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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A new table-fixed retractor.Surg Clin North Am. 1980; 60: 399-405
- Femoral neuropathy secondary to the use of a self-retaining retractor.Dis Colon Rectum. 1995; 38: 1115-1118
- Optimal exposure for hepatobiliary operations using the Bookwalter self-retaining retractor.Am Surg. 1995; 61: 178-181
- Femoral mononeuropathy after radical prostatectomy.Urology. 1990; 36: 539-540
- Intestinal ischemia complicating abdominal aortic surgery.Surgery. 1991; 109: 447-454
- Lower extremity iatrogenic nerve injury due to compression during intraabdominal surgery.Am J Surg. 1997; 173: 504-508
- Postoperative femoral neuropathy.Surgery. 1992; 174: 255-263
- Femoral nerve palsy caused by a self-retaining polyretractor during major pelvic surgery.Urol Int. 2002; 68: 66-68
- Femoral neuropathy subsequent to abdominal hysterectomy.Eur J Obstet Gynecol Reprod Biol. 1985; 20: 385-392
- Colonic perforations after renal transplantation.J Am Coll Surg. 1997; 184: 63-69
- Early posttrans-plant colon perforation.Transplant Proc. 1991; 23: 1782-1784
- Colon perforation after renal transplantation.Clin Transplant. 1997; 11: 88-93
- Gastrointestinal complications in renal transplantation.Transplant Int. 1993; 6: 45-49
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.
