Name: Lateral Meniscal Repair Using the NanoScope™ Micro Arthroscopy System and FiberStitch™ Implant
Uploaded: 2020-09-21T00:00:00Z
Channel: Arthrex
Description: Mark Frame, MBChB (Southampton, UK), demonstrates a lateral meniscal repair using the NanoScope™ system and FiberStitch™ all-suture implant.

<p>Mark Frame, MBChB (Southampton, UK), demonstrates a lateral meniscal repair using the NanoScope™ system and FiberStitch™ all-suture implant.</p>

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VID1-001436-en-US | B | Lateral Meniscal Repair Using the NanoScope™ Micro Arthroscopy System and FiberStitch™ Implant

Mark Frame

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Lateral Meniscal Repair Using the NanoScope™ Micro Arthroscopy System and FiberStitch™ Implant

Today we're going to talk about the new Arthrex NanoScope. I had the opportunity to use it for the first time, and we did this in a pediatric knee, which was really small, taking advantage of the tiny NanoScope only 2.2mm in comparison to a normal scope of around about nearly six millimeters, which made the surgery that much easier. So now we're down here looking at the convenience pack that the NanoScope comes in. This is a sterile single use pack. So simply remove the lid. So there's lots of things in here that you get with a normal scope. Unlike a regular Arthroscope. There's less things to see in this box which is great. It's all integrated into the NanoScope itself. So there's no light cable. The light source is all contained within the the single use NanoScope itself. So this cap here is really important. They really don't throw it in the bin. This is to allow calibration of the NanoScope and you may need it further on in the surgery. So don't throw it away. So this is the body of the scope. This contains everything that a regular stack Includes. So the image sensor is called a chip on a tip, so it's all within the device itself. The LED light source is also contained within this. So there's no separate light cable. It's just a single connection to the console which is fantastic. Obviously this is all sterile. So again you don't need to put it into a separate sterile bag. Just making maneuvering and using the scope much easier. At the top here you've got two obturators. You've got a blunt one and a sharp one depending on what you want to do in your preference. Here you've got the cannulas. So essentially it's the same as a regular scope, except just much smaller. This is the fluid inflow here. And you can see the diameter of this in comparison to normal is very small. So the diameter of the NanoScope itself is 1.9mm. This is 2.2mm. And in comparison to the outer sheath of a regular knee arthroscopy set which is around about six millimeters, or 5.9 to be exact. You get two of these. And so if you want two different portals, you can simply swap between them without having to remove one. These are for the fluid inflow. And again you get two because you've got two cannulas. And they're just a tap to allow fluid in and out of your scope. Now this can be connected to a gravity bag. Or this could be connected to a syringe depending on your preference. At the end of the case all of this is disposable. So it's single use each time. And we'll take a closer look at the actual NanoScope itself. If you look at the top there's two buttons. Again really familiar from a normal arthroscope. The top one is for taking pictures and the bottom one is for taking video. The scope is a zero degree field of view, which is slightly different from a regular scope and just takes a little bit of getting used to. But because it's got such a high viewing angle of 120 20 degrees. It's not a problem at all. The LED light source is cold inside. So again, not doing any harm to the cartilage. And it's only 55g, which is really easy to maneuver and use. The other advantage of the NanoScope is that because it's chip on tip design, there is some flexibility within the scope itself. Now it's not recommended to to bend it, but a little bit of flex won't do any harm to the the scope itself or the image or the camera inside. And as it's disposable at the end of the case, it goes in the bin. Anyway, here we have the NanoScope console with its 13 inch touch screen. Very intuitive user interface. It's got rechargeable battery if you want to maneuver it around to an Ethernet connection, to upload your images to PACs or the hospital network USB for bringing your images and video off the device, and HDMI, which is really great because it means you can connect it to a much larger screen in theater. And it's also got an integrated microphone to allow you to record directly and annotate onto the images and video that you're taking for your arthroscopy. So let's take a look at the nano instruments. These are all single use and really sharp. The first one is the nano probe with a nitinol retractable probe to allow you to go through the cannula. The nano Grasper simple grasper, but much smaller, which is fantastic. Nano straight punch. Same instruments you would have with a regular scope, but just all much smaller. The nano scissors again, great for being able to trim menisci and for getting underneath the femoral condyle the nano upward punch. So this you can see we're in the suprapatellar pouch. Just bringing the scope back. See some synovitis. And this is on a gravity bag. So the fluid pressure is not particularly high. But clearly you can see everything. There's the articular surface of the trochlear groove. And we'll move down into the medial gutter. And you can see just the beginning of the joint line and the posterior edge of the medial femoral condyle and moving down into the medial compartment of the knee. Looking at the tibial articular surface, which looks pristine and the edge of the medial meniscus. This is with the knee just dangling at 90 degrees. And we come across to the middle of the joint. And clearly we can see a healthy looking ACL. And coming into view now we can see the bucket handle tear of the lateral meniscus sitting in front. And now we're establishing our medial portal. There's the needle coming through that we're watching under direct visualization. And that's despite not having a having a 30 degrees, but that 120 degrees of wide angle making all the difference we've managed to put our probe through. This is a regular probe rather than the nano probe. And we're just examining the medial meniscus. Checking the stability of the posterior horn. No pathology here to see at all. The next move is to try and reduce this displaced meniscus using the probe. This is a small parrot beak of the meniscus, but it's essentially a red on red tear. That reduces nicely without any significant plastic deformation. And again, just notice the fantastic view that we've got of everything. We can almost see the entire lateral meniscus. Can see how unstable this is simply with the probe. Looking at where we're planning on putting our meniscal sutures. But before we do that, we need to freshen up the rim. And we use the sharp trocar just to trephine the meniscal capsular junction to encourage healing. Once we repair this meniscus back to where it should be. The metal skid that comes with the FiberStitch, just to aid passage of the meniscal suture needle and to avoid damage to the articular surface That's then removed, and you can see the FiberStitch in the end of the needle, loaded and ready to go. Set to a depth of approximately 16mm. Crx obviously being taken to avoid the direction of the common peroneal nerve fans the needle in through the meniscus and then through the capsule and deploy the FiberStitch. In the posterior capsule. Pulling the needle back into the joint. With the next FiberStitch ready to go. Then insert. The. Needle for a second time through the meniscus, through the capsule, and deploy the second FiberStitch. And then pulling the needle back into the joint. You're left with a loop and a long suture. We pull on the the loop, which snugs down and cinches the very first suture. And you can. See that happening now. And just pulling the meniscus and tensioning it back into the meniscus. Meniscal capsular junction. Then pull the free end of the FiberStitch and just tidy things up. And then finally trim that suture. Being such an unstable and large tear, it's going to take more than one FiberStitch to stabilize things definitively. We swap portals with the NanoScope. Now placing the NanoScope through the medial portal, allowing us a more direct access with the next FiberStitch from the lateral portal into the posterior horn of the lateral meniscus. Again, the skid placed into the knee joint to protect the articular surface. The next FiberStitch needle advanced into the joint. And again you can see the FiberStitch loaded and ready to go in the needle. We find this time a horizontal type suture and the most appropriate. So through the meniscus through the capsule again approximately a depth to 16 to 18mm. To deploy the first FiberStitch into the posterior capsule, retract the needle back into the knee joint. With the second FiberStitch ready to go. Then I plunge the needle in for the second FiberStitch in a horizontal fashion, again through the meniscus, through the capsule. Deploy that FiberStitch into the posterior capsular rim. Pull on the loop to snug things down, and reduce that meniscus back to where it should be. And then pulling the free. Edge. To snug the second loop. And finally trim that FiberStitch free end off. This is with the disposable cutter, and we swap the NanoScope back into the lateral portal for a normal view. And we're going to just take the opportunity with the probe in a minute to check our fixation and see how stable things are. Pass that behind the meniscus in the middle one third. Probably still needs another suture, which we do in a minute. But the posterior horn very stable. That meniscus isn't going anywhere at all. And we're going to place another one just there with the probe. And this is an image of our final suture in place. And that completes our meniscus repair. And all the kit that we've shown already that we used would subsequently just be disposed of. Thank you.

Lateral Meniscal Repair Using the NanoScope™ Micro Arthroscopy System and FiberStitch™ Implant

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