Review proves the value of computers

Computers are now helping medical professionals in most fields of medicine. A new study in France has revealed they can also be of great use in virtually any endoscopic procedure. PHILIPPA BARR looks at one role they can play.
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A review of the use of computer-assisted video endoscopy has drawn the conclusion that computers can be useful in almost any type of endoscopic procedure.

Researchers found that computer assistance allowed greater understanding paranasal sinus structure without increasing operation time in endosnasal surgery.

The use of computers could  be valuable in revision surgery when normal anatomic landmarks were missing.

Investigators from ‘Clinique ORL du CHU de Grenoble’, in Grenoble, France, used computer assisted video endoscopic surgery to treat benign diseases the paranasal sinuses in 20 patients.

They assessed the accuracy and reproducibility of the computer-assisted system by identifying ten anatomical landmarks on each side of the paranasal sinuses using the direct live video-endoscopy image and comparing these images with axial, coronal and sagittal views obtained with the Optical Digitising System (Flashpoint 5000).

The localisation system used by the investigators detects the position of two rigid bodies, one attached to the patient’s head to track motion and the second attached to the operating instrument to track the location of the instrument tip.

A markerless, skin surface registration method was employed to avoid the need for a second computed tomography (CT) scan process fiducial markers. Data from the patient’s usual CT scan is registered.

The computer-assisted system allowed a registration and calibration accuracy less than 1.5mm in 89.2 per cent of cases.

Movements of the patient’s head were monitored reliably using the markerless skin surface points method.

There was no significant increase in the length of the operation and the investigation team concluded: “Computer assistance can be used in almost any type of endoscopic procedure.”

New equipment

New equipment, enabling medical practitioners to obtain a better view of what the endoscopy cameras ‘capture’ is being developed all the time.

One example is the SONY DMP-1000 Video Capture Device and Printer - which does not need a computer to get results.

Images can be used with a computer but can also be printed out.

The DMP-1000 is a small format, small footprint Mavica colour printer intended for use with a wide variety of officebased professional printing applications.

Colour images can be captured, stored and printed directly from a camera or from almost any video source.

Images previously recorded on a floppy disk with the DMP-1000 can be accessed at any time for printing and the device also allows the quick and easy viewing and printing of images captured with a Sony Digital Mavica camera. Its specifications include:

- No computer needed - it can print images directly from a video source or 3.5 inch floppy disk
- Captures and stores video images on to a removable 3.5 inch floppy disk
- High resolution, photo-quality prints
- Remote capture (foot switch) capability
- Instant ‘back to live’ functionality
- Video output allows display of images on a standard TV monitor
- Reverse and duplicate image capability

Health professionals who use endoscopes will, no doubt, also be interested in an innovative package which has been designed to convert fibre optic endoscopes on to video.

The Olympus OTV-S2 Colour Video Camera Package includes an OTV S2 Olympus camera, 13 inch new Panasonic monitor, W42AE procedure cart, scope pole mount and rack, WA Series eyepiece adaptor and rigid endocoupler.

Further information on these pieces of equipment, including price details, plus many other exciting new endoscopy products currently available, or in the pipeline, can be found on the web at: www.endoscopy.com/image_capture.htm
The new OR1 from Storz in Tuttlingen, Germany, gives medical experts the power to seamlessly integrate and control virtually every technology, alls in a single, optimised system that is custom designed to match the individual requirements of the environment it is used in.

This is a conceptual drawing of a Capsule Endoscope which Olympus is aiming to realise asa dream endoscope of the future.

If a patient can easily swallow this endoscope without sedation, it can be widely used for diagnosis in the esophagus, stomach and colon.

It will have various functions that are required for endoscopes, such as an image capturing function, image telemetry function, therapeutic device, positioning function and propulsion system.

An ultrasmall CCD, miniature light source, micro manipulator, micro sensor and signal transmission are required. These functions and devices will be realised by micromachining technologies that the company is pursuing.

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One-stop clinic reduces endoscopy waiting times

A one-stop colorectal clinic in the north of the United Kingdom has resulted in a significant reduction of the number of patients who are waiting for lower gastrointestinal (GI) endoscopy, a study has revealed

Dr L.S. Jones and his colleagues at the Blackburn Royal Infirmary, Blackburn, Lancashire, have been exploring how much a one-stop clinic for colorectal patients can reduce waiting times for lower GI endoscopy. The study involved 197 patients who needed evaluating for a range of colorectal complaints such as rectal bleeding, altered bowel habits and anorectal symptoms.

The clinic was held one day a week for six months, during which patients were examined by a consultant or specialist registrar. After a history was obtained the clinical examination was carried out in consulting rooms equipped with facilities for rigid sigmoidoscopy, proctoscopy and rubber band ligation. Flexible sigmoidoscopy was also performed, but only when it was deemed appropriate, rather than as a strict policy. When this procedure was thought to be necessary, consent from the patient was gained and a phosphate enema was used. No sedation was given.

At the end of their visit, patients were asked if they would complete a questionnaire.

In a subsequent article in the Journal of the Royal College of Surgeons of Edinburgh, Dr Jones’ group observed:

“Colorectal services have traditionally been arranged for the convenience of a hospital and its staff rather than for patients. Consultations and procedures are carried out in different places and at different times. This model is not ideal, particularly for minor interventions and diagnostic procedures.”

During the study, 134 patients underwent proctoscopy, 72 had a sigmoidoscopy and 85 a flexible signmoidoscopy.

Subsequently, 24 patients had a barium enema and three were put on a waiting list for a colonoscopy. The main diagnosis was haemorrhoids, which were diagnosed in 104 patients.

When the one-stop clinic opened, 119 patients were on a waiting list for lower GI endoscopy. At the end of the six month study the number had dropped to 63. Two months later the number had increased to 108.

The results of the questionnaire completed by patients showed that most of them were satisfied enough with the clinic being in the evening. Only 13 per cent (26 patients) reported that they would have actively preferred a daytime clinic and most of these were women with young children.

Dr Jones concluded that flexible sigmoidoscopy without full bowel preparation and without sedation was clinically feasible.
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