Stone surgery Flashcards
guidewire size
0.035 inches
150cm
characteristics guidewire
rigidity
shape memory
torque
conferred by properties material used a tcore
degree surface resistacnce dependent on coating applied
starter guidewire
stainless steel core
PTFE coating
flexible tip
terumo or glidewire
nitinol with hydrophylic coating
nickel titanium alloy has superior shape memory allow to retain original shape
super stiff
nitinol inner core
reinforced with stiffer outer core material
sensor guidewire
combination floppy hydrophilic coated tip and a nitinol PTFE coated kind resistant body
size baskets
1.3 to 3F
zero tip in calyces
escape 1.9F
zero tip comes in 1.9 to 2.4F to 3F for larger stones
length cystoscope
30cm long
17-25Fr
lens angle colours
yellow 70
red 30
0 is green
semi rigid urs dimentions
length
width
channel of working
fibre optic image
34 cm long working element
7-10Fr Tip
channel often 3.4 fr or if two channels will be 2.3Fr each
These instruments use the same coherent image bundle and noncoherent illumination
bundle technology as fl exible scopes but are housed in a semi-rigid metal skin
rather than fl exible vertebrae; they do not defl ect at the tip. Manufactures turn to
semi-rigid telescopes for longer or smaller diameter scopes. In the case of a semirigid
ureteroscope, the design allows a degree of malleability whilst maintaining the
rigidity to advance up a torturous ureter. Semi-rigid telescopes are often used in
paediatric endoscopes where the scope diameters are between 1 and 2 mm. It is possible
to make rod-lens systems this size, but their relative fragility necessitates a
compromise between the optical view and durability.
flexible urs dimensions
fibre optic image
7-80cm long
5.4-9Fr tup
channel often 3.4 Fr
access sheath navigator comes in 13/15
12/14 and 11/13 with lengths 28cm, 36cm, 46cm
access sheath
35-45 cm
10-14Fr
fibre optics
flexible glass or plastic to allow light transmission
process of TIR, little loss light intensity
light leads are non coherent
image transmission is cohernt
A single glass fi bre when stretched to 1/100 mm in diameter and
combined with multiple fi bres in an ordered, coherent bundle can transmit a complete,
but compound, image.
how many fibres in flexible urs
fl exible ureterorenoscope has around 4,000 fi bres in
the bundle and can defl ect 270° in both directions at the tip.
whats inside flexible endoscope
In addition to the coherent fibre bundle for vision, there is a separate noncoherent
bundle that transmits the light into the body cavity, an instrument channel to allow
irrigation and instrumentation and two control wires that are connected to the defl ection
leaver to control the distal tip up and down (Fig. 40.1 ). All of these elements are
free to move independently of each other housed in the vertebrae of the scope as it
fl exes. An outer cover maintains a water-tight environment, allowing the scope to be
effectively cleaned. Any leaks in the outer cover or inner working channel will
allow fl uid ingress into the scope which will affect the view and ultimately seize up
the moving parts. It is important to leak test the scope before every use as fl uid
ingress is also a potential cross contamination risk.
digital endoscopes
Traditionally, any image made through a fl exible endoscope is viewed on a monitor;
this necessitates attaching a camera head to the eyepiece of the scope where it is
converted to a digital format. However, good your camera is, the image will be limited
by the fi bre-optic system of the telescope. With the miniaturisation of chargecoupled
device (CCD) and complementary metal–oxide–semiconductor (CMOS)
video chips, it is now possible to mount the chip at the distal tip of the telescope
without increasing the overall size of the telescope. Removing the optical fi bres and
placing the chip at the source have dramatically improved the quality of images
available from a fl exible endoscope.
size of digitial chip on end flexible urs
8.5Fr
using latest CMOS technology complementary metal oxide semi conductor video chups
also has 270 deflection
8.5Fr fl exible ureterorenoscopes utilise the latest CMOS technology to produce
stunning images of the upper tract without compromising on the external size,
instrument channel or 270° up/down defl ection (Fig. 40.2 ). LED illumination technology
is incorporated into the body of the handpiece, and light is transmitted into
the patient by a conventional noncoherent fi bre bundle. This eliminates the need for
a light guide cable, thus reducing the weight of the instrument and improving its fi ne
manipulation during surgery.
But often thicker
light tramission in cystoscope
A noncoherent glass fi bre system to transmit light into the patient and illuminate
the cavity under view. The fi bre bundle runs through an outer shell of the telescope
from the light post to the distal tip and uses the same type of fi bres as in a
fi bre-optic light cable.
how is image generated on ditial scope
photons striking charge coupled device i.e. chip on tip
baskets for stone surgery
tipped or flat wire or tipless made of nitinol 2 to 3.2 Fr open in parachute or helical ways
access sheath
navigator 12/14F x 46cm sheath length
with insert is 50cm
inside diameter 12F
guidewire allows up to 0.038 inches
escape basket
nitnol
only 1.9F so can fit 200u laser fibre along side
traditional 2.4F basket
In a 3.6F working channel, the 1.9F sheath and 200µ holmium laser fiber together intended to provide irrigation flow equivalent to a 2.4F device
dakota basket
boston
3 wires form the shape
pusen reusable scope working channel
3.6 Fr working channel
self locking mechanism
270 degree deflection
components cystoscope
telescope
sheath
bridge
obturator
