O sistema estéril de liberação para síndrome do túnel do carpo NanoScopic simplificado e completo agiliza os procedimentos endoscópicos de liberação do túnel do carpo (ECTR). Projetado para oferecer precisão e eficiência, esse sistema descartável inclui um NanoNeedle Scope de 180&nbsp;mm, um dispositivo Centerline™ e um instrumento dilatador/raspador sinovial.
 
O sistema de liberação NanoScopic usa um NanoNeedle Scope, que não tem acoplador de endoscópio ou cabo de luz e não gera calor. O sistema não apresenta o embaçamento que é comum nas configurações padrão de endoscópios.

Imaging and Resection

Hand and Wrist

Asif M. Ilyas, MD (Philadelphia, PA), presents a wide-awake endoscopic carpal tunnel release case using the NanoScopic™ release system.

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Human

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.

Operationstechnikvideos

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

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

Wide-Awake Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release Disposable System

Randy Lovell III, MD (Grand Rapids, MI), demonstrates the entire process of performing an endoscopic carpal tunnel release in the office under local anesthesia. He shows his local injection technique, reviews the NanoScopic™ release system’s benefits, and demonstrates his closure technique.
Video timepoints:
0:00-5:40: Administration of local anesthesia
5:40-8:50 : NanoScopic Release System review
8:50-15:15: ECTR procedure under local
15:15-16:25: Closure

Live Surgery: In-Office Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release System

Asif M. Ilyas, MD (Bryn Mawr, PA), discusses the advantages of endoscopic carpal tunnel release (CTR) under local anesthesia using the disposable NanoScopic™ release system.

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Case Presentation Videos

Wide-Awake Endoscopic Carpal Tunnel Release Using the Disposable NanoScopic™ Release System

Elbow

application/pdf

A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Chirurgen-Newsletter

Boletins para cirurgiões

Boletines para cirujanos

Surgeon Newsletters

Scope This Out Volume 25, Number 01

Steven S. Shin, MD (Los Angeles, CA), presents the NanoScopic™ release system for endoscopic carpal tunnel release. Dr. Shin goes over the sterile, single-use system and performs a cadaveric endoscopic release.

NanoScopic™ Carpal Tunnel Release System

Hi, my name is Doctor Stephen Shin. I'm a hand surgeon from Los Angeles, California. And today we'll be introducing the Arthrex NanoScopic carpal tunnel release system. Here we have the Arthrex nano needle that measures 180mm. Below that, we have the Arthrex Centerline. And below that, we have one tool that serves as both a synovial elevator and a dilator. They all come packaged together in one box. So we're going to give you a few tips now on setting up the nano needle. As you can see here at the top, this is the paddle that's connected by this cord to the nano needle. The paddle has a couple of buttons right there. And the nano needle itself is 180mm in length. And the cap and is capped right now. You want to keep the cap on there when you're white balancing your nano needle. So what we're going to do now go ahead and grab the paddle, which is also connected on the other side to the monitor. And you can press either button to white balance your nano needle. Okay. So I'm going to go ahead and do that right now. Just press one of the buttons and that's going to go ahead and calibrate or white balance the nano needle. Once you're done with that, you can go ahead and remove the cap from the nano needle just like that. And now what we're going to do is insert the needle into our Centerline device. And just to note on the Centerline device, this is the same Centerline device that you're used to. However, on the back end, it's slightly modified to have a special adapter that's going to receive your nano needle. Okay, so let's go ahead and do that. I'm going to just insert now the nano needle into the modified Centerline device and go ahead and push it in. And to help you out, you can also look at your monitor at the same time to help guide your nano needle down the tunnel. So here we go. It's pretty easy. It goes smoothly all the way down right there. And the key part at this point is to make sure that you kind of push and twist to secure the nano needle to the Centerline device. So here we go. I'm just going to kind of push there and twist. Now the twisting part is to make sure that the ridges on the nano needle itself are facing up towards you. The reason why it's so important to do that is because that way you can make sure that the blade assembly at the end of your Centerline device is in the correct position at 6:00. Now we're ready to demonstrate the NanoScopic carpal tunnel technique. So as I bend the wrist, I'm going to find a crease a little bit more proximally. And maybe there's one kind of right about here. So I'm going to go ahead and make a small incision. Okay. Right at that crease. And just make my small incision right at that mark. Okay. Again really small. And I'm going to dissect through the tissues. And as you can see you have the palmaris tendon right here. So we're going to go like this and kind of get that out of the way with a retractor. Next I'm going to grab the deeper tissue over here. And I'm going to dissect through that until I see those nice transverse fibers of the antebrachial fascia. So again just carefully go like this. If you're in the right area you're going to see that your median nerve is right right there. So we're at the right depth. Next we're going to take our tool that comes in the kit. And as I mentioned before it has a dilator on one end and the snowmobile elevator on the other end. And you can go either way. You can go the dilator first or you can go the elevator first. When you're inserting this device, try and stay as ulnar as possible within the carpal tunnel. So let me go ahead and put this underneath that layer right there. I'm going to go ahead and I can feel that I'm in the carpal tunnel. Okay. So right now I'm just making it a little space for my instrument. Next you can flip the tool around and then insert the snowmobile elevator end of the tool into the carpal tunnel right into that space. And you want to go ahead and scrape the undersurface of the transverse carpal ligament. I just want to mention that you want to try to hug the hook of the hamate, which is right about here. The more ulnar you stay, the safer you're going to be when you're cutting the transverse carpal ligament. As we know that the recurrent motor branch is going to be more on the radial side. So next we're going to insert the Centerline device into the wrist. And I'm going to go just like this. And I'm going to remove my retractor. I'm going to hold the specimen with my left hand with my thumb on the palm. I'm going to go distally here we can see the transverse fibers of the transverse carpal ligament above. So we're going to go ahead and kind of hug that. And go ahead and push in. And I don't see any longitudinal structures which is nice. Make sure you stay as ulnar as possible within the carpal tunnel. And as you can see I'm kind of pushing down a little bit on the carpal tunnel. And I can kind of feel the distal end of my transverse carpal ligament. Okay. So it's going to be right about there. I'm going to go ahead and deploy my blade by pressing the button. We're going to go ahead and make our retrograde incision and the transverse carpal ligament. We're cutting right there. I'm just jogging back and forth just a little bit because this is a cadaveric specimen. But you can see here that the blade has cut the undersurface of the transverse carpal ligament. And I'm going to go back in and kind of see what I've done. And if I see I haven't gotten the full thickness of it, I'm going to go ahead and repeat that through the same incision. Again, no longitudinal structures I can feel. You can also hear it too, cutting that thick ligament and come all the way down here near the incision. I don't go all the way. I stop right about here because I don't want to t the skin. You see the fat dropping down? That means you know that you're through the full thickness. And let's just go right through there. So after you've completed your carpal tunnel release, I go ahead and release the proximal fascia, and I'll just lift up the skin here. I'll just spread above and below the fascia. And then as much as I can see, I'm going to go ahead and incise it just with my scissors. And that's it. The reason I like to do this is because we know that most of the scarring when you do this surgery is going to be at this incision site. So I like to just open up the fascia proximally as well. So a few advantages to the NanoScopic center release system. It has a zero degree scope and it has the A has a 120 degree field of view, as you can see right here. Probably the best thing I like about the system, though, is that there's no heat at all. Therefore, there isn't any fogging. You don't need any Fred. For example. You don't have to deal with any fogging that's going to obscure your vision while you're cutting the ligament. This also comes in an all disposable kit, so much fewer trays or instruments that your scrub tech has to deal with. You can do several of these in a row, and very quickly you can do also this procedure in any setting. You can do it in the operating room, obviously under general anesthesia or Mac anesthesia. But you can also do this under strict local anesthesia. You can use lidocaine with epinephrine to numb up the whole area about 30 minutes prior to the procedure. And that works very well to do this under local anesthesia. And that's it. You can go ahead and close it with a couple of stitches or however closure you like soft dressing and get them moving right away.

The NanoScopic™ release system includes a Centerline™ device and NanoNeedle Scope for endoscopic carpal tunnel release. The NanoNeedle Scope, Centerline device, and a synovial elevator/dilator instrument come in a sterile, single-use kit. The system connects to the NanoScope monitor, eliminating the need for a large tower. The next generation in visualization, the easy-to-use NanoScopic release system can be used in an operating room, office, or procedure room.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

NanoScopic™ Release System for Endoscopic Carpal Tunnel Release

The NanoScope release system is packaged as a fully sterile kit that includes a nano needle, the Centerline device, and a single use dilator and synovial elevator instrument. Make a transverse incision in the proximal wrist crease between the FCU and the palmaris longus tendons. Dissect down through the antebrachial fascia to gain access to the carpal tunnel space, insert the dilator end of the double ended instrument. Advance the dilator hugging the hook of the hamate. Keep inserting until the far edge of the transverse carpal ligament. Remove the dilator and use the synovial scraper portion of the double ended instrument to clear the underside of the transverse carpal ligament. A washboard like effect should be felt as the instrument is moved back and forth. Assemble the NanoScopic release system by inserting the nano needle scope into the Centerline device. Once the nano needle is in contact with the Centerline device, turn the nano needle until it clicks in. This indicates that the scope is fully seated and at the appropriate level for visualization. Insert the NanoScopic release system into the carpal tunnel space. Visualize the transverse carpal ligament to ensure the device is in the correct plane. Advance the device to the end of the transverse carpal ligament. Once the end of the ligament is visualized and a clear path is established, deploy the blade and pull back to transect the ligament. Reinsert the device to confirm complete division of the transverse carpal ligament.

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

Operationsanleitungen

Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

Guias de técnicas cirúrgicas

Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

Guías de técnicas quirúrgicas

Surgical Technique Guides

NanoScopic™ Release System - Endoscopic Carpal Tunnel Release

Mollie Manley, MD (Akron, OH), introduces the NanoScopic™ release system.

Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release System

This is a fully disposable endoscopic carpal tunnel release kit. In this one set, there are three items. There's a Centerline release handpiece, there's the dilator, as well as the elevator, as well as the 180 millimeter nano needle scope. This then plugs into the NanoScope console, and this whole system produces no heat, which means no fogging without having a tower. It decreases your footprint, which means you can be in a much smaller room and even a procedure room. This also decreases the setup time, since there's not multiple trays to open with not having multiple trays to depend on for the surgery. This can be unlimited, so this will not be the rate limiting factor in how many surgeries you can do in a day. So put the device together. You have the Centerline handpiece and the nano needle. So you place the nano needle into the end of the Centerline handpiece and you'll feel it click in. The striations on here would be facing up or north, but you can move this 360 degrees around to have different looks of the camera. And so this is the view with the blade to release the carpal tunnel, as well as the handpiece attached to the nano needle for setup. You have the person prone with their arm extended. If you have a patient with a very large hand, then you can take two blue towels and have them rolled under the wrist, because you want to make sure that you can get their wrist extended. For standard patients, one rolled blue towel is satisfactory. It is important to have the wrist extended so you can get into the carpal tunnel. I first start out by drawing out my landmarks. What you want to find is the piece of form. So I'll make a small dot there. The hook of a hamate. Because you do want to hug that in here. And you can look for their creases. So to make this as cosmetically pleasing as possible, I try to use and find their natural creases. Sometimes the natural creases here, sometimes it's closer to the palm. I always stay in the crease to again make it cosmetically pleasing, but you can do what you would like for this technique. You do want to stay on the hook of the hamate. You can make your incision slightly more radial, but you do need to make sure you hug that hook to watch out for any aberrant branches. So I would draw up my incision. I then take a scalpel and you can make this smaller or larger depending on when you're first starting out. I would make it a little bit bigger and then use dissecting scissors to dissect down to the antebrachial fascia. After making the incision, we then dissect through the soft tissue. I take a regional or a small retractor of some point and place one radially. Then I place one ulnar. The ulnar one is very important because the ulnar neurovascular bundle, it's much more superficial than you think. And you do want to make sure you protect this, especially if you do decide to hug the handmade more with your incision. So then I go down to the brachial fascia. After finding the brachial fascia, which you can slightly see by this white tissue deep in the wound there. I make a u-type flap. And so what that means is that with the striations like this, you could just take one slit and insert the Centerline like that. But I choose to make a flap like this. So that way you can peel this up. And then this protects all the soft tissue from kind of getting in your way when you're doing the release. So then I take my knife and I make my u-type flap. Then I make the cuts on the side. After I have that flap, all of this fat here, that's pooching out. That's kind of in my way. I can kind of pull that back so that I have a nice pathway to the canal. So I take a two pronged skin hook of some sort. And then now I have a great view of the nerve as well as the canal, so we can take our dilator and help dilate up that canal. And you can really kind of push on the hamade. I always like to hold the retractor on the ulnar side, so that I make sure my ulnar vascular bundle is protected, but then I can use my index finger to kind of feel how far I'm going. And then you use the elevator. Once you go up, you kind of put it in and really rock your hand down, and you can actually feel the striations. And what you're doing is getting the synovium off the undersurface. So at this point, I've prepared the canal and I'm ready for the center line. So the center line has this nice synovial elevator as well as this tip. So I want to take that tip, go right under it. And this is a very important step. If you don't kind of go under it and start it more perpendicular to it and then bring your hand down, you can trap tissue and that can be hard to see. So this is kind of the big part of the learning curve. So you really want to take it like almost perpendicular and drop your hand almost parallel to the hand and elevate and go in. So when you first start doing this, a lot of people want to hold this almost like a pencil. And that's really not helpful because if you're holding it like a pencil, then you can't get your hand down because your hand is in the way. After you place this under that fashion, you can kind of feel that. And again, we made this beautiful flap that helps guide us in. You can feel the striations with the end piece. Now that I'm in and I know where I'm at because my index finger here. So I can feel that I'm kind of at the end of the carpal tunnel. You can deploy your knife. And again, with this system, if you felt like it, you can kind of look different ways around if you want to without actually changing where the handpiece is. But we want to look north. So that's what we're going to do. So you can take your handpiece. And I like to pull back and you can cut a little bit. And then I can see okay did I get far enough. And if not you can get a little bit farther and you can easily see the end of it there. And then I continue to continue to release. And you can put some downward pressure on your hand just to make sure it goes all the way through. I always do multiple passes to make sure we got the entire view. And so when I go in another time I'm looking for this edge. So on the screen you can see that edge right there. And I think there's a piece there left. So I would go in and grab that. And you can really kind of lever your hand up to get that last little bit. And then once you push all the way through, I can actually feel the camera almost midway up the palm. And obviously you want to be careful because of the arch, but I definitely see that there's no fascia, I don't feel any fascia. And so you want to make sure it's all released. The other thing I like to do is after I see that that's released, I actually then push the camera kind of in further and rotate so that one of the flaps then are in my field of view, and I can kind of see that that's entirely free on both sides. Once that release is done, what I do from there is I take all my retractors out. I then use my assistant to hold the skin on the proximal portion, and from here I can then release the antebrachial fascia, and so you can easily see this in view. I do not push my scissors. I want to see the entire way, and I can see the fascia and release it at the end of that release. I'm confident that I've released not only the carpal tunnel, but this brachial fascia as well. So from there I rinse this and I close this. I typically use A40 prolene where I'll make a knot on one end. Then I run it and make the second knot. And basically you just snip the one knot and pull it. I have people actually start using their hand the day of surgery. They can lift anything up to a gallon of milk, encourage them to be active. And most people actually, if they have a desk job, go back to work within a day or two.

Sistema de liberação NanoScopic™

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Guias de técnicas cirúrgicas (1)

NanoScopic™ Release System - Endoscopic Carpal Tunnel Release

Animações de técnicas cirúrgicas (1)

NanoScopic™ Release System for Endoscopic Carpal Tunnel Release

Boletins para cirurgiões (1)

Scope This Out Volume 25, Number 01

Catálogos (1)

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Vídeos apresentações de casos (1)

Wide-Awake Endoscopic Carpal Tunnel Release Using the Disposable NanoScopic™ Release System

Vídeos de técnicas cirúrgicas (4)

Wide-Awake Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release Disposable System

Live Surgery: In-Office Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release System

NanoScopic™ Carpal Tunnel Release System

Endoscopic Carpal Tunnel Release Using the NanoScopic™ Release System

Produtos relacionados (4)

AR-8850DS

AR-3200-0030

AR-3502-CRT

ATX-2601