[Development and Testing of a Miniaturised Arthroscope for Use in Outpatient Wrist Arthroscopy]

Wrist arthroscopy is an established procedure for the diagnosis and treatment of wrist pathologies. It is routinely performed in the operating room under wrist distraction. An arthroscope with the smallest possible diameter could enable diagnostic "in-office" arthroscopy in outpatient clinics without a need for distraction on a horizontally positioned hand. Our goal was to develop such an arthroscope in collaboration with Polydiagnost GmbH (P) and to test and compare it with existing arthroscopy systems from Karl Storz SE & Co. KG (KS) and Arthrex GmbH (A).The prototype of a newly developed miniature arthroscope with an overall diameter of 1.3 mm was tested on twelve fresh-frozen wrist specimens by an experienced hand surgeon in a randomised manner. It was compared with the A "Nanoneedle Scope", which has a 2.4 mm arthroscope shaft, and a KS arthroscopy system with a 2.5 mm shaft. Standardised diagnostic tours were performed and recorded. The systems were evaluated and compared based on the following parameters: preparation of working portals, duration of arthroscopy, handling and manoeuvrability, diagnostic assessment of structures, and suitability for diagnostic and therapeutic arthroscopy.The results showed that the newly developed prototype was rated significantly higher than the KS system in terms of handling, ergonomics, operability, and navigability. No significant differences were observed in the duration of portal preparation or diagnostic view. The image quality of the prototype, and thus its suitability for diagnostic and therapeutic arthroscopy, was still found to be inferior compared to the arthroscopy systems from KS and A.The feasibility of distraction-free arthroscopy using a miniaturised arthroscope with satisfactory imaging results was successfully demonstrated. The newly developed prototype showed superior handling compared with established systems but was still inferior in image quality. With improvements in image quality, the prototype could eventually be adopted for clinical use. A reduction in procedure time through portal preparation could not be conclusively demonstrated. The use of smaller arthroscopy systems could potentially shorten the duration of arthroscopy and minimise side-effects.