Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center
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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.
KeywordsHydrocephalus Ventriculoperitoneal shunt Wound retractor Surgical technique
- ASA score
American Society of Anesthesiologists physical status classification system
Body mass index
Clavien–Dindo classification grade
- H. comm.
Idiopathic normal pressure hydrocephalus
Karnofsky performance status scale
Modified ranking scale
Normal pressure hydrocephalus
Traumatic brain injury
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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