title: The use of a new kind of low profile retractor for arteriovenous fistula procedure simplifies and speeds up the intervention.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the effectiveness of a new kind of disposable surgical retractor in arteriovenous fistula (AVF) procedures in order to achieve an easier, faster and safer surgical intervention.
  
  
  METHODS
  Between January and June 2008, 22 AVF procedures were performed using the 3PAWS ReeTrakt (Insightra Inc. - Irvine, Ca., USA) a self-retaining, low profile retractor. An equivalent patient sample, in which an AVF was performed using conventional retraction devices, was considered for comparison of the intra- and post-operative results.
  
  
  RESULTS
  In all of the 22 AVF procedures performed, the ReeTrakt system has simplified the performance of the surgical team. The retractors were very easy to place. The view of the operating field was always optimal. The introduction of the surgical instruments was at all times extremely easy and unrestricted. We also noted a reduction in the operating time (from an average of 67 min in controls to 43 min). There were no intra-operative complications. No post-operative complications related to the use of this kind of device occurred. Conversely, the amount of intra- and post-operative complications in the control group managed with conventional retraction devices was marginally higher than in the ReeTrakt patient group.
  
  
  CONCLUSIONS
  The ReeTrakt system is a very simple and useful low profile retractor for AVF procedures. Its ultra low profile allows a much improved view of the operating field, an unhindered insertion of the surgical instruments and a shortening of intervention time, avoiding the problems which arise as a result of standard retractors typically used during this kind of procedure. Due to absolute perpendicular retraction it offers a highly atraumatic performance, avoiding swelling and marks on the insertion sites. Therefore, in our opinion, it has the potential to reduce the risk of wound oedema, hematomas or infection associated with the AVF procedure. This is important as many patients are elderly with fragile tissues.
authors.affiliation: Department of General Surgery, Urgency, and Organ Transplantation, University of Palermo, Italy. giusamato1@tele2.it
authors.forename: A I
authors.initials: AI
authors.lastname: Lo Monte
authors.forename: G
authors.initials: G
authors.lastname: Amato
authors.forename: G
authors.initials: G
authors.lastname: Damiano
authors.forename: M C
authors.initials: MC
authors.lastname: Gioviale
authors.forename: C
authors.initials: C
authors.lastname: Lombardo
authors.forename: G
authors.initials: G
authors.lastname: Romano
authors.forename: M
authors.initials: M
authors.lastname: Romano