The instrument: how the piezotome was adapted to operate without an incision
Incisionless rib remodeling is not performed with an off-the-shelf instrument. It uses an adapted piezotome: a device that cuts bone with micro-vibrations, whose tip had to be reshaped, coated and sterilised before it could be used on ribs. That adaptation is called Manzaneda's Tool, and it is published.
What a piezotome is, plainly
It is a device that cuts bone using micro-vibrations rather than a rotating blade. That lets it work bone selectively and gently: it cuts hard tissue while being kinder to the soft tissue around it. It has been used in maxillofacial surgery for years.
The problem is that no piezotome ships ready for ribs. Its tip is designed for a different anatomy and for open-field work, not for reaching bone through a puncture.
The three modifications
The published work describes the adaptation in three steps, and names them explicitly:
- Reshaping the tip of the piezotome so it can reach and work the rib through a puncture.
- Testing coating materials for that adapted tip. The one that adhered and protected best was Rust-Oleum High Heat.
- Sterilising the coated piece so it can be used in theatre.
The result of those three steps is what the article calls Manzaneda's Tool, and the text itself describes it as «a safe and customizable tool» for RibXcar surgery.
Why this matters more than it looks
A surgical technique that needs its own instrument leaves a verifiable trail: the instrument is described, published and can be manufactured. That is the difference between a way of operating and a procedure others can reproduce.
For a surgeon considering the technique, it answers a practical question: what you operate with, and where it comes from.