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The Park Clamp: Use Cases

During a thoracoscopic lung resection, bleeding along staple lines, even of the main pulmonary artery, can be managed with a Park Clamp

The Park Clamp isn’t a true clamp, but rather a compressor. It was designed initialy for the troublesome venous bleeding. It is a ring with ridged edges to provide grip securely welded to a handle. It allows for circumferential compression of tissues, allowing for hemostasis while creating a open space for suturing. The picture above are my colleagues from CCAD -Drs. Andres Obeso and Redha Souilamas perfoming a partial pneumonectomy. The staple line on the artery was bleeding and this can be troublesome, and may require conversion to thoracotomy. The Park Clamp was inserted and provided excellent hemostasis (below).

Hemostasis achieved, a suture can be placed without ongoing hemorrhage without having to convert to a thoracotomy

During one of my cases as a fellow at the Mayo Clinic, I ran into venous bleeding behind the aortic bifurcation. Dr. Thomas Bower, recently retired, came in and lengthened the incision to create more space for more hands, and got all of us -me, the resident, the intern, the RNFA’s, to retract and compress with sponge-on-a-stick to repair the linear tear on the vena cava under the aortic bifurcation.

I’ve always hated this approach because outside of Mayo in 2002, it is very hard to get five people to become your voice activated retractor system, and the sponge on a stick only works well when you are on the hole and less effectively next to the hole. There had to be a better way.

Spinal exposure at the L5-S1 level is treacherous because of the veins

When I returned to academic practice at the Cleveland Clinic, combined cases with other specialties got me operating on tight spaces, frequently heavily scarred, with many blood vessels to control, such as a retroperitoneal spinal exposure illustrated above.

The veins are fragile here and as they are in communication with the central veins, bleed copiously and rapidly.

Look above at the dreaded linear tear on the left iliac vein that can result from simple manipulation of this fragile structure -typically a tributary vein will anchor the iliac and simple retraction can cause a tear.

Sponge on a stick limits view of the injury

Using a sponge on a stick greatly hampers your ability to repair the injury. First, the people applying the sponge on a stick have to have some skill. Second, because they are long and straight, they are constrained by the incision you have created. When applied, the “airspace” above the injury is greatly reduced. Third, hemostasis is never complete unless the whole vein is compressed, which is challenging in the above scenario.

The handle can be bent to create more “airspace” for operating

When the ring is applied, two things happen. Hemostasis is in general complete and there is room to operate, in this case suture. Even in the instance where an artery is bleeding from a flat surface as in a bleeding duodenal ulcer or a lumbar artery in an open aorta, hemostasis is achievable.

Bleeding lumbar arterise can cause a significant blood loss in the time it takes to apply a suture. Fingers will occlude, but no one likes getting stuck with a needle.

The bleeding lumbar artery illustrated above responds well to ring compression. This is also the case where you have bleeding from scarred or irradiated tissue surfaces, or from varicose veins or AV fistulae from the skin. If you don’t have a Park Clamp, you can use the finger rings of the handle on a tonsil or Kelly clamp.

If you don’t have a Park Clamp, you can have one made or you can use the ring handle of a standard clamp.

There seems to be interest among surgeons who have seen this device used, and I will look into manufacturing these. I would not object to surgeons making their own for their personal use -taking apart a long tonsil clamp and bending the ring at a right angle should be simple enough. The clamps I use were manufactured at our prototypic facilities, but 3D printed ones should work fine.

And I will leave you with this final thought. I am in the profession of surgery, and at its core, it’s about helping the patient. If you adapt this idea and help someone, I will have fulfilled my duties.

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