Care And Maintenance; References - Symmetry Surgical GREENBERG Manual De Instrucciones

The key is the concept of the surgeonʼs hands supported at Level II with
movements from the handrest down to Level l, up to Level III.
The stability for most of the surgeonʼs activities will come from the handheld
instruments at Level II resting on the handrest during surgery. This platform
is the hub, or focal point, of all the surgeonʼs work.
With the increased use of microsurgical and advanced surgical technique,
there has developed the necessity of conceptual models of surgery. The
idea of separate levels of instrument structure and surgical performance is
more than a way to describe the assembly of instruments.
mentalizes the operating surgeonʼs performance and brings order and neat-
ness into the surgical process. By adhering to the Staircase Concept,
tools seem to fit more easily where they are being used, performance
becomes more systematic and there is minimal interference from "things
getting in the way." (6,8,9)
The increasing use of Level lll for the mechanical support of instruments of
action greatly increases the surgeonʼs efficiency. The key to Level lll, with
its many options, is to use only the part or parts of the system which are
helpful for a given procedure.
advance so as to maximize efficiency in the use of space.
These instruments, their suggested uses, and the Staircase Concept of
structure and function have developed to concepts of surgery, here con-
densed into seven ideas:
1. Work analysis of each step of a given procedure.
2. Decreasing repetitive movements (particularly instrument exchanges)
during surgery. (8,9)
3. Use of mechanical support for each hand to reduce tremor and fatigue
while increasing precision.
4. Reliance upon mechanical support for instruments in the field.
5. Decreasing reliance upon other operating room personnel so as to
reduce miscommunication and enable the surgeon to work at his own
tempo. (4,5,6,7,8,9)
6. Maintain versatility of the instruments so that new instruments can be
added easily.
7. Reduce the number and required training of assisting personnel and thus
reduce costs. (7,8,9)
These goals are attainable. Surgeons can be more ergonomically efficient,
and the instruments described in the preceding chapters are versatile,
simple, and reliable. The techniques, of course, take time to learn, but as
experience is gained, the surgeon will find that the time required to set up
the system will diminish and the use of mechanically supported instruments
will increase.

Care and Maintenance

For purposes of care and maintenance, it may be helpful to separate the
instruments into bars (primary, secondary, and floating secondary bars),
and FLEXBAR Arms (long and short retractor arms, handrests, microinstru-
ment holders, extra large, large and small instrument holders).
Bars
Cleaning
After each surgery, use a soft brush and mild detergent to remove all resid-
ual debris from each instrument. It is recommended that the instruments
and parts be ultrasonically cleaned.
Lubrication
It is extremely important that moveable parts be properly lubricated to keep
them functional. It is recommended that all components be immersed in a
water-soluble lubricant. PRESERVE
recommended for instruments to be steam sterilized.
FLEXBAR Arms
Cleaning
After each surgery, use a soft brush and mild detergent to remove all resid-
ual debris from each instrument. It is recommended that the instruments
and parts be ultrasonically cleaned.
500-1500-85-L-INS.indd 8
(1,2,3,6)
(6,8,9) Instrument positions should be planned in
(5,7)
(1,2,3)
® Concentrate (catalog no. 43-1033) is
FLEXBAR Arms consist of a series of hollow cylinders through which a
multi-strand steel cable runs. Attached to the cable is a swaged screw
which is threaded into a drawbar. See Figures 56 and 57.
Setting the Drawbar to Zero
WARNING: RESET THE DRAWBAR TO ZERO AFTER EACH USE to help
prevent "drifting" of the FLEXBAR Arms and damage to the drawbar. Do not
store or sterilize FLEXBAR Arms while the cable is under tension.
NOTE: The FLEXBAR Arm is received by the customer with the drawbar at
It compart-
zero setting; the jointed arm has little or no slack and the drawbar is totally
recessed in the well of the tension-setting knob. The FLEXBAR arm is stiff-
(3)
ened during surgery by rotating the tension setting knob clockwise. The hub
of the drawbar will protrude slightly as the cable is pulled. After much use,
the drawbar may begin to protrude excessively (see Figures 58–59).
To relieve this condition, it is necessary to reset the drawbar to zero as
follows:
1. Hold the FLEXBAR Arm of the instrument in the left hand and, with the
forefinger of the right hand, spin the tension-setting knob counterclockwise
until it meets resistance. See Figure 60.
2. Hold the FLEXBAR Arm in the left hand and, with the right hand, spin the
entire clamping assembly clockwise. This will advance the threaded cable
into the drawbar. See Figure 61–62.
Inspecting the Cable and Drawbar
1. With the left hand, hold the FLEXBAR Arm at the most proximal ball joint,
and with the right hand, spin the entire clamping assembly counterclockwise
for eight complete turns to loosen the ball joints. Inspect the cable for wear.
If frayed (Figure 63–64), return for repair or replacement. NOTE: Fraying is
most likely to occur where the cable meets the swaged screw.
2. At this point, the drawbar is at zero setting (fully recessed in the tension
(4,5,6)
knob). Pull the tension-setting knob back to expose the threaded section of
the drawbar and inspect the drawbar for wear. If threads are worn and/or
metal filings can be seen (Figures 65–66), return the instrument for repair
or replacement.
3. Push the drawbar into the slot. Hold the FLEXBAR Arm of the instrument
in the left hand and, with the forefinger of the right hand, spin the entire
clamping assembly clockwise. This will advance the threaded cable into the
drawbar. When resistance is met, turn back one-half turn.
See Figures 67–68.
Lubrication
It is extremely important that moveable parts be properly lubricated to keep
these parts functional. It is recommended that all components be immersed
in a water-soluble lubricant. PRESERVE Concentrate (catalog no. 43-1033)
is recommended for instruments to be steam sterilized.
Sterilization
All components of the GREENBERG Retractor System require cleaning and
sterilization before each use, including the first use.
The instruments can be steam or ethylene oxide sterilized. Refer to the ster-
ilizer manufacturerʼs instructions for correct time, temperature, and pressure
settings.

References

1. Greenberg, I.M.: "Self-Retaining Retractor and Handrest System for
Neurosurgery," NEUROSURGERY, 8:205–208, 1981
2. Greenberg, I.M.: "New Options for the Neurosurgeon, Multiple
Instrumentation in a Single Microsurgical Field," NEUROSURGERY,
9:566–583, 1981
3. Greenberg, I.M.: "Staircase Concept of Instrument Placement in
Microsurgery," NEUROSURGERY, 9:696–702, 1981
4. Greenberg, I.M.: "Cerebral Aneurysm Rupture During Neurosurgery,"
NEUROSURGERY, 15:243–245, 1984
5. Greenberg, I.M.: "Rotation of Scissors While Fixed in the Microsurgical
Field: A Technique for Increasing the Surgeonʼs Efficiency,"
MICROSURGERY, 5:218–227, 1984
6. Greenberg, I.M.: "Self-Retaining Retractors," in Wilkins, R.H.,
Rengachary, S.S., (eds): NEUROSURGERY, New York, McGraw-Hill Book
Co., 1985
8