Laparoscopy, the current standard method of practice in abdominal operations, uses rigid scopes. The method is considered minimally invasive; when compared to open procedures, it results in smaller incisions, less bleeding, shorter recovery time, and less post-operative pain.
Contrasted with rigid procedures, flexible endoscopy is performed via access to natural body orifices rather than incisions, allowing for the visualization and treatment of structures with virtually no need for recovery time. Minimally invasive surgery has been widely used in the United States since the 1980s, although it wasn’t until recently that major advancements in technology for each were realized.
The rigid scopes used for laparoscopy and arthroscopy have seen major design changes within the last several years, including improved picture quality, functionality, and versatility. Some of the greatest improvements are:
The best-known manufacturers in the market for rigid endoscopy now offer 4K picture resolution, an improvement in sharpness more than four times greater than that offered by full HD. Accompanied by a more powerful LED light source, the result is better image quality, a wider color gamut, and contrast enhancement.
Indocyanine Green, or ICG
Commonly used in angiography and open surgeries, ICG has become an ancillary method in identifying tissue perfusion during laparoscopies. The ICG-perfused tissue turns bright green, or actually glows, and is easily distinguished from less perfused tissue. This is crucial to monitor when blood flow is difficult to note, or organ structures are difficult to distinguish from one another.
Using ICG fluoroscopy has proven invaluable in the time-sensitive detection and prevention of tissue injury. To observe the fluoroscopic agent binding to the plasma proteins, a specially-designed camera is needed.
3D technology has been used in medicine since the 1990s and adds tremendous value to the screen image. It allows for easier identification of tissues and vasculature, thus providing a more realistic image of the viewed structures. In recent years, 3D technology has been refined with an updated picture resolution, enhanced depth perception, spatial orientation, and a brighter, more defined image quality.
Despite these advancements, the technology never quite gained mainstream popularity. Perhaps it is because 3D technology requires specialized equipment, involving the CCU, monitor, and scopes.
While flexible scopes have a different design than rigid scopes, technological improvement has been just as innovative. The largest leaps have been made in enhanced tissue visualization and differentiation.
Major manufacturers of flexible scopes responded to the need for improved image contrast. It is a critical component of visualization that allows for real-time differentiation between the blood vessels and other tissues. Improved picture contrast helps determine which tissues are being handled, thus decreasing the risk of mistakenly injuring a blood vessel or causing unnecessary bleeding.
By enhancing the red color output of the light source, visual abnormalities in the mucosal and vascular tissues are much easier to recognize than when viewed under standard white light. Such abnormalities are color- and texture-exaggerated for quicker identification of possible pathological developments.
Wider Field of View
The standard field of view (FOV) for an endoscope is 140 degrees. Now the newest colonoscopes feature increased rotation, allowing for an FOV of 170 degrees. The wider viewing field, along with a brighter illumination, minimizes the risk of missing tissue abnormalities.