Name: Innovation: The Future of Minimally Invasive Surgery
Uploaded: 2020-01-09T00:00:00Z
Channel: Arthrex
Description: Orr Limpisvasti, MD (Los Angeles, CA), presents on the impact of the 1.9 mm NanoScope™ visualization system and the 2 mm Nano hand instruments on the future of minimally invasive arthroscopy.

<p>Orr Limpisvasti, MD (Los Angeles, CA), presents on the impact of the 1.9 mm NanoScope™ visualization system and the 2 mm Nano hand instruments on the future of minimally invasive arthroscopy.</p>

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VID1-000346-en-US | A | Innovation: The Future of Minimally Invasive Surgery

Orr Limpisvasti

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Innovation: The Future of Minimally Invasive Surgery

I'm going to be speaking on the the future of minimally invasive surgery. My name is All-inside. I'm from Kerlan-jobe, just up the road, and I'm not really going to try to prognosticate the future here, but maybe just lend some directional things that are happening as it pertains to arthroscopy. So necessity is the mother of invention. It's sort of become a platitude for us at this point. Obviously, when this was coined, it was coined in a time of necessity. In around 400 B.C., the average human lived about 37 to 41 years. And currently, we're in a time of abundance. It takes a bigger push for us to want to innovate, to want to do something different. And that's why a course like this is really fun, because it sort of explores the edges of where we're going. But even 100 years ago, our arthroscopic forefathers here, you can see on the left there, Takagi, that's 1919. That's literally 100 years ago. Nordentoft 1912, they started to sort of push the limits and see what you can do with the scope. Well, before we had any sense of of what we would be doing today and just for context, to see how far ahead these guys were, the the innovations that were happening at that time, or the television set, household refrigerator and a ballpoint pen. So these guys are just light years ahead. But again, what is it that makes us want to innovate? I remember something that Frank Jobe taught me and told me as I was joining practice was that we have to keep changing what we do. You know, it's very counterintuitive to have someone who's an innovator tell you, okay, coming out of training, honing your skills, trying to perfect what you do now, start to unlearn it, start to change and transform what you do. And that was really something that's that's true even today. You know, he said there's no surgery that he did in his practice towards the end that he did when he started practice. And we're all sort of experiencing the same thing right now. So why is it so hard to change? Why is it so hard for us to change what we do? You know, you know, there's nothing permanent except change. But we've got this resistance. If you talk to any of the surgeons in this room about how they do rotator cuff repair ACL, we've got myself included. You've got this sort of visceral response of this is how I do it. This is how I like to do it. And, and I would just say, you know, at a meeting like this, it's great to, to kind of let go of that grip a little bit and think a little bit more clearly about where this is heading. You know, Steve Pressfield, in his great book called The War of Art, talked about this resistance, these internal hurdles that we create for ourselves that don't allow us to continue to evolve. And as the resistance pertains to arthroscopy, even some of the greats, I mean, these are legends, right? You see, some of the big heavy hitters say, hey, this is this is how I do it. I don't want to change. But, you know, and Charlie Rockwood called the arthroscope the tool of the devil. I mean, these guys had moved the dial so far in open shoulder surgery that that was where they found success. And it seems a little bit funny now that, you know, the question that they were asking was, why would you want to look through a keyhole? We can open the door wide open. So this is what the transformation looks like. On the left here, you've got sort of the early version of what we're doing and, and, you know, sort of looking at what's happening on the right side, how clear the picture is. Synergyrf 4K sort of where we're heading. Makes me a little bit embarrassed looking at this when I complain to my ex about how, you know, I got glare on the scope or the picture isn't that clear? You look at the guy on the left, he's happy as a clam, putting his eyeball on a scope. He's got his scope on the posterolateral part of the knee. He's got a clamp on the posterior medial part of the knee, and he's just probably thrilled to be able to see something and do something. But obviously there are numerous iterations that happen between these two pictures here. A lot of emotional labor went into continuing to transform and move the dial, but some things haven't changed. And that's what we need to think about, is how we're going to move things forward. Because what we've seen change in the last 20 years is what we're doing with the scope, as if the scope were a stable platform. But what you can see here, and this is more true in orthopedics actually, than other medical subspecialties, we have a fairly rigid scope. It's got a fixed angle. It's going to hover in the last 20, 30 years between about four and six millimeters in diameter. So, you know, Eric talked a little bit about the NanoScope coming out. This is kind of an interesting thing. That's going to be a little bit fun because it's going to push you to think. And it's sort of at base camp right now. There's a lot of great technology, the chip on chip technology that's come into this. And we'll talk a little bit about this. We've got a lab coming up that we can just do a quick demo to show everyone what it's capable of. So just take a look at the metric size comparison. So again going down from about 4 to 6mm in diameter to around that two millimeter size, that's a pretty big shift. It's much less invasive. And of course you don't want to just see you want to do so. There's instrumentation that's going to be coupled with that. That's also going to go down from about the four millimeter size down to the two millimeter size. And of course, yes, we're you know, we're skeptical scientists and surgeons here. But I would ask you to bracket your skepticism for a second, because as soon as you say needle scope, NanoScope small scope, you're thinking about the picture on the left. You know, we've all seen it. I'll put our put our hands on it. Seeing pictures coming into the office of what's out there right now. And the current scopes right now are about half the resolution of where the NanoScope is. And the NanoScope is going to continue to improve. And so the picture on the right there is about where we are right now at the NanoScope. And we'll, we'll show you that in a little bit. And of course, you don't want to just see you want to be able to do so. The disposable instruments that come with it, the arthroscopic cannulations that come with it, they're all sort of in that same size, that two, two millimeter size. And this, this slide here that that Eric showed earlier is really sort of the exciting thing. You know, the point isn't really these are the things that you should do with them. It's really more what is it going to work in your practice. What are the things that you want to do with it? For me, I can tell you I'm excited about having a second viewing portal in certain surgeries, shoulder surgeries, knee surgeries, maybe doing some second looks and some cartilage work. But there are people here that do small joint work. There are people here that want to do image guided injections. So we just heard a lot about doing injections for arthritis. Well, when we inject things into the knee, why not make it more precise. Why not put it into a into a specific structure under direct visualization. So this is the kind of case I just want to show real quickly. It's just a case I did last week. It's a college baseball player. Had to do a pasta repair on him. He failed non-operative management. This is sort of what it looks like where you're going to do percutaneous using the three nine knotless. So percutaneous, you place your anchor percutaneously place your sutures. And again it's all good and fine. We sort of come to perfect some of the techniques that we want to use. But all the little moves along the way, right. You're looking downstairs and you're going upstairs, you're going downstairs, you're going upstairs with something like the NanoScope. This whole process would be made much easier. So you can keep the scope, say, upstairs or downstairs, and actually work with a dual visualization. And here's another iteration for you to consider. Again. You can you can work through the same portal. You know, you got a passport cannula, but it's got a second parallel barrel if you would. So you can put the scope and the instrumentation in the same location for a lot of the surgeries that we do. So the paradigm shifts. Where is this sort of headed, you know, is a big shift from open to arthroscopic inpatient to outpatient sort of. The next step, again, is to see how minimally invasive we can be so that we're not actually having to to have our patients as down as much as possible, going from the operating room to maybe more procedure type setting eventually. And, you know, it seems like a stretch right now, but I don't imagine that it's not going to happen pretty soon. So we're just in the beginning here. This is the first step. I'd really encourage you all to to take a look at the NanoScope and should be coming out soon. So if you haven't had a chance to put your hands on it and take a look at it, Chris and Ryan, a bunch of other people are going to be around today to show you what that looks like, and I think we're going to do a quick lab demo. But as it as it pertains to the rest of this meeting, please do your best to to loosen that grip a little bit and think about where things may be heading. Thank you.

Innovation: The Future of Minimally Invasive Surgery

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