Course of the operation
When the shoulder is mirrored, in most cases about two to three small incisions are made. These incisions are often only about 3 millimetres in size and therefore sufficient for this minimally invasive procedure. Finally, the devices required for the operation are inserted through these incisions.
One of these incisions is an endoscope, a special rigid tube. This endoscope is equipped with an illumination and a mini camera. This camera transmits the image to a screen so that the surgeon has a very good magnified view of the operating area.
This enables him to assess all important structures such as bones, tendons, ligaments and bursae. To ensure that blood and tissue fluid do not obstruct his view, he can manually flush the operating area with saline via a pump. Through a further incision, the doctor can introduce various special instruments, the operation of which requires a certain amount of practice and good handling. This enables him to treat any damage to the shoulder joint directly during the arthroscopy. These instruments are, for example, mini scissors, but also instruments for laser and coagulation.
After a two to three day in-patient treatment, the subsequent treatment should be well planned with the attending physician to guarantee the success of the operation. To rebuild the load on the shoulder joint, physiotherapy by appropriate therapists can be helpful.
Advantages of arthroscopy
Arthroscopy is one of the endoscopically performed minimally invasive procedures that allow the experienced surgeon to assess the shoulder joint and directly repair shoulder damage. The optics transfer the image to a monitor. This magnified view offers the surgeon a very good opportunity to perform his operation with the highest precision.
Only small incisions are required to insert the instruments into the surgical site. This has the advantage over operations with a complete opening of the shoulder joint that no healthy structures can be unnecessarily injured. As a result, the operation has a less stressful effect on the patient and causes significantly less pain.
After the operation, the surgical wounds heal more quickly and the shoulder joint can be put under load again more quickly. The operation can be performed as an outpatient procedure or under light anaesthesia. The duration of the operation is approximately 20 minutes to two hours, so the risks involved in any operation are significantly lower and particularly suitable for patients with existing cardiovascular diseases. The operation under anaesthesia then requires an inpatient stay in the clinic for up to three days, depending on the course of the operation.
Risks of arthroscopy
Before a shoulder arthroscopy is performed, a specialist should make an exact assessment of the problem. The indication should be well established by an assessment in advance. It should be ensured that an arthroscopy can repair any existing joint damage or prevent further more serious consequential damage.
The necessary examinations, such as x-rays, magnetic resonance imaging and ultrasound, should be carried out in advance to ensure that the indication for shoulder arthroscopy is confirmed. Although it is a minimally invasive procedure, complications cannot be completely ruled out, as with any other operation. In addition, like any other operation, arthroscopy carries the typical risks.
These include the risk of developing a thrombosis or pulmonary embolism. Larger bleedings are rare in this area, but there is a risk of damaging nerves, which can lead to further damage. Furthermore, there may be an intolerance to the anaesthetics used, which can occur intraoperatively.
After the operation, wound healing disorders or infections can occur, which can develop especially in the case of basic diseases such as diabetes mellitus or immunocompromised patients. In some cases it is then advisable to prevent this by administering antibiotics before the operation. In rare cases, post-operative bleeding or stiffening of the joint may occur.
Nevertheless, the risks of developing complications are much less common than with larger and longer operations. In general, arthroscopy of the shoulder is a well-tolerated and usually complication-free procedure, in which patients are subsequently free of complaints.