Use of Alexis retractor in thyroid and parathyroid surgery

Double-Wound O-Ring Retraction for Chylothorax Surgery in Dogs

A suitable wound retraction is crucial for open surgical treatment of chylothorax in dogs. A single paracostal approach for transabdominal/transdiaphragmatic thoracic duct ligation and cisterna chyli ablation is an effective procedure. For the procedure, the use of stay sutures and handheld or automatic soft tissue retractors is recommended. However, it is often necessary to adjust the retractors several times during the surgery to provide sufficient exposure of the thoracic duct. This prolongs the operation and increases infection risk. In this report, we describe the modified application of two o-ring elastic wound retractors (O-WRs) in three large breed dogs with idiopathic chylothorax. We conclude that the O-WRs provide a static circumferential vision of the operation field and good access to the cisterna chyli, especially to the thoracic duct. The usage of other surgical instruments is not hampered by the O-WRs, and the elastic rings are not damaged by the metal instruments. Once placed in the diaphragmatic area, indeed, they do not require further manual retraction.

Considerations for environmentally sustainable head and neck surgical oncology practice

OBJECTIVE

To evaluate the potential role of head and neck oncologic surgeons in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future.

REVIEW METHODS

This literature review searched for relevant literature about the relevance of waste in surgical head and neck oncology practice and the innovative alternatives to decrease its effect on environment.

CONCLUSIONS

Head and neck oncologic surgeons have a role in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future. However, there exist only limited data on waste management and other procedures in surgical oncology to promote these practices.

IMPLICATIONS FOR PRACTICE

By increasing awareness of the corresponding issues of waste production within the healthcare environment, head and neck surgeons can have a pioneering role in considering how to reduce, recycle and reuse in a more efficient manner. As research in this field accumulates, healthcare providers can engage both managers and clinicians in this process. It remains imperative to provide these professionals opportunities for their work force to rethink current practices in a manner that prioritizes environmentally sustainable head and neck surgical practices.

Alexis Retractor: Institutional Experience of Its Applications in Head and Neck Surgery and Review of the Literature

BACKGROUND

The Alexis retractor is a device that provides simultaneous radial retraction and wound protection during surgical procedures. Although typically used in abdominal and pelvic surgeries, there has been increased development of novel operative techniques utilizing the Alexis retractors in head and neck surgeries.

METHODS

We describe 2 cases of utilizing the Alexis retractor to attain transoral exposure in the setting of free flap reconstruction of intraoral defects.

RESULTS

In both cases, the Alexis retractor provided improved retraction, decreasing the number of instruments required for adequate exposure. Additionally, the polyurethane sheath component acted as a protective membrane over the lips and mucosa.

CONCLUSIONS

The Alexis retractor can be a powerful retraction tool for certain surgical procedures involving the head and neck regions.