hard time retracting during surgery!

[Mkitties]

hey guys i am having a really hard time retracting while in surgery...i guess i just dont have enough upper body strength to do it? has anyone else experienced this? what can i do to improve??
and im talking more about lifting/retracting muscles superiorly, not retracting horizontally where i can lean back and use my body weight.

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[Rendar5]

More torque?

 

[Richie Truxillo]

Learn to retract using your body weight rather than your forearms, this will save you alot of fatigue. You can also use your elbow as a fulcrum if you are retracting superiorly. And never be afraid to ask for the stool if you need it to get a better vantage point.

Otherwise, retracting superiorly stinks. Just gotta hang in there

 

[yohimbine1]

Work out delts and traps more?

 

[toothless rufus]

I just cannot fathom how both physically and mentally one can hold a retractor for even 1 hour, let alone 8+!! That's a incredibly looooong time! I don't think its possible for me to do that. Do you get to take a quick break? How many surgeries where you just watch?

 

[Law2Doc]

I just cannot fathom how both physically and mentally one can hold a retractor for even 1 hour, let alone 8+!! That's a incredibly looooong time! I don't think its possible for me to do that. Do you get to take a quick break? How many surgeries where you just watch?

You won't be holding the same retractor in the same place for 8 hours, but you may go over one hour for sure. You will be holding it for a time, then the surgeon will move your instrument a few inches to the right and you hold it again for a time, then he will swap your retractor for a longer one and you hold that one, and so on. The hardest parts tend not to be the holding as much as the contorted position you may have to be in to give the surgeon room to work without your shoulder obstructing his arm movements. So you may be leaning in from the side, and not really able to see where the toe of the retractor is. And folks keep pushing against the retractor with the instruments they are using, causing it to gradually slip out and then you get yelled at for not holding it still (even though you can't really see that it moved because you are off to the side. You will have a number of surgeries where you just watch, but they tend to be the ones that you are watching because there is no room for you to be at the table, and so as a consequence you can't really see. And watching without seeing is a bit frustrating, but you still have to seem interested if you want to make a good impression. So your goal is generally to be involved in the surgery because then you can sometimes actually see, and then often get to do other stuff if you do a good job with the retractor (cutting sutures, throwing stitches, suctioning, irrigating, using the electrocautery... the fun never stops ).

In my experience surgery is harder on the feet and the bladder than the arms. Get good shoes and never pass a bathroom.

 

[toothless rufus]

You won't be holding the same retractor in the same place for 8 hours, but you may go over one hour for sure. You will be holding it for a time, then the surgeon will move your instrument a few inches to the right and you hold it again for a time, then he will swap your retractor for a longer one and you hold that one, and so on. The hardest parts tend not to be the holding as much as the contorted position you may have to be in to give the surgeon room to work without your shoulder obstructing his arm movements. So you may be leaning in from the side, and not really able to see where the toe of the retractor is. And folks keep pushing against the retractor with the instruments they are using, causing it to gradually slip out and then you get yelled at for not holding it still (even though you can't really see that it moved because you are off to the side. You will have a number of surgeries where you just watch, but they tend to be the ones that you are watching because there is no room for you to be at the table, and so as a consequence you can't really see. And watching without seeing is a bit frustrating, but you still have to seem interested if you want to make a good impression. So your goal is generally to be involved in the surgery because then you can sometimes actually see, and then often get to do other stuff if you do a good job with the retractor (cutting sutures, throwing stitches, suctioning, irrigating, using the electrocautery... the fun never stops ).

In my experience surgery is harder on the feet and the bladder than the arms. Get good shoes and never pass a bathroom.

Thanks. This doesn't seem excessively awful. Knowing a little about what to expect helps.

 

[surrender903]

using just your upper body strength is going to lead you to sore arms and long days. try to lean against the table and involve your hips/obliques more in the process. i also shuffled my weight between feet and that helped as well.

i only got lightheaded once and that was because i didnt eat a breakfast that morning. i told my resident, scrubbed out and got something to eat quickly before the next case.

 

[pincheeric]

The key to retracting for a long time is to know when to retract and when to relax. Pay attention to the surgical field. When the surgeon is actively doing something that is HELPED by your retracting then put all of your strength into it. Many times the surgeon will place the retractor and put it in your hands and then forget you have it. You'll be holding it long after it's useful. When that happens, DON'T take it out of its position because you could get yelled at but you don't have to keep pulling back with so much strength. Also, when you see that the surgeon asks for a different instrument or pauses to talk or something like that, take that time to relax. Bottom line is that putting effort into retracting when it isn't improving the field is wasting your strength. And don't be afraid to switch arms!

 

[Pioneer Village]

Actually, I have something totally different to suggest. The key to retracting ISN'T strength. As an attending at my institution put it: "You really don't ever need to pull hard on it." It's about gentle traction at the appropriate angle. Get a good view of what's going on (the key), and determine whether it's a horizontal pull or more of a shoe-up method that's needed.

I never pull on a retractor any harder than I pull on the refrigerator door to open it. You really aren't supposed to.