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Chapter: Medical Electronics - Recent Trends in Medical Insrumentation

Endoscopy Unit

An endoscopy is a test that looks inside the body. The endoscope is a lo ng flexible tube that can be swallowed. It has a camera and light inside it.

ENDOSCOPY UNIT

 

HISTORY

 

The first endoscope, of a kind, was developed in 1806 by Philip Bozzini with his introduction of a Lichtleiter (light conductor) for the examinations of the canals and cavities of the human body. However, the Vienna Medical Society disapproved of such curiosity. An endoscope was first introduced into a human in 1822 by William Beaumont, an army surgeon at Mackinac Island, MichiganThe use of electric light was a major step in the improvement of endoscopy. The first such lights were external. Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope by Charles David in 1908Hans Christian Jacobaeus has been given credit for early endoscopic explorations of the abdomen and the thorax with laparoscopy (1912) and thoracoscopy (1910).Laparoscopy was used in the diagnosis of liver and gallbladder disease by Heinz Kalk in the 1930. Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancyIn 1944, Raoul Palmer placed his patients in the Trendelenburg position after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy

 

The first gastrocamera was released in 1950 by Olympus Optical Co., Ltd. The device took pictures on monochromatic film using a small light bulb that was triggered manually. The device was of limited use, however, because it did not implement real-time optical capability. Olympus continued its development of endoscopes by incorporating fiber optics in the early 1960s, leading to the first useful endoscopes. In 1964, it released a gastrocamera guided by a fiberscope.  A  few  articles  claim that  Dr.Basil  Hirschowitz  of  Univ.Of  M ichigan,Ann  Arbor discussed the endoscope in early 50's.

 

As endoscopic technolog y improved, so did the methods of gastroin testinal endoscopy. Owing primarily to the efforts of Dr. Hiromi Shinya in the late 1960s, GI en doscopy developed into what is more recognizable a s today's colonoscopy. While many doctors experimented with techniques to take advantage of the new iterations of endoscopes, Dr. Shinya focused on techniques that would allow for successful operation of the endoscope by an i ndividual, rejecting the common practice at the time of utilizing two people. Consequently, many of the fundamental methods and procedures of moderrn colonoscopy were developed by Dr. Shinya.

 

By 1980, laparoscopy tra ining was required by gynecologists to per form tubal ligation procedures and diagnostic evalua tions of the pelvis. The first laparoscopic c holecystectomy was performed in 1984 and the first video-laparoscopic cholecystectomy in 1987. During the 1990s, laparoscopic surgery was extended to the appendix, spleen, colon, stomach, kidney, and liver . Wireless capsule endoscopy or C apsule Endoscopy is now approved in all the countries including Japan where government reimb usement will be available from Oct.2007. Capsule Endoscopy increases detection of Small Bowel tumors where traditional Endoscopy is not very efficient.

 

Endoscopy

 

An endoscopy is a test that looks inside the body. The endoscope is a long flexible tube that can be swallowed. It has a camera and light inside it. Some doctors call it a telescope. Most likely to have an endoscopy to look at thhe inside of

 

Gullet (oesophagus)

Stomach

Duodenum - the first part of the small bowel that attaches to the stomach

Large bowel (colon)

 

There is more detailed information about having a colonoscopy in the bowel cancer section of Cancer Help UK. Below is information about having other types of endoscopy.




Reflected light rays are collected by CCD( Charge coupled device) and electrical signals are produced, which are fed too the video monitor to get image. Thorough one channel of endoscope water and air is conducted to wash and dry the surgical site. The endoscope also has a channel through which surgeons can manipulate tiny instruments, such a s forceps, surgical scissors, and suction devices.

 

A variety of instruments can be fitted to the endoscope for different purposes.A surgeon introduces the endoscope into thee body either through a body opening, such as the mouth or the anus, or through a small incision in the skin.The endoscope gives visual evidence of the problem, such as ulceration or inflammation It can be used to collect a sample of tissue; remove problematic tissue, such as polypss. It is used to take photograph of the hollow internal organs

 

Depending on the body part, each type of endoscopy has its own special term, such as

 

laparoscopy (abdo men, uterus, fallopian tube), laryngoscopy (vocal cords),

 

bronchoscopy (lungs), colonoscopy (colo n), arthroscopy (joint) and Gastroscopy (Stom ach).


 

Components

 

An endoscope can consist of

 

·        A rigid or flexible tube

 

·        A light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system A lens system transmitting the image to the viewer from the fiberscope

 

·        An additional channel to allow entry of medical instruments or manipulators

 

Uses

 

Endoscopy can involve

The gastrointestinal tract (GI tract):

 

esophagus, stomach and duodenum (esophagogastroduodenoscopy) small intestine

 

colon (colonoscopy,proctosigmoidoscopy) Bile duct

 

·        The respiratory tract

·        The nose (rhinoscopy)

·        The lower respiratory tract (bronchoscopy)

·        The urinary tract (cystoscopy) 

·        The female reproductive system

·        The cervix (colposcopy)

·        The uterus (hysteroscopy)

·        The Fallopian tubes (Falloscopy)

·        Normally closed body cavities (through a small incision):

·        The abdominal or pelvic cavity (laparoscopy) 

·        The interior of a joint (arthroscopy)

·        Organs of the chest (thoracoscopy and mediastinoscopy)

·        During pregnancy

·        The amnion (amnioscopy)

·        The fetus (fetoscopy)

·        Plastic Surgery 

·        Panendoscopy (or triple endoscopy)

·        Combines laryngoscopy, esophagoscopy, and bronchoscopy

 

Non-medical uses for endoscopy

 

The planning and architectural community have found the endoscope useful for pre-visualization of scale models of proposed buildings and cities (architectural endoscopy) Internal inspection of complex technical systems (borescope) Endoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposal personnel. The FBI uses endoscopes for conducting surveillance via tight spaces.

Risks

 

Infection Punctured organs

 

Allergic reactions due to Contrast agents or dyes (such as those used in a CT scan) Over-sedation

 

After The Endoscopy

 

After the procedure the patient w ill be observed and monitored by a qualified individual in the endoscopy or a recovery area until a significant portion of the medication has worn off. Occasionally a patient is left wit h a mild sore throat, which promptly responds to saline gargles, or a feeling of distention from the insufflated air that was used during t he procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume his/her usual diet (probably within a few hours) and will be allowed to be taken home. Because of the use of sedation, most facilities mandate that the patient is taken home by another person and not to drive on his/her own or handle machinery for the remainder of the day.

 

Recent developments

 

With the application of robotic systems, telesurgery was introduced as the surgeon could operate from a site physically removed fr om the patient. The first transatlantic surgery has been called the Lindbergh Operation.

 

Upper Endoscopy

 

 

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine ). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).


 

For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). Right before the procedure the physician will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.

 

The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don't show up well on x rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 1 to 2 hours until the medication wears off.

 

Preparation

 

Stomach and duodenum must be empty for the procedure to be thorough and safe, will not be able to eat or drink anything for at least 6 hours beforehand. Also, must arrange for someone to take home—will not be allowed to drive because of the sedatives. Physician may give other special instructions.

 

Need of Endoscopy

 

Endoscopy allows physicians to peer through the body's passageways. Endoscopy is the examination and inspection of the interior of body organs, joints or cavities through an endoscope. An endoscope is a device that uses fiber optics and powerful lens systems to provide lighting and visualization of the interior of a joint. The portion of the endoscope inserted into the body may be rigid or flexible, depending upon the medical procedure.

 

An endoscope uses two fiber optic lines. A "light fiber" carries light into the body cavity and an "image fiber" carries the image of the body cavity back to the physician's viewing lens. There is also a separate port to allow for administration of drugs, suction, and irrigation. This port may also be used to introduce small folding instruments such as forceps, scissors, brushes, snares and baskets for tissue excision (removal), sampling, or other diagnostic and therapeutic work. Endoscopes may be used in conjunction with a camera or video recorder to document images of the inside of the joint or chronicle an endoscopic procedure. New endoscopes have digital capabilities for manipulating and enhancing the video images.


 

This figure shows a rigid endoscope used for arthroscopy. The "image fiber" leads from the ocular (eye piece) to the inserted end of the scope. The "light fiber" is below and leads from the light source to the working end of the endoscope.

 

Performance of Endoscopy

 

Endoscopy can be used to diagnose various conditions by close examination of internal organ and body structures. Endoscopy can also guide therapy and repair, such as the removal of torn cartilage from the bearing surfaces of a joint. Biopsy (tissue sampling for pathologic testing) may also be performed under endoscopic guidance. Local or general anesthetic may be used during endoscopy, depending upon the type of procedure being performed

 

Internal abnormalities revealed through endoscopy include: abscesses, biliary (liver) cirrhosis, bleeding, bronchitis, cancer, cysts, degenerative disease, gallbladder stones, hernia, inflammation, metastatic cancer, polyps, tumors, ulcers, and other diseases and conditions.

 

Endoscopy is a minimally invasive procedure and carries with it certain minor risks depending upon the type of procedure being performed. However, these risks are typically far outweighed by the diagnostic and therapeutic potential of the procedure.

 

Prior to the widespread use of endoscopy and diagnostic imaging, most internal conditions could only be diagnosed or treated with open surgery. Until the last several decades, exploratory surgery was routinely performed only when a patient was critically ill and the source of illness was not known. For example, in certain dire cases, the patient's thorax or abdomen were surgically opened and examined to try to determine the source of illness.

 

Endoscopy can often be done on an outpatient basis. "Outpatient" means that the procedure does not require hospital admission and acute care and observation and may be performed outside the premises of a hospital. Outpatient procedures performed at hospitals or ambulatory centers allow the patient to go home or return to work within a short while after their procedure.

 

Types of Endoscopy

 

Fiber optic endoscopes now have widespread use in medicine and guide a myriad of diagnostic and therapeutic procedures including:

 

Arthroscopy: Examination of joints for diagnosis and treatment (arthroscopic surgery)

 

Bronchoscopy: Examination of the trachea and lung's bronchial trees to reveal abscesses, bronchitis, carcinoma, tumors, tuberculosis, alveolitis, infection, inflammation

 

Colonoscopy: Examination of the inside of the colon and large intestine to detect polyps, tumors, ulceration, inflammation, colitis diverticula, Chrohn's disease, and discovery and removal of foreign bodies.

 

Colposcopy: Direct visualization of the vagina and cervix to detect cancer, inflammation, and other conditions.

 

Cystoscopy: Examination of the bladder, urethra, urinary tract, uteral orifices, and prostate (men) with insertion of the endoscope through the urethra.

 

ERCP (endoscopic retrograde cholangio-pancreatography) uses endoscopic guidance to place a catheter for x-ray fluorosocopy with contrast enhancement. This technique is used to examine the liver's biliary tree, the gallbladder, the pancreatic duct and other anatomy to check for stones, other obstructions and disease. X-ray contrast is introduced into these ducts via catheter and fluoroscopic x-ray images are taken to show any abnormality or blockage. If disease is detected, it can sometimes be treated at the same time or biopsy can be performed to test for cancer or other pathology. ERCP can detect biliary cirrhosis,.cancer of the bile ducts, pancreatic cysts, pseudocysts, pancreatic tumors, chronic pancreatitis and other conditions such as gallbladder stones.

 

EGD (Esophogealgastroduodensoscopy): visual examination of the upper gastro-intestinal (GI) tract. (also referred to as gastroscopy) to reveal hemorrhage, hiatal hernia, inflammation of the esophagus, gastric ulcers.

 

Endoscopic biopsy is the removal of tissue specimens for pathologic examination and analysis.

 

Gastroscopy: examination of the lining of the esophagus, stomach, and duodenum. Gastroscopy is often used to diagnose ulcers and other sources of bleeding and to guide biopsy of suspect GI cancers.

 

Laparoscopy: visualization of the stomach, liver and other abdominal organs including the female reproductive organs, for example, the fallopian tubes.

 

Laryngoscopy: examination of the larynx (voice box).

 

Proctoscopy, sigmoidoscopy, proctosigmoidoscopy: examination of the rectum and sigmoid colon.

 

Thoracoscopy: examination of the pleura (sac that covers the lungs), pleural spaces, mediastinum, and pericardium.

 

Endoscopy Equipment

 

Endoscopes have many practical needs. And H.M.B. Endoscopy Products (Hollywood, Florida) has been providing endoscopic equipment and educating people on the use of endoscopes for more than 17 years..

 


 

In the simplest terms, Endoscopy equipment consists of instruments that can look at the inside of many different organs — these are small, flexible or rigid tubes with a light or lenses on the end that can look into the esophagus, stomach and colon — and in more general terms endoscopy equipment can help doctors look deep inside body structures and hollow organs. An endoscope and related endoscope products and equipment are usually composed of three components:

 

An optic system that allows the doctor to look through the scope into the organ or cavity, or to attach a video camera to the scope

 

A fiberoptic cable to light up the bodily area

 

A lumen (e.g. the bore of a tube, like a needle or catheter) to take tissue samples of the area being viewed


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