Water Immersion Colonoscopy Technique

Water Immersion Colonoscopy Technique

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12.

ROTATION MANEUVER TRAINING- ABLE TO DO 720-DEGREE-ROTATION?

ROTATION MANEUVER TRAINING

When the left hand rotates 180 degrees, the tip would rotate 360 degrees. Practice with the fiberscope on a bed until the rotation can be carried out smoothly and accurately. The practice of the 360-degree-rotation is rotating the left hand 90 degrees counterclockwise and 90 degrees clockwise as the tip would rotate 180 degrees counterclockwise and 180 degrees clockwise, respectively (Chart 12-1). Confirm the rule of the double angular velocity and try to carry out the movement precisely, smoothly and quickly.

When the left hand rotates 360 degrees, the tip would rotate 720 degrees. Practice with the fiberscope on the bed until the rotation can be carried out smoothly and accurately. The practice of the 720-degree-rotation is rotating the left hand 180 degrees counterclockwise and 180 degrees clockwise as the tip would rotate 360 degrees counterclockwise and 360 degrees clockwise, respectively (Chart 12-2). Rotate the scope accurately, smoothly and quickly. If there is need to rotate the scope more, the loop formed on the scope outside the patient's body should be transferred to the connector cable to release it.

 

CHART 12-1 360-DEGREE-ROTATION

AS THE LEFT HAND ROTATES 90 DEGREES COUNTERCLOCKWISE AND 90 DEGREES CLOCKWISE, THE TIP WOULD ROTATE 360 DEGREES.

 

 

CHART 12-2 720-DEGREE-ROTATION

AS THE LEFT HAND ROTATES 180 DEGREES COUNTERCLOCKWISE AND 180 DEGREES CLOCKWISE, THE TIP WOULD ROTATE 720 DEGREES.

 

Beginners tend to fall short of clockwise rotation in the sigmoid colon and/or counterclockwise in the transverse colon and fail to achieve the full intubation. Actually beginners need even more rotation than experts, since their maneuvers are not as effective as experienced endoscopists in the first place, however, they have a tendency to stop in the middle and release the rotation prematurely as they feel uncomfortable in that posture when they would have made it only with a little more rotation. When the scope outside the patient's body is still long, you might need to change the grip of the scope to make 360-degree-clockwise rotation.

(Chart 12-3)

(It does not require the grip change when the scope outside is short or in case of counterclockwise rotation.)

Chart 12-3 360-DEGREE-CLOCKWISE ROTATION

Change the grip.

 

When the tip of the scope rotates 360 degrees it is unable to rotate further. Transfer the loop in the scope to the connector cable and release the loop, then the scope comes back to the home position and can rotate more again. (Chart 12-4) Practice to rotate as many times as needed quickly and smoothly.

 

CHART 12-4 ROTATION

Transfer the loop to the connector cable and release it.

 

MOVIE 12-1 ROTATION

Practice to make 720-degree-rotation smoothly.

 

SLALOM TRAINING

After the practice of angulation and rotation, next is slalom training. For slaloming, clockwise rotation and right angulation (or counterclockwise rotation and left angulation) are used simultaneously (Chart 12-5). Using angulation, even a small rotation can correspond to a larger rotation. Slaloming technique is often applied in the latter part of the sigmoid colon.

 

CHART 12-5 PRACTICE OF SLALOAMING TECHNIQUE

Advance using rotation and angulation simultaneously:

 

During angulation, left rotation and left angulation can be substituted for down angulation, which is more difficult, or right rotation and up angulation for difficult right angulation. It is called angulation change (Chart 12-6). Angulation change is frequently applied in the Singular Method, for example, using right rotation and up angulation after traversing SD with right angulation, or left rotation and left angulation after traversing the mid-transverse colon with down angulation, or right rotation and up angulation after traversing the splenic flexure.

 

Chart 12-6 ANGULATION CHANGE

Change from down angulation (1) to left angulation (2)

 

MOVIE 12-2 ANGULATION CHANGE

Practice to carry out angulation change smoothly, for example, from right angulation to up angulation, from down angulation to left angulation.