Marc Verhoeven died three days after an arthroscopic rotator cuff repair at St Vincent's Private Hospital in 2011.

The former New Zealand provincial rugby representative was a regular gym goer and incredibly fit, even going to the gym the morning of his surgery, the court was told.

A friend who was a doctor had recommended the common operation because Mr Verhoeven was suffering problems with his shoulder.

Rather than being operated on while lying flat, the 50-year-old father was in the "beach chair position" and was sitting upright at a 40-70 degree angle.

This gave his surgeon, Dr Simon Tan, and anaesthetist, Dr Emma Halliday, better access to the shoulder muscles.

However the position increases the risk of a significant drop in blood pressure and heart rate, the counsel assisting the coroner, Kirsten Edwards, said.

An autopsy revealed he died from a "massive catastrophic stroke on the operating table because [there was] not enough oxygen getting to the brain," Ms Edwards said.

He never woke up from the surgery and died three days later.

The inquest was told it was rare for anybody to have a stroke in the beach chair position but patients can suffer inadequate cerebral blood flow unless closely monitored.

Mr Verhoeven also suffered from high blood pressure.

One focus of the inquest will be the conduct of Dr Halliday including "how she monitored his heart rate and blood pressure and her responses to different blood pressure and heart rate during the operation," Ms Edwards said.

Since Mr Verhoeven's death, St Vincent's Hospital has introduced new guidelines for surgery in the beach chair position.

However the inquest will examine whether those changes go far enough and whether all hospitals should adopt similar guidelines, Ms Edwards said.

"For such a young, fit, healthy man undergoing such a routine surgery, it was a terrible shock," she said.

Mr Verhoeven's mother, Margaret and two sisters, Tanya and Joanna, described him as "a star at everything he turned his hand to". The inquest continues.