Die durchsichtigen offenen Kanülen mit optionaler Demontage des Handgriffes erleichtern das Einführen der Instrumente und bieten bedingt durch ihre Durch- sichtigkeit ständige Sicht auf Portale und Gelenkstrukturen. Sie sind aus bruch- sicherem Polykarbonat und tolerieren daher die bei Hüftarthroskopien häufig auftretenden Biegemomente. Die stumpfen bzw. gefasten Enden verhindern iatrogene Knorpelläsionen durch gewaltsames Einführen der Kanüle ins Gelenk. Die Kanülen können mit verschiedenen Quick Connect-Handgriffen benutzt werden. Die Kannülen können beispielsweise mit dem Tear Drop Handle AR-2001 verwendet werden.

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Hip Next Generation in Soft-Tissue Repair and Reconstruction

John J. Christoforetti, MD (Bethesda, MD), demonstrates entry into a hip joint using the FlushFit cannula system. Dr. Christoforetti describes his preferred technique and outlines the features and benefits of using this atraumatic access system.

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Atraumatic Hip Joint Access Using the FlushFit Cannula System

Describing the flush fit cannula system and the appropriate way to get everything set up for success. We're going to start with the standard shoulder knee length arthroscope for use inside the hip, and we're going to be starting by connecting the bridge system over onto your standard arthroscope. We're going to be using the button side of the bridge system to go straight in position. And we're going to use the actual light cord of the bridge system as our guide for where we click this into position. The inflow outflow will now be just on the distal side of your light cord, as in all standard arthroscopic setups. And the key point is to note that on the actual bridge itself, there are two sides to the bridge position. The first is an open U-shape and the second has a chin up bar style construct. Now that's going to be important for later, but we're going to use that as a means of securely attaching our flush fit cannula to this device. When we look at the actual obturator itself, you're going to remember that we've just pointed out this same chin up bar construct. And if I roll this over, you're going to be able to see the U-shaped construct. And the key is just to remember there's nothing to really click into on this side. So we're going to use that chin up bar to hold the actual flush fit cannula in position. I'm going to show at this point, the way that we take that flush fit cannula and give a quick side view, so that it's very clear to understand that this is very nicely marked, so that when you're in the operating room, you know exactly what to do. And when you're looking at the actual release mechanism, you can see that hook that might go over that little chin up bar cutout that we've talked about earlier. When we look at the actual button itself, we're going to be pressing towards the surgeon's hand side of that button and make sure that we get that leverage to work to release. If we press on the other side, there's a safety feature that doesn't allow us to detach prematurely. When we look at the actual insertion on the obturator, now we know to choose the side of the obturator. We know to bring this cannula down into position and the flush fit cannula, then click into position. When it's time for us to go into the hip joint. We would then release this by pressure back on the surgeon's side of the actual device, allowing us to us to easily withdraw at this point. We would then bring our camera into position, and now we're going to really see the true features where this implement shines. I'm going to go ahead and bring this down in the incorrect position, where there's a U-shaped cutout, and turn that piece over to show the chin up bar. And as we see, we slide right in position and we get that click. Now we need to look at the very important safety feature. That really is the compelling reason to think about this instrument for safety. And that's the flush nature of the fit of the tip of this rigid camera inside the softer cannula. We can really see here the protective features for the articular cartilage. With the way this fits, it's important also to note that your standard working length is available at 125mm, but there's also available longer options if those are needed. So when we're going to start with our standard arthroscopic, we're going to go ahead and start in that anterolateral portal where this needle is positioned. The first move is to go down from the skin in through the capsule, penetrating that capsule, but not plunging deep within the field. We're going to remove the central needle obturator. And then we're going to be placing in the nitinol wire. The nitinol wire will go with two finger care, so we don't place a lot of damage. We want to grip and press that in. We want to be very careful. We're going to hold that needle, hold that wire, and we're going to go ahead and just twist with what's called a seldinger technique. In the United States, very typical for making central lines in the intensive care unit. The next we're going to take an 11 blade, and we tend to do is just move that night in a wire safely without again plunging it into the hip joint. And we're going to go ahead and make a linear cut around the wire. What we'll then do is tend to go ahead and spread with a simple surgical instrument, Hemostat or Kelly, so that we make sure that we're freely able to access down to the level of the deep iliotibial band we'll show as we bring this flush fit into the tip of the wire. We simply hold the wire in position, and we're going to go ahead and twist and push down to the level of the hip capsule. And as we work into that hip capsule, we're working with twisting. We don't want to see bending or a lot of excessive force. And this is all part of the spirit of keeping nice patient protection as we're moving forward. Next we want to go and connect the flush fit obturator into the cannula. And when we do so, we want to make sure we have that chin up bar portion of the flush fit obturator aligned with the line on the flush fit cannula. And now we're ready to go ahead and instrument down the knight and the wire and into the hip joint itself. As we go down, we're going to go ahead and hold that stable position again. It's Twist-In push. We use the wire in the back to make sure that if we have the correct angle, that wire is going to come easily in and out. If we have an incorrect angle, it's going to be bound inside the cannula. And these are some principles that are very important for central compartment arthroscopic surgery. As we go ahead and place the cannula, we're going to watch as we dilate and rotate. And we're ready now to go ahead and access the hip joint again. We're going to go ahead and disengage the obturator by going on the surgeon's hand side of the device. And we're going to go back and remembering that the obturator itself and the camera itself have a chin up bar. We've got to align that chin up bar with the line on the cannula so that we click right in. What you're going to see is that we've done a nice job of accessing. We go into the arthroscopic view. One thing to note, most of us, and this of course, is the way our teams have done it as well. We start with a dry arthroscopic surgery. There's no arthroscopic fluid or injection before the surgery. And you can often see a small meniscus type appearance of blue of the flush fit cannula in the periphery of your arthroscopic image. That's going to go away when the arthroscopic fluid enters into the field. Not to worry. And we're going to go ahead and make us a second portal. This portal can either be the anterior portal. And if we do the anterior portal, our angle of approach is typically at about 45 degrees out of both planes, straight down into that anterior triangle position. We're going to see the actual needle penetrate. You'll see a little bit of movement first. And we're going to again for safe access. We're going to just use that like a trampoline effect and make certain that we're in the right position before we access into the hip joint capsule again with two fingers, we're going to go ahead and go right into that capsule. You can see at this point that we have a nice safe access. We're not through the labrum. We're going to go ahead and instrument this one. We're going to next take the nitinol wire. And now we're going to see the very same steps that we saw from the outside in from the inside out. And we're going to go ahead and place the wire down. And we're again being very careful as we move in and out with that wire, not to jam the wire itself against the socket. We then slowly twist and remove the spinal needle right from the edge, so that we have a perfect safe access at this point. We'll then go back to the scan and repeat the same process from the anterolateral portal with a knife linear incision. We're going to spread down through the subcutaneous tissues. We then go ahead and take the obturator for the FlushCut cannula. And we're going to go ahead and dilate again. We're going to keep moving that wire back as we enter the capsule. And as we get just about perch to get into the capsule, we're going to feel a little bit of a give as we enter in safely. So now that we're dilated through, we're going to go ahead and leave the leave the wire in place. We're going to take the actual obturator out. We're going to fasten the flush, fit into position and come down to make the second portal. And this again is the mid anterior portal. What I'll do in this case is keep the tip of the wire in view in the arthroscope, so that we know we're at the right angle. And then that wire isn't burying deep into the hip. And a good assistant makes for a great case. And we can see how that steady hand is holding and giving us that view. Once we get to the actual capsule layer, there's two choices. And I'm going to show them in two ways. One way is to make what's called a all-inside approach, where we go right down over the wire and bring the whole camera cannula and obturator inside all at the same time. This is probably some of the most risky with the traditional systems, because there's going to be a rigid metal cannula coming right across the labrum in this case. Note how the flush fit does not create problems. Now there's also a second way of doing this, which I would advocate, which is to bring the tip of the obturator into the joint. Take the wire out. We're going to take the surgeon side of the tab and release it. We're going to leave that right in position while we bring down the CapsuleCut. And we bring this down right inside. And we can see it goes directly through that five millimeter FlushCut cannula. The FlushCut cannula itself is resting on the outer capsule. And we're making simple inside out moves to create a small what's called periportal. Capsulotomy. And that will give us a perfect amount of room to go ahead and replace the obturator. Realign. Click in position. It'll twist smoothly right into position. And then we want to leave that very soft flush fit edge of the flush fit cannula in place. We can see this is resting on the labrum. And one of the key portions here of safety is that the camera lens will not protrude longer than that flush fit cannula. So we know now our safe steps to switch the camera from the anterolateral to the mid interior position, find the chin up bar position on the t-piece and click ourselves into position. We're going to go back and show using our oblique. We're going to go back and show the original flush fit cannula. And again there's no scalloping of the articular cartilage in this area. With the flush fit cannula. We can back this cannula up and begin to make the second periportal Capsulotomy. We're going to come down the anterolateral portal right down the same pathway entering into the hip. And we're going to make a small periportal capsulotomy to improve mobility. Even in pediatric cases. There's room for us to be safely accessing the hip joint. This particular specimen less than 100 pound total body weight. We have enough room for our instrumentation. Now we're going to go ahead and re access the hip joint with the flush fit. Again. This has all been done dry so far as we add inflow and outflow to the hip joint itself. We're going to start to see these instruments function as they're intended in an aqueous environment. And you can see as the flush fit cannula goes across the articular cartilage, even in a friable specimen, you're seeing no iatrogenic damage. So we're going to go back into the aqueous environment. We're going to go ahead and look at the mid anterior portal. And we're going to just make intentional contact and show the forgiving nature of this flexible plastic against the articular cartilage, demonstrating no iatrogenic trouble with contact against the femoral head. It doesn't mean we strive to hit the femoral head, but we do want to make sure that we're knowing that if we have assistants or trainees that are driving the camera, we're going to be much more protected from any unwanted injury. So now we have a two working portal access to the hip, and we can proceed with a standard diagnostic or operative arthroscopy.

Transparente Kanüle, halb offen, gerundet mit Quick Connect

Clear Open Cannula, Blunt Tip, with Detachable Handle

Open Clear Cánula, punta roma, con mango extraíble

Transparente Kanüle, halb offen, spitz mit Quick Connect

Clear Open Cannula, Tapered Tip, with Detachable Handle

Open Clear Cánula, punta cónica, con mango extraíble

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Hip Next Generation in Soft-Tissue Repair and Reconstruction

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Atraumatic Hip Joint Access Using the FlushFit Cannula System

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Hip Next Generation in Soft-Tissue Repair and Reconstruction

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