Mini-Open Retractor System - IT Médica

Aesculap Spine

Aesculap® Mini-Open Retractor SystemSurgical Technique

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Patient Benefits1

Reduced blood lossReduced pain through minimal muscle devitalizationFaster patient recoveryShortened hospital stay

Visualization

Direct visualization to the spine greatly reduces radiation exposureMinimal learning curve due to direct visualization of the anatomical landmarks without fluoroscopic guidance

Minimal Incision

Extended exposure through minimal incision allows for improved implant placement

Versatility

Compress or distract through the Mini-Open Retractor without an additional incision

Indications

FacetectomyDecompressionDiscectomyLumbar fusionTLIF

1 „Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up“ Sanjay S. Dhall, M.D., Michael Y. Wang, M.D., Praveen V. Mummaneni, M.D., December 2008, Volume 9, Number 6, pp. 560-565, Journal of Neurosurgery: Spine.


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Example of use

A) Lumbar minimally invasive approach for facetectomy.

The Aesculap® Mini-Open Retractor System is designed to providepatients all the benefits of Minimally Invasive Surgery (MIS) whileat the same time reduce the surgeons´ learning curve and radiationexposure as compared to percutaneous surgery. When partneredwith S4® Spinal System and TSPACE® interbody fusion device, theAesculap® Mini-Open Retractor System is especially suited to provide patients the benefits of Minimally Invasive Surgery.

B) Minimally invasive approach to the lumbar spine for a posterior lumbar fusion.

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A Surgical Technique

A.1 Muscle Dilatation

A.1.1 Determination of Blade Length

A.2 Retractor Positioning

A.2.1 Cranial-Caudal Blade Assembly

A.2.2 Retractor Insertion

A.2.3 Medial-Lateral Blade Assembly

A.2.4 Final Construct

A.3 Blade Exchange

A.4 Table Fixation

A.5 Lighting

B Instrument Overview

B.1 Blade Components

B.2 Dilator Components

B.3 Retractor Components

B.4 MIS Implant Instruments

B.5 Table Stabilization

B.6 Lighting Components

C Set Configurations

C.1 Blade Set

C.2 Retractor / Dilator Set

C.3 MIS Implant Instrument Set

C.4 Mechanical Table Arm Set

C.5 Lighting Set

Content


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The cranial-caudal blades have a tubular profile and come in 16.5 mm, 20 mm and 24 mm diameters. The incremental dilatorsystem contains corresponding dilators for each blade diameter.

Dilate the spinal muscles starting with the smallest diameterdilator (ME389T) and work up to the diameter of the cranial-caudal retractor blades which are intended to use.

The dilator handle (ME394T) may be attached to each dilator if desired.

A.1 Muscle Dilatation

The dilators (ME389T – ME393T) are marked with depth indicators.The blade depth references reach from 40 mm up to 110 mm in10 mm increments.

After inserting the final dilation diameter, based on the desiredcranial-caudal blade size, reference blade length.

A.1.1 Determination of Blade Length


Before starting the blade insertion the retractor frames have tobe assembled. For this purpose, both frame racks (ME304R) needto be equipped with a corresponding right frame arm and leftframe arm. By pushing the ratchet release, the frame arms can be positioned on the frame rack. The frame configurations are asfollows:

Lower frame:• Frame Rack (ME304R)• Lower Right Frame Arm (ME302R)• Lower Left Frame Arm (ME303R)

Upper frame:• Frame Rack (ME304R)• Upper Right Frame Arm (ME300R)• Upper Left Frame Arm (ME301R)

A.2 Retractor Positioning

Select the lower frame.

Choose the correct blade length and desired diameter from thereference depth of the dilator.

Insert the cranial-caudal blades by loosening the grub screw,engaging the blades into the frame, and then tightening thegrub screw.

A.2.1 Cranial-Caudal Blade Assembly

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Note:Divide the musculotendinous attachments to the underlying boneprior the insertion of the Mini-Open Retractor System.

After attaching the cranial-caudal blades to the frame arms,the retractor is brought into a tubular position by bringing theframe arms together.

The retractor is lowered over the dilators into the wound.

The dilator handle (ME394T) can be positioned to remove thetissue dilators.

Note:Use the smallest diameter tubular retractor blades required toprovide the necessary exposure.

Lateral fluoroscopy can be used to confirm the right placementof the Mini-Open Retractor.

A.2.2 Retractor Insertion

The blades are opened slightly in the cranio-caudal orientationby rotating the keys of the retractor.

Note:Avoid over-retraction at this stage.

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The blades of the lower retractor may be flared to provide thedesired conical field of view.

Insert the arm rotator (ME380R) into the retractor frame armsand rotate the arms towards each other in an inward direction.

Note:Each blade can be adjusted independently to fine-tune the finalplacement of the retractor and to avoid under- and over-retraction. Each blade can be flared up to 30 degree, in 7.5 degree increments.

If additional medial-lateral retraction is needed, a second retrac-tor frame equipped with flat blades is nested onto the first oneat a 90 degree angle.

The medial-lateral blades of the upper retractor may be inser-ted in a similar fashion using the upper frame of the retractor.The upper retractor frame has gold anodization on the collarfor easy identification.

Note:Tilting of the medial blade allows for exposure of the lateralaspect of the lamina for decompression of the lateral recess.Tilting of the lateral blade exposes the transverse processes forposterolateral fusion.

A.2.3 Medial-Lateral Blade Assembly

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Place the upper retractor arm over the lower retractor arm andexpand and flare the upper retractor in a similar fashion as thelower retractor.

A.2.4 Final Construct

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Blade lengths and shapes may be changed in situ through the use of the blade holding instrument (ME381R).

Rotate the knob clockwise in order that the clamping arms ofthe blade removal tool get in initial position.

To remove a blade, insert the blade holding instrument intothe blade notches and rotate the knob counter-clockwise.

Loosen the grub screw of the frame arm and remove the blade.

A.3 Blade Exchange

To insert a new blade, place the new blade in the retractorarm, tighten the grub screw and rotate the blade removal knobclockwise to disengage the tool.

Note:If necessary, to release the force of the soft tissue on the retractorblades, insert the arm rotator (ME380R) into the retractor andpull back on the collar and rotate the arm to the neutral position.Re-inserting the final dilator will hold the soft tissue while theretractor blade is exchanged.

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If desired, the lower arms of the retractor can be attached tothe table arm.

Attach the fixation element (FF280R) to the operating table.

The mechanical holding arm (FF168R) is fixed to the fixationelement by sliding it into its collar.

Attach the table arm connection block (ME382R) to the retractor frame rack (ME304R).

A.4 Table Fixation

Attach table arm connection block (ME382R) to the mechanicalholding arm (FF168R) by sliding the connection block into thecollar and tighten the knob.

The Mini-Open Retractor is now attached to the table armassembly.

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If desired for additional surgical visibility, the re-sterilizablelight rod (ME421R) can be attached to the 24 mm blade usinga light clip.

• Cranial-caudal light clip (ME387R)• Medial-lateral light clip (ME388R)

Attach the re-sterilizable light rod to the flexible light cable(OP922).

Attach the light clip to the corresponding blade by pushing the clip along the guiding groove of the blade until an audiblesound is perceived.

Insert the metallic part of the re-sterilizable light rod into thelight clip.

For additional visibility, the medial blade and the medial-lateral light clip will provide the best visibility.

It is recommended whenever possible to use an Aesculap® LightSource (OP930) or similar light source rated at 300 W or less.

Note:Using a Light Source greater than 300 W will lead to excessiveheating of the light cable and connector.

A.5 Lighting

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Item No. Description Diameter x Blade Length Shape

ME342T Spyder Retractor C/C Blade 40 x 16.5 mm 16.5 x 40 mm Tubular








ME365T Spyder Retractor C/C Blade 40 x 20 mm 20 x 40 mm Tubular

















Aesculap® Mini-Open Retractor SystemInstrument Overview

Cranial-Caudal Blades

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Item No. Description Length Blade Shape

ME327T Spyder Retractor Delta Blade 40 x 7-17 mm 40 mm Delta








ME287T Spyder Retractor M/L Blade CVD 40 x 7 mm 40 mm Straight























Medial-Lateral Blades

Item No. Description

ME381R Spyder Retractor Blade Handle

Blade Removal

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Item No. Description Diameter

ME389T Spyder Retractor Tissue Dilator 6.0 mm 6 mm


ME391T Spyder Retractor Tissue Dilator 16.5 mm 16.5 mm



ME394T Spyder Retractor Tissue Dilator Handle

B.2 Dilator Components



ME304R Spyder Retractor Mini-Open Frame Rack

ME300R Spyder Retractor Upper Right Frame Arm

ME301R Spyder Retractor Upper Left Frame Arm

ME302R Spyder Retractor Lower Right Frame Arm

ME303R Spyder Retractor Lower Left Frame Arm

ME380R Spyder Retractor Frame Arm Rotator

B.3 Retractor Components

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ME299R S4® MIS Set Screw Driver

ME396R S4®/S4® Element MIS Counter Torque Tube

ME307R S4® MIS Compressor

ME308R S4® MIS Distractor

ME309R S4® MIS Counter Torque Handle

ME314R S4® MIS Set Screw Starter

ME395R S4®/S4® Element MIS Clicking Torque Wrench

B.4 MIS Implant Instruments

MIS Implant Instruments Components

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B.5 Table Stabilization


ME382R Spyder Table Arm Pivot Connection Block

FF168R Holding Arm Mech. 3 Joints RT Adapter

FF280R Adapter F/Or Table W/Ball/Socket Joint

FF169270 Silicone Pad


OP922 Light Cable, 2.5 mm Diameter, 250 cm Length

ME421R Spyder Reusable Fiber Optic Light Rod

ME387R Spyder Light Clip for Cranial-Caudal Blades

ME388R Spyder Light Clip for Medial-Lateral Blades

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B.6 Lighting Components

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Item No. Description Length Recommended Optional

ME365T 20 mm Cranial/Caudal Blade 40 mm 2








ME342T 16.5 mm Cranial/Caudal Blade 40 mm 2








*S76341 Tray for C/C Blades (16.5 and 20 mm)

C.1 Blade Set

Aesculap® Mini-Open Retractor SystemSet Configurations

Cranial-Caudal Blades (16.5 und 20 mm Diameter)










ME381R Spyder Retractor Blade Handle 2

*S76342 Tray for C/C Blades (24 mm)

Cranial-Caudal Blades (24 mm Diameter)

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ME327T 7 mm Medial/Lateral Delta Blade 40 mm 1








ME287T 7 mm Medial/Lateral Straight Blade 40 mm 1






















*S76343 Tray for Medial/Lateral Blades

C.1 Blade Set

Medial-Lateral Blades

* Recommended container for blade sets (all 3 sets together): bottom JK446 and lid JK489 (for single set): bottom JK440 and lid JK489

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ME300R Spyder Retractor Upper Right Frame Arm 1

ME301R Spyder Retractor Upper Left Frame Arm 1

ME302R Spyder Retractor Lower Right Frame Arm 1

ME303R Spyder Retractor Lower Left Frame Arm 1

ME304R Spyder Retractor Mini-Open Frame Rack 2

ME380R Spyder Retractor Frame Arm Rotator 2

ME389T Spyder Retractor TI Tissue Dilator 6 mm 1


ME391T Spyder Retractor TI Tissue Dilator 16.5 mm 1



ME394T Spyder Retractor Tissue Dilator Handle 1

*S76340 Tray for Retractor/Dilator Set

C.2 Retractor / Dilator Set

Aesculap® Mini-Open Retractor SystemSet Configurations

Item No. Description Recommended Optional

ME299R S4® MIS Set Screw Driver 1

ME396R S4® MIS Counter Torque Tube 1

ME307R S4® MIS Compressor Handle 1

ME308R S4® MIS Distractor Handle 1

ME309R S4® MIS Counter Torque Handle 1

ME314R S4® MIS Set Screw Starter 1

ME395R S4® Clicking Torque Wrench 1

*S76344 Tray for MIS Implant Instrument Set

C.3 MIS Implant Instrument Set

* Recommended container: bottom JK440 and lid JK489



ME382R Spyder Table Arm Pivot Connection Block 1

FF168R Mechanical Holding Arm 1

FF280R Flexible Fixation Element (3-D Arm Table Connector) 1

FF169270 Silicone Disc 1

*S76345 Tray for Mechanical Table Arm Set

C.4 Mechanical Table Arm Set

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OP922 Light Cable, 2.5 mm Diameter, 250 cm Length 1

ME421R Spyder Reusable Fiber Optic Light Rod 1

ME387R Spyder Light Clip for Cranial-Caudal Blades 1

ME388R Spyder Light Clip for Medial-Lateral Blades 1

*S76346 Tray for Lighting Set

C.5 Lighting Set



Aesculap AG | Am Aesculap-Platz | 78532 Tuttlingen | GermanyPhone +49 7461 95-0 | Fax +49 7461 95-2600 | www.aesculap.com

Aesculap – a B. Braun company

Subject to technical changes. All rights reserved.This brochure may only be used for the exclusivepurpose of obtaining information about ourproducts. Reproduction in any form partial orotherwise is not permitted.

The main product trademark ‘Aesculap’ andthe product trademarks ‘TSPACE’ and ‘S4’ areregistered marks of Aesculap AG.

Brochure No. O57002 0815/1/1

Mini-Open Retractor System - IT Médica

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