retractor

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. The term retractor is also informally used, though, to describe the distinct, hand-cranked devices such as rib spreaders (also known as distractors) with which surgeons may forcefully drive tissues apart to obtain the exposure.

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.^[2]

Vesalius described a variety of hooks and retractors in the 1500's.

Dr. von Mikulicz invention of a hinged rib spreading retractor in 1904 headed a flurry of development of distractors in the early 20th century, culminating in our modern devices.^[3]

Current

The following is a list of surgical retractors in current use^[4]:

References