Endoscopy
Encyclopedia
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope (ˈɛndəskoʊp), an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. Endoscopy can also refer to using a borescope
in technical situations where direct line of-sight observation is not feasible.
.
An Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrumnt called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.
in Mainz with his introduction of a "Lichtleiter" (light conductor) "for the examinations of the canals and cavities of the human body". However, the Vienna Medical Society disapproved of such curiosity. An endoscope was first introduced into a human in 1822 by William Beaumont
, an army surgeon at Mackinac Island, Michigan
. The use of electric light was a major step in the improvement of endoscopy. The first such lights were external. Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope
by Charles David in 1908. Hans Christian Jacobaeus
has been given credit for early endoscopic explorations of the abdomen and the thorax with laparoscopy
(1912) and thoracoscopy
(1910). Laparoscopy was used in the diagnosis of liver
and gallbladder
disease by Heinz Kalk in the 1930s. Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy
. In 1944, Raoul Palmer placed his patients in the Trendelenburg position
after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.
Karl Storz began producing instruments for ENT
specialists in 1945. His intention was to develop instruments which would enable the practitioner to look inside the human body. The technology available at the end of the Second World War was still very modest: The area under examination in the interior of the human body was illuminated with miniature electric lamps; alternatively, attempts were made to reflect light from an external source into the body through the endoscopic tube. Karl Storz pursued a plan: He set out to introduce very bright, but cold light into the body cavities through the instrument, thus providing excellent visibility while at the same time allowing objective documentation by means of image transmission. With more than 400 patients and operative samples to his name, which were to play a major role in showing the way ahead, Karl Storz played a crucial role in the development of endoscopy. It was however, the combination of his engineering skills and vision, coupled with the work of optical designer Harold Hopkins that ultimately would revolutionize the field of medical optics.
The gastroscope with camera was developed in 1950 by a Japanese team of a doctor and optical engineers. Mutsuo Sugiura, in association with Olympus Corporation
, worked with Dr. Tatsuro Uji and his subordinate, Shoji Fukami, to develop what he first called a "gastro camera". It consisted of a tiny camera attached to a flexible tip with a light bulb. With it, they were able to photograph stomach ulcers that were undetectable by X-ray and find stomach cancers in early stage.
designed a “fibroscope” (a bundle of flexible glass fibres able to coherently transmit an image), which proved useful both medically and industrially. The subsequent research and development of these fibres, led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source - thereby achieving the high level of full spectrum illumination that was needed for detailed viewing and colour photography. (The previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output at the risk of burning the inside of the patient.) Alongside the advances to the optical side, came the ability to 'steer' the tip via controls in the endoscopists hands and innovations in remotely operated surgical instruments contained within the body of the endoscope itself. It was the beginning of key-hole surgery as we know it today.
Fernando Alves Martins, from Portugal, invents the first fibre optics endoscope (1963/64)
in Germany.
Fortunately, both perforation and bleeding are extremely rare during gastroscopy.
Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems.
Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful.
While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently.
A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.
.
Borescope
A borescope is an optical device consisting of a rigid or flexible tube with an eyepiece on one end, an objective lens on the other linked together by a relay optical system in between. The optical system is usually surrounded by optical fibers used for illumination of the remote object...
in technical situations where direct line of-sight observation is not feasible.
Components
An endoscope can consist of- a rigid or flexible tube
- a light delivery system to illuminate the organOrgan (anatomy)In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...
or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiberOptical fiberAn optical fiber is a flexible, transparent fiber made of a pure glass not much wider than a human hair. It functions as a waveguide, or "light pipe", to transmit light between the two ends of the fiber. The field of applied science and engineering concerned with the design and application of...
system - a lensLens (optics)A lens is an optical device with perfect or approximate axial symmetry which transmits and refracts light, converging or diverging the beam. A simple lens consists of a single optical element...
system transmitting the imageImageAn image is an artifact, for example a two-dimensional picture, that has a similar appearance to some subject—usually a physical object or a person.-Characteristics:...
to the viewer from the objective lens to the viewer, typically a relay lensRelay lensIn optics, a relay lens is a lens or lens group that inverts an image and extends the optical tube. Relay lenses are found in endoscopes and periscopes for the purpose of extending the system, and before eyepieces for the purpose of inverting an image...
system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscopeFiberscopeA fiberscope is a flexible fiber optic bundle with an eyepiece at one end, and a lens at the other. It is used for inspection work, often to examine small components in tightly packed equipment, when the inspector cannot easily access the part requiring inspection.The lens is often a wide-angle... - an eyepieceEyepieceAn eyepiece, or ocular lens, is a type of lens that is attached to a variety of optical devices such as telescopes and microscopes. It is so named because it is usually the lens that is closest to the eye when someone looks through the device. The objective lens or mirror collects light and brings...
- an additional channel to allow entry of medical instruments or manipulators
.
Uses
Endoscopy can involve- The gastrointestinal tractGastrointestinal tractThe human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
(GI tract):- esophagusEsophagusThe esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
, stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and duodenumDuodenumThe duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...
(esophagogastroduodenoscopyEsophagogastroduodenoscopyFor other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...
) - small intestineSmall intestineThe small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
(enteroscopyEnteroscopyEnteroscopy is the procedure of using an enteroscope for the direct visualization of small bowel.*video chip endoscope**Double-balloon enteroscopy**Single-balloon enteroscopy**Spiral enteroscopy*wireless endoscopy system**Capsule endoscopy...
) - large intestineLarge intestineThe large intestine is the third-to-last part of the digestive system — — in vertebrate animals. Its function is to absorb water from the remaining indigestible food matter, and then to pass useless waste material from the body...
/colonColon (anatomy)The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
(colonoscopyColonoscopyColonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
, sigmoidoscopySigmoidoscopySigmoidoscopy From Greek Sigma - eidos - scopy, to look inside an s-like object, is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope,...
) - Magnification endoscopy
- bile ductBile ductA bile duct is any of a number of long tube-like structures that carry bile.Bile, required for the digestion of food, is excreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct to form the common bile duct, which opens into the intestine.The...
- endoscopic retrograde cholangiopancreatographyEndoscopic retrograde cholangiopancreatographyEndoscopic retrograde cholangiopancreatography is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems...
(ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy
- endoscopic retrograde cholangiopancreatography
- esophagus
-
- rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
(rectoscopy) and anusAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
(anoscopyAnoscopyAn anoscopy is an examination using a small, rigid, tubular instrument called an anoscope . This is inserted a few inches into to the anus in order to evaluate problems of the anal canal. Anoscopy is used to diagnose hemorrhoids, anal fissures , and some cancers.-Process:This test is usually done...
), both also referred to as (proctoscopyProctoscopyProctoscopy is a common medical procedure in which an instrument called a proctoscope is used to examine the anal cavity, rectum or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end...
)
- rectum
- The respiratory tractRespiratory tractIn humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...
- The noseHuman noseThe visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
(rhinoscopy) - The lower respiratory tractRespiratory tractIn humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...
(bronchoscopyBronchoscopyBronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
)
- The nose
- The earEarThe ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
(otoscopeOtoscopethumb|right|200px|Otoscope - Image of an otoscope thumb|200px|Anatomy of the human ear.thumb|200px|Right tympanic membrane as seen through a speculum.An Otoscope or auriscope is a medical device which is used to look into the ears...
) - The urinary tract (cystoscopyCystoscopyCystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
) - The female reproductive systemReproductive systemThe reproductive system or genital system is a system of organs within an organism which work together for the purpose of reproduction. Many non-living substances such as fluids, hormones, and pheromones are also important accessories to the reproductive system. Unlike most organ systems, the sexes...
(gynoscopy)- The cervixCervixThe cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
(colposcopyColposcopyColposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
) - The uterusUterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
(hysteroscopyHysteroscopyHysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
) - The fallopian tubeFallopian tubeThe Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s (falloposcopy)
- The cervix
- Normally closed body cavities (through a small incision):
- The abdominal or pelvic cavity (laparoscopyLaparoscopyLaparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
) - The interior of a joint (arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
) - Organs of the chest (thoracoscopyThoracoscopyThoracoscopy is a medical procedure involving internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic cavity...
and mediastinoscopyMediastinoscopyMediastinoscopy is a procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy. Mediastinoscopy is often used for staging of lymph nodes of lung cancer or for diagnosing other conditions affecting structures in the mediastinum such as...
)
- The abdominal or pelvic cavity (laparoscopy
- During pregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
- The amnionAmnionThe amnion is a membrane building the amniotic sac that surrounds and protects an embryo. It is developed in reptiles, birds, and mammals, which are hence called “Amniota”; but not in amphibians and fish , which are consequently termed “Anamniota”. The primary role of this is the protection of the...
(amnioscopy) - The fetusFetusA fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
(fetoscopyFetoscopyFetoscopy is an endoscopic procedure during pregnancy to allow access to the fetus, the amniotic cavity, the umbilical cord, and the fetal side of the placenta. A small incision is made in the abdomen, and an endoscope is inserted through the abdominal wall and uterus into the amniotic cavity...
)
- The amnion
- Plastic SurgeryPlastic surgeryPlastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
- Panendoscopy (or triple endoscopy)
- Combines laryngoscopyLaryngoscopyLaryngoscopy is a medical procedure that is used to obtain a view of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during general anesthesia or cardiopulmonary resuscitation or for procedures on the larynx or other parts of the upper...
, esophagoscopyEsophagogastroduodenoscopyFor other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...
, and bronchoscopyBronchoscopyBronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
- Combines laryngoscopy
- Orthopedic surgeryOrthopedic surgeryOrthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
- Hand SurgeryHand surgeryThe field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery...
, such as endoscopic carpal tunnel releaseEndoscopic carpal tunnel releaseEndoscopic Carpal Tunnel Release refers to a method of performing carpal tunnel release surgery using an endoscope or an arthroscopic device.-The procedure:... - Epidural spaceEpidural spaceIn the spine, the epidural space is the outermost part of the spinal canal. It is the space within the canal lying outside the dura mater...
(Epiduroscopy)
- Hand Surgery
- Endodontic surgery
- Maxillary sinusMaxillary sinusThe pyramid shaped maxillary sinus is the largest of the paranasal sinuses, and drains into the nose. It is present at birth as rudimentary air cells, and develops throughout childhood.-General characteristics:...
surgery - ApicoectomyApicoectomyA root end surgery, also known as apicoectomy , is an endodontic surgical procedure whereby a tooth's root tip is removed and a root end cavity is prepared and filled with a biocompatible material....
- Maxillary sinus
- Non-medical uses for endoscopy
- The planning and architectural community have found the endoscope useful for pre-visualization of scale models of proposed buildings and cities (architectural endoscopyArchitectural endoscopyArchitectural endoscopy is an imaging technology that allows realistic views of a scale architectural model to be created, using an analog equipment....
) - Internal inspection of complex technical systems (borescopeBorescopeA borescope is an optical device consisting of a rigid or flexible tube with an eyepiece on one end, an objective lens on the other linked together by a relay optical system in between. The optical system is usually surrounded by optical fibers used for illumination of the remote object...
) - Endoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposalBomb disposalBomb disposal is the process by which hazardous explosive devices are rendered safe. Bomb disposal is an all encompassing term to describe the separate, but interrelated functions in the following fields:*Military:...
personnel. - The FBI uses endoscopes for conducting surveillance via tight spaces.
- The planning and architectural community have found the endoscope useful for pre-visualization of scale models of proposed buildings and cities (architectural endoscopy
An Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrumnt called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.
Early
The first endoscope, of a kind, was developed in 1806 by Philipp BozziniPhilipp Bozzini
Philipp Bozzini was born in Mainz, Germany. On June 12, 1797 he was awarded the degree of doctor of medicine. From 1804 onwards, Bozzini devoted himself virtually completely to develop his instrument, Lichtleiter or "Light Conductor", a primitive endoscope to allow for inspecting the ear, urethra,...
in Mainz with his introduction of a "Lichtleiter" (light conductor) "for the examinations of the canals and cavities of the human body". However, the Vienna Medical Society disapproved of such curiosity. An endoscope was first introduced into a human in 1822 by William Beaumont
William Beaumont
William Beaumont was a surgeon in the U.S. Army who became known as the "Father of Gastric Physiology" following his research on human digestion.-Early life:...
, an army surgeon at Mackinac Island, Michigan
Mackinac Island, Michigan
Mackinac Island is a city in Mackinac County in the U.S. state of Michigan. In the 2010 census, the city had a permanent population of 492, although there are thousands more seasonal workers and tourists during the summer months. From 1818–1882, the city was the county seat of the former...
. The use of electric light was a major step in the improvement of endoscopy. The first such lights were external. Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope
Hysteroscopy
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
by Charles David in 1908. Hans Christian Jacobaeus
Hans Christian Jacobaeus
Hans Christian Jacobaeus was a Swedish internist born in Skarhult. In 1916 he became a professor at the Karolinska Institutet in Stockholm. From 1925 until his death in 1937, he was a member of the Nobel Prize Committee....
has been given credit for early endoscopic explorations of the abdomen and the thorax with laparoscopy
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
(1912) and thoracoscopy
Thoracoscopy
Thoracoscopy is a medical procedure involving internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic cavity...
(1910). Laparoscopy was used in the diagnosis of liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
and gallbladder
Gallbladder
In vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....
disease by Heinz Kalk in the 1930s. Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
. In 1944, Raoul Palmer placed his patients in the Trendelenburg position
Trendelenburg position
In the Trendelenburg position the body is laid flat on the back with the feet higher than the head by 15-30 degrees, in contrast to the reverse Trendelenburg position, where the body is tilted in the opposite direction. This is a standard position used in abdominal and gynecological surgery...
after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.
Wolf and Storz
Georg Wolf (1873–1938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911(Modlin,Farhadi-Journal of Clinical Gastroenterology, 2000).Karl Storz began producing instruments for ENT
Otolaryngology
Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....
specialists in 1945. His intention was to develop instruments which would enable the practitioner to look inside the human body. The technology available at the end of the Second World War was still very modest: The area under examination in the interior of the human body was illuminated with miniature electric lamps; alternatively, attempts were made to reflect light from an external source into the body through the endoscopic tube. Karl Storz pursued a plan: He set out to introduce very bright, but cold light into the body cavities through the instrument, thus providing excellent visibility while at the same time allowing objective documentation by means of image transmission. With more than 400 patients and operative samples to his name, which were to play a major role in showing the way ahead, Karl Storz played a crucial role in the development of endoscopy. It was however, the combination of his engineering skills and vision, coupled with the work of optical designer Harold Hopkins that ultimately would revolutionize the field of medical optics.
Development of the Gastroscope
The first gastroscope was produced by Georg Wolf in 1911 followed by the first model of a semi flexible gastroscope in 1930 in collaboration with Dr. Rudolf Schindler (Grant et Harley, British Medical Journal, Vol 285,1982).The gastroscope with camera was developed in 1950 by a Japanese team of a doctor and optical engineers. Mutsuo Sugiura, in association with Olympus Corporation
Olympus Corporation
is a Japan-based manufacturer of optics and reprography products. Olympus was established on 12 October 1919, initially specializing in microscope and thermometer businesses. Its global headquarters are in Shinjuku, Tokyo, Japan, while its USA operations are based in Center Valley, Pennsylvania,...
, worked with Dr. Tatsuro Uji and his subordinate, Shoji Fukami, to develop what he first called a "gastro camera". It consisted of a tiny camera attached to a flexible tip with a light bulb. With it, they were able to photograph stomach ulcers that were undetectable by X-ray and find stomach cancers in early stage.
Fiber Optics
In the early 1950s Harold HopkinsHarold Hopkins
Harold Horace Hopkins FRS was a renowned British physicist. His Wave Theory of Aberrations, , is central to all modern optical design and provides the mathematical analysis which enables the use of computers to create the wealth of high quality lenses available today...
designed a “fibroscope” (a bundle of flexible glass fibres able to coherently transmit an image), which proved useful both medically and industrially. The subsequent research and development of these fibres, led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source - thereby achieving the high level of full spectrum illumination that was needed for detailed viewing and colour photography. (The previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output at the risk of burning the inside of the patient.) Alongside the advances to the optical side, came the ability to 'steer' the tip via controls in the endoscopists hands and innovations in remotely operated surgical instruments contained within the body of the endoscope itself. It was the beginning of key-hole surgery as we know it today.
Fernando Alves Martins, from Portugal, invents the first fibre optics endoscope (1963/64)
Rod-lens Endoscopes
However, there were physical limits to the image quality of a fibroscope. In modern terminology, a bundle of say 50,000 fibers gives effectively only a 50,000 pixel image - in addition to which, the continued flexing in use, breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). Hopkins realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from very low light transmittance and extremely poor image quality. The surgical requirement of passing surgical tools as well as the illumination system actually within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens' area; they were incredibly hard to manufacture and assemble and optically nearly useless. The elegant solution that Hopkins produced (in the late 1960s) was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube - making them self-aligning and requiring of no other support and allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and utilized the maximum possible diameter available. With the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm. in diameter. With a high quality 'telescope' of such small diameter, the tools and illumination system could be comfortably housed within an outer tube. Once again, it was Karl Storz who produced the first of these new endoscopes as part of a long and productive partnership between the two men. Whilst there are regions of the body that will forever require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are to this day the instrument of choice and in reality have been the enabling factor in modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)Application
By measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre)we can estimate the proportion of haemoglobin in the blood.Disinfection
Disinfection is essential for all types of endoscopes. The first disinfection device was constructed by S.E.Miederer in 1976 at the University of BonnUniversity of Bonn
The University of Bonn is a public research university located in Bonn, Germany. Founded in its present form in 1818, as the linear successor of earlier academic institutions, the University of Bonn is today one of the leading universities in Germany. The University of Bonn offers a large number...
in Germany.
Infection and Over-sedation
The main risks are perforation, or a tear, of the stomach or oesophagus lining and bleeding. Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Typically minor in degree, such bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary.Fortunately, both perforation and bleeding are extremely rare during gastroscopy.
Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems.
Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful.
While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently.
A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.
After the endoscopy
After the procedure the patient will be observed and monitored by a qualified individual in the endoscopy room or a recovery area until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours) and will be allowed to be taken home. Because of the use of sedation, most facilities mandate that the patient is taken home by another person and does not drive or handle machinery for the remainder of the day.Recent developments
With the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the Lindbergh OperationLindbergh Operation
The Lindbergh Operation was a complete tele-surgical operation carried out by a team of French surgeons located in New York on a patient in Strasbourg, France using telecommunications solutions based on high-speed services and sophisticated surgical robotics...
.
Disposable endoscopy
Disposable endoscopy is an emerging category of endoscopic instruments. Recent developments have allowed the manufacture of endoscopes cheap enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of SME are working on the DUET project to build a disposable endoscope.Capsule endoscopy
A new endoscopy technology uses a Magnetically Guided Capsule Endoscope (MGCE) for wireless control, monitor and imaging.External links
- The Atlas of Gastrointestinal Endoscopy
- El Salvador Atlas of Gastroinstestinal Endoscopy
- Endoscope -- an endodontic application
- http://www.massdevice.com/blogs/massdevice/preventing-cross-contamination-flexible-endoscopes
- http://www.advancedimagingpro.com/print/Advanced-Imaging-Magazine/Advances-in-Endoscopy/1$5670
- http://mrg.net/News-and-Events/Press-Releases/HIGH-REUSABLE-ENDOSCOPE-COSTS-PAVE-THE-WAY-FOR-DIS.aspx