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

  • Philipp KraussEmail author
  • Markus Florian Oertel
  • Lennart Henning Stieglitz
Technical Note - Neurosurgical technique evaluation
Part of the following topical collections:
  1. Neurosurgical technique evaluation



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.


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.


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.


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.


Hydrocephalus Ventriculoperitoneal shunt Wound retractor Surgical technique 


ASA score

American Society of Anesthesiologists physical status classification system


Body mass index


Clavien–Dindo classification grade


Swiss franc


Cerebrospinal fluid



H. comm.

Communicating hydrocephalus


Intracerebral hemorrhage


Idiopathic normal pressure hydrocephalus




Karnofsky performance status scale




Square meter




Modified ranking scale


Normal pressure hydrocephalus




Subarachnoid hemorrhage


Traumatic brain injury






Author contributions

All authors confirm that the manuscript and the order of listed authors have been read and approved by all the named authors. L.H.S., M.F.O., and P.K. documented and analyzed the patient data, wrote the manuscript, and performed surgeries.

Compliance with ethical standards

All data and images mentioned in this manuscript were acquired from our institutions’ neurosurgical outcome quality and safety registry, based on local ethics committee approval (Kantonale Ethikkommission KEK-ZH 2012e0244). All patients signed an informed consent for the described procedures.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital of ZurichZurichSwitzerland

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