A change in scope: redefining minimally invasive
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EDITORIAL
A change in scope: redefining minimally invasive Tobias Stornebrink1,2,3 · Kaj S. Emanuel1,2,3,4 · Yoshiharu Shimozono5 · Jón Karlsson6 · John G. Kennedy5 · Gino M. M. J. Kerkhoffs1,2,3 Received: 15 December 2019 / Accepted: 3 February 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
The editors of KSSTA recently highlighted the increase in demand for ankle arthroscopy that is expected for the near future [5]. Arthroscopic techniques are increasingly sophisticated and the range of indications for arthroscopy is broadening accordingly. In contrast with these developments, arthroscopic cameras have hardly changed since their first introduction. We still use rod-lens scopes of substantial diameters, making arthroscopy as invasive as it was decades ago: posing risk to neurovascular tissue [3] and cartilage [4] and causing unnecessarily long recovery times. Current innovation in the field of needle arthroscopy might help to better facilitate the pending increase in ankle arthroscopic procedures. In several lab and patient settings, our international collaborative group has been working with a novel needle arthroscopic system (NanoScope™, Arthrex, Naples, FL). With an optic chip at the camera tip and no inner rod-lenses, this semi-rigid scope remains durable at a total diameter of just 1.9-mm, and 2.26 mm including the cannula. Image quality is higher than that of traditional needle arthroscopes, offering a 400 × 400 pixel number with a 120° field of view. * Gino M. M. J. Kerkhoffs [email protected] 1
Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
2
Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
3
Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands
4
Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
5
Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
6
Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
In contrast with previous needle arthroscopes, this new system comes with tailored surgical instruments, which introduces the possibility of operative needle arthroscopy. The safety and efficacy of this technology was systematically tested in a cadaveric setting, and this fundamental research was translated into a broad clinical portfolio. The results of first studies are promising [1, 2]. Cadaveric experience in the ankle is presented in this issue of KSSTA [1]. In general, operative needle arthroscopy offers a minimally invasive technique, with a less than 3-mm skin incision that requires only paper suture closure. This minimal portal footprint reduces local soft-tissue trauma and often obviates the need for any more than a local anaesthetic, b
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