Water Immersion Colonoscopy Technique

17.	SIMULATION OF THE SINGULAR METHOD-LEARN WITH THE "FINGER-SCOPE"

The Singular Method can be learned without a fiberscope. Actually, the Singular Method should be learned with a finger-scope before starting the colon model training (Chart 17-1, 2). Simulate the right index finger as if the tip of the scope and pretend as if the left hand holds the head of the scope. You can start the practice only with the right hand, and gradually move the right index finger and the left hand in a coordinated manner according to the law of the double angular velocity.

CHART 17-1 LEARN THE SINGULAR METHOD WITH THE FINGER-SCOPE

Practice the movement with the right index finger simulated as the scope tip.

MOVIE 17-1 THE SINGULAR METHOD WITH THE FINGER-SCOPE

This movie sets forth the Singular Method with the finger-scope and the colon model. Also Chart 17-2 "breakdown of the Singular Method with the finger-scope" and Schedule 17-2 "summary of the Singular Method with the finger-scope" should be referred.

The direction of the right index finger can be estimated by doubling the angle of the left hand. The key of the finger-scopy is to correctly coordinate the movement of the right index finger and the left hand. The left hand's position and the direction of the tip of the scope comply with the law of the double angular velocity (Chart 17-2).

Chart 17-2 BREAKDOWN OF THE SINGULAR METHOD WITH THE FINGER-SCOPE

The time shown in the explanation means the direction of the right index finger (simulating the tip of the scope).

1) Start

Start is always at 12 o'clock of the left hand/12 o'clock of the tip.

2) Rectum

Rotate the left hand counterclockwise to 6 o'clock, that makes the tip rotate 360 degrees. During that rotation, push the scope a little and traverse the rectum.

3) The sigmoid colon

After passing the rectum, rotate the left hand clockwise back to 9 o'clock (the tip is at 6 o'clock). Then the s-top is seen upward, traverse that with the up angulation. Withdraw the scope in the latter half of the sigmoid colon.

4) SD

SD comes into the view rightward with the left hand at 10:30 and the tip at 9 o'clock. Traverse the junction with the right angulation.

5) The descending colon

After passing the SD, rotate clockwise back to 12 o'clock.

6) The splenic flexure

At 12 o'clock the splenic flexure is seen upward. Traverse it with the up angulation. Confirm the triangular lumen and 40cm mark and change the posture (the former half is over).

7) The former half of the transverse colon

Together with the posture change, the tip also should rotate 90 degrees to 9 o'clock (the left hand at 10:30). Push the scope straightforwardly.

8) Mid-transverse colon

Mid-transverse colon comes into view downward. Traverse it with the down angulation. Right after the mid-transverse, start withdrawing the scope.

9) The latter half of the transverse colon

The lumen is seen downward first, so withdraw the scope with the down angulation as well as rotating the scope counterclockwise. At 7:30 of the left hand/3 o'clock of the tip, the lumen opens leftward. Withdraw the scope with the left angulation.

10) The hepatic flexure

Advance the scope leftward with the left angulation in the latter half of the transverse colon to hit the wall of the hepatic flexure. There the corner of the hepatic flexure is seen rightward. Traverse it with the right angulation.

11) The ascending colon

After passing the hepatic flexure, rotate clockwise to 12 o'clock and get into the ascending colon with the up angulation and advance to the dead end, namely, the cecum.

SHEDULE 17-2 SUMMARY OF THE SINGULAR METHOD WITH THE FINGER-SCOPE

MOVIE 17-2 THE FINGER-SCOPE LESSON

Check the direction of the tip of the scope and the position of the left hand by doing the finger-scope along with the movie. The left hand's position is; 12 o'clock at start, 6 o'clock at the rectum, 10:30 at the sigmoid colon and SD, 12 o'clock at the descending colon and the splenic flexure, 10: 30 at the posture change through the mid-transverse colon, 7:30 at the latter half of the transverse colon, 9 o'clock at the hepatic flexure, 10:30 at the ascending colon and 12 o'clock at the cecum.

1) Start	Start is always at 12 o'clock of the left hand/12 o'clock of the tip.
2) Rectum	Rotate the left hand counterclockwise to 6 o'clock, that makes the tip rotate 360 degrees. During that rotation, push the scope a little and traverse the rectum.
3) The sigmoid colon	After passing the rectum, rotate the left hand clockwise back to 9 o'clock (the tip is at 6 o'clock). Then the s-top is seen upward, traverse that with the up angulation. Withdraw the scope in the latter half of the sigmoid colon.
4) SD	SD comes into the view rightward with the left hand at 10:30 and the tip at 9 o'clock. Traverse the junction with the right angulation.
5) The descending colon	After passing the SD, rotate clockwise back to 12 o'clock.
6) The splenic flexure	At 12 o'clock the splenic flexure is seen upward. Traverse it with the up angulation. Confirm the triangular lumen and 40cm mark and change the posture (the former half is over).
7) The former half of the transverse colon	Together with the posture change, the tip also should rotate 90 degrees to 9 o'clock (the left hand at 10:30). Push the scope straightforwardly.
8) Mid-transverse colon	Mid-transverse colon comes into view downward. Traverse it with the down angulation. Right after the mid-transverse, start withdrawing the scope.
9) The latter half of the transverse colon	The lumen is seen downward first, so withdraw the scope with the down angulation as well as rotating the scope counterclockwise. At 7:30 of the left hand/3 o'clock of the tip, the lumen opens leftward. Withdraw the scope with the left angulation.
10) The hepatic flexure	Advance the scope leftward with the left angulation in the latter half of the transverse colon to hit the wall of the hepatic flexure. There the corner of the hepatic flexure is seen rightward. Traverse it with the right angulation.
11) The ascending colon	After passing the hepatic flexure, rotate clockwise to 12 o'clock and get into the ascending colon with the up angulation and advance to the dead end, namely, the cecum.