A comment by Sean Marshall (scroll all the way down) got me thinking about bimanual larygoscopy. I realized, when I am doing fiberoptic laryngoscopy, I don’t need to really perform too bimanual anymore. Big paradigm shift since I strongly espoused the virtues ever since I learned the technique from Rich Levitan.
I now outsource external laryngeal manipulation to my assistant; or I do it for the intubator when one of my residents is that intubator. This outsourcing concept was first introduced to me by my friend, Reuben Strayer. He realized you could outsource suctioning. It was a natural progression for me to start outsourcing thyroid manipulation and now tube-prepassage.