Name: Carpal and Midcarpal Technique Using the NanoScope™ System
Uploaded: 2019-07-10T00:00:00Z
Channel: Arthrex
Description: Sanj Kakar, MD (Rochester, MN), demonstrates the NanoScope™ arthroscopy system instrumentation for use in small joints.

<p>Sanj Kakar, MD (Rochester, MN), demonstrates the NanoScope™ arthroscopy system instrumentation for use in small joints.</p>

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VID1-000333-en-US | C | Carpal and Midcarpal Technique Using the NanoScope™ System

Sanj Kakar

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Carpal and Midcarpal Technique Using the NanoScope™ System

What I want to show you is what it looks like. So this is a peel pack literally comes in like this. And just to go over the instrumentation, what you're going to see here is that this is the trocar okay. And we'll show you how to use this as a trocar. It's very thin very slim. You can actually argue you don't need to make an incision to put the trocar in. It's the size of approximately a 14 gauge needle going into the joint. And we do that routinely when we aspirate, for example a septic wrist. This is the NanoScope. And so what you will see, it's ergonomically designed. This is the sort of hub. And then the beauty of this is that this is a flexible scope. It's 1.9mm in diameter but it's flexible. So it's perfectly aligned for the small joints. So for example the radiocarpal midcarpal joint, the the thumb CMC or the MCP or the Pip joints, those difficult areas to get around. This is a flexible scope. And when it sits in the cannula, the cannula actually is an outer diameter of 2.2. So if you think most of us in practice are probably using the 2.7mm millimeters. Scope with the outer diameter of the sheath is at least four millimeters. So this is essentially half the size. And this literally is a plug and play mode in terms of essentially it's like an iPad that you have in your Or so. You don't need those big arthroscopy towers for this. What you'll see is how Arthrex really has revolutionized, once again, the field of arthroscopy. And so if we go from left to right, we want to see these cannulas. Everybody's wrists are a different flavor. So this is essentially you can see it's it's a graded length of a spinal needle. And these gradations will essentially tell you the size of cannula that you can use. If you want. You can put a switching stick into the joint. And then you'll see that there's two cannulas that are made. This is 1.5mm in length, which is probably most applicable for most of the wrist. And what you'll see is as you pull it out, you can see that it's got a stop here to prevent any leakage of fluid if needed. So this is the 1.5cm. But there's also a three centimeter type of cannula for the larger wrist. What's also very also very interesting is that we're all used to this type of probe that we'll see. But what Arthrex has done now is that they've taken the technology to another level. What you'll see is that there's a nitinol wire that comes out that will act as your probe, so you can see that there. And this retracts back in. So very ergonomically designed. We have the new NanoScope instruments. We have a grasper, a scissor and a beater. And you can see the traditional instruments on the right. Traditional instruments are about 13cm. But you can see now for most of hand and wrist we'll be using these which are seven centimeters in length. And so you can see how they've taken the technology down. And what I wanted to show you is actually how this fits through the actual cannula system. So it'll go straight through the cannula and you can see how it fits nicely into the joint. And I know most of us when we do arthroscopy, we're always frustrated. Once we found the portal we can't get it back in. So this cannula will really make passing in instruments a lot easier. And in addition, we'll show you in the demonstration they have a two millimeter shaver which fits right through this. Now remember the angulation of the radius. When you put the needle in for the radiocarpal joint you have you have to lift your hand to pop into the joint. Whereas when you make the midcarpal portals, remember it's much more of a parallel pass straight into the joint as seen. So here we're taking the cannula and what you'll see here. It's a two millimeter cannula. And essentially once we've incise the skin or you can just pop it straight in as a needle, it essentially stays in there. And now what we'll do you can either do wet or dry. I'll show you a trick for doing sort of dry or moist arthroscopy as John was talking about. And so now when you see there's a bit of junk on the lens, a little trick that you can do is take this, wipe it into the soft tissues, and that usually will take it away. And so what you'll see now you have the scaphoid facet right there. And then as we come to the radial side you'll see the radius for capitate and the long radial lunate ligament next to it. Now this little area here you can see is the ligament attitude right here. And if you follow the ligament attest to that's a little trick that will give you a scapholunate ligament. So you can see in this patient there's a little bit of a step off, maybe between the scaphoid on the right and the scapholunate and the lunate on the left. And remember, what we're looking at right here is the membranous portion of the cell. So don't be duped to think that's a dorsal or volar part. Now we're simply coming across. You can see the flexible nature of the NanoScope will allow us. Now we have minimal traction here. So that's one of the advantages of this is where do you use this? Do you use this in the procedure room where you have minimal traction or in the office for diagnosis. And we've discussed this morning about the importance of arthroscopy. And now we're going into the ulnar side of the joint. And you can see here we're underneath the lunate. And there's a tfcc. Now a lot of people ask us about the UT ligament split tear. Where does this exist. It will exist in this area here when I'm pushing onto the wrist. This is basically you'll see the Foveal sign right here. I just want to show you the instrumentation that's been designed for this. So now what we'll do is we'll develop our ulnar portal and come in. So there's the scissors coming in. You can either put the cannula in if you, if you would like at this stage. But we're taking this two millimeter handheld design shaver that will pop in into the joint. And so initially when you're doing it dry, you'll see a ton of junk into the wrist. And then so now you can see here's a shaver. So it's designed it's two millimeters. It's tiny. But this will give you excellent view of the wrist. And you can see here how we can do a sign of ectomy if needed. And debris the tfcc. So now another little trick is sometimes you'll get into the joint and there'll be junk in there. They'll be fluid and things like that. So what we can do is we can do an automatic washout. We can take a ten cc syringe. So what I'm doing a distal radius in is acute and there's fluid in there. I'll just turn on. You can see how the plunger is just depressing itself. This is a trick that was taught to me by Paco del Pino. And you can see how now the joint is being ravaged. If there's any debris in there, if you're doing a ganglion ectomy and you need to see, you can see how the joint is being irrigated through the portal on the actual syringe. And then the next thing I do is I call this the hairdryer maneuver, as I just put the shaver in and just suck out the joint. And now you have an unparalleled view of the articular cartilage if needed. So that's the Radiocarpal portal. Let's do a midcarpal joint arthroscopy. So again, I'm going to go into the Radiocarpal portal. I'm just going to drop into the joint. You can see it sits there. It's essentially hands free when you're doing dry arthroscopy. I would urge you to move to dry because one of the issues when I would do wet arthroscopy is that you would get a lot of soft tissue extravasation in the joint, and it made it very difficult to do an open procedure. So with this you have minimal swelling of the joint. And the beauty of the NanoScope technology is that you don't have to close your arthroscopic portals. These are just steri-strips onto the wounds and you will get an unparalleled closure and cosmesis. So again, here you can see there's a little bit of junk on the camera and then we'll drop in. And now we're right into the joint here. So now you'll see his scaphoid and you'll see there's a bit of junk on the lens on the right. So just take this, wipe it into the soft tissue. Sorry if I'm making a little bit sick there. Let's just give that a little bit of a clean. Okay? So now you can see I've just cleaned it out. So here's the scaphoid. And so when we're doing an arthroscopic scaphoid fixation Beaulieu showed that nicely today. If there's an acute fracture. Well Geisler has a nice technique to do. Fixation of scaphoid nonunion through here. And now what we're doing is we're dropping in. And just like that peri lunate case that I showed earlier, there's the light. So we've cleaned out the joint, and now you have an unparalleled view of the light. And now we showed you the the nanoprobe. And we can take that. And we can try that for you to see how that fits. So essentially it drops into the joint as so. But there you can see essentially the the probe fitting in to the light. And that's another little trick that you can use to try and look at for instability. And you can see in this patient, this patient actually has what we would say a halt lesion. You can see the hamate there on the left. So that I just wanted to show you today the power of this. I mean this is just for standard arthroscopy. But remember the advantage is that you can use this now for the Diu. You can also use this for the smaller joints like the thumb CMC or the MCP or Pip joints.

Carpal and Midcarpal Technique Using the NanoScope™ System

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