• Yosuke Moteki, Yoshikazu Okada, Tatsuya Inoue, Shinsuke Sato, Kentaro Kuwamoto, Shogo Shima, and Yasunari Niimi.
• Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan; Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan. Electronic address: yomoteki@luke.ac.jp.
• World Neurosurg. 2018 Jan 1; 109: 110-114.

ObjectiveWe report the availability of a newly developed, malleable, tin-alloyed omnidirectional retractor-supporting (OD) ring for steady and safe ventriculoperitoneal (VP) shunt laparotomy.MethodsThe OD ring is principally circular in shape, 15 cm in diameter, and is sufficiently malleable to be fitted to the abdominal wall. There are 22 outward protrusions 12 mm in length that are welded to the outside of the ring at regular intervals. The OD ring with twisted rubber bands attached around the protrusions is placed on the abdominal wall surrounding the skin incision. Then the edge is omnidirectionally retracted with blunt minihooks attached to the rubber bands. In our hospital from January 2016 to February 2017, 15 consecutive patients underwent a VP shunt procedure using the OD ring.ResultsIn a VP shunt procedure, our malleable, tin-alloyed OD ring could be smoothly placed on various types of abdominal walls. Moreover, our OD ring system provided a wider and shallower operative field allowing omnidirectional retraction during small laparotomy. Additionally, the OD ring system did not interfere with our surgical manipulations.ConclusionsOur newly developed retraction system with a malleable, tin-alloyed OD ring and minihooks may allow safe and steady small laparotomy for VP shunt.Copyright © 2017 Elsevier Inc. All rights reserved.

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