Acquiring Skill

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Endoscopic ability cannot be bought with the instruments. As with all

mechanical procedures, facility can be obtained only by educating the

eye and the fingers in repeated exercise of a particular series of

maneuvers. As with learning to play a musical instrument, a

fundamental knowledge of technic, positions, and landmarks is

necessary, after which only continued manual practice makes for

proficiency. For instance, efficient use of forceps requires that they

be so familiar to the grasp that their use is automatic. Endoscopy is

a purely manual procedure, hence to know how is not enough: manual

practice is necessary. Even in the handling of the electrical

equipment, practice in quickly locating trouble is as essential as

theoretic knowledge. There is no mystery about electric lighting. No

source of illumination other than electricity is possible for

endoscopy. Therefore a small amount of electrical knowledge, rendered

practical by practice, is essential to maintain the simple lighting

system in working order. It is an insult to the intelligence of the

physician to say that he cannot master a simple problem of electric

testing involving the locating of one or more of five possibilities.

It is simply a matter of memorizing five tests. It is repeated for

emphasis that a commercial current reduced by means of a rheostat

should never be used as a source of current for endoscopy with any

kind of instrument, because of the danger to the patient of a possible

grounding of the circuit during the extensive moist contact of a

metallic endoscopic tube in the mediastinum. The battery shown in Fig.

8 should be used. The most frequent cause of trouble is the mistake of

over-illuminating the lamps. The lamp should not be over-illuminated

to the dazzling whiteness usually used in flash lights. Excessive

illumination alters the proper perception of the coloring of the

mucosa, besides shortening the life of the lamps. The proper degree of

brightness is obtained when, as the current is increased, the first

change from yellow to white light is obtained. Never turn up the

rheostat without watching the lamp.