Arthroscopic surgical instruments-dr_shekhar_srivastav
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ARTHROSCOPY INSTRUMENTS-
CARE,HANDLING & STERILIZATION
Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI
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BASIC ARTHROSCOPY SET-UP
Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI
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SCORECARD
ENDOSCOPIC OPEN Small incision x Less pain x Less morbidity x Accuracy x Early function x Cosmesis x
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ARTHROSCOPY KNEE
One of the Commonest surgery Treatment – Ligamentous and soft tissue injury of knee > precise and accurate than open method Less morbidity and early rehab
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Arthroscopic System
Arthroscope
Light source &
Light Cable
Camera system
Video recorder
Monitor
Arthroscopic
Instruments
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Arthroscopic Surgical Instruments
Mechanical Instruments- Probes, Punches,
Grasping forceps
Motorised Instruments- Shavers
Electrosurgical Instruments- Electrocautery,
Radiofrequency, Laser
Special Instruments- ACL sets, PCL sets, Meniscus repair sets, OATS
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Arthroscope Optical Instrument
-Eye piece
-Attachment for light cable
-Series of lenses
-Optical fibers for transmitting light into joints
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Arthroscope Optical properties-
Diameter of scope
1.9mm , 2.7mm- wrist
& elbow
4 mm – most common-
knee shoulder
Angle of Inclination
Field of view
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Arthroscope Angle of Inclination- increases field of vision
300 scope 700 scope
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Arthroscope sheath with blunt
Obturation
Always blunt obturator. Never sharp
Sheath – 3 parts – Coupler – secure and rapid
fixation
– Spigot plane – Rotating
– Sheath barrel
Smooth transition from obturator to sheath
Smooth transition from scope to sheath
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Care & Handling Should always be
inserted into the joint
through sheath
Sudden Movement
should be avoided as it
may cause cartilage
scuffing
Care taken to avoid
damage by shaver or
other electronic surgical
devices
Inspect for any scratch,
dents or irregularity
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Aging
Manifested by a hazy, murky image
More an arthroscope is used faster it ages
Accelerated by flash sterilizations
Direct Damage of Scope Tip- By
mechanical or motorized instruments
Laser beam accidentally directed towards scope
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Light Source & Fibreoptic Cable
300-350 watts reqd.
Tungsten,Halogen & Xenon Source
Life- hrs
Should not be activated till scope is inserted
into the sheath
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Light Source & Fiberoptic Cable
Fiberoptic Cables-bundled optical glass
fibers
Fragile,handle Carefully
One end connected to light source and
another to A’scope
Length of cable imp
Fiber breakage due to bending stresses
Loss of light transmission
Sterilisation- autoclavable/gluteraldehyde
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Camera System Advantages
Comfortable position
for surgeon
Avoidance of
contamination
Participation of rest of
the team
Camera System
-camera- 1 chip/3 chip
-camera cable
-control unit
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Camera system
Steam autoclaving
can damage camera
casings and seal
Enclose the camera
in sterile, disposable,
clear plastic sleeve
Sterilised – Cidex or
Steris solution
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Video Recorder & Monitor Monitor-
-At least 20 inches
-Placed at cart at surgeons eye level
Video recorder-documentation
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Image Quality
All structures should be uniformly
illuminated from center to periphery
Scope should have satisfactory resolution
Dull & Hazy image
- Check scope for scratches, damages
- Check light Cable
- Check light source
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Instruments
Basket forceps / punches
Grasping forceps
Arthroscopic scissors
Probes
Knives
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Probes Extension of A’scopist fingers
Right angled and tip size 3-4mm
Marking at 5mm
Used to
-Palpate intraarticular structures
-Determine depth
-To maneuver intraarticular structures
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Basket forceps(Punches)
Workhorse of arthroscopic surgeries
Open base where the cut tissue is dropped which can be removed later
No need to remove from joint with each bite
Shaft- straight/curved
Jaws- straight/angled
Also as 150 up & down biting
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Basket forceps(Punches) Various Jaw Configuration
-Wide angled- rapid & efficient cutting
-Narrow or scissor punches
Used for-
-Division of tissue bridges
-R/O deg. Meniscal tissue
-Division of scar tissue
-Detachment of loose cartilage flap
-Piecemeal removal of soft tissue bodies
Carefully used in tight joints as may cause cartilage scuffing
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Grasping Forceps
Straight or angled
Used for removal of-
-Meniscal fragments
-Loose bodies
-Cartilage flaps
-Osteophytes (partially
detached)
-Retrieving synovial biopsy
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Arthroscopic Scissors & Knives
Used in earlier days
Not used now because of high rate of implant breakage within joint
Chondral Damage
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Motorised Instruments ( Shavers)
Control unit
Connecting cable
between handpiece and
control unit
Handpiece
Blades
Suction
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Motorised Instruments
( Shavers)
Outer hollow sheath & inner
cutting rotating cannula
Tip Dia- 3-5.5 mm
Sucks tissue inside outer
sheath for cutting
RPM
cutting soft tissues- 1200-2000
as burr - 2000-4000
Handpiece – Autoclavable
Shaver blades- Disposable
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Electrosurgical, Laser & RF
Electrocautery- Hemostasis
Lateral retinacular release
Laser- YAG laser, Excimer Laser
Delievers high energy with precision
Uses- Meniscus tear, Articular cartilage
Drawbacks-Expensive , Osteonecrosis
Radiofrequency –
Uses- Menisectomy, Coagulation, Capsular shrinkage
Drawbacks- Articular cartilage damage, Osteonecrosis
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Basic Arthroscopic Kit
Arthroscope
Light source & cables
Camera system & Moniter
Arthroscopic probe
Arthroscopic Grasper
Arthroscopic Punches (Basket Forceps)- 2.7 & 3.4 mm upcutting, Rt. & Lt. Rotary
Motorized Shaver
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Cleaning ,Disinfection & Sterilizability Remove gross soiling,blood & organic matter after surgery. Clean the instruments with
sterile water (not saline)
Manual cleaning in enzymatic soak solution
Ultrasonic cleaners- Fine cleaning(hollow &
tubular instrument)
Wiped & dried with clean dry sponge before storage
Care of the personnel handling instruments- aerosolization, splashing of infectious material, injury from sharp objects
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Cleaning ,Disinfection & Sterilizability
Instruments should be
properly arranged in
trays
Sharp instrument tips
should be covered
with caps
Instruments with
moving parts should
be lubricated after
cleaning with water
soluble lubricant
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Cleaning ,Disinfection & Sterilizability
Ethylene oxide gas- good disinfectant
Mechanical Instruments( probes, punches, graspers), Shaver handpiece - Steam Autoclave
Arthroscope, Light cable – Cidex, Steris(Paracetic acid solution) – 30 min
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Supra-patellar pouch
Patellar Articular Surface
Medial Gutter
Medial Compartment- Meniscus
Articular cartilage
Intercondylar Notch- ACL
PCL
Lateral Compartment- Meniscus
Articular Cartilage
Lateral Gutter
Diagnostic Arthroscopy
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Diagnostic Arthroscopy
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THANK YOU