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Anal retractor for use in anorectal surgery
ANAL RETRACTOR J. Assistant
Proctologic
FOR USE IN ANORECTAL REMBRANDT
HELPRICK,
Surgeon, New York University
PORT
WASHINGTON,
G
OOD exposure in all types of surgery often means the difference between a well pIanned and easily executed
FIG. I. Shows the circuIar anal retractor
NEW
SURGERY
M.D. Medical College Clinic YORK
steps are mounted over the adjacent ends of the semi-anuIar members for Iocking them in end abutment with each other.
open and ready for use.
FIG. 2. Shows the circular anal retractor foIded.
The features of the anal retractor may be seen in Figures I and 2. The method of using the anal retractor is shown in Figure 3. The patient is pIaced on the table in the prone position. The tabIe is broken sIightly and a Iength of 3 or 4 inch adhesive is appIied to each buttock just opposite the ana verge, and traction made on the adhesive which is then fastened to the tabIe. By using this position the surgeon is not hampered by having one Ieg on either side of him with very IittIe room for an assistant, as in the Iithotomy position
operation and a we11 planned but difficultly executed operation. This is especially true in operations on the anorecta1 region. HuIIsiek, in 1937, described a maIIeabIe stee1 ring, g inches in diameter with notches at the periphery, to be used in obtaining exposure in anorecta1 surgery. A ring which I have devised, as shown in Figure I, consists of a pair of semianuIar members having their ends in end abutment with each other and connected by hinges so as to be foIdabIe in haIf. Anchor springs are mounted on the top faces of the semi-anuIar members. Rigid 131
132
AnlericanJournalolSurgery
Helfrick-Anal
A black
silk suture is placed in each of the four quadrants of the peri-anal region, passing through the skin only. If one desires
FIG. 3. Shows the circuIar
to remove
and retractor
in use.
the internal hemorrhoids separateIy, the siIk can be placed through the skin tabs; or if one wishes to remove the external hemorrhoids or skin tabs in conjunction with the hemoirhoids, the siIk may be pIaced just dista1 to the tabs
OCTOBER, ,945
Retractor or. externa1
hemorrhoids. Before making traction on the siIk sutures, the sphincter muscIe is gentIy diIated. Traction is made on the bIack siIk sutures, and the silk is sIipped beneath the anchor spring of the circuIar anoscope and tied. As can be seen in Figure 3, exceIIent exposure is obtained and one is abIe to perform the anorectal surgery without an assistant. The features of the circular anoscope are: (I) It provides idea1 exposure; (2) it can be used on any patient regardIess of the size of the buttocks; (3) it obviates the necessity of one or two assistants; (4) it is smaI1, just 645 inches in diameter when the anoscope is opened; (5) when foIded, the anoscope is compact and fits into a steriIizer very easiIy, and (6) it is sturdy when opened and Iocked. The photographs were taken at the Meadowbrook Hospital, Hempstead, New York, through the courtesy of Dr. A. J. McRae, Superintendent of the Meadowbrook Hospital. REFERENCE HULLSIEK, H. E. New ana 20:300, 1937.
retractor.
Minnesota
Med.,
Proctologic
FOR USE IN ANORECTAL REMBRANDT
HELPRICK,
Surgeon, New York University
PORT
WASHINGTON,
G
OOD exposure in all types of surgery often means the difference between a well pIanned and easily executed
FIG. I. Shows the circuIar anal retractor
NEW
SURGERY
M.D. Medical College Clinic YORK
steps are mounted over the adjacent ends of the semi-anuIar members for Iocking them in end abutment with each other.
open and ready for use.
FIG. 2. Shows the circular anal retractor foIded.
The features of the anal retractor may be seen in Figures I and 2. The method of using the anal retractor is shown in Figure 3. The patient is pIaced on the table in the prone position. The tabIe is broken sIightly and a Iength of 3 or 4 inch adhesive is appIied to each buttock just opposite the ana verge, and traction made on the adhesive which is then fastened to the tabIe. By using this position the surgeon is not hampered by having one Ieg on either side of him with very IittIe room for an assistant, as in the Iithotomy position
operation and a we11 planned but difficultly executed operation. This is especially true in operations on the anorecta1 region. HuIIsiek, in 1937, described a maIIeabIe stee1 ring, g inches in diameter with notches at the periphery, to be used in obtaining exposure in anorecta1 surgery. A ring which I have devised, as shown in Figure I, consists of a pair of semianuIar members having their ends in end abutment with each other and connected by hinges so as to be foIdabIe in haIf. Anchor springs are mounted on the top faces of the semi-anuIar members. Rigid 131
132
AnlericanJournalolSurgery
Helfrick-Anal
A black
silk suture is placed in each of the four quadrants of the peri-anal region, passing through the skin only. If one desires
FIG. 3. Shows the circuIar
to remove
and retractor
in use.
the internal hemorrhoids separateIy, the siIk can be placed through the skin tabs; or if one wishes to remove the external hemorrhoids or skin tabs in conjunction with the hemoirhoids, the siIk may be pIaced just dista1 to the tabs
OCTOBER, ,945
Retractor or. externa1
hemorrhoids. Before making traction on the siIk sutures, the sphincter muscIe is gentIy diIated. Traction is made on the bIack siIk sutures, and the silk is sIipped beneath the anchor spring of the circuIar anoscope and tied. As can be seen in Figure 3, exceIIent exposure is obtained and one is abIe to perform the anorectal surgery without an assistant. The features of the circular anoscope are: (I) It provides idea1 exposure; (2) it can be used on any patient regardIess of the size of the buttocks; (3) it obviates the necessity of one or two assistants; (4) it is smaI1, just 645 inches in diameter when the anoscope is opened; (5) when foIded, the anoscope is compact and fits into a steriIizer very easiIy, and (6) it is sturdy when opened and Iocked. The photographs were taken at the Meadowbrook Hospital, Hempstead, New York, through the courtesy of Dr. A. J. McRae, Superintendent of the Meadowbrook Hospital. REFERENCE HULLSIEK, H. E. New ana 20:300, 1937.
retractor.
Minnesota
Med.,