KEY HOLE SURGERY

CARE OF FIBER OPTIC INSTRUMENT
As mentioned earlier post it is possible to undertake surgery
Through the fiber optic endoscope
The working end of the endoscope has outlets for instruments
The instruments are also adapted to reach and function at the operating site




WHAT ARE THE RULES OF SPECIAL CARE OF FIBRE-OPTIC ENDOSCOPES?

The special care required for fiber-optic instruments after
use:
The first principle is that `the useful life of endoscope
instruments is at risk if too many users with different use, and
Maintenance protocols, are using the same instrument.

- Debris and mucus must be removed from the instrument, and the
Channels immediately after use, with a mild detergent such as
Savlon 1 per cent
- Followed by rinsing in warm water
- After thorough cleaning, the insertion tube only of the
endoscope, can be disinfected by immersion in a chemical
fluid such as glutaraldehyde (Cidex)
- Endoscopes used for intra cavity operative procedures on
penetrating tissues, i.e., laparoscopes, arthroscopes,
thorascopes, choledocoscopes etc., must be used in a sterile
condition
- The length of fibroptic light cable, which connects the light
source to the endoscope, must be cleaned at end of each
procedure and handled with great care to prevent damage to
the light conducting glass fibres.
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ENDOSCOPE THE PEEP TOOL

Endoscopes brought about a significant advance to surgery.
You can now see lesions that previously you could not.
You can now take a biopsy under vision and get tissue diagnosis
You can now see the effect of treatment on a lesion.
You can now keep along term record of the lesion for followup.
You can now use endoscopes to execute surgical procedures.



What is the light source



The fiber light bundle is connected at one end to the light
source and at the other to the endoscope.
- It contains a bundle of up to 20,000 flexible optical fibers
which can conduct light but not capable of carrying an
Image (E as shown in Fig 7.1)
- The bundles transmit a pre-focused light of high intensity
and uniform density to the endoscope
- The bundle’s outer covering is metal and PVC, and is flexible
- This light is called cold light since it carries no heat with it


- In addition, a separate set of up to 36,000 optical fibers
capable of carrying an image terminating proximally at an
Eyepiece, and distally at a lens at the end of the endoscope
(F as shown in Fig 7.1)
- Both these sets of optical fibers are contained in a
protective sheath of endoscope, generally this sheath
Incorporates additional channels for:
. Suction (G as shown in Fig 7.1)
. Gas inflation/irrigation (H as shown in Fig 7.1)
. A passage for flexible biopsy or operative forceps and
Electrodes Fig 5.3
. Some special instruments used thriugh this port are shown
in Fig 5.4
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ENDOSCOPY THE PEEP INSIDE

ENDOSCOPY
WHAT ARE RIGID ENDOSCOPES where are the used?

These viewing instruments are metallic telescopes, with light for Diagnosis, and biopsy.

They are introduced through natural body orifices eg. Bronchoscopy, esophascopy, colonoscopy etc.
-Today rigid endoscopes are also being used to view the interior of *joints (arthroscopies) and
*the kidney (nephroscope) and
*abdomen (laparoscope).

They are introduced through incised openings. They have four
Basic components:

* Eye piece (Viewing lens)
* Body tube contains light guide connector, valves to channels
* Shaft (lens channels)
* Distal end Objective lens

WHAT ARE FIBREOPTIC ENDOSCOPES?

These sophisticated instruments have made the diagnosis of
Lesions in the accessible segments of the GI tract possible,earlier, and accurate, since visual imaging, and biopsy of the lesions is possible.
High resolution images can be recorded on:
* Color films for case of record for follow up
* Cine film for arranging learning film material
* Television monitor for ease of viewing of procedure and learning
For realtime assistants

Fibre-optics lighting and imaging systems have replaced the
Conventional rigid optic and light systems in endoscopes.
- Fibre-optics is a term applied to a system for transmitting
light and images through thin optical fibers by total
Internal reflection Fig 5.1
- The fibre-optic endoscope system consists of three parts:
. The light source or generator unit (A as shown in Fig 7.1)
. The insertion tube with the optical image bundle (B as
shown in Fig 7.1)
. The instrument or endoscope control section near the eye
Piece(C as shown in Fig 7.1)
. The light source is a high-intensity lamp in a box with an
In-built curved reflector (D as shown in Fig 7.1)
- This ensures that cold light is passed to the instrument or
Endoscope since the heat is left in the light source box
- Special lamps such as quartz iodine, metal halide and xenon
have been developed to give a higher intensity of light of
up to 500 Watts.
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SET UP THE MICROSCOPE

STEPS OF 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 of switch off must be reversed
- First switch off lights, next stand, lastly wall switch
- Ensure all sterilzable caps or drapes are available

WHEN NOT IN USE CARE

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.
* Cameras are kept locked up for security; the dust cap should be put on the outlet
* All accessories, spare objectives, and eyepieces, should be
kept in dust proof containers
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OPERATING MICROSCOPE

HOW IS DOCUMENTATION AND TRAINING HELPED BY USE OF MICROSCOPES?

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
Fig.
- 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 has 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

WHAT CARE AND MAINTENANCE IS REQUIRED?

. At least two members of OT 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
sterilizableA caps or disposable drapes are always kept in stock
Ant questions be sent to drmmkapur@gmail.com
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