Joimax | Endoscopic Minimally Invasive Spine Surgery
The facility where I work purchased a Joimax system and we are prepping for our first case this week. I still have a lot to learn about this system, but I do like to do a bit of my own research and what not prior to using it for the first time. The Joimax system can be used for pain therapy, spinal stabilization, and decompression/deherniation procedures.
Minimally invasive surgery is growing larger and becoming the preferred option for both patients and surgeons. The Joimax system allows patients needing a surgical procedure on their spine to go home the same day and with minimal pain. How great is that? Patients that have been in pain for years can come in to have surgery and walk out the same day feeling like a brand-new person.
So, a little bit about the equipment. There is a tower, which is called the “NAVENTO”, and it stands for navigation endoscopic tower. This tower is used for each type of procedure that the Joimax system is capable of. On the tower there are a few different machines, there are two screens, one large for visualization and the other for data entry and settings another screen to view during the procedure. There is the Vitegra machine, which is the main ‘computer’ for the tower. There is the camera and light source box which they call ‘Camsource’. The navigation tracking and control unit is called the ‘Intracs’. Next is my favorite—it’s the “Shrill” which is a drill and resection system. When the rep was looking for it while setting up the tower and prepping for the in-service he asked, “where is the shrill?” immediately I responded with “I have no idea what that is…” I couldn’t decide if I felt like an idiot, and this is something that everyone has heard of or if I thought I knew more than I actually did. Well, turns out no one else on my team had heard that term either, phew! It stands for ‘shaver-drill’. There is a radiofrequency machine, the ‘endovapor’. The last machine on the tower is the ‘versicon’ which is an irrigation pump.
Our facility is starting with the TESSYS and iLESSYS. The TESSYS is the ‘transforaminal’ system and the iLESSYS is the ‘interlaminar’ system. These are for decompressive procedures that would otherwise be performed in an open fashion. According to the company, discogenic pain, disc protrusions/herniated discs, spinal stenosis, slipped vertebra and fractures are all diagnoses that could warrant the use of these systems.
Each of these has their own instrument tray with specialized instrumentation to perform the procedure. The TESSYS approach allows the surgeon to access the herniated disc through (trans) the foramen. Then the broken-up disc is removed through the same point of access. The procedure can be performed in prone or lateral position- whichever the surgeon prefers. The iLESSYS system allows for interlaminar access to remove herniated disc material or to treat spinal stenosis. This procedure is performed with the patient in prone position. Both of these done through the Joimax system are less traumatic than the traditional way of repairing these defects.
There are also disposable products that go along with each system- like the irrigation tubing, the drapes, and the “shrill” pieces. These don’t really take up much room in our storage area, which is very nice since there never seems to be enough storage space for what we need. Unfortunately, the drape for the camera cord and the drape with the irrigation pouch were not ordered appropriately for our case, so we will have to improvise. Let’s just say, there were a lot of blankets on the floor and feet got wet. The camera cord is not able to be sterilized so it has to be draped during the procedure, which I see as an opportunity for improvement, and I imagine is already in the works for a change for the company as that is the standard.
The rep went over the set-up for the procedure pretty quickly during the in-service, but besides your basics, everything you need is in the instrument tray, and it is very easily identified. The trays are color coded for each system- one for TESSYS and one for iLESSYS. What impressed me the most about this in-service, was that the rep went to SPD afterwards to go over IFUs (instructions for use) and walk through the decontamination and sterilization process with the team- I have not seen that before from a company. It could be that I just have never noticed or paid attention, but still, impressive. They company is supposed to be present for the first 10 cases per surgeon, not sure that amount will be necessary, but we will see!
The procedure is supposed to take about 2 hours or less from start to finish and the patient is able to recover from anesthesia and go home the same day. Offering this procedure to the population in our area is something I’m very excited about- honestly this is something that I know a lot of people personally that could benefit from this. There are also capabilities on this system that Pain doctors are able to use, I do not know much about that yet, but I’d like to learn!
Overall, this seems like a really cool system with a lot of different modalities and I am excited to continue to learn about it and see the impact it has on the patients!
