Spotlight
On Technology & Technique
A New Design Goes Disposable
Hand-held vitreoretinal tools from Alcon add
the benefits of disposability to 360° actuation.
By Christopher Kent, Senior Associate Editor
When it comes to eye surgery, the importance of surgical skill is matched by the importance of a well-designed, sterile set of tools. The more sophisticated and well-designed the instrument, the more the surgeon can accomplish -- and the less likely it is that surgery will produce complications.
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The Grieshaber Revolution DSP tools feature 360° actuation for easy control no matter how the tool is
rotated. |
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A new line of vitreoretinal surgical tools now available from Alcon is a case in point. Several years ago, Alcon Grieshaber, a Swiss company specializing in the design and manufacture of hand-held instruments, decided to develop a new generation of instruments based on a unique design created at the Duke University Eye Center Biophysics Laboratory in Durham, N.C. Ultimately, the collaborative effort between Grieshaber craftsmen, Duke surgeons and technical experts produced a completely redesigned set of instruments: the Grieshaber Revolution line of surgical tools.
Now, Alcon has created disposable versions of these tools, called Grieshaber Revolution DSP. The new tools feature most of the design advances that made the original Grieshaber Revolution instruments unique, while adding advantages that only a disposable tool could offer.
Actuation from Any Angle
Several design advances set the Grieshaber Revolution instruments apart:
- 360° actuation. Thirty-six levers spanning the circumference of the tool allow the surgeon to activate tip movement regardless of where the surgeon's fingers fall, or how the tool is rotated. (This allows complete freedom of tool placement inside the eye, without affecting instrument operation.)
- The outside (contact) edge of each lever is sculpted in a wavy pattern that provides tactile feedback.
- Lever travel ratio is smaller than that of similar instruments, so less movement is necessary to control tip actuation. This provides greater stability for performing delicate surgical maneuvers.
The original, reusable instruments also feature multiple tips with a "quick connector" design (insert and twist) that Alcon says makes a secure connection with precise piston alignment every time, as well as a handle made of a new, lightweight polymer. (The tools in the new single-use DSP line are self-contained, eliminating the need for interchangable tips.)
Why Disposables?
Alcon decided to create a disposable version of the tools to provide a solution to issues stemming from reusing and autoclaving extremely fine instruments:
- Total sterility as a result of autoclaving can never be absolutely guaranteed.
- If damage occurs because of a mishap during surgery or autoclaving, the instrument must be repaired or replaced. (This is an especially serious problem in a larger institution where tools are sent to other floors for sterilization and autoclaved with instruments from other medical specialties.)
- Having to assemble the instrument requires increased handling and keeping track of parts.
- If sterility is lost during surgery, the procedure has to stop while the instrument is autoclaved again.
- If not cleaned correctly, metal parts can corrode over time.
Disposable tools effectively eliminate these problems. Every tool is guaranteed sterile and ready-to-use; no assembly is required, and another tool is immediately available if the one in use is damaged or no longer sterile. Also, using a new instrument every time ensures consistent reliability and performance.
Of course, single-use instruments entail more purchase cost, but this may be offset by the elimination of repair, exchange and sterilization costs -- not to mention potential lawsuits if sterilization is imperfect and hepatitis or another disease is transmitted.
Covering All the Bases
The Grieshaber Revolution DSP tools come in three models:
End grasping forceps. Features include:
- a fine tip that improves visualization
- a lightweight, balanced handle designed to enhance surgeon comfort and increase control
- holding force that exceeds 50 grams
- a design that lets the forceps be used for multiple purposes.
Vertical scissors. Features include:
- very sharp blades for reliable cutting
- rotatability that makes it easy to reposition the tip
- a distal tip design that makes it easy to establish a cleavage plane.
Fiber optic forceps. Features include:
- easy setup (no assembly required)
- holding force that exceeds 25 grams
- homogenous light transmission that helps eliminate shadows
- prethreaded fiber optics. (Re-usable forceps must be threaded by a technician before surgery, and an imperfect alignment can result in passive egress.)
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Three Grieshaber Revolution DSP tools are available: end grasping forceps, vertical scissors, and fiber optic
forceps. |
Comments From the Field
Peter Kaiser, M.D., who practices at the Cole Eye Institute, Cleveland Clinic Foundation in Ohio, values the 360° design of the Grieshaber Revolution tools. "When I need to rotate the tip, I don't have to contort my hand as I did with previous instruments," he notes. "I can simply spin the tool with my fingertips to get at tissue in hard to reach places like the ciliary body. With some previous instruments the surgeon used a dial to rotate the tip, which was very difficult to do if your hand was in a contorted position.
"The cost of an instrument such as this is easy to justify because it replaces several instruments and makes me more efficient in surgery."
Harry W. Flynn Jr., M.D., who practices at the Bascom Palmer Eye Institute in Miami, has used the Grieshaber Revolution DSP forceps for several months. "They're very comfortable in your hand," he says. "The tips are precise and hold the tissue securely, and the 360° action is very useful."
Despite mixed feelings about having to throw the instrument away after one use, Dr. Flynn appreciates the advantages of disposability. "Considering the cost of repairing nondisposable instruments, this is a welcome addition to our surgical instrument tray. Repair of some nondisposable instruments can cost well over $500."
Ready When You Are
Currently, the Grieshaber Revolution DSP tools are available in sterile, ready-to-use packages of six. For more information, contact your Alcon Surgical vitreoretinal manager for a surgical evaluation, or call Alcon customer service at 800-TO-ALCON.