Name: Nano Arthroscopy - Meniscal Debridement
Uploaded: 2020-01-24T00:00:00Z
Channel: Arthrex
Description: Matt Daggett, DO, MBA (Kansas City, MO), describes his protocol for performing an incisionless diagnostic knee procedure and a meniscal debridement using the 1.9 mm NanoScope™ operative arthroscopy system with the 2.0 Nano instrumentation.

<p>Matt Daggett, DO, MBA (Kansas City, MO), describes his protocol for performing an incisionless diagnostic knee procedure and a meniscal debridement using the 1.9 mm NanoScope™ operative arthroscopy system with the 2.0 Nano instrumentation.</p>

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VID1-000501-en-US | A | Nano Arthroscopy - Meniscal Debridement

Matt Daggett

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Nano Arthroscopy - Meniscal Debridement

Hi, my name is Doctor Matt Daggett. Today I'm going to introduce to you the nano arthroscopy kit. Both the diagnostic and therapeutic aspects. So the nano arthroscopy instrumentation allows us to traumatically perform these procedures, not just in a procedure room, but in standard or replacing traditional instrumentation. It provides a much less invasive option for some of these more simple arthroscopic procedures included in the kit. You have a tegaderm adhesive that can be utilized with the cannula to maintain accurate and stable placement of the cannula during the arthroscopic procedure. The spinal needle included in the kit has graduated markers demonstrating the depth for capsular penetration. The included switching stick also allows for atraumatic switching of arthroscopic portals as needed during the procedure. Here we have the 2.4 outflow suction cannula that allows us to remove any debris obtained during the procedure, whether through meniscal shaving, biting, or any other arthroscopic resection. Here we have the two millimeter nano arthroscopy shaver, which allows us to resect tissue in a very efficient manner in a very small size. Through the arthroscopic nano cannula, before the procedure starts, I'll often talk to the patient and ask the patient how much they want to be a part of this process. They can oftentimes visualize the nano arthroscopy tablet at the same time I am. So I'll see how much they feel comfortable seeing actually, the pathology that is in their knee and also being a part of the overall experience. So once the patient is comfortable in the supine position on the exam table, I will draw out the landmarks. And they're slightly different than traditional arthroscopic portals. First we're going to mark the inferior pole of the patella. And then we're going to mark the lateral And medial joint lines. This will give us constant feedback as far as where we're at in our positioning. I found that especially when the patient's awake, it is very important to understand where your surface landmarks are, as that will increase your efficiency during the procedure and improve the patient's comfort. Traditionally, the arthroscopic portals are a little different. We go right above the joint line, slightly one centimeter away from the patella tendon on the lateral side and on the medial side. You want to be just above the joint line as well. This will allow for easier access to the traditionally hard to reach areas within the knee. Here is our lateral arthroscopic portal. This is going to be our standard visualization portal. And here is the standard medial portal, which will be really the working portal for a lot of our arthroscopic procedures as we get to the therapeutic aspects of Pano arthroscopy. We also have other portals at our disposal. Traditionally, a posterior medial portal can be used and utilized during this procedure, as well as a standard superior lateral portal if you need to get better access to the to the Patellofemoral joint. So as I mentioned, the patient experience and comfort is really essential during these procedures. And so we want to make sure we get excellent local anesthesia before the patient starts the procedure. Oftentimes I will give them the following medication protocol. They will receive 400mg of Celebrex one hour before they come in for the procedure, as well as 600mg of neurontin one gram of Tylenol. And I also have them take an one gram of cephalexin orally just one hour before the procedure. So we really want to make sure we get excellent local cutaneous anesthesia. And so the first mixture we're going to use is a mixture of 1% lidocaine with epinephrine and half percent marcaine plane. This combination allows for some short term anesthetic, but it also decreases the amount of bleeding we're going to have at the injection sites, and really starts the process so that the patient gets more comfortable. Nanoscope now offers many options to address this pathology, seen at the time of diagnostic arthroscopy and through the utilization of either gravity pump or an inflow pump, and the other arthroscopic tools were able to really address this pathology in a minimally invasive manner. Now, in the conclusion of our diagnostic arthroscopy, if we identify intra-articular pathology that we believe can be addressed, we now have the equipment to be able to address these in a minimally invasive manner through the Nano Arthroscopy instrumentation kits. In addition, the stopcocks and inflows can accommodate for both a gravity pump and the standard arthroscopic pump system to allow more efficient fluid management options. Next, we're going to establish our working portal. We take the graduated spinal needle and we can insert that and visualize that upon entrance. The graduated lines on the spinal needle allow us to really identify the depth and appropriate cannula selection for the nano arthroscopy portal. As you can see we have these markings of seven, five, four, and three that give us the depth of trocar that we should utilize. And in this situation, we're going to be utilizing a three trocar cannula. Next step we'll remove the stylet insert the switching stick. And then we're going to back out the spinal needle. In some situations it's nice just to use the obturator first. This allows for some dilation of that portal. And then we back it off. And then we'll include the cannula with that. And it slides directly in without us having to make any incisions which I love. Now to prevent cannula fallout we will utilize these adhesive tegaderm which will really allow our cannula to stay in place. The tegaderm is placed over the cannula onto the surrounding skin. And secured. At this point, we'll make a small incision within the tegaderm itself to allow our instruments to work through. It's amazing that the only incision you make with this product is through the tegaderm, not the skin. Next, we're going to insert the Dynel probe as we insert it through the cannula. This will allow us to really better inspect tissue before we move on to addressing the pathology. The nano probe allows for varying degrees of depth of the probe itself, as the button on the outside allows for us to increase or decrease the amount of probe coming from the instrument. So after we've thoroughly probed, we can then insert the nano straight biter as needed, or other nano instrumentation that goes through the cannula and back into the knee. The efficiency of this two millimeter biter is surprising, even though it is quite smaller than standard arthroscopic instrumentation. It's because of its single use nature, very sharp and efficient. In the same amount of time, it would take you to do a partial meniscectomy with standard equipment. You can utilize this nano biter without any significant difference. With the cannula in place, we can now access inside the knee very efficiently as once the cannula is in place, we can change instrumentation without really causing a lot of damage to the knee itself. The two millimeter nano arthroscopy shaver really allows us to access these hard to reach areas a dramatically. The amazing thing about this technology is it really allows us to treat some of these common orthopedic conditions in a very minimally invasive manner. You can utilize two different methods of removing arthroscopic debris, either the arthroscopic shaver or this 2.4mm outflow cannula. This could be attached to either a syringe or suction tubing to remove arthroscopic debris. This is also a good way to drain the knee at the culmination of the procedure. Another instrument is the nano grasper, which allows us to grasp loose bodies or debris for removal. Once again, all going through the same cannula that you set up at the initial part of the procedure. Here we grab a loose body of cartilage debris floating within the knee. Another helpful tip is that we can utilize the cannula that's already in place, and place our inflow cannula with NanoScope within that, without making any other portal sites. And thus we've switched our visualization in a very efficient, patient friendly manner. Now we can use our upright percutaneously as well. This updater can really be beneficial in hard to reach meniscal pathology. The small size of this nanopowder still allows us to get very efficient resection of these hard to reach meniscal tears. A nice feature of this NanoScope medical grade console is the ability to capture video and annotate with VoiceOver real time during the procedure that you can share with the patient thereafter. One of the biggest things about the NanoScope is its ability to really improve and enhance the patient experience and recovery by educating the patient more about what their condition is, and then enhancing their recovery by using mainly local anesthesia and reducing the amount of general anesthesia. The recovery time of these procedures is significantly less than what's traditionally performed with standard arthroscopy. What's amazing is the recovery time is significantly less just in the short period thereafter surgery, because of that minimal general anesthetic that the patient is receiving compared to standard arthroscopic procedures prior to finishing the procedure, I will always aspirate any of the remaining fluid within the joint, and it really helps with the patient's discomfort. After the fluids are removed, we can take down the tegaderm and remove the cannula. What's amazing is after the procedure, we don't have any incisions to close with suture. At the end, we will apply these JumpStart bandages, which will protect the portal sites, but also help reduce the risk of any infection. The patient is then transferred to the recovery room, where their stay is minimal compared to traditional methods. As we have really minimized or eliminated the use of general anesthesia, it allows us to initiate physiotherapy very quickly after surgery and really hasten the patient's recovery process.

Nano Arthroscopy - Meniscal Debridement

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