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Perception and Performance of a Novel Suction-Integrated Malleable Retractor
Benjamin E Leslie1, Ricardo J Fernández-de Thomas2, Amna Imran3
1School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Background And Objective:
The narrow operative corridors inherent to neurosurgery are easily filled with fluid and limit the number of instruments which can be used simultaneously. This study evaluates the perceived benefit, performance, and likelihood of adoption of a novel suction-integrated retraction device.
Methods:
Resin printing was used to produce a suction-integrated malleable retractor prototype. An artificial blood substitute was pumped into a simulated surgical field. Neurosurgery trainees and attendings (n = 19) participated in 2 trials in which they were tasked with completing 5 simple interrupted sutures per trial. In one trial, surgeons used independent suction and retraction instruments; in the second trial, surgeons used the prototype device. Participants were surveyed on the ease-of-use of the device, likelihood of device adoption, and perceived potential for improving outcomes. In addition, the prototype's feasibility in providing adequate exposure was evaluated across an anterior cervical discectomy and fusion, a conventional, open lumbar laminectomy, and a posterior interhemispheric dissection approach within a cadaveric model. Retraction adequacy was evaluated based on the total exposure area.
Results:
In the simulated surgical field evaluation, the prototype device elicited a test time 53.5 ± 34.1 second [95% CI 37.0-69.9, P = .002] faster than the control. Thirteen participants rated the device as "certain" they would adopt, with 10 also stating they were "certain to recommend" to a colleague. Seventeen participants described the device as "very" or "extremely useful" in improving outcomes. The surgical field exposure evaluation showed a 3.91 cm2 ± 1.16 [95% CI 1.03-6.79, P = .249] difference in exposure area between the prototype and bladed retractor.
Conclusion:
Users appeared eager to adopt and recommend the device due to its perceived potential to improve outcomes. This prototype provides noninferior retraction and exposure in common approaches within a cadaveric model.
