Usability and Advantages of a “Flat Tip” Bayonet-type Micro Forceps in Tissue Dissection during Cerebral Aneurysm Surgery

• Published in: Nōshotchū no geka Vol. 50; no. 4; pp. 317 - 322
• Main Author: TSUTSUMI, Keisuke
• Format: Journal Article
• Language: Japanese; English
• Published: The Japanese Society on Surgery for Cerebral Stroke 2022
• Subjects: blunt dissection; cerebral aneurysm; flat tip bayonet-type micro forceps; neck clipping surgery; Yasargil bayonet micro forceps
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs.50.317

Here we investigated the usability and advantages of a “flat tip” bayonet-type microforceps (FTM) created by processing the tip of Yasargil bayonet microforceps to a thin and flat shape in blunt dissection (BD) during cerebral aneurysm surgery. The ability of the FTM to apply flat pressure in opposite directions to open a narrow gap and scrape it bilaterally using the edge of the tip was a useful feature during BD near the neck of the aneurysm and for detaching blood vessels that had adhered to the aneurysm wall. Its flat tip enables insertion into a restricted space, and the degree of deformation of the aneurysm or vessel wall required to obtain the same separation space is less than that of the standard bipolar forceps. When BD was performed using FTM to form a space posterior to the aneurysm neck, it was not necessary to apply counter pressure with a suction tube to expand the surgical field. We were able to utilize the original function of the suction tube, such as aspiration of the hematoma and cerebrospinal fluid, with a relatively high degree of freedom within the gap created by the FTM. Because the thin, flat structure of the FTM tip allows tissue contact with a smooth surface, it can gently hold delicate and fragile tissues, such as veins or perforating arteries, with minimal trauma. However, the thinner tip of the FTM decreased its grip strength. Various surgical instruments for BD are selected according to the intraoperative environment. With an increased understanding of the characteristics and weaknesses of FTM, its use may be appropriate in certain situations.