1. ENDOSCOPY

2. TERMINAL OBJECTIVE n State the duties and responsibilities of the scrub and circulator technologist during endoscopic surgery.

3. ENABLING OBJECTIVES n State the purpose of endoscopic surgery n List the advantages and disadvantages of endoscopic versus open surgery n List the functions of: u An endoscope, camera, fiber optic light cord, suction/irrigator, video system components

4. ENABLING OBJECTIVES n State the recommended practices for the care and handling of endoscopic instruments and equipment n Connect a real or simulated camera, light cord, and insufflation tubing to a real or simulated video system

5. ENABLING OBJECTIVES n State the function of a verres needle and selected trocars/cannulas. n Prepare a verres needle and selected trocars with cannulas for use in a laparoscopic procedure

6. ENABLING OBJECTIVES n State the cannula sites for selected endoscopic procedures n List selected endoscopic instruments and state their function and uses

7. ENABLING OBJECTIVES n List disinfection/sterilization methods for selected endoscopic instruments and equipment n Demonstrate cleaning techniques for selected endoscopic instruments and equipment

8. ENABLING OBJECTIVES n State the pathology leading to the surgical intervention for selected endoscopic procedures. n State the major steps involved in selected endoscopic procedures.

9. PURPOSE n Visual examination of: u Interior of a body cavity F Abdomen u Hollow organs F Uterus, bladder u Structures F Knee, joint

10. ADVANTAGES VS. DISADVANTAGES

11. ADVANTAGES n Minimal invasion required for confirming a diagnosis n Small incisions n Decreased: u Trauma u Postop pain u Hospital stay u Recovery time

12. DISADVANTAGES n Additional training required for surgeons n Purchase and maintenance of expensive equipment/instrumentation

13. FUNCTIONS OF EQUIPMENT

14. ENDOSCOPE n Lensed instruments used for viewing internal anatomical structures through natural body orifices or a tiny incision n Types varies in diameter and length based on specific patients and procedures

15. TYPES n Rigid n Non-flexible n Optical capability for the for operator u Direct 0 degree

16. RIGID F Angled- -30,70,120 degree Examples: -Cystoscopes -Laparoscopes -Hysteroscopes

17. TYPES n Flexible u Panoramic view u Mostly GI and respiratory tracts F Bronchoscope F Colonoscope F Choleducoscope u Have working channels that permit the use of biopsy forceps & laser fibers

18. CLASSIFICATIONS n DIAGNOSTIC: n Used for observation only n No operating channels u Laparoscope

19. CLASSIFICATIONS n Operative: u Channel allows irrigating, suctioning, inserting, and connecting other instruments. F Bronchoscope 3.8. 3

20. CAMERA UNIT n Camera head u Most important component of the video system Head Cable On/of f Cable Port

21. CABLE n Connects camera head to control unit

22. CAMERA CONTROL UNIT (IMAGE PROCESSOR) n Adjusts color and light intensity n Transmits the image to a video monitor, recorder, hard copy picture, or all three

23. CAMERA CONTROL UNIT (IMAGE PROCESSOR) n White balance-most important! u Common cause for color distortion-not setting the white balance u Must focus camera on white field prior to set balance prior to procedure

24. COUPLERS (Adapters) n Optical coupling devices ysed to connect cameras to various endoscopes

25. CAMERA UNIT n Enables image received by the scope to be transmitted to the monitor n Zoom feature allows the image to be enlarged without moving the scope

26. CAMERA UNIT n The tech may be required to operate the camera u Must have good spatial orientation u Steady hand u Ability to concentrate for long periods

27. FIBEROPTIC LIGHT CORD n Comprised of hundreds of glass fibers that transmit light

28. FIBEROPTIC LIGHT CORD n Light cords-NEVER in contact with drapes for prolonged periods of time u Cause drape to burn u Should be turned off when not in use, or placed on a moist towel n Connects to light source

29. LIGHT SOURCE n Provides illumination essential for visualization n Halogen u Used for office and hospital applications n Xenon u More expensive, lasts longer u Better for smaller diameter scopes

30. LIGHT SOURCE n Halide bulbs u Shorter life span (about 250 hrs) u Less expensive u Bulbs are easier to handle n Rheostat u Used for regulating flow of current from the electrical system

31. SUCTION/IRRIGATOR n Simultaneously suctions and irrigates body cavities u Used F Through irrigating channels F irrigating systems inserted into Operating ports Cannula Operative endoscopes

32. SUCTION/IRRIGATOR n Fluid can be introduced: n Manually through an endoscope u Syringe/Stopcock attached to irrigation tubing n Irrigation pump powered by: u CO2 u Electricity n Provides large quantities of fluids

33. SUCTION/IRRIGATOR n Gravity u Manually force through distal tubing u Pressure bag to increase flow

34. VIDEO SYSTEM COMPONENTS n Monitors (2) u Used for educational training u One on each side of OR bed F Should match the resolution quality of the camera F Second monitor is called slave monitor

35. VIDEO PRINTER

36. VIDEO SYSTEM COMPONENTS n Video Printer u Utilized for teaching purposes u Documentation for patients

37. VIDEO SYSTEM COMPONENTS n VCR u Procedural documentation is needed u Teaching purposes

38. STORAGE SYSTEM Houses multiple components All components must be securely fastened

39. INSUFFLATOR n Provides CO2 for pneumoperitoneum u Non-toxic, highly soluble in blood rapidly absorbed from the peritoneal cavity u Flow and volume monitored by circulator and surgeon F 12-18 mmHg pressure F 9 liters/ minute

40. INSUFFLATOR n Should include a two-way disposable hydrophobic filter to protect patient from chromium particles and colonization of organisms

41. INSUFFLATOR

42. CARE AND HANDLING

43. FUNCTIONS n VERRES NEEDLE,TROCARS AND CANNULAS n Verres Needle n Long insufflation needle is inserted into the abdomen to introduce CO2 into the peritoneal cavity, creating pnemoperitoneum

44. VERRES NEEDLE

45. n Allows visualization of abdominal (or thoracic) structures n Prevents injury to internal structures during surgery

46. VERRES NEEDLE n 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

47. SCOPE GUIDED TROCAR

48. CANNULA/TROCAR

49. REUSABLE TROCAR

50. 10MM HASSON TROCAR

51. CANNULAS/TROCARS n Provides a mechanism for inserting and removing u INSTRUMENTATION u ENDOSCOPES n May be disposable or reusable

52. CANNULAS/TROCARS n Cannula or sheath is inserted into operative site by using trocar and obturator n Once port of entry has been made, trocar is removed, cannula is left in place

53. CANNULAS/TROCARS n Variety of sizes to accommodate diameter of instrumentation u May have spring-loaded end guards that cover sharp tip and protect internal structures after penetration

54. CANNULA SITES

55. LAPAROSCOPIC APPENDECTOMY Periumbilical Port Suprapubic Area Left Lower Quadrant

56. LAPAROSCOPIC CHOLECYSTECTOMY X 10/11mm Supraumbilica l Port X 10mm Trocar Subxyphoid X 5MM LATERAL 5MM LATERAL

57. ARTHROSCOPY OF THE KNEE

58. INSTRUMENTATION

59. n Designed for use in surgical sites and/or procedures n The instrument length, design of the working end, and design of the hand control vary according to needs of the procedure

60. INSTRUMENTATION n Reusable or disposable n May have monopolar and bipolar capabilities

61. CLAMPING INSTRUMENTS n Used to grasp and hold tissue or other materials n Babcock n Allis clamp n Kelly clamp n Alligator clamp

62. CAUTERY

63. MORE INSTRUMENTATION

64. DISSECTORS n Used to cut, divide, or separate tissue n Used for blunt or sharp dissection n Scissors u Straight u Curved (hook scissors) n Balloon dissectors u Blunt dissection or creation of a space i.e. Lap Hernia

65. STERILIZATION METHODS

66. ETO (ETHYLENE OXIDE) n Used for heat-sensitive items u Endoscopes u Lightcords n 12 hr. cycles take instrumentation out of use for extended periods

67. STEAM n Used for most endoscopic accessory instruments n EXCEPT Endoscopes, light cords, cameras u Damages fiberoptic cables

68. STERIS (PERACETIC ACID-35%) n Used for heat-sensitive items n Uses low temperature and 30 minute cycle time

69. CIDEX (2% GLUTARALDEHYDE ) n Disinfects only u High level n Item is completely immersed and lumens filled with solution for 20 minutes u Must be well rinsed in sterile, distilled water before use on patient

70. STERILIZATION METHODS n Documentation of endoscopic instrumentation sterilization recorded in a permanent log u Sterile processing department u Any clinic or OR suite that processes their own

71. CLEANING TECHNIQUES

72. LEAK TESTING n Identifies damaged endoscopes n Requires maintenance u Contaminates can enter interstitial space increasing chance of infection

73. CYTOLOGY BRUSHES n Single use cytology brushes are disposable n Reusable brushes must be cleaned and sterilized

74. CAMERAS n Remove debris carefully from lens n Never touch the lens with fingertips or anything n Never use any substance with alcohol since it may dissolve cement

75. INSTRUMENTS/TROCARS n May have disposable or replaceable tips or reusable shafts or handles that may need to be removed

76. STORING INSTRUMENTS n Place endoscopes and all parts disassembled in well padded perforated tray n Terminal sterilization is preferred

77. PROCEDURES

78. DIAGNOSTIC LAPAROSCOPY n Endoscopic visualization of the peritoneal cavity through the anterior abd wall after the establishment of a pnemoperitoneum n Used to investigate and DX the causes of abd bleeding, pelvic masses, abd pelvic pain, infertillity and other diseases and disorders

79. ARTHROSCOPIC n Endoscopic visualization of the interior of a joint through an arthroscope n Used to diagnose cartilaginous, ligamentous, synovial and bony surface defects and for TX of meniscal, articular cartilage and ligamentous defects in the knee

80. REVIEW & SUMMARY

81. ENDOSCOPY n Questions? n THE END