Elasticated retractionElectrical dissection

Knotless sutures

Rod Mountain

Dundee

Innovations in Head and Neck Surgical technique

Exposure (Incisions / Retraction / Counter traction)

Bleeding (Adr / Mono/Bipolar / Coblation/ Ties/Clips)

Closure (Sutures / Clips / Tissue glues / Strips)

Single operator Neck dissection ?

Exposure ?

Bleeding ?

Wound closure ?

Single operator Neck dissection ?

Exposure

Bleeding

Wound closure

Single operator Neck dissection ?

Exposure

Bleeding

Wound closure

Single operator Neck dissection ?

Exposure

Bleeding

Wound closure

“Traditional” Exposure

• Skin• Subcutaneous• Platysma• Fascia• Muscle• Neural• Vascular

“Elasticated” Exposure

• Skin• Subcutaneous• Platysma• Fascia• Muscle• Neural• Vascular

“Elasticated” Exposure

• Skin• Subcutaneous• Platysma• Fascia• Muscle• Neural• Vascular

Elasticated retraction Principles

• Lateral retraction• Elevation• Eversion• Controlled force• Multi-directional• Adjustable• Skin / Fascia / Muscle

Elasticated retraction Principles

• Lateral retraction• Elevation• Eversion• Controlled force• Multi-directional• Adjustable• Skin / Fascia / Muscle

Elasticated retraction Principles

• Lateral retraction• Elevation• Eversion• Controlled force• Multi-directional• Adjustable• Skin / Fascia / Muscle

Elasticated retraction Principles

• Lateral retraction• Elevation• Eversion• Controlled force• Multi-directional• Adjustable force / angle• Skin / Fascia / Muscle

Elasticated retraction Principles

• Lateral retraction• Elevation• Eversion• Controlled force• Multi-directional• Adjustable• Skin Fascia / Muscle

Skin / Platysma“Lateral + Multidirectional Retraction”

1 2

3 4

Fascia / Muscle“Elevation and Eversion”

1 2

3 4

Superficial to Deep

Wide exposure with elevation

Skin / Platysma

Fascia / Muscle retraction

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field• Reduced tissue trauma• Enhanced assistant / training roles• Single operator• Safer operating

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field• Reduced tissue trauma

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field• Reduced tissue trauma• Enhanced assistant / training roles

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field• Reduced tissue trauma• Enhanced assistant / training roles• Single operator - { Minor to major }

Benefits of Elasticated retraction

• Constant / Controlled field of exposure• Wider / Circumferential field• Elevation / fascia / muscle retraction• Improved visual / technical field• Reduced tissue trauma• Enhanced assistant / training roles• Single operator - { Minor to major }• Safer operating

Haemostatic dissection

• Vessel sealers and dividers• Integrated cutting mechanism • Seal up to 7 mm arteries • 2 to 4 seconds• Reduce operating time• Reduce bleeding• Single operator• Reduced drainage

Haemostatic dissection

Knotless Sutures

• “Barbed” suture technology

• Looped suture end to start

• No knot at end

• Platysma and Skin

Knotless Sutures

• Barbed suture technology

• “Looped”suture end to start

• No knot at end

• Platysma and Skin

Knotless Sutures

• Barbed suture technology

• Looped suture end to start

• “No knot” at end

• Platysma and Subcutaneous Skin

Tracheostomy