instrumentation and set up
TRANSCRIPT
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Arthroscopy Set up and Instrumentation
DR.RAJAT JANGIRCONSULTANT ARTHROSCOPY SURGEONMAHATMA GANDHI HOSPITAL, JAIPUR
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LEARN BASICS
DRIVE SLOW
DON’T DRIVE THROUGH BUSY ROADS
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The Basics…
• Arthroscope
• Lighting
• Instrumentation.
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Arthroscope • Hopkin Rod Lens System
Length 18mm
Diameter 4mm (1.7 to 4 mm)
Viewing angle
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Viewing Angle
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0 °Straight view not recommended
30 ° Increase the field of vision (90 )
Viewing angle
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70 °For viewing special regions
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Barrel length
• Compromise between reach and control
• 18mm recommended for Knee
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Video Camera System
• Single Chip• 3 Chip• HD
• Ease of handling• Mechanism of coupling• Built in Camera functions
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Trochar and Sheath
• One or two spigots• 6 mm
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Light
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Light cable
• Light Source– Xenon
• Light Cable– Fiberoptic– Liquid
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Monitor
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Instrumentation
• Probe
– Finger and eye
• Triangulation • Rendezvous
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Probe• Feel the consistency of a structure• Determine the depth• To maneuver loose bodies• Use the elbow
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Mechanical Instruments
• Basket forceps– Straight– Curved– Angled
• Grasping forceps
• Arthroscopic knife• Arthroscopic Scissors
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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
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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
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Motorized Instruments
• Shaver– Control unit– Connecting cable– Hand piece – Blade– Suction
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Shaver Blade• Outer hollow sheath• Inner rotating cannula with corresponding
windows
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Electrosurgical instruments
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Special instruments
• Chisel• files/ rasps• Curette• mirror
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Tourniquet
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Fluid Distension
Each foot elevate from the level of the joint - 22 mmHg pressure
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Arthroscopy Cart
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Supine position for Arthroscopy
monitor
Side support
Foot rest
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Leg Holder Position for Arthroscopy
monitor
Lithotomy Thigh support
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Positioning devices
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Sterilization
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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
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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
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• 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?
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• Red Out !– Improper Tourniquet– Vigorous suction
• Shaver not function– Poor suction– Improper speed– Blunted or blocked blade
What could be wrong?
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Thank You
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