AM: Describe the evolution of your commitment to orthopaedics.
DR. GUANCHE: It has moved from originally open, big cases to more and more arthroscopic and limited incision surgeries.

AM: Describe the evolution of your commitment to patient positioning.
DR. GUANCHE: Along with the move to less incisions, we need to be more precise with patient positions, where the leg or arm sit and we need access to the entire extremity, as it moves. We can’t just prep one area of the body, we need the whole extremity to be visible.

AM: Here’s a quote used to describe you: “Constantly striving to innovate, and make procedures less invasive, with smaller incisions, less pain, and shorter down-time. He is committed to advancing his field of specialty, and has two orthopaedic device patents to his name.”

What drives your interest in innovation and developing new devices? (related to patient positioning and surgical tools)
DR. GUANCHE: Less pain, quicker mobility for patients, and ultimately a patient happier with their outcomes. This makes my job a lot more rewarding.

AM: You have been using the Allen® Intraoperative Arm Positioner™, what problems does it solve for you?
DR. GUANCHE: Access to the extremity while freeing up one of my hands or arms to move and use during the procedure.

AM: What are the advantages of the Allen Arm Positioner? How does it improve the surgical outcome?
DR. GUANCHE: With the ability to position the extremity in the perfect position and keep it there, the surgery time can be quicker with fewer struggles. Ultimately, if we are able to accomplish the case in less time with less trauma from having to reposition the extremity there is less soft tissue swelling
and quicker recovery from the patient.

AM: What are some of the patient positioning challenges you face and how does the Allen positioner improve ease of positioning, surgical time and outcome, and patient safety?
DR GUANCHE: In total shoulder exposures, there typically is a struggle in preparing the joint for implantation of the new parts. It will typically take at least two hands to accomplish this because of the way the arm has to be rotated and pushed in one direction or the other. The Allen takes out a pair of hands and allows those hands to move instruments and actually help the surgeon with the case, rather than be static for exposure of the area the surgeon needs to see. This is true, in general, in just about any open shoulder exposure.
In arthroscopy, often the surgeon is moving instruments in and out of the joint, while the assistant is holding the scope. Sometimes, the extremity needs to be moved or positioned just right. In these cases, the assistant needs to do the positioning and isn’t able to help with the scope, making the surgeon do that with one hand and to keep working with the other hand. With the Allen, the extremity can be frozen in place while we accomplish this without giving up any of the helping hands that should be available.

AM: How does the Allen Intraoperative Arm Positioner improve the surgical teamwork; i.e. what duties can your PA’s now perform now that they are freed up from having to hold the patient’s arm?
DR. GUANCHE: As I mentioned above, it frees up the PA to use their hands more effectively, taking the positioning out the equation.

AM: What procedures do you perform utilizing the Allen Intraoperative Arm Positioner?
DR. GUANCHE: I have done several total shoulders with the device, however I have also used it for open shoulder surgeries such as rotator cuff. In other joints, I have used it for elbow arthroscopy.

AM: As one of only a small group of surgeons in the country who perform reverse total shoulders, would you use the Allen device in this procedure?
DR. GUANCHE: Absolutely, it helps immensely in the exposure and preparation of the joint for implantation.

AM: Can you cite in detail a case or specific procedure where the surgical outcome was most improved in using the Allen Intraoperative Arm Positioner?
DR. GUANCHE: The best example is where you are doing a total or reverse total with the device and one assistant. In preparation of the glenoid, there is always a struggle with the exposure and trying to have your assistant not only hold the arm in the right spot, but also have their hands in the wound helping with retraction. With the Allen, the device frees up the assistants arms and hands to be more effective with the actual exposure and retraction.

AM: Please describe your experience using the Allen Intra-operative Arm Positioner for an Elbow Scope. Did you experience increased access to the surgical site?
DR. GUANCHE: Yes, better access to the front and the back of the elbow.

AM: Would you recommend using the device for this procedure in the future?
DR. GUANCHE: Yes, I use it all the time now when I do an elbow scope.