Summary
Background: It is a general goal of the operative medicine to minimize the trauma of a surgical
procedure in physical and psychical respect. This has led to the development of a
minimally invasive surgery in cochlear implantation. The established supraaural "Hannover-skin
incision" has been abandoned by many surgeons for just a retroauricular approach.
However, the access for the surgeon is limited in drilling a bed for the implant body.
This could cause difficulties in control of severe bleeding or management of a lesion
of the dura which has regularly to be exposed in pediatric implantation.
Method: Basing on good experiences with an already existing suction wound retractor a novel
instrument with a slim, 43 to 11 mm long blade with integrated suction and illumination
has been developed. The end of the suction line has a distance of 18 mm to the end
of the blade whereas the end of the fiberoptic is located 34 mm from this point. The
instrument's weight is 100g.
Results: This instrument has proven to be useful in 15 consecutive cochlear implantations
and guarantees a brightly illuminated operating field without bone dust or a surplus
of water for irrigation. The handling of this instrument is ergonomic despite the
two cables for the suction and illumination due to the centre of gravity in the middle
of the retractor. All fingers can catch the broad grip, which enables an ergonomic
work without exhaustion.
Conclusions: The newly developed instrument makes it easier and safer to drill out a bony bed for
the implant. Thus an adequate compromise can be respected between minimization of
the trauma and surgical accessibility.
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1 Auszugweise vorgetragen auf der 76. Jahresversammlung der Deutschen Gesellschaft
für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie in Erfurt
