(About Arthroscopic Instruments)
Instrument usage: Arthroscopic instruments are used to cut and trim tissue in a joint, such as a hand, hip, knee, shoulder, or any other small joint.1 The instrumentation used in arthroscopic surgery can range in size depending on the joint that it is being introduced into, such as a hip or knee joint would accommodate instruments that are 2.7mm and 3.4mm, while a smaller joint, such as the temporomandibular joint, would accommodate a scope that is 1.8mm to 2.6mm.
Instruments include biters, graspers, retrievers, punches, picks, knives, curettes, hooks/probes, elevators, scissors, and rigid scopes. Cannulas/trocars, reusable and disposable, are used to instill fluid and introduce the scope. Powered shavers are also used to trim bone and cartilage or on more complex cases to excise bone and tissue.
Key differences:
Biters, graspers, retrievers, punches, elevators, and scissors have ringed hand pieces, ratchet or un-ratcheted, and a 4 inch to 8 inch shaft.1 The jaws will be unique to their use and are commonly about 2mm.1 They may be angled and/or turned to the right, left, upward, downward, or straight.
Picks, knives, and curettes have a solid handle and come in different tip sizes and angles.
The arthroscopic probe or hook is a popular instrument that is commonly used at the beginning of the surgical procedure to examine the joint. The probe is blunt and usually 9.5 inches long and 3 mm to 5mm in diameter. It has calibrations on it so that the surgeon can measure while examining the joint.
The rigid arthroscope is commonly 4mm for knee joints but can be 2.7 mm for smaller joints such as wrist or ankle.
The cannulas/trocars have an obturator that can be sharp or blunt. The choice of the sharp or blunt obturator is dependent upon the surgeon’s preference.
Powered shaves have many different disposable tips that are used for multiple purposes and come in different diameters and angles depending upon the joint and its use.
Safety on the sterile field:
It is important to organize the arthroscopic instruments according to their use and unique jaws.
When passing arthroscopic instruments they should be clean of debris and any bone or tissue that is retrieved must be saved for pathology according to the facilities policy.
The arthroscope should be handled with care throughout the surgical procedure and should be examined before use to be certain that the image is clear and the scope is in working order.
Powered instruments must be assembled correctly since they are complex with gears, rotating shafts, and seals.2
The operator of the powered instrument should also be in control of the foot pedal, which will prevent premature activation of the device, and the foot pedal should be moved away when not in use so that it is not inadvertently activated.2
Air-powered instruments should be used at the correct pressure (measured in pounds per square inch or PSI) set by the manufacturer.2
When passing a powered instrument, it is important to have the safety latch engaged so that the instrument does not start spinning if activated accidentally.
Powered equipment tips and knives should be disposed of with other sharp items on the sterile field and disposed of in a sharps container.
Scrub personnel must use proper precautions during the handling or disposing of sharp items, such as the obturator, knife, or pick to prevent injury and/or damage to the instrument.
Instrument names:
Arthroscopic instruments are commonly called by their name such as “biter” or “grasper” and the angle of the instrument, such as “right angle biter” or “upward grasper.”
References:
1. Millennium Surgical (2022) Arthroscopic instruments from Millennium Surgical. Retrieved from https://www.surgicalinstruments.com/arthroscopy-instruments-from-millennium-surgical
2. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.