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New laparoscopic retractors
Vol. 1, No. 1, November 1993
TheJournal of the American Association of Gynecologic Laparoscopists
New Laparoscopic Retractors
Philip G. Brooks, M.D. Abstract One of the most frustrating problems encountered during diagnostic or operative laparoscopy is the presence of distended loops of large or small bowel or of parts of adjacent or overlying organs. It requires changing the position of the patient and table, and/or tedious pushing or pulling of the bowel or organ out of the operative field. Two new accessory retractors are now available. One expands as a "kite," fits through a 5-mm port, and is reusable. The other is covered with polymeric material, is disposable, inflates to provide a balloon-like atraumatic retraction, and is inserted through a 10-mm cannula.
Operative procedures by laparoscopy are frequent and important surgical options. Often, because of distended loops of bowel, enlarged and heavy adjacent organs, or obesity, retraction of omentum, bowel, or other structures becomes difficult. Narrow instruments such as probes, suction cannulas, and accessory graspers inserted through 5-mm ports are often inadequate to push these structures out of the way. This usually requires a steeper Trendelenburg position, with its increased risks of nerve injury and pressure under the diaphragm. 1 To solve these problems, two new expandable retractors were developed that can be used through 5and 10-mm accessory cannulas. 1 Both are disposable for greater convenience and to reduce the risk of dam-
age during cleaning or reassembly. The first, the kite retractor (Figure 1), is composed entirely of metal, is available in straight and gently curved models, is reusable, and is easily assembled and disassembled for cleaning and sterilization. The entire instrument is 16 inches long, and the tips, when collapsed, are r o u n d e d and measure 4 mm across, allowing the instrument to be used as a blunt probe if desired. Once inserted through the cannula, the retractor is opened mechanically and locked in the open position. It can expand up to a width of 4 cm at the distal portion. The inflatable tissue retractor is also 16 inches long and is designed as thin metal springs covered ~vith polymeric, nonconductive material. It fits easily
From the Department of Obstetrics and Gynecology, U C L A School of Medicine, and Cedars-Sinai Medical Center, Los Angeles, California. Dr. Brooks serves on the medical advisory board of Advanced Surgical, Inc., manufacturers of the retractors described. Address reprint requests to Philip G. Brooks, M.D., 8631 West Third Street, Suite 510E, Los Angeles, CA 90048.
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Vol. 1, No. 1, November 1993
The Journal of the American Association of Gynecologic Laparoscopists
er to direct the o p e r a t i v e i n s t r u m e n t s in all cases. These expandable, atraumatic retractors allow endoscopic surgeons to p e r f o r m what we believe to be faster and much less tedious laparoscopic surgery by displacing overlying tissue structures from the surgical field, and permitting easier access to and visualization of the target operative site.
FIGURE 1. Kite laparoscopic retractors, curved (top) and straight (bottom), are expandable and reusable, and can be inserted through a 5-mm cannula. through a 10-mm cannula when collapsed. Once inside the a b d o m e n or other body cavity, the paddle is inflated by a syringe to provide a soft, 5cm, atraumatic surface for retracting more friable or injury-sensitive tissue. The instrument can be designed in many shapes and angles, the most c o m m o n being the inflatable triangle and straight U shapes (Figure
FIGURE 2. Disposable inflatable tissue retractors, the triangle (left) and the straight U-shaped (right), are disposable and inflatable, and used through a 10-ram cannula.
2). Since a b o u t J a n u a r y 1993 we have used these retractors at our institution for gynecologic and general surgical procedures in which overlying bowel and p o r t i o n s of o r g a n s (liver e d g e , g a l l b l a d d e r , etc.) required initial retraction to expose the area of interest. No additional ports were required, and it was easi-
Reference
1. Levinson C J: Complications of laparoscopy. In Laparoscopy. Edited by JM Phillips, SL Corson, L Keith, et al. Baltimore, Williams & Wilkins, 1977, p 224
61
TheJournal of the American Association of Gynecologic Laparoscopists
New Laparoscopic Retractors
Philip G. Brooks, M.D. Abstract One of the most frustrating problems encountered during diagnostic or operative laparoscopy is the presence of distended loops of large or small bowel or of parts of adjacent or overlying organs. It requires changing the position of the patient and table, and/or tedious pushing or pulling of the bowel or organ out of the operative field. Two new accessory retractors are now available. One expands as a "kite," fits through a 5-mm port, and is reusable. The other is covered with polymeric material, is disposable, inflates to provide a balloon-like atraumatic retraction, and is inserted through a 10-mm cannula.
Operative procedures by laparoscopy are frequent and important surgical options. Often, because of distended loops of bowel, enlarged and heavy adjacent organs, or obesity, retraction of omentum, bowel, or other structures becomes difficult. Narrow instruments such as probes, suction cannulas, and accessory graspers inserted through 5-mm ports are often inadequate to push these structures out of the way. This usually requires a steeper Trendelenburg position, with its increased risks of nerve injury and pressure under the diaphragm. 1 To solve these problems, two new expandable retractors were developed that can be used through 5and 10-mm accessory cannulas. 1 Both are disposable for greater convenience and to reduce the risk of dam-
age during cleaning or reassembly. The first, the kite retractor (Figure 1), is composed entirely of metal, is available in straight and gently curved models, is reusable, and is easily assembled and disassembled for cleaning and sterilization. The entire instrument is 16 inches long, and the tips, when collapsed, are r o u n d e d and measure 4 mm across, allowing the instrument to be used as a blunt probe if desired. Once inserted through the cannula, the retractor is opened mechanically and locked in the open position. It can expand up to a width of 4 cm at the distal portion. The inflatable tissue retractor is also 16 inches long and is designed as thin metal springs covered ~vith polymeric, nonconductive material. It fits easily
From the Department of Obstetrics and Gynecology, U C L A School of Medicine, and Cedars-Sinai Medical Center, Los Angeles, California. Dr. Brooks serves on the medical advisory board of Advanced Surgical, Inc., manufacturers of the retractors described. Address reprint requests to Philip G. Brooks, M.D., 8631 West Third Street, Suite 510E, Los Angeles, CA 90048.
60
Vol. 1, No. 1, November 1993
The Journal of the American Association of Gynecologic Laparoscopists
er to direct the o p e r a t i v e i n s t r u m e n t s in all cases. These expandable, atraumatic retractors allow endoscopic surgeons to p e r f o r m what we believe to be faster and much less tedious laparoscopic surgery by displacing overlying tissue structures from the surgical field, and permitting easier access to and visualization of the target operative site.
FIGURE 1. Kite laparoscopic retractors, curved (top) and straight (bottom), are expandable and reusable, and can be inserted through a 5-mm cannula. through a 10-mm cannula when collapsed. Once inside the a b d o m e n or other body cavity, the paddle is inflated by a syringe to provide a soft, 5cm, atraumatic surface for retracting more friable or injury-sensitive tissue. The instrument can be designed in many shapes and angles, the most c o m m o n being the inflatable triangle and straight U shapes (Figure
FIGURE 2. Disposable inflatable tissue retractors, the triangle (left) and the straight U-shaped (right), are disposable and inflatable, and used through a 10-ram cannula.
2). Since a b o u t J a n u a r y 1993 we have used these retractors at our institution for gynecologic and general surgical procedures in which overlying bowel and p o r t i o n s of o r g a n s (liver e d g e , g a l l b l a d d e r , etc.) required initial retraction to expose the area of interest. No additional ports were required, and it was easi-
Reference
1. Levinson C J: Complications of laparoscopy. In Laparoscopy. Edited by JM Phillips, SL Corson, L Keith, et al. Baltimore, Williams & Wilkins, 1977, p 224
61