Introduction

This chapter explains how to hook up LASE. Five connections are necessary:

• Image - to display the endoscope's image on a TV monitor

• Illumination - provide light for the endoscope

• Laser - connect the kit's laser fiber to the laser

• Irrigation - provide for cooling irrigant inflow

• Aspiration - removes irrigant and ablated nucleus pulpous from patient.

The "Endoscope Coupler"

The "endoscope coupler" connects the endoscope to the camera. The connection of the image fiber is simple: Align the pins on the coupler with the sockets on the LASE “Image connector”, push, and twist clockwise.

Make sure the cap on the coupler is dry. Unscrew the cap if the coupler was washed or sterilized by a method that involves a fluid, and

• Dry the cap thoroughly, including the thread
• Dry the window
• Screw the “cap” back on tightly

(A hint to drying the inside of the silver "cap" is to hook it up to the suction. The water will be drawn out and air-dried.) Sterilizing the endoscope coupler is discussed in Chapter 7.

Types of Video Cameras

All endoscopes require some sort of image coupling system to attach to cameras commonly used in operating rooms. There are three common configurations of camera heads: The C-mount, the B-mount and the V-mount. The Clarus optical coupling system can easily accommodate all three configurations.

There are three common camera types:

C-Mount Cameras

The C-mount configuration is best. It has only one focus ring. The endoscope coupler is directly screwed to the camera body. Screw it in snugly.

V-Mount Cameras

The V-mount optics offers the benefits of the C-mount configuration. The V-mount thread is smaller than the C-mount thread, so a V to C adapter is needed. Screw everything in snugly.

Focusing C and V-Mount Cameras

To prevent the camera from unscrewing from the coupler body hold the part of the coupler where "CLARUS" is printed with one hand, and turn the focus knob with the other hand, so that:

 

• The picture gets smaller

• The edge of the picture is razor sharp

• With good video systems, you will be able to see the pixels (individual fibers) of the endoscope when the focus is perfect

B-Mount Cameras

The B-mount is common. It is more cumbersome than the other methods. The B-mount requires an eyepiece to allow the endoscope coupler to connect with the video camera.

Focusing B-Mount Cameras

The B-mount optic has two focus rings.

1. On the endoscope coupler- acts as a fine focus.

2. On the video camera - acts as a zoom lens.

Proper focus of the B-mount is easy:

• First, turn the camera knob so that the image is as small as possible

• Then using the same methods as for the C and V-mounts, use the endoscope coupler knob for final focus.

Image Orientation

In order to effectively use the LASE endoscope, many doctors orient the image so that the laser fiber appears at the three o'clock position on the television monitor. In this case, if the endoscopies is held with the deflection knob up, "up" on the television monitor corresponds to "up" in the procedure room.

Image orientation is achieved by turning the blue cuff at the connection of the image fiber to the coupler so the image on the video monitor has the laser fiber at the 3 o'clock position

Illumination

In order to get an image, the field must be adequately illuminated. The fiberoptic light cable connected to a light source provides this illumination.

In order to use a Clarus endoscope, a Clarus-brand light cable must be used. The Clarus light cable matches the amount of light required by the endoscope to the amount of light delivered from the light source. This eliminates excess heat from being delivered to the endoscope from the light source, which can damage the endoscope’s proximal end.

The Clarus light cable is provided in four configurations. The four light cables adapt to the types of light sources commonly utilized by hospitals. The proximal configurations of the light cables are:

• ACMI
• Olympus
• Storz
• Wolf/Dyonics

and these four styles can be used with many other brands of light source.

The connections are easy:

The Laser Connection

The laser fiber connection is easy to make. Pass the proximal end of the laser fiber off the sterile field. There is a protective cap on the laser fiber. Remove it. Screw the laser fiber connector into the laser.

LASE uses a "Holmium YAG" laser, also written "Ho:YAG". This laser is commonly used for fragmenting urethral and bladder calculi, and is sometimes used in shoulder and knee surgery. Its light is strongly absorbed by water, the principle component of the nucleus pulposus.

LASE is most commonly performed with lasers manufactured by Coherent or Trimedyne. For Coherent lasers (or for other lasers having a "905 SMA" connector), use the 1100-002 LASE model; for Trimedyne lasers order model 1100-010.

Clarus can supply you with training material about the various lasers that have been used for laser discectomy. Contact Clarus or your sales representative for more information.

Irrigation

The Clarus 5169 Endoscopy Pump is specially designed for use with the Clarus LASE device. Constant irrigation is critical to the proper functioning of the LASE endoscope. The Clarus Endoscopy Pump is a high pressure, low volume irrigation source. Details are found in Chapter 6.

1. Endoscopy pump lever 2. Irrigation tubing set 3. Lock down tab	Endoscopy pump

1. Securely attach the power cord to the pump and plug the power cord into a wall socket or extension cord.

2. Verify that the power switch, located on the backside of the pump, is in the "on" position.

3. Open the pump head using the lever on top of the pump head.

4. Place the tubing set into the pump head.

5. Note the arrow on the face of the pump head that indicates the direction of flow. Verify the tubing set is placed into the pump head such that fluid flows from the saline bag towards the LASE endoscope.

6. Lower the tubing guides, or black plastic "forks", located on each side of the pump head by pushing the lock-down tabs in and down.

7. Close the pump head on the tubing set using the lever on top of the pump head. Verify that the tubing guides are “trapping” the tubing set.

8. Attach the Luer -lock end of the tubing set to the LASE endoscope and pierce the saline bag with the other end.

9. Activate the fluid pump by using the flow start/stop button located on the face of the fluid pump. The physician also has the option of using the footswitch instead of the flow Start/Stop button. The footswitch attaches to a receptacle on the backside of the fluid pump.

10. Using the flow rate adjustment knob on the face of the fluid pump, adjust the flow rate of irrigation to approximately 30 ml/minute as indicated on the LCD flow rate indicator.

11. Remove air from the tubing set by depressing and holding the prime button located on the face of the fluid pump.

12. Be sure there is an adequate flow of saline from the tip of the LASE endoscope before the LASE device is inserted into the working channel.

Aspiration

Wall suction is used to remove the irrigating fluid from a port on the kit's working channel. Turn the aspiration to maximum.