Omnidirectional Malleable Ring Retractor: New Approach to Retraction During Carotid Endarterectomy

Abstract

To resolve problems with retraction instruments in order to obtain shallow and flat operative field in procedures such as carotid endarterectomy, we developed a new malleable tin alloy omnidirectional retraction supporting (ORS) ring. The new ORS ring has an ellipse-shaped (major axis: 275 mm; minor axis: 192 mm) bar frame (4 mm× 6 mm). The bar has 22 equidistant outward protrusions (length, 12 mm; diameter, 2.5 mm). The frame is made of tin alloy with approximately 1% silver, which provides sufficient malleability to fit different cervical surgical approaches. Rubber bands ending with hooks are attached around the protrusions. The new ORS ring can be placed closer to the skin surface, and skin incision edges are horizontally retracted by the hooks attached in the desired direction. The hooks are repositioned in a stepwise fashion at deeper layers of the surgical wound following dissection for carotid artery exposure. The tin alloy ORS ring was used in 30 carotid endarterectomies. As this ring could be closely positioned in all cases, the real depth of the operative fields (with all instruments in place) was reduced by the omnidirectional horizontal retraction without interference with surgical manipulations. Working on the distal internal carotid artery, such as putting a tacking suture in place and arteriotomy closure, could be easily performed. The newly developed malleable tin alloy ORS ring can be a valuable instrument for the easy performance of surgery for cervical carotid lesions. Considering its advantages, it is better than conventional retractors and existing stainless steel ORS rings.