Fisher Wilson A M, Catalino Michael P, Woolard E Alice, Andrews Bethany J, Elton Scott, Quinsey Carolyn
J Neurosurg. 2022 Oct 14;138(6):1740-1747. doi: 10.3171/2022.8.JNS22746. Print 2023 Jun 1.
Current surgical techniques use common surgical instruments for sterile shunt assembly. This study investigated the impact of using these techniques and surgical instruments on the mechanical integrity of the ventriculoperitoneal shunt system, specifically shunt catheters.
The authors conducted failure testing on 85 rifampin-coated catheters and 85 barium-impregnated catheters using 5 different surgical instruments and 2 different surgical techniques. In technique A, the distal end of the catheter was pushed onto the shunt valve inlet connector with the surgical instrument. In technique B, the catheter was pulled over the inlet connector. One hundred sixty catheters underwent 10-repetition-maximum testing, in which the catheter either failed before completion of 10 consecutive assembly/disassembly repetitions or the catheter completed 10 consecutive repetitions. The authors also conducted 100-repetition-maximum tests on 5 barium-impregnated and 5 rifampin-coated catheters using technique A.
Catheter failure rates were significantly different among the different instruments used in assembly (p ≤ 0.001). Post hoc analysis showed that using mosquito forceps with shods resulted in a significantly lower catheter failure rate than the other instruments (p < 0.0005). The catheter failure rate of technique A was significantly lower than that of technique B (5% vs 81%, p < 0.001). There was no statistical difference between the failure rates of the barium and rifampin catheters (42% vs 44%, p = 0.9), but the barium catheters outperformed the rifampin catheters in the 100-repetition-maximum trials (p = 0.02). Instrument type (p = 0.0232) and catheter type (p = 0.0096) were both significant factors in determining the number of assembly/disassembly repetitions needed to cause catheter failure. It took an average of 2.79 repetitions of assembly/disassembly to cause catheter failure. DeBakey forceps had significantly lower mean repetitions to failure (mean 1.38) than the Gerald forceps without teeth (mean 2.73, p = 0.05) and bayonet (mean 3.25, p = 0.02).
This study was the first of its kind to analyze how physical manipulation affects the mechanical integrity of ventriculoperitoneal shunt components. The authors demonstrated a significantly lower shunt catheter failure rate when mosquito forceps with shods and technique A were used in assembly. Moreover, the authors established that use of DeBakey forceps resulted in failure with fewer assembly/disassembly repetitions than use of the Gerald and bayonet forceps, suggesting that DeBakey forceps are the most damaging instrument.
当前的手术技术使用普通手术器械进行无菌分流器组装。本研究调查了使用这些技术和手术器械对脑室腹腔分流系统（特别是分流导管）机械完整性的影响。
作者使用5种不同的手术器械和2种不同的手术技术，对85根利福平涂层导管和85根钡浸渍导管进行了失效测试。在技术A中，用手术器械将导管远端推到分流阀入口接头上。在技术B中，将导管套在入口接头上。160根导管进行了最大10次重复测试，即导管要么在连续10次组装/拆卸重复完成前失效，要么完成10次连续重复。作者还使用技术A对5根钡浸渍导管和5根利福平涂层导管进行了最大100次重复测试。
在组装中使用的不同器械之间，导管故障率有显著差异（p≤0.001）。事后分析表明，使用带套的蚊式止血钳导致的导管故障率明显低于其他器械（p<0.0005）。技术A的导管故障率明显低于技术B（5%对81%，p<0.001）。钡导管和利福平导管的故障率之间无统计学差异（42%对44%，p = 0.9），但在最大100次重复试验中，钡导管的表现优于利福平导管（p = 0.02）。器械类型（p = 0.0232）和导管类型（p = 0.0096）都是决定导致导管失效所需的组装/拆卸重复次数的重要因素。平均需要2.79次组装/拆卸重复才能导致导管失效。德巴基止血钳导致失效的平均重复次数（平均1.38次）明显低于无齿杰拉尔德止血钳（平均2.73次，p = 0.05）和刺刀式止血钳（平均3.25次，p = 0.02）。
本研究首次分析了物理操作如何影响脑室腹腔分流组件的机械完整性。作者证明，在组装中使用带套的蚊式止血钳和技术A时，分流导管故障率明显较低。此外，作者确定，使用德巴基止血钳导致失效所需的组装/拆卸重复次数比使用杰拉尔德止血钳和刺刀式止血钳少，这表明德巴基止血钳是最具破坏性的器械。
