In general, a retractor system needs to fulfill the following requirements for an ideal surgical exposure:
■ Broad, unrestricted view into the abdominal cavity
■ Wide access to the target organ
■ Illumination provided or enabled
■ Stable retraction of the abdominal wall and surrounding organs
■ Careful tissue retraction, preventing local ischemia
■ Freeing up the hands of the surgeon and assistants
■ Adaptability in usage (different patients, different incisions, etc.)
■ Various type of accessories to retract the abdominal wall and organs
Hand-held retractors have the main disadvantage of losing „free hands" of the surgical team. Self-retaining retractors are most commonly used to keep open the abdominal and thoracic cavity.
Two types of self-retaining retractors are available:
1. Closed ring retractors:
Ring system retractors are self-stabilizing by the retaining force of the different retracting devices and do not necessarily need to be fixed to the operating table (e.g. Kirschner, A). The best exposure is achieved by placing one retracting device strictly opposite to the other. In some systems, stabilization and exposure can further be improved by attaching the ring to the operating table by a rail arm.
2. Arm retractors:
Arm retractors need to be fixed to the operating table. They allow for an asymmetric exposure (e.g. Thompson, B).
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