Development of novel thoracic retractor for resuscitative thoracotomy
Abstract Background Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the procedure. Despite its urgency, RT is still conducted using traditional thoracic retract...
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| Format: | Article |
| Language: | English |
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BMC
2025-06-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01423-1 |
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| author | Shoichiro Urabe Junya Shimazaki Tomohisa Izutani Tsuyoshi Hata Mamoru Uemura Hidetoshi Eguchi Yuichiro Doki Kiyokazu Nakajima |
| author_facet | Shoichiro Urabe Junya Shimazaki Tomohisa Izutani Tsuyoshi Hata Mamoru Uemura Hidetoshi Eguchi Yuichiro Doki Kiyokazu Nakajima |
| author_sort | Shoichiro Urabe |
| collection | DOAJ |
| description | Abstract Background Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the procedure. Despite its urgency, RT is still conducted using traditional thoracic retractors originally designed for scheduled surgeries, which pose challenges in emergency settings. To address these limitations, we developed a novel thoracic retractor optimized for RT and evaluated its performance compared to a conventional model. Methods The novel retractor was designed with an arrow-shaped hook for improved intercostal insertion and a continuously rotatable handle to enhance procedural efficiency. A comparative study using excised porcine thoraxes was conducted to assess its performance. Six cm incisions were made in the intercostal spaces bilaterally before retractor insertion. Evaluators inserted the device, performed three handle rotations, and repeated the procedure using the other retractor on the contralateral side. The primary outcome was the time required for three rotations, while secondary outcomes included ease of insertion, ease of rotation, and hook stability, rated on a 6-point scale by evaluators. Results Ten surgeons (n = 10) performed thoracotomy using both the novel and conventional retractors. Comparison of the time required for three handle rotations between the novel and conventional retractors demonstrated a statistically significant reduction with the novel retractor. The median time to complete three rotations was 16.0 [11.7–19.1] seconds with the novel retractor, compared to 7.0 [5.3–8.5] seconds with the conventional model (P < 0.01). The ease of insertion was rated significantly higher with the novel retractor compared to the conventional model (6.0 [5.5–6.0] vs. 2.5 [2.0–3.0], P < 0.01). The ease of rotation was also rated significantly higher with the novel retractor than with the conventional model (5.5 [5.0–6.0] vs. 2.5 [1.0–3.5], P < 0.01). In the evaluation of the hook stability, no significant difference was observed between the novel and conventional retractors (P = 1.0). Conclusions The novel thoracic retractor enables faster and easier thoracotomy compared to conventional model. Given the strong association between time and RT prognosis, this device is well-suited for RT procedures requiring rapid execution. |
| format | Article |
| id | doaj-art-299f6b68d21145b2921232ab6b884709 |
| institution | OA Journals |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-299f6b68d21145b2921232ab6b8847092025-08-20T02:37:35ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-06-013311710.1186/s13049-025-01423-1Development of novel thoracic retractor for resuscitative thoracotomyShoichiro Urabe0Junya Shimazaki1Tomohisa Izutani2Tsuyoshi Hata3Mamoru Uemura4Hidetoshi Eguchi5Yuichiro Doki6Kiyokazu Nakajima7Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka UniversityDepartment of Emergency and Critical Care Medicine, Kansai Medical UniversityKajitech Medical Co., LtdDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Gastroenterological Surgery, Graduate School of Medicine, Osaka UniversityDepartment of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka UniversityAbstract Background Resuscitative thoracotomy (RT) is a critical intervention for patients in traumatic cardiac arrest or hemorrhagic shock, where survival is highly dependent on the time required to perform the procedure. Despite its urgency, RT is still conducted using traditional thoracic retractors originally designed for scheduled surgeries, which pose challenges in emergency settings. To address these limitations, we developed a novel thoracic retractor optimized for RT and evaluated its performance compared to a conventional model. Methods The novel retractor was designed with an arrow-shaped hook for improved intercostal insertion and a continuously rotatable handle to enhance procedural efficiency. A comparative study using excised porcine thoraxes was conducted to assess its performance. Six cm incisions were made in the intercostal spaces bilaterally before retractor insertion. Evaluators inserted the device, performed three handle rotations, and repeated the procedure using the other retractor on the contralateral side. The primary outcome was the time required for three rotations, while secondary outcomes included ease of insertion, ease of rotation, and hook stability, rated on a 6-point scale by evaluators. Results Ten surgeons (n = 10) performed thoracotomy using both the novel and conventional retractors. Comparison of the time required for three handle rotations between the novel and conventional retractors demonstrated a statistically significant reduction with the novel retractor. The median time to complete three rotations was 16.0 [11.7–19.1] seconds with the novel retractor, compared to 7.0 [5.3–8.5] seconds with the conventional model (P < 0.01). The ease of insertion was rated significantly higher with the novel retractor compared to the conventional model (6.0 [5.5–6.0] vs. 2.5 [2.0–3.0], P < 0.01). The ease of rotation was also rated significantly higher with the novel retractor than with the conventional model (5.5 [5.0–6.0] vs. 2.5 [1.0–3.5], P < 0.01). In the evaluation of the hook stability, no significant difference was observed between the novel and conventional retractors (P = 1.0). Conclusions The novel thoracic retractor enables faster and easier thoracotomy compared to conventional model. Given the strong association between time and RT prognosis, this device is well-suited for RT procedures requiring rapid execution.https://doi.org/10.1186/s13049-025-01423-1Thoracic retractorRib retractorRib spreaderResuscitative thoracotomyResuscitationThoracotomy |
| spellingShingle | Shoichiro Urabe Junya Shimazaki Tomohisa Izutani Tsuyoshi Hata Mamoru Uemura Hidetoshi Eguchi Yuichiro Doki Kiyokazu Nakajima Development of novel thoracic retractor for resuscitative thoracotomy Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Thoracic retractor Rib retractor Rib spreader Resuscitative thoracotomy Resuscitation Thoracotomy |
| title | Development of novel thoracic retractor for resuscitative thoracotomy |
| title_full | Development of novel thoracic retractor for resuscitative thoracotomy |
| title_fullStr | Development of novel thoracic retractor for resuscitative thoracotomy |
| title_full_unstemmed | Development of novel thoracic retractor for resuscitative thoracotomy |
| title_short | Development of novel thoracic retractor for resuscitative thoracotomy |
| title_sort | development of novel thoracic retractor for resuscitative thoracotomy |
| topic | Thoracic retractor Rib retractor Rib spreader Resuscitative thoracotomy Resuscitation Thoracotomy |
| url | https://doi.org/10.1186/s13049-025-01423-1 |
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