A Simple and Cost-Effective Retractor for Transorbital Neurosurgery: Technical Note and Application in Lacrimal...

Area of Science:

• Neurosurgery
• Surgical Instrumentation
• Minimally Invasive Surgery

Background:

• Transorbital approaches (TOAs) enable minimally invasive access to cranial fossa lesions.
• Orbital retraction in TOAs is challenging due to narrow corridors and risks of complications.
• Conventional retractors can obstruct surgical corridors and cause uneven tissue pressure.

Purpose of the Study:

• To introduce a handmade, semi-rigid plastic retractor for optimized orbital retraction in TOAs.
• To evaluate the safety, efficacy, and advantages of this novel retractor in keyhole surgery.

Main Methods:

• A semi-rigid retractor was fashioned from a plastic drill bit container.
• Its application was demonstrated in the transorbital eyebrow lacrimal keyhole approach (TELKA).
• Anatomical dissections, operative videos, and clinical case reviews supported the technical description.

Main Results:

• The retractor provided stable, low-intensity retraction with even pressure distribution in thirteen TELKA procedures.
• It minimized corridor obstruction, facilitating both microscopic and endoscopic maneuverability.
• No orbital or visual complications, proptosis, or aesthetic defects were observed postoperatively.

Conclusions:

• The handmade, semi-rigid retractor is a safe, customizable, and reproducible tool for TOAs.
• It enhances surgical freedom and minimizes orbital morbidity, especially in keyhole procedures like TELKA.
• This retractor presents a promising alternative to conventional retraction systems.