Robotic hip arthroscopy: a cadaveric feasibility study.

OBJECTIVE: The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy. METHODS: Hip arthroscopy was performed on two hip joints of a fresh-frozen male human cadaver. The arthroscopic control of the femoral head and neck and acetabular labrum were evaluated using the da Vinci Surgical System. RESULTS: Docking of the robotic system and manipulation of the instruments were successful. Although most regions reached in standard arthroscopy were also reached with this robotic setting, the 5-mm instrument was limited in movement due to its long articulation section. The 8-mm instrument had shorter articulation section and exhibited a full range of motion inside the joints. The posterior part of the femoral head and the posteroinferior portion of the acetabular labrum could not be observed because of the rigidity of the equipment. CONCLUSION: Robotic hip arthroscopy appears feasible in a cadaveric model but has some significant limitations. With the development of special instrumentations, arthroscopy of the large or small joints may be possible with robotic surgery. Robotic surgery may also enable surgeons to perform more complex and precise tasks in restricted spaces.

[Recommendations of the AGA (German-speaking Arthroscopy Association) on equipment of facilities, process quality and qualification of surgeons for arthroscopic interventions]. / Empfehlungen der AGA (Sektion der DGOU) zur Ausstattung der Einrichtung, Prozessqualität und Qualifikation des Operateurs bei arthroskopischen Eingriffen.

Following closely the guidelines of the German Federal Medical Association for quality assurance of outpatient surgery, the AGA (German-speaking Arthroscopy Association) has formulated recommendations on quality standards in arthroscopic surgery. The surgical facility should implement a quality management system. Minimum standards of construction, apparatus, technical and hygiene facilities are included according to the directive of the German Federal Medical Association for quality assurance in outpatient surgery. General organizational requirements and process quality are described. These include the pre-operative diagnosis and therapy, outpatient surgery and anesthesia, the treatment after surgery and the assessment of the quality of the result. Requirements for the qualification of surgeons for authorization to independently execute arthroscopic services and training are formulated. The AGA recommends that in addition to the specialist status for authorization to independently execute arthroscopic services, the qualification "AGA arthroscopist" and for training of other doctors in the field of arthroscopic surgery, the qualification "AGA instructor" should be required.

Effect of joint motion on safety of portals in posterior ankle arthroscopy.

PURPOSE: The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined. METHODS: This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels. RESULTS: The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant. CONCLUSIONS: We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications. CLINICAL RELEVANCE: These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.

All arthroscopic rotator cuff repairs.

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages of glenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of this method, which limits its application to surgeons skilled in both open and arthroscopic shoulder operations. This article contains many technical pearls to, as much as possible, simplify and improve all arthroscopic cuff repair.