Abstract
Orthopaedic joint replacement surgery requires surgical assistants holding retractors in order to adequately visualise the operative field. Typically, total hip and knee replacement operations require at least one surgical assistant and preferably two. As such, tremendous resources are consumed in order to perform elective TJA.
A mechanised pulley system, called the Gripper (Medenvision, Belgium), has been devised to assist with this need for extra “hands” to hold retractors. The Gripper is a table mounted, disposable device used to hold retractors, and is infinitely adjustable with regard to position in space. As such, it can be used in a variety of situations to provide an additional retractor holder, without the need for extra manpower. It is sterile, in the operative field, and can fit retractors with a flat handle. With positioning of the table mounts before prepping and draping, the Gripper can be used during the operation to hold retractors that would otherwise require a surgical assistant. The Gripper can be moved around during different portions of the operation in order to make the most of it use.
In our experience, the Gripper has been most useful in direct anterior approach THA, holding a curved anterior retractor to facilitate acetabular exposure. It is also useful in holding a retractor placed over the tip of the greater trochanter during femoral preparation. In our estimation, it is able to replace a human surgical assistant at a fraction of the cost. Furthermore, the Gripper does not fatigue during the operation and does not compromise the surgical field by needing to adjust its handhold. Because of this, even in an academic center with residents, fellows, and visiting medical students, the Gripper is preferable to human hands holding retractors.
We estimate that a surgical assistant with a starting level salary would have to scrub in on over 300 cases per year in order to make him/herself more cost effective than the Gripper.
