innovation means motion - newclip technicsthe kemis® knife is placed on the distal lip of the...
TRANSCRIPT
-
INN O VAT I O N ME A N S M OT I O N
CARPAL TUNNEL RELEASE SURGERY
KEMIS®
Minimally invasive, non-endoscopic surgical techniqueRetrograde section of the transverse carpal ligamentAnterograde section of the anterior carpal ligament
-
INN O VAT I O N ME A N S M OT I O N
CARPAL TUNNEL RELEASE SURGERY
CUTTING THE TRANSVERSE CARPAL LIGAMENTSTEP 3
The Kemis® knife is placed on the distal lip of the ligament.
Regular pressure is applied to the Kemis® knife until the blade cuts the liga-ment.
In the case of very thick and sclerotic ligaments, it may be necessary to start cutting with a surgical knife before using the Kemis® knife.
Before closing, make sure the release has been properly performed and repo-sition the subfascial adipose tissue.
Once the subcutaneous tissues are incised, the palmar aponeurosis is exposed and incised in the direction of its fibers.
The subfascial adipose tissue, containing nerve endings, is lifted toward the ulnar side of the incision.
The distal lip of the transverse carpal ligament is thus exposed.
It is necessary to locate the eminence of the median nerve and make sure there is no unusual course of the thenar branch.
The insertion of the Kemis® knife is made easier thanks to an elevator or “Mayo” scissors that make it possible to detach the palmar aponeurosis superficially and release the synovium of the flexor tendons and nerve with an endocanalar approach.
ÉTAPE2STEP 2 EXPOSURE OF THE TRANSVERSE CARPAL LIGAMENT
CAUTIONS AND CLOSINGSTEP 4
CAUTIONS• Carefully insert the Kemis® knife until touching the ligament.• Do not move back and forth.
CLOSING• Close the incision with sutures, either resorbable or not, depending on the surgeons’ habits.• Apply an adhesive dressing, encourage patient to move his/her fingers as soon as possible.
ANATOMICAL LANDMARKS STEP 1
The incision is performed so as to expose the distal part of the transverse carpal ligament and the thenar eminence.
Two lines are drawn to mark the incision (1-2cm). Their intersection determines its exact location.
The first line goes from the distal fold of the thenar eminence, with the thumb extended, to the top of the hypothenar eminence.
The second line is drawn along the axis of the lateral edge of the 4th ray (ring finger) and determines the direction of the incision.
The proximal part of the incision can be accurately determined using the palpation of the distal edge of the transverse carpal ligament.
Minimally invasive, non-endoscopic surgical technique.Retrograde approach to cutting of the transverse carpal ligament.This surgical procedure is usually carried out using a local-regional anaesthetic.
The technique presented below is one of the possible surgical approaches. The choice of anatomical landmarks and the technique to be used are left to the discretion of the surgeon.
-
CARPAL TUNNEL RELEASE SURGERY
CUTTING OF THE TRANSVERSE CARPAL LIGAMENT STEP 3
The Kemis® knife is applied to the proximal lip of the ligament.
Apply continuous pressure to the Kemis® knife until the blade cuts the liga-ment.
Check if the anterior carpal ligament cut is complete using the ultrasound system and check if the gesture has not been invasive to the median nerve.
Make the first scan distally and shift every 5 mm to check the passage of the knife between the carpal tunnel and the skin.
Position the wrist in extension.
Make an incision at the fold of the wrist by keeping in reference the two lines for the medial (median nerve) and lateral (ulnar artery) limits.
Carpi-volare landmark and section proximally with Stevens scissors.
ÉTAPE2STEP 2 INCISION
PRECAUTIONS ET CLOSINGSTEP 4
CAUTIONS• Carefully insert the Kemis® knife until touching the ligament.• Do not move back and forth.
CLOSING• Close the incision with sutures, either resorbable or not, depending on the surgeons’ habits.• Apply an adhesive dressing, encourage patient to move his/her fingers as soon as possible.
ANATOMICAL LANDMARKS STEP 1
Gesture control by ultrasound and anatomical diagnosis before this surgical procedure identifying the median nerve and the ulnar artery. This control makes it possible to identify the median nerve and the "guyon canal" (ulnar artery and nerve), to detect anatomical variations and pathological compressions (tumors, aberrant muscles ...) and to diagnose a synovitis of the flexor tendons (diabetes, polyarthritis).
Make the ultrasound scan of the median nerve using the back of the knife and trace the path with a dermographic pen.
Identify the ulnar artery in the "guyon canal" with the help of the color Doppler and trace the path with a dermographic pen.
Place the probe in the palm of the hand (longitudinal) to identify the superficial palmar arch and trace the path with a dermographic pen. The superficial palmar arch indicates the limit of the cut.
The technique presented below is one of the possible surgical approaches. The choice of anatomical landmarks and the technique to be used are left to the discretion of the surgeon.
Minimally invasive surgical technique. Anterograde section of the anterior carpal ligament. This surgical procedure is usually carried out using a local-regional anaesthetic.
-
Broc
hure
EN
- Ke
mis
- Ed
.5 -
04/2
019
- Med
ical
dev
ice
clas
s IIa
- 1
639S
GS
BE
- Re
ad la
belin
g an
d in
stru
ctio
ns b
efor
e us
e.
R EFER EN CES
Non
con
tract
ual p
ictu
res.TECHNICAL FEATURES
Kemis® is an instrument combining both the safety of the open release procedure and the clinical advantages of endoscopic surgery.
3
2
3
1
AN ERGONOMICALLY ENHANCED INSTRUMENTErgonomic design, upper (1) and lower (2) curves designed for reducing the risk of injury of the anatomical structures when inserting the knife.The blade is an integral part of the knife design (3) and does not damage surrounding tissues. Secured cutting of the ligament reducing the risks of median nerve and flexor tendons injury.Palmar aponeurosis preserved.
A SAFER TECHNIQUE
Immediate visualization of the ligament and distal division of the median nerve (thenar branch, digital nerves).Visual monitoring of the anatomic variations of the thenar eminence.The cutting edge of the blade (0,3mm thick) is never in contact with the surrounding anatomical structures, thus avoiding unintentional injury.
A MORE COST-EFFECTIVE TOOL
Optimized knife cost.Single use sterile knife.No endoscopy column or dedicated instrumentation.
SIMPLER POSTOPERATIVE CARESmall incision size.Limited damage to the palm of the hand.
NEWCLIP TECHNICSPA de la Lande Saint Martin, 45 rue des Garottières44115 Haute Goulaine (France)P: +33 (0)2 28 21 23 25 - Fax: +33 (0)2 40 63 68 [email protected]
NEWCLIP USA642 Larkfield Center , Santa Rosa CA 95403, USAP: + 1 707 230 5078 [email protected]
NEWCLIP GmbHPröllstraße 11,D-86157 Augsburg, DeutschlandP: +49 (0)821 650 749 40 [email protected]
NEWCLIP Technics Japan K.K.KKK Bldg. 502, 3-18-1 AsakusabashiTaito-Ku, Tokyo, 111-0053 JapanP: +81 (0)3 58 25 49 81 Fax: +81 (0)3 58 25 49 86www.newcliptechnics.fr
NEWCLIP Australia 3B/11 Donkin StreetWest End 4101, AustraliaP: +61 (0)2 81 886 [email protected]
3(3.1 mm*)
(6.8 mm*)
(6.0 mm*)
* Indicative values
KEMIS®
Réf. Description QtyANC209 Knife for carpal tunnel surgery 5