ENDOSCOPY: Type, Procedure, Preparation, Application, ...

ENDOSCOPY: Type, Procedure, Preparation, Application, ...

ENDOSCOPY

An endoscopy is a minimal invasive procedure where a doctor or surgeon inserts a specialized instrument (Endoscope) directly into the body (through body openings such as mouth, anus, or a small incision) to view, observe, and operate on the internal organs, tissues, and vessels without making large incisions. This procedure can also be used for imaging and minor surgery. Surgeons generally use endoscopy in the following parts of the body:

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i. Esophagus, ii. Stomach, iii. Colon, iv. Ear, v. Nose, vi. Throat, vii. Heart, viii. Ureter, ix. Joints, x. Abdomen.

• Gastrointestinal tract: esophagus, stomach, and duodenum (esophagogastroduodenoscopy), small intestine (enteroscopy), large intestine/colon (colonoscopy, sigmoidoscopy), bile duct, rectum (rectoscopy), and anus (anoscopy).
• Respiratory tract: Nose (rhinoscopy), lower respiratory tract (bronchoscopy).
• Ear: Otoscopy
• Urinary tract: Cystoscopy
• Female reproductive tract (gynoscopy): Cervix (colposcopy), uterus (hysteroscopy), fallopian tubes (falloposcopy).
• Through a small incision: Abdominal or pelvic cavity (laparoscopy), interior of a joint (arthroscopy), organs of the chest (thoracoscopy and mediastinoscopy).

ENDOSCOPE

An endoscope is a long, thin, flexible/metal tube equipped with a light and camera at one end. When inserted through body openings, it captures images of the inside of your body, displaying them on a screen in the operating room. Endoscopes are minimally invasive and can be inserted through the mouth down the throat or through the anus.

Endoscopes can also be inserted into the body through small incisions, for instance, when examining the knee or abdomen. Surgery conducted through such small incisions with the help of special instruments like endoscopes is known as keyhole surgery/minimally invasive surgery.

The endoscope's length and flexibility depend on the specific area of the body the doctor or surgeon needs to see. For example, a straight/rigid endoscope is useful for examining joints, whereas a flexible one is better suited for viewing the inside of the colon.

COMMON TYPES OF ENDOSCOPES AND TYPICAL USES

Rigid Endoscopes

Rigid endoscopes consist of a metal tube containing a series of lenses, fiber optics, or video chips for image transmission, along with fiber optic bundles to deliver light. These endoscopes offer the best image quality and resolution among all types. Some rigid endoscopes also have a working channel through which instruments can be passed, enabling real-time surgical procedures. Rigid endoscopes are commonly used in urology, gynecology, ENT, arthroscopy, endoscopic spine surgery, and general surgery.

Rigid endoscopes range in external diameters from 1 to 12 mm and typically contain high-resolution optical glass rod lenses. They can be forward-viewing (0 degrees) or angled (10-120 degrees) to enable visualization out of the axis of the telescope and to increase the field of view (FOV) by rotating the instrument. The optical quality of lens-generated images from rigid endoscopes still surpasses that of images produced by flexible scopes.

These small tubular telescopes allow surgeons to look inside joints and body cavities that otherwise could only be examined through more invasive procedures. They work well in conjunction with a camera system, providing surgeons with a magnified view of the affected area.

Many brand-name companies manufacture rigid endoscopes in various models to meet different surgical needs for both humans and animals. Commonly, these endoscopes incorporate a convex glass lens system, where small glass lenses are separated by larger air spaces.

Uses of Rigid Endoscopes:

Minimally invasive procedures have transformed modern medicine. The use of rigid endoscopes for various diagnoses and procedures has benefited thousands of patients worldwide. Rigid endoscopes are used in procedures such as:

• Exploration and biopsy of the abdomen (including organs such as the liver, prostate, pancreas, lymph nodes, kidney, small intestines, and others).
• Examination of the thorax and chest.
• Biopsy for diagnosis in cancer patients (including detection and staging).
• Surgery or exploration of the joints (arthroscopy).
• Endoscopic examination and biopsies of organs such as the urinary bladder, nose, and ears.

Flexible Endoscopes

Flexible endoscopes are more versatile than rigid ones, allowing for navigation through hard-to-reach areas by controlling the directional movement of the scope’s distal end. While the lenses consist of flexible fibers, the image quality may not be as crisp and defined as that provided by rigid endoscopes.

Common areas where flexible endoscopes are used include bronchoscopy, colonoscopy, and examining the upper gastroenterological systems.

There are two kinds of flexible endoscopes:

• Fiberoptic endoscopes: These endoscopes have an eyepiece lens, allowing images to be viewed directly or through a camera mounted on the endoscope.
• Videoscopes: These modern endoscopes use a video chip to transmit images directly to a monitor, providing a clear view of the examined area.

Flexible endoscopes offer an advantage in accessing deep areas of the body with less invasiveness compared to surgical approaches. They are used for exploring biopsies and delicate areas of the body, employing systems such as:

• Esophagoscopes
• Nasolaryngoscopes
• Ophthalmoendoscopes
• Colonoscopes

Parts of a flexible endoscope:

Flexible scopes consist of four main parts:

• Insertion Tube
• Control Body
• Bending section located at the distal tip of the insertion tube
• Light-guide connector unit

These components work in combination with peripherals (such as light sources, video processors, cleaning brushes, among others) for diagnostic or treatment procedures. The images or samples obtained during endoscopy can be life-saving and provide researchers with a deeper understanding of the human or animal body.

Current flexible endoscopes may feature a built-in chip at the distal end for enhanced visualization.

What’s the difference between rigid and flexible endoscopes?

Both types of endoscopes are used to look inside the human or animal body for medical reasons, as well as to inspect delicate engineering and mechanical equipment. The main difference lies in their construction. Rigid endoscopes are composed of tubular telescopes with no bending capacity, while flexible scopes are long, one-piece instruments with limited bending capability, offering a broader view of the cavity being examined.

Both types of endoscopes are also used outside the medical field in technical areas such as automotive technology, architecture, and building inspection.

Other Tools Used During Endoscopy

An endoscope typically has a channel through which a surgeon can insert surgical tools to remove tissues for biopsy or provide treatment. The various surgical tools used during endoscopy include:

• Flexible forceps: Used to take tissue samples.
• Biopsy forceps: These tools remove suspicious growths.
• Cytology brushes: Used to take cell samples.
• Suture removal forceps: These tools are used to remove sutures inside the body.