Retractor (medical)

A retractor is a surgical instrument used to separate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts under the incision may be accessed. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade and fitted with a comfortable handle, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in place, or suspended at the end of a robotic arm. Retractors can also be self-retaining and not need to be held once inserted by having two or more opposing blades or hooks which are separated via spring, ratchet, worm gear or other method. The term retractor is also used to describe distinct, hand-cranked devices such as rib spreaders (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. For specialized situations such as spinal surgery, retractors have been fitted both with suction and with fiberoptic lights to keep a surgical wound dry and illuminated.

Surgical retractors

History

Surgical retractors probably originate with very basic tools used in the Stone Age.[1] Branches or antlers of various shapes were used to dig and extract food from the ground. As the use of tools evolved, a variety of instruments came about to substitute for the use of hooked or grasping fingers in the butchering of meat or dissection of bodies. The use of metals in tool making was of great importance. A variety of Roman metal instruments of the hook and retractor family have been found by archeologists. These instruments would generally be called hooks if the end was as narrow as the handle of the instrument. If the end was broad, it would be called a retractor. Also arising from this group of tools were other related tools for displacing (elevators and spatulas) and scooping (spoons and curettes).

In 4th century CE, Indian physician Susruta used surgical tools such as retractors. In a description of the procedure of tonsillectomy from the 7th century CE, Paul of Aegina documents the use of a tongue spatula to keep the tongue out of the way while a form of tonsil hook is used to bring the tonsil forward for excision. In 1000 CE Abu al-Qasim al-Zahrawi, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text Al-Tasrif. Vesalius described a variety of hooks and retractors in the 16th century. Jan Mikulicz-Radecki's invention of a hinged rib spreading retractor in 1904 prompted a flurry of development of retractors in the early 20th century, culminating in 1936 in our modern device based on the design of Enrique Finochietto.[2]

Current
A retractor system setup in place for undertaking a thyroid surgery intervention.

The following is an incomplete list of surgical retractors in use:[3]

Hand-held retractors

  • Hohmann Retractor
  • Lahey Retractor
  • Senn Retractor [4]
  • Blair (Rollet) Retractor
  • Rigid Rake
  • Flexible Rake
  • Ragnell Retractor
  • Linde-Ragnell Retractor
  • Davis Retractor
  • Volkman Retractor
  • Kocher Retractor
  • Farabeuf Retractor
  • Mathieu Retractor
  • Jackson Tracheal Hook
  • Crile Retractor
  • Meyerding Finger Retractor
  • Little Retractor
  • Love Nerve Retractor
  • Green Retractor
  • Goelet Retractor [5]
  • Cushing Vein Retractor
  • Langenbeck Retractor
  • Richardson Retractor [6]
  • Richardson-Eastmann Retractor
  • Kelly Retractor
  • Deaver Retractor [7]
  • Doyen Retractor
  • Parker Retractor
  • Parker-Mott Retractor
  • Roux Retractor
  • Mayo-Collins Retractor
  • U.S. Army Retractor [8]
  • Ribbon Retractor

Self-retaining retractors

  • Rultract Skyhook Retractor System
  • Alm Retractor
  • Lone star retractor
  • Galaxy II retractor
  • Gelpi Retractor
  • Gutow Retractor [9]
  • Weitlaner Retractor
  • Beckman-Weitlaner Retractor
  • Beckman-Eaton Retractor
  • Beckman Retractor
  • Adson Retractor
  • Balfour Retractor [10]
  • Finochietto Retractor or Rib spreader
  • Deaver retractor
  • Army-Navy Retractor
  • Amputation retractor
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References
  1. Kirkup, John (2006-05-15). The Evolution of Surgical Instruments – An Illustrated History from Ancient Times to the Twentieth Century. Norman Publishing. ISBN 978-0-930405-86-1.
  2. Bonfils-Roberts, E (May 1972). "The Rib Spreader: A Chapter in the History of Thoracic Surgery" (PDF). Chest. 61 (5): 469–474. doi:10.1378/chest.61.5.469. PMID 4558402. Archived from the original (PDF) on 2008-12-17. Retrieved 2008-04-22.
  3. "General Instrument Sourcebook – KMedic" (PDF). Archived from the original (pdf) on November 12, 2006. Retrieved 2008-04-22.
  4. A History of Surgery in the Instrument Tray: Eponymous Tools Used in Hand Surgery https://pubmed.ncbi.nlm.nih.gov/17826545/
  5. http://library.sccsc.edu/surgtech/retracting2.htm
  6. http://library.sccsc.edu/surgtech/retracting2.htm
  7. http://library.sccsc.edu/surgtech/retracting2.htm
  8. http://library.sccsc.edu/surgtech/retracting2.htm
  9. http://www.accuratesurgical.com/products/hand-surgery/category/719-gutow-self-retaining
  10. https://journals.lww.com/jpelvicsurgery/Citation/1999/11000/The_Balfour_Retractor__Donald_Church_Balfour.10.aspx
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