Endoscopy

Emma Barty; Philip Lhermette

doi:10.22233/9781905319725.10

Endoscopy

British Small Animal Veterinary Association , 195 (2008); https://doi.org/10.22233/9781905319725.10

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Endoscopy

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Authors: Emma Barty and Philip Lhermette
From: BSAVA Manual of Canine and Feline Advanced Veterinary Nursing
Item: Chapter 10, pp 195 - 219
DOI: 10.22233/9781905319725.10
Copyright: © 2008 British Small Animal Veterinary Association
Publication Date: January 2008

Abstract

The word endoscopy literally means to ‘look inside’, and instruments have been available for many years to enable physicians to peer into various body cavities and take diagnostic samples. More sophisticated instrumentation has now greatly increased the scope and usefulness of these techniques to include interventional surgery. As equipment costs come down, endoscopy is being integrated into many veterinary practices as a routine procedure. This chapters discusses Principles of flexible and rigid endoscopy; Care and maintenace; Flexible endoscope procedures; and Rigid endoscope procedures.

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Figures

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10.1

(a) Umbilicus of a flexible endoscope. The probes on the right connect to the light source for provision of light and insufflation. The side connectors are for attaching the wash bottle and suction, and for cleaning. (b) Leak tester that can be attached to the endoscope before cleaning to check the integrity of the seals. Entry of fluid into the endoscope is a potentially catastrophic event. © 2008 British Small Animal Veterinary Association

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10.1 (a) Umbilicus of a flexible endoscope. The probes on the right connect to the light source for provision of light and insufflation. The side connectors are for attaching the wash bottle and suction, and for cleaning. (b) Leak tester that can be attached to the endoscope before cleaning to check the integrity of the seals. Entry of fluid into the endoscope is a potentially catastrophic event.

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10.2

Handpiece of a gastroscope. This shows two rings, which allow four-way deflection of the tip, together with an instrument channel, and buttons for insufflation/irrigation and suction. © 2008 British Small Animal Veterinary Association

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10.2 Handpiece of a gastroscope. This shows two rings, which allow four-way deflection of the tip, together with an instrument channel, and buttons for insufflation/irrigation and suction.

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10.3

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10.3 Handpiece of a bronchoscope. There is a single control to allow two-way deflection of the tip.

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10.4

Tip of the insertion tube of a gastroscope. There is a single lens for image collection, two lenses for illumination, a large combined channel for instruments/suction and a smaller channel for insufflation/irrigation. © 2008 British Small Animal Veterinary Association

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10.4 Tip of the insertion tube of a gastroscope. There is a single lens for image collection, two lenses for illumination, a large combined channel for instruments/suction and a smaller channel for insufflation/irrigation.

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10.6

Fields of view for angled rigid endoscopes. (a) The most commonly used veterinary endoscopes are 0 and 30 degrees. (b) Relation between angle of view and field of view in a rigid endoscope. © 2008 British Small Animal Veterinary Association

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10.6 Fields of view for angled rigid endoscopes. (a) The most commonly used veterinary endoscopes are 0 and 30 degrees. (b) Relation between angle of view and field of view in a rigid endoscope.

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10.7

Ancillary equipment. (a) Light source. This example is adaptable for both rigid and flexible endoscopy (the adaptor for flexible endoscopy is in place). (b) Combined suction/irrigation device. The large bottle on the left is for collection of aspirated fluids and the smaller bottle on the left is a fluid trap to protect the suction pump. The bottle on the right is the wash bottle for irrigation. (c) Camera head for attachment to the eyepiece of a rigid endoscope. Adaptors are available for connection to flexible endoscopes. (d) Automatic carbon dioxide insufflator. There are controls for selected intracavitory pressure and maximum gas flow rate, and displays for actual intracavitory pressure, instantaneous gas flow and total volume used during the procedure. The gas cylinder connector is not shown. (e) Electrosurgery unit suitable for connection to instruments for open or endoscopic surgery. © 2008 British Small Animal Veterinary Association

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10.7 Ancillary equipment. (a) Light source. This example is adaptable for both rigid and flexible endoscopy (the adaptor for flexible endoscopy is in place). (b) Combined suction/irrigation device. The large bottle on the left is for collection of aspirated fluids and the smaller bottle on the left is a fluid trap to protect the suction pump. The bottle on the right is the wash bottle for irrigation. (c) Camera head for attachment to the eyepiece of a rigid endoscope. Adaptors are available for connection to flexible endoscopes. (d) Automatic carbon dioxide insufflator. There are controls for selected intracavitory pressure and maximum gas flow rate, and displays for actual intracavitory pressure, instantaneous gas flow and total volume used during the procedure. The gas cylinder connector is not shown. (e) Electrosurgery unit suitable for connection to instruments for open or endoscopic surgery.

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10.8

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10.8 Arthroscopic shaver system. The disposable handpieces are seen on the top of the equipment and the foot pedal is in front of it.

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10.9

(a) Diode laser with coiled laser fibre attached. A handpiece is shown which can be removed when the fibre is used endoscopically. The aiming laser (not the surgical laser) is illuminated at the tip. (b) Specialized eye protection such as these goggles must be worn whenever the laser is in use. © 2008 British Small Animal Veterinary Association

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10.9 (a) Diode laser with coiled laser fibre attached. A handpiece is shown which can be removed when the fibre is used endoscopically. The aiming laser (not the surgical laser) is illuminated at the tip. (b) Specialized eye protection such as these goggles must be worn whenever the laser is in use.

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10.10

Accessory instruments for flexible endoscopy. (a) The tips of a pair of serrated flexible biopsy forceps. (b) Polypectomy snare used to encircle the base of a polypoid mass or to retrieve foreign bodies. (c) Three-pronged grasping forceps used to retrieve foreign bodies. © 2008 British Small Animal Veterinary Association

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10.10 Accessory instruments for flexible endoscopy. (a) The tips of a pair of serrated flexible biopsy forceps. (b) Polypectomy snare used to encircle the base of a polypoid mass or to retrieve foreign bodies. (c) Three-pronged grasping forceps used to retrieve foreign bodies.

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10.11

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10.11 Cystoscopy sheath for a rigid endoscope, with two irrigation/insufflation ports and an instrumentation channel.

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10.12

Additional instruments for laparoscopy and thoracoscopy. (a) Reusable laparoscopic cannula with sharp trocar (assembled above; disassembled below). (b) Ternamian Endotip® cannula. The threaded cannula allows controlled insertion and retains the cannula in the body wall during the procedure. The insert shows tip detail. (c) Palpation probe. Note the blunt tip (left) and graduations to allow assessment of lesion size and depth. (d) Babcock forceps (5 mm), such as might be used to grasp the ovary or stomach wall. © 2008 British Small Animal Veterinary Association

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10.12 Additional instruments for laparoscopy and thoracoscopy. (a) Reusable laparoscopic cannula with sharp trocar (assembled above; disassembled below). (b) Ternamian Endotip® cannula. The threaded cannula allows controlled insertion and retains the cannula in the body wall during the procedure. The insert shows tip detail. (c) Palpation probe. Note the blunt tip (left) and graduations to allow assessment of lesion size and depth. (d) Babcock forceps (5 mm), such as might be used to grasp the ovary or stomach wall.

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10.13

Additional instruments for arthroscopy. (a) Arthroscopic forceps, such as might be used to grasp cartilage flaps or bone fragments. (b) Arthroscopic cannulae (centre) with trocars (left and right), a spare seal and switching sticks (bottom). (c) Jacket into which fluid bags can be placed for pressurized infusion during arthroscopy. © 2008 British Small Animal Veterinary Association

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10.13 Additional instruments for arthroscopy. (a) Arthroscopic forceps, such as might be used to grasp cartilage flaps or bone fragments. (b) Arthroscopic cannulae (centre) with trocars (left and right), a spare seal and switching sticks (bottom). (c) Jacket into which fluid bags can be placed for pressurized infusion during arthroscopy.

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10.14

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10.14 Biopsy tissue cassettes avoid loss of small endoscopic biopsy specimens during transport and processing.

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10.16

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10.16 Cleaning bath for flexible endoscopes with provision for soaking and flushing of channels. (Courtesy of Veterinary Endoscopy Systems, UK Ltd)

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10.18

A T-connector has been placed between the endotracheal tube and the breathing system in this dog, allowing passage of a bronchoscope without disconnecting inhalational anaesthesia. © 2008 British Small Animal Veterinary Association

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10.18 A T-connector has been placed between the endotracheal tube and the breathing system in this dog, allowing passage of a bronchoscope without disconnecting inhalational anaesthesia.

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10.19

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10.19 Video-endoscopic image of a foreign body (piece of rock) in the left mainstem bronchus of a dog.

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10.20

Fibreoptic endoscopic image of a rectal adenocarcinoma in a dog. Note the pixellation in this image, which is due to the fibres in the endoscope, compared with the videoendoscopic image in Figure 10.19 . © 2008 British Small Animal Veterinary Association

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10.20 Fibreoptic endoscopic image of a rectal adenocarcinoma in a dog. Note the pixellation in this image, which is due to the fibres in the endoscope, compared with the videoendoscopic image in Figure 10.19 .

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10.21

Rigid rhinoscopy. (a) Normal turbinates in the ventral meatus of a dog during saline irrigation. (b) Pharyngeal opening of the Eustachian tube (the slit to the left of the image) in a dog. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery ) © 2008 British Small Animal Veterinary Association

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10.21 Rigid rhinoscopy. (a) Normal turbinates in the ventral meatus of a dog during saline irrigation. (b) Pharyngeal opening of the Eustachian tube (the slit to the left of the image) in a dog. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery )

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10.22

Endoscopic image of the vestibule of a bitch, showing the vaginal os dorsally and urethral opening below. Infusion of saline has distended the tissues, making the anatomy accessible. © 2008 British Small Animal Veterinary Association

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10.22 Endoscopic image of the vestibule of a bitch, showing the vaginal os dorsally and urethral opening below. Infusion of saline has distended the tissues, making the anatomy accessible.

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10.23

Treatment of urethral sphincter mechanism incompetence. Injecting bulking agent into the urethral wall using a 23-gauge needle. Note the magnification afforded by the endoscope. © 2008 British Small Animal Veterinary Association

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10.23 Treatment of urethral sphincter mechanism incompetence. Injecting bulking agent into the urethral wall using a 23-gauge needle. Note the magnification afforded by the endoscope.

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10.24

Veress needle. (a) Disassembled, with the outer sharp cannula above and the inner spring-loaded blunt needle below. (b) Assembled. Insufflation tubing is attached to the tap on the right. © 2008 British Small Animal Veterinary Association

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10.24 Veress needle. (a) Disassembled, with the outer sharp cannula above and the inner spring-loaded blunt needle below. (b) Assembled. Insufflation tubing is attached to the tap on the right.

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10.25

Liver biopsy. (a) Examining the liver of a dog using a palpation probe to separate the lobes and assess the texture. The liver in this patient is pale and brown. (b) Immediately following biopsy with cup forceps. Haemorrhage is usually minimal, as in this case. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery ) © 2008 British Small Animal Veterinary Association

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10.25 Liver biopsy. (a) Examining the liver of a dog using a palpation probe to separate the lobes and assess the texture. The liver in this patient is pale and brown. (b) Immediately following biopsy with cup forceps. Haemorrhage is usually minimal, as in this case. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery )

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10.26

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10.26 Kidney biopsy. The spring-loaded needle is passed into the cortex and away from the hilus.

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10.27

Laparoscopic ovariohysterectomy in a bitch. (a) View of the uterus; the bladder is to the right and the bifurcation is seen immediately cranial to this. (b) The uterus exteriorized following transection of the ovarian pedicles and broad ligament. The endoscope is seen in a cannula, close to the umbilicus, on the right of the picture. (c) Abdomen after laparoscopic spay, showing the three portal sites: cranial to the umbilicus; caudal to the umbilicus; and slightly cranial to the pubis. For ovariectomy only the two most cranial ports are required. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery ) © 2008 British Small Animal Veterinary Association

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10.27 Laparoscopic ovariohysterectomy in a bitch. (a) View of the uterus; the bladder is to the right and the bifurcation is seen immediately cranial to this. (b) The uterus exteriorized following transection of the ovarian pedicles and broad ligament. The endoscope is seen in a cannula, close to the umbilicus, on the right of the picture. (c) Abdomen after laparoscopic spay, showing the three portal sites: cranial to the umbilicus; caudal to the umbilicus; and slightly cranial to the pubis. For ovariectomy only the two most cranial ports are required. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery )

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10.28

Laparoscopic removal of a cryptorchid testicle from a dog. The testicle has been retrieved through an enlarged instrument portal. The endoscope is in a portal to the left of the prepuce. Light from the endoscope is seen transilluminating the instrument portal. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery ) © 2008 British Small Animal Veterinary Association

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10.28 Laparoscopic removal of a cryptorchid testicle from a dog. The testicle has been retrieved through an enlarged instrument portal. The endoscope is in a portal to the left of the prepuce. Light from the endoscope is seen transilluminating the instrument portal. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery )

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10.29

Laparoscopic-assisted cystoscopy in a dog. View from inside the bladder of the urethra at the pelvic flexure; a polyurethrane urethral catheter is seen extending into the bladder. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery ) © 2008 British Small Animal Veterinary Association

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10.29 Laparoscopic-assisted cystoscopy in a dog. View from inside the bladder of the urethra at the pelvic flexure; a polyurethrane urethral catheter is seen extending into the bladder. (Reproduced from the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery )

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10.30

Elbow arthroscopy: fragmented coronoid process in a dog. Note the disrupted articular cartilage of the coronoid process in the lower half of the image, compared with the intact cartilage of the humeral condyle in the upper part. © 2008 British Small Animal Veterinary Association

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10.30 Elbow arthroscopy: fragmented coronoid process in a dog. Note the disrupted articular cartilage of the coronoid process in the lower half of the image, compared with the intact cartilage of the humeral condyle in the upper part.

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10.31

Elbow arthroscopy: dog positioned in semidorsal recumbency and draped for a medial approach to the left elbow. Saline has been injected to distend the joint (the syringe on the left) and a needle has been placed cranial to this to establish the access for the arthroscope. © 2008 British Small Animal Veterinary Association

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10.31 Elbow arthroscopy: dog positioned in semidorsal recumbency and draped for a medial approach to the left elbow. Saline has been injected to distend the joint (the syringe on the left) and a needle has been placed cranial to this to establish the access for the arthroscope.

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10.32

Shoulder arthroscopy: osteochondrosis dissecans in a dog. A large fragment of articular cartilage is seen, separated from the underlying humeral head (below) by an obvious cleft. © 2008 British Small Animal Veterinary Association

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10.32 Shoulder arthroscopy: osteochondrosis dissecans in a dog. A large fragment of articular cartilage is seen, separated from the underlying humeral head (below) by an obvious cleft.