Chapter 1 Materials and Set-up

10.1055/b-0035-121111

Chapter 1 Materials and Set-up

Introduction

Arthroscopic exploration of the wrist has been practiced for decades, but arthroscopic surgery has been developed relatively recently. The wrist is particularly mobile, with very little space between its constituent radiocarpal, midcarpal, and distal radioulnar joints. A good set-up maintains joint position and produces axial traction to create sufficient space between the joints through which to pass instruments.

Materials

Arthroscopy Column

The arthroscopy column is the same for all transmitted surgery and includes a monitor, a video camera, and a light source. A compact camera head is the most adapted to the small camera used. Xenon or LED lamps are replacing halogen lamps because they last longer and provide better quality lighting. Additionally, image or video recording devices are available for record keeping, publication, or teaching purposes. Such progress in lighting sources and recording technology allows the integration of a video camera, a light source, and video exporting into the same compact box.

A printer is no longer necessary, but printing is still a simple, immediate method for providing an intraoperative report to show the patient and to file in the patient’s record.

Arthroscope

A small arthroscope (1.9–2.7 mm) is usually used for the wrist, with a camera angled at 30° ( Fig. 1.1 ). It must be short (60–80 mm) to adapt to the size of the wrist and the depth of the surgery zone and to avoid obstruction of instruments outside the wrist. The sheath includes a connector for irrigation, and the trocar must be blunt to avoid cartilaginous lesions.

Instruments

The instruments are also designed for precision and to limit the magnitude of external movements ( Fig. 1.2 ). The probe is the basic instrument for joint exploration. Fine instruments such as graspers and resection forceps are used. Angulated instruments can provide access to certain structures that would otherwise be inaccessible through the small joint intervals.

**Fig. 1.1** Arthroscope with camera angled at 30°, size 1.9 mm and 2.4 mm in diameter.

**Fig. 1.2** Basic instruments: probe, basket grasper, and mini motor with shaver and bur.

**Fig. 1.3** Set-up with vertical traction using a stand, allowing the entire forearm to be free in the surgical field.

A motor is fitted with abrasive instruments, such as shavers or burs, of appropriate sizes (2–3 mm in diameter and 6–8 cm long). Basic instruments include a knife for synovial resection (aggressive cutter) and a bur (usually 3 mm) for bony resection.

An electric bipolar diathermy machine is used for efficient tissue resection by vaporization and requires an irrigation system for joint cleaning.

A cannulated wide-bore needle is used for passage of sutures and mini anchors are used for ligament repair. Specific instrument kits are available for more complex procedures such as triangular fibrocartilage complex (TFCC) reinsertion.

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