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ENDOSCOPY
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TERMINAL OBJECTIVE
State the duties and responsibilities of the scrub and circulator technologist during endoscopic surgery.
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ENABLING OBJECTIVES State the purpose of endoscopic
surgery List the advantages and disadvantages
of endoscopic versus open surgery List the functions of:
An endoscope, camera, fiber optic light cord, suction/irrigator, video system components
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ENABLING OBJECTIVES State the recommended practices
for the care and handling of endoscopic instruments and equipment
Connect a real or simulated camera, light cord, and insufflation tubing to a real or simulated video system
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ENABLING OBJECTIVES State the function of a verres
needle and selected trocars/cannulas.
Prepare a verres needle and selected trocars with cannulas for use in a laparoscopic procedure
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ENABLING OBJECTIVES
State the cannula sites for selected endoscopic procedures
List selected endoscopic instruments and state their function and uses
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ENABLING OBJECTIVES List disinfection/sterilization
methods for selected endoscopic instruments and equipment
Demonstrate cleaning techniques for selected endoscopic instruments and equipment
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ENABLING OBJECTIVES State the pathology leading to
the surgical intervention for selected endoscopic procedures.
State the major steps involved in selected endoscopic procedures.
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PURPOSE Visual examination of:
Interior of a body cavityAbdomen
Hollow organsUterus, bladder
StructuresKnee, joint
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ADVANTAGES VS. DISADVANTAGES
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ADVANTAGES Minimal invasion required for
confirming a diagnosis Small incisions Decreased:
Trauma Postop pain Hospital stay Recovery time
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DISADVANTAGES
Additional training required for surgeons
Purchase and maintenance of expensive equipment/instrumentation
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FUNCTIONS OF EQUIPMENT
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ENDOSCOPE
Lensed instruments used for viewing internal anatomical structures through natural body orifices or a tiny incision
Types varies in diameter and length based on specific patients and procedures
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TYPES Rigid Non-flexible Optical capability
for the for operator Direct
0 degree
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RIGIDAngled- -30,70,120 degreeExamples:-Cystoscopes-Laparoscopes-Hysteroscopes
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TYPES Flexible
Panoramic view Mostly GI and respiratory tracts
BronchoscopeColonoscopeCholeducoscope
Have working channels that permit the use of biopsy forceps & laser fibers
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CLASSIFICATIONS DIAGNOSTIC:
Used for observation only No operating channels
Laparoscope
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CLASSIFICATIONS Operative:
Channel allows irrigating, suctioning, inserting, and connecting other instruments.Bronchoscope
3.8.3
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CAMERA UNIT Camera head
Most important component of the video system
Head Cable
On/off
Cable Port
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CABLE
Connects camera head to control unit
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CAMERA CONTROL UNIT(IMAGE PROCESSOR)
Adjusts color and light intensity Transmits the image to a video
monitor, recorder, hard copy picture, or all three
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CAMERA CONTROL UNIT(IMAGE PROCESSOR) White balance-most important!
Common cause for color distortion-not setting the white balance
Must focus camera on white field prior to set balance prior to procedure
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COUPLERS (Adapters) Optical coupling devices ysed to
connect cameras to various endoscopes
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CAMERA UNIT Enables image received by the
scope to be transmitted to the monitor
Zoom feature allows the image to be enlarged without moving the scope
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CAMERA UNIT The tech may be required to
operate the camera Must have good spatial
orientation Steady hand Ability to concentrate for long
periods
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FIBEROPTIC LIGHT CORD Comprised of hundreds of glass
fibers that transmit light
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FIBEROPTIC LIGHT CORD
Light cords-NEVER in contact with drapes for prolonged periods of time Cause drape to burn Should be turned off when not in
use, or placed on a moist towel Connects to light source
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LIGHT SOURCE Provides illumination essential for
visualization Halogen
Used for office and hospital applications
Xenon More expensive, lasts longer Better for smaller diameter scopes
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LIGHT SOURCE Halide bulbs
Shorter life span (about 250 hrs) Less expensive Bulbs are easier to handle
Rheostat Used for regulating flow of current
from the electrical system
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SUCTION/IRRIGATOR Simultaneously suctions and irrigates
body cavities Used
Through irrigating channelsirrigating systems inserted into
• Operating ports• Cannula• Operative endoscopes
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SUCTION/IRRIGATOR Fluid can be introduced: Manually through an endoscope
Syringe/Stopcock attached to irrigation tubing
Irrigation pump powered by: CO2 Electricity
Provides large quantities of fluids
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SUCTION/IRRIGATOR Gravity
Manually force through distal tubing
Pressure bag to increase flow
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VIDEO SYSTEM COMPONENTS
Monitors (2) Used for educational training One on each side of OR bed
Should match the resolution quality of the camera
Second monitor is called slave monitor
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VIDEO PRINTER
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VIDEO SYSTEM COMPONENTS
Video Printer Utilized for teaching purposes Documentation for patients
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VIDEO SYSTEM COMPONENTS
VCR Procedural documentation is
needed Teaching purposes
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STORAGE SYSTEM•Houses multiple components
•All components must be securely fastened
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INSUFFLATOR Provides CO2 for pneumoperitoneum
Non-toxic, highly soluble in blood rapidly absorbed from the peritoneal cavity
Flow and volume monitored by circulator and surgeon
12-18 mmHg pressure9 liters/ minute
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INSUFFLATOR Should include a two-way
disposable hydrophobic filter to protect patient from chromium particles and colonization of organisms
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INSUFFLATOR
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CARE AND HANDLING
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FUNCTIONS VERRES NEEDLE,TROCARS
AND CANNULAS Verres Needle Long insufflation needle is inserted
into the abdomen to introduce CO2 into the peritoneal cavity, creating pnemoperitoneum
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VERRES NEEDLE
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VERRES NEEDLE Allows visualization of abdominal
(or thoracic) structures Prevents injury to internal
structures during surgery
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VERRES NEEDLE 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
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SCOPE GUIDED TROCAR
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CANNULA/TROCAR
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REUSABLE TROCAR
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10MM HASSON TROCAR
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CANNULAS/TROCARS Provides a mechanism for inserting
and removing INSTRUMENTATION ENDOSCOPES
May be disposable or reusable
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CANNULAS/TROCARS Cannula or sheath is inserted into
operative site by using trocar and obturator
Once port of entry has been made, trocar is removed, cannula is left in place
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CANNULAS/TROCARS Variety of sizes to accommodate
diameter of instrumentation May have spring-loaded end
guards that cover sharp tip and protect internal structures after penetration
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CANNULA SITES
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LAPAROSCOPIC APPENDECTOMY
Periumbilical Port
Suprapubic Area
Left Lower Quadrant
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LAPAROSCOPIC CHOLECYSTECTOMY
X
10/11mmSupraumbilical Port
X
10mm Trocar Subxyphoid
X X
5MMLATERAL
5MMLATERAL
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ARTHROSCOPY OF THE KNEE
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INSTRUMENTATION
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INSTRUMENTATION Designed for use in surgical sites
and/or procedures The instrument length, design of
the working end, and design of the hand control vary according to needs of the procedure
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INSTRUMENTATION Reusable or disposable May have monopolar and bipolar
capabilities
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CLAMPING INSTRUMENTS
Used to grasp and hold tissue or other materials
Babcock Allis clamp Kelly clamp Alligator clamp
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CAUTERY
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MORE INSTRUMENTATION
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DISSECTORS Used to cut, divide, or separate tissue Used for blunt or sharp dissection Scissors
Straight Curved (hook scissors)
Balloon dissectors Blunt dissection or creation of a
space i.e. Lap Hernia
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STERILIZATION METHODS
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ETO (ETHYLENE OXIDE)
Used for heat-sensitive items Endoscopes Lightcords
12 hr. cycles take instrumentation out of use for extended periods
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STEAM Used for most endoscopic
accessory instruments EXCEPT Endoscopes, light cords,
cameras Damages fiberoptic cables
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STERIS (PERACETIC ACID-35%)
Used for heat-sensitive items Uses low temperature and 30
minute cycle time
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CIDEX (2% GLUTARALDEHYDE) Disinfects only
High level Item is completely immersed and
lumens filled with solution for 20 minutes Must be well rinsed in sterile,
distilled water before use on patient
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STERILIZATION METHODS Documentation of endoscopic
instrumentation sterilization recorded in a permanent log Sterile processing department Any clinic or OR suite that
processes their own
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CLEANING TECHNIQUES
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LEAK TESTING Identifies damaged endoscopes Requires maintenance
Contaminates can enter interstitial space increasing chance of infection
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CYTOLOGY BRUSHES Single use cytology brushes are
disposable Reusable brushes must be cleaned
and sterilized
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CAMERAS Remove debris carefully from lens Never touch the lens with fingertips
or anything Never use any substance with
alcohol since it may dissolve cement
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INSTRUMENTS/TROCARS May have disposable or
replaceable tips or reusable shafts or handles that may need to be removed
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STORING INSTRUMENTS Place endoscopes and all parts
disassembled in well padded perforated tray
Terminal sterilization is preferred
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PROCEDURES
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DIAGNOSTIC LAPAROSCOPY
Endoscopic visualization of the peritoneal cavity through the anterior abd wall after the establishment of a pnemoperitoneum
Used to investigate and DX the causes of abd bleeding, pelvic masses, abd pelvic pain, infertillity and other diseases and disorders
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ARTHROSCOPIC Endoscopic visualization of the
interior of a joint through an arthroscope
Used to diagnose cartilaginous, ligamentous, synovial and bony surface defects and for TX of meniscal, articular cartilage and ligamentous defects in the knee
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REVIEW & SUMMARY
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ENDOSCOPYQuestions?THE END