Page 60 - Clinical Manual of Small Animal Endosurgery

48 Clinical Manual of Small Animal Endosurgery

Tower

Anaesthetist

Patient
Anaesthesia
machine

Assistant

Surgeon Instruments

Fig. 2.18 Theatre organisation for arthroscopy. The surgeon, the patient
and the arthroscopy tower are all aligned, with the surgeon looking directly
beyond the patient at the monitor on the arthroscopy tower.

maintain the camera orientated correctly so that excursions inside the
joint capsule correlate with the image viewed on the monitor. For this
reason the camera is held in a fixed orientation (normally with the
camera cable pointing towards the surgeon’s midriff). To make use of
the increased field of view facilitated by the 30° viewing angle, the scope
is rotated on its axis by moving the light post and cable. A fully func-
tional surgical operating table should be used to allow tilting and
elevation/lowering of the table to facilitate easy access to all surfaces of
the joint under investigation. Patient tilting is especially important for
stifle arthroscopy, when positioning the dog in a reclined dorsal recum-
bency facilitates the most convenient arthroscopic examination. Position-
ing aids such as sandbags, vacuum beanbags and ties are necessary to
position the patient prior to draping and to act as a fulcrum or to assist
distracting a joint to improve arthroscopic access.
Prior to performing any preparatory procedure the light post is con-
nected to the arthroscope sleeve and the light source is activated, the
scope is inserted into the cannula and the camera head is fixed to the
scope eyepiece. Focus is adjusted by directing the tip of the scope close
up to a sterile surgical swab, brightness is adjusted at the light source
and white balance is performed and confirmed while the swab is viewed.
Once the equipment is set up and the image quality is satisfactory, the
arthroscopic procedure can progress. Generally, the arthroscopic proce-
dure proceeds with three preliminary steps, as described below.