ARTHROSCOPY INSTRUMENTS- CARE,HANDLING & STERILIZATION. Dr.SHEKHAR SRIVASTAV
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1 ARTHROSCOPY INSTRUMENTS- CARE,HANDLING & STERILIZATION Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy Delhi Institute of Trauma And Orthopedics SANT PARMANAND HOSPITAL,DELHI
2 BASIC ARTHROSCOPY SET-UP Dr.SHEKHAR SRIVASTAV Knee & Shoulder Arthroscopy Delhi Institute of Trauma And Orthopedics SANT PARMANAND HOSPITAL,DELHI
3 SCORECARD ENDOSCOPIC OPEN Small incision Less pain Less morbidity Accuracy Early function Cosmesis x x x x x x
4 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
5 Arthroscopic System Arthroscope Light source & Light Cable Camera system Video recorder Monitor Arthroscopic Instruments
6 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
7 Arthroscope Optical Instrument -Eye piece -Attachment for light cable -Series of lenses -Optical fibers for transmitting light into joints
8 Arthroscope Optical properties- Diameter of scope 1.9mm, 2.7mm- wrist & elbow 4 mm most commonknee shoulder Angle of Inclination Field of view
9 Arthroscope Angle of Inclination- increases field of vision 30 0 scope 70 0 scope
10 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
11 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
12 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
13 Light Source & Fibreoptic Cable watts reqd. Tungsten,Halogen & Xenon Source Life- hrs Should not be activated till scope is inserted into the sheath
14 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
15 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
16 Camera system Steam autoclaving can damage camera casings and seal Enclose the camera in sterile, disposable, clear plastic sleeve Sterilised Cidex or Steris solution
17 Video Recorder & Monitor Monitor- -At least 20 inches -Placed at cart at surgeons eye level Video recorderdocumentation
18 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
19 Instruments Basket forceps / punches Grasping forceps Arthroscopic scissors Probes Knives
20 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
21 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 15 0 up & down biting
22 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
23 Grasping Forceps Straight or angled Used for removal of- -Meniscal fragments -Loose bodies -Cartilage flaps -Osteophytes (partially detached) -Retrieving synovial biopsy
24 Arthroscopic Scissors & Knives Used in earlier days Not used now because of high rate of implant breakage within joint Chondral Damage
25 Motorised Instruments ( Shavers) Control unit Connecting cable between handpiece and control unit Handpiece Blades Suction
26 Motorised Instruments ( Shavers) Outer hollow sheath & inner cutting rotating cannula Tip Dia mm Sucks tissue inside outer sheath for cutting RPM cutting soft tissues as burr Handpiece Autoclavable Shaver blades- Disposable
27 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
28 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
29 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 instrumentsaerosolization, splashing of infectious material, injury from sharp objects
30 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
31 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
32 Diagnostic Arthroscopy Supra-patellar pouch Patellar Articular Surface Medial Gutter Medial Compartment- Meniscus Articular cartilage Intercondylar Notch- ACL PCL Lateral Compartment- Meniscus Articular Cartilage Lateral Gutter
33 Diagnostic Arthroscopy
34 THANK YOU
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