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Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center


Krauss, Philipp; Oertel, Markus Florian; Stieglitz, Lennart Henning (2019). Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center. Acta Neurochirurgica, 161(7):1361-1365.

Abstract

OBJECTIVE: Ventriculoperitoneal shunt implantation is a common procedure in general neurosurgery. The patient population is often fragile, ranging from elderly to pediatric patients, and avoidance of perioperative complication is of utmost importance. Abdominal catheter dislocation has been found to be a common cause for early shunt dysfunction and needs to be avoided by optimal visualization of the abdominal catheter insertion zone. Here, we introduce a self-holding wound retractor system Alexis® and demonstrate its use for abdominal shunt surgery in a series of patients.
METHODS: We explain the use of the Alexis® self-holding wound retractor during open ventriculoperitoneal shunt surgery in a series of 16 patients operated at our institution.
RESULTS: The self-holding retractor consists of two polymer rings connected by a polymer membrane. The deep ring is easily placed on the internal fascia of the straight muscle and circular retraction is achieved by twisting the upper ring. Free hand working can then be performed by a single surgeon with good abdominal exposure. No case of abdominal dislocation or infection occurred in our series, although no properly powered statistical analysis can be performed regarding the sample size.
CONCLUSION: We demonstrate the Alexis® Wound Retractor, which is an easy tool for optimal visualization of the abdominal catheter insertion zone. We believe it can facilitate surgical practice of shunt surgery, especially in obese patients.

Abstract

OBJECTIVE: Ventriculoperitoneal shunt implantation is a common procedure in general neurosurgery. The patient population is often fragile, ranging from elderly to pediatric patients, and avoidance of perioperative complication is of utmost importance. Abdominal catheter dislocation has been found to be a common cause for early shunt dysfunction and needs to be avoided by optimal visualization of the abdominal catheter insertion zone. Here, we introduce a self-holding wound retractor system Alexis® and demonstrate its use for abdominal shunt surgery in a series of patients.
METHODS: We explain the use of the Alexis® self-holding wound retractor during open ventriculoperitoneal shunt surgery in a series of 16 patients operated at our institution.
RESULTS: The self-holding retractor consists of two polymer rings connected by a polymer membrane. The deep ring is easily placed on the internal fascia of the straight muscle and circular retraction is achieved by twisting the upper ring. Free hand working can then be performed by a single surgeon with good abdominal exposure. No case of abdominal dislocation or infection occurred in our series, although no properly powered statistical analysis can be performed regarding the sample size.
CONCLUSION: We demonstrate the Alexis® Wound Retractor, which is an easy tool for optimal visualization of the abdominal catheter insertion zone. We believe it can facilitate surgical practice of shunt surgery, especially in obese patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Neurology (clinical)
Uncontrolled Keywords:Hydrocephalus; Surgical technique; Ventriculoperitoneal shunt; Wound retractor
Language:English
Date:1 July 2019
Deposited On:31 Jan 2019 15:06
Last Modified:29 Jul 2020 09:08
Publisher:Springer
ISSN:0001-6268
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s00701-018-03794-0
PubMed ID:30635726

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