Fig 1.

Positioning and portals, (A) outside superior and (B) anterior view. The patient is placed in the lateral decubitus position with 3 to 4 kg traction in 30° abduction at the scapular plane. The standard glenohumeral portals that are used are the posterior portal, created 2 cm inferiorly and 1 to 2 cm medially to the posterior acromial corner and the anterosuperior portal (using a spinal needle outside-inside technique) created just medially to the anterolateral corner of the acromion, through the rotator interval, just distally to the intraarticular part of the long head biceps tendon (LHBT). Also, standard subacromial portals are used: anterior portal (using a spinal needle outside-inside technique), at the level of bicipital groove directed perpendicularly to the LHBT; lateral portal, located 2 to 3 cm distal to the lateral edge of the acromion passing through the deltoid muscle. Accessory portals that are usually required are the Neviaser portal (created in the superior soft spot surrounded by the clavicle anteriorly, the medial acromion, and the spine of the scapula posteriorly. The skin incision is located 1 cm medial to the medial border of the acromion) and the posterolateral portal (from a skin incision located 2 cm below the lateral edge of the acromion, slightly anteriorly to the prolongation of the posterior edge of the acromion into the subacromial bursa).