Practical Application of Shoulder Arthroscopy. Chau Pui Man Jasmine APN CMC Operating Theatre
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1 Practical Application of Shoulder Arthroscopy Chau Pui Man Jasmine APN CMC Operating Theatre
2 Shoulder Arthroscopy Team event Aware of the unique requirements Equipment/Instrument Anesthesia Patient positioning Surgical technique Ensure maximum efficiency & patient safety
3 Practical Application Patient Positioning Theatre Layout Instruments for shoulder arthroscopy
4 Patient Positioning Lateral Decubitus position Beach-chair position
5 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
6 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
7 Lateral Decubitus Position Additional lateral support prevent patient fall back Plastic bag cover the patient prevent NS soak through Secure patient s head with elastoplasts The patient, in the lateral decubitus position, is held with a vacuum bean-bag.
8 Roll back position Patient position with appropriate support for head and axillary roll
9 Shoulder Traction Equipment Three-Point Traction Tower Shoulder Traction and Rotation (STaR) Sleeve
10 Patient Positioning Aids (Lateral Decubitus Position) Vacuum-pac bean bag Suction valve Positioning gel pad Lateral support
11 Patient Positioning (Beach-Chair Position) Beach-chair table, in supine position Head, neck & body are support in a neutral position Placed into 10 0 to 15 0 Trendelenberg Hips flexed to 45 0 to 60 0 Knees flexed to 30 0 Pressure points padded Portion of the back of the table removed for access to the posterior shoulder
12 Keep body in good alignment (Head, neck & body) Secure the circuit tubing to prevent disconnection
13 Patient Positioning Aids (Beach-Chair Position) Head rest Various gel pad, pillows & safety strap Foot support & safety strap Side Tray
14 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
15 Operating Room Layout Anaesthetic machine Anaesthetist Monitor Traction Device Light source Camera Printer Suction bottle Tower Electrocautery Shaver Electric suction Saline Tower Surgeon Assistant Surgical access Scrub nurse Working trolley Instrument trolley Overhead perspective of the operating room set up used for shoulder arthroscopy (Lateral decubitus position)
16
17 Operating Room Layout Tower Monitor Suction bottle Electrocautery Shaver Electric suction Saline Tower Light source Camera Printer Side Tray Anaesthetic machine Anaesthetist Assistant Surgeon Working trolley Scrub nurse Instrument trolley Overhead perspective of the operating room set up used for shoulder arthroscopy (Beach- Chair position)
18
19 Equipment needed for the ENTIRE Everything g the surgeon needs to complete the job procedure Access Patient Set Up Cannulas Pumps Visualisation Cameras Scopes Image Capture Data Manipulation Resection Manual Radiofrequency Electrical Electro-Mechanical Repair Anchors Tacks Suturing Instruments Guides
20 Equipment for Shoulder Arthroscopy Surgical monitor Radiofrequency machine Shaver power Saline Tower Camera & Light source Data management system Printer Electric suction machine Surgical monitoring system Trolley for arthroscopic equipment
21 Instrument for Shoulder Arthroscopy
22 Arthroscopic Cannulas Different size of cannula Reusable Obturator
23 Suture Anchor Anchor with different material (Titanium, Absorbable, Plastic)
24 Instrument for anchor fixation Suture Retriever Suture cutter & scissors Knot pusher Suturing passing instrument Arthroscopic suture passing
25 Observe for complications Immediate post-op management Airway obstruction due to extraarticular leakage of fluid Adequate pain control Have bulky dressing Apply shoulder immobilizer Observe for any wound oozing
26 Thank You
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