Arthroscopic Surgical Instruments - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
1. ARTHROSCOPY INSTRUMENTSCARE,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
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
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
300-350 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
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
20. Probes
Extension of A’scopist
fingers
Right angled and tip size 34mm
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 150 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- 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
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