Retractor (medical)
A retractor is a surgical instrument by which a surgeon can either actively separate the edges of a surgical incision or wound, or can hold back underlying organs and tissues, so that body parts under the incision may be accessed. The two are each available in many shapes, sizes, and styles. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade 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 situ, 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 some other method and pull on opposite sides of a wound. The term retractor is also used to describe the 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 the 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.
History
Surgical retractors probably originate with very basic tool use 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 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.[citation needed]
Vesalius described a variety of hooks and retractors in the 16th century.[citation needed]
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
The following is an incomplete list of surgical retractors in use:[3]
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HAND HELD RETRACTORS
- Hohmann Retractor
- Lahey Retractor
- Senn Retractor
- 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
- Cushing Vein Retractor
- Langenbeck Retractor
- Richardson Retractor
- Richardson-Eastmann Retractor
- Kelly Retractor
- Deaver Retractor
- Doyen Retractor
- Parker Retractor
- Parker-Mott Retractor
- Roux Retractor
- Mayo-Collins Retractor
- U.S. Army Retractor
- Ribbon Retractor
SELF RETAINING RETRACTORS
- Alm Retractor
- Lone star retractor
- Gelpi Retractor
- Gutow Retractor
- Weitlaner Retractor
- Beckman-Weitlaner Retractor
- Beckman-Eaton Retractor
- Beckman Retractor
- Adson Retractor
- Balfour Retractor
- Finochietto Retractor or Rib Spreader
Gallery
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Surgical retractor.jpg
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Deaver retractor 01.JPG
Deaver retractor
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Surgical retractor Orem.jpg
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Amputation retractor.svg
Amputation retractor
References
- Famous Canadian Physicians: Dr. Norman Bethune at Library and Archives Canada
