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 5 •• 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 7 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