Summary

Description of a suture based technique to reduce fluid outflow from arthroscopic portals, improving intra-operative visibility, while still allowing portal use.

Abstract

Visualisation is paramount for efficient and safe arthroscopic surgery. Many techniques are employed to improve intraoperative visualisation such as maintaining a low systolic blood pressure, using arthroscopic pumps to control pressure, including adrenaline in arthroscopic fluid, utilising radiofrequency devices to control bleeding, and the use of portal cannulas. Portal cannulas generate additional costs, can be difficult to work around intraoperatively, and are often not used for every portal during shoulder arthroscopy.
Rapid fluid outflow from non-cannulated portals can cause flow turbulence, initially attributed by Burkhart et al to the 'Bernouli effect'. This is the negative pressure gradient that occurs perpendicular to high velocity flow, creating a suction effect, with the resulting turbulent flow impairing intraoperative visibility. Controlling flow of arthroscopic fluid, particularly out-flow through non-cannulated portals, leads to improved visualisation even without controlling all bleeding vessels. Burkhart originally described a simple solution, placing a finger over the portal to stop flow. We describe a simple and effective technique using sutures to oppose the underlying soft tissue in non-cannulated portals, while allowing free use of the portal once sutures are placed. This improves intraoperative visualisation, frees up the surgeon and assistant to focus on other aspects of the operation, and does not require additional equipment such as sheaths or cannulas.