Download 1 Endoscopy Endoscopy: is a diagnostic medical procedure used to

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Endoscopy
Endoscopy: is a diagnostic medical procedure used to visualize the interior surface
of an organ by inserting a small (tiny) tube into the body usually through natural body
opening or by small an acquired incision.
Endoscopy used also for taking biopsy , removal of foreign body , grasping ,
aspiration , cytology , suction , insufflations , irrigation after adding an accessories ,
and operative endoscope used for doing minimally invasive surgery .
The endoscope consists from:
1-rigid or flexible fiberscope , containing one or more optical fiber system and
possibly a channel for mechanical devices. ( Fiberscope )
2-light delivery system to illuminate the organ or object under inspection, the light
source is normally outside the body and the light is typically directed by an optical
fiber system.
3-a lens system transmitting the image to the viewer from the fiberscope.
4-in operative endoscope, an additional channel to allow entry of medical
instrument to biopsy or to facilitated doing operations.
The gastrointestinal fiberscope consists from 3 parts. The insertion tube , the
hand piece , and the umbilical cord.
Insertion tube : consist from –image guide (IG) and light guide (LG)
bundles
channels for suction , irrigation , and insufflations , four deflection cables and several
layers of protective materials.
Last tip called bending section. (One way , two way, or 4 way angulations).
Hand piece- contain , eyepiece , air /water and suction valves, deflection control
knobs and locks and the opening to the accessory channel.
The umbilical cord –contain the portion of the fiberscope that connect to the light
source, including connectors for insufflations and irrigation.
History:
The first endoscope was developed in 1806 by Philip Bozzini , in 1822 William
Beaumont introduced endoscopy in human. In 1894 Nitze use endoscope with
photographic device (photocystoscopye ). David in 1908 uses a bulb for illumination
in hysteroscopy. Jacobeus make endoscopic exploration of the abdomen and thorax
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at 1910 , and 1912. Laparoscopy was used for diagnosis of liver and gallbladder
disease by German Heinz Kalk in the 1930. At 1960 cold light was used for the first
time in endoscopy this mean that light could be generated outside the body and
transported to the endoscope by fiberoptic cable.
Surgery as well as examination did not begin until the late 1970 and then only with
young and healthy patient. By 1980 laparoscopy training was required by
gynecologists to perform tube ligation procedures and diagnostic evaluation of the
pelvis. The first laparoscopy cholecystectomy in 1987. During the 1990 laparoscopy
surgery was extended to the appendix , spleen , colon , stomach , kidney , and liver.
Now the wireless capsule endoscopy is promising technology.
Types of endoscopy :
A-For gastrointestinal tract (GIT ) .
1-oesophagogastroduodenoscopy –for esophagus , stomach and duodenum.
2-Enteroscopy –for proximal small bowel , capsule endoscopy also can be used.
3- Colonoscopy –for examination of colon. Proctosigmoidoscopy -for sigmoid colon.
4- Bile duct –endoscopy retrograde cholongiopancreatography.
---intraoperative cholongioscopy.
B-The respiratory tract :
1-Rhinoscopy –for the nose . 2- Bronchoscopy –for the lower respiratory tract.
C-The urinary tract : *cystoscopy –for the urinary bladder .
D-The female reproductive system :
1-colposcopy --- for the cervix .
2-hystroscopy –for the uterus .
3-falloscopy – for the fallopian tubes .
E-Normally closed body cavities (through a small incision ).
1-laproscopy –for the abdominal or pelvic cavity.
2-arthroscopy –for the interior of the joint.
3-thoracoscopy and mediastinoscopy- for the organs of the chest .
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Advantages :
1-Although it need highly specialized equipment , but its simple and easy technique
2-Help to direct visualization of organ, or lining tissue of organs.
3-Give accurate diagnosis.
4-Consider as a minimal invasive procedure.
5-By endoscopy easily to take biopsy, or removing of foreign body, or doing minor
surgery with laser or electrosurgery—etc.
Complications :
1-Although the endoscopic procedure is painless, but there is mild discomfort. In
Vet. Endoscopy the patient was anesthetize to solve this complication. (Should be
anesthetized ).
2-perforation of the organ during inspection or taking biopsy (with the un-skilled
endoscopist ). Its rare complications occur in 5%of patient.
3- Infection , due to using of unsterilized instrument.
Laparoscopy and laparoscopic surgery:
Laparoscopy: is an operative procedure designed for the visual inspection and
biopsy of the peritoneal cavity and its organs.
Laparoscopic surgery : (minimally invasive surgery )(keyhole surgery)(bandaid
surgery ) is a modern surgical technique in which operations in the abdominal ,
pelvic , or thoracic cavity are performed through small incision (0.5-1 cm ) under
using the endoscope for visualization and illumination. The abdomen usually
insufflated with Co2 gas to create a working and viewing space, additional 5-10
mm thin instruments can be introduced by the surgeon through trocars ( hollow
sheaths ). Four incision of 0.5-1.5 cm will be sufficient to perform a laparoscopic
cholecystectomy.
Advantages :
1- Reduce blood loss (less need for blood transfusion ).
2- Shorter recovery time (due to small incision).
3- Minimize post –operative pain.
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4- Reduce the hospital stay time(with a same day discharge or 1-2 days
compared with 5-7 days in conventional surgery (although procedure times are
usually slightly longer).
5- Reduced exposure of internal organs to possible external contaminates thereby
reduced risk of acquiring infections.
6- Reduced incisional hernias, especially in obese patients.
7- Some surgeons say it is safe when applied to surgery for cancers such as
cancer of colon (reduce the chance of recurrence of cancer).
Disadvantages:
1-restricted vision .
2-difficulty in handling of the instruments (hand –eye coordination ).
3-lack of tactile perception .
4- limited working area.
5-technical complexity of the surgical approach.
6-excessive pneumoperitoneum may cause death.
7- Improper technique cause severe trauma to the organs, bleeding , organ perforation
, gas embolization , subcutaneous emphysema.