What's New in Arthroscopic Visualization

Orthopedics

By: Dan O'Connor

Published: 8/1/2019

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Give your surgeons a crystal clear view of what's happening, when it's happening.


As the arthroscope knocks around the dark and fluid-filled field of the orthopedic surgeon's cramped quarters, impossibly crisp and colorful video streams live on the sleek monitor. With not a weak link along the 4K UHD optical chain, the camera head, the camera control unit and the monitor work in unison to create ultra-high-definition images that are 4 times the resolution and 4 times the color reproduction of standard HD. Good visualization is critical for successful arthroscopic surgeries, where it all comes down to how well your physicians can see in the joint so they know when to tamp something down and when to trim something out.

As Joleen Harrison, BSN, RN, CASC, the administrative director at the 4-OR Mankato (Minn.) Surgery Center, says, "Surgeons want to see an absolute clear picture." Manufacturers have responded with advanced visualization systems that offer your surgeons unparalleled image resolution and color reproduction. Here are some features to look for when picking a picture-perfect arthroscopy video platform.

1. Autoclavable. Many of today's camera heads are fully autoclavable, a sterilization benefit not lost on John Kelly, MD, an orthopedic surgeon at the University of Pennsylvania in Philadelphia, Pa. He remembers not so long ago when "we used to have to bag our cameras because they were not autoclavable."

VISUALIZE SUCCESS Your monitors, camera system and camera heads must all be 4K for your arthroscopic surgeons to get the clearest image possible.   |  Pamela Bevelhymer, RN, BSN, CNOR

2. Tablet control. Some visualization systems let you control the tower from the nurse documentation station, which means you no longer have to interact with the equipment on the tower at the sterile field. You can also create independent surgeon profiles for their desired settings on the tablet, recording such preferences as camera head settings, image storage (directly into the EMR or archive to the server) and image appearance (how bright, how vibrant, how red the reds are). For a knee arthroscopy, you want the knee to look white so you'd focus less on vibrant color and more on minimizing bright spots. For a shoulder scope, you'd set the brightness higher because you're working in a larger cavity.

3. Voice command. Some platforms let you talk to the tower much like you'd ask Alexa: Picture. Record. Shaver. Oscillate. "I do a lot of teaching," says Dr. Kelly, "so it's great to be able to record videos with a simple voice command."

4. Video integration. You can capture and manage video and images at the touch of a button. Surgeons can annotate the images and videos so they can show the family the procedure on a tablet.

5. Automated fluid pumps. Arthroscopic visualization depends on a steady inflow and outflow of irrigation into the joint space. Automatic pumps provide and maintain a constant positive pressure by sensing pressure changes throughout a case — such as when a burr is activated or if the surgeon begins using the shaver handpiece — and adjusting the fluid flow accordingly for optimal suction and clarity.

"Pumps today give you instantaneous feedback and have on-demand capabilities so you don't get those lulls in pressure," says Dr. Kelly.

6. True 4K. Besides giving surgeons more life-like representations of tissue and anatomy, true 4K from scope to monitor lets surgeons work with clearer, crisper images and magnify images without losing definition. "The clarity and resolution of the pictures is about 5 times greater than it was before," says Dr. Kelly.

We stress true 4K because pairing a 1080p camera with a 4K monitor will not produce 4K images. At Mankato Surgery Center, the 4-year-old scopes are still working well, but they're not 4K — even though the box light cord and monitors are 4K. "So it's not truly 4K because of our scope and camera differences," says Ms. Harrison. "All the components influence the image our doctors see on the screen."

7. Arthroscopic electrocautery. Surgeons can better ablate or cauterize tissue intraoperatively and reduce bleeding that can impair their view. The latest innovations are also safer, because they can operate more efficiently at lower power settings, and are more ergonomic for easier use through small cannulas.

8. Clear access cannula. Don't overlook the cannula as an object that can obstruct surgeons' vision. Transparent cannula bodies let surgeons clearly visualize sutures and surgical knots. OSM

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