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

  • Technical Note - Neurosurgical technique evaluation
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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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Abbreviations

ASA score:

American Society of Anesthesiologists physical status classification system

BMI:

Body mass index

CDG:

Clavien–Dindo classification grade

CHF:

Swiss franc

CSF:

Cerebrospinal fluid

f:

Female

H. comm.:

Communicating hydrocephalus

ICH:

Intracerebral hemorrhage

iNPH:

Idiopathic normal pressure hydrocephalus

kg:

Kilogram

KPS:

Karnofsky performance status scale

m:

Male

m2 :

Square meter

min:

Minute

mRS:

Modified ranking scale

NPH:

Normal pressure hydrocephalus

OP:

Operation

SAH:

Subarachnoid hemorrhage

TBI:

Traumatic brain injury

VP:

Ventriculoperitoneal

y:

Years

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Philipp Krauss, Markus Florian Oertel & Lennart Henning Stieglitz

Authors
  1. Philipp Krauss
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  2. Markus Florian Oertel
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  3. Lennart Henning Stieglitz
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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.

Corresponding author

Correspondence to Philipp Krauss.

Ethics declarations

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.

Additional information

Comments

The authors present what seems to be an easy-to-use self-holding retractor visualization of the abdominal wall/peritoneum in shunt surgery. This device has already been used in several surgical procedures, but so far not in neurosurgery.

Knut Wester

Oslo, Norway

This article is part of the Topical Collection on Neurosurgical technique evaluation

HIGHLIGHTS

• Safe and easy visualization of the abdominal catheter insertion zone for VP-shunting.

• Optimizing minimal invasive exposure in obese VP-shunt patients.

• Facilitating single-surgeon shunt implantation

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Krauss, P., Oertel, M.F. & Stieglitz, L.H. Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center. Acta Neurochir 161, 1361–1365 (2019). https://doi.org/10.1007/s00701-018-03794-0

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  • DOI: https://doi.org/10.1007/s00701-018-03794-0

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