Fig. 1
Operating room. (a) Lateral view of the surgical table placed in beach chair position; the column is visible at the foot of the table; (b) View from behind; (c) the patient is placed in beach chair position
Scialytic Lamps
The word ‘scialytic’ comes from the Greek words σkιά «shadow» and –lityc «producing lysis». This light source is in fact also known as ‘shadowless lamp’.
The surgeon needs to be able to see the anatomical structures being operated upon perfectly (especially for deep planes), and homogeneous illumination serves this purpose. The most important characteristic in surgical illumination is shadow dispersion, an effect obtained through the intersection of multiple light beams.
Furthermore, the light is filtered in such a way as to only transmit the radiations of the visible spectrum, thereby eliminating the infrared radiation responsible for the thermal effects that may damage tissues. State-of-the-art lamps use LED technology as a light source and do not need any filter.
The scialytic lamp may be installed on the ceiling or the wall of the theatre. The theatre is usually equipped with a main light source and multiple satellites, both of which are attached to mechanical adjustable arms that allow them to be pointed at the surgical field. The characteristics of the scialytic lamp (as recommended by the Illuminating Engineering Society) are:
Light intensity: between 25,000 and 100,000 lux
Colour temperature: between 3,500 and 6,700 K (in order to avoid colour distortion)
Specific Equipment for Shoulder Arthroscopy
Arthroscopic Column
The Shoulder Arthroscopy Instrument Set
Arthroscopic shoulder surgery should be performed in operating rooms specifically equipped for this purpose. Even though surgical procedures are carried out through arthroscopy, in which tissue exposure is extremely limited, the risk of infection should be taken into account.
Equipment Set-Up
After positioning the patient, the equipment needs to be set up. The video and shaver equipment is placed on either a movable video cart or a ceiling-mounted arm, on the anterior side of the table and facing the surgeon. The basic equipment includes: 32″ high-definition video monitor connected to the camera control through a RGB line, camera box, light source, shaver power source, videotape recorder and irrigation pump (Fig. 2). Fluid management and dynamics are essential for the performance of advanced arthroscopic procedures.
Fig. 2
Arthroscopic column assembled
- (a)
Videotape. Optional equipment: DVD video recorder, video printer and Zip drive or CD-ROM recorder for image-capture (Fig. 3). It is used to capture, print and store information and/or pictures in permanent digital format and subsequently used them to enhance operative reports.
Fig. 3
32″ High-definition video monitor
- (b)
Camera. Currently the best cameras are characterized by high-definition technology (HD-vision 1080 pixel), LED lighting (solid state Xenon Bright light source) based on 30,000 h of bulb life, image management based on a video system that streams live to any authorized remote viewer, HD still capture and HD video recording (Fig. 4).
Fig. 4
Optic system with high-definition technology (HD-vision 1080 pixel)
- (c)
Shaver. The arthroscopic shaver system is a software-based tool that provides aggressive tissue resection and rapid bone debridement. This easy-to-use system is ideal for all arthroscopic procedures (Fig. 5). The rotation speed of the blades ranges from 100 to 8000 revolutions per minute. Engagement of the blades occurs automatically when the minimum and maximum speed are adjusted.
Fig. 5
Arthroscopic shaver system. The motor allows a rotation speed of the blades from 100 up to 8000 revolutions per minute
- (d)
Radio Frequency Ablation (Fig. 6). The electrosurgical system is capable of controlling a host of different instruments, including disposable arthroscopic ablation probes, disposable monopolar arthroscopic electrodes, reusable and disposable monopolar open procedure pencils and tips, and reusable bipolar forceps. In addition to its standard cut, coagulation and bipolar modes, the electrosurgical generator is equipped with ten blend modes that can be incrementally adjusted to allow precise tissue ablation or cutting with the right amount of haemostasis. This system was designed with patient safety as its highest priority. As the tissue impedance varies, the power is adjusted to deliver a consistent clinical effect. Overall, this technology allows the electrosurgical generator to cut or ablate tissue more efficiently with lower power levels within safe temperature ranges in either the open or arthroscopic environment.
Fig. 6
The electrosurgical system for radiofrequency ablation
- (e)
Fluid management. The arthroscopy pump is an integrated inflow (40 mmHg) and outflow (100 mmHg) fluid management system that may also be used as a simple inflow-only arthroscopy pump (Fig. 7). It is a safe, reliable, user-friendly system that maintains constant, non-pulsed control of intra-articular rinsing and distension pressure throughout an arthroscopic surgical procedure. It is designed to provide continuous pulse-free flow that reacts immediately to changes in intra-articular pressure, thus ensuring that joint distension is sustained even under high shaver extraction volumes or secondary outflow. The user-defined settings for inflow pressure and outflow rates are adjustable through controls located on the touch panel screen or on the remote control.
Fig. 7
Fluid management system. Arthroscopy pump with integrated inflow and outflow controlRelated posts:
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