Retraction systems in single-incision laparoscopic surgery and NOTES

As minimally invasive surgery techniques evolve to include methods such as single-incision laparoscopic surgery (SILS) and natural orifice translumenal endoscopic surgery (NOTES), a major challenge has been maintaining surgical exposure through limited incisions in which instruments are introduced within the same axis. One of the basic tenets of laparoscopic surgery is triangulation. This allows for maximal exposure of the surgical field and the optimal retraction required for tissue dissection. Difficulties adhering to these principles secondary to instruments entering the abdomen through a common port, and therefore a parallel alignment, have led to the development of several novel retraction systems. The purpose of this chapter is to review established and developing innovations in retraction systems for SILS and NOTES procedures.