Setup, Distraction, and Instrumentation

Abstract

Ankle arthroscopy, as for most arthroscopy, requires a large operating room essentially dedicated to arthroscopy. The room requires special attention to electrical control with appropriate grounding. All electric cables must have adequate shielding to prevent macroor microshocks. The operating room must be large enough to accommodate all arthroscopy equipment and operating room personnel. Ankle arthroscopy requires a significant amount of equipment, including the operating table and distraction device, arthroscopy cart, first and second instrument tables, suction and pump systems, and instrument storage cart. Occasionally, fluoroscopy is needed; therefore the room must be large enough to accommodate this additional equipment and personnel. Operating room personnel must be able to move around the room freely and maintain appropriate sterile and unsterile areas. The anesthesiologist must have the necessary equipment for general, regional, or local anesthesia. The arthroscopy cart should be mobile such that it can be moved about the room and contain the video camera, video monitor, motorized shaver, light source, and video recorder or printer. The instrument cart should be equipped with a full supply of motorized tools, extra sterile light cords, an extra camera and arthroscope, and backup instruments in case of malfunction or contamination. It is ideal if the circulating nurse, scrub nurse, and assistant are specialized in arthroscopic surgery. They must be familiar with all arthroscopic equipment and be able to troubleshoot any problems. It is extremely important that the scrub nurse be familiar with the goals of the procedure so he or she is able to anticipate the needs of the surgeon. Performing ankle arthroscopy often requires several coordinated steps with both hands; therefore the surgeon cannot be distracted by having to show the scrub nurse what instruments are needed next. A new scrub nurse should be supervised by a nurse or operating room (OR) technician who is experienced in ankle arthroscopy until the new scrub nurse has sufficient experience. All personnel, including the surgeon, must have a thorough knowledge of how the camera, monitor, recorder/printer, and distension fluid system functions. They must also be able to clean, inspect, and appropriately care for all instruments. The Mayo stand contains sharp instruments and the most commonly used diagnostic instruments, such as trocars, cannulas, and probes. The back table contains the therapeutic instruments, such as graspers, baskets, and curettes.