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Portals navigation

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Portals navigation

  1. 1. Shoulder Arthroscopy: Basic Portals – Landmarks – Navigation Nikolaos Tzanakakis Orthopedic Surgeon 2nd Orthopedic Dept. Center for Shoulder Arthroscopy IASO General Hospital Athens, Greece
  2. 2. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  3. 3. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  4. 4. Patient Positioning: Beach Chair can easily convert to open surgery… ask your instructors later today www.shoulder.gr
  5. 5. Patient Positioning: Lateral Decubitus Our preferred position www.shoulder.gr
  6. 6. Lateral Decubitus positioning 30° backward inclination www.shoulder.gr
  7. 7. Padding bony prominences Adequate patient stabilization Beware of the neck Patient Positioning: Lateral Decubitus www.shoulder.gr
  8. 8. Arm Draping www.shoulder.gr
  9. 9. Traction: NO more than 4 Kgrs Axonal traction: 3.2 Kg for body weight<65 Kg 4.0 Kg for body weight>65 Kg www.shoulder.gr
  10. 10. Choose patient positioning Beach chair VS. Lateral decubitus  Are equally useful and promising  Have the same landmarks  Decision depends on surgeon’s training and preferences www.shoulder.gr
  11. 11. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  12. 12. Room Set up Lateral decubitus allows easy access to the anterior and posterior part of the joint www.shoulder.gr
  13. 13. Keep the operating room cold to avoid fogging but Keep the patient warm www.shoulder.gr
  14. 14. Instruments in side pocket – easily available www.shoulder.gr
  15. 15. The arthroscopic tower opposite the surgeon www.shoulder.gr
  16. 16. Is everything ready BEFORE starting ? www.shoulder.gr
  17. 17. Commonly used tools arranged by the scrub nurse www.shoulder.gr
  18. 18. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  19. 19. Skin Marking – Bony Landmarks www.shoulder.gr
  20. 20. Skin Marking – Basic Portals P AS AI PL L www.shoulder.gr N
  21. 21. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  22. 22. Before Entering the Scope Spinal Needle insertion www.shoulder.gr
  23. 23. Saline Backflow Saline in Before Entering the Scope www.shoulder.gr
  24. 24. Arthroscope in GH joint www.shoulder.gr
  25. 25. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space www.shoulder.gr
  26. 26. First view from posterior portal www.shoulder.gr
  27. 27. View from posterior portal www.shoulder.gr
  28. 28. Checking Rotator cuff PASTA Full RC tear www.shoulder.gr
  29. 29. Creating Anterior Portals www.shoulder.gr
  30. 30. Creating Anterior Superior Portal www.shoulder.gr
  31. 31. Switching stick into AS portal www.shoulder.gr
  32. 32. Scope into Anterior Superior portal www.shoulder.gr
  33. 33. View from Anterior Superior portal www.shoulder.gr
  34. 34. View from Anterior Superior portal www.shoulder.gr
  35. 35. Creating Anterior Inferior portal www.shoulder.gr
  36. 36. Three main portals for GH arthroscopy www.shoulder.gr
  37. 37. Topics  Patient positioning  Room set-up  Landmarks - Skin Marking  Creating portals  Glenohumeral Joint Navigation  Subacromial Space Navigation www.shoulder.gr
  38. 38. Creating the PosteroLateral portal 1cm distal, 1cm posterior to PL acromion corner www.shoulder.gr
  39. 39. Two posterior portals: better view & better suture management Portals for Subacromial arthroscopy www.shoulder.gr
  40. 40. Portals for Subacromial arthroscopy  Scope into Posterolateral portal www.shoulder.gr
  41. 41. Portals for Subacromial arthroscopy  Create the Lateral portal  3-4cm distal to the lateral acromion www.shoulder.gr
  42. 42. Don’t Worry…be happy www.shoulder.gr
  43. 43. Find a good pump, good anesthesiologist, good head scrub nurse. It is better to have them friends!!! The most difficult thing… www.shoulder.gr
  44. 44. Bleeding control www.shoulder.gr
  45. 45. Bursa removal www.shoulder.gr
  46. 46. Uncovering acromion www.shoulder.gr
  47. 47. AC joint – Auxiliary portal www.shoulder.gr
  48. 48. Checking Rotator Cuff Pathology www.shoulder.gr
  49. 49. Thank you for your attention www.shoulder.gr

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