ENDOSCOPY 6 Laprocopy procedures in use & on trial

LAPAROSCOPIC SURGERY (Fig. above)

Objective

To perform operations within the abdominal cavity under vision:

•       To perform these procedures through the use of laparoscopy and other small related instruments.

         These surgical procedures have an advantage over open surgical procedures because:

•       The operative trauma is less.

•       The postoperative discomfort and pain are less.

•       The patient recovery and return to full activity is quicker.

•       The hospital stay is reduced bringing down cost.

The established procedures today are in:

•       Gynecological surgery.

•       General surgery

         a.      Gallbladder

         b.      Appendix.

•       Intra-articular surgery.

•       Thoracoscopy.

The procedures under trial are:

•       Vagotomy.

•       Repair of hernia.

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ENDOSCOPY 5 Lower objectives position procedure instrumens

Lower Gastrointestinal Endoscopy (Figs above)

Objective

The examination of the interior of the colon for viewing and biopsy.

Position

Usually left lateral.

Anesthesia

Surface and sedation with IV diazepam.

Procedure

1.      Patient is sedated with diazepam.

2.      Lubricated colonoscope introduced.

3.      View rectum through eyepieces.

4.      Advance colonoscope under vision keeping to the center of of the colon.

5.      Entire colon can be examined while withdrawing instruments.

6.      Biopsies or cytology specimens can also be obtained.

Instruments

•       Colonofiberscope.

•       Fiberoptic light source/diathermy power supply.

•       Biopsy forceps (these includes those suitable for cutting, grasping, taking cytology specimens, etc).

•       Accessories for endoscopic diathermy (e.g. snares, cutter, electrodes).

•       Colon stiffening tube.

•       Lubricant, e.g. lignocaine (xylocaine) gel.

•       Water container/irrigator.

•       Carbon dioxide gas source.

•       Medical vacuum.

•       Camera. 

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ENDOSCOPY 4 upper GI Procedure position steps instruments

Upper Gastrointestinal Endoscopy (Figs above)

Objective

Examination and biopsy of esophagus, stomach and duodenum.

Position

Left lateral or sitting.

Anesthesia

Surface and sedation with IV diazepam.

Procedure

1.      Patient is sedated with intravenous diazepam.

2.      Plastic mouth-guard.

3.      Lubricated fiberscope.

4.      Passed into mouth over the tongue.

5.      Patient asked to swallow.

6.      Instruments advanced.

7.      No force should be used.

•       As instruments enter esophagus examine through eyepiece.

•       Advance instrument under vision into stomach.

Instruments and Equipments Required

•       Suitable fiberscope (e.g., forward, or side viewing).

•       Fiberoptic light source/diathermy power supply.

•       Mouth guard.

•       Biopsy forceps (these include those suitable for cutting, grasping, taking cytology specimens, etc).

•       Accessories for endoscopic diathermy (e.g., snares, knives, electrodes).

•       Angled tongue depressor.

•       Pharyngeal spray.

•       Topical anesthetic, e.g. 1 percent lignocaine (xylocaine).

•       Lubricant, e.g. lignocaine (xylocaine) gel.

•       Esophageal bougies and tubes sizes 16 and 18 Charriere gauge may be required water container/irrigator.

•       Medical vacuum.

•       Camera if required.

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ENDOSCOPY 3 gastroscopes duodenoscopes colonoscopes

GASTROINTESTINAL FIBERSCOPES
(INCLUDING GASTRoSCOPES,
DUODENOSCOPES AND COLONOSCOPES)

Based on the angle of view, there are three types of instruments:

1.      Forward or oblique (foreoblique) viewing for examination and biopsy This is suitable for examining the esophagus, most of the stomach and the upper part of the duodenum.

2.      Side or lateral viewing for examination, biopsy and operative procedures in the duodenum This is needed when full examination of esophagus, stomach, duodenum and biliary system is required. This includes the fundus of the stomach and the duodenal bulb.

3.      Forward viewing with two channels for complex operative procedures This is generally larger in diameter than the previous two and has suitable dimension channels incorpo­rated for operating instruments. A wide range of procedures can be undertaken.

         All three types of instruments can be obtained from several manufacturers.

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