Name: Introduction to the NanoScope™ Operative Arthroscopy System
Uploaded: 2019-07-18T00:00:00Z
Channel: Arthrex
Description: Asheesh Bedi, MD (Ann Arbor, MI), introduces the NanoScope™ arthroscopy system and demonstrates its use in knee arthroscopy.

<p>Asheesh Bedi, MD (Ann Arbor, MI), introduces the NanoScope™ arthroscopy system and demonstrates its use in knee arthroscopy.</p>

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VID1-000165-en-US | D | Introduction to the NanoScope™ Operative Arthroscopy System

Asheesh Bedi

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Introduction to the NanoScope™ Operative Arthroscopy System

Wanted to have the opportunity this morning to demonstrate all what you need to perform a NanoScope here in the operating room or in the office. It's impressive. As you can see, what's on the table here really lets you take throughout the entire phases of care the little that you need for preparation, then the camera and even the equipment here for instrumenting a knee or a shoulder or other joints. I do want to talk a little bit about the instrumentation to access the joint. You can see on the top right side of the table are the tools that we use to place the NanoScope you can see everything can be done through placement with a spinal needle and a guidewire. And then what's placed over the top is this disposable obturator and cannula system. I think it's important to mention and emphasize how atraumatic and small this is relative to our conventional tools. As all of us know in the Or with our routine. Quote unquote, 3.5mm scopes. The outer diameter of those cannulas is 6.5mm and very large. And correspondingly, the tools that we use to instrument are quite large. This is an outer diameter sheath of 3.0. And all of the of the instrumentation here that is going into the knee joint is 2.0. As you can see, accessing here with the NanoScope itself, it's a 1.9mm camera with an outer 2.2mm sheath. So that is about a third of the size of the routine instrumentation that we're currently using. And that, of course, offers several advantages. Number one, first and foremost, minimal trauma to the soft tissue. But of course, an ability to access pathology and see things in the knee joint without iatrogenic injury to the cartilage in ways that we never have been able to before. So again, just emphasizing those points here, the 2.0mm or 2.2mm outer diameter of these instruments and two millimeter instruments in terms of probes, biters and graspers, here are the two syringes that come in the prep kit. Here's the disposable 11 blade for access into the joint here your ace wrap, sterile drape and sterile towel, as well as gauze. And all of that comes in the prep kit. And then moving forward here, your access kit, which will involve your spinal needle, your guidewire, as well as your disposable obturator and cannula, and then the adhesive custom tegaderm that allows you to secure the cannula to the knee joint to avoid loss of access during the case. So here we have a right knee. We're going to go ahead and demonstrate our ability to use the NanoScope here. We can hook the inflow from the pump in the Or environment right to the cannula here. So now we'll introduce the NanoScope there into our cannula. And you can see right away you're oriented were in the notch. That's your ACL ligament that we're looking at right here. There's the lateral compartment of the knee joint here. Here as we walk around we're going to walk around the ACL towards the medial compartment of the knee here. As you can see without applying any valgus to the knee joint really whatsoever, we're already able to see a reasonable amount of the medial compartment of the knee and then walk around here past the ACL without any varus. We can really drive all the way to the back of the knee. Ability to access the entire lateral compartment of the knee. This is without any varus on the knee joint. This is now starting to apply a little bit of varus. We can start to see the entire lateral compartment and lateral plateau and cartilage there. So the NanoScope is a zero degree scope. But as you can see it gives you a fairly panoramic 120 degree field of view. So here as we've entered from a lateral portal you get this broad perspective. Being able to see the lateral compartment here you can actually see a meniscus tear in the lateral compartment there entrapped inside the joint here you can pan across. There's our ligamentum. We can work across that and underneath it and even get into the medial compartment of the knee here and see the inside of the knee. So it really gives us a broad view. And this is without a second portal and without really any manipulation of the knee. The knee is just hanging at 90 degrees here. So now we can probably place our second portal here. To do that we'll use a spinal needle. This will be coming in from the medial portal. There you can see the beauty of this is under direct vision. We can watch the needle tip come into the knee joint here. In this case, because of our ligamentum, we're going to want to have a direct view of that needle before we place that working cannula. We're now inserting the guidewire via that spinal needle. You can see we can directly triangulate that to our desired location. And then we use the disposable 11 blade just to gently nick the skin to allow for placement of our working cannula. So here we just come along the wire and just make a slight dilation there to allow for our cannula to be inserted there. As you can see there, we're triangulated right just deep to our ACL there. And there's our cannula. The wire can then come out. Our working cannula is in position there. And now we can remove the obturator. And we're in a perfect orientation and position here to instrument the joint I think you can see on the screen there that's triangulated right to the lateral meniscus. As we look here, there's that lateral meniscus tear that we saw earlier. So we're in good position. Now. We have this tegaderm custom tegaderm that now can hold this cannula in position. As you can see it's smooth to smooth to minimally traumatize the soft tissues, but this allows us to have no concern that as we slide instruments in and out, we don't have the problem of the cannula coming out of place. So as you can see now we have this adhesive in place that will maintain the cannula in place. You can see with this reverse trampoline effect, I can still pull the cannula back and forth to adjust my working length, but it will still maintain it in position. So you still have the flexibility to adjust your position. You can see here as we work on the lateral side there towards that lateral meniscus tear, I can bring it in and bring it closer, but I can certainly also bring it back as well here towards the ACL and the notch. Now we'll use this probe. As you can see this can nicely be inserted through your cannula. Here we can instrument the lateral compartment. We can see this lateral meniscus I want to point out that we're seeing all of these structures without any assistant applying any various to the knee joint. So I'm able to drive in here. I'm going to drive right to the posterolateral portion of the knee right there towards the popliteal hiatus. Here we can we can check our ACL again, our probe there Checking the fibers of the ACL. Bring that through there. They're lifting up on those fibers. And here, if we want to drive into the posterolateral portion of the knee, I'd like to show this here with a zero degree scope from the lateral portal. I'm now looking in the posterior lateral aspect of the knee, retracting those ACL fibers. There we are at the root of the lateral meniscus there. There's our medial compartment of the knee joint. Here. Again without any valgus we're able to look right over there as I now valgus the knee. This is now our medium straight biter. There a small biter that we can instrument there. Again two millimeter biter, as you can see there. And there you can see there's our posterior horn of our lateral meniscus. I think you can see the incredible view there. I normally with a standard knee scope am not able to see the meniscal root with this clarity. You see there where the meniscal root there I can. The very common location to have these small little oblique parrot beak or small radial tears. Then you can appreciate here I'm biting away a little bit of that portion of the lateral meniscus. And then we'll demonstrate here where as we resect that portion we can then use our suction aspiration tool to remove those little meniscus fragments. So here, under great precision with great visualization, we're biting away those portions of the meniscus here and then here. Now we can see we've created some of those fragments. We can put in our suction aspiration tool there. So now we've accessed the suprapatellar pouch here. And the patellofemoral joint. This is from a standard supralateral portal just distal to the vastus lateralis. You can see here a great view of the suprapatellar pouch. I'm driving here into the medial gutter. I'm pulling back here. There is your patella with Chondral disease you can see there. But now as we work a little distal, you can see a good view of patellofemoral tracking. There's actually a pica there that's entrapped between the patellofemoral joint. As we flex there you can actually watch the patella track along the trochlea. So even with this zero degree scope, we're able to get to every aspect of the joint and inspect every aspect of the joint in this minimally invasive way. Here you can see both our medial patellar facet, our lateral facet. There I'm able to drive in and even show you the odd facet there. There's the odd facet. Here's our deepest aspect of our trochlear groove. And you can see here we've done nothing to manipulate or injure the fat pad, which can be a source of bleeding and trauma and pain. So there again, just with this percutaneous portal fully able to evaluate the patellar chondral surfaces and and trochlear surfaces, as you can see there. So looking here now I think you guys can see there is the there is our lateral compartment. There's our ACL ligament fibers here. We can drive just deep to our ACL. And here I'm driving into the back of the knee. That's our posterolateral recess a traumatically accessed without difficulty. Again sometimes now as we're doing procedures we want posterolateral portals to instrument ramp lesions. Sometimes we use them to have an indwelling camera for a unique view of a lateral route. I'm going to take a spinal needle there and just show you how a traumatically. Now we can access those locations. And here, under direct vision, with the knee hanging in a in a neutral position, I can bring the needle in and directly under vision, I'll introduce it into the knee joint here. So we're going to watch that directly here. Come in. And there's our needle right there. See that allows me now to bring this. This would allow us to now access ramp lesions here. That's the posterior aspect of the lateral meniscus as we work medial. This would allow us to access a lateral meniscus root here. This is a portal that we sometimes even create to inspect posterior chondral lesions on the lateral femoral condyle, or even to access for placing sutures to pull in a lateral meniscus transplant. So having an indwelling portal or cannula here to do that is a tremendous advantage. Here we're through a superomedial portal. I think you can appreciate this is just deep to vastus medialis as I bring my hand distal here. This gives you a very unique vantage point and perspective. You can see all the way down the trochlea in deep flexion and extension. See that we can see the patella and the medial facet engaging there. This is a great view for looking at medial patellofemoral compartment disease and for assessing, tracking, and also to assess, for example, after an mpfl procedure, a patellar tilt and alignment. So you can see in a minimally invasive way where sometimes we don't even perform an arthroscopy at the time of an mpfl, a NanoScope would allow us through a needle to inspect our alignment and inspect our tracking as an augment to that procedure, where sometimes we don't perform an arthroscopy. You can see there a unique view of our patellar cartilage and our trochlear groove. There you can see fissuring in the deepest aspect of the trochlear groove. An exceptional view of that. This may be something we would want to do prior to a tibial tubercle osteotomy, or an mpfl to assess the control surfaces, to make sure that the patient is a suitable candidate for those procedures. All things that we currently rely on the MRI on. But here with a NanoScope with minimal additional morbidity to the procedure, essentially no additional morbidity, we can assess that in the Or.

Introduction to the NanoScope™ Operative Arthroscopy System

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