Thursday, September 07, 2006

Stuff That Works

There's a humorous blog that I read frequently that occasionally posts about "stuff that works" -- things that seem to be worth the money and get the job done. Well, I'm not too proud to copy that concept, and will occasionally highlight a few things that make my life easier in (and sometimes out of) the operating room.

During the Dark Ages, while I was in medical school, the surgery rotation was exciting, interesting, challenging --- and frequently the source of sore muscles. Why? Well, in big operations, the challenge of making sure the operating surgeons had enough exposure to the operating field was left to the medical student. I spent many hours "holding hooks," basically pulling on various retractors to open the abdominal wall and allow good visualization. But, let's be honest, my arms got tired! And there was not a student among us who were not regularly admonished to "pull harder!" or "toe in!" by a sharp-tongued attending or senior resident.

When I started the first day of my residency, I knew that there would be many hours spent working on my biceps in the OR, watching and learning on the "bigger" cases or when there were not enough medical students around to hold hooks. But very quickly I encountered a vision straight out of the heavens: the Upper Hand Retractor! Here was a "self-retaining" retractor that would hold its position once set and make the experience of participating in, say, an open cholecystectomy an actual learning process, rather than a muscle bulking one!

While the Upper Hand was nice, over the next few years I enjoyed the use of a variety of other retractors, starting with the one that still has the best name: the Iron Intern.
This baby seems strong enough to hold back a raging bull, is elegantly designed, and works well in the upper abdomen. I haven't seen one in use since I left residency, I supect because it had at the time one flaw --- it did not provide retraction beyond it's two arms.



Once I entered practice, the two retractors I used the most were the Thompson and the Bookwalter --- the latter most frequently. The Thompson retractor is quite stout, wears well, and "works every time." It is adaptable for use around the abdomen by adding lengths of metal bars, sort of like a Tinkertoy, to allow retraction in all directions.







The Bookwalter is a retractor based upon a circular or oval ring, to which retractor arms are attached to once again allow 360 retraction. Over the past several years, I have found it to be the easiest to set up and use for routine cases.





These days, however, I have been making use of the Omni-Tract retractor more frequently. It is easily attached to the operating table, is easy to set up and adjust, and just plain works well. It is particularly useful in retracting the upper abdomen in large patients --- it seems to hold a bit better in my experience.

I suspect that a few very innovative, engineering-minded surgeons were behind the development of these instruments. I also suspect that they didn't make huge amounts of money from them, because once purchased, they last a long time and don't need to be replaced often. I know for a fact, however, that my arms, shoulders, and eyes are eternally grateful!