As is true of most important technologies, the development of arthroscopy is complex. The idea of visualizing the interior of the knee joint was pursued and advanced by many orthopedic surgeons in many centres over the first half of the 20th century. However, arthroscopy’s emergence as a thriving field within orthopaedic surgery over the late 1960s and 1970s was made possible by the Watanabe Type No. 21, the first effective and commercially manufactured arthroscope.
Persistence is undoubtedly among the more important factors behind this instrument’s emergence in Japan. Its underlying research program began in 1918 when Dr. Kenji Takagi (1888-1963), professor at the University of Tokyo, used an endoscopic instrument to examine the interior of a cadaver knee joint. Takagi, along with a cohort of younger colleagues, continued to develop a series of arthroscopes until his retirement in 1949.
This work was continued by his younger colleague Dr. Masaki Watanabe (1911-1995) at the Tokyo Teishin Hospital. In 1959, Watanabe and his colleagues notably developed the Type No. 21 arthroscope that would revolutionize the field.
Drs. Jackson and Ikeuchi (left) discuss cases with Dr. Watanabe (right) during Dr. Jackson’s time at Tokyo Teishin Hospital in 1964. (McGinty 1991, 3)
Atlas of Arthroscopy by Watanabe, Takeda and Ikeuchi (1957)
This first edition atlas of arthroscopy was published by Watanabe’s group in 1957. Although photographs and film had been recorded through the arthroscopes in Japan as early as 1932, these were presumably of insufficient quality for publication. For this reason, this first edition of the atlas features 68 paintings created by Mr. Shinichiro Fujihashi, an artist specializing in endoscopy. Below are a series Fujihashi’s paintings depicting osteoarthritis.
The collection’s copy of this atlas features a dedication to Dr. Jackson from Dr. Masaki Watanabe dated 1964, the year of Jackson’s visit to Japan. The second edition of the atlas, which features photographs made with the Watanabe. 21 arthroscope, was published in 1969. The third edition was published in 1978.
Watanabe Type No. 21 Arthroscope Set (c. 1960s)
The collection includes three original Watanabe 21 arthroscopy sets in various states of completeness, as well a many other Watanabe items. These sets were produced by Shinko Optical Co. of Tokyo, Japan. A complete set featured both forward looking and side looking arthroscopes as well as a light carrier for the halogen bulb and electrical leads to a power supply that is not represented in the collection. It also included a sheath (6mm OD), a trocar, and a large and small biopsy forceps as well as consumables such as rubber O rings and many spare halogen bulbs.
These sets were distributed by Professional Orthopaedic Supplies Ltd. based in Rexdale. It was likely the first North American distributor of Watanabe equipment. Dr. Jackson was probably involved in brokering this arrangement. The details of that process may be available in Dr. Jackson’s papers at Library and Archives Canada.
Watanabe Type No. 21 Forward Looking Arthroscope, Assembled (c. 1960s)
The Watanabe 21 was the first effective arthroscope. It had very good optics and a bright integrated illuminator, a tiny incandescent halogen bulb directly adjacent to the optics. It had an integrated system for irrigating and distending the joint. It was part of a carefully developed and integrated system that enabled many surgical tasks, from photography to biopsy and the beginnings of arthroscopic surgery.
However, the system also had important limitations. The illuminator gave off heat and was fragile. With the offset illuminator, the instrument’s “double barrelled” tip was quite broad. The arthroscopes could not be autoclaved. A broken instrument had to be sent to Japan for repair.
Such limitations were addressed by Watanabe’s team, which developed a version with fibreoptic illumination as well as a series of narrow “Selfloc” arthroscopes. However, with the success of the Watanabe 21, incumbent endoscope manufacturers soon entered the field. These manufacturers had many advantages including access to important patents (notably the Hopkins rod lens system) as well as experience making autoclavable instruments.
The Watanabe 21 is shown here with the optional beam splitter used for teaching. It shows the coupling system that was also used for the 35 mm camera mount.