Huntington Hospital, Pasadena, CA

An Evidence-Based Time Analysis of the ReeTrakt®
An Assistant-Free, Self-Retaining, Surgical Retractor
James A. Recabaren MD, FACS
Huntington Hospital, Pasadena, CA
Abstract
Introduction:
Surgical retraction has always been an integral part of
the surgeon’s operative experience. There are a variety
of surgical retractors routinely utilized. The concept of
the “self-retaining” retraction has long caught the
attention of many surgeons. The advantage is a tireless
retraction without the need of an assistant dedicated to
this task.
Objectives:
To record the time duration of a group of defined
operative procedures using the ReeTrakt®, assistantfree, self-retaining retractor system and compare to
conventional retraction.
Participants:
A prospective, randomized trial was completed in a
community-based hospital. The time data was collected
using the operative suite records. Forty-three
consecutive Thyroid/Parathyroid, general anesthesia,
cases were evaluated.
All eligible cases were
prospectively randomized to conventional manual
retraction or ReeTrakt self-retraction. Twenty-three
patients were randomized to conventional retraction
and the remainder (nineteen patients) to ReeTrakt selfretraction. Times recorded were from time of incision
until completion of surgical closure. All times were
recorded contemporaneously upon completion of the
surgical procedure.
Results:
The mean operative time for the conventional retraction
group (n=23) was 103.2 minutes. The mean operative
time for the ReeTrakt group (n=19) was 77.1 minutes.
This represents a mean savings of 26.16 minutes. This
difference was statistically significant with a p value of
0.000 (two-sample T-test, using Minitab). The range of
times for the ReeTrakt group was numerically denser,
indicating a more reproducible result in this group.
Conclusion:
The data indicates that the ReeTrakt self-retaining
retractor is statistically more time efficient that
conventional retraction. Freeing the need for a surgical
assistant for retraction further enhances the benefit.
This translates into a temporal and economic
advantage to both the surgeon and hospital. Based on
our data, we propose the use of the ReeTrakt selfretaining retraction system as a time saver for the
surgeon and an economic savings for the institution.
k
Introduction
A surgical retractor is an instrument by which the surgeon can
actively separate the edges of a surgical incision or wound,
allowing the field under the incision to be accessed. Retractors
can also be self-retaining and not need to be held once
inserted. They function by having two or more opposing blades
or hooks, which are separated, pulling on opposite sides of a
wound.
Surgical assistance is necessary for the successful conduct of
various types of surgery that require steady retraction
throughout the procedure. Prolonged surgery can cause
fatigue for the assistant who may not be able to sustain the
optimal retraction throughout the procedure. To overcome this
problem, different types of self-retaining devices have been
developed for exposure during surgery. Thyroidectomy and
Parathyroidectomy are frequently performed, similar operations
requiring continuous exposure to perform precise dissection
and avoid damage to the vital structures associated with the
thyroid gland. The use of self-retaining retractors for Thyroid/
Parathyroid surgery has yet to gain popularity.
Figures 1-4
Results
Sticky Pad Base
3-Paw Hook Design
Retraction Strap
Fig. 1A
Fig. 1B
Conclusions
* P<0.05
Median = 102
Median = 73
Background
Our hypothesis was that self-retraining retractors are more
efficient in the conduct of a surgical procedure. It freed the
need for a surgical assistant and alleviated the concern of
assistant fatigue and frequent readjustments of conventional
retractors. Using a standardized operation, thyroidectomy and
parathyroidectomy, a trial was designed to compare the
outcomes of conventional retraction vs. ReeTrakt (Insightra
Medical, Irvine, CA, USA), low-profile, self-retaining retraction
system (Figs. 1A, 1B).
Fig. 2
Methods
A prospective, randomized trial was designed to compare the
two groups limited to the standardized operative procedure.
Forty-three consecutive patients undergoing Thyroidectomy or
Parathyroidectomy were randomized to conventional retraction
or ReeTrakt retraction. The randomization was achieved using a
smart phone application (Random Number©, R. Bell Utilities).
An odd number randomized ReeTrakt and an even number
randomized to conventional retraction. ReeTrakt retraction
utilized the ReeTrakt system composed of a self-retaining, low
profile hook or claw retractor affixed to field using surgical
adhesive. This self- retaining retractor required no assistant to
maintain. Conventional retraction was limited to Jackson, Senn
and Army- Navy standard retractors and each required a
surgical assistant to hold. All surgical procures were performed
by the same surgeon.
Times were recorded from the operating room record, listing
“incision” time and completion of closure, as the beginning
and end of the study interval. The numbers were then
statistically evaluated using the Minitab Statistical Suite.
The results of data collection fell into three main categories;
duration of procedure, deviation of the two groups and density
of data groups. The mean duration of the ReeTrakt group (n=19)
was 77.1 minutes. The mean duration of the conventional
retraction group (n=23) was 103.2 minutes. The mean difference
was 26.16 minutes. Using a two-sample T-test, the P value =
0.000 (Fig. 2). Evaluating the density of the two groups, the
ReeTrakt was denser in comparison to the conventional group
(Fig. 3). There were no surgical complications in either group.
• The ReeTrakt retraction system was statistically more time
efficient compared to conventional retraction. With more
than a twenty-six minute advantage, it significantly
shortens the duration of the procedure by approximately
25%.
• No assistant was needed for the ReeTrakt group (Fig. 4).
The enhanced access and visibility provided by the lowprofile retractor and no need for a surgical assistant
generates a significant economic impact on surgical costs.
• The total procedural minute costs are reduced by a mean
of 25%, in addition to the savings of the surgical assistant
fees.
• The ReeTrakt patients had a denser range of case duration
than the conventional retraction group. This may indicate
that the time duration for the ReeTrakt group is more
reproducible than that of conventional retraction.
• The ReeTrakt system can reduce surgical procedure
duration and the costs of appropriate surgical procedures.
• To not take advantage of this technology is negligent with
the surgeon’s time and the hospital’s reimbursement.
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Fig. 3
1
10
Fig. 4
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