In-vitro Force Assessments of an Autoclavable Instrumented Sternal Retractor

Giovanni Saggio, Giuseppe Tancredi, Laura Sbernini, Costantino Del Gaudio, Alessandra Bianco, Jacob Zeitani


It is well known that median sternotomy might lead to rib and/or sternum micro/macro-fractures and/or brachial plexus injuries, eventually resulting in chronic pain with significant impact on patient’s quality life.Postoperative chronic pain is recognized as a multifactorial complex issue, it has been assessed that excessive sternum retraction forces can be considered one of these factors. On this basis, the Authors developed a reliable and sterilizable system potentially able to real-time monitor and control the retraction forces along the hemisternums. A Finochietto sternal retractor was instrumented by means of ultra-thin force sensors interfaced with ad hoc electronic circuitry. Two different sets of sensors were adopted, one of which able to support autoclave operating conditions. In vitro tests were performed by means of a made on purpose dummy. The instrumented retractor allows monitoring of the force exerted on both the arms during the opening procedure. Force versus time patterns were real-time acquired and stored, distribution of forces was determined along with the values of mean, maximum and plateau force. Results demonstrate the reliability of the instrumented retractor in measuring forces, up to 400N. Cost-effectiveness and feasibility can be considered further additional values of the proposed instrumented retractor.


  1. Aigner, P., Eskandary, F., Schlöglhofer, T., Gottardi, R., Aumayr, K., Laufer, G., Schima, H., 2013.Sternal force distribution during median sternotomy retraction.J.Thorac.Cardiovasc. Surg., 146(6), pp. 1381-1386.
  2. Atluri, P., Stetson, R. L., Hung, G., Gaffey, A. C., Szeto, W. Y., Acker, M. A., & Hargrove, W. C. (2016). Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy. The Journal of thoracic and cardiovascular surgery, 151(2), 385-388.
  3. Baisden, C.E., Greenwald, L.V., Symbas, P.N., 1984. Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations.Ann.Thorac. Surg., 38(3), pp. 192-194.
  4. Bolotin, G., Buckner, G. D., Jardine, N.J., Kiefer, A.J., Campbell, N.B., Kocherginsky, M., Raman, J., Jeevanandam, V., 2007.A novel instrumented retractor to monitor tissue-disruptive forces during lateral thoracotomy. J. Thorac. Cardiovasc. Surg. 133(4), pp. 949-954.
  5. Bruce, J., Drury, N., Poobalan, A.S., Jeffrey, R.R., Smith, W.C., Chambers, W.A., 2003. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain, 104(1-2), pp. 265-273.
  6. Gjeilo, K. H., Klepstad, P., Wahba, A., Lydersen, S., &Stenseth, R., 2010, “Chronic pain after cardiac surgery: a prospective study,” ActaanaesthesiologicaScandinavica, 54(1), pp. 70-78.
  7. Greenwald, L.V., Baisden, C.E., Symbas, P.N., 1983. Rib fractures in coronary bypass patients: radionuclide detection. Radiology, 148(2), pp. 553-554.
  8. Hazelrigg, S. R., Cetindag, I. B., Fullerton J., 2002.Acute and chronic pain syndromes after thoracic surgery. Surg. Clin. North Am., 82(4), pp. 849-865.
  9. Healey, S., O'Neill, B., Bilal, H., Waterworth, P., 2013.Does retraction of the sternum during median sternotomy result in brachial plexus injuries?. Interactive CardioVascular and Thoracic Surgery, 17(1), pp. 151-158.
  10. Meyerson, J., Thelin, S., Gordh, T., Karlsten, R., 2001.The incidence of chronic poststernotomy pain after cardiac surgery - a prospective study, ActaAnaesthesiol. Scand., 45(8), pp. 940-944.
  11. Ochroch, E.A., Gottschalk, A., Troxel, A.B., Farrar, J.T., 2006. Women suffer more short and long-term pain than men after major thoracotomy.Clin. J. Pain, 22(5), pp. 491-498.
  12. Reser, D., Holubec, T., Caliskan, E., Guidotti, A., Maisano, F., 2015. Left anterior small thoracotomy for minimally invasive coronary artery bypass grafting.Multimed.Man.Cardiothorac.Surg., pp. 1-5.
  13. Riillo, F., Bagnato, C., Allievi, A. G., Takagi, A., Fabrizi, L., Saggio, G., Arichi, T., Burdet, E., 2016. A Simple fMRI Compatible Robotic Stimulator to Study the Neural Mechanisms of Touch and Pain.Annals of biomedical engineering, 1-11.
  14. Saggio, G., Orengo, G., Leggieri A., 2016. Sensory Glove and Surface EMG with Suitable Conditioning Electronics for Extended Monitoring and Functional Hand Assessment. Proc. 9th Int. Joint Conf. on Biomedical Engineering Systems and Technologies (BIOSTEC), co-located 9th Int. Conf. on Bio-inspired Systems and Signal Processing (BIOSIGNALS), 21- 23 February 2016, Rome, Italy.
  15. Steele, P.R.C., Curran, J.F., Mountain, R.E., 2013. Current and future practices in surgical retraction. The Surgeon 11(6), pp. 330-337.
  16. Suzuki, S., Kikuchi, K., Takagi, K., Masuda, H., Yoshizu, H., Tanaka, S., Ogata, T., 1990. Brachial plexus injury and fracture of the first rib as complications of median sternotomy. Journal of the Japanese Association for Thoracic Surgery, 38(9), pp. 1459-1462.
  17. Unlu, Y., Velioglu, Y., Kocak, H., Becit, N., Ceviz, M., 2007.Brachial plexus injury following median sternotomy. Interactive CardioVascular and Thoracic Surgery, 6, pp. 235-237.
  18. vanGulik, L., Janssen, L.I., Ahlers, S.J.G.M., Bruins, P., Driessen, A.H.G., van Boven, W.J., van Dongen, E.P.A., Knibbe C.A.J., 2011. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy.European Journal of Cardio-thoracic Surgery, 40(6), pp.1309-1313.
  19. Ward, A.F., Grossi, E.A., Galloway, A.C., 2013. Minimally invasive mitral surgery through right minithoracotomy under direct vision. J Thorac Dis., 5( 6), pp. 673-679.
  20. Wildgaard, K., and Kehlet, H., 2011. Persistent Postsurgical Pain Syndromes, Chronic postthoracotomy pain-What is new in pathogenic mechanisms and strategies for prevention?.Techniques in regional anesthesia and pain management, 15(3), pp. 83-89.
  21. Woodring, J.H., Royer, J. M., Todd, E.P., 1985.Upper Rib Fractures Following Median Sternotomy. The Annals of Thoracic Surgery, 39(4), pp. 355-357.

Paper Citation

in Harvard Style

Saggio G., Tancredi G., Sbernini L., Del Gaudio C., Bianco A. and Zeitani J. (2017). In-vitro Force Assessments of an Autoclavable Instrumented Sternal Retractor . In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 1: BIODEVICES, (BIOSTEC 2017) ISBN 978-989-758-216-5, pages 25-31. DOI: 10.5220/0006111300250031

in Bibtex Style

author={Giovanni Saggio and Giuseppe Tancredi and Laura Sbernini and Costantino Del Gaudio and Alessandra Bianco and Jacob Zeitani},
title={In-vitro Force Assessments of an Autoclavable Instrumented Sternal Retractor},
booktitle={Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 1: BIODEVICES, (BIOSTEC 2017)},

in EndNote Style

JO - Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 1: BIODEVICES, (BIOSTEC 2017)
TI - In-vitro Force Assessments of an Autoclavable Instrumented Sternal Retractor
SN - 978-989-758-216-5
AU - Saggio G.
AU - Tancredi G.
AU - Sbernini L.
AU - Del Gaudio C.
AU - Bianco A.
AU - Zeitani J.
PY - 2017
SP - 25
EP - 31
DO - 10.5220/0006111300250031