ACTA NEUROCHIRURGICA
Acta Neurochirurgica 46, 303 306 (1979)
9 by Springer-Verlag1979
Neurosurgical Service, Idaho Falls Hospital, Idaho Falls, Idaho, U.S.A.
Neurosurgical Suction Tips * By W. Cuatico
With 2 Figures
Summary
The author presents a newly designed suction tip which minimizes the risk of tissue, but maintains effective suctioning pressure under all conditions. An adequate suction device has evolved into an essential and indispensable part of any neurosurgical operation. The finer and more detailed the operative field, as in microsurgery, the more crucial it becomes. One of the major problems encountered is the ease and frequency with which structures get caught in and stuck to the tip of the sucker, thereby nullifying the suction effect. When this happens, increasing the suction pressure is understandably useless. In fact, it may cause inadvertent damage to the structures which the surgeon wants to preserve. To counter this problem many devices have been introduced. The most universally and widely used tips are those designed by Frazier. By releasing the thumb hole, suction pressure drops precipitously thus releasing the stuck structures. The disadvantage is abvious: not only is the suction thereby rendered ineffective, but the dexterous manoeuverability of the surgeon's hands becomes compromised. Then there is the recently introduced tip of Shababian 1. The danger of the footplate breaking off during rough manoeuvres is quite real. Also, it is abvious that this tip probably cannot be filed to the desired size to render it effective in microneurosurgical operations. The foot plate's getting caught and entan* Manufactured by Becton & Dickinson & Codman.
0001-6268/79/0046/0303/$ 01.00
304
w. Cuatico:
gled during crucial dissections is a potential danger. Ya~argil ~ recently introduced the variable pressure suction machine. This expensive machine automatically adjusts to the pressure required to maintain adequate suction. In addition, Ya~argil blunted the tip to minimize damage that may result with a sharper edge. It is abvious that an ideal suction tip should possess the following features: 1. Effective suctioning pressure that can be maintained under all conditions. 2. The device should minimize damage to tissue that inadvertently gets stuck to the suction hole. 3. Easy manoeuverability, including little compromise to the dexterity of the surgeon's hands. 4. Relative safety. 5. Appropriate size. 6. Reasonable cost. After examination of the available suction tips, it would appear that Ya~argil's come closed to these ideals. There are two major drawbacks: 1. The cost--the suction apparatus costs thousands of dollars, 2. Tissues still get stuck to the hole even with this apparatus. It was with all these facts in mind that the present suction tip was designed. It is also less costly compared to Yasargil's entire unit of suction machine and tip. The basic design incorporates side holes--four in number--that cut down the effective suction force of the main hole by 50~ In other words, there is a 50~ less suctioning force against stuck tissue in the main hole, should this occur. When this happens, suction is still maintained through the side holes with a force of only 50~ Thus, damage to tissue is minimized and yet some suction is still maintained. It is felt that this is especially invaluable in microsurgery. Extensive trials have shown that they are indeed excellent tools. The presence of side holes may conceivably weaken the structural integrity of the tip, but this has proved not to be the case. While no claims are made that this tip satisfies all the ideal qualities mentioned, it is an excellent tip with the major advantage of minimizing tissue damage without compromizing the skilled manoeuverability of the surgeon's hands, with suction force still maintained, though at a reduced level. The tips come in four different sizes (Fig. 1): 1.5 mm with 1.5 mm side holes. 2.4 mm with 1.0 mm side holes. 3.3 mm with 0.8 mm side holes. 4.2 mm with 0.4 mm side holes.
Neurosurgical Suction Tips
305
GRIPPERS
,,'CL"~T ~ OM
~ZT-F~ 1 CM
\
4
20CM
]A
C ~:~.B
2 CM
35~ ANGLE
E
D4,. 5MM 4MM 1,SMM 7MM 12MM
O
II 4MM 3MM 1MM 7MM 12MM 2MM
III 2MM IMI 3M-M 2MM 0.8MM 0.7MM 0.4MM (C=4HOLES) 7MM 7MM 12MM 12MM 2MM 1
"C" HOLES ~ ( / ~
C O N S T R U C T E D OF SEMI-MALEABLE
STAINLESS STEEL METAL OR EQUIVALENT
Fig. 1. Diagram of the suction tips with their corresponding dimensions
1 CM
\
J
20GM
d F
D
~ 11 117IV A 5MM 4MM 3MM 2MM S 4MM 3MM 2MM 0.7MM C 1.5MM 1MM 0.SMM 0.4MM (C=4HOLES)
"C" HOLES \\k
JJ
E 12MM 12MM 12MM 12MM
IF.=MM =.=MM '=M
'MM
CONSTRUCTED OF SEMI-MALEABLE STAINLESS STEEL METAL OR EQUIVALENT
Fig. 2. By incorporating a 2nd tube, a suction-irrigation device was designed as shown. All dimensions are similar to those in Fig. 1
306
W. Cuatico: Neurosurgical Suction Tips
Two grippers are incorporated to stabilize the device during delicate manoeuvres. A suction-irrigation device has also been designed with a second tube beneath the main tube with essentially similar dimensions (Fig. 2). References
1. Shababian, S., Modified suction tip technical note. J. Neurosurg. 47 (1977), 793. 2. Ya~argil, M. G., Vise, W. M., Bader, O. C. H., Technical adjuncts in neurosurgery. Surg. Neurol. ,9 (1977), 331--336. Author's address: Dr. W. Cuatico, P.O. Box 1666, Idaho Falls, ID 83401, U.S.A.
Acta Neurochirurgica 46, 303 306 (1979)
9 by Springer-Verlag1979
Neurosurgical Service, Idaho Falls Hospital, Idaho Falls, Idaho, U.S.A.
Neurosurgical Suction Tips * By W. Cuatico
With 2 Figures
Summary
The author presents a newly designed suction tip which minimizes the risk of tissue, but maintains effective suctioning pressure under all conditions. An adequate suction device has evolved into an essential and indispensable part of any neurosurgical operation. The finer and more detailed the operative field, as in microsurgery, the more crucial it becomes. One of the major problems encountered is the ease and frequency with which structures get caught in and stuck to the tip of the sucker, thereby nullifying the suction effect. When this happens, increasing the suction pressure is understandably useless. In fact, it may cause inadvertent damage to the structures which the surgeon wants to preserve. To counter this problem many devices have been introduced. The most universally and widely used tips are those designed by Frazier. By releasing the thumb hole, suction pressure drops precipitously thus releasing the stuck structures. The disadvantage is abvious: not only is the suction thereby rendered ineffective, but the dexterous manoeuverability of the surgeon's hands becomes compromised. Then there is the recently introduced tip of Shababian 1. The danger of the footplate breaking off during rough manoeuvres is quite real. Also, it is abvious that this tip probably cannot be filed to the desired size to render it effective in microneurosurgical operations. The foot plate's getting caught and entan* Manufactured by Becton & Dickinson & Codman.
0001-6268/79/0046/0303/$ 01.00
304
w. Cuatico:
gled during crucial dissections is a potential danger. Ya~argil ~ recently introduced the variable pressure suction machine. This expensive machine automatically adjusts to the pressure required to maintain adequate suction. In addition, Ya~argil blunted the tip to minimize damage that may result with a sharper edge. It is abvious that an ideal suction tip should possess the following features: 1. Effective suctioning pressure that can be maintained under all conditions. 2. The device should minimize damage to tissue that inadvertently gets stuck to the suction hole. 3. Easy manoeuverability, including little compromise to the dexterity of the surgeon's hands. 4. Relative safety. 5. Appropriate size. 6. Reasonable cost. After examination of the available suction tips, it would appear that Ya~argil's come closed to these ideals. There are two major drawbacks: 1. The cost--the suction apparatus costs thousands of dollars, 2. Tissues still get stuck to the hole even with this apparatus. It was with all these facts in mind that the present suction tip was designed. It is also less costly compared to Yasargil's entire unit of suction machine and tip. The basic design incorporates side holes--four in number--that cut down the effective suction force of the main hole by 50~ In other words, there is a 50~ less suctioning force against stuck tissue in the main hole, should this occur. When this happens, suction is still maintained through the side holes with a force of only 50~ Thus, damage to tissue is minimized and yet some suction is still maintained. It is felt that this is especially invaluable in microsurgery. Extensive trials have shown that they are indeed excellent tools. The presence of side holes may conceivably weaken the structural integrity of the tip, but this has proved not to be the case. While no claims are made that this tip satisfies all the ideal qualities mentioned, it is an excellent tip with the major advantage of minimizing tissue damage without compromizing the skilled manoeuverability of the surgeon's hands, with suction force still maintained, though at a reduced level. The tips come in four different sizes (Fig. 1): 1.5 mm with 1.5 mm side holes. 2.4 mm with 1.0 mm side holes. 3.3 mm with 0.8 mm side holes. 4.2 mm with 0.4 mm side holes.
Neurosurgical Suction Tips
305
GRIPPERS
,,'CL"~T ~ OM
~ZT-F~ 1 CM
\
4
20CM
]A
C ~:~.B
2 CM
35~ ANGLE
E
D4,. 5MM 4MM 1,SMM 7MM 12MM
O
II 4MM 3MM 1MM 7MM 12MM 2MM
III 2MM IMI 3M-M 2MM 0.8MM 0.7MM 0.4MM (C=4HOLES) 7MM 7MM 12MM 12MM 2MM 1
"C" HOLES ~ ( / ~
C O N S T R U C T E D OF SEMI-MALEABLE
STAINLESS STEEL METAL OR EQUIVALENT
Fig. 1. Diagram of the suction tips with their corresponding dimensions
1 CM
\
J
20GM
d F
D
~ 11 117IV A 5MM 4MM 3MM 2MM S 4MM 3MM 2MM 0.7MM C 1.5MM 1MM 0.SMM 0.4MM (C=4HOLES)
"C" HOLES \\k
JJ
E 12MM 12MM 12MM 12MM
IF.=MM =.=MM '=M
'MM
CONSTRUCTED OF SEMI-MALEABLE STAINLESS STEEL METAL OR EQUIVALENT
Fig. 2. By incorporating a 2nd tube, a suction-irrigation device was designed as shown. All dimensions are similar to those in Fig. 1
306
W. Cuatico: Neurosurgical Suction Tips
Two grippers are incorporated to stabilize the device during delicate manoeuvres. A suction-irrigation device has also been designed with a second tube beneath the main tube with essentially similar dimensions (Fig. 2). References
1. Shababian, S., Modified suction tip technical note. J. Neurosurg. 47 (1977), 793. 2. Ya~argil, M. G., Vise, W. M., Bader, O. C. H., Technical adjuncts in neurosurgery. Surg. Neurol. ,9 (1977), 331--336. Author's address: Dr. W. Cuatico, P.O. Box 1666, Idaho Falls, ID 83401, U.S.A.
