Retraction mechanics of Finochietto-style self-retaining thoracic retractors

Abstract

Objectives Analyze the mechanics of Finochietto-style retractors, including the responses of thoracic tissues during thoracotomy, with an emphasis on tissue trauma and means for its reduction. Methods Mechanical analyses of the retractor were performed, including analysis of deformation under load and kinematics of the crank mechanism. Thoracotomies in a porcine model were performed in anesthetized animals (7) and fresh cadavers (17) using an instrumented retractor. Results Mechanical analyses revealed that arm motion is a non-linear function of handle rotation, that deformation of the retractor under load concentrates force at one edge of the retractor blade, and that the retractor behaves like a spring, deforming under the load of retraction and continuing to force open the incision long after crank rotation stops. Experimental thoracotomies included retractions ranging from 50 to 112 mm over 30 to 370 s, generating maximum forces of 118 to 470 N (12–50 kgf). Tissue ruptures occurred in 12 of the 24 retractions. These ruptures all occurred at retraction distances wider than 30 mm and at forces greater than 122.5 N. Significant tissue ruptures were observed for nearly all retractions at higher retraction rates (exceeding ½ rotation of the crank per 10 s). Conclusions The Finochietto-style retractor can generate large forces and some aspects of its design increase the probability of tissue trauma.

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

“…Surgeons at our center have also tried to conduct E-NSM using retractors to raise the pectoralis major muscle, gland, and skin. However, as in some reports, complications are increased due to uneven stress and unclear dissection layers, and the operation time is very long ( 9 , 10 ). Through the sum of our experience, our team proposed an innovative technique that involves a changed dissection sequence and incorporates air-insufflation for submuscular space and gland dissection; the technique is named “reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM).” Our previous studies have demonstrated that R-E-NSM could create sufficient space, improve dissection access, and avoid interference of instruments.…”