Summary of "Colonoscopy | technique of insertion"

Video focus

Demonstration of colonoscope insertion technique, loop management, and basic maneuvers to advance the scope safely through the rectum, sigmoid and into the right colon.
Emphasis on scope orientation, torque steering, controlled insufflation/irrigation, patient positioning and coordinated breathing to facilitate passage.

Begin with correct scope orientation and centering the screen to avoid mucosal injury and to direct the tip toward the lumen.
Advance the scope using small, coordinated pushes combined with torque (right/left rotation) rather than forceful straight pushing.
Minimize and reduce loops (especially in the sigmoid) by torque steering, withdrawing the shaft slightly, applying abdominal pressure and changing patient position.
Use suction/insufflation and water wash to remove excess air and foam for better visualization.
Recognize and negotiate anatomic landmarks and flexures (sigmoid turns, splenic/left colic flexure — LCF, hepatic/right colic flexure — RCF) using angulation and torque rather than brute force.
Coordinate with the patient (breath holds, diaphragmatic pushes) to assist passage through angulated segments.
Prefer gradual, repeated small adjustments (pull/push, torque, angulation) over large abrupt movements.

Enter the rectum/anal verge with correct orientation; center the endoscopic view on the lumen.
Avoid directing the tip at folds or valves; choose the path of least resistance.

Lightly advance while making small tip rotations (for example, rotate ~180° when appropriate) to align with the lumen.
Use tip angulation (up/down/left/right) to negotiate initial folds.

Anticipate loops and trapped air in the sigmoid; release air as needed to reduce overdistension.
Apply torque to the shaft (right/left) to steer the scope around tight bends.
If resistance is felt, withdraw slightly and torque to reduce loop (shape correction).
Consider abdominal pressure or ask the patient to change position (e.g., adjust laterally or modify knee position) to help reduce sigmoid loops.

Combine maneuvers: tip angulation + shaft torque + small insertion/retraction motions to pass angulated turns.
When encountering a sharp turn, try turning the tip slightly to the opposite side to avoid hooking the wall, then advance.
Avoid excessive tip angulation that forces the tip into the wall.

Recognize loop formation when scope motion becomes sluggish or ineffective.
Release loops by withdrawing the shaft while maintaining tip position, or by rotating the shaft to uncoil.
Once straightened (or reduced), continue gentle advancement.

Identify landmarks (for example, a characteristic sigmoid appearance, then local transverse/ascending colon landmarks).
For difficult segments, ask the patient to take a deep breath and hold; use a diaphragmatic push to aid passage.
Use small, repeated downward or forward “flick” maneuvers combined with coordinated breathing to advance.

Keep movements small and controlled; repeated gentle pushes/pulls with coordinated torque are more effective than force.
If scope advancement is awkward but progressing, continue methodically—avoid forcing.
If a loop cannot be resolved, consider positional changes, abdominal pressure, or withdrawal and reattempt.

LCF and RCF likely refer to left colic flexure (splenic flexure) and right colic flexure (hepatic flexure).
Abbreviations such as LT/MT/RT likely indicate local landmark names or positions in transverse/ascending colon segments; some subtitle phrases were garbled and were interpreted for likely clinical meaning.
Terms like “loop release,” “key point folding,” “right torque/left torque,” “air trapped,” and “use gas and water” reflect standard colonoscopy maneuvers (loop reduction, torque steering, insufflation/irrigation).