Craniotomy Position: Patient Lateral (Park Bench); Craniotomy Position: Patient Sitting - Symmetry Surgical GREENBERG Manual De Instrucciones

Level ll—Dual Handrests
Step 1—Attaching Short Couplers
(Refer to Figure 17-1 for use with the Gardner Skull Clamp or to Figure 18-1
for use with the Symmetry Surgical Skull Clamp.)
Attach two short couplers (A and B) to the frame to support handrests.
Short couplers can also be used to support extra large, large or small instru-
ment holders. (Retraction/Dissection omitted from illustrations for simplicity.)
NOTE: Instead of the short couplers, two secondary bars can be mounted
on the frame to support handrests; however, this assembly is less desirable
due to limitations in positioning the handrests.
Step 2—Attaching Handrests
(Refer to Figure 17-2 for use with the Gardner Skull Clamp or to Figure 18-2
for use with the Symmetry Surgical Skull Clamp.)
Mount a handrest onto each of the short couplers. It is suggested that the
surgeon place the handrests directly on top of the surgical field.
Coarse adjustments are made by moving the handrest back and forth in the
operative field. Fine adjustments of the handheld instrument are made by
the supported hand holding the instrument between thumb, index, and third
finger, utilizing extension, flexion, and rotation (see Figure 19).
To provide physical support and complete independence of movement for
each hand at Level ll, the use of two handrests is recommended for most
procedures; with surgical activity taking place in the trough formed between
the handrests (see Figure 20).
Level lll—Instruments of Action
Level lll mechanically supports and stores additional instruments in or near
the operative site during surgery. For example, secondary and floating sec-
ondary bars attach to the structure at Level I and are positioned above
Level ll. Instrument holders of various sizes attach to the secondary and/or
floating secondary bars, with instruments such as pneumatic drills, ultra-
sonic aspirators, ultrasound probes, handheld lasers, and scissors attached
to the instrument holders. These instruments are referred to as "instruments
of action." The surgical functions at Level lll are determined by the specific
instruments of action chosen.
Because the instruments of action are supported independently in or near
the surgical field, the surgeon can return to these instruments and use them
as needed. This lessens the surgeonʼs reliance on other surgical team
members. By adjusting the tension of the instrument holders and secondary
or floating secondary bars, the surgeon is able to work within approximately
a two-inch cube (see Figure 21). When planned and executed correctly, this
cube encompasses the operative site so that many activities in the proce-
dure are accomplished without readjustments.
Step 1—Attaching Floating Secondary Bar to Frame
(Refer to Figure 22-1 for use with the Gardner Skull Clamp or to Figure 23-1
for use with the Symmetry Surgical Skull Clamp.)
Attach a floating secondary bar to the frame to hold instruments of action.
Step 2—Attaching Extra Large, Large and Small Instrument Holders
(Gardner Skull Clamp: refer to Figures 22-2 through 22-6.
Symmetry Surgical Skull Clamp: refer to Figures 23-2 through 23-6.)
Extra large, large and small instrument holders, mounted on the floating
secondary bar, support pneumatic drills, ultrasonic aspirators, ultrasound
probes, and handheld lasers. Additional floating secondary bars and instru-
ment holders can be added as needed to support instruments of action at
Level lll.
NOTE: To help support the weight of tubing, use a sterile rubber band as
shown in Detail A.

Craniotomy Position: Patient Lateral (Park Bench)

Suggested assembly for:
Level I Retraction, Dissection, Suction
Level ll Handresting (one handrest for each hand)
Level lll Instruments of Action
using the Symmetry Surgical Skull Clamp, catalog no. 19-1042 or 19-1043*
for craniotomy with patient in lateral, or "Park Bench" position.
*Symmetry Surgical no longer sells Symmetry Surgical Skull Clamps.
500-1500-85-L-INS.indd 6
Level I—Retraction
THE PATIENT IS DRAPED AND THE FIELD IS STERILE. The entire
assembly process shown is carried out by sterile technique, with the
GREENBERG Primary Bar clamp being applied on top of the sterile drapes
covering the headrest.
Step 1—Attaching Primary and Floating Secondary Bars
The primary bar is mounted to the Symmetry Surgical Skull Clamp on top of
the sterile drapes. Attach a floating secondary bar to the primary bar as
shown in Figure 24. NOTE: The floating secondary bar is not included in the
GREENBERG Universal Retractor and Handrest Kit and must be purchased
separately. See "Ordering Information" section of this instruction manual.
Step 2—Attaching Retractor Arms, Microinstrument Holders (Figure 25)
Attach retractor arms and microinstrument holders to the floating secondary
bar for retraction/dissection.
Step 3—Attaching Additional Retractor Arms and Microinstrument
Holders (Figure 26)
If additional supported instrumentation from the opposite side of the cran-
iotomy opening is required, an additional primary and floating secondary bar
can be added as shown. Continuous microsuction is frequently mounted at
this level with the advantage of being out of the traffic pattern of handheld
instruments entering and leaving the field. Additional instruments for retrac-
tion/dissection can be mounted if needed.
Level ll—Handrests
Step 1—Attaching Primary Bar (Figure 27)
Attach a primary bar to the Symmetry Surgical Skull Clamp, and one to the
operating room table.
Step 2—Attaching Floating Secondary Bar (Figure 28)
Attach a floating secondary bar to the primary bar that was mounted onto
the operating room table.
Step 3—Attaching Short Couplers (Figure 29)
Attach one short coupler to the floating secondary, and one to the primary bar.
Step 4—Attaching Handrests
One handrest is mounted on each side of the operative field, as shown in
Figure 30.
Step 5—Counterretraction (Figure 31)
At this point, counterretraction and suction can be added.
Level lll—Instruments of Action
Step 1—Attaching Primary Bar (Figure 32)
Mount a primary bar to the Symmetry Surgical Skull Clamp as shown.
Step 2—Attaching Floating Secondary Bar (Figure 33)
Attach a floating secondary bar to the primary bar.
Step 3—Attaching Instruments of Action
Secure desired instruments of action to floating secondary bar using extra
large or large and small instrument holders. A pneumatic drill is shown in
Figure 34; however, ultrasonic aspirators, ultrasound probes, and handheld
lasers can all be supported at Level lll.

Craniotomy Position: Patient Sitting

Suggested assembly for:
Level I Retraction, Dissection, Suction
Level ll Handresting (one handrest for each hand)
Level lll Instruments of Action
using either the Gardner Skull Clamp or the Symmetry Surgical Skull
Clamps, when patient is sitting:
1. Posterior Fossa Craniotomy
2. Posterior Cervical Laminectomy
Level I—Retraction
Bring patient to a sitting position and apply Gardner or Symmetry Surgical
Skull Clamp. FROM THIS POINT, THE PATIENT IS DRAPED AND THE
FIELD IS STERILE. The entire process shown is carried out using sterile
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