Properitoneal mechanical retraction apparatus and methods of using

Abstract

A fan retractor has a pair of angle-shaped elements moveable relative to one another. The angle-shaped elements include first legs disposed in a generally parallel relationship, and second legs that extend laterally from the first legs, and are adapted for engaging with the abdominal wall. The second legs fan out upon rotation of the first legs relative to one another and have an effective thickness, measured in the direction defined by the first legs, that decreases distally from the first legs. The retractor also includes a lifting device that applies a lifting force to the angle-shaped elements. In variations, the second legs have a stiffness that decreases distally from the first legs; the first legs are linked so as to contrarotate relative to one another; the retractor includes a lifting force indicator; and the lifting device unidirectionally applies the lifting force to the angle-shaped elements. The fan retractor is preferably used properitoneally, that is, the second legs of the retractor are inserted between the properitoneal fat layer and the peritoneum. With this placement of the retractor, the peritoneum provides a drape over the bowel and omentum and prevents the second legs of the retractor from snagging the bowel or the omentum. The fan retractor may additionally be used conventionally with its second legs placed posteriorly relative to the peritoneum.