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Tissue-disruptive forces during median sternotomy.

Gil Bolotin1, Gregory D Buckner, Nigel B Campbell

  • 1North Carolina State University, Raleigh, North Carolina, USA.

The Heart Surgery Forum
|January 12, 2008
PubMed
Summary

Instrumented retractors reduce surgical forces during median sternotomy. This novel device monitors retraction forces, potentially decreasing tissue damage and postoperative pain for patients.

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Area of Science:

  • Surgical Innovation
  • Biomedical Engineering
  • Thoracic Surgery

Background:

  • Median sternotomy commonly causes acute and chronic pain, often underestimated.
  • Mechanical retractors exert significant forces on the skeletal cage during sternotomy.
  • Hypothesis: Instrumented retractors can monitor and control forces, reducing damage and pain.

Purpose of the Study:

  • To develop and test a novel instrumented retractor for real-time force monitoring during median sternotomy.
  • To evaluate if reduced retraction forces decrease tissue damage and postoperative pain.

Main Methods:

  • Developed a novel instrumented retractor with real-time force monitoring capabilities.
  • Tested the retractor in 16 sheep median sternotomies, comparing standard vs. force-feedback retraction.

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  • Monitored retraction forces, blood pressure, and heart rate throughout the procedures.

    • Main Results:

    • Instrumented retraction reduced average forces by 37.2% (103.0 N vs. 64.7 N) and peak forces by 30.9% (368.8 N vs. 254.8 N).
    • Force feedback led to a more deliberate surgical pace (12.1 min vs. 7.3 min).
    • Heart rate was significantly higher during standard retraction, indicating reduced animal stress with force feedback.

    Conclusions:

    • The novel instrumented retractor significantly lowered average and peak retraction forces during median sternotomy.
    • Reduced retraction forces correlated with decreased animal stress, evidenced by lower heart rates.
    • This technology may lead to less tissue damage and reduced postoperative pain after sternotomy.