Malleable Brass Retractor
Malleable Brass Retractor is made by soldering a piece of Brass Strip with the straight stainless steel pipe. A hole is made at the tip of the brass retractor. The whole instrument is insulated. We can bend this or make any shape outside or inside the abdomen. For doing this inside the abdomen, we take the tip of the retractor into the 5mm stainless steel trocar sheath and apply pressure in different direction. For straightening the bent retractor again, we take the tip into the trocar and apply pressure in oppositedirection.

Usages
• To go across the esophagus for Hiatus Hernia Surgery.
• To go across the Mesoappendix.
• Taking the tape or the thread across the appendix, renal    vessel, splenic vessel, ureter.
• Retract the pelvis of the kidney as Gilvernet Retractor.
• To coagulate the bleeder in the hidden areas like crus of    the diaphragm.

ENDOBAG
If gall bladder has perforated and there is spillage of bile, gall stones, or gall bladder is very thick, these situation demands that endobag should be used. Gall stone can be picked up and placed in the bag and bag is removed at the end of the procedure.

Various type of material can be used for this:
1. Sterile condom.
2. Plastic covering of Ryles’ tube.
3. Plastic covering of TUR set tube.
4. Colostomy bag.

Problems
• Endo bag does not open inside.
• Additional grasper is required to hold the lips of endobag.

Solution
• Evert the lips of endobag outside the abdomen.
• Tie two long threads on two edges of the everted lips.
• Push endobag through the port after removing the canula.
• Place the canula now and hold the threads with the   artery forceps.
• You will see that edges are already everted in the   abdomen.
• Place the stones and GB in the endobag.

Pull all together means threads, grasper GB and the trocar and evert the edges of endobag & remove all stones & GB.

Ambu Bag–Pneumoperitenum
In case the CO2 gas finishes or your insufflator is not working and you are in the middle of the procedure, options are either to convert or to proceed. If you wish to proceed, connect the ambu bag to the silicon tube and tube to the cannula, ask someone to repeatedly inflate to the desired level of the abdominal distension and continue the procedure using air.
 

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