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1. Shoulder Arthroscopy:
Basic Portals – Landmarks –
Navigation
Nikolaos Tzanakakis
Orthopedic Surgeon
2nd Orthopedic Dept.
Center for Shoulder Arthroscopy
IASO General Hospital
Athens, Greece

2. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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3. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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4. Patient Positioning: Beach Chair
can easily convert to open surgery…
ask your instructors later today
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5. Patient Positioning:
Lateral Decubitus
Our preferred position
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6. Lateral Decubitus positioning
30° backward inclination
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7. Padding bony prominences
Adequate patient stabilization
Beware of the neck
Patient Positioning:
Lateral Decubitus
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8. Arm Draping
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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
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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
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11. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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12. Room Set up
Lateral decubitus allows easy access to the
anterior and posterior part of the joint
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13. Keep the operating room cold
to avoid fogging
but
Keep the
patient warm
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14. Instruments in side pocket –
easily available
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15. The arthroscopic tower opposite
the surgeon
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16. Is everything ready
BEFORE starting ?
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17. Commonly used tools arranged
by the scrub nurse
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18. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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19. Skin Marking – Bony Landmarks
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20. Skin Marking – Basic Portals
P
AS
AI
PL
L
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21. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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22. Before Entering the Scope
Spinal Needle
insertion
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23. Saline Backflow
Saline in
Before Entering the Scope
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24. Arthroscope in GH joint
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25. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space
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26. First view from posterior portal
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27. View from posterior portal
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28. Checking Rotator cuff
PASTA
Full RC tear
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29. Creating Anterior Portals
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30. Creating Anterior Superior Portal
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31. Switching stick into AS portal
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32. Scope into Anterior Superior portal
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33. View from Anterior Superior portal
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34. View from Anterior Superior portal
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35. Creating Anterior Inferior portal
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36. Three main portals for GH arthroscopy
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37. Topics
 Patient positioning
 Room set-up
 Landmarks - Skin Marking
 Creating portals
 Glenohumeral Joint Navigation
 Subacromial Space Navigation
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38. Creating the PosteroLateral
portal
1cm distal, 1cm posterior to PL acromion corner
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39. Two posterior portals:
better view & better suture management
Portals for Subacromial arthroscopy
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40. Portals for Subacromial arthroscopy
 Scope into Posterolateral portal
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41. Portals for Subacromial arthroscopy
 Create the Lateral portal
 3-4cm distal to the lateral acromion
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42. Don’t Worry…be happy
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43. Find a good pump,
good anesthesiologist,
good head scrub nurse.
It is better to have them friends!!!
The most difficult thing…
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44. Bleeding control
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45. Bursa removal
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46. Uncovering acromion
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47. AC joint – Auxiliary portal
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48. Checking Rotator Cuff Pathology
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49. Thank you for your attention
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