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Arthroscopy Equipment Update
Sharper scope and camera systems provide better visualization.
Bill Meltzer
Publish Date: October 10, 2007   |  Tags:   Orthopedics

Recent improvements in arthroscopic telescopes and cameras may help your surgeon perform cases a little more efficiently and promote improved reprocessing. Here's a look at five features setting the current generation of scopes apart from their predecessors.

  • Sharper scope optics. Manufacturers haven't altered fundamental scope design (the Hopkins or rod-lens scope has been a mainstay since the 1960s), but they've significantly upgraded the optics. Current-generation scopes provide greater site magnification, transmit more light and broaden the field of view. For example, Richard Wolf arthroscopy product manager Steve Lowry says current scopes such as his company's Direct Couple line transmit about 25 percent more light to the operative site than systems that were state-of-the-art as recently as five years ago.

"It's easier to visualize lesions with the new scopes," says S. Terry Canale, MD, the director of the Campbell Clinic in Nashville, Tenn., "especially along the edges of the field, which were dark and distorted."

  • Fewer blind spots. Trad-itional angled scopes (typically 30-degree and 70-degree models) alleviate many visualization problems, but surgeons still en-counter occasional blind spots.

Hip Arthroscopy On The Rise

In recent years, arthroscopic ACL and rotator cuff repairs have garnered attention while indications for hip arthroscopy, arguably a more challenging service, have increased. However, fewer surgeons master hips because dense soft tissue and tricky bony anatomy make maneuvering the scope and introducing the instruments hard.

Fortunately, several technological improvements make it easier. I routinely switch between 30-degree and 70-degree video-articulated scopes during cases; I use the 70-scope for most of the case for greater side-to-side and up-and-down visualization. You'll need specialized instruments that are larger than instruments for other procedures - longer cannulas (up to 5.5 mm) and curved shaver blades, and specialized obturators and trocars. The development of hip-specific instrumentation and refined shaver systems has helped immeasurably.

Fluid management, important for all types of arthroscopy because of water flowed into the joint during the procedure, is especially crucial in hip arthroscopy to reduce extra-vasation of fluid from the hip joint.

With improved instrumentation and techniques, I now use arthro-scopy to remove loose bodies, repair labral tears and diagnose degenerative disease. In some cases, I use arthroscopy to delay total hip replacement. Still, hip arthroscopy has one of the steepest learning curves for orthopedic surgeons - it takes up to 50 cases to attain proficiency.

Dr. Ceballos ([email protected]) is the assistant medical director of the Orthopaedic Institute at Mercy Hospital in Miami.

To assist perpendicular visualization, Arthrex and Olympus introduced a scope with a 115-degree field of view (the True-View II scope). Dr. Ceballos, who has not yet worked with a 115-degree scope, says it "could be helpful for seeing side-to-side and up-and-down," especially during hip arthroscopy.

In particular, he says a distortion-free 115-scope could significantly reduce surgeons' compensating for blind spots or poorly illuminated peripheral areas by bending the cable at acute angles - a practice that can damage the light fibers and put scopes out of commission.

But there's a learning curve. "It takes surgeons more practice to orient themselves at 70 degrees than 30, and it's another jump going to 115," says Dr. Ceballos.

  • Arthroscopy-specific camera heads. Orthopedic surgeons used to use one-size-fits-all endoscopic camera systems; sharing them with general and GYN surgeons, and urologists. Some manufacturers, such as Smith & Nephew and Olympus, now offer arthroscopy-specific camera heads.

"For most knee, shoulder and ankle arthroscopies, 30-degree visualization works fine. I mostly use a 70-degree scope for hip arthroscopy. But sometimes I need to visualize areas perpendicular to the scope tip," says Cesar Ceballos, MD, the assistant medical director of the Orthopaedic Institute at Mercy Hospital in Miami.

"Orthopedic surgeons often manipulate the scope and video with one hand while holding an instrument such as a shaver in the other," says Alex Seifert, the director of surgery center systems for Arthrex. "An arthroscopy camera head is less bulky than those for other specialties and allows the surgeon fingertip control."

  • Smaller-diameter scopes. It's now possible to obtain identical images using smaller diameter arthroscopes. For example, Linvatec offers a 2.9mm scope optically equivalent to a 4mm. "There's less trauma, and we can make smaller incisions and we can see better in tight spaces," says Dr. Ceballos.
  • Autoclaveable scopes and cameras. Arthroscopes and cameras are now designed to withstand the rigors of steam sterilization, including flash sterilization. "We've always had to process these fragile items in chemical solutions," says Gabrielle White, RN, the administrator of orthopedic services for Hoag Hospital in Newport Beach, Calif. "Now there's a choice between chemical processing, gas or the autoclave, which is more efficient and more environmentally sound."

She says manufacturers are fine tuning scopes' and cameras' autoclave compatibility to withstand repeated exposure to high temperatures and pressure. For example, Olympus arthroscopy product manager Mike Malave says the TrueView II scope system from Arthrex and Olympus can be autoclaved up to 2,000 times, thanks to gold soldering on instrument joints and a gold-impregnated seal on the distal edge. Smith and Nephew's ED-3 Plus camera head is fully compatible with peracetic acid sterilization or steam.

Sum of the parts
"Arthroscopy is a mature technology, so the design tweaks come in bite-sized increments," says Texas-based equipment planner Scotty Farris. "It's over the long haul that you can quantify the improvements in terms administrators and surgeons appreciate."

TrueView II arthroscope with Visera Camera System
(800) 933-7001 (Arthrex)
(800) 645-8100 (Olympus)
Price: Varies by equipment/ accessory purchase

Linvatec 2.9mm arthroscope
(800) 237-0169
Price: $1,500-$2,200

Richard Wolf
Richard Wolf Direct Couple Scope
(800) 323-WOLF
Price: $3,995 (list)

Karl Storz
Storz Hopkins II arthroscope
(800) 421-0837
Price: $1,500

MSI Precision
(800) 633-7283
Price: Not provided

Smith & Nephew
360 Camera with Ed-3 procedural camera head
(800) 821-5700
Price: Not provided

Stryker autoclavable
c-mount arthroscope
(800) 729-2917
Price: not provided