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Diaphragmatic Ultrasound after Thoracic and Abdominal Surgery
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Luigi Vetrugno, Daniele Orso, Elena Bignami, Gianmaria Cammarota
Retractors play a clear role in creating an adequately wide surgical field during an operation. The retractor is usually secured to the patient's bed by means of the upright metal bar. The valves applied to the wound are moved by metal cables retracted by a pulley placed on the metal arch, and a sliding cable fixes the retraction in the desired position. In this way, the upper abdomen and the patient's organs are optimally exposed.
Instrumentation and Operating Theater Set up in Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The ThoraTrak® MICS Retractor System has multiple interchangeable blades – including various lift blades and thoracotomy blades. This modular retractor system can accommodate various procedures and patient anatomies. It is a reusable, stainless-steel retractor, designed specifically for minimally invasive procedures. It has got different parts: rail clamp, long and short mounting rail, retractor tack and blades (Figure 4.25 and Figure 4.26).
Ureteropelvic junction obstruction
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Lauren E. Corona, Kate H. Kraft
A self-retaining retractor may aid exposure. Gerota's fascia is opened longitudinally and the overlying fat dissected away, taking care not to strip the renal capsule, which may be adherent. Patients who may have had renal leak or a decompressive nephrostomy tube may also have an inflamed, scarred layer of fat. If possible, the dissected fat as a single layer should be maintained, as it will be useful at the end of the case. Small blood vessels are coagulated. Branches and tributaries of the renal vessels around the anterior hilum should be sought. It is rarely necessary to skeletonize the vessels. The kidney should be mobilized sufficiently to expose the renal pelvis. The kidney can be held either by a well-padded retractor or by an assistant's hand. Displacing the kidney out of the depths of the incision may improve exposure, but exaggerated positions should be avoided because of the stretch imposed on the renal vessels and the risk of thrombosis or avulsion. In reoperative cases, approaching along the posterior aspect may be the safest way to begin mobilization; the hilum will be directly anterior with no major vessels to encounter before the pelvis.
Usefulness of the Lone Star Retractor System for harvesting the superficial temporal artery: technical note
Published in British Journal of Neurosurgery, 2023
Koichi Torihashi, Takafumi Ogura, Tomohiro Hosoya, Sadao Nakajima, Makoto Sakamoto, Masamichi Kurosaki
The STA-MCA anastomosis procedure is sometimes used for moyamoya disease, complex large aneurysms, and cerebral ischemia due to major vessel occlusion. Harvesting the STA as a donor vessel is the first important step for STA-MCA anastomosis. Some reports have introduced other methods for harvesting the STA: the ultrasonic scalpel method;1 the bipolar cutting method;5 the endoscopic method;2,4 the endoscope with retractor attachment;3 and a blunt malleable brain retraction method.1 We used the LS retractor system, which consists of a retractor ring and elastic stays, to harvest the STA. The LS retractor system is comprised of a variety of self-retaining, adjustable retractors that offer superior access and visualization across a wide range of surgical applications. Abdominal surgeons, plastic surgeons, and otolaryngologists consider the LS retractor system a useful instrument.12
Open Radiofrequency Ablation Combined with Splenectomy and Pericardial Devascularization vs. Liver Transplantation for Hepatocellular Carcinoma Patients with Portal Hypertension and Hypersplenism: A Case-Matched Comparative Study
Published in Journal of Investigative Surgery, 2023
Xishu Wang, Ximin Sun, Yongrong Lei, Jun Pei, Kuansheng Ma, Kai Feng, Wan Yee Lau, Feng Xia
A self-retained retractor was used after an incision using a midline incision with a right horizontal extension. Splenectomy and pericardial devascularization were first performed. In all patients, the spleen enlargement extended beyond the left subcostal margin (Figure 1A). Pericardial vessels were then dissected proximally for more than 7 cm (Figure 1B). After splenectomy, intraoperative ultrasonography (IOUS) was routinely used to determine the location, size and number of tumors. Radiofrequency ablation of HCC was performed (Figure 1C). When the tumor was less than 3 cm, one radiofrequency needle was used to repeatedly puncture, and ablate the tumor. The RF power was 120 watts, the working time was 3 minutes (Figure 1D). When the tumor was larger than 3 cm and less than 5 cm, two radiofrequency ablation needles were used for repeated puncture and ablation. The RF power was 180 watts, and the working time was 5 minutes. The device used was a multipolar internally cooled-tip CelonProSurge™ (Celon—POWER System OLYMPUS Medical®).
Bilateral laminotomy through a unilateral approach (minimally invasive) versus open laminectomy for lumbar spinal stenosis
Published in British Journal of Neurosurgery, 2021
Jack Horan, Mohammed Ben Husien, Ciaran Bolger
The patient is positioned in the prone position under general anaesthesia. Local anaesthesia and epinephrine are injected into the incision site. An incision over the midline is performed on the side that is more symptomatic. The retractor is then placed. Correct position of the retractor is confirmed by fluoroscopy. The microscope is brought in and the ipsilateral lamina is viewed. An ipsilateral hemilaminectomy is performed using a high-speed drill bit. The spinous process and contralateral lamina are then undercut and drilled, enabling visualization and access to the contralateral side. The ligamentum flavum is identified. It is left in situ during removal of the contralateral bone as it serves to protect the dura during this stage of bone removal. Following the removal of contralateral bone the ligamentum flavum is then removed. When adequate decompression is achieved, the retractors are removed with care and the incision is closed.