AANA Lab Course 915 - Foundations in Arthroscopy-Operating Room Set-Up and Equipment-John Orwin, M.D.

Operating Room Set-Up and Equipment-John Orwin, M.D.

Pdf Summary

Dr. John F. Orwin of the University of Wisconsin outlines key principles and practical considerations for shoulder arthroscopy setup and procedure. He emphasizes having a reproducible, case-specific setup that is easy to execute, allowing selection of the approach best suited to the surgeon's preference for smooth operation. Both general and regional anesthesia, particularly intrascalene blocks, can aid postoperative pain control but require skilled anesthesiologists experienced in regional techniques.<br /><br />Two primary patient positions are discussed: modified lateral decubitus and beach chair. Modified lateral decubitus, the most common, requires a suspension device to hold and manipulate the arm for optimal visualization of intra-articular and bursal structures. The patient is tilted 20-30 degrees posteriorly with padding for pressure points and protection of head, neck, eyes, and ears. The suspension system must permit arm manipulation while applying limited weight (10-15 pounds) to avoid nerve injury, maintaining controlled abduction and flexion angles.<br /><br />The beach chair position allows easy conversion to open stabilization without needing suspension devices. Throughout the procedure, draping with water barrier collection bags and ensuring complete shoulder access are critical. Surgeons, assistants, and anesthesiologists should have unhindered patient access and clear visualization of video monitors.<br /><br />Essential arthroscopic equipment includes a 30-degree arthroscope, camera, disposable cannulas, shaver, electrocautery, irrigation pump, and procedure-specific instruments. Equipment must be well maintained to prevent failures such as fluid extravasation. Common irrigants include lactated ringers and saline.<br /><br />A key takeaway is that surgeons must thoroughly understand and be comfortable with their chosen approach and equipment, taking full responsibility for equipment operation and patient safety, rather than relying on nursing staff. This ensures effective, safe shoulder arthroscopy with optimal outcomes.

Keywords

shoulder arthroscopy

surgical setup

patient positioning

modified lateral decubitus

beach chair position

intrascalene block

arthroscopic equipment

postoperative pain control

fluid extravasation prevention

surgeon responsibility