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Rigid and flexible scopes

The move towards minimally invasive surgical procedure has brought about a host of different of diagnosing and treating many conditions using scopes. 

There are 2 main types of surgical scopes:

• Rigid telescopes
• Flexible scopes

Rigid telescopes

Direct visualisation of a diseased area inside the body can be achieved by using a telescope or tube passed through a natural orifice or through a small incision in the skin. This may be rigid employing a series of lenses, or flexible employing optic fibres to convey the illuminating light, and to convey the image to the eyepiece.

The endoscope is often fitted with one or more extra channels through which operating instruments may be passed such as electrosurgery probes, or manipulating, grasping or crushing forceps. These channels may also be used for delivering fluids or gas, providing suction, or passing sampling catheters or laser light pipes.

Rigid endoscopic procedures

In general, htese procedures allow only for the observation of the larynx along a vertical axis. This has limitations concerning diagnosis, physiopathological interpretation of diseases, treatment and follow-up.

Research work on laryngeal microanatomy reinforces the need to assess the larynx in different perspectives to improve the evaluation of pathology. This led to the systematic use of rigid endoscopes with different angles of vision (0º, 30º, 70º and 120º) during microlaryngoscopy, performed with conventional endotracheal intubation.

Rigid Endoscopy associated with Microlaryngeal Surgery (REMS) significantly enhances the ability to assess the endolarynx, offers high quality imaging even of regions that are traditionally difficult to explore: the inferior surface and free border of the vocal cord, the anterior commissure, ventricle and subglottis.

Flexible scopes

In the case of flexible endoscopes the operating handle may also include controls for manipulating the tip to the site required.

There is almost no part of the body not accessible for endoscopic viewing or treatment, and typical sites include the ear, throat, urinary tract, lungs, intestines and abdominal cavity.

Scope Procedures

Colposcopy

This is a means of viewing the cervix, vagina and/or vulva with a microscope.

The microscope does not go inside you. By using the microscope and a special wash solution (weak vinegar), the physician may be able to identify any abnormal cells. This examination is called colposcopy.

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Laparoscopy

Laparoscopy is direct visualisation of the peritoneal cavity, ovaries, outside of the tubes and uterus by using a laparoscope. The laparoscope is an instrument somewhat like a miniature telescope with a fibre optic system which brings light into the abdomen.  It is about as big around as a fountain pen and twice as long.

An instrument to move the uterus during surgery will be placed in the vagina. Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. The gas is removed at the end of the procedure.

Microlaparoscopy

This is a new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal. If this procedure is appropriate for the condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.

Endoscopy

Endoscopy is a medical procedure that enables a physician to look at the gastrointestinal tract with a flexible instrument called an endoscope. Endoscopic procedures are used to diagnose ailments, to screen for diseases such as colorectal cancer, to remove foreign bodies, and to treat many diseases and conditions of the GI tract, bile duct and pancreas.

Colonoscopy

Colonoscopy enables the doctor to examine the lining of the colon (large intestine) for abnormalities by inserting a flexible tube as thick as a finger into the anus and slowly advancing it into the rectum and colon.

In general, the preparation consists of either consuming a large volume of a special cleansing solution or clear liquids and special oral laxatives. The colon must be completely clean for the procedure to be accurate and complete.  Colonoscopy is well-tolerated and rarely causes much pain. The patient might feel pressure, bloating or cramping during the procedure. A sedative to may be given to help relax the patient and therefore better tolerate any discomfort.  The procedure itself usually takes 15 to 60 minutes.

If the doctor thinks an area needs further evaluation, he or she might pass an instrument through the colonoscope to obtain a biopsy (a sample of the colon lining) to be analysed. Biopsies are used to identify many conditions, and the doctor might order one even if he or she doesn't suspect cancer. If colonoscopy is being performed to identify sites of bleeding, the doctor might control the bleeding through the colonoscope by injecting medications or by coagulation (sealing off bleeding vessels with heat treatment). The doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don't usually cause any pain.

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. The doctor can't always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she might send removed polyps for analysis. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer.  The doctor might destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. He/She may also use a technique called "snare polypectomy" to remove larger polyps. That technique involves passing a wire loop (snare) through the colonoscope and removing the polyp from the intestinal wall using an electrical current.  The patient should feel no pain during the polypectomy.

Flexible sigmoidoscopy

Flexible sigmoidoscopy lets the doctor examine the lining of the rectum and a portion of the colon (large intestine) by inserting a flexible tube about the thickness of a finger into the anus and slowly advancing it into the rectum and lower part of the colon.

In general, preparation consists of one or two enemas prior to the procedure but could include laxatives or dietary modifications as well. However, in some circumstances the doctor might advise you to forgo any special preparation.

Flexible sigmoidoscopy is usually well-tolerated. The patient might experience a feeling of pressure, bloating or cramping during the procedure. The patient lies on their side while the doctor advances the sigmoidoscope through the rectum and colon. As the doctor withdraws the instrument, he will carefully examine the lining of the intestine.

If the doctor sees an area that needs further evaluation, he might take a biopsy (sample of the colon lining) to be analysed. Biopsies are used to identify many conditions, and he might order one even if he or she doesn't suspect cancer.

If the doctor finds polyps, he or she might take a biopsy of them as well. Polyps, which are growths from the lining of the colon, vary in size and types. Polyps known as "hyperplastic" might not require removal, but benign polyps known as "adenomas" are potentially precancerous. The doctor might ask the patient to have a colonoscopy (a complete examination of the colon) to remove any large polyps or any small adenomas.

After the procedure, the patient might feel bloating or some mild cramping because of the air that was passed into the colon during the examination. This will disappear quickly when they pass gas. Rectal bleeding can occur several days after the biopsy.