--- title: 'Second Roundtable Discussion' type: 'lesson' url: 'https://doc.social/courses/transos-expertsroundtable-discussion/second-roundtable-discussion' course: 'TransOs ExpertsRoundtable Discussion' course_url: 'https://doc.social/courses/transos-expertsroundtable-discussion' position: '4 of 7' author: 'Brett Sanders' transcript: 'yes' --- # Second Roundtable Discussion ## Summary _This lesson is a recording without a written summary._ ## Transcript 1,117 words · 6 min · 4 speakers · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source. [0:00] Speaker 1: It's a, it's been a ton of fun to, to be a part of it, and um. [0:06] Speaker 1: Yeah. [0:07] Speaker 1: So that's [0:09] Speaker 1: Uh, uh, you know, I, I, I wouldn't have expected to change something in my practice. I'm 4.5 years out from fellowship, you know, this early, dramatically change something, you know, all I do is Shoulder and elbow, you know, and so Rotator cuffs, you know, probably do 5 or 6 a week. And so to, to change what I do more than anything else this early in my career was something if you had told me leave fellowship, I would have said no way. Um. [0:35] Speaker 1: And, and it's, it's been a ton of fun. I enjoy doing the cases more. Um, I think it's more fun than doing than anchors, to be honest with you. [0:44] Speaker 2: I agree. I think anchors are so old and easy, and they make such big holes when you're used to making and seeing the smaller holes, you know, yeah, and the suture configurations are such, so much more creative, and, and there's so many more options that you can do, you know, it's, it, it, it, it, it was a lot more fun for me. I agree. I was getting kind of bored. [1:04] Speaker 2: What was your Learning curve, you know, when you started, you know, 345 cases, more? [1:11] Speaker 1: Yeah, I mean, I said, I'd already been tying, um, and so that came naturally. It was just, it's just kind of practicing in my mind how I was going to, you know, sitting with you with the model was helpful to be, and, and seeing how you, you know, the Xbox, the peripheral, you know, sutures, the sliding knots, stuff like that, just, just doing that outside the, you know, the body a couple of times and, and knowing where I was gonna put my knots just helped me to feel more comfortable going in there. Um. [1:39] Speaker 1: You know, the, to get the, the flow with my, you know, my reps and like what them to expect, it takes a couple cases, but really a couple cases, I mean, it's [1:51] Speaker 1: It was not a big Learning curve in that regards. [1:53] Speaker 2: We, we got something brought up here from, uh, Brad and maybe Bill can, can, can address this as pretty high volume, uh, arthro tunneler users from the past. We had a, a lot of docs that we're gonna adopt and they said, oh, I tried that and it was so futsy in the past, it was hard to get the thing to work and hard to pass and [2:16] Speaker 2: I've even had a couple of docs say that, you know, they watched the video of, of the Transo and they say, well, there's no way it's actually working that easy and [2:24] Speaker 2: And then they try it and they say, oh well, actually it does work that easy, but, uh, you know, is, is it, what, what, Brad, you've, you've done tons of Arthur Tunneler. What, what, what do you think is the most salient improvement uh from the first mover to an improver like the transo? [2:41] Speaker 3: Uh. [2:42] Speaker 3: Well, we were talking about pullout earlier and one of the biggest issues with pullout is how many passes you make uh to pass the suture through a given tunnel. [2:51] Speaker 3: And with Arthur Tunneler, um, there were occasions where, um, you couldn't quite hit the hook or hit the wire loop and you'd have to make, uh, another pass or maybe, um, two more passes with the drill bit to, to make sure that you were passing to the, to the wire loop. And so you might have had, uh, 2, maybe 3, tunnels to finally, uh, pass your suture through, um. [3:17] Speaker 3: Uh, where, where with tensor, it's one and done. It's one pass and it's, it's a much more lower profile coming in from the lateral side. It's, it's, uh, penetrating the bone without having to be pre-drilled. So it [3:32] Speaker 3: It's, it's much more accurate. It's a much more sturdy device. It feels, uh, much more substantial in your hands. Um, you do the, the single pass and, uh, it's far less traumatic to the bone. So if we're differentiating, uh, arthro tunneller versus tensor, the, the biggest thing is less trauma to the bone. [3:53] Speaker 3: And it's just that simple. You're gonna have uh far more consistency with that pass and I think it's gonna lead to less frustration with those who are converting from anchors over to transosseous. Um, it's, uh, it's pretty satisfying the first time the surgeon hits that hook and pulls the suture out. They've passed the suture. Once they've done that, they feel like they've got it and they're gonna get that with uh Tensor far more than Arthur Tunneler, uh, on a given pass. [4:22] Speaker 2: Uh, Bill, any thoughts on usability? [4:25] Speaker 4: Yeah, I agree that the tunneler is uh, the arthro tunneler is a bit futzier. So like Brad was saying, occasionally you have to drill multiple times and kind of change the angle a little bit. And again, that probably kind of weakens the lateral tunnel to some degree. Um, the, the transos, uh, you, you put the all in there and it grabs the stitch. It, it does it. I mean, it works. It doesn't miss. [4:51] Speaker 4: Um, and again, that, that probably, uh, like you're saying, compacting the bone rather than drilling the bone probably increases that strength of the, or the, the, the strength of the lateral tunnel and prevents cut out. [5:04] Speaker 4: Um, the Other thing is the transos is a bit bigger. So if you have a bigger patient with a, a wider tuberosity and you really want to recreate that entire footprint, you, you have better ability to do that with Transos. The tunneler is a, a little more narrow, um, so you, you can't make uh as big of a footprint recreation as you can with the Transos. So, you know, occasionally I'll run into that with a bigger patient. [5:33] Speaker 4: Um, transits, you can get lower down on the, the lateral, uh, proximal humerus as well. [5:39] Speaker 4: Um, [5:40] Speaker 4: But especially for someone who's switching from anchors to transosseous, Transos is easier. It's less futsy, it's going to miss less. So there's, there's way less of a frustration level that's going to be there. [5:58] Speaker 2: Great. Um, [6:00] Speaker 2: Yeah, that uh. [6:02] Speaker 2: That hook, uh, on the outer shaft of the transos was designed, you know, from an amalgamation of CT database. [6:11] Speaker 2: Uh, of the, you know, average volumetric CT scan of a tuberosity. So it, it generally will, will recapitulate the, uh, surface area, you know, of, of most of, of most of the tuberosities as you allude to. ## In this course - [Previous: Incorporating Transosseous into ASCs and Insurance Coverage](https://doc.social/llms/courses/transos-expertsroundtable-discussion/incorporating-transosseous-into-ascs-and-insurance-coverage.md) - [Next: Transitioning to Transosseous at the ASC/hospital and Surgical Tips](https://doc.social/llms/courses/transos-expertsroundtable-discussion/transitioning-to-transosseous-at-the-asc-hospital-and-surgical-tips.md) - [All lessons: TransOs ExpertsRoundtable Discussion](https://doc.social/llms/courses/transos-expertsroundtable-discussion.md)