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The Lowsley-Peterson universal endoscope
THE LOWSLEY#PETERSON UNIVERSAL ENDOSCOPE* A NEW INSTRUMENT AND ITS USES OSWALD S. LOWSLEY, M.D., F.A.C.S. AND ANDREW P. PETERSON, M.D. NEW YORK CITY
T
HERE is hardIy an endoscopic probIem which cannot be met with someone of the endoscopes avaiIabIe. The
they are of the so-called “dry” type. Very few have any provision for the introduction of catheters or electrodes, and
FIG. I. Obturator is placed in sheath and its tip deflected by turning the knurled knob of its handie. The instrument is then passed into the bladder and inverted as one wouId pass and invert a concave cystoscope for the examination of the trigone. The obturator is then straightened and withdrawn; fight and water connections are made. The sheath should be permitted to 811 with water before the telescopic unit is inserted. Before insertion, the telescope should be adjusted so that a small sector of the sheath remains visible at from IO to 2 o’clock, with the cable connecting post at 6 o’clock.
oId Brown-Buerger cysto-urethroscope can these few are of such restricted use as to be used for procedures ranging from be specific (for instance, McCarthy’s inbiIatera1 renaI peIvic Iavage to simuI- strument for the catheterization of the taneous catheterization of both ejaculatory ejaculatory ducts). ducts. It may take considerabIe time and Experience in over 1500 endoscopies patience, but it can be done. with the most commonly used instruments, Most endoscopes have direct vision, such as the Brown-Buerger cysto-urethrowhiIe a few have forobIique optica systems. scope, the McCarthy panendoscope and The oIder ones have no telescopes, since ejacuIatory duct catheterizing instrument, * Read before the New York Academy of Medicine, Section on Urology, November 18, 1936. 168
NW SERIES VOL.XXXIX,NC,.IjLowsIey,
Peterson-UniversaI
and the LowsIey urethroscope, gave us the desire to design an endoscope, incorporating the best features of these instruments
FIG. 2. With the ffow of water adjusted to a light trickIe, the instrument is slowly withdrawn from the bIadder and observation of the vesical neck and posterior urethra made during the withdrawal. As the veru appears in the fenestra (I) the ocuIar end of the endoscope is raised and slightly advanced until the visible sector of the sheath is pIaced over and behind the veru (2). The flow of water necessary for the distention of the urethra can now be shut off completely. By turning the teIescopic unit to the right (3) or Ieft (4) the IateraI portions of the veru may be examined.
and permitting the use of a new idea, i.e., having the entire assembIy of teIescope, Iight-carrier and guides rotatabIe within the sheath. Our experience showed direct vision to be the most practica1, since it permits visuaIization of the entire circumference of the urethra and the urethra1 aspect of the vesical neck at one gIance and without rotation of the instrument. The rotation of any instrument in an even sIightIy inff amed posterior urethra causes bIeeding and makes proper observation diffxcuIt or impossibIe. The teIescope shouId be independent of the Iight-carrier, aIIowing for necessary adjustments. TubuIar guides are needed for the introduction and precise appIication
Endoscope
American Journd
of SUWIY 1%
of catheters and electrodes. The head of the instrument shouId have a Iocking device that is easiIy operated and reIiabIe.
FIG. 3. Catheterization of ducts Iocated on the fronta aspect of the veru. The teIescope is loosened and retracted until the Iight buIb and guides become visible. The catheter is then fed in unti1 it nears the veru. Rotation of the teIescopic unit, with or without torsion of the catheter, wiI1 give the proper direction to the catheter tip for entering the ejacuIatory orifice to be catheterized. Further passage shouid be made sIowIy and by short stages unti13 to 5 cm. have been passed. For technica reasons it is advisabIe to catheterize one duct at a time. BiIateraI work needs exactness and precision that is not easiIy acquired.
The obturator shouId be defIectabIe and permit fixation in the deffected position. The new instrument described here incorporates a11 these features. The obturator (I and 2 of Fig. I) is of the deffectabIe beak type, the position of the beak being controIIed by the knurIed knob of the handIe. The sheath (3 of Fig. I) is of 24 Charribre caIiber, round and beveIed at its dista1 end to increase the size of the fieId and provide a canopy for the verumontanum. The teIescope is of the direct vision type and adjustabIe in position. The Iight-carrier and catheter guides form one unit with the teIescope (4 of Fig. I), and the entire assembIy can be rotated in the sheath by means of a coIIar. (5 of Fig. I.)
170
American Journalof SurgeryLowsIey,
Peterson-UniversaI
Two tubuIar guides of F 5 capacity run aIong the Iight-carrier. The externa1 end of the guides is Iong and suffIcientIy curved
FIG. 4. Catheterization of duct opening on the side of the veru. The tip of the catheter is engaged from the left side and passed for z to 3 mm. The cable post is then rotated cIockwise until the catheter appears to be pointing towards the vesica1 neck, before further passage is effected.
to keep the catheters away from the examiner’s face. The interna ends are shorter than the Iight-carrier and are not provided with specia1 deffectors, the direction of the catheters being given by the pointing and the position of the instrument. The handling of the endoscope for the observation of the verumontanum is iIIustrated in Figure 2. The various positions of the instrument for the catheterization of ejacuIatory ducts opening on the fronta1, IateraI or upper aspects of the veru-
Endoscope
JANUARY,1938
montanum are cIearIy shown in Figures 3, 4 and 5. AIthough the instrument has been de-
FIG. 3. Catheterization of ducts Iocated on the top of the veru. The ocular end of the endoscope is raised unti1 the beve1 of the fenestra is flush with the floor of the posterior urethra, and one appears to be Iooking down on the verumontanum. Rotation of the telescopic unit wiI1 bring the posterior aspect of the veru, the two sides and its front into the field of vision, as desired. Retraction of the teIescope wit1 permit observation of the entire veru and insertion and passage of the catheter with a facility not to be obtained with any other instrument.
signed for posterior urethra1 work, particuIarIy for the catheterization of the ejacuIatory ducts, it wiI1 give good service in anterior urethroscopy, in&ding the coaguIation of infected gIands, fuIguration of poIyps in the posterior urethra and on the bIadder floor, and uniIatera1 or biIatera1 uretera catheterization and renaI peIvic Iavage.
T
HERE is hardIy an endoscopic probIem which cannot be met with someone of the endoscopes avaiIabIe. The
they are of the so-called “dry” type. Very few have any provision for the introduction of catheters or electrodes, and
FIG. I. Obturator is placed in sheath and its tip deflected by turning the knurled knob of its handie. The instrument is then passed into the bladder and inverted as one wouId pass and invert a concave cystoscope for the examination of the trigone. The obturator is then straightened and withdrawn; fight and water connections are made. The sheath should be permitted to 811 with water before the telescopic unit is inserted. Before insertion, the telescope should be adjusted so that a small sector of the sheath remains visible at from IO to 2 o’clock, with the cable connecting post at 6 o’clock.
oId Brown-Buerger cysto-urethroscope can these few are of such restricted use as to be used for procedures ranging from be specific (for instance, McCarthy’s inbiIatera1 renaI peIvic Iavage to simuI- strument for the catheterization of the taneous catheterization of both ejaculatory ejaculatory ducts). ducts. It may take considerabIe time and Experience in over 1500 endoscopies patience, but it can be done. with the most commonly used instruments, Most endoscopes have direct vision, such as the Brown-Buerger cysto-urethrowhiIe a few have forobIique optica systems. scope, the McCarthy panendoscope and The oIder ones have no telescopes, since ejacuIatory duct catheterizing instrument, * Read before the New York Academy of Medicine, Section on Urology, November 18, 1936. 168
NW SERIES VOL.XXXIX,NC,.IjLowsIey,
Peterson-UniversaI
and the LowsIey urethroscope, gave us the desire to design an endoscope, incorporating the best features of these instruments
FIG. 2. With the ffow of water adjusted to a light trickIe, the instrument is slowly withdrawn from the bIadder and observation of the vesical neck and posterior urethra made during the withdrawal. As the veru appears in the fenestra (I) the ocuIar end of the endoscope is raised and slightly advanced until the visible sector of the sheath is pIaced over and behind the veru (2). The flow of water necessary for the distention of the urethra can now be shut off completely. By turning the teIescopic unit to the right (3) or Ieft (4) the IateraI portions of the veru may be examined.
and permitting the use of a new idea, i.e., having the entire assembIy of teIescope, Iight-carrier and guides rotatabIe within the sheath. Our experience showed direct vision to be the most practica1, since it permits visuaIization of the entire circumference of the urethra and the urethra1 aspect of the vesical neck at one gIance and without rotation of the instrument. The rotation of any instrument in an even sIightIy inff amed posterior urethra causes bIeeding and makes proper observation diffxcuIt or impossibIe. The teIescope shouId be independent of the Iight-carrier, aIIowing for necessary adjustments. TubuIar guides are needed for the introduction and precise appIication
Endoscope
American Journd
of SUWIY 1%
of catheters and electrodes. The head of the instrument shouId have a Iocking device that is easiIy operated and reIiabIe.
FIG. 3. Catheterization of ducts Iocated on the fronta aspect of the veru. The teIescope is loosened and retracted until the Iight buIb and guides become visible. The catheter is then fed in unti1 it nears the veru. Rotation of the teIescopic unit, with or without torsion of the catheter, wiI1 give the proper direction to the catheter tip for entering the ejacuIatory orifice to be catheterized. Further passage shouid be made sIowIy and by short stages unti13 to 5 cm. have been passed. For technica reasons it is advisabIe to catheterize one duct at a time. BiIateraI work needs exactness and precision that is not easiIy acquired.
The obturator shouId be defIectabIe and permit fixation in the deffected position. The new instrument described here incorporates a11 these features. The obturator (I and 2 of Fig. I) is of the deffectabIe beak type, the position of the beak being controIIed by the knurIed knob of the handIe. The sheath (3 of Fig. I) is of 24 Charribre caIiber, round and beveIed at its dista1 end to increase the size of the fieId and provide a canopy for the verumontanum. The teIescope is of the direct vision type and adjustabIe in position. The Iight-carrier and catheter guides form one unit with the teIescope (4 of Fig. I), and the entire assembIy can be rotated in the sheath by means of a coIIar. (5 of Fig. I.)
170
American Journalof SurgeryLowsIey,
Peterson-UniversaI
Two tubuIar guides of F 5 capacity run aIong the Iight-carrier. The externa1 end of the guides is Iong and suffIcientIy curved
FIG. 4. Catheterization of duct opening on the side of the veru. The tip of the catheter is engaged from the left side and passed for z to 3 mm. The cable post is then rotated cIockwise until the catheter appears to be pointing towards the vesica1 neck, before further passage is effected.
to keep the catheters away from the examiner’s face. The interna ends are shorter than the Iight-carrier and are not provided with specia1 deffectors, the direction of the catheters being given by the pointing and the position of the instrument. The handling of the endoscope for the observation of the verumontanum is iIIustrated in Figure 2. The various positions of the instrument for the catheterization of ejacuIatory ducts opening on the fronta1, IateraI or upper aspects of the veru-
Endoscope
JANUARY,1938
montanum are cIearIy shown in Figures 3, 4 and 5. AIthough the instrument has been de-
FIG. 3. Catheterization of ducts Iocated on the top of the veru. The ocular end of the endoscope is raised unti1 the beve1 of the fenestra is flush with the floor of the posterior urethra, and one appears to be Iooking down on the verumontanum. Rotation of the telescopic unit wiI1 bring the posterior aspect of the veru, the two sides and its front into the field of vision, as desired. Retraction of the teIescope wit1 permit observation of the entire veru and insertion and passage of the catheter with a facility not to be obtained with any other instrument.
signed for posterior urethra1 work, particuIarIy for the catheterization of the ejacuIatory ducts, it wiI1 give good service in anterior urethroscopy, in&ding the coaguIation of infected gIands, fuIguration of poIyps in the posterior urethra and on the bIadder floor, and uniIatera1 or biIatera1 uretera catheterization and renaI peIvic Iavage.