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Instrumentation

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Abstract

When most veterinary surgeons hear the term , they think of a flexible endoscope being used to examine the upper or lower gastrointestinal (GI) tract. In reality, the general term endoscopy means 'to look inside', and refers to an almost endless number of applications that make use of both flexible and rigid endoscopes. To name a few, GI endoscopy, bronchoscopy, cystoscopy, rhinoscopy, arthroscopy, laparoscopy and thoracoscopy are all endoscopic procedures performed by doctors and veterinary surgeons using flexible or rigid endoscopes, depending upon the anatomy, available equipment and preference of the surgeon. This chapter considers Flexible endoscopes; Rigid endoscopes; The endoscope system; The endoscopy team and theatre set up; and Care, cleaning, storage and maintenance.

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Figures

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2.1 A flexible video-endoscope with 4-way tip deflection. (©Karl Storz GmbH & Co. KG)
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2.2 Fibrescope (2.7 mm diameter, 100 cm long) with 2-way tip deflection. (©Karl Storz GmbH & Co. KG)
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2.3 Tip deflection in a gastroscope. Up/down deflection. Right/left deflection. (©Karl Storz GmbH & Co. KG)
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2.4 Video-gastroscope handpiece. (©Karl Storz GmbH & Co. KG)
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2.5 Leakage tester. (©Karl Storz GmbH & Co. KG)
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2.6 Fibrescope (5.2 mm diameter, 85 cm long) with 2-way tip deflection. (©Karl Storz GmbH & Co. KG)
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2.7 Video-endoscope attached to a video processor, light source and irrigation bottle. (©Karl Storz GmbH & Co. KG)
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2.8 Fibreoptic image with broken fibres. (©Karl Storz GmbH & Co. KG)
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2.9 Flexible instruments. (Reproduced from with permission from the publisher)
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2.10 Rigid endoscopes (telescopes). (©Karl Storz GmbH & Co. KG)
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2.11 HOPKINS rod lens system and a conventional optical system. (©Karl Storz GmbH & Co. KG)
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2.12 Telescope viewing angles. 0 degrees. 30 degrees. (©Karl Storz GmbH & Co. KG)
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2.13 Rod lens otoscope (5 mm diameter with an integrated channel of 5 Fr). Cystoscope/rhinoscope (9.5 Fr diameter with an integrated channel of 3 Fr). Operating laparoscope (10 mm diameter with a 5 mm integrated channel). (©Karl Storz GmbH & Co. KG)
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2.14 Semi-rigid endoscope (1 mm diameter, 20 cm long). (©Karl Storz GmbH & Co. KG)
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2.15 Multi-Purpose Rigid™ endoscope. Top down: Examination and protection sheath, arthroscopy sheath, laparoscopy trocar and operating sheath. Laparoscopic ovariectomy in a puppy. (©Karl Storz GmbH & Co. KG)
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2.16 Laparoscope (5 mm diameter) (right) with a standard trocar/cannula (middle) and EndoTIP cannula (left). (©Karl Storz GmbH & Co. KG)
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2.17 Canine arthroscope (1.9 mm diameter) in sheath with sharp and blunt obturators. Extended length cystoscope (29 cm working length, 17 Fr outer diameter). Rigid endoscope (2.9 mm diameter, 36 cm long) with optical grasping forceps. (©Karl Storz GmbH & Co. KG)
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2.18 Multi-Purpose Rigid™ endoscope with operating sheath and biopsy forceps. Tips of a variety of 5 Fr flexible instruments. (©Karl Storz GmbH & Co. KG)
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2.19 Multi-Purpose Rigid™ endoscope (2.7 mm diameter) in operating sheath (left) and arthroscope sheath (right). (©Karl Storz GmbH & Co. KG)
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2.20 Biopsy forceps for use alongside a telescope. (©Karl Storz GmbH & Co. KG)
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2.21 Standard laparoscopy cannula and trocar. (©Karl Storz GmbH & Co. KG)
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2.22 Telescope through cannula used for laparoscopy and thoracoscopy. (©Karl Storz GmbH & Co. KG)
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2.23 EndoTIP cannulae require no trocar for entry. (©Karl Storz GmbH & Co. KG)
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2.24 Rigid instruments used for laparoscopy and thoracoscopy. Laparoscopic palpation probe, grasping forceps and biopsy forceps. (©Karl Storz GmbH & Co. KG)
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2.25 Laparoscopic surgery using a 5 mm laparoscope and EndoTIP cannula. Note the use of disposable forceps for coagulation and cutting. (©Karl Storz GmbH & Co. KG)
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2.26 Halogen light source with built-in air pump for insufflation. Fibreoptic light-transmitting cable. (©Karl Storz GmbH & Co. KG)
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2.27 The video chain starts with a light source and ends with a video monitor. (©Karl Storz GmbH & Co. KG)
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2.28 Xenon light source (175 watt) with a connector for a simple fibreoptic light cable. Xenon light source (100 watt) with a built-in air pump and connection for a gastroscope. (©Karl Storz GmbH & Co. KG)
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2.29 Hand-held light source attached to a rod lens otoscope. (©Karl Storz GmbH & Co. KG)
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2.30 Air pump designed for insufflation during GI endoscopy. (©Karl Storz GmbH & Co. KG)
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2.31 Carbon dioxide insufflator designed for laparoscopy. (©Karl Storz GmbH & Co. KG)
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2.32 Veress needle. The blunt hollow stylet protrudes through the sharp outer needle. The sharp outer needle with the spring-loaded stylet retracted. (©Karl Storz GmbH & Co. KG)
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2.33 VETPUMP2 suitable for insufflation, irrigation and suction. (©Karl Storz GmbH & Co. KG)
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2.34 An arthropump accurately regulates the flow rate and pressure of sterile fluids needed to distend the joint space during arthroscopy. (©Karl Storz GmbH & Co. KG)
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2.35 Basic endoscopic video system. Clockwise (bottom left): camera head, camera control unit, xenon light source with fibreoptic cable and video monitor. Endo-video camera attached to a rigid endoscope. Endo-video camera attached to a fibrescope. (©Karl Storz GmbH & Co. KG)
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2.36 Video cables. (©Karl Storz GmbH & Co. KG)
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2.37 The AIDA DVD system is a digital image capture device. The TELE PACK compact, portable endoscopy system includes a camera, light source, keyboard, digital capture system and integrated flat screen monitor in one unit. (©Karl Storz GmbH & Co. KG)
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2.38 An electrosurgical generator can be used for both endoscopic and open surgery. (©Karl Storz GmbH & Co. KG)
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2.39 LigaSure vessel sealing device (manufactured by Tyco). (©Karl Storz GmbH & Co. KG)
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2.40 Hotblade disposable bipolar cutting and coagulation instrument (manufactured by Patton Surgical). (©Karl Storz GmbH & Co. KG)
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2.41 Motorized arthroscopic shaver system with handpieces and blades. (©Karl Storz GmbH & Co. KG)
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2.42 Mobile cart with monitor, digital capture device, camera and light source. Mobile cart with flat screen monitor, camera, light source, digital capture device, carbon dioxide insufflator, arthropump and VETPUMP2. (©Karl Storz GmbH & Co. KG)
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2.43 Room set up for gastroscopy. Room set up for laparoscopy in left lateral recumbency. Room set up for laparoscopy in dorsal recumbency. This is the ideal set up for multiple surgeons or procedures where the surgeon must move from one side of the patient to the other. Note the additional monitors. (©Karl Storz GmbH & Co. KG)
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2.44 Cleaning brushes for endoscopes and instruments. (©Karl Storz GmbH & Co. KG)
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2.45 Sterilization and storage tray for rigid endoscopes and instruments. (©Karl Storz GmbH & Co. KG)
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2.46 Mobile cart with video-endoscope stored in a hanging position to maximize drainage and reduce stress on glass fibres. (©Karl Storz GmbH & Co. KG)

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