98 .

Procedures Surgicol Procedures lncluding Minimol Access

Gostroiniesiino.l Surgery

QQ

Supplies

ftcussion

Small basin (with saline and syringe) Lubricating jellY

Needle,

liis

".{.,-25-g Specimen containers

Suction tubing
249)

:oge

(for specimen removal)

Aspirating tubes

i;i;;i;;ttfr"tics
SpeciolNotes

(as for Bronchoscopv' see pp' 246-

resthesia when the patient is unable to tolerate the pqocedure because of pain and tenderness, or for fffrysy, polypectomy, and so on, when these procedures rue too risky outside the operating room environment.
hocedure Bigid Sigmoidoscopy. The anus is digitally lubritated and examined. Anoscopy may be performed. The sigrnoidoscope is inserted and advanced under clirect risualization until obstructed by an unyielding anguhion of the lumen or to the full length of the scope. De. fuitive inspection of the mucous membrane is done as -'^ scppe is withdrawn. Air may be insufflated to distend the lumen for better visualization. A variety of inrhuments may be used via the scope, for example, bopsy forceps, suction-electrocoagulator, snare, or clip elplicator. Scopes are usually 18'to 19 mm in diameter; hrger diameters to 30 mm may be employed when
anesthesia is given.

procedure is performed for diagnosis, excision of pn[5ps, biopsy of lesions, and so on. Sigmoidoscopy is pnrformed in the operating room under sedation or

See EsophagoscoPY, P. 97'

cotoNoscoPY
Definition
Endoscopic visualization of the large intestine ;;il ;; cecum (and occasionallv ihe verv terminal

from

ileum).
Discussion

gastroinTotal coJonoscopy is usually performed in the oi the radiology departrn-ent' i".ti"ti-tCO htoratory

b;;;d;-'to ttris include colonoscopv performed il;tfu open laparotomy or -certain pediatric exami*h"r, g"rr"tul anesthepia is required' Colon".tl"it trt" distal colon may be performed"r."pv-fmii"a-to room bv inserting 9"1{ 3 portion of i; ;fi; operating ii" ."f"i""."p""o" Uv employing a flexible fiberoptic "Sig*bido"oPr, u1l"oy' for Pro;;"i'"td;;;"p". Su" Prepara;;A;;;;'it";aration of the Patient, Skin and Supfu^ O""pt"!, Equipment, Instrumentation'
plies.

Flexible Sigmoidoscopy. Digital examination and anoscopy are performed. The tip of the scope is insted, and under direct visualization the scope is adranced by various torquing and advancement motions to the length of the scope (30 or 65-cm) or until resistance, patient discomfort, or inability to see the lumen ahead is reached. Definitive examination is done on
withdrawal. Various accessory instruments (e.g., electrosurgical biopsy forceps, snare, cautery, cytology trush, or irrigating tube) may be employed.
Preporotion of the Potient

stoMolDoscoPY
Definition
and Endoscopic visualization of the anal canal' rectum' sigmoid colon.

Positions for rigid sigmoidoscopy include jackknife, modified lateraUSims', or lithotomy. The modified lat-

eraUSims' position is generally preferred for flexible sigmoidoscopy, although the jackknife position may be employed. Apply electrosurgical dispersive pad.