Use of a Self-retaining Retractor for Minimally Invasive Approaches to the Aorta

The technique of open repair of abdominal aortic aneurysms and aorto-iliac reconstruction has changed little over the past four decades. Endovascular approaches remain under investigation but are limited by anatomical considerations and questions regarding efficacy, safety and durability have not yet been fully answered. Laparoscopic and laparoscopically assisted techniques have been investigated, used alone or in conjunction with a minilaparotomy technique. More recently successful aortic reconstructions using minilaparotomy incisions of 8–10 cm without laparoscopy have been reported. This report describes our preliminary experience with a minimally invasive approach to aortic surgery using a newly developed self-retaining retractor (Ecotracte, Advanced Surgical Concepts, Bray, County Wicklow, Ireland). The retractor (Fig. 1) is composed of two plastic rings joined by a polythene sheet. The inner ring, placed intra-abdominally, is malleable but expands firmly outwards to maintain its circular shape. As this ring is flexible, it may be introduced through a small incision with a lesser circumference. Its flexibility also allows it to be placed precisely around the field of dissection. The outer ring is a more rigid structure, which remains outside the abdominal cavity and also has the added advantage of acting as a wound protector. Once the intra-abdominal ring is in position the plastic sheet is drawn through the outer hoop and stretched backwards over its outer circumference. This draws the walls of the wound and the abdominal viscera outwards and creates an open wound with stable and wide exposure.