Shadowing a Colonoscopy with Dr. Silas

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Shadowing a Colonoscopy with Dr. Silas

When we first arrived at Advocate Lutheran General Hospital in Park Ridge, IL, Dr. Silas took us to the GI Lab where the colonoscopies, endoscopies, and other procedures on the gastrointestinal track are performed. After signing HEPA agreements and providing the department with proof from the Bioengineering Department at the University of Illinois Urbana-Champaign, we headed into a procedure room. We got to spend about 15 minutes learning about the different functions of the colonoscope. Since the colon is not a sterile part of the body, each of us were able to hold the colonoscope and practice using the different features of the colonoscope to be used in the upcoming colonoscopy. Images of this experience are shown below.

Image Description
This image shows Ryan working with Dr. Silas to learn the proper way to hold the colonoscope in the left hand while handling the shaft of the scope with the right hand. Holding the colonoscope in this way allows the mechanical motion of the tip to be controlled by turning the dials with the left thumb. One dial allowed for up and down movement of the tip while the other facilitated left and right motion. Turning both dials in unison, using the left thumb and right hand, allows for motion in any direction.

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Here is a focused view of Ryan using the colonoscope.  As you can see the shaft of the scope is grasped by the left hand.  Ryan, however, is using the scope inappropriately and with his right hand.  During and actual procedure, the thumb of the left hand would be used to turn the tip of the scope, which Dr. Silas is holding. The right hand is used to guide the scope into the colon as well as remove it.

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This picture shows the front end of the scope. This is the first portion to enter the colon and you can't see in this picture, but there are various sections on the tip of scope used for many different things. One section acts similar to a window washer and sprays water over the viewing lens inside the body. Another section is capable of suctioning out materials inside the body such as removed polyps or other interesting items.  A pulsing light is also visible on the leading edge as well as a high definition camera. All these advancements are crucial to proper investigation and used multiple times per procedure.

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Here, Collin is attempting to use the colonoscope. Again, he is using it incorrectly, with two hands. In the bottom right corner of the photo you can see the piece of equipment that connects the scope to its power source. The cord between the handle and the base is referred to as the "umbilical cord" by the physicians and nurses. It contains fiber optic cable which transports the light source from the base to the leading tip of the scope as well as electrical components which transfer the photos from the tip to the computer where they can be examined by the physician.

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Here, we see Dr. Silas demonstrating the suction acting capable at the tip of the scope.This can be useful when removing small polyps from the colon as well as improving visibility in the area being investigated.

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Here, we have the "clip". This is used to repair the area where a polyp had been removed. Since many patients undergoing colonoscopies are on blood thinners such as Comudin, when a large polyp is removed there is often fear that excessive bleeding may occur. This device acts much like a staple or stitch.  When the plunger is pulled upward the leading end opens much like pair of pliers. When the clip is directly above the area where the polyp was removed, the plunger is pushed down and the clip clamps down on the wound. The clip is then released and the tubing that encased it is drawn back out through the body. The clip will stay in the body for a few days until the wound is completely sealed up. It then falls off and since it is so small leaves the body through excretion. More information about the clip can be found here.

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This device is called the snare. Its mechanics and function are explained in the following picture.

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The device shown here is called the "snare". It is used to remove polyps found in the colon. The device is controlled by the physician's thumb and acts very similar to a net. The snare is placed through a tiny hole near the handle which follows the scope inside the body and to the area that requires it. When the plunger is moved down a looped wire extends from the tip of the scope. This looped area is then placed around the polyp and the plunger is pulled upward the loop retracts into the colonoscope while sending a pulse of current to cauterize and liberate the polyp from the inner colon tissue. The polyp can be suctioned into the colonoscope through the suction function. The polyp can then have a biopsy preformed to see if it is cancerous. More information on the snare is available here.

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Here is the packing for the clip. The clip, which is shown in detail in an earlier photo, is essential to sealing up the area where a polyp has recently been removed. The price for this item is approximately $200.

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Here we see where the colonoscopes are cleaned.  The cleaning process is very thorough as a scope can range to about 30,000 dollars. Therefore, cleaning them after every use is the only logical option.  It however, is very thorough and time consuming. Not only are they placed in a completely aseptic environment and then washed multiple times with special solutions, but each channel much be connected to a special tube and flushed out. This makes for a very long cleaning process but is essential to keep each patient safe.

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Here, we can see how each of the green and gray tubes are connected to a channel on the colonoscope. This flushes out anything that may be present from the previous procedure.

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After the scopes undergo a rigorous cleaning process in the machines, they are hung to dry in a sealed cabinet.

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Here Collin, Megan, and Ryan are seen holding the scope. You can see the handle or shaft being held by Megan. Collin is holding the end the goes into colon and which through everything is seen. The "umbilical cord" begins at the bottom of the handle and goes to the base unit which is visible on the left side of the picture.

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Before each procedure the scopes are washed down and then placed in these containers to sit and wait until they are needed by the physician.

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Here, Dr. Silas is seen working on the computer after completing the first procedure of the day. Each picture taken during the procedure is saved with the patients file to allow for easy access by the physician and the patient themselves. Using a computer program provided by Pentax, doctors are able to highlight certain regions through labels, arrows, circles, etc. This is important for record keeping.

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Images taken with the colonoscope of the colon during the first colonoscopy we shadowed are shown below.

Image Description
The appendiceal oifice, a curved indent distinguishing the location of the appendix in the lumen of the colon.
The cecum, a pouch that connects the ileum, or final section of the small intestine, with the colon of the large intestine. It is separated from the ileum by the ileocecal valve.
The ileum, which is the final section of the small intestine--the bumps are nodules of lymphoid tissue, which are normal in the ileum.
The transverse colon, which is the segment of the colon that travels horizontally across one's body in the abdomen connecting the ascending and descending portions of the colon. The triangular folds are characteristic of the transverse colon.
A polyp is an abnormal growth of tissue arising from a mucous membrane; a small polyp is shown here.
A clip on polypectomy site ( site where we removed the polyp). More information concerning the clip can be found here.
The appendiceal orifice of the second patient.
Retroflexed view of the rectum--the black object is the scope; the purplish tissue surrounding the scope are internal hemorrhoids.
The ileum of another patient--no nodules in patient #2.
The cecum of the second patient.
A picture of Collin, as taken from the colonoscope camera.
A picture of Megan, as taken from the colonoscope camera.
A picture of Ryan, as taken from the colonoscope camera.

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