Parks retractor.

Abstract

The use of a surgical speculum (latin for mirror, from specere: to watch) or retractor has been described since ancient times. An anal speculum (catopter) for haemorrhoids, abscesses, and fistulas was mentioned in Hippocrates’ dissertations from around 400 BC1. Many years followed without further advances in transanal surgery owing to pain, limited anaesthesia, morbidity, and even death2. Perhaps the most famous fistulotomy in history (1685) necessitated the development of new instruments, when King Louis XIV had an anal fistula treated by the ‘barber surgeon’ Charles-Francois Felix. He spent months developing new instruments and refining his technique by undertaking ‘surgical training’ on guinea pigs and less well-to-do patients. Among these instruments was a three-bladed self-retaining anal retractor (Fig. 1a), a predecessor of the retractor described in this article. The evolving interest in, and optimization of, transanal excisions of anal and rectal tumours at the beginning of the 20th century demanded improved access to, and visualization of, the rectum. In Benign Tumours of the Rectum3, Alan Guyatt Parks (1920–1988) described and illustrated the use of a two-bladed self-retaining speculum for excision of rectal adenomas. A three-bladed version (Parks retractor) (Fig. 1b) was described in a later article in 19734. It formed the basis of two principles essential for peranal excision: that the anal canal could be opened to achieve exposure with the retractor, and that submucosal injection facilitated dissection. As Parks stated, the key to optimal surgery is ‘good exposure, good exposure, good exposure’5. Parks had many other innovations and contributions from the aetiology and classification of anal fistula to pelvic floor physiology, haemorrhoid surgery, and ileal reservoir with ileoanal anastomosis6.