Fluid delivery systems for arthroscopy

In any type of surgery, is critical for success. In arthroscopy, good exposure translates into obtaining and maintaining visualization throughout procedure. Good visualization, in turn, requires a properly functioning optical system (lens, scope, and camera/video equipment) and adequate joint distention by a system that delivers and maintains an optically clear medium into joint. Proper distention of joint by a clear medium facilitates accurate diagnosis as well as safe and efficient manipulation of arthroscope and surgical instrumentation. Lack of adequate joint dis tent ion is probably most common avoidable cause of poor visualization in arthroscopy (1). Since synovial fluid is a poor optical medium, with no potential for surgeon to control its volume in joint, it is replaced, for arthroscopy, with either gas (2,3,4) or fluid (5,6,7). At present time, joint distention is most commonly accomplished by pressurizing joint with a liquid medium such as saline or Ringer's lactate (8). With rapid growth of arthroscopy over past 15 years, two basic types of fluid delivery systems have evolved: (a) a gravity-feed sometimes called the drip method, where a fluid bag (usually 3 L) is elevated 4 -5 ft above joint from an i.v. pole, and (b) an automated mechanical pumping system. The purpose of this article is to review setup and use of these systems, as well as inherent advantages and disadvantages of each.