Performance of arthroscopic irrigation systems assessed with automatic blood detection

Abstract

Purpose: During arthroscopies, bleeding episodes occur as a result of tissue damage. Irrigation systems assist in minimizing these disturbances. The performance of three arthroscopic irrigation systems in clearing bleeding episodes was evaluated objectively.

Methods: One surgeon performed 99 shoulder arthroscopies using three irrigation systems: gravity infusion, single roller, and double roller pump. The three irrigation systems groups were matched postoperatively for type of surgery-acromioplasty, SLAP, release, rotator cuff repair and capsule repair, and operation duration. The recorded arthroscopies were analyzed for the presence of bleeding episodes with a special computer program that automatically detects the tinctures of red-colored blood. A least 20% of an arthroscopic image had to be covered with blood to qualify as bleeding episode.

Results: The median (min-max) presence of bleeding episodes as a percentage of the operation time was 6.6% (0.0-43.6%) for gravity infusion, 3.7% (0.2-46.4%) for the single roller, and 3.3% (0.0-19.3%) for the double roller pump, respectively. The large variation could be attributed to the occurrence of arterial bleeding episodes during some procedures. No significant differences were found between the irrigation systems. For a subgroup including acromioplasties and releases, significant differences were found in favor of both roller pumps (P < 0.05).

Conclusions: Overall, the roller pumps did not outperform gravity infusion. However, from the results, high-risk procedures for bleeding episodes were identified (acromioplasty and release of a frozen shoulder) that can benefit from the use of roller pumps. A clear view is essential to perform an arthroscopic procedure safely and efficiently.

Figures

Fig. 1

Three arthroscopic irrigation systems were assessed for their performance with automated blood detection: a gravity infusion, b single roller pump, and c double roller pump. For the gravity infusion, two bags were routinely hung on a pole at a standard height, but only one was used at the same time

Fig. 2

Result of automated detection of bleeding episodes of one arthroscopic frozen shoulder release operation. The percentage of red-colored arthroscopic image area per video frame is automatically detected and plotted against time (gray line). The threshold level of 20% is indicated by the striped horizontal line. All frames that demonstrate more than 20% red image area coverage are included to determine the presence of bleeding episodes. One bleeding episode is indicated by the vertical black lines

Fig. 3

Boxplot is shown of the bleeding episode time as percentage of the operation time. The results are shown for the subgroups removal procedures consisting of 18 matched operations and reconstruction procedures consisting of 12 matched operations (Tables 1, 2)