“Innovation distinguishes between a leader and a follower.” – Blaise Pascal

Method of Ryle’s tube Insertion in INTUBATED patients

“Please introduce the Ryle’s tube.” This sentence spoken by the surgeon in the O.T. causes a lot of unease to the anesthesiologist. It is a difficult task to cross the laryngopharynx. It is invariably associated with intra-nasal trauma & posterior nasal bleed. Ryle’s tube being soft, tends to get coiled in the oral cavity. This problem can be overcome by using a tube which maintains its shape. Endotracheal tube (#8.0 or 8.5) is a tube which is readily available in OTO esophageal intubation is performed using a laryngoscope. Through this E.T. tube, a Ryle’s tube is passed into the stomach. Once Ryle’s tube is in place, E.T. tube may be removed leaving the Ryle’s tube behind.

The approach can be:
1. Oral-oesophageal– In case (a) Ryle’s tube is not required post-operatively (b) In ICU where an intubated patient is on a ventilator. This route avoids intra nasal trauma & bleeding.
2. Nasal-oesophageal– In case Ryle’s tube is required postoperatively (in a conscious patient).

In cases where Crash induction is done using Sellick’s manouvre (Patients with full stomach-LSCS, Intestinal obstruction), intubation of esophagus with # 9 E.T. tube, helps in removing solid & bigger food particles. Similar procedure enables a quick stomach wash in cases of poisoning.

Another innovative use of Ryle’s tube
For Endo-luminal vision of stomach during Laparoscopic Cystogastrostomy / polypectomy, Ryle’s tybe can be used to rapidly insuffulate stomach with CO2. Ryle’s tube is connected to insuffulator through a Three-way connector (ones used for I/V lines). Directional flow knob of the connector is used to choose insuffulation of abdomen or stomach or both. This creates a lot of space inside the stomach even for endosuturing thus avoiding a large incision on anterior stomach wall.

Innovative pre peritoneal distention balloon (PDB)
Under vision space creation for Laparoscopic hernia repair (TEP), Retroperitoneoscopic surgery using reusable 10mm trocar cannula, finger-stall glove, 10mm metallic blunt rod, insufflating bulb, suture.

10mm metallic blunt rod is first pushed posterior to rectus muscle instead of index finger. Rod is then used within the cannula to stretch the finger stall glove while creating the space close to pubic ramus (cave of Retzius).

A Gauze piece tied around 10mm reusable trocar cannula to prevent gas leakage (as an alternative to Hassan’s trocar cannula).

Barron’s band ligator for hemorrhoids
Good quality bands created from 14 F Foley’s catheter.

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