Endoscopic Video Systems

Endoscopy: TV Cameras Look Inside

Objectives
Describe clinical applications of endoscopic video
systems
Analyze the construction and function of rigid and
flexible endoscopes
Differentiate between fiberscopes and videoscopes
State the advantages and disadvantages between a
three-chip and single-chip color CCD camera in
endoscopy
List common types of light sources for surgical video
illumination
 Introduction
 An endoscopic video system allows the physician to look inside
the patient’s body by inserting a light pipe with viewing optics
(endoscope) into the body through a natural lumen or a small
surgical puncture
 Endoscopic inspection is now widely used in many diagnostic
and therapeutic procedures
 Endoscopic surgery has replaced many open surgical
procedures because they are less traumatic to the patient,
cause less discomfort and enable shorter recovery times
 These surgical procedures are usually called minimally invasive
surgeries
Applications
Laparoscopy – minimally invasive treatment and
examination of organs and tissues in the
peritoneal cavity using and endoscope and other
special instruments (puncture)
Arthroscopy – minimally invasive treatment and
examination of joints (puncture)
Gastrointestinal and Bronchial Endoscopy -
minimally invasive treatment and examination of
the GI tract and respiratory tract (natural lumen)
 Typical System Components

Endoscope
Light source
Video camera
Image processor
Video display(s)
Image management system
 Additional System Components

Trocars/cannulae
Gas insufflators – CO2 or N2O
Air, water and suction pumps
Laser, ESU, U/S, cutters, forceps, scissors, biopsy snares,
etc.
Endoscopes
Used by surgeon to view anatomical structures and
perform therapy to the interior of the body
Diameter varies from the 1.7 mm needle fetoscope to the
5 mm arthroscope to the 22 mm colonoscope
Length must be appropriate to reach the desired
structure
Can be rigid or flexible
Rigid Endoscopes
Hollow sheaths that allow straight viewing or a
sheath with an eyepiece and lens system that
allows viewing in a variety of directions
Sheaths of most are stainless steel, but there are
plastic sheathed scopes but they are usually
disposable
Optical fibers surrounding the lenses transmit
illumination to the object form an external light
source
Rigid Endoscopes
Insufflator connected to laparoscope or trocar via air
hose that injects N2O or CO2 into abdominal cavity
Though operating laparoscopes have eyepieces, they are
usually connected to video systems that allow viewing
live feed and/or still images on a video monitor
Top: Jacket tube (enclosing fiber cable), connector for fiber cable and outer eyepiece
Middle: Inner tube with eyepiece
Bottom: Deflector prism with (some broken) optical lenses and distance pieces
Flexible Endoscope
Long flexible insertion tube connected to a proximal
housing
Can be inserted into curved orifices of organs (colon,
lung, stomach, etc.)
Wires running from control head to the distal tip
enable operators to angle the insertion end facilitating
insertion and viewing
Flexible Endoscope (Colonoscope)
 Flexible Endoscope Sections

Insertion tube
Control head
Light guide connector
Universal cord (light guide tube)
Flexible Endoscopes - Fiberscopes
Insertion tube contains two bundles of optical fibers,
one for the illumination, one for the image
Water channel
Air channel
Instrument channel
Gas channel
Flexible Endoscopes - Videoscopes
Optical fiber bundle replaced by video camera
chip mounted at the tip of the insertion tube
Picks up image and converts to electrical signal
directly
Has a larger diameter due to larger size of camera
chip
External diameter ranges from 0.5 mm
(bronchoscope) to 14 mm (colonoscope)
Working length ranges from 550 mm
(bronchoscope) to 2,000 mm (colonoscope)
Flexible Endoscopes - Videoscopes

Water channel
Air channel
Instrument channel
Gas channel
Light Sources
Connected to the illumination light guide of the
endoscope to provide light for viewing and surgical
fields or body cavities
Provide sufficient level of visible light for diagnostic
observations and surgical procedures
Usually emits wide light spectrum; visible, infrared,
and sometimes UV
Filters prevent radiation from entering the body
which would cause thermal burns or fire otherwise
Endoscopy System: Light Source at Bottom
Light Sources
Xenon and quartz-halogen lamps are popular for
endoscopic procedures due to their high intensity and
near-daylight spectrum
Manually configure brightness of bulb using aperture
Automatic brightness control is provided by the video
processor to maintain optimum illumination throughout
procedure
Output and color temperature usually decrease with time
(xenon-500 operating hours)
Most lamps require forced cooling to maintain a safe
operating temperature
Camera, Processor and Display
Camera attached to eyepiece (through an adapter) of
a rigid scope or to the proximal end of the flexible
scope
Single chip mosaic color filter CCD (charge-coupled
device) camera is most commonly used
Uses red, green, blue filters overlaying each CCD pixel
Another single chip design uses a color wheel
containing red, green and blue filters on the wheel
 Camera, Processor and Display
Three chip CCD splits the incoming light into red, green
and blue beams and each beam is directed to one of
three dedicated CCDs
Three chip systems provide a higher resolution image
than the mosaic filter system and a higher refreshing rate
than the color wheel system
CCD chip is integrated into the tip of the scope for a high
quality image free from distortion, degradation from
optical misalignment and deterioration of the optical
fibers and lens system
Camera, Processor and Display
Image or video processor responsible for white
balance, brightness, contrast, color control, focus and
shutter control
Some processors can support automatic gain control,
multiformatting and character generation
Camera, Processor and Display
Video and/or still images are displayed on one or more
color monitors
Typical medical-grade video monitors have low leakage
current with high brightness and high contrast, allow
gamma curve calibration and can support resolution
better than 800 lines per frame
Both cathode ray tube (CRT) and liquid crystal display
(LCD) monitors are used in endoscopic systems
Insufflators
Assists with maintaining a pneumoperitoneum to
enlarge the working space for surgical instruments
and increase the field of view of the surgeon
Nitrous oxide or carbon dioxide are introduced into
the peritoneal cavity to distend the abdomen during
the procedure
Acts as a pressure-controlled flow regulator
converting the high-pressure gas source to about 10-
15 mmHg before delivering to patient
Automatically regulates flow to maintain user
selected pressure throughout procedure
Flow and pressure alarms are built in to ensure
patient safety
 Common Problems
Mechanical wear and tear
Electronic component failure
Improper cleaning, disinfection, and sterilization
processes
Water leakage
Optics damage
Light source burns