The first stones are those that support the building
In the first block of exercises, we will learn to manipulate objects in the three dimensions of space, to plan arthroscopic surgery and to perform arthroscopic knots. In this first block, which includes exercises 1 to 6, the vision portal and the working portal are in the same plane, similar to how we would perform arthroscopy with the anteromedial and anterolateral portals of the knee.
This is the easiest working configuration because it is the most natural. It is very important to acquire the first good surgical habits during this block, since it is possible to do these exercises quickly and badly, but if we make mistakes in this block, we will accumulate them for later, more complex situations. If we accumulate technical errors while learning arthroscopy, it will become progressively more difficult for us to progress, and often we will not know why. Being careful with the position and orientation of the camera, avoiding repetitive movements and having full control of the triangulation are the key points of this block. A smooth, clean, and error-free technique is key to optimal management of complex arthroscopic situations.
The camera image must always maintain the horizontal plane. Often, to gain time, we tend to perform the exercises without having previously managed to position the camera completely horizontal, which greatly complicates triangulation and, in the end, generates iatrogenesis and increased surgical time. It is worth spending time to position the camera correctly.
If the camera is tilted 30º, a horizontal movement of the tweezers breaks up the image into a horizontal movement and a vertical movement, which makes triangulation difficult. However, if we keep the camera horizontal, the movement of the clamp is perfectly translated into the image, avoiding repetition
Arthroscopy does not have the objective of seeing a structure from close up, but rather of allowing us to see and manipulate intra-articular structures in a minimally invasive way. Its main difficulty is the need to navigate a 3D space through the vision of a 2D camera. Therefore, it is essential to try to gain the maximum field of vision possible, to simplify the triangulation process. Spending some time to get as global a view as possible of our work area will greatly simplify the surgery and allow us to be more precise, more elegant and faster.
Dress me slowly, I'm in a hurry. It takes much more time to do two quick moves than one slow move. For this reason, it is essential that arthroscopic surgery be slow and smooth, without force and without repeating movements. When we do not have the camera correctly oriented, or the field of vision is not good, it is common to have to open the clamp several times before being able to pick up a part, for example. it is better to make slow movements of the tweezers and move progressively, than to make sudden movements and have to repeat them until we achieve our goal.