ENDOSCOPY

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

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

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

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

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

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

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.

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

ADVANTAGES VS. DISADVANTAGES

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

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

FUNCTIONS OF EQUIPMENT

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

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

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

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

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

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

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

CABLE n Connects camera head to control unit

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

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

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

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

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

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

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

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

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

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

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

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

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

VIDEO PRINTER

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

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

STORAGE SYSTEM Houses multiple components All components must be securely fastened

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 mmHg pressure F 9 liters/ minute

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

INSUFFLATOR

CARE AND HANDLING

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

VERRES NEEDLE

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

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

SCOPE GUIDED TROCAR

CANNULA/TROCAR

REUSABLE TROCAR

10MM HASSON TROCAR

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

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

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

CANNULA SITES

LAPAROSCOPIC APPENDECTOMY Periumbilical Port Suprapubic Area Left Lower Quadrant

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

ARTHROSCOPY OF THE KNEE

INSTRUMENTATION

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

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

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

CAUTERY

MORE INSTRUMENTATION

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

STERILIZATION METHODS

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

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

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

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

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

CLEANING TECHNIQUES

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

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

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

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

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

PROCEDURES

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

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

REVIEW & SUMMARY

ENDOSCOPY n Questions? n THE END