Thompson Retractor User Manual - Thompson Surgical Instruments
Contents
1. 6 THOMPSON RETRACTOR USER MANUAL STEP 1 Use an assistant if needed to position ring frame 5cm 2 above the patient s body surrounding the incision site STEP 3 Wrap the latch cam joint jaws around the ring frame shown far left and secure by flipping the latch cam joint handle to the locked position while grasping the extension arm for leverage shown left STEP 2 Unlock the cam joint on the rail clamp to release the extension arm and slide the extension arm toward the ring frame STEP 4 Once ring and extension arm are in place lock the cam joint on the rail clamp by flipping the rail clamp cam joint handle to the locked position to secure S LOCK BILATERAL CERVICAL SPINE FRAME aiso APPLIES TO NON S LOCK STEP 1 To secure the Elite II Rail Clamp to the table be sure the jaws of the rail clamp are completely open by turning the knob at the top of the rail clamp Once open secure the rail clamp by placing the open rail clamp jaw over the sterile drape on either side of the table CAUTION If the patient is obese avoid compressing the patient s body When necessary use a wider OR table or add to the width of the table using our Rail Extender 41917 STEP 2 To tighten the Elite Rail Clamp to the table turn the knob at the top of the rail clamp and utilize the attached two hanging handles for added leverage when needed STEP 3 Repeat Steps 1 and 2 to2. In the first groove 1 the blade will be allowed to swivel In the second groove 2 the blade will lock in position by mating with serrations on the handle STEP 15 STEP 16 Slide the 1 4 x 1 4 Side Clip Slide joint over the end of the L Bar A Insert the medial lateral blade into the incision and retract handle back by hand with the clip side of the joint and the knob on top as shown B Snap the handle into the clip joint and turn the knob with fingers or with T Handle to TIP Do not allow joint to slide off of the U or L Bar Tighten slightly tighten to prevent it from sliding but do not tighten all the way down TIP If the handle does not easily snap in the joint may need to be loosened first 14 THOMPSON RETRACTOR USER MANUAL MIS PLA POSTERIOR LUMBAR ACCESS SYSTEM continuen ADDING MEDIAL LATERAL RETRACTION continue STEP 17 A To add a lateral retractor attach the desired blade to the S Lock Interchangeable Head Insert the blade in to the incision and retract towards the U Bar B Snap the S Lock Interchangeable Head on to the U Bar If it does not easily snap on joint may need to be loosened with fingers or T Handle To lock use the T Handle to tighten the joint C To retract the lateral blade apply the T handle to the U Bar where it attaches to the L Bar STEP 18 To angle medial lateral blades use fingers to rotate the knurled portion of the handle or if additional leverage is needed apply the Ang
3. CAUTION If patient is obese avoid compressing the patient s body When necessary use a wider OR table or add to the width of the table using a Rail Extender 41917 STEP 4 Insert the angled arm into the bottom cam joint on the rail clamp and position around the incision STEP 5 Lock the angled arms to the rail clamp by flipping the rail clamp handle into locked position while grasping the rail clamp for leverage Repeat with the second angled arm on opposite rail clamp if desired STEP 6 Add retractors as needed See page 8 ALTERNATE STAGGERED BILATERAL FRAME SET UP STEP 1 STEP 2 A Attach an Elite II Rail Clamp to the patient s right side of the table A Position the upper abdominal angled arm in the rail clamp s upper cam joint and secure it 8 to B Add a rail clamp to the opposite side at the patient s thigh 10cm 3 4 depending on desired elevation of the costal margin above the patient s chest B Position the lower abdominal angled arm in the rail clamp s lower cam joint and position it just above the patient s pubic bone STEP 3 STEP 4 A Place an angled arm in the top cam joint of the lower abdominal rail clamp Add retractors as needed See page 8 B Interconnect its distal end with that of the upper abdominal angled arm using 1 2 x 1 2 cam joint 421100 THOMPSON RETRACTOR USER MANUAL 9 S LOCK HINGED RING FRAME aiso APPLIES TO NON S LOCK UNILATERAL TABLE MOUNT STEP 1 STEP 2 A
4. cause some difficulty when trying to un clip the handle To easily remove clip on cam joints from arms pinch the back of the cam from the frame joint using thumb and index finger Gently lift up off of arm SOLUTION THOMPSON RETRACTOR USER MANUAL 21 ANTERIOR CERVICAL SET UP TIPS AND TRICKS ELITE lI RAIL CLAMP see next page Placement The rail clamp should be attached to the bed rail in line with the top of the patient s head TIP If the rail clamp height is in the way consider using the 11 rail clamp for a lower profile working area Or utilize the Infinite Height Rail Clamp if sharing the frame for lumbar procedures see next page TIP The rail clamp may be positioned on either side of the table if obstructing the surgeon or assistant s movements TIP The rail clamp may be positioned at the patient s shoulder if no rail space is available near the patient s head or if the rail clamp is more out of the way near the patient s shoulder Ensure the rail clamp will not interfere with imaging of the affected cervical levels See next page TIP If no rail space is available near the patient s head but the rail clamp is desired near the patient s head utilize a rail extender CROSSBAR Placement The crossbar should be positioned 2 3 fingers level above the patients head See next page for an alternate set up that eliminates the crossbar TIP If more space is needed above the patient th
5. Handles or cam joints can be attached between the two cam joints as long as the cam joint handles are locked out of the way SOLUTION Rotate the cam joint handles out of the way so that they don t block the crossbar before locking them down ISSUE The retractor handle won t reach far enough The retractor handle might not be reaching far enough gt if the arms are too far apart or if the retractor handle cam joint is attached on the outside of the frame SOLUTION Attach the retractor handle cam joint so that the cam joint is on the inside of the frame It will provide more reach If this is still not enough room move the angled arms closer to the operative site ISSUE The retractor handle sticks out in attached to the handles can rotate 360 so the handles do not have to lock back in gt the direction they are rectracting If using S Lock Technology blades and handles the blade can be locked in any orientation to the handle so that it doesn t swivel if the handle is rotated out of the way 20 THOMPSON RETRACTOR USER MANUAL the working area NO a e Ve Retractor handle cam joints and the blades nn E SOLUTION A Rotate the handle so that it angles away from you before locking Rotate the blade so that it still retracts in the desired position B Utilize S Lock blades and handles to prevent blade swivel THOMPSON RETRACTOR TIPS AND TRICKS cont
6. the button is fully extended out of the handle to secure Insert S Lock blade nipple into S Lock handle by pushing button TIP When in swivel position nipple should be seated inside handle head just below flush as pictured STEP 4 RELEASING BLADES Press button in to disengage STEP 3 LOCK WHEN SWIVEL IS NOT DESIRED Lock S Lock blade in position on the lock groove nipple setting by pushing the button again and pressing straight down over the handle to engage the serrations Ensure the button is fully extended out of the handle to secure Locked j TIP To switch between two settings during use unlock the handle or release retraction for ease of use NOTE Blades with SO before part number swivel only and do not lock in any orientation SO blades must only be used with SL handles I I ANGLING RETRACTOR MICRO ADJUSTABLE RETRACTOR HANDLE ADJUSTMENT HANDLE ADJUSTMENT Micro Adjustable knob provides leverage and microadjustments for precise blade retraction Ratcheted handle makes Rotating feature provides for quick and easy blade atraumatic alignment adjustment without having to on anatomy and precise blade unlock cam joint positioning Blades may be angled or toed 35 in or out with fingers or wrench for low profile Uncompromised Exposure 8 THOMPSON RETRACTOR USER MANUAL ALTERNATE COMPONENTS INFINITE HEIGHT RAIL CLAMP STEP 1 if To secure the Infinite Height Ra
7. to prevent clip from moving on the blade Do not block light OPTION S Lock may be utilized to rotate blade without affecting clip position in most cases If clip position is affected move clip and light to a different blade THOMPSON RETRACTOR USER MANUAL CENTRAL CERVICAL ACCESS CCA RETRACTOR SYSTEM For frame set up see Bilateral Cervical Spine Frame page 7 BLADE PLACEMENT AND HANDLE ATTACHMENT STEP 1 Use the Depth Gauge to select the appropriate blade length and attach the Manipulator Handle to the blade as shown STEP 2 Holding the Manipulator Handle place the first blade driving the blade tip in to the anterior aspect of the spine Use extreme caution at C6 C7 and in all areas where the patient s vertebral artery runs more anteriorly STEP 5 A Insert the blade nipple into the Release the plunger with the handle on the Swivel groove and swivel the blade to the desired position lf desired lock the blade in position by pushing the plunger again and pressing straight down over the handle ow DO NOT use bone levers with non hinged S Lock handles Bone levers may only be used STEP 4 To secure the blade attach an S Lock Hinge to the blade nipple handle by pushing the plunger i with SL45003LH or SL42126LH STEP 3 Attach a Clip Clip Joint to the Angled Arm nearest to the blade placed in Step 2 as shown STEP 6 Attach the S Lock Hinged Handle to the Cl
8. attach the second Elite II Rail Clamp on opposite side of the table STEP 4 STEP 5 Insert the angled arms into the open cam joint on both rail clamps Lock the angled arm in place by flipping the rail clamp cam joint parallel to the axis of the neck 10 12cm 4 5 from the midline handle into locked position and grasping the rail clamp for NOTE To facilitate downward lateral retraction the arm on leverage the surgeon s side should be approximately 5cm 2 lower than its counterpart THOMPSON RETRACTOR USER MANUAL HANDLES AND BLADES RETRACTOR HANDLE ATTACHMENT STEP 1 STEP 2 ALTERNATE STEPS 1 AND 2 STEP 3 Clip cam joint onto frame at any location Position blade in site and attach Alternately attach blade to handle first use Retract amp lock in position Handles are permanently mounted in the Cam handle to blade handle to position blade in site then secure I clip on joints to create a one piece handle by clipping cam joint to frame SPECIAL HANDLE AND BLADE FEATURES S LOCK All S Lock blade and handle part numbers start with an SL or SO and are only compatible with other S Lock blades and handles STEP 1 COMBINE S LOCK BLADE AND HANDLE S Lock handles have serrated faces that match up with serrations on S Lock blades for precise blade placement STEP 2 SWIVEL ALIGNS ON TISSUE Release button with handle on the swivel groove nipple setting and swivel to desired position Ensure
9. keep instrument handles UNLOCKED open when not in use YA Only LOCK down cam joint handles when rods are present or in place Always UNLOCK open handles before adjusting rods or disassembling equipment Ensure cam joint holes have smooth inner surface free of scratches or burs before inserting rods Ensure rod surfaces are smooth free of gouges scoring before placing into cam joint holes vad Carefully align screw knobs to smoothly tighten engage threads Keep threads clean and lubricated Always depress blade handle release button while attaching detaching blades THOMPSON RETRACTOR USER MANUAL DO NOT Use parts with residue call Thompson if you have questions on staining or residues Sterilize instruments without pre cleaning blood debris can embed and cross contaminate Use high pH products or those containing chloride will strip protective layer on metal and cause rust Q Use saline when soaking instruments Store instruments wet or semi dry will stain and corrode the metal Store instruments dirty debris can contaminate and rust the metal LOCK instrument handles down when not in use will damage collapse cam joints Q LOCK handles without rods in place will collapse distort settings Q Adjust rods while cam joint handles are LOCKED down twisting force will damage both pieces Insert rods into damaged cam joint holes force fit will damage both pieces Insert damaged rods into cam join
10. ND TRICKS ccccccsssssscssssssssescecsssesssessseees 22 23 DO S AND DON TS OF INSTRUMENT CLEANING AND STORAGE eeeeheeeeeeekeeeee 24 THOMPSON RETRACTOR USER MANUAL 3 S LOCK QUICK FRAME OR S LOCK SPINE FRAME aiso APPLIES TO NON S LOCK STEP 1 To secure the Elite Il Rail Clamp to the table be sure the jaws of the rail clamp are completely open by turning the knob at the top of the rail clamp Once open secure the rail clamp by placing the open rail clamp jaw over the sterile drape on either side of the table CAUTION Avoid compressing the patient s body with frame components to prevent nerve STEP 2 STEP 3 damage To tighten the Elite II Rail Clamp to the Insert the crossbar into the rail clamp and position When necessary use a wider OR table or table turn the knob at the top of the the crossbar approximately 3 to 5 cm above the add 2 1 2 to the width of the table by rail clamp and utilize the attached two patient Prior to inserting the crossbar the cam using our Rail Extender 41917 hanging handles for added leverage jointon rail clamp needs to be fully open by when needed flipping handle out into the unlocked position STEP 4 STEP 5 STEP 6 Lock the crossbar to the rail clamp by flipping Insert the frame arms into the cam joints on the crossbar With the frame arm positioned flip the cam joint the rail clamp cam joint handle into locked and position the frame arms over th
11. Thompson Retractor User Manual Thompson Retractor amp SET UP INSTRUCTIONS FOR ALL THOMPSON RETRACTORS THOMPSON RETRACTOR USER MANUAL TABLE OF CONTENTS FRAMES S Loc Quick Frame or Spine SSE 4 BGC Bilateral EE N 5 ola 00 20 GSE EEE S Lock Bilateral Cervical Spine Frame osoronvnverervrvervrversererserrsrressrsensssensrsenersenessssrsersensssene FRAME COMPONENTS Retractor Handle Atlachm ent sesadiesibtauddivbivteluniedanedevesettasel 8 MT E E KEK KRKRKRKRMw MRMRMRMRMR NE ev 8 Angling Retractor Handle Adjustment ner reeeeek kereker ekkerekek 8 Micro Adjustable Retractor Handle Adjustment c cceeeessssessestsseseeseeseseeseceseeteeteseeteseenss 8 Alternate Components Infinite Height Rail Clamp IHRC rere 9 Pee 9 ILLUMINATION LEE 10 EVA 10 Fler ones EAE E EE 10 Min Retractor Lite L i i Li 42 EE 10 SPECIALTY SYSTEMS Central Cervical Access CCA Retractor System ccccssescesessesesseseseesesessesesteseecsseseeneseeneseees 11 MIS PLA Posterior Lumbar Access SySterf u erer kererkekekee 12 15 laparoscopic 1 ONG EEE 16 17 Bolling Mitral Valve Retractor rere ekere ekere kerek ereke 18 Body Contouring System 5 ix c 4 1ec ka kis kyaneyyebe nenen eke lak hekdkye saiaren 19 THOMPSON RETRACTOR TIPS AND TRICKS ccccsssccsssssssccsscssssecsessscesssessssees 20 21 ANTERIOR CERVICAL SET UP TIPS A
12. e crossbar may be rotated upward TIP When accessing uppermost cervical levels an extension arm can be added to the crossbar to help facilitate the appropriate angles of retraction TIP The crossbar may also be placed over the patient s chest depending on where the rail clamp is set up see next page ANGLED ARMS Placement Position arms low and wide creating a low profile working area and ensuring enough distance for handle retraction TIP Keep arms level with the incision Placing too low may interfere with imaging TIP The 18 Arms have 8 and 10 sides For more reach place the 8 portion in the crossbar TIP When securing the arms to the crossbar ensure the cam handle on the cam joint is in the same plane as the arms and not over the center of the crossbar taking up real estate for the handles to be attached HANDLES Placement Handles can be clipped on to the arms or the crossbar at any location TIP Use the S Lock feature to lock blades securely in place while moving the retractor handle out of the way on the surgeon s access side Ma 27 SA ey SA TTS TY Ezy PS Dok Ger Ay LT L a EG Sa bees i E TH a SPE Dna 4 2 g l it J zx p VL ri at J aw p d TIP Utilizing S Lock technology blades are easily placed by locking the blade in place on the handle and using in the same manner as a hand held retractor to position Once in place the handl
13. e may be clipped onto the frame and secured 22 THOMPSON RETRACTOR USER MANUAL RADIOLUCENT BLADES Placement Blades may be positioned in the head and toe direction as well as medially and laterally Blades may be positioned for 1 4 levels of exposure from upper to lower cervical regions TIP Most often the need for toothed blades is eliminated through the use of a table mount I Longitudinal Longitudinal 30 70mm lengths Micro Concave Medial Lateral 35 80mm lengths Concave Tapered Medial Lateral 35 70mm lengths Microdiscectomy 35 60mm lengths Midline Odontoid Malleable Mandible Odontoid Longitudinal Cephalad Longitudinal Cephalad Left and Right blades 20mm x 90mm Multiple sizes available ALTERNATE PRODUCT SOLUTIONS FOR ANTERIOR CERVICAL ALTERNATE RAIL CLAMP PLACEMENT The rail clamp may also be placed at the patient s chest level as an alternate to the standard anterior cervical frame set up The rail clamp and crossbar are positioned at the patient s chest with the angled arms attached toward the head low and wide 18 Elite II Rail Clamp 11 Elite II Rail Clamp Infinite Height Rail Clamp INFINITE HEIGHT RAIL CLAMP An alternate option to the Elite II Rail Clamp the Infinite Height Rail Clamp can easily be adjusted to any height between 13 and 22 and can be utilized with the spine frame for any exposure 11 ELITE Il RAIL CLAMP For an even lower prof
14. e patient s body low and handle into locked position To secure each arm position and grasping the rail clamp for wide around the operating space All cam joints should be grasp the frame components for leverage leverage in unlocked position when inserting frame arms COMPLETE FRAME SET UP ABDOMINAL EXAMPLE COMPLETE FRAME SET UP CERVICAL EXAMPLE For retractor handles and blades see page 8 For retractor handles and blades see page 8 For additional anterior cervical tips and tricks see pages 22 23 ADDITIONAL SUGGESTED SET UPS For complete selection of suggested set ups see the Thompson Surgical Atlas WE RECOMMEND RELAXING TENSION ON RETRACTORS EVERY 20 MINUTES TO ENSURE PROPER BLOOD FLOW 4 THOMPSON RETRACTOR USER MANUAL S LOCK BILATERAL FRAME iso APPLIES TO NON S LOCK STEP 1 Attach the Elite II Rail Clamp to one side of table as shown on page 4 Steps 1 and 2 Repeat on opposite side of table with second Elite II Rail Clamp STEP 2 Insert the bilateral crossbar into the top cam joint of the rail clamp making sure cam joints are fully open unlocked position on either side of the OR table Adjust the bilateral crossbar s height 8 to 10 cm 3 4 over the patient STEP 3 Lock the bilateral crossbar to the rail clamp by flipping the rail clamp handle into the locked position and grasping the rail clamp for leverage A rigid crossbar may be used in place of the hinged bilateral crossbar
15. e right arm direction until blades meet THOMPSON RETRACTOR USER MANUAL MIS PLA POSTERIOR LUMBAR ACCESS SYSTEM continuen OBTAIN EXPOSURE STEP 7 Slide the caudal cephalad blades attached to the frame over the dilators and rotate the frame so that the frame rack runs parallel to the spine TIP Hold blades together at the neck during insertion over dilators for the smoothest step transition TIP Point the rack away from the surgeon for a larger working area STEP 9 xw A STEP 8 A Loosen the knurled knob on the distal end of the Articulating Arm B Loosen the black knob knob shown in step 9B on the Articulating Arm and pull the distal end of the arm toward the frame rack Unlock the cam joint on the rail clamp if needed Insert the distal end of the arm over the end of the frame rack C Tighten the knurled knob on the distal end of the arm to lock the frame to the table mount TIP Use an assistant to hold the frame and blades steady while attaching to the table mount STEP 10 Hold frame in position while an assistant A locks the cam joint on the rail clamp Remove the dilators in one step by pulling up on the initial dilator then B tightens the black knob Use caution handing dilators to avoid dropping TIP If adjustments are needed simply loosen the black knob to add flexibility to the TIP If friction occurs between the dilators and the blades hold the arm Reposition the frame and
16. her from the operation site SEQUENTIAL DILATION STEP 3 A After the incision is made insert the first dilator and sequentially add the next three dilators B Take note of the depth marked on the dilator that is closest to the skin for blade length selection TIP Use caution holding dilators to avoid dropping Do not use dilators if they are deformed or dented V press pawl with finger Em TE STEP 4 A Assemble the frame beginning by holding the rack with the toothed side facing away B Slide the Left and Right Frame Arms on to the rack so that the buttons are pointing outward C The left arm should be on the assembler s left and the right arm should be on the assembler s right center line STEP 5 STEP 6 A Select the Left and Right Caudal Cephalad C C Blade that Press down the pawls located on each frame arm near the rack to slide the frame corresponds with the depth noted in Step 3 Attach the blade arms together Center the arms on the rack for maximum retraction potential marked L to the left frame arm by pressing the button on the TIP Ensure the blades are touching to enable a close fit with the dilators If blades arm and inserting the blade nipple into the arm then releasing are not aligned straight check to make sure the frame arms are not angled If button to secure connection the arms are angled locate the angling nut in Step 12 and turn in the opposite B Repeat steps to attach the blade marked R to th
17. il Clamp to the table be sure the jaws of the rail clamp are completely open by turning the knob toward the bottom of the rail 5 m PR clamp counter clockwise P Once open secure the rail clamp by e p placing the open rail clamp jaw over Pte kn the sterile drape on either side of the amp Rotate q 8 lock PARA table to loosen cam joint Secure Knob cam joint CAUTION Avoid compressing the patient s body with frame components to prevent nerve STEP 3 damage Starting with the height in the tallest setting adjust rod to the desired When necessary use a wider OR table height by rotating counter clockwise to loosen the cam joint or add 2 1 2 to the width of the table Slide the post down to the desired height and tighten the knob by using our Rail Extender 41917 clockwise to secure the setting Tighten cam joint completely to lock STEP 2 STEP 4 To tighten the Infinite Height Rail Clamp to the table turn the knob toward the Add frame components to rail clamp cam joint s bottom of the rail clamp clockwise utilizing the attached four hanging handles for added leverage when needed Do not attempt to adjust rail clamp height with frame components attached unless supporting the weight of the frame components with a hand The post will not slide easily during height adjustments if this is not done LOWER ABDOMINAL BAR BILATERAL USE STEP 1 A Using an assistant insert either end of the Lower Abdomina
18. ile you may choose to use the 11 Elite II Rail Clamp BILATERAL CERVICAL SPINE FRAME If a lower profile bilateral option is preferred the Bilateral Cervical Spine Frame may be used Dual 11 Elite II Rail Clamps our smallest Elites ever offer a low profile bilateral frame to increase frame stability increase working space and reduce frame set up time See page 7 RAIL EXTENDER If the OR table rail does not extend past the patient s head a rail extender may be needed The rail extender attaches to the OR table rail and adds length to the rail where needed The rail clamp can then be secured to the rail extender JACKSON FRAME ADAPTER If using a Jackson spine table the Jackson Frame Adapter may be connected to the table to add a standard bed rail to attach the Thompson frame THOMPSON RETRACTOR USER MANUAL 23 DO S AND DON TS OF INSTRUMENT CLEANING STORAGE AND INSPECTION 24 DO Check that all parts have been properly cleaned and sterilized and that no unacceptable stains or residues are present on parts YA Always pre clean instruments before placing into sterilizer VA Use low to average pH products cleaning agents Dd Use distilled water when soaking instruments va Always ensure instruments are completely dry before storing Always store instruments in clean condition in a dry amp sterile environment Protect instruments when storing wrap instruments or use instrument case trays va Always
19. inuen There s no room to retract further A Open up the angled arms to create a wider frame and point handles away If the angled arms are set up too close retraction space may be limited from your working space Additionally the handle cam joints can take up retraction space and the handle can reach maximum retraction early when it runs into the cam joint like the two bottom handles in the photo above B For more retraction room attach handle cam joints with the bulk on the outside of the arm ISSUE SOLUTION The retractor is up too high and it feels like I m working in a Lower the crossbar shown and or angled arms as necessary The angle tunnel in the arm allows you to lower the arm while keeping a portion of it If the angled arms and crossbar are positioned up too high the handles will be parallel to the ground for an even set up Using angling handles will aid in forced to angle downward to reach the incision adding to the tunnel effect and lowering the overall profile as well causing the handles to stick up The crossbar only needs to be about 5cm 2 off Alternately the angled arms may be set up low and wide see photo above of the patient and the angled arms can go lower as long as they don t touch the patient or block imaging ISSUE It is difficult to remove the Micro Adjustable Handle from the Retractor Frame Micro Adjustable Handles clip securely onto the frame and will not fall off This may
20. ip Clip Joint The S Lock Hinged Handle will slide freely in the joint STEP 7 STEP 8 Retract the handle back and remove the manipulator Place an additional blade across from the first and add blades to handle Secure the retraction by turning the Clip Clip the adjacent levels to be visualized knob to tighten the joint THOMPSON RETRACTOR USER MANUAL 11 MIS PLA POSTERIOR LUMBAR ACCESS SYSTEM 12 TABLE MOUNT STEP 1 STEP 2 A Attach the Elite II Rail Clamp jaw to the table rail 45 65cm 18 24 away A Insert the Articulating Arm into the rail clamp cam joint from the site of operation on either side of the table over the sterile drape B Ensure the distal end of the arm can reach the site of operation with several B To secure turn the knob at the top of the rail clamp and utilize the inches of flexibility attached hanging handles for added leverage when needed C Rotate the arm out of the working area until ready to be used and lock to the TIP Position so that the rail clamp will not interfere with imaging equipment rail clamp by flipping the rail clamp cam joint handle to the locked position CAUTION If patient is obese avoid compressing patient s body When grasping the rail clamp for leverage necessary use a wider OR table or add to the width of the table using Rail TIP If a larger range of motion is needed move the rail clamp closer to operation Extender 41917 site If arm is too close move the rail clamp fart
21. l Bar in to the Elite II Rail Clamp cam joint lower cam joint if using with a 2 cam jointed rail clamp on either side of the patient Position the Lower Abdominal Bar around the incision keeping the lateral sides low and wide STEP 2 Secure the Lower Abdominal Bar by locking the cam joints on both Elite II Rail Clamps UNILATERAL USE STEP 1 A Using an assistant insert either end of the Lower Abdominal Bar into the crossbar cam joints on either side of the patient Position and hold the Lower Abdominal Bar around the incision keeping the lateral sides low and wide STEP 2 Secure the Lower Abdominal Bar in position by locking the cam joints on the crossbar THOMPSON RETRACTOR USER MANUAL ILLUMINATION PRODUCTS LITE WAND If using a Retractor Lite skip these steps and begin with Step 4 STEP 1 STEP 2 STEP 3 Clip the Lite Wand cam joint anywhere on the Secure the Lite Wand in place by locking the cam joint Bend the gooseneck to position the distal retractor frame that will allow the distal end of end of the Lite Wand the light to illuminate the incision NOTE If deeper illumination is needed continue to Steps 4 and 5 If not skip to Step 6 RETRACTOR LITE AND LITE WAND If using a Retractor Lite begin here STEP 4 Attach Lite Clip to distal end of Lite Wand or Retractor Lite with the thin opening toward the back of the lite STEP 5 While applying pressure to the blade for
22. leverage slide the lite and Lite Clip onto the desired blade Push all the way onto blade to secure N STEP 6 O Plug Lite Wand or Retractor Lite cable into the appropriate light source and turn source on NOTE If using xenon light products be sure that the bulb in your hospital s xenon light source is properly functioning is turned up all of the way and doesn t need to be replaced A bulb that has been used over 700 hours can reduce light by up to 30 Also replacing bulbs with less expensive off brand bulbs can cause light reductions in lighting accessories such as ours Light sources should be Xenon only 300W Lastly check to make sure your light source properly fits our Lite Wand Xe and Retractor Lite Xe plugins An improper fit will reduce light emissions We provide adapters for Olympus Storz and Wolf light sources if needed MINI RETRACTOR LITE LED cervicat USE ONLY 10 STEP 3 Plug Mini Retractor Lite STEP 1 STEP 2 cable into LED Press distal end of Mini Retractor Lite 40002MRL into Slide Mini Lite Clip and Mini Retractor Lite on to retractor blade clip is intended Light Source Mini Lite Clip 40026MRL Apply pressure to the rigid to be used with Thompson anterior cervical blades Adjust clip so that the light LLS 2000 and metal portion of the light only to avoid damaging cable emitting end of Mini Retractor Lite is unobstructed and points down blade face turn source on STEP 4 Reduce cable tension
23. ling Wrench to the hexed portion of the handle REMOVAL To remove the retractor begin by returning all blades to a straight up and down position by unangling all blades Next remove the medial and lateral retractors by loosening the joints removing handles and blades and sliding them off of the U or L Bar Carefully return the caudal cephlad blades to the start position by pressing the pawl so that the blades can be pushed together Dismount the Articulating Arm from the frame and gently pull the frame and blades up to remove from the patient MIS RETRACTOR LITE LED STEP 1 Insert the distal ends of the light into the blade channels STEP 2 Swing the light ends back so that they hook under the frame arms securely TIP Do not pull on cable during this step apply pressure to rigid metal portion of distal end to avoid damaging cable TIP More or less pressure may be needed to secure the light ends under the frame arms variations in pressure needed are normal STEP 3 Plug light cable in to light source and turn light source on REMOVAL DO NOT remove lights from blades without first turning the light source off Please refer to MIS Retractor Lite LED IFU for all precautions Gently apply pressure to unhook the light ends from the frame arms and slide light ends out of blade THOMPSON RETRACTOR USER MANUAL 15 LAPAROSCOPIC 16 ELITE II RAIL CLAMP SET UP STEP 1 To secure the Elite II Rail Clam
24. ooved rod For unilateral setup pannus weighing less than 251bs skip step 5 and go to step 6 For bilateral setup pannus weighing 25lbs or more continue to step 5 STEP 5 A Repeat Steps 1 and 2 to attach the second Elite II Rail Clamp on the opposite side of the OR table B Insert the straight arm into the Elite II Rail Clamp s cam joint vertically and lock by flipping the rail clamp cam joint handle into the locked position C Insert the grooved rod into the straight arm cam joint and flip the cam joint handle to the locked position to secure grasping the straight arm for leverage STEP 6 A Attach perforating towel clips to pannus as needed and loop the finger rings over the Towel Clip Crank hooks B Retract as needed by turning the Towel Clip Crank s knobs clockwise Add retractors as needed CAUTION Release retractors every 20 minutes to ensure proper blood flow THOMPSON RETRACTOR USER MANUAL 19 THOMPSON RETRACTOR TIPS AND TRICKS ISSUE The crossbar sticks out and in the way The crossbar was designed for versatility it can be raised and lowered while also being rotated The key is to remember to rotate the crossbar so that if there is any excess length it is pointing out of the way SOLUTION Rotate the crossbar and point excess length out of the way lower the crossbar height as needed ISSUE There is no room to add a handle or cam joint to the crossbar
25. ositioned toward the top for easier access inset photo 18 STEP 4 STEP 5 Select shortest retractor necessary for patient size Three lengths are provided Insert retractor into joint retract anatomy and lock joint by turning knob clockwise Repeat for additional retractors THOMPSON RETRACTOR USER MANUAL BODY CONTOURING SYSTEM STEP 2 STEP 1 To secure the Elite Il Rail Clamp to the table be sure the jaws of the rail clamp are completely open by turning the knob at the top of the rail clamp Once open secure the rail clamp by placing the open rail clamp jaw over the sterile drape on either side of the table CAUTION Avoid compressing the patient s body with frame components to prevent nerve damage When necessary use a wider OR table or add 2 1 2 to the width of the table by using our Rail Extender 41917 To tighten the Elite II Rail Clamp to the table turn the knob at the top of the rail clamp and utilize the attached two hanging handles for added leverage when needed A Insert the 90 grooved rod into the rail clamp with the grooved portion in the horizontal position Prior to inserting the rod the cam joint on rail clamp needs to be fully open by flipping handle out into the unlocked position B Lock the rod to the rail clamp by flipping the rail clamp cam joint handle into locked position and grasping the rail clamp for leverage STEP 4 A Slide the Towel Clip Cranks over the gr
26. p to the table be sure the jaws of the rail clamp are completely open by turning the knob at the top of the rail clamp Once open secure the rail clamp by placing the open rail clamp jaw over the sterile drape on either side of the table STEP 2 To tighten the Elite II Rail Clamp to the table turn the knob at the top of the rail clamp and utilize the attached two hanging handles for added leverage when needed STEP 3 Insert the holder into the rail clamp and lock in place by flipping the rail clamp cam joint handle into the locked position while grasping the rail clamp for leverage CAUTION If the patient is obese avoid compressing the patient s body When necessary use a wider OR table or add to the width of the table using our Rail Extender 41917 HOLDER ADJUSTMENT Follow the instructions for adjusting preferred holder LAPAROSCOPIC ARTICULATING ARM STEP 1 RELEASE ARM TENSION Release the tension of the arm by turning the black knob counter clockwise to loosen FLEXIBLE LAPAROSCOPIC HOLDER STEP 1 SECURE POSITION Position the arm ensuring it will allow the scope or instrument to reach the incision Secure the position by tightening the universal joint A loosen C tighten STEP 3 ADD AN ATTACHMENT A Turn the knurled knob on the distal end counter clockwise to loosen B Insert the attachment into the opening CTurn knob clockwise to tighten STEP 2 ADJUST ARM POSITION Po
27. sert scope into bushing Insert scope and bushing into Scope Grip Position scope and turn clockwise the joint clockwise to tighten securing in place NOTE To reposition scope joint on holder may need to be loosened SCOPE CLIP Provides a less firm hold for quick in and out panning of flat scopes STEP 1 INSERT SCOPE Insert scope into the Scope Clip and position STEP 2 EASILY ADJUST Scope may be easily adjusted for in and out panning NOTE Scope Clip is reusable STEP 1 STEP 2 STEP 3 Open the Duo Head by turning the joint counter Insert laparoscopic instrument into one side of the Turn the joint clockwise to tighten securing in place clockwise Duo Head and position THOMPSON RETRACTOR USER MANUAL 17 BOLLING MITRAL VALVE RETRACTOR e T Bar 8 47201N eh e L Bar 2 47200N amp L Bar 2 47200N L Bar 6 x 8 47202N STEP 1 With sternal spreader in place determine where retractor blades will be needed Select T or L Bar clamp s of choice to allow for mounting of retractor blades See examples above other configurations are possible NOTE Custom bar dimensions are available STEP 2 STEP 3 Turn knurled knob on the clamp counter clockwise to open place over spreader and turn Slide joint onto bar where retractors are needed To avoid suture snags knob clockwise to tighten until secure position the knob toward the bottom of the bar as shown Alternately the knob may be p
28. sition the arm ensuring it will allow the scope or instrument to reach the incision Lock into place by tightening the black knob C tighten Y STEP 2 ADJUST ARM TENSION Turn the hanging handle to adjust tension counter clockwise to loosen clockwise to tighten STEP 3 ADD AN ATTACHMENT ATurn the knurled knob on the distal end counter clockwise to loosen B Insert the attachment into the opening CTurn knob clockwise to tighten THOMPSON RETRACTOR USER MANUAL COMPLETE SET UP See Attachments steps on page 17 COMPLETE SET UP See Attachments steps on page 17 NOTE Always loosen arm tension before moving the scope or instrument LAPAROSCOPIC continuen HOLDER ADJUSTMENT continue Follow the instructions for adjusting preferred holder RIGID LAPAROSCOPIC HOLDER STEP 1 POSITION HEIGHT E STEP 2 POSITION DISTAL END STEP 3 ATTACH INSTRUMENT COMPLETE SET UP Adjust height by unlocking the cam joint and Position the distal end of the holder and Loosen the joint on the distal end and insert Shown with Nathanson Hook moving the holder up or down then secure tighten the universal joint laparoscopic instrument into the opening attached Tighten the joint to secure ATTACHMENTS Follow the instructions for attachment of choice SCOPE GRIP AND BUSHING Holds the scope tightly and prevents rotation of angled scopes STEP 1 STEP 2 STEP 3 Open the Scope Grip by turning the joint counter In
29. t holes will damage both pieces Q Screw down knobs with threads misaligned will strip cross threads dirty threads will jam knobs Q Pull blades from handles without depressing handle release button will damage blade amp nipple Rev B 121515 trumeng1215 Thompson bt SURGICAL INSTRUMENTS wh 10170 East Cherry Bend Road Traverse City Michigan 49684 phone 231 922 0177 fax 231 922 0174 thompsonsurgical com EC REP Emergo Europe Molenstraat 15 2513 BH The Hague THE NETHERLANDS C 0297 2015 Thompson Surgical Instruments Inc Traverse City Michigan S Lock PLA and the T Circle logomark ifi are Registered Trademarks of Thompson Surgical Instruments Inc Patents US497 1038 US5025780 US5888197 US5897087 US5902233 US5984865 US6033363 US6416465 US6511423 US7338442 US7749163 US8257255 US8360971 US8617064 Other patents pending The MIS Retractor Lite LED 40002MIS Mini Lite Wand LED 40020LE and LED Light Source LLS 2000 are manufactured by Sunoptic Technologies and distributed by Thompson Surgical Instruments Made in the USA
30. then re tighten the black knob TIP Arch the section of the arm with the black knob upwards to add counter pressure to the frame and to allow for easy access to the knob if adjustments are needed frame in position as the dilators are removed to prevent the frame from rising up STEP 11 STEP 12 Retract blades independently to the desired exposure by turning the nut closest to the Angle blades independently to the desired exposure by turning the frame rack labeled OPEN using the T Handle To reverse retraction press the pawl nut labeled ANGLE using the T Handle To reverse the angle turn located on the frame arm as done in Step 6 the T Handle in the opposite direction THOMPSON RETRACTOR USER MANUAL 13 MIS PLA POSTERIOR LUMBAR ACCESS SYSTEM continuen ADDING MEDIAL LATERAL RETRACTION STEP 13 To prevent muscle creep medial and lateral blades or hooks may be added A lf medial and lateral retraction is desired place the L Bar over the Frame Rack outside of the Frame Arms and secure by turning the knob B To add a lateral retractor place the U Bar Add on on to the L Bar rack by pressing the pawl on the U Bar Add on STEP 14 Select the desired blade style s for retraction in the medial and or lateral direction in a depth that is 10 20mm longer than the depth used for the caudal cephalad blades A Press the gold plunger on the handle B Insert the blade s in to the S Lock Cam II Angling Handle s
31. ttach the Elite II Rail Clamp to one side of Insert the extension arm into the table as shown on page 4 Steps 1 and 2 rail clamp cam joint and temporarily lock in place by flipping the rail CAUTION If patient is obese avoid clamp cam joint handle to the compressing the patient s body When locked position necessary use a wider OR table or add to the width of the table using a Rail Extender 41917 BILATERAL TABLE MOUNT OPTION nor INCLUDED IN KIT If necessary for increased ring stability and especially for larger exposures such as liver transplant utilize a second rail clamp mounted on the opposite side of the table with an additional extension arm RING FRAME ASSEMBLY Select the appropriate sized ring frame based on the procedure size SMALL CIRCULAR RING LARGE OVAL RING NOTE Screw must be completely tightened and serrated faces must be fully seated together to ensure a secure attachment Mate the ring halves together so that the serrated faces meet each other Mate the ring halves and extensions together so that the serrated faces meet each other Rotate the 2 tightening screws clockwise to secure the ring halves together on each side The ring may be secured in a hinged or flat position Rotate the 4 tightening screws clockwise to secure the ring halves and ring extensions together The ring may be secured ina hinged or flat position MOUNTING THE RING FRAME
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