1904 Annals of Surgery  
Working space, light, and range of vision are important factors in producing speed, accuracy of detail, and ease of execution in operative work done deep in the abdomen and pelvis. In pelvic work, Trendelenburg posture and marsupiali¬ zation by gauze have removed many technical difficulties. The remaining obstacle, viz., the abdominal wall, at times causes very annoying interference and delay, necessitating a choice between an incomplete toilette and prolonged narcosis. The immediate and remote
more » ... mmediate and remote consequences of such defections as bleeding radicals, weeping raw surfaces, and exposed pedicles are apparent. So is the depression of all vital forces due to prolonged and profound ether narcosis. Of special moment in this connection is the decreased resistance to bacterial in¬ vasion, which occasionally determines a fatal issue. There are times during most deep operations when an open abdominal wound facilitates work. With the hope of simplifying the methods by which this may be accomplished, I have had made a self-retaining retractor which can be easily, and speedily inserted, removed, or adjusted to a nicety. It is opened or closed by an accustomed group of muscles, those used for luemostats or scissors being brought into action. To avoid intricate mechanism, these retractors are composed of only two pieces, and are made in three sizes for abdominal walls of varying thickness. The blades are not detachable, and consequently require no especial manipulations to place them. They are small, slender, curved, hug the abdomen, and keep well out of the way. They occupy much less room than the ordinary single retractor and the hand that holds it. The ratchet is like that of an artery forceps, and consequently requires no individual handling for adjustment. This instru-977
doi:10.1097/00000658-190406000-00008 pmid:17861476 fatcat:lwmitzedj5ghvmapdmrzaarhfm