Technique Guidesynthes.vo.llnwd.net/o16/Mobile/Synthes North America... · 2011-10-05 · AO Principles 4 Preparation ... sterile, for Insight Access Retractor ... Refer to the technique

Instruments and implants approved by the AO Foundation

Insight Access Retractor System.Minimally invasive access for theposterior thoracolumbar spine.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

Insight Access Retractor System 2

AO Principles 4

Preparation 5

Surgical Technique 6

Instruments 16

Set List 18

Image intensifier control

Synthes

Insight Access Retractor System. Minimally invasive access for the posterior thoracolumbar spine.

The Insight Access Retractor System allows access for decompression and fusion through a minimally invasive approach.

Retractor– Versatile blade configurations and large selection of blades

provide direct minimal access to operative level (Figure 1) – Radiolucent aluminum blades and arms allow visualization

of bony anatomy and disc space– Numerous table-mounting points increase the retractor

stability to OR table (Figure 2)– Release button returns retractor to parallel position quickly

(Figure 3)

2 Synthes Insight Access Retractor System Technique Guide

Table-mounting points

Releasebutton

Figure 3

Figure 2

Figure 1

Synthes 3

Retractor handles– Permit cranial /caudal and medial / lateral blades to

independently angulate up to 30° for additional access(Figure 4)

– Available in two angles to accommodate varying patientanatomy

Lighting option– Light clip illuminates the surgical field (Figure 5)

Additional retractor systems– Insight Access Tube Set, refer to technique guide for use

Figure 5

Figure 4

Retractor handleRetractor handle,shallow angle

AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.¹ They are:– Anatomic reduction – Stable internal fixation – Preservation of blood supply – Early, active mobilization

The fundamental aims of fracture treatment in the limbs and fusion of the spine are the same. A specific goal in thespine is returning as much function as possible to the injuredneural elements.2, 3


1. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger. Manual of InternalFixation, 3rd Edition. Berlin; Springer–Verlag. 1991.

2. Ibid. 3. M. Aebi, J.S. Thalgott, J.K. Webb. AO ASIF Principles in Spine Surgery. Berlin;

Springer–Verlag. 1998.

Preparation

Synthes 5

Preparation

Required sets

01.612.100 MIS Support System

01.615.100 Insight Access Retractor Set

01.809.011 Dilation Instrument Set

Required instruments

03.612.031 Fiber Optic Light Cable

03.615.004S Light Clip, sterile, for Insight Access Retractor

Optional set

01.615.101 Insight Access Tube Set

Refer to the Insight Access Tube Set Technique Guide for use.

Refer to the MIS Support System Assembly Guide for assemblyand use of MIS support components.

Surgical Technique


1Approach

Instrument

02.809.001 1.6 mm Kirschner Wire

The minimally invasive approach uses a paramedian incisionmade through the skin and fascia. This allows muscle splittingwithin the multifidus and longissimus cleavage plane.

Determine the location of the skin incision using anatomiclandmarks or radiographic imaging. Create an incision; thencut through the subcutaneous tissue and make a fascial incision.

Position a Kirschner wire in the incision and advance it carefullywhile controlling the position under radiographic imaging.Fix the Kirschner wire in the bony structure where the minimallyinvasive procedure is planned.

Warning: Ensure Kirschner wires remain securely positionedthroughout the entire procedure. The tip of the Kirschnerwire should be monitored by radiographic imaging to ensureit does not slip off the bony structures (e.g., facet joint) andpenetrate the dura or nerve root.

3Determine length of cranial/caudal blades

Use the dilator to determine the length of the cranial /caudalblades required, by observing the depth measurement on thedilator at skin level.

Synthes 7

2Dilate incision

Instruments

03.610.001 Dilator, 10.0 mm/1.8 mm (light blue)

03.610.002 Dilator, 13.0 mm/10.0 mm (yellow)

03.610.003 Dilator, 16.0 mm/13.0 mm (white)

03.610.004 Dilator, 19.0 mm/16.0 mm (violet)

Insert the 10.0 mm/1.8 mm (light blue) dilator over theKirschner wire. Continue dilation placing the 13.0 mm/10.0 mm(yellow) dilator over the dilator, 10.0 mm/1.8 mm dilator.Continue with sequential dilation until insertion of the 19.0 mm/16.0 mm dilator.

The retractor has a starting diameter of 19 mm and will fitover the 19.0 mm/16.0 mm dilator.

Warning: Ensure the Kirschner wire does not slip out beforethe retractor is in place. The Kirschner wires are long enoughto be held in place by hand during soft tissue dilation.

Surgical Technique

4Assemble cranial/caudal frame and blades

Instruments

03.615.100 Retractor Frame, cranial /caudal

03.615.300– Retractor Blades, cranial /caudal,03.615.390 left, 40 mm–100 mm

03.615.400– Retractor Blades, cranial /caudal,03.615.490 right, 40 mm–100 mm

Optional instrument



Attach the selected cranial /caudal blades to the cranial /caudalretractor frame as shown below.

Note: Blades are etched with the letters L or R for left andright orientation, and should match up with the L or R etchings on the retractor frame.


5Insert cranial/caudal frame

Insert the cranial /caudal frame over the dilators and into theincision. Remove the dilators once the frame is inserted.

Synthes 9

Surgical Technique

6Expand cranial/caudal retractor frame

Use the knob to expand the retractor frame. Ensure theswitch on the frame is in the locked position.

Warning: If it is not possible to expand the retractor, ensurethe skin and fascia incision is large enough and the switch isin the locked position.


KnobFrame switch

ProtrusionProtrusion7Insert retractor light clip (optional)



Place the blue circle on the light clip over the protrusion ofthe cranial retractor frame. Pull the light clip until it snapsinto the protrusion.

Insert the light clip cable into the end of the fiber optic lightcable. Turn on the light source.

Synthes 11

03.615.005

Figure 2

Figure 1

Figure 3

03.615.003

Release button

8Toe cranial/caudal retractor blades

Instrument

03.615.003 Retractor Handle

03.615.005 Retractor Handle, shallow angle

Attach either the retractor handle or shallow angle retractorhandle to toe the cranial /caudal retractor blades (Figure 1).The blades can toe to an angle of 10°, 20° or 30° (Figure 2).

Notes:Press button to release toe angle position.

Retractor handle available in two angles to accommodatevarying patient anatomy (Figure 3).

Warning: If it is not possible to toe the blade, ensure theskin and fascia incision is large enough.

Use of excessive force to toe the retractor blade can lead toblade damage and failure.

10Assemble medial/ lateral frame and blades

Instruments

03.615.002 Retractor Frame, medial / lateral

03.615.500– Retractor Blade, medial / lateral,03.615.590 narrow, 40 mm–110 mm

03.615.600– Retractor Blade, medial / lateral,03.615.690 wide, 40 mm–110 mm

Select medial / lateral blades and assemble the medial / lateralframe.

Note: Each length has both a wide and narrow selection.A shorter length blade is usually required at the midline dueto patient anatomy.

Surgical Technique

9Connect frame assembly to table mount

Connect the cranial /caudal frame to the flex arm and removethe retractor handles.


Flex arm

11Insert medial/ lateral frame

Insert the medial / lateral frame into the cranial /caudal frameand into the incision.

Synthes 13

13Final assembly

Connect the medial / lateral frame to a flex arm, if desired. Remove the retractor handles.

Perform the procedure (laminectomy, discectomy, etc.), usinginstruments through the retractor blades.

Refer to the technique guide of the chosen system for thesurgical technique.

Surgical Technique

12Expand and toe medial/ lateral retractor frame

Expand the medial / lateral frame to the desired length andattach retractor handles to toe the blades.

Note: Press the button to release the toe angle position.

Warning: If it is not possible to expand the retractor or toethe blade, ensure the skin and fascia incision is large enough.Ensure the switch is in the locked position.

Use of excessive force to toe the retractor blade can lead toblade damage and failure.


Release button

14Handheld retraction (optional)

Assemble a medial / lateral blade onto a retractor handle. This assembly will act as a handheld retraction instrumentand will aid in providing medial / lateral tissue retraction when necessary.

Synthes 15

Instruments

03.615.002 Retractor Frame, medial / lateral

03.615.003 Retractor Handle


03.610.008 Dilator, 19 mm



Retractor Blades, cranial /caudal, right03.615.440 40 mm03.615.450 50 mm03.615.460 60 mm03.615.470 70 mm03.615.480 80 mm03.615.490 90 mm03.615.400 100 mm

Retractor Blades, medial / lateral, narrow03.615.540 40 mm03.615.550 50 mm03.615.560 60 mm03.615.570 70 mm03.615.580 80 mm03.615.590 90 mm03.615.500 100 mm03.615.510 110 mm

Synthes 17

Retractor Blades, cranial /caudal, left03.615.340 40 mm03.615.350 50 mm03.615.360 60 mm03.615.370 70 mm03.615.380 80 mm03.615.390 90 mm03.615.300 100 mm

Retractor Blades, medial / lateral, wide03.615.640 40 mm03.615.650 50 mm03.615.660 60 mm03.615.670 70 mm03.615.680 80 mm03.615.690 90 mm03.615.600 100 mm03.615.610 110 mm

Insight Access Retractor Set (01.615.100)

Graphic Case60.615.100 Graphic Case, for Retractor

Instruments03.615.002 Retractor Frame, medial / lateral

03.615.003 Retractor Handle, 2 ea.


03.610.008 Dilator, 19 mm


Retractor Blades, cranial /caudal, left, 2 ea.

03.615.340 40 mm

03.615.350 50 mm

03.615.360 60 mm

03.615.370 70 mm

03.615.380 80 mm

03.615.390 90 mm

03.615.300 100 mm

Retractor Blades, cranial /caudal, right, 2 ea.

03.615.440 40 mm

03.615.450 50 mm

03.615.460 60 mm

03.615.470 70 mm

03.615.480 80 mm

03.615.490 90 mm

03.615.400 100 mm


Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer tohttp://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htmor to the below listed inserts, which will be included in the shipping container:– Processing Synthes Reusable Medical Devices—Instruments, Instrument Trays

and Graphic Cases—DJ1305– Processing Non-sterile Synthes Implants—DJ1304

Retractor Blades, medial / lateral, narrow, 2 ea.

03.615.540 40 mm

03.615.550 50 mm

03.615.560 60 mm

03.615.570 70 mm

03.615.580 80 mm

03.615.590 90 mm

03.615.500 100 mm

03.615.510 110 mm

Retractor Blades, medial / lateral, wide, 2 ea.

03.615.640 40 mm

03.615.650 50 mm

03.615.660 60 mm

03.615.670 70 mm

03.615.680 80 mm

03.615.690 90 mm

03.615.600 100 mm

03.615.610 110 mm

Required Set/ Instrument01.612.100 MIS Support System (contains 03.612.031

Fiber Optic Light Cable)

01.809.001 Dilation Instrument Set


Optional Set

01.615.101 Insight Access Tube Set

Synthes 19

Synthes Spine1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2011 Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 2/11 J9680-A

www.synthes.com

Documents

Technique Guidesynthes.vo.llnwd.net/o16/Mobile/Synthes North America... · 2011-10-05 · AO Principles 4 Preparation ... sterile, for Insight Access Retractor ... Refer to the technique