A piezotome is a surgical device that uses ultrasonic vibrations to cut bone precisely while sparing soft tissue (nerves, blood vessels, mucosa). It’s basically bone surgery on “precision mode.”
What it’s used for
In plastic surgery (and related fields), it’s commonly used for:
- Rhinoplasty (especially piezo rhinoplasty for nasal bone osteotomies)
- Facial bone contouring
- Orthognathic surgery
- Craniofacial procedures
- Dental/implant surgery
Why surgeons like it
- Selective cutting: Cuts mineralized bone but not soft tissue
- High precision: Cleaner, controlled osteotomies
- Less bleeding: Cavitation effect improves visibility
- Less trauma: Reduced swelling, bruising, and postop pain
- More control than chisels/saws (and quieter, too)
Using a piezotome in rib removal surgery (for rib cartilage or rib segment harvest) is very much a precision-first approach, and it has some real advantages when done properly.
Why a piezotome makes sense for rib surgery
A piezotome’s ultrasonic cutting is selective for mineralized tissue, which is ideal when you’re working right next to:
- Pleura
- Intercostal vessels
- Intercostal nerves
- Perichondrium / muscle
Key advantages in rib removal or rib harvest
- Reduced risk of pleural injury
Ultrasonic cutting won’t slice soft tissue the way oscillating saws or rib shears can. - Cleaner, more controlled cuts
Especially helpful when taking partial rib segments or preserving rib contour. - Less bleeding
Cavitation effect improves hemostasis around intercostal vessels. - Lower postoperative pain potential
Less crushing/thermal trauma compared to rongeurs or saws.
Technical considerations (important)
- Use low to moderate power settings to avoid heat buildup
- Continuous saline irrigation is mandatory
- Best for precision cuts, not bulk removal (you still need rongeurs for debulking)
- Slower than a saw — this is about control, not speed
Limitations
- Need adequate incisional access
- Dense cortical rib bone takes time
- Requires familiarity with hand pressure and angle
- Still need standard thoracic precautions (piezo ? pleural immunity)
Bottom line
For rib removal surgery the piezotome offers greater safety margins and finesse, particularly near the pleura and neurovascular bundle. It’s not a replacement for all rib instruments, but it’s an excellent adjunct when precision matters.
Dr. Barry Eppley
World-Renowed Plastic Surgeon