Usefulness of the Lone Star® Retractor in Thyroid and Parathyroid Surgery

Regarding the article published in the latest issue of the Cirugía Española journal, “Use of Alexis^® Retractor in Thyroid and Parathyroid Surgery” by Dr. Lois-Ortega et al.,¹ we agree on the need to use devices that provide good exposure of the thyroid gland for thyroidectomy or parathyroidectomy.

In addition to creating a good surgical field, these devices also traumatize the skin less than the standard technique, which involves fixation of the upper and lower flaps with silk suture.² This method can leave marks on the skin and require the use of another type of separator (Farabeuf type), which keeps one of the assistant's hands occupied.

Instead of the Alexis^® retractor, in our endocrine surgery unit we have recently been using another type of retractor device, the Lone Star^® retractor. This system provides tissue retraction with elastic bands that are affixed to the skin by hooks. It is widely used in colorectal,³ gynecological and urological surgery,⁴ and its use in head and neck procedures has also been described.^5,6

The technique used in our unit is similar to that used by Lois-Ortega et al. After the initial Kocher incision and the dissection of the upper flap and lower flap below the platysma, we placed the device as symmetrically as possible, anchoring the hooks to the subcutaneous cellular tissue: 2 in the area above, 1–2 below, and 2 lateral. Subsequently, we separated the prelaryngeal muscles, maintaining retraction with 2 other elastic bands on each side (Figs. 1 and 2). Thus, this device frees the assistant from tissue separation duties in order to freely use her/his hands to better assist the thyroidectomy. As was the case in the commented article, the use of this retractor in thyroid and parathyroid surgery has also not been described in the current literature.

Fig. 1.

Exposure of the left hemithyroid using the Lone Star^® device during hemithyroidectomy.

Fig. 2.

Exposure of the thyroid with the Lone Star^® retractor during total thyroidectomy.

In conclusion, we found the article by Lois-Ortega et al. very interesting, and we concur with the use of new technologies that facilitate exposure of the surgical field while providing greater safety and convenience, which benefit patients as well as surgeons.