How Retractors Have Changed To Accomodate MIS Techniques
Al Fischer, National Sales Manager, Mediflex Surgical Products
Surgeons' need for retraction to provide excellent visualization of the operative site has not changed as the industry shifted from open surgery to minimally invasive techniques. The development of retractors for minimally invasive procedures has paralleled that of open surgery; from hand-held instruments to self-retaining devices and finally to table-mounted retractor systems.
When choosing a retractor, consider if it will do what is required of it—hold tissue away from the operative site. The chosen retractor should be designed specifically for the tissue that will be retracted. The liver, for example, may need a different retractor than omentum. It is also desirable that retractors be as atraumatic as possible, easy to insert through a cannula or percutaneously, and simple to use once in the patient.
When determining which retractor is best, equal consideration should be given to what will hold the retractor during the procedure. Surgeons are moving away from hand held retractors and towards devices to hold retractors for minimally invasive procedures.
Two factors are driving this. The first is the clinical advantage of positioning a retractor exactly where it is needed, keeping it in that position and having no extraneous movement such as that caused by tremor. The second factor is financial. A human retractor holder is expensive (and subject to tremor).
A surgical holder and positioner should be easy to attach to the OR table. It should be of a low-enough profile that it will not interfere with the surgeon or assistant. If it will hold a retractor that seldom needs to be moved during the procedure, a rigid arm may prove to be appropriate. If regular movement may be needed, a more flexible arm may be optimal. Since the retractor and the arm must work in concert, consider buying both from the same manufacturer to insure this compatibility.