In theatre in Lyon
A morning observing in the operating theatre at Clinique Du Parc in Lyon, France, with Dr Jerome Garret.
What a surgical visitation is
Visiting another surgeon in order to watch them operate, sometimes called an observership or a visitation, is a standard part of continuing education in surgery. It is usually arranged directly between the two surgeons, lasts anywhere from a morning to several weeks, and involves no operating by the visitor. The purpose is to see how someone else sets up, sequences and executes operations the visitor already performs, because the differences that matter are generally in the detail of technique rather than in the broad principles, and detail of that kind is not conveyed well in writing or in a lecture.
What the cases involved
Cuff tear arthropathy is the state a shoulder reaches when the rotator cuff tendons have been torn for a long period and the joint surfaces have worn as a result. A reverse shoulder arthroplasty is the usual replacement in that situation, because its design does not depend on the cuff. A Latarjet stabilisation transfers a small block of bone to the front of the socket in order to stop a shoulder that dislocates at the front from doing so again. Posterior instability, where the shoulder tends to slip backwards rather than forwards, is less common, and is often associated with a tear of the labrum at the back of the socket. Individual results vary.
What was covered
The morning's discussion covered three areas:
- Reverse shoulder arthroplasty using the Tornier Ascend Flex prosthesis, for a shoulder with cuff tear arthropathy and arthritis.
- Open Latarjet stabilisation for anterior shoulder instability.
- Rotator cuff repair.
A case of posterior instability with a labral tear was also discussed.
Watching another surgeon's whole morning list is a different exercise from watching a single demonstration case. The variation between cases, and the decisions made when anatomy does not match the plan, are where most of the learning sits.
Related information
- Our reverse total shoulder replacement page
- Our shoulder instability page
- Our rotator cuff repair page
- Our anterior instability page