Veterinary Nursing Journal

ISSN: 1741-5349 (Print) 2045-0648 (Online) Journal homepage: http://www.tandfonline.com/loi/tvnj20

An introduction to endoscopy Part 2: Rigid

endoscopes

Catherine Goulding DipAVN(Surgical)RVN CertEd MBVNA

To cite this article: Catherine Goulding DipAVN(Surgical)RVN CertEd MBVNA (2008) An

introduction to endoscopy Part 2: Rigid endoscopes, Veterinary Nursing Journal, 23:4, 9-14,
DOI: 10.1080/17415349.2008.11013671

To link to this article: http://dx.doi.org/10.1080/17415349.2008.11013671

Published online: 21 Nov 2014.

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 An introduction to endoscopy
Part 2: Rigid endoscopes

news & reports

Catherine Goulding DipAVN(Surgical) RVN CertEd MBVNA
Rigid endoscopes, as the name suggests, are not flexible; in useful to store all the equipment in
fact, if they bend, they are unable to be used. Within the one place; it must be easy to move
jacket tube are several small glass beads, if the tube bends the around.
glass beads will break causing a distorted image. These glass
beads give several advantages over the fibres in a flexible A camera head (Figure 5) is
endoscope, including a clearer picture, more light and a larger essential and attaches to the
field of view. eyepiece. The other end connects

clinical
to the camera unit (Figure 6),
Rigid scopes can be used to view a variety of areas in the which is positioned on the tower.
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body. As such these scopes are available in different sizes. A This is probably the most
scope to be used for cystoscopy (viewing of the bladder) in a expensive piece of equipment and
Westie cannot be used for laparoscopy (viewing of the must therefore be handled with
abdomen) in a care. This item of equipment
Great Dane due to Figure 4: An endoscopy tower. cannot be autoclaved so is covered

clinical/practical
the different areas with a sterile
involved. A range camera sleeve
of different sizes when used for
available is shown sterile surgical
in Figure 1. The procedures.
anatomy of a rigid
endoscope is Figure 5: The camera head attaches to the eyepiece
shown in Figure 2. and …… A light source is
vital and usually consists of a light unit (Figure 7) and separate
Figure 1: Different sizes of rigid endoscope.
light cable. The light cable itself can be sterilised (usually using
cold sterilisation) and this is attached to the rigid scope. The
light unit is normally
positioned on the tower
and should only be
switched on
immediately prior to the
procedure as the bulb
has a short life.
Figure 2: Anatomy of a rigid endoscope: 1. object lens and distal exit;
2. jacket tube; 3. colour coding for direction of view of scope; A monitor is vital
4. attachment for light cable; 5. eyepiece.
(Figure 8) and should be Figure 6: ….. the other end connects to the camera
positioned for ease of unit.
The object lens can be one of use by the scope
three shapes, 0º, 12º or 30º (Figure operator during the
3), depending on the area to be procedure (usually
examined. The lens shapes are all directly in front of the
colour coded for ease of selection. scope operator).
Figure 7: The light unit is normally positioned on
VETERINARY NURSING JOURNAL

Equipment required the tower.

As well as the actual endoscope,
other equipment is necessary
before a rigid endoscope can be
Figure 3: The object lens can
be one of three shapes, 0º, 12º
used. However some of this
or 30º. equipment is only necessary if the
scope is to be used in a sterile
Figure 8: The monitor should
manner, for example arthroscopy, where the scope is to be be positioned for ease of use by
placed actually into a joint. An endoscopy tower (Figure 4) is the scope operator.

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 An insufflator
(Figure 9) is
necessary when
performing
laparoscopy. In the
abdomen, all
news & reports

organs are next to

each other, so
viewing individual Figure 11:
Arthroscopy
Figure 9: The insufflator is positioned on the tower. organs is difficult instruments.
unless air is put
into the abdomen. An insufflator will allow a controlled Figure 12 shows the rigid scope within the stifle joint; the
amount of gas (normally carbon dioxide) into the abdomen to camera is attached as is the fluid giving set. The sterile field is
allow separation of the organs and which can then be easily marked with the use of drapes and towel clips and the camera
viewed. The amount of gas going into the abdomen must be itself is covered with a sterile camera sleeve.
controlled otherwise extreme patient discomfort will occur.
The insufflator is also positioned on the tower and is attached
clinical

to sterile tubing which in turn is attached to an extra

instrument entering the body wall.
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Irrigation fluid is necessary during some procedures due to

similar reasons to those requiring the use of an insufflator
during laparoscopy. Fluid in a joint will help the surgeon to
see structures more clearly. A fluid pump (Figure 10) is ideal
to ensure fluid is pumped through the scope at the correct
pressure and rate. If a fluid pump is not available then a rapid
comment

Figure 12:
infuser can be used, but this cannot deliver as accurate a fluid Arthroscopy of the
rate as the pump can. It is not stifle joint.
unusual to use in excess of five
litres of fluid during rigid Rhinoscopy
endoscopy, depending on the As the nasal cavity and nostrils are not sterile, rhinoscopy is
procedure concerned. This fluid not a sterile procedure. There is no need to drape the area,
will end up on the floor and although this can be a messy procedure so it is still advisable
could cause a health and safety Figure 10: A fluid pump ensures that to use a camera sleeve to protect the equipment. The rigid
issue to theatre personnel if not fluid is pumped through the scope at scope is placed into each nostril to allow the nasal cavity to be
features

dealt with in an appropriate the correct pressure and rate. viewed. Biopsies can be taken of this area. The only extra
manner. equipment required is a sheath to be placed over the scope to
protect it from damage.
Areas suitable for rigid endoscopy Figure 13 shows the nasal
G Arthroscopy - looking into a joint chambers of a Border Collie
G Rhinoscopy - looking into the nose suffering from Aspergillus, a
G Cystoscopy - looking into the bladder fungal infection.
G Laparoscopy - looking into the abdomen
miscellaneous

G Thoracoscopy - looking into the thorax Cystoscopy

As the bladder and urethra are
This list is not exhaustive as many other areas can be scoped, not sterile areas, cystoscopy is
especially in exotic patients. The skills required for this type of not a sterile procedure. As for
surgery are significantly different to those for required for rhinoscopy, the area does not
normal surgery. The operator needs to have good hand/eye need to be draped, although a Figure 13: The nasal chambers of
co-ordination and must look at the monitor when moving the camera sleeve will protect the a Border Collie suffering from
equipment from fluid. The Aspergillus, a fungal infection.
instruments rather than looking directly at the operating site.
rigid scope is placed into the
VETERINARY NURSING JOURNAL

Arthroscopy urethra of female dogs to allow the bladder neck to be viewed

Arthroscopy is a sterile procedure; all sterilisable equipment
must be sterilised, either by steam or chemical sterilisation
methods. Unsterilisable items must be made sterile by
covering with a sterile sleeve. The area under investigation
must be clipped and prepared in a sterile manner and then
draped for surgery. A basic surgical pack should be available as
well as the arthroscopic instruments of the surgeon’s choice
(Figure 11).
Vol 23 | No 4 | April 2008
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and biopsies can be taken of the area. Again, it is advisable to
use the protective sheath during use.
Laparoscopy
Laparoscopy is a sterile procedure, all sterilisable equipment
must be sterilised, either by steam or chemical sterilisation
methods. If cold sterilisation as being used (e.g. Meddis), this
must be rinsed thoroughly from the instruments using
 deionised water. Unsterilisable items must be made sterile by
covering with a sterile sleeve. The area under investigation must be
clipped and prepared in a sterile manner and then draped for surgery.

Laparoscopic instruments (Figure 14) look significantly different

from arthroscopy instruments due to the nature of their use.

news & reports

There is a wide range of varying instruments available and they
can be disposable or multi-use. The diameter of these instruments
is either 5 mm or
10 mm and they can Figure 19: Grasping forceps.
have interchangeable
or fixed handles. The
handles can also
include special controls
and attachments on
them. The instrument
in Figure 15 can be

clinical
separated into two
Figure 14: Laparoscopy instruments. parts (Figures 16
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and 17).

Available instruments Figure 20: Palpation probe. Figure 21: Scissors.

for laparoscopy
include biopsy forceps (Figure 18), palpation probe

Figure 15: This instrument can be separated into
two parts, see Figures 16 and 17.
clinical/practical
(Figure 20), scissors (Figure 21), grasping forceps
(Figures 19 and 22) to name but few. Instrument
portals (Figure 23) are necessary as these provide a
route of access for the laparoscopy instruments.

An instrument portal with a trocar must be first

Figure 16: One part of the instrument shown in
Figure 15……
inserted into the abdomen using designated
landmarks. The trocar is then removed and the
rigid scope is placed through the instrument
portal; further instrument portals are added
depending on how many further instruments are Figure 22: Grasping forceps.
to be used at any one
time for the procedure.

Figure 24 shows the

rigid scope within
the instrument portal
in the abdomen, the
camera is attached, as
is the grey light
Figure 23: Instrument portals provide a route of access for the laparoscopy
cable. The sterile instruments.
field is marked with
the use of drapes and
Figure 17: …… and the other part.
towel clips and the camera itself is
covered with a sterile camera sleeve.
The straw coloured tubing is
attached to the insufflator, allowing
carbon dioxide gas to be inserted
VETERINARY NURSING JOURNAL

into the abdomen; the other end of

Figure 18: Biopsy forceps.
the tubing is attached to an
instrument portal, directly entering
the abdominal cavity. Biopsies can
be taken of this area and viewing of
the post-biopsied area is advisable so
that any haemorrhage can be Figure 24: Laparoscopy of the abdomen, showing rigid
monitored (although with the scope with camera (in a sterile camera sleeve) attached to
it.

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13
 magnification of the area, even a small amount of blood can (e.g. Medizyme). DO NOT use an ultrasonic cleaner as this
look like a major haemorrhage). will break the glass rods within the scope
G Rinse to remove any residual blood, protein material, and
The use of contaminants
laparoscopic G Rinse thoroughly in distilled water to remove any residual
equipment as cleaning solution
compared to G Clean the lenses and the fibre optic inlet post with alcohol
standard surgical wipes or cotton tip applicators soaked in 70% alcohol to
clinical

equipment remove any residue or film

reduces theatre G Wipe the optical elements clean with a lint-free soft cloth
time, anaesthetic G Dry the entire telescope with a lint-free soft cloth
time and aids G After cleaning, inspect the telescope for cleanliness and
patient recovery. damage
As a full surgical
procedure has Cleaning rigid endoscopy instruments
clinical/practical

not been carried G Instruments should be cleaned as soon as possible after use,
Figure 25: A probe is used to examine the surface of the out, recovery preferably immediately
kidney. time is much
shorter and the incision is a fraction of the size of a normal
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laparotomy incision. In Figure 25 a probe is used to examine

the surface of the kidney.

Thoracoscopy
Thoracoscopy is a sterile procedure; all sterilisable equipment
must be sterilised, either by steam or chemical sterilisation
methods. If cold sterilisation is being used (e.g. Meddis), this
comment

must be rinsed thoroughly from the instruments using

deionised water. Unsterilisable items must be made sterile by
covering with a sterile sleeve. The area under investigation Figure 27: Some instruments must be disassembled to allow for adequate
must be clipped and prepared in a sterile manner and then cleaning.
draped for surgery. Thoracoscopy instruments are the same as
laparoscopy G Instruments should be disassembled for cleaning (see
instruments, Figure 27 for disassembled instrument portal with trocar)
although the G Manual cleaning should be with a soft brush or cloth.
insufflator is G Deionised water should be used to rinse instruments after
features

not necessary cleaning.

due to the air G Instruments should never be placed in sterile saline solution
already as this will lead to pitting and corrosion.
contained G Instruments should be dried immediately after rinsing.
within the G All jointed instruments should be oiled with instrument oil
thoracic cavity. after cleaning. Stopcocks should be greased.
A very basic G Instruments must be clean to allow proper sterilisation.
surgical pack G Routine wiping over of other ancillary equipment,
miscellaneous

is required in including the units on the tower itself, will extend their
addition to lives.
Figure 26: The thoracic cavity in a dog with a chylothorax. these
Note that fibrin tags can be seen between the lung lobe
instruments. Rigid endoscopy can be an invaluable diagnostic tool in small
(bottom right of the picture) and the parietal pleura.
Figure 26 animal practice although its expense may preclude its use in
shows the thoracic cavity in a dog with a chylothorax - fibrin every veterinary centre.
tags can be seen between the lung lobe (bottom right of the
picture) and the parietal pleura. As previously mentioned this With thanks to Dr Alistair Freeman for the use of the photographs for this article.
reduces anaesthetic time and aids patient recovery. As a full
VETERINARY NURSING JOURNAL

thoracotomy has not been carried out, recovery time is much

shorter and the incision is a fraction of the size of a normal
thoracotomy incision.

Cleaning a rigid endoscope

G Place the telescope in a plastic container immediately after
use and soak with a neutral pH enzymatic cleaning solution

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