technique guide - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/mobile/synthes north...

Instruments and implants approved by the AO Foundation

Insight Access Tube Set. Minimallyinvasive access system.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

Insight Access Tube Set 2

AO Principles 3

Preparation 4

Surgical Technique 5

Set List 12

Image intensifier control

Synthes

Insight Access Tube Set. Minimally invasive access system.

The Insight Access Tubes allow an open procedure to be accomplished in minimal space with reduced tissue damage.

The system can be used to perform discectomies, laminectomiesand interbody fusion procedures.

Tubes– Radiolucent aluminium tubes allow visualization of bony

anatomy and disc space– Large selection of tube diameters and lengths provide

direct minimal access to operative level– Table-mounting point increases the tube stability to OR table

Lighting option– Bifurcated light clip provides illumination and reduces

shadows in surgical field

Additional retractor systems– Insight Access Retractor System, refer to technique guide

for use

2 Synthes Insight Access Tube Set Technique Guide

Synthes 3

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 andfusion of the spine are the same. A specific goal in the spineis returning as much function as possible to the injured neural elements.2, 3

AO Principles

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


Required sets

01.612.100 MIS Support System

01.615.101 Insight Access Tube Set

01.809.011 Dilation Instrument Set

Required Instruments

03.612.031 Fiber Optic Light Cable

03.615.132S Light Clip, sterile, for Insight Access Tubes

Optional set

01.615.100 Insight Access Retractor Set

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

Note: Two flex arms may be used simultaneously on the flex arm bridge for bilateral approaches.

Table mounting is very important for facilitating work througha tubular access system. It is recommended to always use thetubes in combination with the Synthes MIS Support System,which securely fixes the tubes to the OR table.

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

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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; theincision length should match the respective tube diameter(16–28 mm). Cut through the subcutaneous tissue andmake a fascial incision of the same length.

Position a Kirschner wire in the incision and advance it carefully while controlling the position under radiographicimaging. Fix the Kirschner wire in the bony structure wherethe minimally invasive 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.


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)

03.610.005 Dilator, 22.0 mm/19.0 mm (green)

03.610.006 Dilator, 25.0 mm/22.0 mm (orange)

03.610.007 Dilator, 28.0 mm/25.0 mm (blue)

Insert the 10.0 mm/1.8 mm dilator (light blue) over theKirschner wire. Continue to dilate the incision by inserting sequentially larger dilators, to obtain the required diameter.

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

Surgical Technique

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3Select tube

Instruments

03.615.163– Insight Access Tubes, 16 mm03.615.169 30 mm–90 mm lengths





Optimal instruments


03.612.031 Fiber Optic Light Cable

Choose the correct tube length according to the depth ofthe last dilator. The etched ring marks indicate the depth ofthe tube.

Use the shortest allowable tube to access the posterior bonystructures of the spine for uncompromised instrument mobility.


4Insert tube

Insert the selected tube over the last dilator and push down.

Place the tube with the Hudson connecter directed away fromthe surgeon. This maximizes the working area and visibility.

Surgical Technique

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5 Connect tube to flex arm

Connect the tube with the flex arm by pulling back the coupling on the flex arm and aligning the flats of the tube’sHudson connector to the slot of the flex arm. The tube snaps into the flex arm.

Position the tube in the desired working position and hold it in place. Turn the tension knob on the flex arm until it is secured.

To reposition the tube, release the flex arm tension by loosening the tension knob. Place the tube in the desired position, then retighten the tension knob.

Surgical Technique


6Remove K-wires and dilators

After securing the tube with the flex arm, the K-wire anddilators can be removed.

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7Insert tube light clip (optional)

Slide the light clip over the neck of the tube until it snapsinto position. Insert the light clip cable into the end of thefiber optic cable. Turn on the light source

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

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

Insight Access Tube Set (01.615.101)


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

Graphic Case

60.615.101 Graphic Case, for Insight Access Tubes

InstrumentsInsight Access Tubes, 16 mm

Length (mm) Length (mm)

03.615.163 30 03.615.167 70

03.615.164 40 03.615.168 80

03.615.165 50 03.615.169 90

03.615.166 60

Insight Access Tubes, 19 mm


03.615.193 30 mm 03.615.197 70 mm

03.615.194 40 mm 03.615.198 80 mm

03.615.195 50 mm 03.615.199 90 mm

03.615.196 60 mm



03.615.223 30 mm 03.615.227 70 mm

03.615.224 40 mm 03.615.228 80 mm

03.615.225 50 mm 03.615.229 90 mm

03.615.226 60 mm

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Required set/ instrument

01.809.011 Dilation Instrument Set

01.612.100 MIS Support System (contains 03.612.031Fiber Optic Light Cable)


Optional set

01.615.100 Insight Access Retractor Set



03.615.253 30 03.615.257 70

03.615.254 40 03.615.258 80

03.615.255 50 03.615.259 90

03.615.256 60



03.615.283 30 mm 03.615.287 70 mm

03.615.284 40 mm 03.615.288 80 mm

03.615.285 50 mm 03.615.289 90 mm

03.615.286 60 mm

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 J9681-A

www.synthes.com

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