ENDOSCOPY 7 Laproscopy 2 steps

Anesthesia

Local anesthesia for intraluminal surgery or general anesthesia.

Position

Supine.

Procedure

         1.      A small 0.5 cm incision is given just below the umbilicus.

         2.      Lift the abdominal wall between thumb and finger and insert Veress needle.

         3.      The entry of the needle through rectus sheath and peritoneum will be signaled by the sucking of the air through the needle.

         4.      The needle should be freely mobile and on aspiration there is no blood.

         5.      Connect the insufflator, the pressure on the gauge should be less than 4 mm.

         6.      Allow gas flow at 1 liter per minute and stop when 2.53 liter have been insufflated.

         7.      Percuss the liver to confirm loss of liver dullness.

         8.      Withdrawn Veress needle and insert 10 mm Trocor and Cannula.

         9.      Withdrawn Trocor and insert laparoscope, connect insufflator to the laparoscope.

         10.    Inspect abdominal cavity through eyepiece.

         11.    Create accessory openings relevant to the procedure.

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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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