Name: Nano Suction Punch Portfolio
Uploaded: 2023-11-08T00:00:00Z
Channel: Arthrex
Description: Sanj Kakar, MD (Rochester, MN), introduces the 2.8 mm Nano suction punch portfolio.

Imaging and Resection

<p>Sanj Kakar, MD (Rochester, MN), introduces the 2.8 mm Nano suction punch portfolio.</p>

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VID1-004113-en-US | A | Nano Suction Punch Portfolio

Sanj Kakar

Human

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Nano Suction Punch Portfolio

Here we're introducing the new suction punch system. And what's unique about this are two features. Number one, there's a suction regulator switch which will allow you to dial in your suction. And number two is a 360 degree rotation wheel. And what's advantageous about the wheel is that it allows you to fine tune your resection based on the anatomy of the tissue that you're resecting, and you can modulate the position of the cutting window based on this using the rotation wheel. These suction punches come under two lengths. There's a 70 millimeter length and a 130 millimeter length. And when you look at the resection features, there are three types of window. You have the traditional flat tip window. You have the scooped elevator window. And with this feature you'll see that the elevator allows you to get underneath the tissue, raise the tissue to deliver it within the cutting system. And we have the bullet back punch window, which allows you to also resect the tissue based on your needs. So today we're going to be showcasing the Nano arthroscopy two millimeter reusable instrumentation line, as well as the suction punch system doing radiocarpal arthroscopy through the three four and the six portal. So first of all, coming in I feel this is tubercle. Just come distal to Lister's. There's a soft spot right here, and that's where we're going to come in for our three four portal. So we're just through the skin, and then we're just going to spread down and then pop into the joint. So we're spreading moving the extensor tendons out of the way and in we go. We're just open up that portal. We'll do dry arthroscopy. You can do wet arthroscopy if you want. But this is dry arthroscopy. And if we need fluid we'll do the automatic washout technique. So in comes the arthroscopy cannula. Just pop in. You can see we can move it side to side. So we know we're in the joint. And then we'll take the nano grip which just slides on. And this allows us to give us finer control when we're navigating the nano needle scope. Scopes goes in. Clicks in. Sin. And then we just pan back to look at our view. So here we are. We're in the joint. So you can see we've got scaphoid. We have scaphoid facet below us. And we have the extrinsic ligaments. The radius for capitate ligament long radial lunate ligament. If I turn my hand around you can see membranous portion of the scapholunate ligament. Here's the inter sulcus ridge. And then we drop our hand down, come underneath the lunate. And then we are we have the tfcc. So next we're going to make our ZR portal. So feel the ECU tendon. And we're just going to come radial to that and above the tfcc. So there you can see me moving the carpus. The needle just comes straight in. So we're going to make a small transverse incision. You can do vertical portals if you want. It doesn't really matter. And then we're going to spread in trying to come above the tfcc. So now we have the shaver the two millimeter shaver in the ZR portal. And you can see that there's some synovitis Here, and you can see there's a tfcc tear as a complicated tear right here. And so you can take the shaver. The shaver does a good job with the synovitis. But sometimes, especially with the tfcc. Or if, for example, you're in the elbow with a pica. The shavers are sometimes not aggressive enough. So you need a different tool which has got a sharper resection line to it. But you can also modulate and rotate the cutting features of the blade system. So here you are with debriding the synovitis to get a better view. But you can see with a two millimeter shaver. It's doing a good job. Now you can put a, for example, a Torpedo shaver in. But we're going to show you now the nano suction punch system okay. So now we've introduced the 70 millimeter suction pump. And this is a scooped elevator window. And you can see with the scoop what I can do is come underneath the tissue and come in with the scoop. Come under it. And then if you look back here you can see that the that the window is open and so the suction is off. And so what I can simply do with my thumb is close the suction which draws the tissue in. As you can see here and now, it will allow me to deploy the system and debris the tissue. So I'm going to turn the suction off for a minute. But with fluid you can do this. And now you can see as the suction punch is coming in how it debris the tissue. But you can see here there's something in my way. So what I'm going to do now is rotate the window of the device. So here I can rotate this now. And I can actually get that tissue that's in my way right there. You can see it's coming in nicely. And now I can use this sucker and the punch and it's cutting backwards. So this is what's advantageous about the suction punch system is that it allows me to draw this tissue in. Now you can see it's being drawn right in. And now I can deploy the suction and the, the biting aspect and cutting resection tool. And if I'm not happy with this angle I simply rotate the wheel around. And now you can see I've rotated this more towards me. It draws the tissue in. And there I can simply cut away. And this is what will make your tissue resection much more efficient. But in a dry environment, the actual cutting system doesn't generate heat, which is advantageous to prevent any overheating or thermal issues. And so you can see here I can't quite get underneath it. And so now what I'll do is use the elevator. You can see I'm pushing the elevator in. Now I've got the tissue actually within the actual binding jaws. And there it comes in. And then I can turn the suction on to draw it in, use that elevator system to come underneath the tissue. And there I'm deploying the system. And so here you can see there's actual tissue up here. So I'm rotating the wheel to to get it into better view. So there's it away from me. Now I'm rotating this there is. Now I've used the suction to draw it in. You can see it actually draws it in. And now I can cut away. And what's useful for this is that I can do this with one hand motion, as opposed to needing to use a foot pedal or anything like that. So now this is the bullet back punch. Window. Suction punch system. What you could see with the previous system. It had that scooped elevator which gets you under the tissue. So now I've got underneath the tissue and I've developed that plane. And that's the advantage of that system. And now you can use this one here to come in underneath. And you can see I've slid under the tissue. And now I can deploy the actual cutting system. And you can see now I'm getting nice bites of that tissue. But the tissue is now behind me. So typically what would you do. You can alternate your portals, but I don't want to alternate my portals. I want to be more efficient. So now what I'll do is I'll just back this out, I'll rotate this around and now I'll cut backwards on myself. So now this allows me to cut actually the tissue backwards. So now here I can lift up my hand and I can cut backwards and I can get a circumferential cut of that tfcc or for example, a plica or any soft tissue that's in your way. And you can see the tissue actually being caught within the cutting system right here. And now if I want to clear out, I simply turn the suction on and you can see the tissue has actually been withdrawn within the suction system. And there the suction is off. I can bite back. So here you can see the tissue there. I'm rotating the wheel to get a better back bite. Take a bite. There's the tissue within the actual system. Turn the suction on. And there's the tissue actually withdrawn within the suction device itself. No need to take the instrument in and out. It all does it for you. So it allows resection to be much more efficient than before. Here you can see now, coming all the way back, I've lifted up my hand, I've rotated the wheel and I'm cutting the tissue backwards. So what we're going to do now is show you the suction punch system with fluid. So we're going to do this with wet arthroscopy. I've turned the suction on. And now we're going to introduce fluid in. And you'll see that the system just cuts just as well. And what's good about this is that it's actually cuts the tissue at the same time. There. You can see the fluid coming in. It's biting the tissue. You can actually audibly hear it. And I'm going to go backwards on myself. There we are. We're cutting away. And if I actually show you within the you can see how it actually sucks the tissue up. And so the cutting device is actually clear for another there I am rotating the wheel around. And this will allow me to cut backwards on myself. And I can use that elevator to get just underneath that final rim of tissue right there to lift it up off the distal ulna to get underneath it, and then allow me to go in to rotate this to get to that corner and then just deploy the system, getting underneath that tissue. And that's what's nice about this elevator. It allows you to come underneath and bite away. And there you can see the debridement of that tfcc of that central tear.

Nano Suction Punch Portfolio

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