Endoscopy and its Types

Ms.Oinam Robita Chanu 1

Endoscopy
• Endoscopy means looking inside the body using an endoscope, an
instrument used to examine the interior of a hollow organ or cavity of
the body
• An endoscope or viewing scope is used by the surgeon to view
anatomical structures and perform therapy to the interior of the
body.
• The diameter of an endoscope varies from the 1.7-mm needle
fetoscope to the 5-mm arthroscope to the 22-mm colonoscope.
• The length of the endoscope must be appropriate to reach the
desired structure.
• Endoscopes can be rigid or flexible
Ms.Oinam Robita Chanu 2
Endoscopic video system components
• A typical endoscopic video system consists of the following
components:
An endoscope
A light source
A video camera
An image processor
One or two video display monitors
An image management system

Ms.Oinam Robita Chanu 3

Cont.
• Depending on the procedure, some of the following instruments and
devices may be used in endoscopic procedures:
Trocars/cannulae
Gas insufflators—CO2 or N2O
Air, water, and suction pumps
Laser, ESU, cutters, forceps, scissors, biopsy snares, etc

Ms.Oinam Robita Chanu 4

 Rigid Endoscope
• Rigid scopes are either hollow
sheaths that allow straight
viewing (such as laryngoscopes)
or a sheath with an eyepiece and
lens system that allows viewing in
a variety of directions (such as
cystoscopes).
• The sheaths of most rigid scopes
are made of stainless steel,
although plastic-sheathed scopes
(mostly disposable) are available

Ms.Oinam Robita Chanu 5

Cont.
• Series of rod lenses to convey high-resolution, wide field of view
images to the eyepiece
• Objects seen through a rigid scope may be magnified or reduced
depending on the distance between the object and the tip of the
scope.
• Optical fibers surrounding the rod lenses transmit illumination to the
object from an external light source connected to the rigid scope via a
fiber-optic light cable

Ms.Oinam Robita Chanu 6

Cont.
• During a procedure, the object can be viewed directly through the
eyepiece.
• In practice, the eyepiece is often coupled to a video camera and the
images are displayed on a video monitor
• Rigid endoscopes are commonly used in urology, gynecology, ENT,
arthroscopy, endoscopic spine surgery and general surgery

Ms.Oinam Robita Chanu 7

Flexible Endoscope
• Instead of a rigid shaft, a flexible fiberscope has a long flexible
insertion tube connected to a proximal housing
• Flexible endoscopes can be inserted into curved orifices of organs
such as colon, lung, and stomach.
• To facilitate scope insertion and viewing, wires running from the
control head to the distal tip enable the user to angulate the distal
end of the insertion tube
• Common areas of use include: bronchoscopy, colonoscopy and
viewing of the upper gastroenterological systems

Ms.Oinam Robita Chanu 8

Cont.

Ms.Oinam Robita Chanu 9

Cont.
• A flexible endoscope consists of the following sections:
Insertion tube
Control head
Light guide connector
Universal cord (or light guide tube)
• In a typical fiberscope, the insertion tube contains two bundles of
optical fibers, one for the illumination and the other for the image.
• A water channel, an air channel, and an instrument channel are also
included in the insertion tube
Ms.Oinam Robita Chanu 10
Cont.

Ms.Oinam Robita Chanu 11

Cont.
• During an endoscopic procedure, the physician holds the control head
to manipulate the insertion tube, introducing water or air to flush the
site.
• The control head houses the up/down and left/right angulation
control knobs to move the distal tip of the insertion tube as well as
the air/water and suction control valves.
• The opening of the instrument channel is also located on the control
head

Ms.Oinam Robita Chanu 12

Cont.
• The light guide tube is a flexible tube containing the fiber-optic
bundle for the light source.
• It also has separate air, water, suction, and CO2 channels connected to
those in the insertion tube via valves on the control head.
• The light guide connector houses the adaptor for the fiber-optic
bundle to the light source
• The connectors for air, water, suction, and CO2 (as well as the
electrical connector for videoscope) are also located on the light
guide connector

Ms.Oinam Robita Chanu 13

Cont. (not needed for exam)

Ms.Oinam Robita Chanu 14

Types of Flexible Endoscopes
1. Fiberoptic endoscopes: These have an eyepiece lens that allows the
image to be viewed directly or through a camera mounted on the
endoscope

2. Videoscopes: This kind of endoscope is the response of modern

technology to medicine. With the use of a video chip, images inside
of the body are transmitted directly to a monitor, allowing a clear
view of the area of study

Ms.Oinam Robita Chanu 15

LIGHT SOURCES
• A light source is connected to the illumination light guide of the rigid
or flexible endoscope to provide illumination for viewing the surgical
fields or body cavities.
• Light sources are intended to provide the physician a sufficient level
of visible light for diagnostic observations and surgical procedures.
• A light source usually emits a wide spectrum covering the visible,
infrared, and sometimes ultraviolet radiation.
• Infrared filters are installed in the light source to prevent infrared
radiation from entering the body, which otherwise can cause thermal
burn or even fire
Ms.Oinam Robita Chanu 16
Cont.
• A surgical light source can use a variety of lamps, including xenon,
quartz halogen, metal halide, and mercury vapor.
• Xenon (color temperature from 5,600 to 6,600 K) and quartz halogen
(from 3,200 to 5,500 K) are popular lamps for endoscopic procedures
due to their high intensity and near-daylight spectrum (5,000 to 6,000
K).
• The output intensity of a light source can be adjusted either by an
adjustable aperture or by changing the brightness of the lamp

Ms.Oinam Robita Chanu 17

Cont.
• A typical xenon lamp has an approximate useful life span of 500
operating hours.
• Most lamps require forced cooling to maintain a safe operating
temperature

Ms.Oinam Robita Chanu 18

Types of Endoscopy
Types of Endoscopy Area Examined Name of Endoscope
Arthroscopy Joints Arthroscope
Bronchoscopy Lungs Bronchoscope
Colonoscopy Colon Colonoscope
Cystoscopy Bladder Cystoscope
Enteroscopy Small intestine Enteroscope
Hysteroscopy Inside of the uterus Hysteroscope
Laparoscopy Abdominal or pelvic area Laparoscope
Laryngoscopy Larynx Laryngoscope
Mediastinoscopy Mediastinum, the area between the lungs Mediastinoscope
Sigmoidoscopy Sigmoid colon (bottom part of the colon) Sigmoidoscope
Thoracoscopy, also Area between the lungs and the chest wall Thoracoscope
known as a
Pleuroscopy
Ms.Oinam Robita Chanu 19
Cont.
Types Area Examined Name of Endoscope
Upper gastrointestinal esophagus and upper intestinal Gastroscope
endoscopy tract
Ureteroscopy Urinary tract Ureteroscope
Proctoscopy Rectum and sigmoid colon Proctoscope
Colposcopy Vagina and cervix Colposcope

Ms.Oinam Robita Chanu 20

Laparoscope
• A laparoscope is an example of a rigid endoscope
• A viewing laparoscope employs a series of rod lenses to convey high-
resolution, wide field of view images to the eyepiece.
• Objects seen through a laparoscope may be magnified or reduced
depending on the distance between the object and the tip of the
scope.
• Optical fibers surrounding the rod lenses transmit illumination to the
object from an external light source connected to the laparoscope via
a fiber-optic light cable

Ms.Oinam Robita Chanu 21

Cont.
• An insufflator is connected to the laparoscope or the trocar via an air
hose.
• Through an air channel in the shaft of the laparoscope (or the trocar),
N2O or CO2 gas is injected into the abdominal cavity.
• The external diameter of a typical viewing laparoscope ranges from 5
to 10 mm
• In an operating laparoscope, the eyepiece is offset from the shaft (by
a set of prisms) to allow insertion of the instrument through a
separate instrument channel in the shaft
• The external diameter of a typical operating laparoscope ranges from
8 to 12 mm

Ms.Oinam Robita Chanu 22

Cont.
• During a procedure, the object can be viewed directly through the
eyepiece.
• In practice, the eyepiece is often coupled to a video camera and the
images are displayed on a video monitor

Ms.Oinam Robita Chanu 23

Gastroscope
• Gastroscope is an example of a flexible endoscope
• It is a flexible plastic tube approximately four feet long and one half inch
wide.
• It contains optic fibers with a light source that allow the gastroscope to
function like a video camera.
• The doctor uses this to see the swallowing tube (esophagus), stomach, and
part of the small intestines (duodenum).
• The gastroscope also has a hollow channel or tunnel throughout its entire
length.
• The tunnel provides a way for the doctor to give medications or biopsy the
swallowing tube, stomach, or small intestines to diagnose and treat certain
conditions
Ms.Oinam Robita Chanu 24
Cont.

Ms.Oinam Robita Chanu 25

Bronchoscope
• Bronchoscope- An instrument is inserted into the airways, usually
through the nose or mouth, or occasionally through a tracheostomy
• Two Types
1. A rigid bronchoscope is a straight, hollow, metal tube
Doctors perform rigid bronchoscopy less often today, but it remains
the procedure of choice for removing foreign material and for several
other treatments
Rigid bronchoscopy also becomes useful when bleeding interferes
with seeing the area

Ms.Oinam Robita Chanu 26

Cont.
2. A flexible bronchoscope is a long thin tube that contains small clear
fibers that transmit light images as the tube bends
Its flexibility allows this instrument to reach further points in an
airway than rigid bronchoscopy
The procedure can be performed easily and safely under local
anesthesia

Ms.Oinam Robita Chanu 27

Latest Endoscopic Technology
• Capsule endoscopy
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Chromoendoscopy
• Endoscopic ultrasound (EUS)
• Endoscopic mucosal resection (EMR)
• Narrow band imaging (NBI)

Ms.Oinam Robita Chanu 28

Capsule endoscopy
• A revolutionary procedure known as a capsule endoscopy may be
used when other tests aren’t conclusive.
• During a capsule endoscopy, you swallow a small pill with a tiny
camera inside.
• The capsule passes through your digestive tract, without any
discomfort to you, and creates thousands of images of the intestines
as it moves through

Ms.Oinam Robita Chanu 29

Ms.Oinam Robita Chanu 30
Endoscopic retrograde
cholangiopancreatography (ERCP)
• ERCP combines X-rays with upper GI endoscopy to diagnose or treat
problems with the bile and pancreatic ducts.

Ms.Oinam Robita Chanu 31

Chromoendoscopy
• Chromoendoscopy is a technique that uses a specialized stain or dye
on the lining of the intestine during an endoscopy procedure.
• The dye helps the doctor better visualize if there’s anything abnormal
on the intestinal lining

Ms.Oinam Robita Chanu 32

Endoscopic ultrasound (EUS)
• EUS uses an ultrasound in conjunction with an endoscopy.
• This allows doctors to see organs and other structures that aren’t
usually visible during a regular endoscopy.
• A thin needle can then be inserted into the organ or structure to
retrieve some tissue for viewing under a microscope.
• This procedure is called fine needle aspiration

Ms.Oinam Robita Chanu 33

Endoscopic mucosal resection (EMR)
• EMR is a technique used to help doctors remove cancerous tissue in
the digestive tract.
• In EMR, a needle is passed through the endoscope to inject a liquid
underneath the abnormal tissue.
• This helps separate the cancerous tissue from the other layers so it
can be more easily removed

Ms.Oinam Robita Chanu 34

Narrow band imaging (NBI)
• NBI uses a special filter to help create more contrast between vessels
and the mucosa.
• The mucosa is the inner lining of the digestive tract

Ms.Oinam Robita Chanu 35

Arthroscopy
• Arthroscopy is a surgical procedure orthopaedic surgeons
use to visualize, diagnose, and treat problems inside a joint.
• The word arthroscopy comes from two Greek words,
"arthro" (joint) and "skopein" (to look).
• The term literally means "to look within the joint”
• In an arthroscopic examination, an orthopaedic surgeon
makes a small incision in the patient's skin and then inserts
pencil-sized instruments that contain a small lens and
lighting system to magnify and illuminate the structures
inside the joint
Ms.Oinam Robita Chanu 36
Contd.

Ms.Oinam Robita Chanu 37

Cont.
• Light is transmitted through fiber optics to the end of the arthroscope
that is inserted into the joint
• By attaching the arthroscope to a miniature television camera, the
surgeon is able to see the interior of the joint through this very small
incision rather than a large incision needed for surgery
• The television camera attached to the arthroscope displays the image
of the joint on a television screen, allowing the surgeon to look, for
example, throughout the knee.
• This lets the surgeon see the cartilage, ligaments, and under the
kneecap.

Ms.Oinam Robita Chanu 38

Cont.
• The surgeon can determine the amount or type of injury and then
repair or correct the problem, if it is necessary
• Arthroscope is an example for rigid endoscope

Ms.Oinam Robita Chanu 39

Reference
• Biomedical device technology- principles and design by Anthony y. k.
chan

Ms.Oinam Robita Chanu 40