![]() This may work even better when combined with well-structured training programs that carefully make use of trainees’ self-assessment and structured practice such as those described by Mohammed et al ( 19). ![]() Creating early awareness of the mechanical and kinetic behaviour of the colonoscope and the patient’s anatomy may help to improve endoscopist performance ( 18). However, they do so from an experience-based perspective and not in terms of fundamental mechanical causes and solutions. Current colonoscopy manuals and the literature extensively describe the conventional scope manoeuvres that can be used to prevent or solve insertion problems ( 1, 2, 15– 17). Many attempts to reduce patient discomfort have been made, ranging from using hypnosis or music, to using thinner scopes or using water to expand the colon ( 14). Sedation is often used to prevent pain, although it increases the risk of complications and lowers patient satisfaction ( 12, 13). The actions required to perform a full colonoscopy can also be painful for the patient. Furthermore, the extensive training in practice that is required to master gastrointestinal endoscopy procedures has a negative effect on endoscopy case throughput and cost ( 11). This results in colonoscopy being a time-consuming procedure and one that is difficult to master ( 4– 8, 10). The functionally necessary flexibility and length of the scope shaft and the floppy nature of the colon and its attachments hamper, and may prohibit, reaching the cecum and visualizing the entire colon (success rates for experienced endoscopists generally average between 80% and 99%, with some averages <80%) ( 3– 9). The scope is inserted into the anus and pushed into the colon up to the cecum or terminal ileum, while bending the tip to negotiate around colonic bends ( 1, 2). A digital camera, light supply fibres and channels for instruments, air and water are embodied in the instrument. Its distal end (‘tip’) can be bent in four directions by twisting control wheels on a grip at the proximal end of the scope. A scope is an endoscope with a 1.2 m to 1.6 m long flexible but torsionally stiff shaft. Highly advanced colonoscopes (‘scope’) are used to screen the human colon for diseases and abnormalities, and also for treatment.
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