In theatre at Hospital Mermoz
A morning in theatre with Dr Arnaud Godenèche at Hospital Mermoz in Lyon, observing shoulder replacement surgery using the Tornier Ascend Flex prosthesis and arthroscopic rotator cuff repairs.
The discussion throughout was directed at how to improve results for patients, which is the only reason worth making these trips.
Why surgeons travel to watch each other operate
A visitation is an arrangement to spend time in another surgeon's theatre watching their operating list. It is a long established part of surgical practice and continues throughout a career, not just during training. Published papers and edited operative videos convey the steps of a procedure, but a great deal of what makes an operation work is not written down: how the patient is positioned, how the trays are laid out, the order in which structures are released, how much tension is accepted on a repair, and what the surgeon does when the anatomy is not as the imaging suggested.
Seeing the whole morning also shows the decisions either side of the operating: how the case was selected, what was explained beforehand, and what instructions were given for the recovery period. Visits of this kind are usually reciprocal, and surgeons travel in both directions over the years.
The two operations observed
Shoulder replacement involves replacing the worn surfaces of the ball and socket joint with artificial components, and is considered for arthritis or joint surface damage causing pain and loss of movement that has not responded to non-operative treatment. Different implant systems take different approaches to how the components are fixed to bone and how closely they reproduce the original shape of the joint, so watching a surgeon who uses a particular system regularly is a direct way to understand its advantages and its awkward points.
Arthroscopic rotator cuff repair addresses tears in the group of four tendons that hold the ball of the shoulder in its socket and rotate and lift the arm. Arthroscopic means the work is done through small portals using a camera and fine instruments rather than through an open incision. The torn tendon is freed, the bone surface prepared, and the tendon drawn back to its attachment and held with anchors placed into the bone while it heals. Whether a tear is repairable, and what the repair should involve, depends on the size and pattern of the tear, the quality of the tendon and the individual patient. Individual results vary.