Robotic surgery has been used for a long time; it is earning space and its use is expanding in daily medical practice in several surgical specialties, with advantages over traditional surgical methods. This Technical Note presents an endoscopic robotic posterior shoulder approach that allows the surgeon to perform latissimus dorsi transfer endoscopically. This Technical Note describes the use of the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) for transfers related to rotator cuff tears.

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When the long head of the biceps tendon is diseased, tenodesis is an appropriate treatment strategy. The specific technique used is dependent on visualization, fixation method and hardware, and tenodesis location. For suprapectoral tenodesis techniques, those that fix the tendon within or below the bicipital groove can be challenging owing to the transverse humeral ligament covering the groove. To accurately identify the biceps tendon in this area, the ligament often requires resection. Ultrasound provides surgeons with a safe and noninvasive tool to visualize the biceps tendon as it exits the bicipital groove, negating the need for unroofing and other pitfalls associated with traditional techniques. This technical note describes an ultrasound-guided suprapectoral biceps tenodesis procedure.

Objective: This study aims to assess a new technique used for pectoralis major reconstruction using bone tunnel and fixation with metallic anchors in the contralateral cortical bone. Methods: Patients who had undergone post-surgical reconstruction of the pectoralis major at least 24 months before were assessed by the UCLA Shoulder Score and the Simple Shoulder Test and compared with the contralateral side by manual goniometry. Subgroup analysis was also performed between grafted and non-grafted patients. Results: 13 patients fulfilled the inclusion criteria. The average UCLA score was 34.77 ± 0.12, compared with the standard 27 of good and excellent results p < 0.0001. The Simple Shoulder test mean was 11.92 ± 0.08. Grafted and non-grafted subgroups had no statistical differences for UCLA p = 0.58 and Simple Shoulder Test p = 1.00. Long term losses for elevation or external rotation were lower than 5º. No lesions recurred. All patients returned to their physical activities with no restrictions. Conclusion: The pectoralis major reconstruction technique using a bone tunnel and metallic anchors in the contralateral cortical bone was effective. However, its execution needs special care to avoid complications. Level of Evidence IV, Case Series.