Surgeons and Their Tools: A History of Surgical Instruments and their Innovators. Part III: The Medical Student's Best Friend-Retractors

摘要

This is the third of five manuscripts reviewing the historical origins of some of the more commonly used surgical instruments and takes ‘‘time out’’ to remind current surgeons about the surgical pioneers on whose shoulders they now stand and whose inventions they now use. Retraction IS the element of surgery that allows for deeper exploration of tissues by opening and exposing a large wound or deep space. Some historians believe that surgical retractors were heavily influenced by hooked tools used as early trenching implements to extract food from the bedrock during the late Old Stone Age.1 Examples of these early tools include reindeer antlers and wood branches. During the Renaissance, retractors were lacking and the hooked fingers of surgeons or assistants supplied the necessary retraction for deep wound exploration and much to the chagrin of medical students and residents, this procedure is still commonly used in many modern operating rooms. Fortunately, the development of metal surgical hooks, handheld retractors, and self-retaining retractors occurred, which has freed up and extended the surgeons' hands. Albucasis, the Muslim surgeon and author of Al-Tasrif surgical textbook, is credited with devising numerous hooks for surgical retraction, which were characterized by a terminal bend that rotated at least 135°. His inventions included sharp and blunt single-, double-, and triple-ended hooks of varying sizes. These sharp hooks were initially developed for accurately securing specific tissues or organs with minimal trauma and were used for dissection, excisions, eye operations, or for isolating bleeding vessels for liga-tion. These more primitive instruments later gave rise to the 19th century tenaculum. Albucasis used his arsenal of hooks in various surgical procedures including circumcisions, tracheotomies, hemorrhoidectomies, and dental extractions. Blunt hooks were used for isolation and dissection of major nerves and blood vessels, deep retraction, and retraction of skin and wound edges where sharper hooks posed a traumatic risk. Albucasis also developed a three-ended eyelid hook for eye surgery as well as large single blunt hooks for obstetrics and fetal extraction.