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Surgical Technique

Minimal Invasive Access System for the Thoracolumbar Spine

INSIGHT™ Lateral

Access System

Summary of Contents for DePuy Synthes INSIGHT Lateral Access System

Page 1: ...Surgical Technique Minimal Invasive Access System for the Thoracolumbar Spine INSIGHT Lateral Access System...

Page 2: ...mantling 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: ...ractor Parts 4 AO Spine Principles 5 Indications and Contraindications 6 Surgical Technique Preparation 7 Access and Exposure 9 Retraction 14 Accessories 25 Removal 32 Product Information Cleaning Pos...

Page 4: ...parts are semi radiolucent alumi num for fluoroscopic visualization Radiolucent carbon ber handles to avoid interference during anterior posterior fluoroscopy Low Profile Accessories In blade embedded...

Page 5: ...Speed nut designed for quick and ne adjustment of retractor opening up to 70 mm Different Retraction Techniques Various xation points to strong arm system are designed to enable surgeon preferred tec...

Page 6: ...Attachment point for connector for Strong Arm for forward retraction Attachment point for connector for Strong Arm for backward retraction Speed nut RETRACT nut PUSH button Third blade holder Left bl...

Page 7: ...anagement underpin the design and delivery of the Curriculum Stability Alignment Biology Function 1 2 AO Spine Principles Stability Stabilization to achieve a speci c therapeutic out come Biology Etio...

Page 8: ...provide a minimally invasive ap proach to the thoracolumbar spine It is designed for needs of various indications and or surgical techniques Indications and Contraindications In case the INSIGHT Late...

Page 9: ...py and approach by confirming In lateral fluoroscopy the endplates are parallel with superimposed pedicles In A P fluoroscopy the endplates are parallel the pedicles reside in the cranial portion of t...

Page 10: ...erred side of the operat ing table by loosening it and attaching it onto the table rail Insert the strong arm or universal arm with flat side facing away from the table 2 Secure table clamp by tighten...

Page 11: ...he abdominal muscle layers and incise the transversalis fascia to enter the retroperitoneal space 1 Move the peritoneum anterior with forefinger and continue with blunt dissection to gently palpate do...

Page 12: ...order to avoid neural structures it is recommended to use triggered EMG neuromonitoring detection of motoric nerves Additionally use direct visual control detection of sensoric nerves Note With the ec...

Page 13: ...e 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 pos...

Page 14: ...on away from any sensitive structures e g posterior nerves Slide the small dilator rounded tip first over the neuromonitoring probe or Kirschner Wire in the orientation of preferred direction of dilat...

Page 15: ...ator 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 ments in the surgical field Determine...

Page 16: ...816 180 in 10 mm increments Assemble the retractor by attaching the blade holders to the retractor body see chapter Cleaning Positions Assembly p 37 Open the retractor by compressing the handles and...

Page 17: ...ation of left and right blades to the zero position by turning the angulation nuts with the Screwdriver for INSIGHT Lateral Access System accordingly 2 Set the third blade to zero position by pushing...

Page 18: ...19 Wrench for INSIGHT Lateral Access System Attach connector to the respective point on the retractor A or B see next page and tighten with the Screwdriver or wrench depending on tightening preference...

Page 19: ...ward retraction of the retractor body with left and right blade holders relative to the fixed third blade holder or Retract Backward If backward retraction is desired B attach the connec tor to either...

Page 20: ...e dilators Note The handles of the retractor can be placed either anterior or posterior depending on surgeons preference Retraction Use fluoroscopic imaging to determine the position of the retractor...

Page 21: ...es to determine the position of the retractor Identify presence of os teophytes Do not apply excessive force when insert ing retractor Attach Retractor to Strong Arm or Universal Arm Attach connector...

Page 22: ...essing the handles and turning the speed nut 1 Use fluoroscopic images to determine the position of the retractor Remove the dilators Use caution when removing the dilators so as not to dislodge the p...

Page 23: ...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 an...

Page 24: ...ystem Surgical Technique 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 counter...

Page 25: ...on the retractor 1 Use fluoroscopic imaging during change of angulation to determine the position of the blades In order to reduce the angulation turn the screwdriver in the other direc tion Remove t...

Page 26: ...move the retractor see chapter Removal p 32 Repeat patient positioning and neuromonitoring steps for subsequent levels Note Patient position may need to be adjusted through table adjustment in order t...

Page 27: ...or 03 816 710S Disposable Light for INSIGHT Lateral Access System sterile 03 816 706 Light Cable 03 816 709 Adapter for Light and Cable Optional 03 816 701 Wolf Adapter for Light Source 03 816 702 Sto...

Page 28: ...16 DePuy Synthes INSIGHT Lateral Access System Surgical Technique Accessories Reusable Light Wolf Storz Olympus ACMI Disposable Light Wolf Storz Olympus ACMI...

Page 29: ...the light output level Do not use higher wattage than indicated for the light cables and reusable light 300 W Depending on light source temperature of the light cables and or adapters may exceed 43 C...

Page 30: ...a common blade Assemble the instrument for disc anchor blade see chapter Cleaning Positions Assembly p 42 When inserting the assembled instrument into the disc anchor blade ensure that it is in the d...

Page 31: ...clockwise to engage the disc anchor component 4 Retract the disc anchor component by pulling up the instrument 5 Disengage the instrument by turning the knob to the disengaged position clockwise 6 Pr...

Page 32: ...creep a blade extension can be used with the accessories instru ment 1 The blade extension provides an additional 10 mm in blade length 2 To reduce lateral tissue creep winglets can be used Each wingl...

Page 33: ...the scoop counterclockwise 7 into the retractor opening until it no longer resides behind the blade and can be removed Unscrew the accessories instrument from the extension Precaution Do not repositio...

Page 34: ...03 816 014 Turning Knob for Instrument for Disc Anchor Blade 03 816 015 Push Button for Instrument for Disc Anchor Blade Switch off the light source and remove the light Then remove retract all remai...

Page 35: ...t and right blade holder with the screwdriver to bring the blades back into the zero position 2 Turn in the opposite direc tion of the etched arrows Push the button etched with PUSH while turning the...

Page 36: ...w driver or wrench by turning counterclockwise For cleaning reprocessing and storage disassemble the blades from the retractor using the blade removal tool Assemble the sleeve for blade removal tool o...

Page 37: ...3 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...

Page 38: ..._483199 AD 08 2017 03 816 001 03 816 002 03 816 003 03 816 004 2 1 1 1 2 1 2 03 816 010 03 816 010 3 3 4 4 03 816 010 2 1 03 816 001 03 816 004 03 816 002 03 816 003 Cleaning Positions Assembly 33 DeP...

Page 39: ...1 2 3 4 5 1 1 1 1 3 4 2 2 03 816 010 1 Page 2 3 Synthes GmbH 2017 All rights reserved SE_483199 AD 08 2017 1 3 4 2 03 816 010 INSIGHT Lateral Access System Surgical Technique DePuy Synthes 33...

Page 41: ...1 2 3 4 Synthes GmbH 2017 All rights reserved SE_507887 AB 08 2017 03 816 011 03 816 016 Page 1 2 03 816 011 03 816 016 INSIGHT Lateral Access System Surgical Technique DePuy Synthes 33...

Page 43: ...16 300 Synthes GmbH 2017 All rights reserved SE_494480 AD 08 2017 03 816 310 03 816 320 03 816 330 03 816 340 03 816 350 03 816 360 03 816 370 03 816 380 1 3 2 2 03 816 013 03 816 012 03 816 015 03 81...

Page 44: ...Synthes GmbH 2017 All rights reserved SE_494480 AD 08 2017 1 2 03 816 013 1 03 816 280 380 03 816 013 03 816 012 03 816 015 03 816 014 03 816 280 380 44 DePuy Synthes INSIGHT Lateral Access System Su...

Page 46: ...Technique Instruments 03 809 941 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...

Page 47: ...ateral Access System 03 816 010 Screwdriver for INSIGHT Lateral Access System 03 816 013 Inner Shaft for Instrument for Disc Anchor Blade 03 816 012 Instrument for Disc Anchor Blade 03 816 019 Wrench...

Page 48: ...m eccentric medium for INSIGHT Lateral Access System 03 816 040 Blade length 40 mm 90 mm 03 816 090 10 mm increments 03 816 036 Winglet right 03 816 806 Dilator 6 mm eccentric small for INSIGHT Latera...

Page 49: ...T Lateral Access System sterile 03 816 280 Disc Anchor Blade for Third Blade 03 816 380 Holder length 80 mm 180 mm 10 mm increments 03 816 703 Olympus Adapter for Light Source 03 816 702 Storz Adapter...

Page 50: ...T Lateral Access System Surgical Technique 03 662 029 Handle for Neuromonitoring Stimulation Probe 03 662 027S Neuromonitoring Stimulation Probe 03 662 028S Electrode Kit for Neuromonitoring Instrumen...

Page 51: ...es without for INSIGHT Lateral Access System instruments 68 809 041 Tray for Blades and Scoop without for INSIGHT Lateral Access System instruments 68 809 042 Tray for Accessories and Blades without l...

Page 52: ...Webb JK 1998 AO ASIF Principles in Spine Surgery Berlin Springer 2 Aebi M Arlet V Webb JK 2007 AOSPINE Manual 2 vols Stuttgart New York Thieme 3 Moro T Kikuchi S Konno S Yaginuma H 2003 An Anatomic S...

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Page 56: ...es com Not all products are currently available in all markets This publication is not intended for distribution in the USA All surgical techniques are available as PDF files at www depuysynthes com i...

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