Rigid endoscopy

The rigid endoscope is an extremely versatile instrument that can be placed in any available bodily orifice - and where a suitable orifice does not exist, one can be made surgically!

The superb optics and high degree of magnification give a much better view of the surgical site than is possible with conventional open surgery, and with considerably less trauma to the patient.

Rhinosinusoscopy

The nose is an extremely inaccessible spot for conventional surgery, and collection of samples by nasal flush is unreliable. Foreign bodies can often be embedded deep within the turbinate structure, where they are difficult to retrieve blind, and the potential for iatrogenic damage is high. Rhinoscopy allows direct visualisation of the nares from the nasal planum to the naso-pharynx. This allows collection of biopsies and tissue samples in cases such as aspergillosis under direct visualisation, and at great magnification. Tumours and polyps can be resected or ablated of with the diode laser through the instrument channel of the endoscope. In cases where lesions or infection involves the sinuses, sinusoscopy can be of great benefit since biopsies of this site are often more revealing than those taken from nasal mucosa.

Urethrocystoscopy

Whilst radiography and ultrasonography can give us quite a bit of information about the structure and pathology of the bladder and urethra, that information is somewhat limited. Endoscopy provides direct visualisation of the vagina, urethra and bladder enabling us to biopsy lesions, retrieve stones and check for position and function of the ureters. Small tumours and polyps can be debulked or removed with the laser. Cases of transitional cell carcinoma of the trigone, for example, whilst not curable, may be given a reprieve for some time by debulking the tumour with the laser to relieve urethral blockage.

Thoracoscopy

Thoracic lesions are particularly difficult to access by conventional surgery making traditional thoracotomy a technically demanding procedure for the surgeon, and extremely traumatic procedure for the patient, with extended recovery times and great discomfort. The thorax lends itself well to endoscopy and many procedures within the thorax can be carried out with minimal trauma and excellent recovery times. Pericardectomy, biopsy of mediastinal or pulmonary masses, removal of lung lobes and inspection of the pleura, lungs and pericardium can all be carried out endoscopically.

Arthroscopy

Conventional surgery of the joints often allows poor visualisation of lesions and results in considerable surgical trauma. Arthroscopy is the modality of choice for joint evaluation where radiography is inconclusive, and is ideal for treatment of OCD lesions, fragmented coronoid processes and joint mice etc. Soft tissue structures in and around the join, such as ligaments and joint capsule can be assessed for damage or inflammation.

Laparoscopy

Laparoscopy enables us to investigate the whole abdomen through a small puncture incision. All the abdominal organs can be visualised, palpated and biopsied as necessary. Organ morphology can often be very informative and liver or pancreatic biopsies etc. can be taken from abnormal sites under direct visualisation. This allows us to watch for, and control any haemorrhage, directly, which may be safer than taking blind or ultrasound guided biopsies trans-abdominally. Laparoscopic biopsies are larger and therefore more representative than those taken with traditional "Trucut" type biopsy needles. Since biopsies can also be taken from areas which look grossly abnormal, the diagnostic yield is generally much higher. Laser ablation of focal lesions such as hepatic tumours can be carried through the endoscope channel. The laser can be used for haemostasis or as a "hot scalpel" to enable us to carry out surgery within the abdomen. Ovariectomy, polypectomy and removal or ablation of focal tumours can be carried out with minimal trauma.

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