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. 2025 Jun 17;33(1):106.
doi: 10.1186/s13049-025-01423-1.

Development of novel thoracic retractor for resuscitative thoracotomy

Shoichiro Urabe  1   2 , Junya Shimazaki  3 , Tomohisa Izutani  4 , Tsuyoshi Hata  2 , Mamoru Uemura  2 , Hidetoshi Eguchi  2 , Yuichiro Doki  2 , Kiyokazu Nakajima  5   6
Affiliations

Development of novel thoracic retractor for resuscitative thoracotomy

Shoichiro Urabe et al. Scand J Trauma Resusc Emerg Med. .

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.

Keywords: Resuscitation; Resuscitative thoracotomy; Rib retractor; Rib spreader; Thoracic retractor; Thoracotomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Animal Care and Use Committee of IVTeC Co. Ltd. (Animal Welfare Committee, approval number: IVT 23 − 15). All animal procedures were conducted in accordance with the American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals (2020). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Development of the New Thoracic Retractor. A, Conventional finochietto retractor. B, Design of the new retractor. C, Arrow-shaped hook. D, Rotatable handle. E, Gear guard
Fig. 2
Fig. 2
Handle Rotation Time Trial. A, Before rotation. B, After three rotations
Fig. 3
Fig. 3
Result of Rotation Time
Fig. 4
Fig. 4
Evaluations of Functional Performance. A, Ease of Insertion. B, Ease of rotation. C, Hook stability
See this image and copyright information in PMC

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