Successful Training in Gastrointestinal Endoscopy. Группа авторов. Читать онлайн. Newlib. NEWLIB.NET

Автор: Группа авторов
Издательство: John Wiley & Sons Limited
Серия:
Жанр произведения: Медицина
Год издания: 0
isbn: 9781119529682
Скачать книгу
hand at about 10 cm with the index finger down near the tip. The scope tip is then positioned at the anal canal at roughly a 45° angle. The index finger then gently pushes the tip of the scope though the anal canal and the scope is then advanced. This technique gives better control of the tip during insertion. With this technique and the next, the second (outer) glove on the right hand remains on until after scope insertion and can then be removed and discarded.

      2 Along‐side finger: The right index finger is inserted into the anal canal and the scope is inserted alongside this as the finger is withdrawn.

      3 Straight insertion: The scope is held with the right hand at about 20 cm from the tip and is positioned perpendicular to the anal canal. The scope tip is then inserted straight into the rectum. This is probably the most direct approach and most commonly used method.

      Scope advancement

      Once in the rectum, the objective is to advance the scope quickly and safely to the cecum. In order to accomplish this, the endoscopist needs to be able to steer the scope tip in the direction desired. This is done with a combination of the scope dials as well as torque of the scope. Being able to locate the colonic lumen when lost is also a mandatory early skill. Barring looping of the scope or tight angulations, the cecum can sometimes be reached with these simple techniques alone. Other skills such as loop reduction, navigation of angulated turns, and terminal ileum (TI) intubation will be covered later in this chapter.

      Tip control

      Torque

      Scope advancement techniques

Photo depicts torque to change from horizontal to vertical. Photo depicts one-handed technique. With the one-handed advancement technique, all of the dial control is done by the left hand, primarily using the large dial. The right hand is responsible for providing torque and advancement, and generally does not leave the scope shaft. Photo depicts two-handed technique. With the two-handed technique, the right hand is moved back and forth between the shaft of the scope and the small right/left dial, while the left thumb controls the large inner dial.