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Sclerotherapy Of Esophageal Varices
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Important modifications to optimally adapt the rigid 50-cm esophagoscope with distal fiber lighting to paravariceal injection have been designed by Paquet.19,45 A large-bore suction channel was mounted inside the endoscope to facilitate identification of the bleeding site in a clean esophagus. A wide-angle rigid 60-cm fiberscope (Hopkins type, Storz, Tuttlingen, Germany) with additional distal high-power fiber lighting is fixed inside a metal tube, which can be freely rotated with the large-bore esophagoscope. After passing the instrument down to the cardia, the metal tube coaxially covering the small diameter fiberscope is exchanged. A 2.0 cm long, 12-gauze cannula is fixed at the distal end of a second tube. When this tube is tilted over the fiberscope, the optical system exactly focuses the tip of the needle and provides optimal conditions to inject the sclerosant solution (Figure 5).
Envoi: Today and tomorrow
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
In other fields, a pelvic abscess can be drained with needles inserted transcutaneously under image guidance and the whole colon can be removed laparoscopically. Internal organs can be visualised through natural orifices to examine the trachea and bronchi (bronchoscopy), the upper gastrointestinal tract (oesophagogastroduodenoscopy) the lower urinary tract and bladder (cystoscopy) and the colon (colonoscopy), to name a few examples. A major milestone in the design of the endoscope was made by the physicist Harold Hopkins (1918–1994) who was the pioneer of fibre optics. His research in nuclear and optical physics led to his invention of the zoom lens that was first used in televising a sporting event in 1948. This was soon followed by the ‘fibrescope’, where light shining through a bundle of flexible glass fibres no more than 0.025 mm was used to produce an image. At a meeting with a gastroenterologist, Hopkins became aware of the risks posed by the rigidity of the endoscopes. Together with Karl Storz (1911–1996), a German instrument maker, the two developed a flexible endoscope that utilised fibre optic science to illuminate the gastrointestinal tract. The flexible endoscope provided images of high resolution and could negotiate acute angles in the gastrointestinal tracts with a much lower risk of perforation. Flexible instruments that could be inserted through endoscopes, cystoscopes and bronchoscopes were developed to take samples of cells or tissue for analysis, deal with bleeding and remove cancerous growths.
Recognition and Management of the Difficult Airway
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Valerie Cunningham, Alistair McNarry
It is helpful for the fibrescope to be attached to a CCTV system, particularly for training. An appropriate size tracheal tube is loaded onto the fibrescope and the scope is introduced under vision into the mouth or more patent nostril. The fibrescope is advanced without touching the mucosa until the vocal cords are seen. Additional local anaesthetic may be applied before the fibrescope is advanced to the carina. The tube is advanced or railroaded over the fibrescope. This may be difficult because the bevel impinges on the larynx. Use of a small diameter tube and rotation of the tube minimize this problem.
Clinical application of a curved video suspension laryngoscope in laryngeal surgery
Published in Acta Oto-Laryngologica, 2022
Hangjin Li, Wei Zhang, Hui Qu, Jizhe Wang
Endolaryngeal microsurgery is usually accompanied by the use of suspension laryngoscopy (SL) to treat vocal cord lesions, including benign and malignant changes. The anatomy of the oral cavity and the pharynx is clearly curved, yet SL relies on a direct ‘line-of-sight’ of the glottis by aligning the oral, pharyngeal, and laryngeal axes [1,2]. This conventional approach could result in unnecessary injury or local trauma due to potential postoperative complications, including hypoesthesia, immobility of the tongue, laceration of the lateral tonsillar pillar, tooth fracture, swelling, mucosal injury, bleeding, incomplete surgery, and longer surgical time [3–6]. Elevating the head, pressing the throat, and using a flexible fiberscope are some of the currently used alternative approaches, each having certain advantages and disadvantages [7,8]. Optimal therapy requires new solutions to address shortcomings as far as possible.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
The current available pediatric flexible bronchoscopes range in outer diameter (OD) sizes from 2.2 to 6.3 mm, with channel sizes ranging from 1.2 to 3.2 mm in diameter. The 2.2-mm bronchoscope does not have a suction channel and is therefore limited in its utility. This scope is a fiber scope and not a videoscope, and thus requires a camera system in order to be able to display images on a monitor. The most commonly used scope is the 2.8-mm OD bronchoscope because it is the smallest diameter scope with a suction channel [10]. The 4.0- or 4.9-mm OD bronchoscope provides the bronchoscopist with the benefit of a larger 2.0-mm suction channel. The 2.0 mm working channel allows interventions as most instruments need a 2.0 mm working channel to be inserted. These instruments enable the bronchoscopist to remove foreign bodies (FB), as well as perform transbronchial needle aspiration (TBNA). Recently a 4.9 mm diameter scope with HDTV image quality and with a 2.2 mm working channel (Olympus BF-H1100) was launched as an intervention scope. This allows insertion of instruments and has suction ability.
Long-arm Clip for Transcatheter Edge-to-Edge Treatment of Mitral and Tricuspid Regurgitation – Ex-Vivo Beating Heart Study
Published in Structural Heart, 2019
Michal Jaworek, Guido Gelpi, Claudia Romagnoni, Federico Lucherini, Monica Contino, Gianfranco B. Fiore, Riccardo Vismara, Carlo Antona
Percutaneous treatments of MV and TV regurgitation using the XTR Clip device design were assessed in an ex-vivo beating heart model that was specifically designed for MV12 and TV13 treatment assessment. Porcine left or right hearts were actuated by a positive displacement pump causing dynamic opening and closing of the heart valves. The aorta or pulmonary artery were connected to a flow loop simulating systemic or pulmonary circulation impedance with adjustable peripheral resistance, respectively. In both left and right heart testing protocols, the systems were set to reproduce physiological resting conditions (heart rate 60 beats/min; stroke volume 70 mL). Peripheral resistance was adjusted to yield mean baseline aortic and pulmonary artery pressures at approximately 100 mmHg and 15 mmHg, respectively. With this setup, pressure changes could be observed depending on flow conditions at pathological and post-treatment conditions. Echocardiography was used to measure valve morphology and to help guide device implantation (iE33 equipped with X7-2t probe, Philips, Eindhoven, The Netherlands). Direct visualization of the valves in the atrial view was enabled by fiberscope imaging (ENF-GP, Olympus Corp., Tokyo, Japan).