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Johnson & Johnson DePuy Synthes INSIGHT Lateral Access System Manual

Minimal invasive access system for the thoracolumbar spine surgical technique
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Minimal Invasive Access System for the Thoracolumbar Spine
INSIGHT™ Lateral
Access System
Surgical Technique

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Summary of Contents for Johnson & Johnson DePuy Synthes INSIGHT Lateral Access System

  • Page 1 Minimal Invasive Access System for the Thoracolumbar Spine INSIGHT™ Lateral Access System Surgical Technique...
  • Page 2 Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance...

  • Page 3: Table Of Contents

    Table of Contents Introduction INSIGHT™ Lateral Access System Description of Retractor Parts AO Spine Principles Indications and Contraindications Surgical Technique Preparation Access and Exposure Retraction Accessories Removal Product Information Cleaning Positions/Assembly Instruments Instruments for Neuromonitoring Trays and Vario Cases Bibliography INSIGHT Lateral Access System Surgical Technique DePuy Synthes...

  • Page 4: Insight™ Lateral Access System

    • Winglets to provide further 7 mm anterior/posterior soft tissue retraction • Blade extensions to provide additional 10 mm of blade length in situ • Disc anchor blade designed to increase retractor stability DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 5 Seamless Retraction: Speed nut designed for quick and fi ne adjustment of retractor opening up to 70 mm Retractor Blades: • Click-on blades for quick assembly • Blade length 40 to 180 mm Different Retraction Techniques: Various fi xation points to strong arm system are designed to enable surgeon preferred technique: • Backward retraction of third blade...

  • Page 6: Description Of Retractor Parts

    Attachment point for connector for Strong Arm for backward retraction Attachment point for connector for Strong Arm for forward retraction Right blade Third blade holder holder Left blade holder Left and right blade DePuy Synthes INSIGHT Lateral Access System Surgical Technique...

  • Page 7: Ao Spine Principles

    AO Spine Principles The four principles to be considered as the foundation for proper spine patient management underpin the design and delivery of the Curriculum: Stability – Alignment – Biology – Function. Stability Alignment sagittal Stabilization to achieve Balancing the spine in axial coronal a specifi...

  • Page 8: Indications And Contraindications

    Indications and Contraindications In case the INSIGHT Lateral Access System is used in combination with implants or instruments, please refer to the respective surgical techniques for indications and contraindications and additional surgical steps. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...

  • Page 9: Preparation

    Preparation 1. Patient Positioning Instruments 03.662.028S Electrode Kit for Neuromonitoring 03.809.942 Table Clamp for Universal Arm 03.816.800 Strong Arm 03.809.941 Universal Arm For the lateral approach, the patient is placed and taped in the lateral decubitus position as illustrated (1). Note: Ensure that the position of the operative level is perpendicular to the floor for easier orientation of...
  • Page 10 Insert the strong arm or universal arm with flat side facing away from the table (2). Secure table clamp by tightening it. Precaution: Ensure that the rotation of the strong arm or universal arm is securely locked by the table clamp. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...

  • Page 11: Access And Exposure

    Access and Exposure 1. Approach the Spine Locate and mark the correct operative level and asso- ciated incision site under lateral fluoroscopy and make a skin incision. Incision should be large enough to accom- modate the retractor and subsequent retraction. Retract the subcutaneous tissue and bluntly dissect through the abdominal muscle layers and incise the transversalis fascia to enter the retroperitoneal space (1).
  • Page 12 Map out a safe corridor through the psoas muscle to the operating level by stimulating with the neuromoni- toring probe (1). Once achieved, continue to perform a blunt dissection of the psoas muscle under direct visual control. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 13 Precaution: In addition, lateral and AP fluoroscopy should be utilized to place the neuromonitoring probe/Kirschner Wire through the psoas and into the annulus of the desired intervertebral disc space (2). In case no neuromonitoring is used, the 3.0 mm Kirschner Wire can be utilized. Precaution: Ensure the neuromonitoring probe or Kirschner Wire remains securely in position until...
  • Page 14 Keep downward pressure on the dilators until the strong arm or universal arm has been fixed to the retractor. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 15 A second stimulation probe can be placed in the dilator groove in order to check on surrounding nerve struc- tures (2). By turning the outermost dilator with a second probe in place, surrounding tissue can be monitored for presence of motoric nervous structures (3). Precaution: Do not stimulate against any instru­...

  • Page 16: Retraction

    (see chapter “Accessories, Additional Stability” instruction p. 28). Note: The disc anchor blade can only be attached to the third blade holder. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 17 Place Retractor In Zero Position: Close the retractor by releasing speed nut ( ). Return angulation of left and right blades to the zero position by turning the angulation nuts with the Screwdriver for INSIGHT Lateral Access System accordingly ( ).
  • Page 18 (from the left and right side) to avoid subsequent conflict with angulation mechanism. For the role of the different attachment options, see next page. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 19 Forward/Backward Retraction Options Retract Forward If forward retraction is desired (A), attach the connector to the third blade holder connection point. Subsequent clockwise rotation of the RETRACT nut results in forward retraction of the retractor body (with left and right blade holders) relative to the fixed third blade holder.
  • Page 20 (2). Maintain the dilators and retractor in place until the strong arm or universal arm has been fixed to the retractor. 90° DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 21 Precaution: In order to reduce tissue creep: • Retractor blades must be in zero position (3) • The retractor blades should be placed against the disc space and/or the vertebral endplates. Precaution: Use fluoroscopic images to determine the position of the retractor. Identify presence of os­ teophytes.
  • Page 22 Wire from the disc space. Note: Leave the stimulation neuromonitoring probe/ Kirschner Wire in place for orientation while open­ ing the retractor. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 23 4. Retract Forward/Backward Instrument 03.816.010 Screwdriver, for INSIGHT Lateral Access System To perform either forward or backward retraction (see A and B in chapter “Forward/Backward Retraction Op- tions” instruction p. 17), turn the RETRACT nut clockwise with the screwdriver (1). Use fluoroscopic imaging during retraction to determine and confirm the position.
  • Page 24 Retraction Release Forward/Backward Retraction To release the forward or backward retraction, push the button with corresponding laser etching PUSH (2) while turning the RETRACT nut counterclockwise using the screwdriver (3). DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 25 5. Blade Angulation Instrument 03.816.010 Screwdriver, for INSIGHT Lateral Access System If additional exposure of the surgical site is needed or if the exposure needs to be centralised around the neuro- monitoring probe/Kirschner Wire, use the screwdriver to independently angle the right or left blade and turn it in the direction of the arrow etched on the retractor (1).
  • Page 26 Repeat patient positioning and neuromonitoring steps for subsequent levels. Note: Patient position may need to be adjusted (through table adjustment) in order to perform sub­ sequent levels (see chapter “Patient Positioning”, described on p. 7). DePuy Synthes INSIGHT Lateral Access System Surgical Technique...

  • Page 27: Accessories

    Accessories Light System Instruments 03.816.080– Blade, length 80–180 mm 03.816.180 (in 10 mm increments) 03.816.700 Reusable Light, for INSIGHT Lateral Access System 03.816.705 Bifurcated Light Cable 03.816.709 Adapter, for Light and Cable 03.816.710S Disposable Light, for INSIGHT Lateral Access System, sterile 03.816.706 Light Cable 03.816.709...
  • Page 28 Accessories Reusable Light Wolf Storz Olympus ACMI Disposable Light Wolf Storz Olympus ACMI DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 29 Slide the reusable light (1) or disposable light (2) into the light slots. Secure light underneath the provided hooks. Connect the light cable to the light source. Turn on the light source. Precautions and Warnings • Do not bend fiber optic cables/lights under a radius of 5 cm.
  • Page 30 (anterior or posterior) structure damage. Always confirm the absence of nerves before insert­ ing the disc anchor. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 31 To retract the disc anchor, slide the instrument (in the disengaged position) (1) down the groove until it sits on the disc anchor component (3). Rotate the turning knob to the engaged position (coun- ter-clockwise) to engage the disc anchor component (4). Retract the disc anchor component by pulling up the instrument (5).
  • Page 32 Use the scoop with the blade extension and/or winglet to retract soft tissue. This is to reduce the risk of soft tissue damage due to com­ pression by the blade extension and winglet. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 33 The scoop is used to retract soft tissue. Glide the scoop down on the concave side of the blades to the site of tissue creep. Push the soft tissue behind the blade (5). Then slide the accessory down the respective accessory groove (6).

  • Page 34: Removal

    Before the retractor can be removed, all accessories (blade extensions and winglets) have to be removed (1), the disc anchor has to be retracted and the retractor must be placed in the zero posi­ tion. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 35 The retractor has to be placed in the zero position as follows (2): • Close the left and right blades by loosening the speed nut on the retractor body ( • Turn the angulation nuts on the left and right blade holder with the screwdriver to bring the blades back into the zero position ( ).
  • Page 36 – blade holder connection (1). Advance the sleeve for the blade removal tool until the blade is engaged (2). Alternatively, the flat spring can be compressed by hand without the sleeve. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 37 Pull the blade out (3). Retract the sleeve for the blade removal tool in order to release the blade. Disassemble the blade holders from the retractor body according to the disassembling instructions (see chapter “Cleaning Positions/Assembly” illustrated on the next page).

  • Page 38: Cleaning Positions/Assembly

    Cleaning Positions/Assembly 03.816.001 03.816.002 03.816.003 03.816.004 03.816.010 03.816.010 03.816.010 03.816.001 03.816.003 03.816.004 03.816.002 Page 1/3 DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 39 03.816.010 03.816.010 Page 2/3 INSIGHT Lateral Access System Surgical Technique DePuy Synthes...
  • Page 40 03.816.010 Page 3/3 DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 41 03.816.011 03.816.016 Page 1/2 INSIGHT Lateral Access System Surgical Technique DePuy Synthes...
  • Page 42 03.816.011 03.816.016 Page 2/2 DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 43 03.816.012 03.816.310 03.816.013 03.816.320 03.816.014 03.816.330 03.816.340 03.816.015 03.816.350 03.816.280 03.816.360 03.816.290 03.816.370 03.816.300 03.816.380 03.816.013 03.816.012 03.816.014 03.816.015 03.816.013 Page 1/3 INSIGHT Lateral Access System Surgical Technique DePuy Synthes...
  • Page 44 03.816.013 03.816.280-380 03.816.280-380 03.816.013 03.816.012 03.816.014 03.816.015 Page 2/3 DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 45 Page 3/3 INSIGHT Lateral Access System Surgical Technique DePuy Synthes...

  • Page 46: Instruments

    Universal Arm 03.809.942 Table Clamp for Universal Arm 03.816.001 Retractor Body 03.816.002 Blade Holder, left, for No. 03.816.001 03.816.003 Blade Holder, right, for No. 03.816.001 03.816.004 Third Blade Holder, for No. 03.816.001 DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 47 03.816.010 Screwdriver, for INSIGHT Lateral Access System 03.816.011 Blade Removal Tool 03.816.016 Sleeve, for Blade Removal Tool No. 03.816.011 03.816.012 Instrument for Disc Anchor Blade 03.816.013 Inner Shaft, for Instrument for Disc Anchor Blade 03.816.014 Turning Knob, for Instrument for Disc Anchor Blade 03.816.015 Push Button, for Instrument for Disc Anchor Blade...
  • Page 48 INSIGHT Lateral Access System 03.816.816 Dilator,  16 mm, eccentric, large, for INSIGHT Lateral Access System 03.816.040– Blade, length 40 mm–90 mm 03.816.090 (10 mm increments) 03.816.100– Blade, length 100 mm–180 mm 03.816.180 (10 mm increments) DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 49 03.816.280– Disc Anchor Blade for Third Blade 03.816.380 Holder, length 80 mm–180 mm (10 mm increments) 03.816.700 Reusable Light, for INSIGHT Lateral Access System 03.816.701 Wolf Adapter, for Light Source 03.816.702 Storz Adapter, for Light Source 03.816.703 Olympus Adapter, for Light Source 03.816.704 ACMI Adapter, for Light Source 03.816.705...

  • Page 50: Instruments For Neuromonitoring

    Instruments for Neuromonitoring 03.662.027S Neuromonitoring Stimulation Probe 03.662.028S Electrode Kit for Neuromonitoring 03.662.029 Handle for Neuromonitoring Stimulation Probe DePuy Synthes INSIGHT Lateral Access System Surgical Technique...

  • Page 51: Trays And Vario Cases

    Trays and Vario Cases The trays with the instruments for the INSIGHT Lateral Access System can be assembled to the needs of the surgeon. They can be stored in Vario Cases with corre- sponding height. 68.809.040 Tray, for Retractor and Dilators, (without ) for INSIGHT Lateral Access System instruments...
  • Page 52 (2 vols.), Stuttgart, New York: Thieme 3. Moro T, Kikuchi S, Konno S, Yaginuma H (2003): An Anatomic Study of the Lumbar Plexus with Respect to Retroperitoneal Endoscopic Surgery. Spine: 28 (5), pp 423–428. DePuy Synthes INSIGHT Lateral Access System Surgical Technique...
  • Page 56 Synthes GmbH Not all products are currently available in all markets. Eimattstrasse 3 4436 Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: +41 61 965 61 11 All surgical techniques are available as PDF files at Fax: +41 61 965 66 00 0123 www.depuysynthes.com...

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