Water Immersion Colonoscopy Technique

Water Immersion Colonoscopy Technique

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18.

MASTER THE SINGULAR METHOD FOR 3 MONTHS WITH THE COLON MODEL -THE 10-FOLD RULE OF COLON MODEL INSERTION TIME

There is a strong positive correlation between insertion time on the colon model and on the human body. The average insertion time on the human body is assumed to be about 10 times as that of the colon model (Chart 18-1). For example, if the insertion time on the colon model is 3 minutes, the estimated insertion time on the human body (i.e. the "actual" insertion time) is 30 minutes. With the skill at this level the total intubation would be often difficult, therefore, the insertion time on the colon model is ought to be 3 minutes at its longest before you actually start the real examination.

If the insertion time on the colon model is under 1 minute, the "actual" intubation time should be under 10 minutes, which is considered a fairly good level. The shortcut to improvement is to practice on the colon model over and over until the insertion time becomes shorter than 1 minute.

 

CHART 18-1 THE 10-FOLD RULE OF COLON MODEL INSERTION TIME

The average insertion time on the human body is thought to be 10 times as that on the colon model.

 

Chart 18-2 INSERT THE SCOPE IN LESS THAN 1 MINUTE ON THE COLON MODEL

Being able to insert the scope in less than 1 minute on the colon model is the shortest way to learn the colonoscope insertion technique.

 

COLON MODEL TEST

In order to clarify your skill level, I created the "colon model qualification of rank" system (Chart 18-3). The trial insertion can be performed only once. You can choose any fiberscope and can apply any insertion technique at the test. Depending on the insertion time the rank is given; 3 "kyu" for more than 3 minutes and under 4 minutes, 2 "kyu" for more than 2 minutes and under 3 minutes, and 1"kyu" for more than 1 minute and under 2 minutes, "shodan" for more than 50 seconds under 1 minute, and 2 "dan" for more than 40 seconds than 50 seconds. Roughly speaking, 2 "kyu" is considered as ready for the real colonoscopy on the human body and "shodan" is considered as a full-fledged endoscopist.

 

CHART 18-3 FLOWCHART OF THECOLON MODEL TEST 

 

MOVIE 18-1 THE SINGULAR METHOD ON THE COLON MODEL 1

Rectum; From the home position (the left hand at 12 o'clock), rotate counterclockwise to 7:30 with the left hand.

The former half of the sigmoid colon; Having the s-top upward and traverse it with push and the up angulation.

The latter half of the sigmoid colon; Withdraw the scope with the super-up angulation and with the left hand at 10:30, traverse SD with the right angulation.

The splenic flexure; Push the scope with the up angulation and traverse the flexure with the left hand at 12 o'clock (Along with the passing, the left rotates to 10:30).

Transverse colon; Traverse the middle part with the down angulation. Withdrawing the scope, rotate counterclockwise with the left angulation and advance along the left wall to the hepatic flexure.

 

MOVIE 18-2 THE SINGULAR METHOD COMPARISON BETWEEN THE FINGER-SCOPE AND THE FIBERSCOPE ON THE COLON MODEL 1

The singular method should be learned with the finger-scope and practice on the colon model. However, the basis is the same between the finger-scope simulation and the insertion on the colon model.

 

MOVIE 18-3 THE SINGULAR METHOD ON THE COLON MODEL 2

Essentially the singular method is common between on the colon model and the real human body. The difference is that on the human body the early shortening, the hand press and other