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.

1
00: 00: 00 000 -> 00: 00: 03, 775
rotation

2
00: 00: 03, 776 -> 00: 00: 08, 335
The basic stance is 12 o'clock left and 12 o'clock tip.

3
00: 00: 08, 336 -> 00: 00: 16, 830
Left rotation is 9 o'clock left by 6 o'clock at 6 o'clock.

4
00: 00: 16,831 -> 00: 00: 25, 222
It's 10:30 on the left hand side and 9 o'clock at the tip.

5
00: 00: 25, 223 -> 00: 00: 33, 178
It's 1:30 on the left and 3 o'clock at the tip.

6
00: 00: 33,179 -> 00: 00: 40, 714
When the left hand is 3 o'clock, the tip is 6 o'clock.

7
00: 00: 40,715 -> 00: 01: 04,897
180 degrees to the left, 180 degrees to the right, rotation is 360 degrees.

8
00: 01: 04,898 -> 00: 01: 15, 384
I will practice to be smooth and accurate.

9
00: 01: 15, 385 -> 00: 01: 24, 472
Let's rotate the rotation with your left hand without twisting with your right hand.

10
00: 01: 24, 507 -> 00: 01: 47, 482
Turn 180 degrees to the left until 6 o'clock, the tip turns 360 degrees and it is 12 o'clock.

11
00: 01: 47, 517 -> 00: 02: 02, 401
Turn 180 degrees to the right until 6 o'clock, the tip turns 360 degrees and it is 12 o'clock.

12
00: 02: 02, 402 -> 00: 02: 14, 521
This is rotation 720 degrees.

13
00: 02: 14, 522 -> 00: 02: 18,072
Please practice this many times.

 

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.

1
00: 00: 00 000 -> 00: 00: 04, 055
Angle change

2
00: 00: 04,056 -> 00: 00: 08, 783
It is a technique that is applied strongly when angle is difficult to apply.

3
00: 00: 08,784 -> 00: 00: 20,481
When it exceeds SD-J, etc., and want to further add a right angle

4
00: 00: 20,482 -> 00: 00: 25, 565
Change the right angle to the up angle.

5
00: 00: 25, 566 -> 00: 00: 38, 552
At that time add a little light rotation.

6
00: 00: 38,553 -> 00: 00: 46,424
The transverse colon transverses at the down angle.

7
00: 00: 46,425 -> 00: 00: 55, 720
Change it to the left angle in order to make the down angle even stronger.

8
00: 00: 55,721 -> 00: 01: 27,067
In this case add a little left rotation.

9
00: 01: 27,068 -> 00: 01: 42, 531
If you do not add rotation, the angle of tip bending will shift.

10
00: 01: 42, 532 -> 00: 01: 50, 402
By slightly rotating, you will have applied an angle strongly.

11
00: 01: 50,403 -> 00: 02: 0 6, 546
If you change the right angle as it is, the direction changes.

12
00: 02: 0 6, 547 -> 00: 02: 19, 825
If there is only a slight rotation of light it will not turn.

13
00: 02: 19, 825 -> 00: 02: 34, 504
Let's practice it many times until you acquire it.