Greetings and welcome to the first of many postings in the mini series, Lighthouse InSight in which I’ll share details and insights to various topics related to the use of medical optics and visualization. I hope you find them as interesting and informative as I do!

Last week I had the pleasure to attend the 2019 Annual Meeting of the ASSH (American Society for Surgery of the Hand). Despite the scorching heat in Las Vegas (110˚F!), it was a really cool event. This annual meeting offers dozens of courses, meetings, and lectures from leading surgeons and key figures in the upper extremities, small joints, and orthopedic fields. However, as a self-proclaimed medical device nerd, my attention was focused on the show’s “Solutions Center” where many devices were on display. These products ranged from simple temporary motion stabilization devices to complex orthopedic kits consisting of an array of plates, screws, and tools for surgical repair of bone fractures.

Many of the devices on display are used in open surgery, allowing the surgeon to directly view the surgical site. However, there was one particular application that really caught my attention; carpal tunnel release. While this procedure is often done as an open surgery, there is a trend toward endoscopic carpal tunnel release (ECTR) which provides many benefits to the patient, such as a smaller scar, quicker procedure, and reduced healing time. Here, I knew, was an opportunity to employ modern endoscopic visualization.

Before I geek out too much on the exciting opportunities for visualization in ECTR, let’s talk a bit about the procedure itself. According to the American College of Rheumatology website, an estimated 4-10 million Americans are affected by carpal tunnel syndrome, which can cause pain and numbness in the hand. Carpal tunnel syndrome is caused when the median nerve is compressed or pinched by the transverse carpal ligament (flexor retinaculum) near the heel of the hand. Carpal tunnel release, which is a surgical method of alleviating carpal tunnel syndrome, is done by severing the transverse carpal ligament to relieve pressure on the median nerve. When properly healed, the carpal ligament has grown and reattached itself, recreating the healthy tunnel that allows the median nerve to pass through without excessive pressure.

Now, back to the exciting part: endoscopic visualization! While the industry is practicing ECTR, the adoption rate is quite low. One explanation is that when the endoscopic procedure was originally developed, the medical camera technology was quite a bit different than today. To achieve the benefits of ECTR, it’s important to keep the incision as small as possible. At the time, most visualization systems comprised of a traditional endoscope and camera attached to a bulky (and expensive) endoscopic tower. The endoscopes are not only costly, but prone to damage and breaking during cleaning and sterilization.

Enter the age of laptops and mobile phones in which the global consumption of image sensors explodes and drives miniaturization, cost reduction, and performance improvements. Unfortunately, the speed with which the med device industry adopts new technology is significantly behind the consumer market and thus we’ve seen little advancement in the products. I believe we are entering a time when this ripe technology will start seeing more utilization in applications like ECTR. By reducing the upfront device costs, improving reliability & reuse, and giving the surgeon freedom to place a (sterile) mobile monitor near the surgery site, both health care providers and surgeons will see the benefits.

I am passionate about providing medical device companies with expert turnkey solutions for medical optics and visualization. I am quite fortunate to be able to share my excitement and enthusiasm daily with the amazingly talented team here at Lighthouse Imaging; a world-leading provider of custom OEM solutions and contract manufacturing. Do you have any questions or comments about this topic? I’d love to hear from you.

Benjamin Gray, CTO