Origins of ANDRE™

Aspirating Neurological Dissector & Retractor for optimal Exposure

As a Neurosurgeon with a special interest in spine, one of the most common operations I perform is the lumbar laminectomy. As the population ages, the number of people needing this operation has continued to grow. Older patients are of course less tolerant of complications, or even of lengthy operative times.

One of the more common complications encountered in a laminectomy is a dural tear. In any patient, but particularly in the elderly, this is a feared complication for multiple reasons. It adds significantly to operative time, and generally requires extended post operative bed rest to enhance healing and prevent CSF leakage, and it may also require additional surgery to stop the leak. Prolonged bed rest, especially among the elderly, increases the risk of other complications such as Infection, deep vein thrombosis, pulmonary embolus and pneumonia, each of these are potentially life threatening. All these secondary complications can result from a small tear that may only measure a couple of millimeters in length.

Andre was born out of my desire to have a faster and safer way to perform an operation that I was already striving to accomplish at the highest level of my abilities. I noted that many of the tears occurred because either visualization of the dura was sub-optimal, or because the dura was inordinately adherent to the overlying lamina. Even in cases where visualization was good and there was minimal scarring or adherence, small string-like attachments between laminar bone and the dura would create tears when the bone was nibbled and lifted off with a Kerison, or rongeur.

Also, In a number of cases, dural tears occurred as a result of burrs that had developed at the tip of the metal suction. While subsequently using the metal suction as a retractor, the burr would damage dura, particularly when the dura was thin. Regardless as to how or why they occur, dural tears are potentially disastrous occurrences that must be avoided at all costs.

To achieve my goal of minimizing dural tears I realized I needed help. I needed something that would retract dura without inadvertently tearing it; I needed something that would aspirate blood and fluid to preserve visualization; I needed something that would dissect these “invisible” adhesions between dura and ligament or bone; and I needed something that would work in the increasingly smaller incisions that were becoming prevalent in “minimal access surgery”. In addition, I needed to have all of these features without substantially changing my surgical technique, or growing a third arm. Being right handed, I needed a device that would dissect, probe, aspirate and retract with relative ease in my non-dominant hand, while I used my dominant hand to manipulate the bone biting rongeur.

I knew what I needed. I knew it had to be operated with a single hand. I knew it had to be simple, both in practice and in design. The Andre device was born out of these necessities. With Andre I can retract the dura, break adhesions between lamina and dura, and still continuously remove blood and fluid to allow clear visualization of the important anatomic structures. I no longer need a metal suction, Penfield dissectors, or neuropatties in the wound. Andre replaces, or rather combines, the function of retraction, aspiration and dissection provided by these other devices in a single device and allows my surgeries to go faster, smoother, and with fewer complications.

It is my sincere hope that devices such as Andre will eventually make dural tears a thing of the past. Since adopting Andre, I have cut surgical times by at least a third and, as I write this, I can say with great pleasure that I cannot recall the last time I had to repair a dural tear; a pleasant thought indeed!

Loubert S. Suddaby, MD