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Arthroscopy
Set up and Instrumentation
DR.RAJAT JANGIR
CONSULTANT ARTHROSCOPY SURGEON
MAHATMA GANDHI HOSPITAL, JAIPUR
LEARN BASICS
DRIVE SLOW
DON’T DRIVE THROUGH
BUSY ROADS
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
• Arthroscopi...
Basket Forceps
• Open base that permits the tissue to drop free within
the joint
• Subsequently removed from the joint by ...
Scissors
• 3-4 mm in diameter
• Jaws : straight or hooked
• Hooked scissors are preferred
– Pulling the tissue rather than...
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 hour
M...
What could be wrong?
• No image on screen (Black Screen)
• Light source is turned off
• No power supply to monitor
• Video...
• Blurred image
– Camera not focused
– Improper fluid inflow
– Improper suction, turbid fluid
– Cameral head is not clear
...
• Red Out !
– Improper Tourniquet
– Vigorous suction
• Shaver not function
– Poor suction
– Improper speed
– Blunted or bl...
Instrumentation and set up
Instrumentation and set up
Instrumentation and set up
Instrumentation and set up
Instrumentation and set up
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Instrumentation and set up

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ARTHROSCOPY

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Instrumentation and set up

  1. 1. Arthroscopy Set up and Instrumentation DR.RAJAT JANGIR CONSULTANT ARTHROSCOPY SURGEON MAHATMA GANDHI HOSPITAL, JAIPUR
  2. 2. LEARN BASICS DRIVE SLOW DON’T DRIVE THROUGH BUSY ROADS
  3. 3. The Basics… • Arthroscope • Lighting • Instrumentation.
  4. 4. Arthroscope • Hopkin Rod Lens System Length 18mm Diameter 4mm (1.7 to 4 mm) Viewing angle
  5. 5. Viewing Angle
  6. 6. 0 ° Straight view not recommended 30 ° Increase the field of vision (90 ) Viewing angle
  7. 7. 70 ° For viewing special regions
  8. 8. Barrel length • Compromise between reach and control • 18mm recommended for Knee
  9. 9. Video Camera System • Single Chip • 3 Chip • HD • Ease of handling • Mechanism of coupling • Built in Camera functions
  10. 10. Trochar and Sheath • One or two spigots • 6 mm
  11. 11. Light
  12. 12. Light cable • Light Source – Xenon • Light Cable – Fiberoptic – Liquid
  13. 13. Monitor
  14. 14. Instrumentation • Probe – Finger and eye • Triangulation • Rendezvous
  15. 15. Probe • Feel the consistency of a structure • Determine the depth • To maneuver loose bodies • Use the elbow
  16. 16. Mechanical Instruments • Basket forceps – Straight – Curved – Angled • Grasping forceps • Arthroscopic knife • Arthroscopic Scissors
  17. 17. 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
  18. 18. 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
  19. 19. Motorized Instruments • Shaver – Control unit – Connecting cable – Hand piece – Blade – Suction
  20. 20. Shaver Blade • Outer hollow sheath • Inner rotating cannula with corresponding windows
  21. 21. Electrosurgical instruments
  22. 22. Special instruments • Chisel • files/ rasps • Curette • mirror
  23. 23. Tourniquet
  24. 24. Fluid Distension Each foot elevate from the level of the joint - 22 mmHg pressure
  25. 25. Arthroscopy Cart
  26. 26. Supine position for Arthroscopy monitor Side support Foot rest
  27. 27. Leg Holder Position for Arthroscopy monitor Lithotomy Thigh support
  28. 28. Positioning devices
  29. 29. Sterilization
  30. 30. Care and Sterilization of Instruments • Fiberoptic arthroscopes and cables Best method is – Gas (ethlyene oxide) :1 hour Most commonly used – Activated glutaraldehyde (Cidex) • Knives, graspers, basket forceps, cannulas Steam autoclave
  31. 31. 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
  32. 32. • 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?
  33. 33. • 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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