Identify, which of the following retractor is used in abdominal surgery?

AIIMS Delhi NO- 2019

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

The instrument shown is a Doyen retractor, identified by its wide, curved, saddle-shaped blade and fenestrated handle.
It is a handheld abdominal retractor used in various abdominal and pelvic surgeries.
Its most classic application is in Cesarean sections, where it is used to retract the urinary bladder inferiorly to protect it from injury during uterine incision.
The shape of the blade is specifically designed to cup and hold the bladder safely out of the surgical field.

Option A: Vaginal surgeries use different types of retractors, such as speculums (e.g., Auvard's weighted speculum, Sims' speculum), which are designed to open the vaginal canal. A Doyen retractor is too large and shaped for abdominal, not vaginal, retraction.
Option B: A thoracotomy involves opening the chest cavity. This requires robust instruments capable of spreading the ribs, such as a Finochietto rib spreader. A Doyen retractor lacks the strength and design for this function.
Option D: This option is incorrect because 'Cesarean section' is a valid and primary use for the Doyen retractor.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification and application of surgical instruments as background academic context rather than a clinical decision trigger.
A crucial nursing responsibility in the operating room is to anticipate the surgeon's needs and ensure the correct instruments are ready. For a Cesarean section, the scrub nurse must have the Doyen retractor available immediately after the abdominal cavity is opened to facilitate bladder protection.
Proper instrument identification is a key competency for patient safety. Handing the wrong instrument can cause delays, increase surgical time, and potentially lead to tissue damage.
What if the Doyen retractor is unavailable? The surgeon might use a malleable or a Deaver retractor as a substitute, but these may not provide the same optimal, gentle, and stable retraction of the bladder, slightly increasing the risk of injury.

How to Approach the Question

First, carefully examine the image to identify the key features of the surgical instrument. Note the wide, curved, saddle-like blade and the long handle with a hole.
Based on these features, identify the instrument. This is a Doyen retractor.
Next, recall or deduce the function of the instrument based on its design. The wide, curved blade is designed to hold back a large, soft organ without causing damage.
Evaluate the given options, which are types of surgeries. Consider in which of these procedures such retraction would be necessary.
A Cesarean section is an abdominal surgery involving an incision near the bladder. Retracting the bladder is a critical step, making the Doyen retractor a perfect fit.
Eliminate the other options. Thoracotomy requires rib spreading, and vaginal surgery uses different types of speculums. Therefore, Cesarean section is the most appropriate answer.

Concept Tested & Keywords

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E6 Gynecology Williams p. 429-437