ENDOSCOPES 1

Endoscopy

RIGID ENDOSCOPES

These viewing instruments are metallic lit telescopes for diagno-sis and biopsy. They are introduced through natural body orifices, e.g. bronchoscopes, esophascope, colonoscope, etc. 

Today rigid endoscopes are also being used to view the interior of joints (arthroscopes) and the kidney (nephroscope) and abdomen (laparoscope). They are introduced through incised openings. They have four basic components:

•       Eyepiece (viewing lens).

•       Body (light guide connector, valves to channels).

•       Shaft (lens channels).

•       Distal end (objective lens).

FIBEROPTIC endoscope

These sophisticated instruments have made the diagnosis of lesions in the accessible segments of the GI tract earlier and accurate since biopsy of visualized lesions is possible. High- resolution images can be recorded on:

•       Color film documentation of lesion and follow up.

•       Cine film for arranging learning material and documen-tation.

•       Television monitor for ease of procedure and learning.

         Fiberoptics lighting and imaging systems have replaced, the conventional optic and light systems in endoscopes.

•       Fiberoptics is a term applied to a system for transmitting light and images through thin optical fibers by total internal reflection 

•       The fiberoptic endoscope system consists of four parts:

         a.      The light source or generator unit 

         b.      The insertion tube with the optical image bundle)

         c.       The instrument or endoscope control section near the eyepiece 

         d.      The light source is a high-intensity lamp in a box with an in-built parabolic reflector

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3 OPERATING MICROSCOPE CARE & MAINTENANCE check list

Care and Maintenance

•       At least two members of staff should be trained for round the clock responsibility of checking, setting up and storing the instrument.

•       These staff members keep contact with the manufacturer/supplier of the microscope on the performance of micro­scope.

•       They should have read the supplied instruction books.

•       Supplies of spare parts, such as lamps, fuses and sterilizable caps or disposable drapes are always kept in stock.

Preparation of the Microscope for the Operation

•       Position the microscope over the table for the operation and as required by the surgeon, be sure to leave space required by the assistant, scrub nurse, anesthesia team, equipment and sterile trolleys.

•       Arrange the path of the mains lead from the wall socket to ensure that it is not in the path of flow of the OT staff.

•       Check and tighten, if necessary, the safety locks between microscope and stand.

•       Ensure that correct objectives and binocular tubes are inserted for the particular operation.

•       Clean the objectives and eyepieces of main and assistants’ microscope.

•       Switch on the microscope.

•       First at the wall socket.

•       Second at the stand.

•       Switch on the lights.

•       After the operation this procedure must be reversed.

•       first switch off lights, next stand, lastly wall switch.

•       Ensure all sterilizable caps or drapes are available.

         Dust is very harmful for microscopes thus they should be kept covered with a dust cover when not in use and never left without objective, binocular tube or eyepieces fitted.

•       If cameras are kept locked up for security, the dust cap should be put on outlet.

•       All accessories, spare objectives, and eyepieces, should be kept in dust proof containers.

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2 Operating microscope Assisting & Training

Assistants Microscope Attachment

An assistant microscope is a separate binocular viewing system with eyepieces. It provides the same stereoimage as provided in the main microscope. This is through a beam splitter, which splits the image and directs it to the assistants’ microscope, which has its own independent magnification control. This makes it possible for the assistant to participate and assist in surgical procedures.

Documentation and Training

It has been possible to document (photograph) different stages of the procedure and record the finding as observed through the microscope. This progress have been achieved through:

•       Introduction of high speed artificial light color films.

•       Introduction of 35 mm film color camera with automatic exposure control.

•       Introduction of co-axial flash equipment, controlled through sensor in the modern 35 mm camera.

•       Cine camera also have been adapted for the microscope work.

•       Today high quality color television cameras have also been introduced:

         a.      These have facilitated video recording of procedures.

         b.      These video films are cheaper than Cine films.

         c.       Light weight, Solid state inexpensive cameras can provide excellent observation facilities for training of microsurgery trainees.

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6 Operating Microscopes Types Uses

Operating Microscopes

introduction

The use of magnification has been a recent addition to a surgeons’ instrument list. 

Loupes and magnifying glasses have been used in the past but operating microscopes have improved the clarity of the vision, the depth of focus and the lighten­ing of the operation site and such complicated two layer suture on small structures can be performed quickly, accura­tely and in comfort with no strain on the neck muscles. Most operating microscope are:

1.      Floor mounted (Fig.above).

2.      Ceiling mounted (Fig.above).

Features of an Operating Microscope

•       Hand operation or foot operation.

•       Automatic focus and zoom.

•       Assistant microscope view arm.

•       Camera attachment arm.

Basic Uses

The operating microscope is used for two purposes:

•       The first is to provide a magnified view of small structures (small vessel and nerve anastomosis).

•       The second is to provide a magnified view of larger structures upon which more precise surgical procedcure needs to be performed (Disc surgery).

Types of Operating Microscopes

There are two basic types of operating microscope, with several variations, depending upon the surgical specialty involved.

•       The first is the manual type, featuring hand controlled fixed magnification stepwise (6x, 9x...) and control knobs for focus 

•       The second type is the zoom system, this has the advantage of offering continuous magnification through the whole range of the magnification of the system including focus through foot controls.

Controls

In the case of the manual microscope, all controls such as focusing, magnification change and tilt of the microscope are done by hand knobs.

•       These can be covered with sterilizable rubber caps provided with the microscope

•       The complete instrument can be draped with a loose sterile plastic drape and the knobs adjusted through this drape.

         With motorized microscopes, the functions are normally controlled by a foot switch

•       The controls can be built into a specially designed operating chair

•       Alternatively a hand switch, inserted into a sterile plastic bag for use during operation.

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