Traditional Retractors Research Articles

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Indications, Techniques, and Outcomes.

Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture

To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture. Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared. Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05). Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

Oblique Angled Retractor for Lumboperitoneal Shunt Implantation via Lateral Abdominal Laparotomy.

A normal retractor often interferes with the ribs and/or thighs of the ipsilateral side when the skin and abdominal muscles are towed while performing the lumboperitoneal shunt (LPS) procedure in the lateral position. To overcome this, we developed an obtuse-angled retractor. We modified the traditional retractors into oblique-angled retractors. The blade of the new retractors was bent to 60 degrees, the entire blade was thinned, and the tip of the blade was tapered. To date, we have performed approximately 30 LPS procedures in the lateral position using the new oblique-angled retractor and confirmed its usefulness. An oblique-angled retractor helps confirm the accurate placement of the tip of the retractor blades, even in obese patients in whom the retractor often interferes with the ribs and/or thighs.

P.154 Characterizing and comparing brain injury associated with traditional self-retracting brain retractors with novel tubular retractors

Background: Tubular retractors are FDA approved and in the Neurosurgical marketplace, but adaptation has been hampered by lack of evidence showing superiority over traditional retractors when performing subcortical surgery. This study examines brain injury associated with traditional brain retractors versus tubular retractors. Methods: Nine porcine models underwent a simulated neurosurgical operation. Retractors were inserted for four hours after which the porcine model was euthanized. The en-bloc extracted porcine brain was fixed in 10% formalin, paraffin embedded, sectioned at 4 um and stained with hematoxylin and eosin (H&amp;E) using standard laboratory protocols. Computer algorithms were generated to calculate areas of cerebral edema and hemorrhage adjacent to retractor surfaces. Results: Using a two-tailed t-test with a significance level of 0.05, traditional brain retractors were associated with statistically significantly greater cerebral edema when compared to tubular retractors (17.36 um2 vs. 12.42 um2; p = 0.0038). There was no statistically significant difference in mean areas of hemorrhage between traditional brain retractors and tubular retractors noted (3.43 um2 vs 3.60 um2; p = 0.8297). Conclusions: Tubular retractors are associated with significantly less edema in surrounding brain than traditional retractors. On histopathological merits, this study supports the application of tubular retractors over traditional retractors.

305 Characterizing and Comparing Brain Injury Associated With Traditional Self-Retracting Brain Retractors With Novel Tubular Retractors

INTRODUCTION: Tubular retractors are FDA approved and in the Neurosurgical marketplace, but adaptation has been hampered by lack of evidence showing superiority over traditional retractors when performing subcortical surgery. METHODS: Nine porcine models underwent a simulated neurosurgical operation. Retractors were inserted for four hours after which the porcine model was euthanized. The en-bloc extracted porcine brain was fixed in 10% formalin, paraffin embedded, sectioned at 4 um and stained with hematoxylin and eosin (H&amp;E) using standard laboratory protocols. Computer algorithms were generated to calculate areas of cerebral edema and hemorrhage adjacent to retractor surfaces. RESULTS: Using a two-tailed t-test with a significance level of 0.05, traditional brain retractors were associated with statistically significantly greater cerebral edema when compared to tubular retractors (17.36 um2 vs. 12.42 um2; p = 0.0038). There was no statistically significant difference in mean areas of hemorrhage between traditional brain retractors and tubular retractors noted (3.43 um2 vs 3.60 um2; p = 0.8297). CONCLUSION: Tubular retractors are associated with significantly less edema in surrounding brain than traditional retractors. On histopathological merits, this study supports the application of tubular retractors over traditional retractors.

P.211 Characterizing and comparing brain injury associated with traditional self-retracting brain retractors with novel tubular retractors

Background: Tubular retractors are FDA approved and in the Neurosurgical marketplace, but adaptation has been hampered by lack of evidence showing superiority over traditional retractors when performing subcortical surgery. This study examines brain injury associated with traditional brain retractors versus tubular retractors. Methods: Nine porcine models underwent a simulated neurosurgical operation. Retractors were inserted for four hours after which the porcine model was euthanized. The en-bloc extracted porcine brain was fixed in 10% formalin, paraffin embedded, sectioned at 4 um and stained with hematoxylin and eosin (H&amp;E) using standard laboratory protocols. Computer algorithms were generated to calculate areas of cerebral edema and hemorrhage adjacent to retractor surfaces. Results: Using a two-tailed t-test with a significance level of 0.05, traditional brain retractors were associated with statistically significant greater areas of cerebral edema when compared to tubular retractors (17.36 um2 vs. 12.42 um2; p = 0.0038). There was no statistically significant difference in mean areas of hemorrhage between traditional brain retractors and tubular retractors (3.43 um2 vs 3.60 um2; p = 0.8297). Conclusions: Tubular retractors are associated with significantly less edema in surrounding brain than traditional retractors. On histopathological merits, this study supports the application of tubular retractors over traditional retractors.

Polymer Based Abdominal Retractor According to Existing Design Parameters

Abdominal retractors are an essential tool for successful execution of laparoscopy. Their initial and running costs however can be a hindrance for clinics to implement them into their surgical units. New medical grade polymers offer high medical performance with reasonable strength properties at a fraction of the price to traditional steel instrumentation. This work investigates the possibility of using such polymers as a substitute material for common deep surgery retractors made of medical grade stainless steel. The design is based on measurements taken with a modified deep retractor, integrating a force transducer to obtain loading, during laparoscopy. Geometric and strength properties of the traditional retractor under the measured load condition were simulated in a FEA environment. A design study was then performed utilizing the same model but with modified material (PEEK 450GL30) and geometric properties until a suitable design was obtained. Provided logical geometrical considerations, it was possible to obtain a polymer based design capable of withstanding the load conditions measured during laparoscopy with some limitations.

Gooseneck Flexible Brain Retractor-Utility of Flexible Gooseneck Tubing in Neurosurgery.

Brain retractor is an indispensable instrument in Neurosurgery craniotomy set. Gooseneck tubing is an engineering marvel and has many applications (Reading lamp, Microphone, Tablet/phone holder, etc). We present a brain retractor made with an ultra-light duty Gooseneck tubing and report its use in five craniotomies for various pathologies. The traditional flexible brain retractor (Leyla) consists of three principal parts: a flxation base, a flexible arm or arms, and a blade holder. We replaced the flexible arm by an ultra-light duty Gooseneck tubing in our new retractor. The retractor proved very useful in the five cranial surgeries done and no complications were noted during its use. Gooseneck flexible Brain Retractor is a safe and cheaper alternative to the presently available brain retractor system. It has several advantages compared to traditional retractor. The efficacy and supremacy over traditional retractor systems need to be confirmed by further studies.

Retractorless Surgery for Giant Vestibular Schwannomas via the Retrosigmoid Approach

A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery. Clinical data of 61 patients with giant (≥4 cm diameter) vestibular schwannomas undergoing craniotomy were retrospectively analyzed. Patients were divided into 2 cohorts: 1) 35 patients with traditional retractor surgery performed between June 2016 and July 2017; 2) 26 patients with retractorless surgery performed between June 2016 and July 2018. Duration of operation, intraoperative blood loss, extent of resection, rate of retention of facial nerve function, postoperative brain injury rate, intracranial infection rate, hospitalization time, and grade of facial nerve function were compared between the 2 groups. The incidence of postoperative brain injury was 3.84% in the retractorless surgery group, which was significantly lower compared with the traditional retractor surgery group (22.86%) (P < 0.05). No significant differences were found regarding the other characteristics compared. Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.

Endoport-assisted microsurgical resection of cerebral cavernous malformations

The aim of this case series is to describe the surgical technique and postoperative outcomes for endoport-assisted microsurgical resection (EAMR) of cerebral cavernous malformations (CCM). Significant manipulation of subcortical white matter tracts may be necessary for the successful resection of CCM located in deep brain regions. Minimally invasive neurosurgical devices such as endoport systems can decrease disruption of the cortex and white matter tracts overlying deep-seated CCM through small cranial and dural openings. The role of endoport technology in modern CCM surgery is incompletely understood. Three patients with symptomatic CCM underwent EAMR at our institution using the BrainPath endoport system (NICO Corporation, Indianapolis, IN, USA). Complete resection was achieved in two patients. One patient with a large 4.5cm callosal CCM was left with a small residual lesion. There were no postoperative complications and all patients were functionally independent (modified Rankin Scale score 2 or less) at follow-up. Based on our initial experience with EAMR for CCM we believe the endoport can be an effective alternative to traditional retractor systems. Due to the nature of the small craniotomy and durotomy performed for endoport placement EAMR has the potential to improve surgical outcomes by reducing postoperative pain, analgesic requirements and hospital stays. Therefore, EAMR may be considered for appropriately selected CCM patients, although additional experience is necessary to improve our understanding of its role in CCM management.

Omnidirectional retractor-supporting ring as a new device for carotid endarterectomy.

In carotid endarterectomy (CEA), the traditional retractors are often difficult to use because they tend to obstruct surgical manipulations, especially in the deep operative field on the rostral side. The authors have invented a new omnidirectional retractor-supporting ring (OD ring) to solve the problems of traditional retractors. The OD ring has an ellipsoid-shaped frame (major axis: 275 mm, minor axis: 192 mm) with 22 equally spaced outward protrusions. Rubber bands from which blunt mini-hooks are hung are twisted around the protrusions. The OD ring was placed on the operative area, and the skin edges were retracted by mini-hooks placed symmetrically. The hooks were moved gradually from the shallow to the deep operative field as surgical dissection continued to expose the carotid bifurcation and distal internal carotid artery (ICA). The OD ring was used in 158 consecutive CEAs in the authors' institute between July 2010 and October 2013. The OD ring provided a flatter surgical field and was less obstructive than traditional retractors, thereby facilitating surgical manipulation in the deep operative field such as at the distal ICA. Furthermore, because of its simpler shape, angiorrhaphy could be conducted more smoothly, with less tangled thread during closure of the arteriotomy. There were no technical complications related to the OD ring. As a new retractor system for CEA, the OD ring is less obstructive and provides a flatter surgical field than traditional retractors, thereby facilitating surgical manipulations in the deep operative field around the distal ICA.

Pete's bar: alternative use of the laryngoscopy suspension bar to improve surgical exposure during small incision cochlear implantation

Cochlear implant surgery is increasingly being performed through a small incision because of the benefits associated with this technique, such as fewer wound complications. Efforts have been made to maximise surgical exposure in order to improve this evolving technique; this includes the development and use of new retractors. For instance, elasticated stay hooks can retract skin in a radial fashion and they are less bulky than traditional retractors. These hooks are usually attached directly to surgical drapes or to a disposable retractor ring; there are disadvantages to both of these methods. This paper describes a technique using a laryngeal suspension bar in which the bar acts as a fixed structure to which these elasticated stay hooks can be attached. This technique was found to be safer, cheaper and more effective for obtaining optimal surgical exposure compared with a technique whereby the stay hooks are attached directly to the drapes or to a disposable retractor ring.

A novel retractor designed for mouse microsurgery

To introduce a novel retractor with magnetic fixator for mouse microsurgery. The retractor was consisted of a magnet, a screw, two screw nuts and a hook made of dental stainless wire. The screw was connected to the magnet with magnetic force, and then was assembled to be a so-called magnetic fixator. The hook was clamped by two screw nuts on the screw, and these makes up of the retractor finally. Comparison has been done between the novel retractor and traditional retractor in the clinical application of the otocyst exposure. The retractor can quickly claw and retract massive tissue like muscles and vessels to the target position, thus, this properties would tend to offer a clear and expanded operative field. In addition, the height, orientation and strength of traction was all adjustable. By Comparison with tradition retractor, the operative incision can be shorten via the application of the retractor, also, it would reduce the trauma of muscles and vessels as well as the accidental rate of bleeding in the process of operation. The retractor can offer a expanded operative field of the mouse otocyst conveniently. It could be a simple, powerful and minimal invasive tool for mouse microsurgery.