Minimal Invasive nvasive Surgery: Surgical endoscopy

Slide 1Surgical Surgical endoscopyendoscopy
Faculty of Medicine Siriraj Hospital Mahidol University
26th October 2009
Menu’s Today •• Principles of Flexible Principles of Flexible EndoscopyEndoscopy •• Accessory Devices in Accessory Devices in EndoscopyEndoscopy •• Applied Anatomy of Applied Anatomy of EndoscopyEndoscopy
–– Upper GI Upper GI EndoscopyEndoscopy –– Lower GI Lower GI EndoscopyEndoscopy
•• Basic principle of ERCPBasic principle of ERCP
Principles of Flexible Principles of Flexible EndoscopyEndoscopy
1. How about your experiences in Flexible 1. How about your experiences in Flexible endoscopyendoscopy (EGD & Colonoscopy)?(EGD & Colonoscopy)?
1.1. <10 cases<10 cases 2.2. 1010--30 cases30 cases 3.3. 3030--50 cases50 cases 4.4. 5050--80 cases80 cases 5.5. >80 cases>80 cases
Principles of flexible endoscopy 5
OutlineOutline
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•• FiberopticFiberoptic endoscopesendoscopes –– Bundles of small Bundles of small fiberopticfiberoptic fibers (60fibers (60--70 70 μμm)m)
•• VideoendoscopesVideoendoscopes –– Light: Light: fiberopticfiberoptic bundlesbundles –– Image: ChargeImage: Charge--coupled device (CCD) chip coupled device (CCD) chip
cameracamera
ComponentsComponents 1.1. Supply plugSupply plug 2.2. Umbilical cordUmbilical cord 3.3. Control headControl head 4.4. Insertion tubeInsertion tube 5.5. Bending sectionBending section
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Light SourcesLight Sources
(150 W) lamp(150 W) lamp
Control HeadControl Head
Insertion TubeInsertion Tube 1.1. Suction, air, and water channelSuction, air, and water channel 2.2. WaterjetWaterjet channelchannel 3.3. Controlling wiresControlling wires 4.4. Electrical wiresElectrical wires 5.5. FiberopticFiberoptic bundlesbundles
Air Insufflations & IrrigationAir Insufflations & Irrigation
Principles of flexible endoscopy 11
Suction and InstrumentationSuction and Instrumentation
Principles of flexible endoscopy 12
Principles of flexible endoscopy 13
Bending Section & TipBending Section & Tip •• AngulationAngulation systemsystem
–– A series of joints connected with four A series of joints connected with four angulationangulation wires at 3, 6, 9, 12 owires at 3, 6, 9, 12 o’’clockclock
•• Distal tipDistal tip –– ForwardForward--viewing scopeviewing scope –– SideSide--viewing scopeviewing scope
Principles of flexible endoscopy
TwoTwo--Finger GripFinger Grip
ThreeThree--Finger GripFinger Grip
Principles of flexible endoscopy 17
EndoscopicEndoscopic MovementsMovements
Principles of flexible endoscopy 18
Documentation of FindingsDocumentation of Findings •• Date and time of the examinationDate and time of the examination •• PatientPatient’’s identifications identification •• ProcedureProcedure •• InstrumentInstrument •• Anesthesia and anesthetic recordAnesthesia and anesthetic record •• IndicationsIndications •• FindingsFindings •• ComplicationsComplications •• Recommendations/planRecommendations/plan
Menu’s Today •• Principles of Flexible Principles of Flexible EndoscopyEndoscopy •• Accessory Devices in Accessory Devices in EndoscopyEndoscopy •• Applied Anatomy of Applied Anatomy of EndoscopyEndoscopy
–– Upper GI Upper GI EndoscopyEndoscopy –– Lower GI Lower GI EndoscopyEndoscopy
•• Basic principle of ERCPBasic principle of ERCP
Accessory DevicesAccessory Devices
•• Diagnostic DevicesDiagnostic Devices •• Therapeutic DevicesTherapeutic Devices
2. What the followings is not diagnostic 2. What the followings is not diagnostic devices?devices?
1.1. Biopsy forcepsBiopsy forceps 2.2. Cytology brushesCytology brushes 3.3. Aspiration needleAspiration needle 4.4. Hot biopsy Hot biopsy 5.5. None of the aboveNone of the above
WorkingWorking ChannelChannel
Biopsy ForcepsBiopsy Forceps
BasketBasket Dilatation Devices : Balloon Dilatation Devices : Balloon HemostaticHemostatic DevicesDevices
Snare Snare PolypectomyPolypectomy
-- Wire loop housed Wire loop housed -- SheathSheath -- Handle controlHandle control -- Electrical connectorElectrical connector
Wire loop housed Wire loop housed Snare wire : 0.30Snare wire : 0.30--0.47 mm0.47 mm Braided stainless steel material (most)Braided stainless steel material (most) Shape : Oval or Elliptical Shape : Oval or Elliptical Loop diameter : 2.0 Loop diameter : 2.0 --2.5 cm2.5 cm Length : 5Length : 5--6 cm 6 cm
Hexagonal
Elliptical
NeedleNeedle-- or Anchoror Anchor--tipped snarestipped snares
Small polyp (<6mm) : Hot or Cold biopsy Small polyp (<6mm) : Hot or Cold biopsy Suction retrievalSuction retrieval
Large polyp (>6mm) : Snare Large polyp (>6mm) : Snare MultiprongedMultipronged grasping grasping
forceps (tripod or forceps (tripod or pentapodpentapod), ), Basket Basket Net Net
Retrieval DevicesRetrieval Devices
Retrieval DevicesRetrieval Devices
EndoscopicEndoscopic ClipsClips
Standard ClipStandard Clip 6 mm length 6 mm length 1.2 mm width1.2 mm width 7 mm fully open 7 mm fully open
EndoscopicEndoscopic ClipsClips
EndoscopicEndoscopic ClipsClips
Menu’s Today
1. How about your experiences in Flexible endoscopy (EGD & Colonoscopy)?
Outline