Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 127

As trainees will quickly find, reaching the thumb to the smaller right/left dial can be difficult and awkward. Many trainees early in their training will be tempted to remove their right hand from the scope shaft and use this hand to turn the small dial. By correctly placing the scope's umbilical cable on the outside of the left arm (rather than running between the left arm and flank of the endoscopists), the scope handle rotates slightly bringing the control knobs slightly closer to the users thumb. However, with correct technique, the need for this small dial can be minimized. The most efficient method of steering is combining torque with use of the up/down dial. In general, experienced endoscopists would agree that, rather than using excessive right/left dial control, it is better to teach the use of scope torque in either direction to reorient the right or left turns in the lumen so that they are oriented toward the top or bottom of the screen. This is accomplished with the right hand rotating the shaft of the scope. Firm torque of the scope's shaft in the desired direction can rotate the entire shaft of the scope inside the patient and realign a horizontal turn in the lumen to one that is vertically oriented (Figure 6.13). Once in this position, the large up/down dial can be used to steer in the direction desired.