A detailed overview of endoscope handling and maintenance best practices to ensure maximum up time and minimizing repair costs. Overview covers rigid and flexible endoscopes, terminologies, common issues, best practices. Target audience include physicians, surgical technicians, OR nurses, Sterile Processing technician, biomedical engineers

1. SURGICAL OPTICS LLC
ENDOSCOPE INSERVICE

2. INTRODUCTION
• 70% of endoscope repairs are caused by accidents
• Cost of equipment failure is more than repair or replacement
cost
• Education / Training
• Accident Prevention
• Demystifies diagnostics & facilitates informed repair decisions
• Managing repair expenditure is a cross-functional effort
• This presentation is Chapter I …

3. GOALS FOR THIS SESSION
• Fundamentals of endoscope (functionality, construction,
nomenclature, common issues)
• Enhance awareness of proper “care and feeding” of these
high precision, delicate, expensive devices
• Provide a starting point and roadmap for on-going repair cost
management

4. ENDOSCOPES OVERVIEW
Common functionalities of all scope types:
• Provide illumination (via fiber optics or LED’s)
• Provide Visualization (via an image bundle or CCD)
• A working channel for irrigation, biopsy or other therapeutic devices
• An interface to related devices and accessories (processor, light source,
video printer, sheaths, suction pump, etc.)

5. CLASSIFICATION
Fiber Optics
Video (CCD)
Ultrasound
Direct View
Video
Ureteroscope
Operative
(Offset)

6. COMMON SPECIFICATIONS
• Working length
• Diameter (distal, or insertion tube)
• Direction of View (DOV)
• Field of View (FOV)
• Channel Size (biopsy, working)
• Reprocessing Methodology
When is this information important:
• Looking for compatible scopes (loaner, replacement, etc.)
• Cross referencing one manufacturer’s model against another
Selecting appropriate accessories (cleaning brushes, instruments, light
cable, reprocessing equipment
Note: “cheat sheet” available on line or customer service can help if make
and models are available (or visa versa)

7. COMMENTS ON NOMENCLATURES
• Terminologies are not universal and vary by manufacturer or
user
e.g. telescope, lens refer to the same instrument…
• Or too general so that they create confusion
e.g. a cystoscope can be a rigid scope or a flexible scope.
• Or different names for the exact same device:
e.g. A rigid cystoscope and a hysteroscope
e.g. a 4mm 30 deg arthroscope is physically the same as a 4mm 30
deg ENT scope or SinuScope
• Awareness of these issues reduces stress and confusion!

8. RIGID ENDOSCOPE ANATOMY
Objective Lens
Objective Lens
Light Fiber
Rod Lens
Ocular
Ocular
Eye Piece
Eye Piece
Rod Lens
Light Cone

9. COMMON FAILURES
POOR IMAGE QUALITY
Partial Image
Scratched lens Foggy Image
Rainbow Image
Debris in view
Out of focus Shadows in view

10. COMMON FAILURE
ILLUMINATION & MECHANICAL
• Illumination:
• Low light output
• Burnt/ Broken fibers
• Shadows
• No light
• Etc.
• Mechanical:
• Wandering image
• Bent / Dent shaft
• Damaged Tip
• Etc.
Burnt light cone Laser damaged tip
Bent shaft Hole in shaft

11. FAILURE MODES
• Impact, shock or stress – Glass components easily damaged
• Reprocessing (chemical, heat, pressure)
• Accelerates aging and staining of lenses
• Reduces light transmission
• Darkens image overall
• Wear and Tear
• Lens delaminate
• Fiber bundle becomes porous, retains moisture
• Other joints, seals failure causing leakage
• Spacer coating flakes off, casting off debris

12. FLEXIBLE ENDOSCOPE OVERVIEW
FUNCTIONALITIES RECAP
• Visualization
• Illumination
• Angulation (2-way, 4-way)
• Working Channel (biopsy, therapy)
• Air/Water (insufflation, cleaning)
• Suction
• Remote control of video capture, printer,
etc.
More Functionality = More Complexity
Complexity = Higher Repair Frequency +
More Training + Higher Repair $

13. FLEXIBLE ENDOSCOPE NOMENCLATURES

14. FLEXIBLE ENDOSCOPE NOMENCLATURES
CONTINUED
ETO Connector
Water Resistant Cap
Universal Cord
(Light Guide Tube)
Light Guide Connector
“E/L Connector”

15. WHAT’S INSIDE

16. COMMON FAILURES
FLUID INVASION
Inside view of punctured
channel
Failed Water(resistant) Cap Internal Corosion

17. COMMON FAILURES
IMPACT & STRESS
Note: often times there is no
observable external evidence of
tubes being crushed or collapse.
Colonoscopes are especially
vulnerable due to their long I/T
Video scopes with heavy U-cord
connectors are also vulnerable
to handling mishaps
Small diameter scopes
(intubation, ENT, etc. ) especially
Ureteroscopes (DUR-8, URF-P3,
et.c) can not tolerate any
amount of weight / pressure on
the I/T and almost any damage
is “catastrophic”

18. COMMON FAILURES
ANGULATION SYSTEM & TUBES
The repair of the same angulation prolem, e.g. loss of
articulation in one or more directions, can range from a
minor adjustment to a major angulation system rebuild.
This determination can only be made by fully
disassembling the scope for inspection at the repair
facility.
Insertion tube stiffness will change with age (becoming
softer).
Frequent use of stiffness control on some models and
setting in highest stiffness level (e.g. while in storage) will
significantly shortens life of stiffness control harness and
insertion tube.

19. A BRIEF COMPILATION OF BEST PRACTICES
• Leak Test
• Best defense against
catastrophic failure /damage.
• Simple procedure but must be
properly done
• Learn about “false positives” as
well as “false negatives” in leak
testing
• Handling
• Practice handling with colonoscope
• Practice switching hands.
• Observe “coiling radius”
• Minimize number of hand-offs from
bed side to processing and back
• Plugging in and removing E/L
connector to light source
• Protect distal end at all times
Complete
document
available on line
or via email

20. BEST PRACTICES CONTINUED
• Work Flow
• On alert during vacations & holidays
• Staff turnover (shift change, new personnel, rotation, etc.)
• Case load vs. inventory
• Bench Marking – Data collection & analysis
• What metrics to measure? Cost / procedure, MTBF, cost of
ownership, repair history, failure analysis, etc.
• Pay-as-you-go or service contract? What kind of contract?
• Working with Vendors
• Insist on explanation of repairs and any options available (in
language that you can understand)
• Review history and expenditure and ask for help identifying any
trends or opportunities for reducing expenditures
• Maintain or have vendor maintain complete repair history
• Seek a second opinion for major repairs

21. RECAP
 Majority of repairs are from accidents
 Training helps in accident avoidance
 Scopes are delicate, sophisticated, expensive devices (electro, opto,
mechanical) operating in very harsh environment of water,
chemical, heat, and sharp tools.
 Surveyed a large swath of endoscope landscape and terminologies
frequently encountered
 Reviewed a number frequently encountered failures, and causes
 Reviewed a number of best practices for managing repair
expenditures

22. FURTHER READING
Olympus -Physician Handling Tips to
Minimize Flexible Endoscope Damage
Olympus- Endoscope Disinfection Guide
Surgical Optics – User Tips - Various
Topics
• AORN Journal 12/11/2007
Benefits of process change
(Rigids)
• AORN Recommended Practices
for Use & Care of Endoscopes
(January 1998)
• Endonurse 04/01/2008
The High Price of Scope Leaks
• Materials Management Nov 11,
2010 Nancy Scholssberg, R.N.
• Lower endoscope costs with repair
reduction plan

23. RESOURCES
• To request electronic copy of this presentation
• To schedule department specific sessions
• To get help with work flow, or repair history review/analysis
• Discuss repair cost reduction plans
Contact: Surgical Optics LLC
www.surgical-optics.com
email: sales@surgical-optics.com
Cell phone: 408-569-9029