Arthroscopy Set up and Instrumentation

DR.RAJAT JANGIRCONSULTANT ARTHROSCOPY SURGEONMAHATMA GANDHI HOSPITAL, JAIPUR

LEARN BASICS

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The Basics…

• Arthroscope

• Lighting

• Instrumentation.

Arthroscope • Hopkin Rod Lens System

Length 18mm

Diameter 4mm (1.7 to 4 mm)

Viewing angle

Viewing Angle

0 °Straight view not recommended

30 ° Increase the field of vision (90 )

Viewing angle

70 °For viewing special regions

Barrel length

• Compromise between reach and control

• 18mm recommended for Knee

Video Camera System

• Single Chip• 3 Chip• HD

• Ease of handling• Mechanism of coupling• Built in Camera functions

Trochar and Sheath

• One or two spigots• 6 mm

Light

Light cable

• Light Source– Xenon

• Light Cable– Fiberoptic– Liquid

Monitor

Instrumentation

• Probe

– Finger and eye

• Triangulation • Rendezvous

Probe• Feel the consistency of a structure• Determine the depth• To maneuver loose bodies• Use the elbow

Mechanical Instruments

• Basket forceps– Straight– Curved– Angled

• Grasping forceps

• Arthroscopic knife• Arthroscopic Scissors

Basket Forceps

• Open base that permits the tissue to drop free within the joint

• Subsequently removed from the joint by suction

• 3-5mm sizes with straight or curved shaft

• Usually used for trimming the peripheral rim of the meniscus

Scissors

• 3-4 mm in diameter• Jaws : straight or hooked• Hooked scissors are preferred– Pulling the tissue rather than pushing away

• Right and left curved

Motorized Instruments

• Shaver– Control unit– Connecting cable– Hand piece – Blade– Suction

Shaver Blade• Outer hollow sheath• Inner rotating cannula with corresponding

windows

Electrosurgical instruments

Special instruments

• Chisel• files/ rasps• Curette• mirror

Tourniquet

Fluid Distension

Each foot elevate from the level of the joint - 22 mmHg pressure

Arthroscopy Cart

Supine position for Arthroscopy

monitor

Side support

Foot rest

Leg Holder Position for Arthroscopy

monitor

Lithotomy Thigh support

Positioning devices

Sterilization

Care and Sterilization of Instruments

• Fiberoptic arthroscopes and cables Best method is– Gas (ethlyene oxide) :1 hourMost commonly used– Activated glutaraldehyde (Cidex)

• Knives, graspers, basket forceps, cannulas Steam autoclave

What could be wrong?

• No image on screen (Black Screen)• Light source is turned off• No power supply to monitor• Video camera lens is not clear

• No input to Monitor (Blue or Multi-coloured Bands)• Input is improperly plugged• Wrong format• Malfunctioning Video

• Blurred image– Camera not focused– Improper fluid inflow– Improper suction, turbid fluid– Cameral head is not clear

• Joint looks strange– Non anatomic position of scope

What could be wrong?

• Red Out !– Improper Tourniquet– Vigorous suction

• Shaver not function– Poor suction– Improper speed– Blunted or blocked blade

What could be wrong?

Thank You