Introduction - Symmetry Surgical GREENBERG Manual De Instrucciones

Introduction

by l.M. Greenberg, M.D.
Since its introduction in 1975, the GREENBERG Retractor and Handrest
System has been most frequently used in conjunction with the Gardner
Headrest as a support base. Many surgeons, however, prefer to use the
Symmetry Surgical™ Skull Clamp because of its mechanical advantages.
The GREENBERG System is a set of instruments which surrounds the
operative site. First are a pair of 6 inch (15.2 cm) long, steel primary bars,
0.5 inch (1.3 cm) in diameter, with clamps for attachment to the headrest.
Longer secondary bars, 12 inches (30.5 cm), are then clamped to either the
primary bars or to each other. FLEXBAR™ Retractor Arms are attached to
these secondary bars and serve to support and position various instru-
ments, including handrests, retractor blades, suctioning devices, dissectors,
scissors, or drills. Most recently the increasingly sophisticated manner in
which this system is used has lead to the practice of conceptualizing three
progressively-higher levels of instruments, based upon function.
Level I (Figure 1)
This is the level at which the system is attached to either the headrest or
the railing of the operating room table and is the physical foundation of the
system. The function at this level is to create a stable perimeter about the
operative field for mechanical support of normally hand-held instruments.
The surgical tasks at this level consist primarily of retraction, dissection
and suction.
Level II (Figure 2)
This level has one function—handrests for surgeon support.
Level III (Figure 3)
Structurally, Level lll consists of a network of flexible arms on which other
instruments will be supported above the handrests and kept in or near the
operative site during surgery. The functions at this level are dictated by the
specific instruments chosen. These instruments are referred to as
"instruments of action."
In creating new instruments, I have kept in mind the need to perform a sur-
gical procedure with greater ease and control, while using a lesser amount
of physical effort, and being more independent from operating room person-
nel. These instruments and instructions for their use are presented in this
manual. Proper utilization of these instruments will permit both physical and
conceptual order: physically, by compartmentalizing instrument structure
into levels; and conceptually, by assigning specific tasks to those levels.
Description
The GREENBERG Retractor and Handrest System provides a means for
self-retaining retraction, support of the surgeonʼs hands, and support of
instrumentation during neurosurgery. It must be used with either a
Symmetry Surgical Skull Clamp, catalog no. 19-1042 or 19-1043* , or a
Gardner Skull Clamp, catalog no. 19-1020, for cranial procedures.
Indications
The GREENBERG Retractor and Handrest System is indicated for self-
retaining retraction, support of the surgeonʼs hands, and support of surgical
instruments.
Contraindications
The GREENBERG Retractor and Handrest System is not designed, sold,
or intended for use except as indicated.
WARNING
Failure to read and follow instructions in this manual may lead to device
malfunction, which could result in patient injury or death.
CAUTIONS
RESET THE DRAWBAR TO ZERO AFTER EACH USE of the FLEXBAR
Arms. Do not store or sterilize FLEXBAR Arms while under tension. See
the "Care and Maintenance" section of this instruction manual for preventive
maintenance.
Forcing FLEXBAR Arms to move against preset tension can cause the
cable to wear and possibly break, and the ball joints to become scored
causing FLEXBAR Arms to drift. See the "Care and Maintenance" section
of this instruction manual for preventive maintenance.
*Symmetry Surgical no longer sells Symmetry Surgical Skull Clamps.
S.indd
500-1500-85-L-IN 3
The GREENBERG Neurosurgical Retractor System
GREENBERG Primary Bar, Figure 4, attaches to skull clamp.
Catalog no. 50-1507
The GREENBERG Primary Bar is the base of the GREENBERG Retractor
System. The primary bar is attached to the skull clamp by turning the vise
(A) counterclockwise until the opening (B) is sufficient to surround the base
or arms of the skull clamp.
GREENBERG Secondary Bar, Figure 5, attaches to primary bar.
Catalog no. 50-1508
The GREENBERG Secondary Bar is used to construct the framework on
which retraction, handrests, and instruments of action are attached. The
secondary bars attach to the primary bars and to each other by means of
a vise grip (A).
GREENBERG Floating Secondary Bar, Figure 6, attaches to primary
or secondary bar, or short coupler.
Catalog no. 50-1516
The GREENBERG Floating Secondary Bar is used in the same way as the
GREENBERG Secondary Bar; however, the floating secondary bar incorpo-
rates a universal joint (A) enabling conical adjustment of the angle of the
bar. The vise clamp of the floating secondary bar (B) mounts onto the
primary or secondary bar, or short coupler. It can also be mounted onto a
flat metal edge of up to 0.50 in. (1.3 cm) thickness.
Turning the universal joint adjustment lever (C) counterclockwise permits
adjustment of the rod. To stabilize the rod in the desired position, turn the
joint lever clockwise until tightened. The slot in the collar of the universal
joint permits 90° positioning of the floating secondary bar while maintaining
stability. The joint lever is usually positioned upward for the convenience of
the surgeon.
See assembly instructions for using the GREENBERG Floating Secondary
Bar in conjunction with the Symmetry Surgical Skull Clamp.
NOTE: Floating secondary bars are not supplied with the GREENBERG
Universal Retractor and Handrest Kit, and must be ordered separately; see
"Ordering Information" section of this instruction manual.
GREENBERG Long Retractor Arm, 9 inches (22.9 cm) long, attaches
to primary or secondary bar.
Catalog no. 50-1509
GREENBERG Short Retractor Arm, 6 inches (15.2 cm) long, attaches
to primary or secondary bar.
Catalog no. 50-1511
The GREENBERG Retractor Arm, Figure 7, is a FLEXBAR Arm which can
be locked in various positions. A mini-vise (A) at one end of the retractor
arm holds all sizes of GREENBERG retractor blades. A clamp located at
the other end attaches the retractor arm to either a primary or secondary
bar. A tension-setting knob positions the retractor arm. To position the
retractor arm, turn the tension-setting knob counterclockwise until the
retractor arm becomes limp. Position the retractor arm as desired, then turn
the tension-setting knob clockwise to tighten. For minor adjustments to the
retractor arm, loosen the tension-setting knob slightly. Reposition the retrac-
tor arm, then tighten the knob. NOTE: When retractor blades are set in the
field and subtle positioning is needed, no change in tension or readjustment
of the knob is necessary.
CAUTION: Forcing the FLEXBAR Arm to move against preset tension can
cause the cable to fray and eventually break. Also, the ball joints can
become scored causing the FLEXBAR Arm to drift. See "Care and
Maintenance" section of this instruction manual for preventive maintenance.
GREENBERG Microinstrument Holder, Figure 8, attaches to secondary
or floating secondary bar.
Catalog no. 50-1529
The GREENBERG Microinstrument Holder is a FLEXBAR Arm used to
support continuous suction and those microinstruments used repeatedly
within the retracted field. Secure the microinstrument at a point along its
shaft in the maxi-vise (A) or, preferably, secure the microinstrument at its
handle so that the microinstrument holder is out of the field, preventing
obstruction of the surgical field.
Refer to "GREENBERG Long/Short Retractor Arm" for
positioning instructions.
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