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Received December 2, 2020, accepted July 8, 2022, date of publication July 20, 2022

Defects detected in Rigid Endoscopes 

By William K. de Souza and Marcelo A. Marciano

Hospital Moinhos de Vento, Porto Alegre, RS, Brasil

ABSTRACT

Surgical procedures using rigid endoscopes are well known for having advantages over conventional surgical proce-
dures. However, these instruments are fragile and are subject to breakage. The objective of this study was to record 
and analyze the frequency and types of repairs required for different types of rigid endoscopes used in surgical 
procedures. As a result, it was possible to correlate the number of defects with the amount and types of procedures, 
incidences of repairs by types of optics, and types of defects by types of rigid endoscopes. According to the survey, 
smaller instruments are more subject to damage and need repairs.   
Keywords – Surgery Video; Defects in Rigid Endoscopes; Analyses and correlations.

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De Souza and Marciano : Defects detected in Rigid Endoscopes

INTRODUCTION

Minimally invasive surgical procedures have many 
advantages over conventional procedures.1-3 The device 
used to enable the visualization of the site of the procedure 
by video surgery is called a rigid or optical endoscope. 
Different optical models are used in pediatric and adult 
surgeries with different sizes and thicknesses. The design 
of a rigid endoscope also has the technical characteristic of 
tip angulation that varies between 0° and approximately 
135°.3

Rigid endoscopes are widely used in surgical procedures, 
particularly in hospitals. However, rigid endoscopes are 
fragile, so monitoring use at all stages of the instrument’s 
workflow is essential. Due to this fragility, there is a high 
incidence of malfunctions and defects throughout the in-
strument’s use. These defects leave the devices unusable 
and impact the surgical schedule. Also, when malfunctions 
are not diagnosed in the flow stages, problems may only 
be perceived at the time of surgery. 

It is important to check if the optic lenses are cracked 
or scratched or the optical rod is dull. A blurry image 
may be the result of moisture entering the optical system. 
Given the reflected light view, the surfaces should appear 
smooth and bright.3 

Because of the above, collecting data on the number 
of device defects in specific hospitals and their possible 
causes was considered necessary to help evaluate and 
minimize future failures. Therefore, the main objective 
of this work was to map the defects and understand the 
possible causes of failures of these devices used in the 
operating room of a private, non-profit 500-bed hospital 
in southern Brazil. More than 2,000 surgical procedures 
are performed monthly in this hospital, and more than 
600 are watched by video.

METHODS

For the management of rigid endoscopes, all optics 
belonging to the organization were recorded by type 
(such as arthroscope, hysteroscope, laparoscope), size, 
composition and angulation, model, and brand. As a re-
sult, more than 50% of rigid endoscopes in the hospital’s 
operating room were acquired after 2017 and had less 
than 5 years of use, as shown in Table 1.

A form was developed and adopted to record the use of 
rigid endoscopes in the Surgical Center that could perform 
traceability of the flow of use of this device. When rigid 
endoscopes are returned to the Material and Steriliza-
tion Center, they are examined by a nursing professional 
to ensure that the device is returned in good condition. 
If it is found that the device is not fit for use after the 
cleaning procedures, it is sent to the clinical engineering 
team to do the initial technical analysis. The engineer-
ing clinic opens the service order, evaluates the device, 
and if it is impossible to perform the internal repair, it 
is sent to qualified technical assistance. When the rigid 
endoscope returns from repair, it is inspected, and the 
data and information are recorded in a checklist. Finally, 
the device is delivered to the material and sterilization 
plant if deemed fit for use. Work orders with the defect 
data of rigid endoscopes between 2017 and 2020 were 
then analyzed, and some of the results are shown below. 

Findings 

It was possible to observe that the relationship between 
procedures using rigid arthroscopy endoscopes is ap-
proximately 4 times lower than the number of procedures 
with hysteroscopy and laparoscopy. However, Figure 1 
illustrates that arthroscopes have four times the repair 
density concerning the number of failures in hysteroscopy 
and laparoscopy endoscopes.

RESULTS

It was possible to observe that the relationship of 
procedures using rigid arthroscopy endoscopes is ap-
proximately 4 times lower than the number of procedures 
with hysteroscopy and laparoscopy. However, Figure 1 
illustrates that arthroscopes have four times the repair 

TABLE 1. Rigid Endoscopes Acquisition Year 

YEAR OF ACQUISITION ENDOSCOPES

<2017 43%
2017 14%
2018 27%
2019 14%
2020 2%

TOTAL 100%



7 J Global Clinical Engineering Vol.5 Issue 2: 2022

De Souza and Marciano : Defects detected in Rigid Endoscopes

density in relation to the number of failures in hysteros-
copy and laparoscopy endoscopes.

Figure 2 illustrates the number of repairs required 
for the devices between 2017 and 2020. Arthroscopes 
are, first and foremost, the equipment that most needs 
repair over the years. Hysteroscopes vary widely in the 
total number of repairs required. This was especially 
notable between 2018 and 2019 when a 50% drop in the 
number of repairs occurred. By 2020, there was a very 
low total number of repairs on all types of endoscopes. 
Because many elective surgeries were canceled due to 
the COVID-19 pandemic.

A survey of the main types of defects by optical types 
was also carried out. Figure 3 illustrates the incidence and 
types of defects in the different endoscopes. Hysteroscopes 
can be found to have a higher incidence of tube defects and 
broken internal lenses due to their manipulation during 

surgery. Arthroscopy optics, on the other hand, suffered 
more damage due to contacts with surgical motors, which 
damaged the distal window and the internal lenses.

As shown in Figure 3, arthroscopes have 8 types of 
defects. Hysteroscopes 7 and laparoscopes 6. 

CONCLUSION 

Paying attention to the entire operational flow of rigid 
endoscopes is imperative from purchase (acquisition of a 
good quality instrument), through the decontamination 
process and use, to the maintenance of instruments for 
video surgery. How they are sterilized, used, maintained, 
and inspected after repairs is the key to minimizing opera-
tional failure. A specialized team is required to supervise 

FIGURE 1. Relationship between types of procedures for video 
and breaks of rigid endoscopes. 

FIGURE 2. Relationship between maintenance by type of rigid 
endoscopes.  

FIGURE 3. Types of occurrences by optical type.   



J Global Clinical Engineering Vol.5 Issue 2: 2022  8

De Souza and Marciano : Defects detected in Rigid Endoscopes

the use of these instruments and evaluate their conditions 
at each stage of the workflow, to ensure a quick diagnosis 
the moment a malfunction occurs. The procedures for 
the development and qualification of professionals and 
companies providing maintenance services of these instru-
ments are paramount, as they are decisive factors in the 
quality of repair and avoiding rework. With the study, it 
was possible to correlate the amount of defects with the 
amount and types of procedures, incidences of repairs 
by types of optics, and types of defects by types of rigid 
endoscopes. According to the survey, smaller instruments 
are more subject to damage and the need for repairs, as in 
the case of arthroscopes, which also presented the most 
diversity of defects.

It was also appropriate to share the statistics of fail-
ures, defects, downtimes, and costs with the users of 
these devices. And try collaboratively to think of actions 
to mitigate the damage. Since the costs of purchase are 
high, as well as the costs of maintaining and repairing 
these delicate instruments. In addition to impacting the 
agenda of surgical procedures. As these video procedures 
have been well disseminated for some time, the savings in 
acquisition, the proper use, and reduction of repairs can 
contribute to the control of the costs of medical-surgical 
procedures.

REFERENCES

1. SOBRACIL. Homepage [Internet]. Available at: https://
www.sobracil.org.br/consultapublicaans/index.asp. 
Last accessed 03/19/2018. 

2. Couto Neto J. Homepage [Internet]. Available at:  http://
www.drjoaocouto.com.br/atuacao/videocirurgia/. 
Last accessed 03/19/2018.

3. Smith & Nephew. Otica Rigida for Endoscopy Smith 
& Nephew- IFU 0051. Available at: https: //www.
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sil/201604/80804050051%20%20otica%20rigida%20
para%20endoscopia%20smith%20nephew-%20
ifu%200051-%20reva.pdf. Last accessed 03/30/2018.

https://www.sobracil.org.br/consultapublicaans/index.asp
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