7-Practical Application of Shoulder Arthroscopy [唯讀] Application of Shoulder Arthroscopy ......
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Transcript of 7-Practical Application of Shoulder Arthroscopy [唯讀] Application of Shoulder Arthroscopy ......
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Practical Application of Shoulder Arthroscopy
Chau Pui Man Jasmine APN CMC Operating Theatre
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Shoulder Arthroscopy
• Team event• Aware of the unique requirements
– Equipment/Instrument– Anesthesia– Patient positioning– Surgical technique
Ensure maximum efficiency & patient safety
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Practical Application
• Patient Positioning
• Theatre Layout
• Instruments for shoulder arthroscopy
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Patient Positioning
• Lateral Decubitus position
• Beach-chair position
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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
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• 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
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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
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Patient position with appropriate support for head and axillary roll
Roll back position
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Shoulder Traction Equipment
Three-Point Traction Tower
Shoulder Traction and Rotation (STaR) Sleeve
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Patient Positioning Aids (Lateral Decubitus Position) (Lateral Decubitus Position)
Vacuum-pac bean bag Suction valve
Positioning gel pad Lateral support
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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
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Keep body in good alignment (Head, neck & body)
Secure the circuit tubing to prevent disconnection
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Patient Positioning Aids (Beach-Chair Position)Head rest
Side TrayFoot support & safety strap
Various gel pad , pillows & safety strap
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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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Elec
troc
aute
rySh
aver
Elec
tric
su
ctio
n
Tow
er
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
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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
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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
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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
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Instrument for Shoulder Arthroscopy
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Arthroscopic Cannulas
Reusable Obturator
Different size of cannula
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Suture Anchor
Anchor with different material(Titanium, Absorbable, Plastic)
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Instrument for anchor fixation
Suture Retriever Suture cutter & scissors
Suturing passing instrumentKnot pusher
Arthroscopic suture passing
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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
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Thank You