ENDOSCOPY

TERMINAL OBJECTIVE

State the duties and responsibilities of the scrub and circulator technologist during endoscopic surgery.

ENABLING OBJECTIVES State the purpose of endoscopic

surgery List the advantages and disadvantages

of endoscopic versus open surgery List the functions of:

An endoscope, camera, fiber optic light cord, suction/irrigator, video system components

ENABLING OBJECTIVES State the recommended practices

for the care and handling of endoscopic instruments and equipment

Connect a real or simulated camera, light cord, and insufflation tubing to a real or simulated video system

ENABLING OBJECTIVES State the function of a verres

needle and selected trocars/cannulas.

Prepare a verres needle and selected trocars with cannulas for use in a laparoscopic procedure

ENABLING OBJECTIVES

State the cannula sites for selected endoscopic procedures

List selected endoscopic instruments and state their function and uses

ENABLING OBJECTIVES List disinfection/sterilization

methods for selected endoscopic instruments and equipment

Demonstrate cleaning techniques for selected endoscopic instruments and equipment

ENABLING OBJECTIVES State the pathology leading to

the surgical intervention for selected endoscopic procedures.

State the major steps involved in selected endoscopic procedures.

PURPOSE Visual examination of:

Interior of a body cavityAbdomen

Hollow organsUterus, bladder

StructuresKnee, joint

ADVANTAGES VS. DISADVANTAGES

ADVANTAGES Minimal invasion required for

confirming a diagnosis Small incisions Decreased:

Trauma Postop pain Hospital stay Recovery time

DISADVANTAGES

Additional training required for surgeons

Purchase and maintenance of expensive equipment/instrumentation

FUNCTIONS OF EQUIPMENT

ENDOSCOPE

Lensed instruments used for viewing internal anatomical structures through natural body orifices or a tiny incision

Types varies in diameter and length based on specific patients and procedures

TYPES Rigid Non-flexible Optical capability

for the for operator Direct

0 degree

RIGIDAngled- -30,70,120 degreeExamples:-Cystoscopes-Laparoscopes-Hysteroscopes

TYPES Flexible

Panoramic view Mostly GI and respiratory tracts

BronchoscopeColonoscopeCholeducoscope

Have working channels that permit the use of biopsy forceps & laser fibers

CLASSIFICATIONS DIAGNOSTIC:

Used for observation only No operating channels

Laparoscope

CLASSIFICATIONS Operative:

Channel allows irrigating, suctioning, inserting, and connecting other instruments.Bronchoscope

3.8.3

CAMERA UNIT Camera head

Most important component of the video system

Head Cable

On/off

Cable Port

CABLE

Connects camera head to control unit

CAMERA CONTROL UNIT(IMAGE PROCESSOR)

Adjusts color and light intensity Transmits the image to a video

monitor, recorder, hard copy picture, or all three

CAMERA CONTROL UNIT(IMAGE PROCESSOR) White balance-most important!

Common cause for color distortion-not setting the white balance

Must focus camera on white field prior to set balance prior to procedure

COUPLERS (Adapters) Optical coupling devices ysed to

connect cameras to various endoscopes

CAMERA UNIT Enables image received by the

scope to be transmitted to the monitor

Zoom feature allows the image to be enlarged without moving the scope

CAMERA UNIT The tech may be required to

operate the camera Must have good spatial

orientation Steady hand Ability to concentrate for long

periods

FIBEROPTIC LIGHT CORD Comprised of hundreds of glass

fibers that transmit light

FIBEROPTIC LIGHT CORD

Light cords-NEVER in contact with drapes for prolonged periods of time Cause drape to burn Should be turned off when not in

use, or placed on a moist towel Connects to light source

LIGHT SOURCE Provides illumination essential for

visualization Halogen

Used for office and hospital applications

Xenon More expensive, lasts longer Better for smaller diameter scopes

LIGHT SOURCE Halide bulbs

Shorter life span (about 250 hrs) Less expensive Bulbs are easier to handle

Rheostat Used for regulating flow of current

from the electrical system

SUCTION/IRRIGATOR Simultaneously suctions and irrigates

body cavities Used

Through irrigating channelsirrigating systems inserted into

• Operating ports• Cannula• Operative endoscopes

SUCTION/IRRIGATOR Fluid can be introduced: Manually through an endoscope

Syringe/Stopcock attached to irrigation tubing

Irrigation pump powered by: CO2 Electricity

Provides large quantities of fluids

SUCTION/IRRIGATOR Gravity

Manually force through distal tubing

Pressure bag to increase flow

VIDEO SYSTEM COMPONENTS

Monitors (2) Used for educational training One on each side of OR bed

Should match the resolution quality of the camera

Second monitor is called slave monitor

VIDEO PRINTER

VIDEO SYSTEM COMPONENTS

Video Printer Utilized for teaching purposes Documentation for patients

VIDEO SYSTEM COMPONENTS

VCR Procedural documentation is

needed Teaching purposes

STORAGE SYSTEM•Houses multiple components

•All components must be securely fastened

INSUFFLATOR Provides CO2 for pneumoperitoneum

Non-toxic, highly soluble in blood rapidly absorbed from the peritoneal cavity

Flow and volume monitored by circulator and surgeon

12-18 mmHg pressure9 liters/ minute

INSUFFLATOR Should include a two-way

disposable hydrophobic filter to protect patient from chromium particles and colonization of organisms

INSUFFLATOR

CARE AND HANDLING

FUNCTIONS VERRES NEEDLE,TROCARS

AND CANNULAS Verres Needle Long insufflation needle is inserted

into the abdomen to introduce CO2 into the peritoneal cavity, creating pnemoperitoneum

VERRES NEEDLE

VERRES NEEDLE Allows visualization of abdominal

(or thoracic) structures Prevents injury to internal

structures during surgery

VERRES NEEDLE Spring-loaded needle has an outer

sharp hollow cannula with an inner blunt retractable stylet with a two-way stopcock at base for control of gas flow

SCOPE GUIDED TROCAR

CANNULA/TROCAR

REUSABLE TROCAR

10MM HASSON TROCAR

CANNULAS/TROCARS Provides a mechanism for inserting

and removing INSTRUMENTATION ENDOSCOPES

May be disposable or reusable

CANNULAS/TROCARS Cannula or sheath is inserted into

operative site by using trocar and obturator

Once port of entry has been made, trocar is removed, cannula is left in place

CANNULAS/TROCARS Variety of sizes to accommodate

diameter of instrumentation May have spring-loaded end

guards that cover sharp tip and protect internal structures after penetration

CANNULA SITES

LAPAROSCOPIC APPENDECTOMY

Periumbilical Port

Suprapubic Area

Left Lower Quadrant

LAPAROSCOPIC CHOLECYSTECTOMY

X

10/11mmSupraumbilical Port

X

10mm Trocar Subxyphoid

X X

5MMLATERAL

5MMLATERAL

ARTHROSCOPY OF THE KNEE

INSTRUMENTATION

INSTRUMENTATION Designed for use in surgical sites

and/or procedures The instrument length, design of

the working end, and design of the hand control vary according to needs of the procedure

INSTRUMENTATION Reusable or disposable May have monopolar and bipolar

capabilities

CLAMPING INSTRUMENTS

Used to grasp and hold tissue or other materials

Babcock Allis clamp Kelly clamp Alligator clamp

CAUTERY

MORE INSTRUMENTATION

DISSECTORS Used to cut, divide, or separate tissue Used for blunt or sharp dissection Scissors

Straight Curved (hook scissors)

Balloon dissectors Blunt dissection or creation of a

space i.e. Lap Hernia

STERILIZATION METHODS

ETO (ETHYLENE OXIDE)

Used for heat-sensitive items Endoscopes Lightcords

12 hr. cycles take instrumentation out of use for extended periods

STEAM Used for most endoscopic

accessory instruments EXCEPT Endoscopes, light cords,

cameras Damages fiberoptic cables

STERIS (PERACETIC ACID-35%)

Used for heat-sensitive items Uses low temperature and 30

minute cycle time

CIDEX (2% GLUTARALDEHYDE) Disinfects only

High level Item is completely immersed and

lumens filled with solution for 20 minutes Must be well rinsed in sterile,

distilled water before use on patient

STERILIZATION METHODS Documentation of endoscopic

instrumentation sterilization recorded in a permanent log Sterile processing department Any clinic or OR suite that

processes their own

CLEANING TECHNIQUES

LEAK TESTING Identifies damaged endoscopes Requires maintenance

Contaminates can enter interstitial space increasing chance of infection

CYTOLOGY BRUSHES Single use cytology brushes are

disposable Reusable brushes must be cleaned

and sterilized

CAMERAS Remove debris carefully from lens Never touch the lens with fingertips

or anything Never use any substance with

alcohol since it may dissolve cement

INSTRUMENTS/TROCARS May have disposable or

replaceable tips or reusable shafts or handles that may need to be removed

STORING INSTRUMENTS Place endoscopes and all parts

disassembled in well padded perforated tray

Terminal sterilization is preferred

PROCEDURES

DIAGNOSTIC LAPAROSCOPY

Endoscopic visualization of the peritoneal cavity through the anterior abd wall after the establishment of a pnemoperitoneum

Used to investigate and DX the causes of abd bleeding, pelvic masses, abd pelvic pain, infertillity and other diseases and disorders

ARTHROSCOPIC Endoscopic visualization of the

interior of a joint through an arthroscope

Used to diagnose cartilaginous, ligamentous, synovial and bony surface defects and for TX of meniscal, articular cartilage and ligamentous defects in the knee

REVIEW & SUMMARY

ENDOSCOPYQuestions?THE END