Professor MD MD hc Guido Schumacher
Endoscope is an optical device intended for inspection of the inner cavity of the human body. It is designed as flexible (sometimes rigid) optical tube with light allowing an examiner to observe the inner situation. There are many types of endoscope depending on their purposes. Normally, they are named after area of exploration they designed for, e.g. rhinoscope is used for nasal examination; arthroscope is for joints; thorascope – for pleural cavity; angioscope – for blood vessels etc.
Some sources refer to endoscopy – which is any procedure using endoscope – as “innovative method” but, in fact, it is not true. First endoscope for medical purposes was introduced as early as in 1806 although it was not used then. But first endoscopic examination was performed not long after that by Antonin Jean Desormeaux and it was real challenge as it had happened before the invention of electricity.
For sure, modern endoscope differs significantly from its predecessors and now it is included into complex computers systems allowing translating images from a camera to a monitor. In Clinic of Braunschweig we use endoscopic examinations as well as endoscopic surgery to diagnosis and treat a variety of problems in all body areas.
Gone are the days when sinus operations were performed with opens surgery through the incisions on the face or in the mouth. Using of nasal endoscopes allow avoiding unattractive scars and many complications associated with traditional approach. Currently, the majority of nasal operations for sinus problems are done with a technique called functional endoscopic sinus surgery (FESS).
Using endoscopes for sinusitis is very natural as there are two natural openings – nostrils – acting as pathways all the way to the sinuses. Common reason to do the sinus surgery is chronic sinusitis which is recurrent problems with sinus ventilation caused with infections, allergies and other reasons that sometimes are not very clear. Another reason for sinus surgery may be an anatomical defect that leads to blockage of airflow or worsening of sense of smell. Depending on extent of the problem you may need treatment for one sinus or for both of them. When procedure is performed for both sinuses at the same time it is called bilateral endoscopic sinus surgery.
Surgery is usually done under general anesthesia. A surgeon inserts a rhinoscope to provide visualization inside and fix up the problem. After removing blockage the surgeon perform other necessary actions when needed as cleaning of the sinuses or delivering medicine directly to the problem area. Sometimes reconstruction of the bone may be undertaken for permanent blockage removal. Endoscopic sinus surgery is an effective mean to get rid lasting problems that were not improved with conservative medicine.
Minimally invasive method can be also used in spine surgery. The whole range of spine diseases can be treated with endoscopic surgery as:
The most common endoscopic procedure for spine is micro discectomy done for interverberal disks herniation. It is surgery to remove a portion of herniated disks for decompression of the spinal nerve. Endoscopic technique helps to avoid large incisions and provide more accurate surgery sparing the most of the tissues.
Coronary Artery Bypass Grafts (CABG) is one of the most demanded cardiologic operation for coronary heart disease. In the past this procedure was performed with open surgery that involved stopping the heart and switching the patient to the heart-lung machine that provided body with oxygen enriched blood while the heart was motionless. This type of surgery has numerous complications and contraindications and a number of patients are illegible to GABG because of its risks.
With endoscopic approach to bypass surgery it has become to treat diseased coronary artery even in those patients who had strict health contraindications. Operation is usually done via incision in the groin and donor material for bypass is delivered via catheter inserted into the femoral vein. Thus, endoscopic coronary bypass allows improving blood flow to the heart maximally sparing the body of patient and avoiding common side effects of open surgery and using pulmonary bypass.
There are two options for endoscopic bypass surgery:
Choosing one of the methods depends on the overall patient health situation and comorbidities that probably need additional treatment.