Dry Arthroscopic Excision of Dorsal Wrist Ganglion Jason Gray, M.D., Todd Zuhlke, M.D., Shane Eizember, M.D., Ramesh Srinivasan, M.D.  Arthroscopy Techniques  Volume 6, Issue 1, Pages e207-e211 (February 2017) DOI: 10.1016/j.eats.2016.09.018 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Appreciate the surgeon's and anesthesiologist's positioning relative to the patient. The patient (yellow star) is supine and once intubated the bed is turned 90° with the anesthesiologist (black star) and equipment on the nonoperative side. The surgeon (red star) stands on the operative side, in this case right, with direct access to the dorsal aspect of the wrist. The right arm is abducted 90°, and the elbow flexed to 90° with the hand in axial traction. The monitor (not pictured) is placed at the foot of the bed in the surgeon's direct line of sight. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 With the patient lying supine, the right wrist is suspended with 5 kg (approximately 10-12 lbs) of traction in a traction tower (black star). Initially, the 6R portal is identified with 22-gauge finder needle localization, identified by the red arrow. Note the dorsal ganglion (black arrow). Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 With the patient lying supine and the right wrist suspended, a skin incision is made with a No. 15 blade at the site of the 6R portal identified in Figure 1. Mosquitoes are used to spread soft tissue in a longitudinal direction parallel to the extensor tendons, identified by the red arrow. Note the dorsal ganglion (black arrow). Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 With the patient lying supine and the right wrist suspended, a blunt trochar is introduced to the wrist joint via the 6R portal, identified by the red arrow. Note the dorsal ganglion (black arrow). Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 An intra-articular view of the right wrist joint. The ganglion stalk, denoted by the red arrow, will be seen via the 6R viewing portal inserting on to the dorsal aspect of the scapholunate ligament. The carpus is denoted by the black star and the distal radius by the red star. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 With the patient lying supine, the right wrist suspended, and the arthroscope inserted in the 6R portal, an 18- or 22-gauge needle, denoted by the red arrow, is passed through the cyst into the joint at the level of the stalk. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 With the patient lying supine, the right wrist suspended, and the arthroscope inserted in the 6R portal, the shaver, denoted by the red arrow, is inserted intra-articularly directly through the cyst and stalk. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 An intra-articular view of the right wrist joint. Visual confirmation of dorsal stalk resection, red arrow, is viewed through the 6R portal. The carpus is denoted by the black star and the distal radius by the red star. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 With the patient lying supine and the right wrist suspended, clinical confirmation of cyst excision is appreciated, denoted by the red arrow. Compare to Figures 1-3, in which the ganglion was denoted by black arrows. In addition, note the absence of generalized swelling about the wrist due to lack of fluid extravasation. Arthroscopy Techniques 2017 6, e207-e211DOI: (10.1016/j.eats.2016.09.018) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions