Practical Application of Shoulder Arthroscopy

Chau Pui Man Jasmine APN CMC Operating Theatre

Shoulder Arthroscopy

• Team event• Aware of the unique requirements

– Equipment/Instrument– Anesthesia– Patient positioning– Surgical technique

Ensure maximum efficiency & patient safety

Practical Application

• Patient Positioning

• Theatre Layout

• Instruments for shoulder arthroscopy

Patient Positioning

• Lateral Decubitus position

• Beach-chair position

Patient Positioning (Lateral Decubitus Position)

• Operative shoulder exposed vertically

• Beanbag is placed underneath for support

• Head is maintained in neutral position with a foam pad/pillow

• Axillary roll is placed to support the thorax and prevent pressure

• Pressure points are padded on both legs

• Nonoperative arm is placed on an arm board

• Operative arm is placed into a foam traction

• Weight applied to the traction device

Lateral Decubitus Position

The patient, in the lateral decubitus position, is held with a vacuum bean-bag.

Plastic bag cover the patient – prevent NS soak through

Secure patient’s head with elastoplasts

Additional lateral support – prevent patient fall back

Patient position with appropriate support for head and axillary roll

Roll back position

Shoulder Traction Equipment

Three-Point Traction Tower

Shoulder Traction and Rotation (STaR) Sleeve

Patient Positioning Aids (Lateral Decubitus Position) (Lateral Decubitus Position)

Vacuum-pac bean bag Suction valve

Positioning gel pad Lateral support

Patient Positioning(Beach-Chair Position)

• Beach-chair table, in supine position• Head, neck & body are support in a neutral position• Placed into 100 to 150 Trendelenberg• Hips flexed to 450 to 600

• Knees flexed to 300

• Pressure points padded• Portion of the back of the table removed for access

to the posterior shoulder

Keep body in good alignment (Head, neck & body)

Secure the circuit tubing to prevent disconnection

Patient Positioning Aids (Beach-Chair Position)Head rest

Side TrayFoot support & safety strap

Various gel pad , pillows & safety strap

Operating Room Layout

• Proper setup is important to facilitate the practice of shoulder arthroscopy

• Each team member is expected to familiar with all the aspects of the procedure, not just his/her primary task

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Monitor

Light sourceCameraPrinter

Anaestheticmachine

Workingtrolley

Instrument trolley

Surgeon

Scrub nurse

Assistant

Anaesthetist

TractionDevice

SalineTower

Suctionbottle

Operating Room Layout

Overhead perspective of the operating room set up used for shoulder arthroscopy (Lateral decubitus position)

Surgical access

Operating Room Layout

Anaestheticmachine

Light sourceCameraPrinter

Monitor

Workingtrolley

SideTray

ElectrocauteryShaverElectric suction

Tower

SalineTower

Suctionbottle

Overhead perspective of the operating room set up used for shoulder arthroscopy (Beach-Chair position)

Anaesthetist

SurgeonAssistant

Scrub nurse

Instrument trolley

AccessAccessPatient Set UpPatient Set UpCannulasCannulasPumpsPumps

VisualisationVisualisationCamerasCamerasScopesScopesImage CaptureImage CaptureData ManipulationData Manipulation

Equipment needed for the ENTIRE procedure

ResectionResectionManualManualRadiofrequencyRadiofrequencyElectricalElectricalElectroElectro--MechanicalMechanical

RepairRepairAnchorsAnchorsTacksTacksSuturingSuturingInstrumentsInstrumentsGuidesGuides

Everything the g the surgeon needs to complete the jobneeds to complete the job

Equipment for Shoulder Arthroscopy

Surgical monitoring system

Printer

Data management system

Camera & Light source

Surgical monitor

Radio-frequencymachine

Shaverpower

Electric suction machine

Trolley for arthroscopic equipment

Saline Tower

Instrument for Shoulder Arthroscopy

Arthroscopic Cannulas

Reusable Obturator

Different size of cannula

Suture Anchor

Anchor with different material(Titanium, Absorbable, Plastic)

Instrument for anchor fixation

Suture Retriever Suture cutter & scissors

Suturing passing instrumentKnot pusher

Arthroscopic suture passing

Immediate post-op management

• Observe for complications– Airway obstruction due to extraarticular leakage

of fluid • Adequate pain control• Have bulky dressing• Apply shoulder immobilizer • Observe for any wound oozing

Thank You