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Sternum Lift-Up Device

Usage

3D animation of the device

The device  in reality

Subxiphoid thymectomy

An important intervention in the treatment of myasthenia gravis and certain tumor diseases is nowadays increasingly being solved with robotic technologies. However, the necessary equipment is not yet available in many places. In such cases, it is very important to raise the sternum to the appropriate height during surgery. Thus, the thymus is available from the xiphoid. This avoids performing a complete median sternotomy.

MIRPE

 

Instead of traditional surgical solutions, MIRPE offers a much faster procedure with smaller surgical incisions, thereby significantly reducing both the surgical burden on the patient and the duration of recovery, not to mention the cosmetic benefits. The procedure is now widespread worldwide, and its long-term effectiveness has been proven. It is particularly beneficial for children.

Read more: https://www.sciencedirect.com/science/article/pii/S1522294218301156

 

The method:

The essence of the MIRPE procedure is to place a stiffening metal rod (INOX steel) in the chest, which fixes the sternum in an elevated position. Dimensions of the flat bar (width: 18-22mm; thickness: 2-3mm, length: 200-450mm). During the operation, before insertion, the rod is bent into a suitable arc shape, and then it is passed through the chest with its convexity facing downwards for approx. at the height of the xiphoid process, in a horizontal plane. After insertion (both ends of the rod are accessible through the skin incisions), the rod is rotated 180° along the horizontal axis. The bulge then points upwards and fixes the sternum at the desired height. The only difficulty with the technique is precisely this translation. Overcoming the elasticity of the deformed chest, the bar must be turned over with a relatively small lever.

Read more: https://storage.googleapis.com/production-bluehost-v1-0-3/323/1193323/CAPQvSp0/2d5270d901d44530b49a1e8b4e2d654a?fileName=Pectus_Full%201.pdf 

The solution

Of course, performing surgeries is much easier, and the chance of complications can also be reduced if we try to lift the sternum by hand or with some other device, but this is not always easy. It is possible to use some sort of stand or support structure attached to the operating table, but these devices – even if their height can be adjusted – were not developed for lifting. They are usually only attached to the operating table on one side, so they are not stable and rigid enough. On devices with adjustable height, the degree of adjustment is not fine enough, and the set position is not held reliably either. That is why we developed the tool presented below, the prototype of which is constantly in use and proves its usefulness.

S-LUP (Sternum Lift-Up Device)

The device we developed is connected to the rail of the operating table on both sides, thus it has a very stable and robust structure. Backlash and swings have been minimized, thereby facilitating accurate adjustment. Together, the device and the frame can be moved according to an extremely large number of degrees of freedom, so it is certain that the correct sternum position is already available before the implant is inserted, thus helping to make a more accurate measurement. The sternum can be lifted both with the hook shown in the picture and with sternum lifting pliers. 

  1. The frame can be moved along the length of the operating table
  2. The frame can be tilted in the direction of the head and feet compared to the vertical plane
  3. The lifting structure can be moved laterally (para-saggitally) on the horizontal support bar of the frame
  4. The lifting structure can be tilted along the horizontal axis in the head-to-foot direction
  5. The height of the sternum lifting hook can be adjusted to the dimensions of the chest
  6. The lifting hook with the threaded lifting mechanism approx. It can be raised to a height of 120 mm 

The vertical legs of the frame turn upward and outward from the plane of the operating table, thereby leaving more room for the operators’ arms to move freely. 

Assembly/disassembly before surgery is extremely simple and does not require special tools. The width of the stand is adjustable, so it can be mounted on all kinds of operating tables. It can be easily attached to the side rails of the operating table with the hinged clamp used to attach standard 18mm diameter instruments. 

When disassembled, the length of the longest part is 740 mm, so it can be placed on a tray in large sterilizers.

Material:

support arms and lifting mechanism 1.4301 (ISO304) INOX

sternum hook 1.4401 (ISO316) INOX

The entire structure can be sterilized (high-pressure steam) and contains no allergens. 

Parts of the structure that elevates the sternum:

  1. vertical support bar 2 pcs
  2. 2. horizontal support bar 1 pc
  3. complete lifting mechanism 1 pc
  4. sternum hook (316) 1pc 

The device complies with ISO and CE regulations.

Series production of the device has not yet begun. Therefore, we can satisfy the needs based on individual orders. If you are interested, please contact us via our contact details!

make@ap-x.hu