Surgical Retractors

A retractor is a surgical instrument that is used to hold back underlying organs and tissues, so that body parts under the incision may be accessed without any fear of damage to the organs lieing at the above levels. Surgical retractors have a wide variety and retractors come under various shapes, sizes and strength.

Importance of Surgical Retractors

During the dissection/inspection, surgeon needs an exposure best as possible while inflicting a minimum of trauma to the surrounding tissue. The handles of the retractor may be hook shaped, notched, or ring shaped to give the holder a firm grip without tiring. The blades of the retractors are at a right angle to the shaft. The blades can be smooth, raked, or hooked.

Materials

Surgical retractors reaquire a very high grade stainless steel as they hold internal organs during an operation. A common material used in the making of retractors is superior grade stainless steel. Stainless steel is preferred because of its strength and its ability to be sterilized. The retractors are therefore extremely hard. However, there are some drawbacks of stainless steel retractors like they become very slippery when they come into contact with blood and other body fluids which can lead to tissue damage during operation. Moreover, stainless steel is also thermally highly conductive which also results in tissue injury as it quickly absorbs heat from the tissue with which it comes in contact. Another disadvantage is that they have reflective surfaces which produce glare under the high level illumination which is very common during surgical procedures.

To overcome these drawbacks, polymeric materials are used in the making of surgical retractors. Such polymeric materials include

  • Polyetherimide
  • Polyimide and
  • Thermosetting materials

It is to be noted that any material of construction of surgical retractors is that

  • It must be sterilizable
  • It must be autoclavable

to allow for the necessary sterilization process so they may be reused for multiple, successive surgical procedures.

Types of Retractors

There are two types of retractors on the basis of their functionality.

  • Self retaining retractors
  • Handheld retractors



Self Retaining Retractors (link)

Self retaining retractors do not need an assistant to hold them in place. self retaining retractors hold tissue apart and lock it in place. Rib Spreaders come in this category. They hold the ribs apart during the abdominal surgery when the required organ is located inside the rib cage. Followings are the commonly used retractors

Hand Held Retractors (link)

can be hand held retractors. The hand held retractors require an assistant to hold them but the self retaining ones don’t once they are adjusted in position. The correct method of using a hand-held retractor is that it must be held by its handle properly so as to produce maximum exposure of the surgical area, maximum leverage, and steady retraction.

  • turner warwick 4 & 2 blades
  • pozzi abdominal (blade 6.2 x 3.8cm)
  • pozzi abdominal with central blade
  • ricard with central blade
  • balfour abdominal with central blade
  • kirschner with frame + blades
  • gosset (blade 5.5cm)
  • gosset (blade 3.8cm)
  • sternal abdominal 66cm
  • sternal abdominal fixation device
  • sternal abdominal blade
  • goligher with 2 center blade & 4
  • lateral blade
  • Berkeley abdominalk  (blade 3.5 x 6cm)
  • Travers 4 x 5 teeth 20cm blunt
  • Irwin 4 x 4 teeth 17.8cm sharp
  • Weislander 2 x 3 teeth 11cm sharp
  • Norfolk and Norwich 4 x 5 teeth 21.5cm
  • Rntne hospital 3 x 4 teeth 15.9cm
  • Weislander 3 x 4 teeth 13  15.6
  • Weislander 3 x 4 teeth 13  16.5cm
  • Weislander 3 x 4 teeth 19.5 – 24cm
  • Weislander 5 x 6 teeth 25.5cm sharp
  • St marks hospital perineal (blade 7 x 4cm)
  • Jolly thyroid 15.2cm
  • Millin retopublic with center blade
  • Turner warwick with frame and 6 blade
  • Gelpi vulva 13.5 – 16.5cm
  • Jackson burrows 16.5cm
  • Finson 7cm
  • Alms 7 10cm
  • Logan 5cm
  • Kilner skin 5cm small & long teeth
  • Cone 14.5cm
  • Jansen shea 10.5cm
  • Jefferson 14cm
  • Henderson 13cm
  • Travers 19.5cm
  • Cone laminectomy 24.5cm hinged arm
  • Cone hemi 16.5 25.4cm left hinged arm
  • Cone hemi 16.5 25.4cm right hinged arm
  • Harvey Jackson laminectomy 28cm
  • Adson 26.5cm
  • Beckmann adson 31cm
  • Adson 32cm simi sharp
  • Mollison 16.5 13.3cm
  • Shah intra aural 15.2cm with center blade
  • Plester jansen 14cm
  • Wallace modified plester jansen 14cm

Varieties of Surgical Retractors

Each type of surgical retractors have specific properties as per the usage. For instance:

  • Tissue Retractor: During a surgery, the tissue retractors hold tissue flaps away from the treatment site. This provide better visibility, reach and undisturbed working. Some retractors may have fork like prongs. This allows the handling of the tissue without causing much damage.
  • Cheek Retractor: These retractors are designed to hold and retract the cheeks, tongue, or a portion of the mucosa during surgical procedures. The retractors are made of metal or plastic, and may be large, curved, or angled.
  • Senn retractor is simple.
  • The deaveris more exotic.
  • The hohmann is orthopedic retractor.
  • Army-navy is a bladed retractor.
  • Rake retractors are forked.
  • Common self retaining retractors are weitlaner and gelpi. Also use adsons and balfours.

Kinds of Retractors

Depending on the various body parts which need to be operated, there are different names given to retractors such as follows:

  • Lung Retractor
  • Abdominal Retractor
  • Skin Retractor
  • Eyelid Retractor
  • Canny Ryall Retractor
  • Scalp Retractor
  • Pin Retractor
  • Vertical Retractor
  • Cone Retractor
  • Arterial Retractor
  • Fan Blade Retractor
  • Vaginal Retractor
  • Laminectomy Retractor
  • Thyroid Retractor
  • Nerve Root Retractor etc.

Common Surgical Retractors in use

The following is a list of surgical retractors in current use

  • Lahey Retractor
  • Senn Retractor
  • Blair (Rollet) Retractor
  • Rigid Rake
  • Flexible Rake
  • Ragnell Retractor
  • Linde-Ragnell Retractor
  • Davis Retractor
  • Volkman 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
  • Parker Retractor
  • Parker-Mott Retractor
  • Roux Retractor
  • Mayo-Collins Retractor
  • U.S. Army Retractor
  • Ribbon Retractor
  • Alm Retractor
  • Self Retaining Retractors
  • Gelpi Retractor
  • Weitlaner Retractor
  • Beckman-Weitlaner Retractor
  • Beckman-Eaton Retractor
  • Beckman Retractor
  • Adson Retractor
  • Balfour Retractor

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