TechnologyPneumatic Kerrison rongeur: technical note☆,☆☆
Introduction
An estimated 80% of the surgical practice of most neurosurgeons and virtually 100% of orthopedic spinal surgeons involves operations to remove bone in and around the spinal canal. Manual fatigue, soreness, and aching of the hands, as well as at times the tendonous attachments to the elbow, are a common concomitant of manual bone removal particularly when done over the course of several years. To address this problem, engineers at the Aesculap AG Company Tuttlingen, Germany designed a pneumatic powered Kerrison rongeur with a pneumatic module providing 2 pressure levels that we evaluated for safety, ease of use, and the reduction in the surgeon's manual fatigue. We report our experience with the pneumatic Kerrison rongeur and discuss our results.
Section snippets
Instrumentation and methods
The pneumatic Kerrison rongeur used in this study is shown in Fig. 1, Fig. 2, Fig. 3. It consists of 4 parts: the instrument itself which integrates a handle and shafts in different lengths (235 and 285 mm) and widths (2-6 mm) (Table 1); a slim and flexible disposal twin tubing which provides for compressed air; a pneumatic interface; and reusable air hose for connection to the central pressure source.
When squeezing the trigger, 2 pressure levels are sequentially activated: first, a low-power
Patients
Between February 2007 and January 2008, we used the pneumatic Kerrison rongeur in 125 operations. These included anterior cervical discectomies, cervical laminectomies, thoracic laminectomies, lumbar laminectomies, microdiscectomies, medial facetectomies, and foraminotomies (Table 2). These operations were carried out in the standard open fashion as well as through microsurgical incisions using the metrix port and other minimally invasive techniques.
Utility of the pneumatic Kerrison rongeur in different types of spinal surgery
Irrespective of whether the surgery involved the cervical, thoracic, or lumbar spine in an open or minimally invasive approach, bone and ligamentum flavum were removed with no complications and no additional risk of a dural tear or venous plexus damage [2]. No complications occurred as a result of instrument design or malfunction. The pistol grip handle was ergonomically comfortable and used exactly as one would a standard Kerrison rongeur—but with much greater ease. It could be easily held in
Discussion
This pneumatically powered Kerrison rongeur has evolved from previous attempts to design instrumentation to reduce manual fatigue. Approximately 20 years ago, the Ronjair system (3M, Inc, Minn St. Paul) was developed for this purpose. It was also pneumatically driven but had several drawbacks, which led to its obsolescence. The handle grip itself was large and cumbersome. Most importantly, it provided for only one high-force pressure level and could only be opened after applying a maximal
Conclusion
We found the pneumatic Kerrison rongeur highly useful in all of the spinal procedures in which it was evaluated. We had no complications related to instrument design or use. The setup time for operating room personnel took no more than a minute or 2. It offers several advantages over previously introduced pneumatic systems and has a high level of safety. Most significantly, it provides a marked reduction in manual fatigue and discomfort associated with spinal operations and bone removal.
References (4)
- et al.
The efficacy of using an image-guided Kerrison punch in performing an anterior cervical foraminotomy: an anatomic analysis
Spine
(1999) - et al.
Microendoscopic lumbar discectomy: technical note
Neurosurgery
(2002)
Cited by (5)
Improving Surgeon Well-Being: Ergonomics in Neurosurgery
2023, World NeurosurgeryErgonomics in Spine Surgery
2022, Clinical Spine Surgery
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The authors have not received any financial support in conjunction with the generation of this paper nor its submission.
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This work was supported in part by a grant from the Dennis and Rose Heindl Foundation.