- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
- Department of Neurosurgery, Seguchi Neurosurgical Hospital, Iida, Japan
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
DOI:10.4103/2152-7806.154464Copyright: © 2015 Horiuchi T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Horiuchi T, Seguchi T, Ito K, Hongo K. Usefulness of needle holder with a function of fine forceps for bypass surgery in both hands. Surg Neurol Int 02-Apr-2015;6:55
How to cite this URL: Horiuchi T, Seguchi T, Ito K, Hongo K. Usefulness of needle holder with a function of fine forceps for bypass surgery in both hands. Surg Neurol Int 02-Apr-2015;6:55. Available from: http://sni.wpengine.com/surgicalint_articles/usefulness-needle-holder-function-fine-forceps-bypass-surgery-hands/
Background:In bypass surgery, a single-handed needle holder is usually used with other handed fine forceps. Recently, a needle holder with the function of fine forceps has been developed.
Methods:In this technical note, usefulness of newly developed needle holders in both hands is presented in bypass surgery.
Results:With this method, surgeons can make stitches and ties by both hands without exchanging instruments.
Conclusions:This method is effective and may result in faster anastomotic procedure comparing with the traditional one.
Extracranial-intracranial (EC-IC) bypass surgery such as superficial temporal artery-middle cerebral artery (STA-MCA) bypass has been widely performed for moyamoya disease, artery involved tumors, complex aneurysms, and selected ischemic stroke due to arteriosclerosis.[
Illustrations of a new anastomotic method using both-handed needle holder with a function of fine forceps. (a) Traditional method using a needle holder in the dominant hand and a fine forceps in the nondominant hand. (b) The present method using both-handed newly developed needle holder. The present needle holder in the left hand can hold the adventitia of the vessel. (c) The tips of the present needle holder on the left are placed into the vessel lumen and the right needle holder thrusts the needle through the vessel wall between the left-sided tips which provide counter pressure. (d) Tying procedure the suture with both-handed needle holders
STA-MCA bypass is carried out in the standard manner[
A new type of needle holder having fine long jaws as acting fine forceps is recently released from Mizuho Co., Ltd., Tokyo, Japan and Muranaka Medical Instruments Co., Ltd., Osaka, Japan [Figures
Although several surgical techniques are available such as double insurance bypass,[
The present needle holder allows a surgeon an excellent handling such as placing tips into the vessel lumen for counter-pressure [
The fine forceps sometimes damage or snap monofilament nylons during tying threads because the tips of forceps are too sharp and hold nylons in a pin-point manner. By contrast, the present smooth needle folder jaw with rounded edges rarely damage monofilament sutures. This is also an advantage of a both-handed needle holder technique.
In our experience, only the present needle holder usage without fine forceps is difficult in very small recipient bypass (less than 0.7 mm in size) in some patients with moyamoya disease. Therefore, such extremely fragile vessel bypass still requires the ultra-fine forceps.
This technique can facilitate faster and more efficient microsurgical anastomosis, which the novice neurosurgeon may find useful. The present needle holder in both hands might reduce the occlusion time without exchanging the instruments.
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