CV 2-7 11/2014-E
DESTANDAU Endoscopic Approach
with the Mobile ENDOSPINE® Operating Tube
For central to far lateral disc herniations and
lumbar spinal stenosis
DESTANDAU Endoscopic Approach with the Mobile
ENDOSPINE® Operating Tube
For central to far lateral disc herniations and lumbar spinal stenosis
Lumbar disc herniations and lumbar canal stenosis occur very frequently. If surgery is required,
the standard surgical treatment remains a posterior approach to the spine. The ENDOSPINE®
operating tube makes treatment of all kinds of disc herniations from medial to far lateral
possible, not only on the lumbar spine but also for the cervical and thoracic levels. Lumbar
canal decompression is also possible.
Especially when operating on adipose patients or in very deep-seated pathologies like a
foraminal disc hernia or spinal canal stenosis, using the ENDOSPINE® operating tube allows a
smaller skin incision while retaining a standard surgical approach. The difference is, however,
that the surgeon has a view right inside the surgical field, very close to the pathology being
treated.
Apart from the aesthetic aspect, the more atraumatic approach with the ENDOSPINE®
operating tube provides a better post-operative comfort, a faster recovery and a faster return to
normal activities.
2 3
The ENDOSPINE® – 4 Main Features
The ENDOSPINE®
l Two hands…
l …one endoscope…
l …and 4 instruments
A view inside
l Permanent and comprehensive
visualization and monitoring of the
working tips
l 4 degrees of freedom
l Instant mobility
l Unsurpassed view of the anatomy
l Minimized bone resection
Treatment of medial disc herniations
After a paramedian incision, the
ENDOSPINE® operating tube is inserted in
the direction of the posterior arc.
Bone resection includes part of the
superior lamina and of the intervertebral
articulation with exposure of the dural sac
and nerve root.
The posterior longitudinal ligament needs to
be resected as well. Once the nerve root has
been identified, it is generally retracted using
the integrated nerve retractor.
The herniated portion of the disc is expelled
by pressure from the spatula and extracted
using the grasping forceps.
4 5
Treatment of foraminal and extra-foraminal herniations
The paramedian incision is made 1 cm
more cranial than in the case of a medial
herniation. The operating tube faces the
foramen at the level of the exiting nerve
root, slightly above the disc space.
The lateral limit of the isthmus is exposed.
The nerve retractor, which is not utilized
as such in this kind of procedure, can be
used as a muscle retractor. To achieve this,
the nerve retractor is inserted upside-down
outside the operating tube to retract the
paraspinal muscle laterally.
After bone resection with the KERRISON
punch, the ligament is exposed and
removed. Dissection around the nerve root
leads to herniation.
After removal of the herniation with a
grasping forceps, the nerve root is freed.
* herniation
N nerve root
*
N
Treatment of lumbar spinal stenosis
Spinal stenosis is responsible for intermittent radicular claudication and is probably the
leading cause of impaired mobility in elderly people.
If the diagnosis is made before the onset of neurological signs, decompression surgery
enables the patient to quickly regain their usual autonomy.
The aim of this endoscopic technique is to minimize surgical trauma and to offer surgical
treatment to elderly patients whose loss of mobility could lead to severe complications.
The goal of the mobile ENDOSPINE® system is bilateral decompression using a unilateral
posterior endoscopic approach. This operation can be performed under spinal anesthesia or
under general anesthesia. The aim of this surgical technique is bilateral decompression using
an unilateral approach.
The approach is basically the same as for medial disc herniations and is preferably started
on the left side. Part of the superior lamina and the medial part of the intervertebral
articulation are resected to expose the thecal sac.
The lateral expansion of the yellow ligament and a part of the intervertebral articulation have
to be removed, working in a caudal direction, to decompress the left side of the spinal canal
and the left nerve root.
The ENDOSPINE® is then tilted to the other side and the same procedure is repeated on
the right side, i.e. to decompress the right side of the spinal canal and the right nerve root.
Cotton swabs are used during the procedure to protect the dural sac.
For a single level stenosis, the operating time is less than one hour and the hospitalization
period is 48 hours. Special postoperative precautions are not necessary and the patient can
immediately return to normal walking activities.
The advantage of this technique lies in its minimal invasiveness. Furthermore, immobilization
or fixation with plates, screws or cages is not required. The resulting reduction in costs is an
advantage in both the so-called developed countries where health costs are exponentially
increasing as well as in other cost-sensitive countries.
6 7
The aim of this technique is bilateral
decompression using a unilateral approach.
The approach is basically the same as for
medial disc herniations but preferably started
on the left side. Part of the superior lamina
and the medial part of the intervertebral articulation are resected to expose the thecal sac.
S
The lateral expansion of the yellow ligament
and a part of the intervertebral articulation
have to be removed, working in a caudal
direction, to decompress the left side of the
spinal canal and the left nerve root.
S Tip of the working instrument
Then, through simple inclination of the
ENDOSPINE® operating tube, the same
procedure is repeated on the right side to
decompress the right side of the spinal canal
and the right nerve root.
N Cotton swabs are used during the procedure
to protect the dural sac.
N Nerve root L4 right
N Endoscopic Discectomy
DESTANDAU Recommended Set
1
2
3
4
5
6
7
8
9
10
11
15
13
14
12
8 9
Endoscopic Discectomy
DESTANDAU Recommended Instrument Set
1 28163 DL
Bone Punch, dismantling, 90° upbiting, not through-cutting, 3 mm,
working length 18 cm
2 28163 DF
Bone Punch, dismantling, upbiting 45° forward, not through-cutting, 3 mm,
working length 18 cm
3 28163 DXH
DESTANDAU ENDOSPINE® Working Insert, with positioning detent,
with adjustable Nerve Protector 28163 DPH, for use with ENDOSPINE®
Operating Tube 28163 DW, with working channel diameter 8 mm and irrigation
channel, for use with HOPKINS® Telescope 28095 AA
4 28163 DW
DESTANDAU ENDOSPINE® Operating Tube, oval, with Obturator 28163 DO,
for use with Working Insert 28163 DXH
ENDOSPINE® Retractor Blade, conical, length 5 cm, for use with ENDOSPINE®
Operating Tube 28163 DW and 28163 DWS (not illustrated)
28163 DRG
5 *
Bipolar Cable, dependent of the HF electrosurgical unit used
6 28163 DC
Spoon Forceps, dismantling, robust, oval, single action jaws,
spoon size 3 x 10 mm, working length 15 cm
7 28163 DZ
TAKE-APART® MANHES Bipolar Coagulation Forceps, with connector pin for
bipolar coagulation, width of jaws 1 mm, diameter 5 mm, length 20 cm
8 28163 DG
Chisel, flat, straight, with handle, distal width 15 mm, working length 9 cm
9 28163 DHN
Palpation Hook, blunt, distally angled 90°, hook length 5.5 mm,
working length 13 cm
0 28163 DNN
Elevator, spatula slightly curved, distal width 5 mm, working length 13 cm
q 28163 TK
Trephine, with round handle, diameter 3 mm, working length 22 cm
w 28163 DU
FERGUSON Suction Tube, angled, with cut-off hole, diameter 3.7 mm,
working length 11 cm
e 28095 AA
HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 4 mm,
length 18 cm, autoclavable, fiber optic light transmission incorporated,
color code: green
r 28163 DD
Localization Device, for fluoroscopic determination of the point of incision for
ENDOSPINE® Operating Tube 28163 DW
t 495 NA
Fiber Optic Light Cable, with straight connector, diameter 3.5 mm, length 230 cm
Recommended container for storage and sterilization:
39711 A
UNIDRIVE® S III NEURO SCB
40 7017 01-1
40 7017 01-1
UNIDRIVE® S III NEURO SCB, motor control unit
with color display, touch screen, two motor outputs,
integrated irrigation pump and integrated SCB module,
power supply 100-240 VAC, 50/60 Hz
20 7120 33
20 7120 33 High-Speed Micro-Motor, max. speed 60,000 rpm, including
connecting cable, for use with UNIDRIVE® S III NEURO
Accessories:
280053
Universal Spray, 6x 500 ml bottles
– HAZARDOUS GOODS – UN 1950
including:
Spray Nozzle
031131-10*
Tubing Set, for irrigation, for single use,
sterile, package of 10
* mtp medical technical promotion gmbh, Take-Off GewerbePark 46,
78579 Neuhausen ob Eck/Germany, Tel.: +49 (0) 7467 94504-0, Fax: +49 (0) 7467 9450499,
E-Mail: [email protected], www.mtp-tut.com
10 11
252663
252663
High-Speed Handpiece, long, angled, 60,000 rpm,
for use with High-Speed Micro-Motor 20712033
330120 L
High-Speed Standard Burr, long, diameter 2 mm,
shaft diameter 2.35 mm, for single use, sterile, package of 5,
for use with 60,000 rpm HIgh-Speed Handpiece 252663
330140 L
Same, diameter 4 mm
330150 L
Same, diameter 5 mm
330240 L
High-Speed Diamond Burr, long, diameter 4 mm,
shaft diameter 2.35 mm, for single use, sterile, package of 5,
for use with 60,000 rpm High-Speed Handpiece 252663
330250 L
Same, diameter 5 mm
It is recommended to check the suitability of the product for the intended procedure prior to use.
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KARL STORZ Endoscopy-America, Inc.
2151 East Grand Avenue
El Segundo, CA 90245-5017, USA
Phone:
+1 424 218-8100
Phone toll free: 800 421-0837 (US only)
Fax:
+1 424 218-8525
Fax toll free:
800 321-1304 (US only)
E-Mail:
[email protected]
96162006 CV 2-7 11/2014/EW-E
KARL STORZ GmbH & Co. KG
Mittelstraße 8, 78532 Tuttlingen, Germany
Postbox 230, 78503 Tuttlingen, Germany
Phone: +49 (0)7461 708-0
Fax:
+49 (0)7461 708-105
E-Mail: [email protected]
www.karlstorz.com