Four Hand Arthroscopic Latarjet- Surgical Technique

Background: Arthroscopic Latarjet shoulder operation, in which the Coracoid process and the adjoining tendons of the Biceps short head & Coracobrachialis are transferred and fixed to the anterior glenoid neck, is technically demanding and time consuming.
Purpose: to describe the surgical technique for Arthroscopic Latarjet, done simultaneously by two surgeons, operating on the same shoulder. Presentation includes video demonstration of the set up.
Materials and Methods: 5 patients (all males, mean age 26 years) with gross instability, engaging Hill Sachs lesion or recurrent dislocation after surgical stabilization, underwent this procedure. Diagnostic arthroscopy through a posterior viewing portal and anterior rotator interval portal was done in beach chair position by the first (Gleno Humeral -GH) surgeon. Once Latarjet procedure was decided, two more anterior portals were created. Through an accessory antero lateral, viewing, second set portal, the Coracoid process was accessed, by the more experienced ( Extra Articular- EA) surgeon. Superior, medial and lateral aspects of Coracoid were freed from soft tissue, Coraco acromial ligament and pectoralis minor, respectably, using a low antero inferior portal, located above the conjoined tendon. Meanwhile, GH surgeon, handled intra articular pathologies ( ie SLAP lesion, loose bodies, biceps tear etc.), and prepared the anterior glenoid neck, performed capsulotomy, excised the middle gleno humeral ligament and cleared posterior and superior margins of the Subscapularis tendon. Rotator interval was excised by GH surgeon. Then both surgeons joined to perform Coracoid osteotomy. Subscapularis split and bone graft preparation was done by EA surgeon from the medial pectoralis portal, while GH Surgeon expanded the split from the joint. Both surgeons joined to insert the coracoid process through the split and fix it with two cannulatd screws to the glenoid neck.
Results: Surgery time was shorter by 22 minutes, compared to 5 consecutive arthroscopic Latarjet done by a single surgeon. There were no complications. All patients were released from hospital the next day.
Conclusion: This technique is feasible and enables a combined operation of two surgeons on one shoulder. Extra articular and intra articular procedures done simultaneously may shorten operation time in this technically demanding operation.