BioPlug 5.2 SPS Secure Portal System

Transcription

1 ART /2017-E BioPlug 5.2 SPS Secure Portal System For use in reconstructive shoulder surgery on the humeral head

2 BioPlug 5.2 SPS Secure Portal System For use in reconstructive shoulder surgery on the humeral head BioPlug 5.2 is a resorbable suture anchor from KARL STORZ, which is characterized, in particular, by its material and excellent pullout resistance. The material is an amorphous stereocopolymer poly-(l-co-d, L-lactide) 70:30, which has already been used with great success in the MEGA FIX B and MEGA FIX P products. This special material and, accordingly, the BioPlug 5.2, degrades (bioresorbs) slowly and without any resorption reactions. It remains amorphous during the entire degradation process. BioPlug 5.2 has a core drill hole with a diameter of 4.6 mm. The complete instrument set for use with the BioPlug is not only reusable but has also been produced in line with the accustomed KARL STORZ high quality standards, thereby meeting even the toughest demands. The anchor is supplied in sterile packaging and without thread. This has the advantage that the user is not restricted to using the thread material from the manufacturer. The reusable instruments allow for more cost-efficient work. The positioner for the BioPlug 5.2 can also be used for the smaller BioPlug

3 Rotator cuff tear shapes V-shaped U-shaped L-shaped 3

4 Acromioplasty Type I Type II Type III Different acromial types according to the Bigliani classification, TYPE 1-3. Access to the subacromial space Insertion of the cannula through a mid-lateral portal into the subacromial space. (from left to right): Preparatory marking of the lateral edge of the acromion as well as the creation of an orientation line on the rear edge of the AC joint (according to Snyder) using the acromionizer. Insertion of the acromionizer from dorsal under lateral arthroscopic control. The acromionizer does not lie flat too much removal of the acromion acromionectomy. 4

5 Anatomical reconstruction of an L-shaped tear in the rotator cuff Lateral view, dorsal and ventral portal has been created. Piercing of the vertical tear on the rotator cuff: a) Threading through of the monofilament support suture/pull-through suture. b) Extracorporal knotting of the support suture with a multifilament thread. Pulling the support suture through the rotator cuff tear and out of the cannula. Knotting of the first side-to-side suture. Insertion of two further side-to-side sutures in the same way. Dissection of the supraspinatus tendon insertion/footprint. Optionally with the acromionizer/burr, which results in minimal hemorrhaging. Predrilling of a core drill hole with the 4.6 mm Drill TC in the area around the footprint and driving in the BioPlug 5.2 anchor. 5

6 Removal of the insertion instrument set as well as arrangement of the threads. (Arthroscopic view from lateral) Pulling of a thread towards dorsal with the thread catcher. Piercing of the rotator cuff and pulling of the support suture towards dorsal. Piercing of the rotator cuff and pulling of the support suture towards dorsal. 6

7 Insertion of the switching stick through the ventral cannula in order to position the suture pair which has already been threaded through outside the cannula. Subsequent insertion of the dorsal cannula via the switching stick which remains in the subacromial space. Pulling of the thread towards dorsal with the thread catcher. Piercing of the rotator cuff and pulling of the support suture towards dorsal. Knotting of the support suture and pulling it through the rotator cuff. 7

8 Pulling of the corresponding thread to the ventral. The first thread suture can then be knotted. Subsequently, the thread pair still positioned outside of the cannula (green) can be knotted. Step by step, the rotator cuff is completely sutured. Complete reconstruction of an L-shaped rotator cuff tear. 8

9 The outback knot The knot is started with the suture ends held like reins between the index finger and the thumb. The left thumb is placed over the left strand by turning the thumb once in the clockwise direction. The thread rests medially across the thumb. The right-hand strand is then crossed over the left thumb to form a loop. The left-hand strand is passed upwards through the loop, forming a knot that rests on top of the thumb. The left index finger pulls the right-hand strand underneath the left strand to form a loop. 9

10 The index and middle finger are now passed through the loop and presented with the right-hand strand. The index and middle fingers of the left hand pull the suture end through the loop. The loose strand is then passed downwards through the loop formed near the thumb. The left index finger is brought to the left thumb to widen the loop. The loose strand is brought down to the index and long finger with the right hand. Then the knot is gently pulled downwards with the thumb and index finger and the loop is allowed to slip off the thumb. The thread pulled through is secured with a clamp this is the flip thread which prevents the knot from opening. The left strand is the lead thread which delivers the knot to its target. 10

11 The knot can be brought to the desired final position with the aid of a knot pusher. It is important to keep the knot loose at all times to prevent premature locking. The knot is advanced to the tissue to be fixated. The knot is locked by pulling on the lefthand strand. Two or three alternating half hitches provide additional knot security. The final knot. 11

12 28229 DS High-Flow Arthroscope Sheath, with snap-in coupling mechanism, diameter 6.5 mm, working length 13.5 cm, two stopcocks, rotating, for use with HOPKINS II telescopes 0, 30, 70 and Obturators BC/BT BC Obturator, blunt, for use with Arthroscope Sheath DS/S BT Obturator, semisharp, for use with Arthroscope Sheath DS/S BX Changing Rod, length 23 cm, for use with arthroscope sheaths with inner diameter 4 mm BP* BioPlug, bioresorbable suture anchor, diameter 5.2 mm, length 14 mm, sterile, for single use, for use with Inserter TI TC Drill, for preparation of the tunnel for BioPlug BP, with laser marking for the depth of the drill hole, diameter 4.6 mm, length 18 cm 12

13 28179 TI Inserter, with lateral thread guide and thread clip at the handle, working length 18 cm, for use with BioPlug BP and BP I Crochet Hook, working length 15 cm KP Knot Pusher, working length 18 cm KP Knot Pusher and Suture Cutter, for cutting sutures up to size USP 2 including: Insert and Blade Handle SC Suture Cutter, for cutting sutures size USP 2 13

14 28179 GH OB GH HALF PIPE, long, working length 95 mm, for use with Obturator OB OB Obturator, for use with HALF PIPE GH/GK SGN SILGRASP Suture Grasper, straight jaws, sheath diameter 3 mm, straight, handle with cleaning connector, working length 14 cm AGN SILGRASP Alligator Grasping Forceps, surgical, straight jaws, sheath diameter 3 mm, straight, handle with cleaning connector, working length 12 cm AGSN SILGRASP Alligator Grasper, surgical, with ratchet, straight jaws, sheath diameter 3 mm, straight, handle with cleaning connector, working length 12 cm PGN SILGRASP Foreign Body Grasping Forceps, aggressive, straight jaws, sheath diameter 3 mm, straight, handle with cleaning connector, working length 14 cm PGSN SILGRASP Foreign Body Grasper, aggressive, with ratchet, straight jaws, sheath diameter 3 mm, straight, handle with cleaning connector, working length 14 cm 14

15 28179 BB AB Osteotome, width 5.5 mm AC Osteotome, width 8 mm BB Elevator, width 4 mm, 15 curved upwards, working length 15 cm BC Elevator, width 4 mm, 30 curved upwards, working length 15 cm CB Glenoid Rasp, width 5.5 mm, curved upwards 30, working length 15 cm CC S.L.A.P. Rasp, width 5.5 mm, 30 curved downwards, working length 15 cm Suture Instruments HG Handle, for use with monofilament threads size USP 2-0 to 2, for use with Suture Attachments PA-PH, NA-NG and Wheel Attachment HR HR Wheel Attachment, for use with monofilament threads size USP 2-0 to 2, for use with Handle HG and Wheel R R Wheel, for use with monofilament threads size USP 2-0 to 2, for use with Wheel Attachment HR BG Suture Catcher, with inserter, sterile, package of 10, for use with Suture Attachments PA-PH and NA-NG, Wheel Attachment HR and Handle HG 15

16 Suture Instruments PA PA Suture Attachment, distal tip curved upwards, straight, 5 mm in height, working length 15 cm, for use with Handle HG PB Same, 7 mm in height PC Same, 8 mm in height PD Same, hook-shaped distal tip, curved upwards, 8 mm in height PE/PF PE/PF PE Suture Attachment, hook-shaped distal tip curved upwards, straight, 8.7 mm in height, working length 15 cm, for use with Handle HG and not for use with Cannulas SS/SL/BS/BL PF Same, 10 mm in height PG Suture Attachment, distal tip angled 30 to right, straight, 8 mm in height, working length 15 cm, for use with Handle HG PH Same, angled 30 to left R1 Cleaning Adaptor, for use with Suture Attachments PA-PH and NA-NG R2 Cleaning Adaptor, for use with Handle HG 16

17 33136 P CLICKLINE Handle, with thumb release, with 4 locking positions, for use with Suture Attachments LA/LC/LL/LR/LRG LA LA SHOULDER PRO Suture Attachment, for punching soft tissue and suture management in shoulder arthroscopy, curved upwards, working length 15 cm, for use with Handle P, color code: black LC SHOULDER PRO Suture Attachment, for punching soft tissue and suture management in shoulder arthroscopy, straight, working length 15 cm, for use with Handle P, color code: blue LR SHOULDER PRO Suture Attachment, for punching soft tissue and suture management in shoulder arthroscopy, curved to right, also curved to right in sheath, working length 15 cm, for use with Handle P, color code: green LL SHOULDER PRO Suture Attachment, for punching soft tissue and suture management in shoulder arthroscopy, curved to left, also curved to left in sheath, working length 15 cm, for use with Handle P, color code: red LRG SHOULDER PRO Suture Attachment, for punching soft tissue and suture management in shoulder arthroscopy, retrograde opening, also curved upwards in sheath, working length 15 cm, for use with Handle P, color code: white 17

18 Recommended Sets EB EO EC EP FB FO FC FP Positioning Needle Obturator Guide Wire Dilator DG OG SA/SB SC/SD DF Optional: The sets include Handle DH, which makes it easier to introduce Dilator DL. Transparent plastic cannulas for single use, sterile, package of 10, are available as an alternative to reusable cannulas. Threaded Cannulas SA-SD for single use are supplied unsterile. 18

19 Portal Systems for Shoulder Arthroscopy SPS Secure Portal System E Basic Set for SPS Secure Portal System including: Positioning Needle Obturator Guide Wire, package of 6 Dilator Handle, for Dilator DL Valve Housing Set of Gaskets, unsterile, package of 10 A workable instrument set requires the following supplementary sets: 1. For inner diameter 6.1 mm, working length 7 cm EB Handle, with integrated dilator EO Obturator, diameter 4 mm, for use with Handle EB SA Cannula, with thread, transparent, for single use 2. For inner diameter 6.1 mm, working length 8.5 cm EC Handle, with integrated dilator EP Obturator, diameter 4 mm, for use with Handle EC SB Cannula, with thread, transparent, for single use 3. For inner diameter 8.25 mm, working length 7 cm FB Handle, with integrated dilator FO Obturator, diameter 4 mm, for use with Handle FB SC Cannula, with thread, transparent, for single use 4. For inner diameter 8.25 mm, working length 8.5 cm FC Handle, with integrated dilator FP Obturator, diameter 4 mm, for use with Handle FC SD Cannula, with thread, transparent, for single use Optional: GS Set of Gaskets, 10x 2 sealing caps, sterile, for use with Valve Housing DG/OG GU Set of Gaskets, 10x 2 sealing caps, unsterile, for use with Valve Housing DG/OG OG Valve Housing, without LUER-Lock, for use with Cannulas and Set of Gaskets GU/GS It is recommended to check the suitability of the product for the intended procedure prior to use. 19

20 KARL STORZ SE & Co. KG Dr.-Karl-Storz-Straße 34, Tuttlingen/Germany Postbox 230, Tuttlingen/Germany Phone: +49 (0) Fax: +49 (0) ART /2017/EW-E