The technology

The ViewSite Brain Access System (VBAS; Vycor Medical) is a transparent tubular brain retractor system designed to access and visualise the surgical field during microneurosurgical techniques. It consists of an introducer and a working channel port, secured by a spring-controlled latch. VBAS is available in a range of device lengths (3 cm, 5 cm and 7 cm) and diameters (6 mm, 12 mm, 17 mm, 21 mm and 28 mm), and is compatible with most standard surgical arms and neuronavigational systems.


The device is designed to give clear access and a visible working channel during brain surgery, while distributing brain tissue evenly. The company claims that compared with conventional self-retaining spatula-based brain retractor systems, VBAS has the potential to minimise tissue damage. It claims that this can lead to reduced operating times, shorter intensive care unit (ICU) stays, and shorter postoperative hospital stays. The company claims that using VBAS may lead to lower morbidity and mortality and may allow operations on otherwise inoperable or difficult to reach brain locations.

Current care pathway

Brain retraction is important during brain surgery because it allows the surgeon to secure surgical space and access deep areas in the brain and skull base. It can be done using different types of retractor systems. The type of retractor used depends on the surgical approach, the size of the lesion and where it is located, and the preference of the surgeon. The most used brain retractors are self-retaining retractor systems with moveable arms and attachable blades (brain spatulas). These are made from malleable stainless steel or silicone rubber and have been associated with surgical brain injuries. The extent of surgical brain injury is influenced by several factors including the duration of retraction, the distribution of pressure applied and the structure of the brain tissue at the retraction site. Tubular brain retractors, such as the VBAS, have been designed to help reduce the number of brain retractor injuries. Other tubular retractor systems are available, including BrainPath (NICO) and METRx (Medtronic; indicated for use in spinal surgery rather than brain surgery).

No clinical guidelines on the use of brain retractors were identified.

Population, setting and intended user

VBAS is intended to be used to access and visualise the surgical field during brain surgery. It is approved for use in children and adults. The experts suggested that anatomy and deep-seated location would usually indicate when it should be used rather than specific histological diagnosis. VBAS would be commonly used for different types of deep-seated or intraventricular brain lesions or tumours (such as brain metastases, colloid cysts, and central neurocytomas) and intraventricular or intracerebral haemorrhage.

The technology would be used in secondary care by neurosurgeons during brain surgery.


Technology costs

The technology costs £410 per procedure (excluding VAT). This cost is for a single-use sterile packed system and is the same for all sizes of VBAS retractor. The company said that it includes the introducer, removable dilator and the navigation pointer holder adaptor.

Costs of standard care

The company states that self-retaining spatula-based brain retractors cost between £8,000 and £14,000. Standard retractor systems are re-sterilisable and reusable unlike tubular retractors which are single-use.

Resource consequences

The technology is currently being used in 12 UK neurosurgical hospitals (there are 31 neurosurgical sites in the UK).

The company said that adopting the technology may release resources through shorter operating times, reduced ICU stays and reduced postoperative hospital stays. There is no published evidence to support this claim. The company states that training on how to use the VBAS system, including appropriate preoperative sizing and correct and safe disposal, is included free of charge and provided for the whole clinical team.

The experts commented that no practical difficulties and no changes in facilities and infrastructure are associated with adopting the VBAS.