Chapter 16: Perioperative care
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Endoscopy
Definition
Endoscopy is the procedure of examining the interior of a hollow organ or body cavity using special equipment referred to as an ‘endoscope’.
Related theory
An endoscope consists of a rigid or flexible tube that carries fibreoptic cables to transmit light. It relays images to a camera and provides channels for instruments to be inserted to carry out procedures. The images are usually displayed on a monitor (Figure 16.25) and there is provision to take still photographs as well as video so that the whole procedure can be recorded.
Figure 16.25 Example of a complete endoscopy stack system.
Endoscopy can be used both for diagnosis and for therapy, such as controlling bleeding in hollow organs. There are various types of endoscopy that can be performed in an operating room:
- Flexible endoscopy includes gastroscopy, colonoscopy, bronchoscopy and cystoscopy.
- Rigid endoscopy includes rigid cystoscopy, rigid hysteroscopy, colposcopy and rigid sigmoidoscopy.
The use of an endoscope is much less invasive than open or laparoscopic surgery because these instruments are inserted through the natural orifices leading to various organs. This also means that recovery is quicker and there are fewer complications (Kumar et al. [94]).
Endoscopy can be performed in a number of different areas of the body and also to examine the internal state of various organs, such as the oesophagus, stomach and large intestine. Advances in endoscopy have significantly altered the approach to the management of various surgical conditions (BSG [39]). The perioperative care of patients undergoing endoscopy follows the same principles of care as any other surgical intervention.
Head and neck
The nasal cavity, oral cavity, pharynx and larynx are all accessible to endoscope examination and procedures, and both rigid and flexible endoscopes can be used. The flexible scopes consist of two types. One is mainly used to provide vision. The other has working channels that allow specialized instruments to pass through to carry out treatment and also to allow irrigation and suction of any aspirates.
Oesophagus
The oesophagus can be examined using both rigid and flexible scopes, which are used to diagnose tumours, obtain biopsies, remove foreign bodies, and dilate or insert stents to overcome blockages.
Stomach
The stomach is usually examined using a flexible endoscope. The main aims are to provide diagnosis, obtain biopsies or aspiration of gastric fluids, remove foreign bodies and control bleeding from ulcers.
Large bowel
The large bowel consists of the rectum, colon and caecum. The rectum is usually examined using a rigid rectoscope or sigmoidoscope. The colon and caecum are examined using a flexible colonoscope.
Large bowel endoscopy is used for the diagnosis of inflammatory disease, polyps and tumours. Where necessary, endoscopic dilatation of the large bowel is carried out with the aid of a flexible endo‐balloon (to dilate a narrowed channel, which could be due to obstruction from stricture) or the insertion of a stent (to open a passage that is blocked by a tumour).
Urinary system
Endoscopy of the urinary system usually involves examination and therapy relating to the urethra and bladder. Occasionally the ureter and kidney can also be examined using specialized flexible endoscopes. The urethra and bladder are generally examined using rigid endoscopes. However, a flexible endoscope (such as a cystoscope or ureteroscope) would be used for specific interventions. In patients with kidney stones, flexible endoscopes combined with rigid endoscopes are used to remove the stones using the percutaneous approach (percutaneous nephrolithotomy) (Ganpule et al. [66]).
Endoscopy plays a major role in the treatment of urinary tract problems such as enlarged prostate and bladder tumours. In patients with benign prostatic hyperplasia, transurethral resection has revolutionized the treatment, making possible removal of the obstruction without open surgery. It is one of the most commonly performed procedures in many surgical centres.
Gynaecology
In the field of gynaecology, rigid endoscopy is generally the preferred choice of procedure. It is used to carry out diagnosis or treatment of the female reproductive organs. Colposcopy in gynaecology refers to viewing the cervix, vagina and/or vulva with a specialized rigid instrument. The aim of colposcopy is to examine for any cancer in the organ (Khan et al. [88]).
