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Archive Orthopedic Surgery 2020

Advances in Arthroscopic Visualization

Crisp 4K imaging is just one of several key components you should expect from your system.

Shane Nho

Shane Nho, MD, MS

BIO

IN SYNC
Pamela Bevelhymer, RN, BSN, CNOR
IN SYNC The camera head and display monitor must be in 4K. A 1080p camera with a 4K monitor won't get you a true 4K image.

The value of crisp visualization during arthroscopy couldn't be clearer. If surgeons can't optimally observe the joints they're diagnosing and treating, the best possible outcomes may not be realized. Arthroscopy is one of the most commonly performed orthopedic procedures and recent advancements in the visualization systems surgeons use have provided them the most up-to-date technology for the best possible patient care.

We recently re-evaluated our video tower systems and have been pleased with the changes we made.

It starts with the camera

Quality and durability of the camera head are key because they ultimately dictate what is viewed on the screen. In addition to a really good camera, we chose a 4K monitor, which offers four times the resolution and color reproduction of standard HD and more detailed images of small tissues and organs. Here's the most critical factor: Make sure the camera and monitor display are both 4K to ensure the imaging chain produces a near life-like picture of tissue inside the joints. If you pair a 1080p camera with a 4K monitor, you won't get a true 4K image.

There are other exciting innovations in arthroscopic visualization systems that aren't simply about picture quality, but still should factor heavily in your decision.

  • Autoclavable. Many newer camera heads are autoclavable, which can free up OR time. The typical low-temp sterilization process for a camera head is about 45 minutes. However, autoclavable camera heads cut that time to about 15 minutes.
  • Data storage. Visualization systems offer more data storage options than ever. You can load video and images to a CD or upload them directly to a server. Some systems also enable you to upload images and video directly into a patient's electronic health record. Cloud-based data storage is especially beneficial because it allows anyone on the patient care team to upload and access it.
  • Voice control. This is just like talking to "Alexa" on an Amazon Echo. Surgeons must wear headsets to use this feature and, full disclaimer, I haven't used it yet. However, I've talked to other surgeons who've used it in the OR, and they give it high marks. With these features, you can activate commands and record audio during surgeries. I know some surgeons who video record parts of surgeries and audio record descriptions of them. Afterward, they can share the audio and video files with patients.
  • Better fluid pumps. Advancements in infusion pump systems have also improved the standards for arthroscopy. Newer pump systems make the fluid management during surgery more consistent. During arthroscopic procedures, fluid is injected into the joint, but is also removed during use of the shaver handpiece or burr. It's important to regulate fluid to avoid a dry joint. Newer automated pumps sense the change in fluid and increase or decrease the level depending on the most optimal conditions, allowing for a more stable surgical field and improved visualization of the operative space.

The last thing you want a surgeon to say during an arthroscopic procedure is, "Why can't I see anything?"

Bundle and save

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We'll continue to see many visualization breakthroughs that will enhance joint treatment for years to come.

When shopping for a visualization system, it's vital to make sure the individual components communicate with each other. If you purchase one vendor's camera, another vendor's shaver, and yet another vendor's radiofrequency (RF) probe, you could run into compatibility problems. Finding compatible systems, typically from the same vendor, can save you a lot of headaches in the long run.

Second, many vendors sell their arthroscopy systems in bundled packages, just like you'd buy internet and TV from the same cable provider. The vendors bundle the costs of the pump, shavers, burrs, RF system, camera and monitor. Compare the quality of the camera head and display monitor between the vendors. Then, choose the vendor that has the most complete and cost-effective package.

We'll continue to see many visualization breakthroughs that will enhance joint treatment for years to come. As providers of top-level orthopedic care, we owe it to our patients to keep up with these advances. OSM

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