Self - assistant Hook / retractor In Surgery

In surgery every surgeon needs to be completely seeing the place of pathology and this matter will certain with help of hook/retractor and assistant(s). But when mass of person(s) (assistants) are many, it effects on surgeon and quality of surgery during of surgery and after that, but when surgeon does operation him/herself, surgeon can more control on surgery, does carefully and with accuracy of surgery or if the surgeon does not have access to any assistant(s), surgeon can do operation him/herself. In this case surgeons use patients that need to operation in osteosurgery (for instance: osteosynthesis) and inner places (for instance: gastrosurgery) or remove of tumors, cysts and…. For treatment of these patients’ surgeons use new method of surgery for hold of muscles and bones for surgeon to operate patients; And this article is about apparat that called, Self-assistant hook/ retractor in surgery, that helps to surgeons to operate patients in every places, positions and any part of body that needs to operate, without interference of any assistants. Therefore, the aim of this study is to use of self-assistant hook/retractor in surgery can be useful for surgeon that does every operation(s) him/herself in any part of body with confidence, calm and concentration.
Keywords: Hook, Retractor, Assistants, Self-assistant, Surgery


A hook (official alternate term in Latin: hamulus) is an instrument usually metal curved or bent near its tip, used for suspending, catching, holding, pulling something or fixation of a part or traction[1 , 3].


The small medical instruments make it possible for the surgeon to grasp and separate small tissues like nerves and ligatures, and grip small muscles, among many other tasks and it is called a surgical hook or surgery hook and they have

different hook ends and hook sizes so surgeons and patients can choose the ones that are most likely to streamline procedures and improve precision. The design of most surgery hooks are small instruments with a straight or curved shaft and a hook at the end. The hooks made plans for grasping, moving, and sometimes removing, various types of tissues or objects[2].


In medicine a retractor (or in some cases called hook) or other form of it is hook, is a surgical instrument used to separate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts under the incision may be accessed[4]. The retractors play a decisive role in surgery and they come in different sizes, shapes and designs[6]; And their various designs are used to hold an incision open, hold back tissues or other objects to maintain a clear surgical field, or each other structures and they also have the feature hand-held or self-retaining through a ratcheting mechanism[7].


Benefits of surgical retractors for surgeons and operating room are professionals hold an incision or wound open during surgical procedures and move of holding back underlying organs or tissues, allowing doctors/nurses better visibility and access to the exposed area[6].


For seeing the surgical cavity where it is needed, surgeon must choose the right retractor that will bring comfort and light directly into the surgical cavity. For a physician, surgical rotation can be severe on his/her arms and for a patient that wants the best care[6].


If persons have specifically Certified Surgical Assistants, Registered Nurse First Assistants, Physicians Assistants, or Surgical Technologists, may assist surgeons in the process of retraction that called Surgical assistants[5].


As specified, surgeons must have assistant(s) to do operations, because one or many person(s) (assistants) during surgery must hold hooks/retractors to open operation place for surgeon that can see the sightly place; And after that surgeon can operate patients.


In new method for use of retractor/hook in operations with this mass of person(s) (assistants), surgeons can embrace the self-assistant hook/retractor in surgery (Fig 1).

The self-assistant hook/retractor in surgery is a device that helps doctors in surgery do any kinds of operations without any assistant in surgery room.


Surgeons can use this device in every place that want, if haven’t any helper (assistant) to help them for operations and the self-assistant hook/retractor is effective apparat for help to treat patients.


The basis of this apparat is stretch (expand) and constrict (condense) or in another word is opened and closed the place that surgeons must operate that place; For example: Head, Neck, Upper limb (Arms, Forearms, Hand), Trunk (Thorax, Abdomen, Pelvis) and Back. And, Lower limb (Thigh, Leg, Foot).


And surgeon can use it in viscera in upper and lower limbs (inner places in the body) for any types of operations.
The self-assistant hook/retractor in surgery can carry in every places, without any problem and uses it immediately and easy implement to use for operations and portable.


Methods
After that surgeon cutted the place that wanted to operate and needed to open the place for instance for osteosurgery (osteosynthesis), remove of soft tissues (cyst, swelling, tumor,…), surgery of different organs (liver, spleen, stomach, gut,…) in any parts of body could use this apparat. Surgeon must disinfect the place of surgery with neutral spirits and must anesthetize the surgical site with help of anesthetics and after that surgeon must incised skin with scalpel[7 , 8], and then with help of Mosquito forceps[7 , 8] cutted cutaneous and subcutaneous fats, muscles, fascias (fasciae), and revealed nerves and vessels without cutted through them and when indicated for example, bones for surgery or viscera organs (liver, spleen, stomach, gut,…) to surgery or cyst, swelling or tumor, for surgery or remove them, we could use self-assistant hook/retractor to open and hold the place for surgery without any assistant to hold hooks or retractors.

Structure
The construction of this apparat is stainless, light, portable steel (metal). And size of this apparat is variable, it means that you own selves can change the size of apparat, according to measure and size of operation place, because the self-assistant hook/retractor in surgery (Fig 1) has property (feature) of lap ability. The design of this device is basis on 6D movements (Up, Down, Right, Left, Front, Back).


Results
The form of self-assistant hook/retractor was like ring (Fig 1) that changed itself to form and measure, according to form (e.g. oval, round, triangle, rectangular,… or just direct line) and measure (e.g. small, average or big) of place of operation and apparent of patient’s body, like: slim, average or fat body that surgeon cutted it and can use in every position of body’s patient that put on surgical bed. This apparat had lap ability that surgeon could change the measure of place operation, even when surgeon (had been) operating the patient. The surgeon regulated the wide side (section) of apparat by pushed to outward or pulled it to inside in order to set it up to lock this apparat from lateral or wide side (section) to muscle that surgeon want ed to operate and hold ed it. And with help of holders’ bone holding forceps/clamps (Fig 2, 3), they had the ability to be movable (mobile) and surgeon could rotate and regulate them in different angles to operate patient easier and fast. In addition, the surgeon could move the apparat to four different directions such as up, down, left, and right in order to see the place of operation. Lap ability body of device enabled a surgeon to screw in one side that embedded on self-assistant hook/retractor for up and down device (Fig 2, 3) and another screw in other side that embedded of apparat for left and right movement (Fig 2, 3) of self-assistant hook/retractor.
After surgery for had been released of self-assistant hook/retractor (Fig 1) from muscles, surgeon must unscrew (loosen) screws of up, down and left, right screws (Fig 2, 3) to unfix them from muscles and after that pressured to clamp/spine to unlock apparat from muscles totally.

Discussion
The self-assistant hook/retractor in surgery (Fig 1) could evaluated to help surgeons in everywhere and every time that they have wanted to operate patients and any kind of operations without assistant or it was not even in assistant that could help surgeon in operation. This device could use into easy, portable, light, sterilized, and surgeon could change the measure of this device whatever the surgeon has liked.
In this section, you can see the design of self-assistant hook/retractor, its parts and different types of use in various positions (situations) with figures.

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Master's student

Younesijadidi Amirhossein