more training and running-in.

It is hoped that this article can help clinicians better understand the importance of bronchoscopy position selection and standing position layout, continuously improve the level of diagnosis and treatment in practical work, and provide patients with more high-quality medical services.