Arthroscopic surgical instruments-dr_shekhar_srivastav

ARTHROSCOPY INSTRUMENTS-

CARE,HANDLING & STERILIZATION

Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy

Delhi Institute of Trauma And Orthopedics

SANT PARMANAND HOSPITAL,DELHI

BASIC ARTHROSCOPY SET-UP

Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy

Delhi Institute of Trauma And Orthopedics

SANT PARMANAND HOSPITAL,DELHI

SCORECARD

ENDOSCOPIC OPEN Small incision x Less pain x Less morbidity x Accuracy x Early function x Cosmesis x

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

Arthroscopic System

Arthroscope

Light source &

Light Cable

Camera system

Video recorder

Monitor

Arthroscopic

Instruments

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

Arthroscope Optical Instrument

-Eye piece

-Attachment for light cable

-Series of lenses

-Optical fibers for transmitting light into joints

Arthroscope Optical properties-

Diameter of scope

1.9mm , 2.7mm- wrist

& elbow

4 mm – most common-

knee shoulder

Angle of Inclination

Field of view

Arthroscope Angle of Inclination- increases field of vision

300 scope 700 scope

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

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

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

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

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

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

Camera system

Steam autoclaving

can damage camera

casings and seal

Enclose the camera

in sterile, disposable,

clear plastic sleeve

Sterilised – Cidex or

Steris solution

Video Recorder & Monitor Monitor-

-At least 20 inches

-Placed at cart at surgeons eye level

Video recorder-documentation

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

Instruments

Basket forceps / punches

Grasping forceps

Arthroscopic scissors

Probes

Knives

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

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

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

Grasping Forceps

Straight or angled

Used for removal of-

-Meniscal fragments

-Loose bodies

-Cartilage flaps

-Osteophytes (partially

detached)

-Retrieving synovial biopsy

Arthroscopic Scissors & Knives

Used in earlier days

Not used now because of high rate of implant breakage within joint

Chondral Damage

Motorised Instruments ( Shavers)

Control unit

Connecting cable

between handpiece and

control unit

Handpiece

Blades

Suction

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

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

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

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

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

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

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

Diagnostic Arthroscopy

THANK YOU