Arthroscopy (procedure) - v0.9 - Ready for review

Jim Casewhat do you think about making this generic for Endoscopy by broadening target values for 405813007 |Procedure site - Direct (attribute)| and 424226006 Using device (attribute) - unwieldy? The optional 2nd RG allows for the procedure with procedure aspect?

Monica Harry,  Happy for you to test this.  Do you want me to make the necessary edits to make it generic?  I think the second RG would need to be more generic as well as there are a number of other types of actions that would be performed that are not surgical...

Monica Harry,

After thinking about this, trying to generalize this template may not be the best approach.  Endoscopes can be used as access devices in some cases such as GI procedures.  We could try and produce a generic template that allows attribute subtypes at the top level of endoscopy, but then that makes the decision of which attribute to use up to each modeler. I will try and develop the top level template and see what falls out.

Yongsheng Gao,

This template is ready for review

Victor Medina - Hi Victor, would appreciate you taking a look at this template when you are ready, please and thank you, Monica

Yes. Sure.

Hi Jim Case and Monica Harry , I hope it's okay if I post a question on this template here, rather than by email. We are trying to follow for the 20 arthroscopy/arthroscopic concepts we have in our extension. We struggled first with using device here vs. using access device for endoscopies, but guessed in the end that here it's using device because it is the incision that provides access, not the arthroscope - correct?

Following this template however I found myself unable to redefine 60251000146107 |arthroscopic suturing of medial meniscus (procedure)|, because a suturing is defined with using device = surgical suture, and you can only use one using device per group. If I leave out using device = arthroscope in that particular group, it will not classify beneath 84877006 |Arthroscopy of knee with meniscus repair (procedure)|, which does not seem right.

Maybe the arthroscopic surgical procedure could be defined with a guidance intent group, the way CT & MRI guided procedures are modelled; rather than adding the 'using device = arthroscope'?

Feikje Hielkema-Raadsveld,

Happy to try and resolve your issue.  You are correct that the USING DEVICE relationship is used here because it is not the arthroscope that provides the access.  There are incisions made to insert the arthroscope, which is then used for visualization.  Depending on the type of arthroscope, other procedures may be performed through the scope, but in your case WRT to suturing, the scope itself does not perform the suturing, but the suturing may be "through" the scope.  In all cases the visualization of the joint is done via the arthroscope, while the suturing may be done through portals inserted into the joint or through an additional scope inserted into the joint.  

This means that in all cases, the scope is used to visualize, but in some cases it is also used as the access device to allow for the sutures to be fixed.  At this point, the template does not allow for an additional USING ACCESS DEVICE in the third role group, but that seems to be a reasonable addition if it is deemed necessary to state that the access to the joint for suturing is done through the arthroscope.  However, this is not always the case. 

You have identified an issue with the modeling of 84877006 |Arthroscopy of knee with meniscus repair (procedure)|.  After reviewing a number of arthroscopic procedures, I do not think we need the USING DEVICE relationship on the "repair" role group, as there are many other types of devices that may be used to perform the repair.  Unless the repair device is stated in the FSN, we do not really know which device has been used to perform the repair. 

I will need to test the impact of removing the USING DEVICE relationship from Arthroscopic procedures that include a surgical action role group.   

Testing has shown that a general solution to this issue will be challenging.  I will create a ticket to begin looking at this in more detail.

Feikje Hielkema-Raadsveld,

I have revised the template to allow for any device to be used in the Surgical action role group.  This has resulted in the need to inactivate a couple of grouper concepts:

128324006 |Arthroscopy with surgical procedure (procedure)|

281811000 |Arthroscopic surgical procedure on knee (procedure)|

but there is no other substantial change to the arthroscopy hierarchy.

Thanks Jim Case , That's great! And thanks for the advance warning, we may need to get rid of a few similar groupers in our extension.

Jim Case  for our procedure thesaurus we want to be able to make a difference between an arthroscopic examination and an arthroscopic examination with a procedure done in the same setting. Is there a way to make this difference now considering the new template?

Natasha Krul

Yes, you can add an additional procedure to the arthroscopy using the optional third role group, which has more attributes that would be needed to define the additional procedure.  There are many examples already in the hierarchy (e.g.281814008 |Arthroscopic lateral patellar release (procedure)|)

The changes that were referenced above did not make it into the January release so the February release will be the first one to see these changes.

Jim Case I do understand that in these specific cases it will be possible to add an optional role group, provided you know what the exact procedure is. So if I am understanding correctly, SNOMED does not make a difference between 239411005 |Diagnostic arthroscopy of joint (procedure)| and 128324006 |Arthroscopy with surgical procedure (procedure)| and 13714004 |Arthroscopy (procedure)|? All first 2 were inactivated and replaced by 13714004 |Arthroscopy (procedure)|. Wouldn't it be clinically relevant to distinguish between these types of arthroscopies?

Hi Jim Case  should we relax the range constraint on the optional role group? Currently, it is restricted to surgical action. It could be actions other than << |Inspection|, such as 301761003 |Arthroscopic synovial biopsy (procedure)|. This would enable to model of different kinds of arthroscopic procedures. Otherwise, the method has to be 360028004 |Surgical biopsy - action (qualifier value)|. 

Yongsheng Gao,

At this point, we do not have any non-surgical actions being performed in our current content.  The actions hierarchy is being reviewed by Victor and the notion of "surgical" action may be going away.  Since arthroscopy is already considered a surgical procedure, what is your concern about using surgical biopsy as the action in the optional RG (that is how it is modeled now)?