A retractor is a

surgical instrument A surgical instrument is a medical device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...

used to separate the edges of a

surgical incision A surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible ...

wound A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma (mechanical, thermal, chemical), or can develop slowly over time due to underlying diseas ...

or to hold away certain

organ Organ and organs may refer to: Biology * Organ (biology), a group of tissues organized to serve a common function * Organ system, a collection of organs that function together to carry out specific functions within the body. Musical instruments ...

s and tissues (i.e. to provide tissue ''retraction'') so that body parts underneath may be accessed during

surgical operation Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

s. The broad term ''retractor'' typically describes a simple steel tool possessing a curved,

hook A hook is a tool consisting of a length of material, typically metal, that contains a portion that is curved/bent back or has a deeply grooved indentation, which serves to grab, latch or in any way attach itself onto another object. The hook's d ...

ed, or angled blade, which is manually manipulated to help maintain a desired position of tissue during surgery. More sophisticated retractors may be clamped in place (usually to a tableside frame) or suspended at the end of a

robotic arm A robotic arm is a type of mechanical arm, usually programmable, with similar functions to a human arm; the arm may be the sum total of the mechanism or may be part of a more complex robot. The links of such a manipulator are connected by join ...

. Retractors can also be "self-retaining" and no longer need to be held once inserted, having two or more opposing blades or hooks which are separated via spring,

ratchet Ratchet may refer to: Devices * Ratchet (device), a mechanical device that allows movement in only one direction * Ratchet effect in sociology and economics * Ratchet, metonymic name for a socket wrench incorporating a ratcheting device * Ratc ...

worm gear A worm drive is a gear train, gear arrangement in which a worm (which is a gear in the form of a Screw thread, screw) meshes with a worm wheel (which is similar in appearance to a spur gear). Its main purpose is to translate the motion of two p ...

or other method. The term ''retractor'' is also used to describe distinct, hand-cranked devices such as rib spreaders (also known as thoracic retractors, or distractors) with which surgeons may use to forcefully drive tissues apart to obtain exposure. Different surgery specialties can have specific kinds of retractors – e.g., for certain kinds of

spinal surgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the specialty (medicine), medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system ...

, such as Minimally Invasive Transforaminal Lumbar Interbody Fusions, some retractors are fitted both with suction and with

fiberoptic An optical fiber, or optical fibre, is a flexible glass or plastic fiber that can transmit light from one end to the other. Such fibers find wide usage in fiber-optic communications, where they permit transmission over longer distances and at ...

lights to keep deep surgical wounds both dry and illuminated.

Surgical assistant An assistant surgeon, also known as a surgical assistant, surgeon's assistant, assistant in surgery or first assistant, is a healthcare professional who provides direct manual and/or instrumental assistance to meet the in-procedure demands of a su ...

s, whether they be another

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

, surgical residents or professionally trained procedure assistants (specifically Certified Surgical Assistants, Registered Nurse First Assistants, Physicians Assistants, or Surgical Technologists), may assist the operating surgeon in the process of retraction.

History

Surgical retractors probably originate with very basic tools used in the

Stone Age The Stone Age was a broad prehistory, prehistoric period during which Rock (geology), stone was widely used to make stone tools with an edge, a point, or a percussion surface. The period lasted for roughly 3.4 million years and ended b ...

. 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 4th century CE, Indian physician Susruta used surgical tools such as retractors. In a description of the procedure of

tonsillectomy Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA). For those wit ...

from the 7th century CE,

Paul of Aegina Paul of Aegina or Paulus Aegineta (; Aegina, ) was a 7th-century Byzantine Greek physician best known for writing the encyclopedia, medical encyclopedia ''Medical Compendium in Seven Books.'' He is considered the “Father of Early Medical Writing ...

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 Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari (;‎ c. 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis or Abulcasis (from Arabic ''Abū al-Qāsim''), was an Arab physician, surgeon and chemist from al-And ...

, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text

Al-Tasrif The ''Kitāb al-Taṣrīf'' (), known in English as The Method of Medicine, is a 30-volume Arabic encyclopedia on medicine and surgery, written near the year 1000 by al-Zahrawi, Abu al-Qasim al-Zahrawi (Abulcasis). It is available in translation. ...

Vesalius Andries van Wezel (31 December 1514 – 15 October 1564), Latinization of names, latinized as Andreas Vesalius (), was an anatomist and physician who wrote ''De humani corporis fabrica, De Humani Corporis Fabrica Libri Septem'' (''On the fabric ...

described a variety of hooks and retractors in the 16th century. 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.

Current

The following is an incomplete list of surgical retractors in use: In 2021, a self-retaining ring retractor in the UK was given HRH The Queen's Award for Enterprise in the Innovation category as the first and only retractor ever to be awarded.

Hand-held retractors

* Hohmann Retractor * Lahey Retractor * Senn Retractor * Blair (Rollet) Retractor * Rigid Rake * Flexible Rake * "Cat's Paws" – sharp, wide rakes * Ragnell Retractor * Linde-Ragnell Retractor * Davis Retractor * Volkman Retractor * Farabeuf Retractor * Mathieu Retractor * Jackson Tracheal Hook * Meyerding Finger Retractor * Little Retractor * Love Nerve Retractor * Green Retractor * Goelet Retractor * Cushing Vein Retractor * Langenbeck Retractor * Richardson Retractor * Richardson-Eastmann Retractor * Deaver Retractor * Doyen Retractor * Parker Retractor * Parker-Mott Retractor * Roux Retractor * Mayo-Collins Retractor * "Army-Navy" Retractor * Ribbon Retractor – malleable, able to be bent as the surgeon desires

Self-retaining retractors

* Rultract Skyhook Retractor System * Alms Retractor * Lone Star Retractor
Galaxy II retractor
* Gelpi Retractor * Gutow Retractor * Weitlaner Retractor * Beckman-Weitlaner Retractor * Beckman-Eaton Retractor * Beckman Retractor * Balfour Retractor – typically used in lower abdomen and pelvic surgery
Rib spreader
(a.k.a. Finochietto retractor) * Travers Retractor * West Retractor * Norfolk & Norwich Retractor

Gallery

File:Surgical retractor.jpg, Balfour retractor File:Deaver retractor 01.JPG, Deaver retractor File:Doyen's Retractor.jpg, Doyen retractor (abdominal) File:Surgical retractor Orem.jpg, Farabeuf retractor File:Volkmann Retractor 1.jpg, Volkmann retractor (informally known as "rake") File:Amputation retractor.svg, Amputation retractor

References

at Library and Archives Canada {{DEFAULTSORT:Retractor (Medical) Surgical instruments