title: Performance of arthroscopic irrigation systems assessed with automatic blood detection.
abstract: OBJECTIVE
  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.
authors.affiliation: Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. g.j.tuijthof@amc.uva.nl
authors.forename: G J M
authors.initials: GJ
authors.lastname: Tuijthof
authors.forename: M M
authors.initials: MM
authors.lastname: de Vaal
authors.forename: I N
authors.initials: IN
authors.lastname: Sierevelt
authors.forename: L
authors.initials: L
authors.lastname: Blankevoort
authors.forename: M P J
authors.initials: MP
authors.lastname: van der List
mesh_terms: D020679:Arthroscopes; D001182:Arthroscopy / Q000379:methods*; D004867:Equipment Design; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D012785:Shoulder Joint / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D014741:Video Recording