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Category: ACQUIRING SKILL
Source: 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.
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