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.

1
00: 00: 00,000 -> 00: 00: 04, 588
I will explain one pattern method using a colon model.

2
00: 00: 04, 623 -> 00: 00: 10, 476
The start starts at the 12 o'clock position on the left hand side,

3
00: 00: 10, 511 -> 00: 00: 16, 731
The rectum will rotate to the left until 7:30 pm and advance.

4
00: 00: 16,766 -> 00: 00: 25,299
When it enters S, it turns clockwise, and at the position of 9 o'clock left

5
00: 00: 25,299 -> 00: 00: 30, 763
S Look at the top in the up direction and cross over with an up angle.

6
00: 00: 30,798 -> 00: 00: 39,003
S The second half will rotate clockwise while pulling.

7
00: 00: 39,038 -> 00: 00: 45,771
When turning right from 9 o'clock to 10:30 o'clock,

8
00: 00: 45,806 -> 00: 00: 49, 643
Since SD will be visible in the right direction

9
00: 00: 49,678 -> 00: 00: 52, 827
I cross over with a right angle.

10
00: 00: 52, 862 -> 00: 01: 01, 211
If you cross SD with a right angle

11
00: 01: 01,246 -> 00: 01: 05, 851
Light rotated until 12 o'clock left hand,

12
00: 01: 05,886 -> 00: 01: 12,028
As you go down the descending colon you will see spleen curve in the up direction

13
00: 01: 12,063 -> 00: 01: 14, 331
Go over at an up angle.

14
00: 01: 14, 366 -> 00: 01: 22, 524
Confirm that you crossed and convert your posture with splenic flexure.

15
00: 01: 22,559 -> 00: 01: 35,980
The left hand will also rotate counterclockwise from 12 o'clock to 10:30 o'clock with the change of body position.

16
00: 01: 36,015 -> 00: 01: 44, 651
As long as the left side of the transverse colon remains at 10:30, and it pushes straight

17
00: 01: 44, 666 -> 00: 01: 50, 139
Because the mid transverse appears in the down direction

18
00: 01: 50, 174 -> 00: 01: 55, 659
Hook on down angle and start pull.

19
00: 01: 55, 694 -> 00: 02: 03, 932
While pulling left hand to left half hour until 7:30

20
00: 02: 03, 967 -> 00: 02: 08, 410
The down angle will change to the left direction

21
00: 02: 0 8, 445 -> 00: 02: 12, 924
It strikes the hepatic flexion at the left angle.

22
00: 02: 12, 959 -> 00: 02: 16, 659
After hitting the left,

23
00: 02: 16, 659 -> 00: 02: 22, 228
If you cross the right corner of the liver curvature with a right angle
2
00: 02: 22, 228 -> 00: 02: 27, 563
Light rotated until 12 o'clock,

25
00: 02: 27,598 -> 00: 02: 34, 683
I will reach the ascending colon and cecum at an up angle.

 

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.

1
00: 00: 00,000 -> 00: 00: 05,598
The right index finger of the finger endoscope

2
00: 00: 05,598 -> 00: 00: 07, 734
I simulate the scope tip.

3
00: 00: 07, 734 -> 00: 00: 15, 315
Therefore, the left hand and right hand fingertip are in double advancement relation.

4
00: 00: 15, 350 -> 00: 00: 19,067
Understand there and share these two videos

5
00: 00: 19,067 -> 00: 00: 20,890
I would like you to compare.

6
00: 00: 20,890 -> 00: 00: 27,778
Rectum first turn left and pass.

7
00: 00: 27,813 -> 00: 00: 31, 410
S going back a little,

8
00: 00: 31,410 -> 00: 00: 38,978
The left hand is pulling the S top at 9 o'clock.

9
00: 00: 38,978 -> 00: 00: 40,802
It is a pull method.

10
00: 00: 40,837 -> 00: 00: 48,337
As approaching SD, the left hand turns right from 9 o'clock to 10:30 pm,

11
00: 00: 48,372 -> 00: 00: 54,322
I 'm trying to cross SD at 10:30 on my left.

12
00: 00: 54, 357 -> 00: 01: 05, 042
If it crosses the SD, turn further clockwise to 12 o'clock left hand,

13
00: 01: 05, 077 -> 00: 01: 08, 659
We will proceed to splenic bending with a basic stance.

14
00: 01: 08,694 -> 00: 01: 14, 642
If you cross the splenic curve at an up angle, you will change your posture.

15
00: 01: 14,677 -> 00: 01: 25, 137
The left hand shifts from 12 o'clock to 10:30 with posture change.

16
00: 01: 25, 172 -> 00: 01: 32, 137
I will push and midtransverse

17
00: 01: 32, 137 -> 00: 01: 33, 888
Because it looks downwards,

18
00: 01: 33, 888 -> 00: 01: 40, 323
Go over the mid transverse at the down angle.

19
00: 01: 40, 358 -> 00: 01: 44, 322
If it crosses over, it will start pulling immediately,

20
00: 01: 44, 357 -> 00: 01: 50, 722
While doing this, left rotate

21
00: 01: 50, 757 -> 00: 01: 55, 906
(Turn counterclockwise) and apply a left angle.

22
00: 01: 55, 941 -> 00: 02: 05, 216
Then it will be shaped like the tip hits the liver.

23
00: 02: 05, 251 -> 00: 02: 10, 530
It is a liver curvature as it hits.

24
00: 02: 10, 565 -> 00: 02: 17, 914
Once you cross the liver curvature with a right angle this time,

25
00: 02: 17, 914 -> 00: 02: 23, 682
Rotate right until 12 o'clock to reach the cecum.

 

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

1
00: 00: 00,000 -> 00: 00: 09,439
S push up and cross over by pushing up.

2
00: 00: 09,439 -> 00: 00: 17, 166
S I will pull the latter half forward.

3
00: 00: 17, 166 -> 00: 00: 22, 294
SD crosses at the right rotation angle and right angle.

4
00: 00: 22, 324 -> 00: 00: 25, 855
The splenic curvature goes up at an up angle.

5
00: 00: 25, 885 -> 00: 00: 32, 191
Position and press.

6
00: 00: 32,221 -> 00: 00: 36, 332
Go down the middle of the transverse colon with a down angle.

7
00: 00: 36, 333 -> 00: 00: 37, 333
Pull from here and proceed with the left rotation left angle.

8
00: 00: 37,334 -> 00: 00: 38, 334
When it strikes to the left, it crosses the liver curvature with a right angle.

9
00: 00: 38, 335 -> 00: 00: 51, 644
It is caecum with light rotation up angle.

10
00: 01: 02,016 -> 00: 01: 07, 463
Rectum is left angle left rotation

11
00: 01: 07, 493 -> 00: 01: 18, 113
S top pushes up and goes up.

12
00: 01: 18, 143 -> 00: 01: 28, 306
Pull it over and cross the SD with light.

13
00: 01: 28, 307 -> 00: 01: 34, 249
Splenic lymph is up and transcends posture.

14
00: 01: 34, 250 -> 00: 01: 35, 250
Push the transverse colon

15
00: 01: 35, 251 -> 00: 01: 38, 411
The middle part of the transverse colon crosses over at a down angle

16
00: 01: 38, 411 -> 00: 01: 41, 346
Left rotation left angle

17
00: 01: 41, 347 -> 00: 01: 44, 642
When you hit the left, you cross the liver curvature with a right angle.

18
00: 01: 44, 643 -> 00: 01: 45, 643
Arrive at the cecum with light rotation up-angle.