Use Of Self-retaining Retractor Research Articles

Usage of Modified Makuuchi Incision for Surgical Management of Complex Renal and Adrenal Lesions.

Background: Modified Makuuchi (MM) incision is less popular among the urological fraternity as Chevron, subcostal, flank, and midline incisions are commonly used for most of the complex renal and adrenal conditions. We present our experience and report the outcomes of patients operated using this incision.Materials and methods: The records of patients who underwent open surgery for upper abdominal urological conditions using MM incision over the last five years in our department were retrospectively reviewed. Patient demographics, laterality of the lesion, size of the lesion, level of inferior vena caval (IVC) thrombus, intraoperative blood loss, local tumor invasion, need for concomitant hepatectomy, need of diaphragmatic resection, use of self-retaining retractors, operative time, hospital stay, wound-related complications, and readmissions were analyzed.Results: Some 18 patients underwent open surgery by this incision for various complex renal and adrenal conditions during the study period. Patients included those with large upper pole renal and adrenal masses, renovascular conditions like renal artery aneurysm, renal/adrenal masses with liver and diaphragmatic infiltration requiring hepatectomy, diaphragmatic resections, or IVC thrombectomy. The mean size of renal and adrenal masses was 13.8 (±6.3) cm, mean operative time was 370 (±210.6) minutes, mean blood loss was 1124 (±990.3) mL, and mean hospital stay was 11.65 (±13.2) days. Four patients had surgical site infection (SSI) and one had readmission.Conclusion: The MM incision can be widely adapted for complex renal and adrenal surgeries and should become a part of the various commonly used incisions by urologists.

Risk factors for the development of flank hernias and bulges following surgical flank approaches to the kidney in adults

ObjectivesTo evaluate the incidence and risk factors for the development of flank incisional hernias or bulges following surgical flank approaches to the kidney. Patients and methodsIn all, 100 consecutive adult patients who underwent variable renal surgeries via flank approaches were included in this prospective study. The incidence and risk factors for flank hernias and bulges were studied at 1- and 6-months postoperatively. ResultsAt 6 months postoperatively, the incidence of flank bulge was 14% and for lumbar hernia was 10%. The univariate analysis showed 13 significant factors to be associated with the occurrence of a flank bulge or hernia following flank incisions. When the significant risk factors in the univariate analysis were studied by multivariate analysis, using a logistic regression analysis, four independent risk factors were identified. These were: body mass index (BMI) ≥26.3 kg/m2 (P = 0.04), the use of a self-retaining retractor during surgery (P = 0.02), not preserving or identifying the neurovascular bundle (NVB) during surgery (P = 0.028), and postoperative abdominal distention (P = 0.001). Moreover, all cases included in our study who underwent en masse wound closure, developed surgical wound infection or who had constipation developed postoperative flank bulge or hernia. ConclusionHigh BMI, the use of self-retaining retractor, not identifying or preserving the NVB, postoperative abdominal distention, en masse wound closure, surgical wound infection, and constipation are significant risk factors associated with postoperative flank hernia and bulge.

Retractorless surgery for third ventricle tumor resection through the transcallosal approach

ObjectiveResection of tumors of the third ventricle through the transcallosal-interforniceal approach presents a surgical challenge with potential serious postoperative neurological deficits and complications. Retraction injury of the deep brain tissue and veins is a possible reason. Here, we aimed to investigate the feasibility and value of retractorless surgery in third ventricle tumor resection. Patients and methodsSince 2014, a total of 31 patients with third ventricle tumors were operated in our institution. All patients were operated using the transcallosal-interforniceal approach with a straight incision. The use of self-retaining retractor or constant retraction was not allowed. At the end of surgery, the opening of corpus callosum was sealed with fibrin glues. The degrees of tumor resection and postoperative neurological function deficits as well as complications were analyzed. The effect of retractorless surgery was evaluated according to the brain edema around the surgical approach on T2 imaging. ResultsThirty-one tumors were located in the anterior, middle, and posterior of the third ventricle. Total or gross total resection was achieved in 25 patients (80.6%). Postoperative neurological function deficits occurred in 4 patients (12.9%), and patients with mutism had a good recovery 3 weeks post-surgery. Retraction injuries around the surgical pathway were not obvious on T2 imaging. In addition, no subdural hygroma and subcutaneous fluid accumulation occurred. ConclusionsThe application of retractorless surgery in third ventricle tumors is feasible with enough exposure of tumors. This application could decrease the occurrence of postoperative neurological deficits and complications by avoiding the retraction injury on the deep brain structures.

Use of Self-Retaining Retractors in Obese and Extremely Obese Pregnant Women [23R

INTRODUCTION: Cesarean delivery in obese patient presents unique surgical challenges. The use of a wound protector retractor, specifically Alexis™ O Ringer Retractor may facilitate the efficiency of the procedure. METHODS: A Retrospective review was conducted on a cohort of (N=134) obese and extremely obese pregnant women delivered by cesarean section in a single learning hospital. Three groups were created with the following categorization: Group A: N=54 women with body mass index (BMI) of 30–50 kg/m2. Group B: N=60 women with BMI≥50 kg/m2. Group C: N=20 women with a BMI≥50 kg/m2 on whom the device was not utilized. All surgeries were performed by resident physicians with staff supervision. RESULTS: Skin incision to hysterotomy time averaged 13 minutes in Group A, 11 minutes in Group B, and 15 minutes in Group C. Ranges were 3–26, 8–17, 5–27 minutes respectively. Seventy-two percent of skin incisions were Pfannenstiel incisions. CONCLUSION: The use of the protector retractor appears to assist in shortening the time between skin incision to hysterotomy in obese and extremely obese pregnant patients. Further research may assist in expanding the statistical analysis and the clinical utility of the use of this device.

Massive haemorrhage associated with inadvertent incision of a suspected carotid artery pseudoaneurysm in a cat

A 12-year-old, castrated male, domestic long-haired cat experienced massive haemorrhage associated with an incision of a swelling on the neck 2 weeks after right-sided ventral bulla osteotomy. Emergent control of haemorrhage was gained through unilateral carotid artery ligation. Cardiopulmonary resuscitation was provided in conjunction with massive blood transfusion. The cat made an unremarkable recovery. Carotid artery pseudoaneurysm due to surgical disruption of the carotid artery during ventral bulla osteotomy, specifically through the use of self-retaining retractors, was suspected. This case highlights the development of pseudoaneurysm as a potential complication of head and neck surgery, and additionally describes a case of massive transfusion in a cat.

To perform operative procedures in an optimized local atmosphere: Can it reduce post-operative adhesion formation?

BackgroundAdhesion formation is a major problem following abdominal surgery as it creates a considerable economic burden in addition to an increased risk for complications. In the present study, an effort was made to reduce post-operative adhesion formation by creating an artificial atmosphere within and around the abdominal cavity during an open surgical procedure. Methods82 Wistar male rats (Clr:WI) (200 gr, 7 weeks) were randomized into two groups. The abdominal cavity of the control group was exposed to the normal atmosphere of the operating-theatre during surgery (21% O2, 21 °C, 40–47% relative humidity (RH)), while the abdominal cavity of the study group was exposed to an artificial atmosphere during surgery (3–6% O2, >75% CO2, 95–100% RH, 37 °C). Adhesion induction consisted of a laparotomy along linea-alba, four lesions in the anterior abdominal-wall, blood from the tail vein dripped inside the abdominal cavity and exposure to the atmosphere around the wound by use of self-retaining retractors. In addition, a liquid-sample for quantitative bacteriologic cultivation and bacterial load (CFU/ml) calculation was taken just before closure. After 3 weeks the abdominal cavity was scored for the extent, tenacity and severity of adhesions before the rats were euthanized. The two-sample-Wilcoxon-rank-sum test was used in the analysis. ResultsHighly significant differences in postoperative total adhesion score, extent-, severity- and tenacity-score were found (P < 0.01). No differences were found between the two groups regarding mean bacterial load (P > 0.05). ConclusionsThe rats exposed to the warmed and humidified artificial atmosphere consisting of more than 75% carbon dioxide and 3–4% oxygen during surgery had more severe and more post-operative adhesions compared to the rats that were exposed to the ambient air during surgery.

AORN Ergonomic Tool 5: Tissue Retraction in the Perioperative Setting

Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. Ergonomic Tool #5: Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.

Laparoscopic myomectomy—an unusual cause of meralgia paresthetica

Meralgia paresthetica may be associated with diabetes, trauma, infection, and use of self-retaining retractors. Our patient experienced left upper thigh paresthesia after undergoing laparoscopic myomectomy with extensive dissection of the left retroperitoneal space. Neurologic evaluation confirmed meralgia paresthetica. The patient was observed for 4 months, by which time the neuropathy resolved spontaneously.

The Use of Self-retaining Retractors in Surgery for Spinal Cord Tumors

The Use of Self-retaining Retractors in Surgery for Spinal Cord Tumors

The use of self-retaining retractors in surgery for spinal cord tumors: technical note.

Self-retaining retractors may be useful in spinal tumor surgery. In this study, the tumors were retracted away from the surrounding tissue by pronged hooks attached to flexible self-retaining retractors; by this process, we could avoid placing pressure on the spinal cord. A clear dissection plane was exposed between the underside of the tumor and the surrounding spinal cord, so that the surgeon had both hands free to perform the operation. Two retractor base systems were used: 1) Sugita's multipurpose headframe for the cervical region, and 2) a newly designed U-shaped, table-fixed retractor base for the thoracic and lumbosacral regions. Most retracting instruments used in cranial surgery can be used with either system.

Femoral Neuropathy Subsequent to Abdominal Hysterectomy. A Comparative Study

In a prospective study of two 5-yr periods two groups of patients undergoing pelvic operative procedures were compared. Iatrogenic femoral neuropathy occurred in 282 patients who underwent pelvic abdominal surgery in the first group of women, an overall incidence of 7.45%. The neuropathy was associated with the use of self-retaining retractors during surgery. Femoral nerve neuropathy occurred only in two patients in the second group in whom no retractors were used during operation. No other contributing factors were found. The duration of complaints ranged from 3 to 90 days. Spontaneous recovery occurred in 265 patients, while in 17 there were residual mild symptoms for up to 116 days. No serious sequelae have been observed. Prevention of this mostly mild yet annoying syndrome may be achieved if no retractors are used in gynecological operations, or, if they are necessary, due to difficult conditions at surgery or if the operation is long, they should be used with care and loosened from time to time. It is estimated that the incidence of iatrogenic femoral nerve neuropathy is higher than reported, since in very mild cases the patient fails to mention her complaints. The prognosis is usually rather good.

Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study

In a prospective study of two 5-yr periods two groups of patients undergoing pelvic operative procedures were compared. Iatrogenic femoral neuropathy occurred in 282 patients who underwent pelvic abdominal surgery in the first group of women, an overall incidence of 7.45%. The neuropathy was associated with the use of self-retaining retractors during surgery. Femoral nerve neuropathy occurred only in two patients in the second group in whom no retractors were used during operation. No other contributing factors were found. The duration of complaints ranged from 3 to 90 days. Spontaneous recovery occurred in 265 patients, while in 17 there were residual mild symptoms for up to 116 days. No serious sequelae have been observed. Prevention of this mostly mild yet annoying syndrome may be achieved if no retractors are used in gynecological operations, or, if they are necessary, due to difficult conditions at surgery or if the operation is long, they should be used with care and loosened from time to time. It is estimated that the incidence of iatrogenic femoral nerve neuropathy is higher than reported, since in very mild cases the patient fails to mention her complaints. The prognosis is usually rather good.

Compression neuropathy subsequent to renal transplantation

Compression neuropathy occurred in 7 patients who underwent renal transplantation. The neuropathy occurred on the same side as the surgery and was associated with the use of self-retaining retractors. Other contributing factors were presence and degree of uremia and diabetes. We suggest that self-retaining retractors be used carefully and length of application reduced to a minimum. Efficient dialysis prior to transplantation may decrease the incidence and severity of neurologic deficit by reducing the extent of uremia.