In this blog post, we will take a look at arthroscopic surgery, a procedure that uses small, precise instruments to look inside joints, and examine whether it can be an effective treatment without incisions.
Frozen shoulder, cruciate ligament injury, and herniated disc. Do you know what these three conditions have in common? First of all, they are all common conditions that we often encounter in our daily lives, and they all cause chronic pain. And one more thing: these three conditions are symptoms that appear in the shoulder joint, knee joint, and spinal joint, respectively. In other words, they are all joint conditions. Joints are the areas that connect bones, and they are composed of numerous ligaments and accessory structures that are intricately intertwined. The human body moves constantly throughout our entire lives. Therefore, various conditions inevitably occur in the joints where bones collide with each other. The most useful tool for examining or operating on diseases inside joints is an endoscope inserted into the space between joints, called an arthroscope. To understand the principle of arthroscopy, it is necessary to first understand the anatomical structure of joints. The human body has more than 200 bones, but the areas where diseases actually occur frequently are the joints where two bones move against each other.
These types of joints are called synovial joints. In such cases, if the bones come into direct contact with each other, they would quickly wear away. To prevent this, the ends of the bones are covered with cartilage, and the space between them is carefully covered with ligaments and other connective tissue. This space is called the joint capsule.
The joint capsule consists of a small cartilage tissue called the meniscus, a strong but flexible fibrous outer membrane, and an inner synovial membrane that produces lubricating fluid. The lubricating fluid produced by the synovial membrane fills the joint capsule, preventing the adjacent bones from coming into direct contact with each other. An arthroscope is an endoscope that is inserted into these joints.
The operating principle of an arthroscope is fundamentally the same as that of a general endoscope. It consists of a tube equipped with a strong light and a small camera that allows the internal space to be projected onto an external projector in real time. Strictly speaking, only the tube with the camera is called an arthroscope, but in the operating room, there are various types of tubes prepared so that the surgeon can work at the same time. These are connected to various tools, such as a cautery device that generates heat and cutting tools, enabling a wide range of operations. The internal volume of the space and the required mobility and precision vary greatly depending on the type of joint, so the detailed specifications, such as the flexibility and length of the tube, are selected and used differently for each surgical situation.
Several preparations are necessary before inserting the arthroscope into the body. First, the patient is anesthetized, and then the incision site is selected considering the direction in which the arthroscope will enter the surgical site. A thick, short portal is installed to connect the inside and outside, which acts as a passageway, similar to installing an elevator shaft in a building. If the tube is inserted directly, the wound may gradually widen, so it is inserted into the space that has been widened in advance. Once the space is opened by installing the portal, it is filled with saline solution to secure sufficient space for the arthroscope to operate.
Once all preparations are complete, the medical staff inserts the arthroscope and begins the surgery. If the joint cavity is cloudy due to excessive fibrous tissue, it is sucked out and cleaned. If it is necessary to incise ligaments or tendons, a cautery or small scissors are used to cut them. Complex procedures such as suturing wounds are also possible. Usually, three or more portals are installed so that sutures can be crossed and knotted. At this point, it is very important to control the pressure of the saline solution. If the pressure is too high, the space will expand excessively and water will flow out of the portals, but if the pressure is too low and falls below blood pressure, bleeding will occur in the blood vessels. After the desired lesion has been removed, the arthroscope is removed and the incision in the skin is sutured to complete the surgery.
The biggest advantage of arthroscopy is that it is not necessary to completely open the surgical site. In the past, the surgical site was incised and completely opened for surgery. However, in the case of knee arthroscopy, the surgery is performed by making two or three 10-20 mm incisions. Because the incisions are so small, the scars left after surgery are much smaller, and the risk of infection and complications is minimized.
The recovery time after surgery is short, so patient satisfaction is very high, and the hospital stay is short, which is also economical. Because of these characteristics, arthroscopy is also called a minimally invasive procedure. Due to its convenience, arthroscopy is widely used in various orthopedic procedures. The purpose of arthroscopy can be broadly divided into diagnosis and surgery.
When arthroscopy is used for diagnosis, it is possible to visually confirm lesions in ligaments, cartilage, and menisci, as well as take photographs and collect samples. In surgical procedures, it is possible to look inside the joint and perform surgery directly, so arthroscopy is used in cases of torn ligaments, meniscus tears, cartilage tears, and surgery on villi and blood vessels inside the joint. The knee joint is the joint where arthroscopy is most commonly used, but it is also frequently used in the shoulder, hip, waist, and spinal joints. Arthroscopic surgery is particularly suitable for athletes and other professions that require quick recovery times due to frequent injuries.
Medicine is advancing at a frightening pace. In particular, with the rapid development of electronic engineering in the 20th century, research on robot-assisted surgery is being conducted in a wide range of fields. Robotic surgery, known as “Da Vinci surgery,” is already being used in clinical practice in fields other than arthroscopy, and it may not be long before arthroscopy is replaced by robotic surgery. However, even such robots will add different features to the many advantages of arthroscopy, and the significance of arthroscopy in achieving maximum results with minimal injury in narrow joints will remain in the history of medicine.
