Abstract
Objectives
To report on five serious intraoperative damages to nonprocedure-related organs during
10 years of experience with the Bookwalter device. Self-retaining retractors are helpful
devices, particularly during major transperitoneal and retroperitoneal operations.
Various retractors are available and allow the use of all combinations of blades to
maintain exposure during each step of an operation. Furthermore, by using these devices,
most operations can be performed by two surgeons only.
Methods
With the help of the operation protocols, more than 4000 applications of the Bookwalter
device between January 1992 and December 2001 were retrospectively reviewed. Four
cases with damage to the large bowel and one of femoral neuropathy were documented.
Results
In one transperitoneal and three retroperitoneal approaches, serious damage to the
large bowel occurred. None was recognized before postoperative days 2 and 7. One femoral
neuropathy was noted.
Conclusions
The Bookwalter self-retaining retractor is a helpful and safe device in exposing the
intraoperative situs. However, care must be taken in patients with risk factors, such
as immunosuppression and diverticulitis, and particularly in retroperitoneal operations
when tightening the blades. When the intra-abdominal cavity is not exposed, damage
to other organs may not be directly noted, which could explain the delay of several
days to the onset of symptoms.
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Article info
Publication history
Accepted:
July 8,
2002
Received:
April 30,
2002
Identification
Copyright
© 2002 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.