Endoscopy means looking inside and refers to looking inside the human body for medical reasons.
It is a minimally invasive diagnostic medical procedure used to evaluate the interior surfaces of an organ by inserting a small scope in the body, often but not necessarily through a natural body opening. Through the scope, one is able to see lesions.
An instrument may not only provide an image but also enable taking small biopsies and retrieve foreign objects. Endoscopy is the vehicle for minimally invasive surgery.
Many endoscopic procedures are relatively painless and only associated with mild discomfort, though patients are sedated for most procedures. Complications are rare but may include perforation of the organ under inspection with the endoscope or biopsy instrument. If this occurs, surgery may be required to repair the injury.
One can distinguish:
- using a light delivery system to illuminate the organ under inspection. Nowadays the light source is outside the body and the light is typically directed via an optical fiber system.
- transmitting the image through a lens system, and in flexible systems a fiberscope to the viewer.
- in recent years having a camera, called a capsule camera or video pill at the distal end of the optical system to project findings on a video system.
- in operative endoscopes having an additional channel to allow entry of instruments to biopsy or operate.
Endoscopy equipment is primarily manufactured by Japanese imaging companies Fujinon, Pentax and Olympus. Pentax and Olympus are the most notable innovators in this field.
Endoscopic equipment can be used to visualize and collect specimens from:
- Normally closed body cavities (through a small incision):
- The abdominal or pelvic cavity (laparoscopy)
- The interior of a joint (arthroscopy)
- Organs of the chest (thoracoscopy and mediastinoscopy)
The first endoscope, of a kind, was developed in 1806 by Philip Bozzini but such a device was not introduced into a human until 1853. Of limited value even in diagnosis the procedure was named laparothorakoskopie in 1911. Its use in the diagnosis of liver and gallbladder disease was extended by the German Heinz Kalk in the 1930s. Its diagnostic use in gynaecology is dated from the 1940s and Raoul Palmer, who placed his patients in the Trendelenburg position so air could inflate the pelvic area.
For diagnostic endoscopy Basil Hirschowitz invented a superior glass fiber for flexible endoscopes. The technology resulted in not only the first useful medical endoscope, but the invention revolutionized other endoscopic uses and led to practical fiberoptics.
Surgery as well as examination did not begin until the late 1970s and then only with young and 'healthy' patients. By 1980 laparoscopy training was required by gynecologists to perform tubal ligation procedures and diagnostic evaluations of the pelvis. The first laparoscopic cholecystectomy was performed in 1984 and the first video-laparoscopic cholecystectomy in 1987. During the 1990s laparoscopic surgery was extended to the appendix, spleen, colon, stomach, kidney, and liver.
With the application of robotic systems, telesurgery was introduced as the surgeon could operate from a site physically removed from the patient. The first transatlantic surgery has been called the Lindbergh Operation.
In 2001 Given Imaging introduced the first pill-sized endoscopic capsule with a camera. Over the following years other manufacturers introduced new models with additional improvements. As of 2004, 1 cm x 2 cm endoscopic capsules can capture 0.4 megapixel video at up to 30 frames/second. They can even give doctors rotational control over the capsule to adjust the camera direction, can take tissue samples and can deliver medications to patient's body. The capsules cost upwards from $120 and can be powered by battery or wireless transmission.
About robotic surgery Pentax Medical Company Olympus Medical Systems