Name: How the NanoScope™ System Impacts Sports Medicine Innovation
Uploaded: 2019-07-01T00:00:00Z
Channel: Arthrex
Description: Paul C. Brady, MD (Knoxville, TN), demonstrates a shoulder technique using the NanoScope™ arthroscopy system. The NanoScope imaging system allows physicians to perform a diagnostic arthroscopy using a disposable camera that connects to a high-definition portable tablet.

<p>Paul C. Brady, MD (Knoxville, TN), demonstrates a shoulder technique using the NanoScope™ arthroscopy system. The NanoScope imaging system allows physicians to perform a diagnostic arthroscopy using a disposable camera that connects to a high-definition portable tablet.</p>

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VID1-000022-en-US | E | How the NanoScope™ System Impacts Sports Medicine Innovation

Paul C. Brady

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How the NanoScope™ System Impacts Sports Medicine Innovation

Hey, I'm Doctor Paul Brady, and I just wanted to show you the latest technology on nano arthroscopy. So this is the kit with the arthroscopic camera, the NanoScope. So inside the kit, you have the camera itself, which connects to your console. It has two cannulas with obturators. And then it's got some stopcocks that you'll attach to the cannulas if necessary to insufflate with fluid. Some of the instruments that we have available for nano arthroscopy is a probe with a retractable tip that you can use to probe tissue. We have a up biter little micro biter here for limited debridement of labral tissue or meniscal tissue. We have the the same biter device in a straight pattern. It's two millimeters in size. And then we have some arthroscopic. Scissors. Some straight scissors. Again they're serrated on the top to. Allow it to grab the tissue. These are very good for simple. Procedures such as a biceps tenotomy procedure. You can do a nano arthroscopy. And then do a biceps tenotomy with these scissors. We have a grasper two millimeter. Grasper again with teeth on top and the bottom. And that's good for removing loose bodies within the intra-articular space or grabbing tissue. Then we have a 17 gauge spinal needle. This is from the percutaneous. Insertion kit. It's got the inner cannulation which we can remove. And then through the spinal needle we can insert a guidewire over top of the guidewire. We can insert our nano Pano cannula comes in three different sizes three millimeter, five millimeter, seven millimeter. And this will allow you to utilize these instruments, such as the beiter or a grasper through the cannula and then work through the cannula. The cannula comes. It has a Mercedes dam there which allows for minimal fluid extravasation. So let's go to the shoulder and how I would use nano arthroscopy in my practice. You know, the nice thing about this possibility is you can have the patient walk into your procedure room at your clinic or at your surgery center and have them sit in a chair. You could do some some prep and then I'll just I'll do some local sedation right in where I would normally do a posterior portal. I'll do a little wheel here. I'd do another one laterally. Little wheel there. I'd do another one anteriorly. Really. And then I would probably at that point I would kind of mark where I did my local sedation. And that'll remind me the areas that are currently numb. All right. So if I want to do other portals that's fine. I can do other angles to the shoulder, but I want to numb those areas up before I introduce that. And once I had the skin numb, I would start with my 18 gauge spinal needle and I would insert it into the joint. And I can kind of move around and feel that I'm in the joint. And then once I felt like I was in the joint, I would take my lidocaine and I would inject the joint. And if it goes in freely, easily, then you're probably in the joint. Okay. So once once I let that sit for a few minutes, I would take an 11 blade knife and I'd just make a small little nick on the skin. Very, very small. Not an arthroscopy. Portal size. Literally about. I went about halfway down on my 11 blade. It's really just a nick in the skin. And then I'm going to take my cannula with the trocar. And I'm going to introduce this into the joint. So even without fluid in there I can see pretty well I can take the patient, I can move them up like this. I can look at his rotator cuff. If we did a rotator cuff repair, I could pretty quickly assess the integrity of that rotator cuff. But so this patient, I would immediately say, look, hey, we've got a pretty substantial rotator cuff tear here. We need to we need to have a talk about that. I can look down the joint. I can look at the humeral and glenoid surfaces. And you can see here that that even though this is only 1.9mm diameter, which is about a third of a normal arthroscopic camera system, you can still see pretty much everywhere. And once again, even though it's it's a zero degree camera, it's got a nice field of view here. We can see that articular cartilage defect on this patient's humeral head. We can take the patient through a gentle range of motion. External rotation. We can do a dynamic assessment. You know with the superior labrum and athletes we're always worried about type two slap tears in a throwing athlete, and sometimes they're hidden. But you could have the patient either on command or you could take their arm, put them in an abduction external rotation position, and you could see if you get a peel back sign that suggests a type two slap tear with posterior extension, you could look at internal impingement again with abduction external rotation. You can do all these dynamic tests that you can't do with MRI or with even MRI. So okay, so that's about as much as we can do with air. Let's go ahead and insufflate the joint with some saline. I can see kind of the very upper edge of the subscapularis, but I really can't see the subscapularis insertion. I can see we have a lot of fraying of the biceps here. So I know I'm going to probably do a biceps tenotomy. So let's go ahead and use the 17 gauge needle. So that's going to be a pretty good. I want to make sure I can. That's going to be a good angle to see my upper subscapularis. That's going to be a pretty good angle I think, to cut the biceps if I need to. So let's take the inner part out of there and insert a nitinol. And again, I'll make a little nick. Just. Just barely touch right on the edge of this. There we go. So now we've got our second camera cannula in a more anterior portal location. I can use that to to probe the biceps, to look underneath the biceps, to look down on my sub scalp. But I can't see again. I can't see my sub scalp very well. Okay. So let's let's switch our camera because. So now we have a nano cannula in a more anterior location. Through this cannula we could use the probe. We'll put a probe in there. And again once the probe is in there we can we can put that camera there I can look underneath there. That's definitely a significant labral superior posterior superior labral tear. I could I could probe the articular surfaces, make sure there's no loose cartilage. So I want to get that bubble out. So I'm going to put a 18 gauge needle again through my numb area over my lateral portal. And I'll just use the the 18 gauge to suck out those bubbles. Okay. So that there we have a better perspective. Now I can use that probe to to palpate the biceps tendon to lift up the biceps tendon, I can pull the probe back and just use the probe sheath to lift up that biceps, to look under the biceps. Look at my anterior cuff attachment. Let me put the camera in my anterior portal here. So there I'm looking down on it. Now here you can see my posterior. That's where my camera was back there okay. But now I'm looking down on everything again. The patient's awake so the patient can move his arm for me or her arm for me. I can abduct a little bit, rotate, give some distraction. I can see all the way down to the inferior glenoid. There's our subscapularis attachment. That's the middle glenohumeral ligament there. That's the glenoid. That's the middle glenohumeral ligament. And there we're looking right down on our subscapularis attachment site. We have little fraying of our upper subscapularis. If we get if we get lost in this portal, then we can always just go back to our posterior portal for this debridement procedure or biceps tenotomy, we can use these two millimeter straight scissors through our nano cannula. So now we can see that biceps. And we can just start anteriorly work our way posteriorly. And I just I don't I don't close the scissors all the way. I just do little small partial bites. Good. So there we've done a biceps tenotomy. I think on a live patient with an active biceps that'll pull down into the groove a little bit. So, subacromial, I'd probably do the same thing where I would. I would have this numb area of skin here. I'd put an 18 gauge. I would put that into the into the subacromial space to make sure seem to be in the subacromial space. Let's inject that. So I'm just going to fill the subacromial space here, and then I'm going to make a small neck again so we can see a little bit of the subacromial space from the bursal perspective. Let's abduct the arm a little bit, see how far laterally we can look. So you can see here with, with the nanotechnology. It does give us some options as far as being able to do this from both a diagnostic as well as a limited therapeutic standpoint in a surgical procedure room or an in-office procedure room, we can really offer the patients unprecedented diagnostic capabilities, as well as some minimal therapeutic capabilities in that setting.

How the NanoScope™ System Impacts Sports Medicine Innovation

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