The Four Peaks Surgery Center in Sun City, Arizona, now exclusively uses Galaxy II retractors for its urology and urogynaecology procedures and has halved retractor costs as a result. Kriston Bertelsen, Surgical Technologist and Assistant Administrator at the centre, explains why she switched to the Galaxy II.
Four Peaks is a privately-owned, Banner Health-affiliated urological and urogynaecological surgical centre serving a practice of 14 primary care offices that refer patients from the Phoenix area for specialist consultations. The centre offers an attractive, cost-effective model of private care, primarily because it is dealing with far fewer patients on a daily basis than larger hospitals – 17-18 compared to hundreds. Kriston said: “We pride ourselves on high standards and continually monitor patient satisfaction very closely, making sure that we keep our ratings high at 97 per cent or more. We literally scrutinise every single comment and people love us!”
The mounting costs of disposables
A significant disadvantage of being a privately-owned specialist centre is that it doesn't receive the same level of reimbursement that hospitals do. Kriston explained: “It is crucial for us to keep a keen eye on costs and try to keep margins as low as possible to balance being able to offer competitive pricing with keeping the centre financially viable. Although I am a certified surgical technician and regularly assist with procedures, my role here has evolved to include purchasing, billing and negotiating costs from suppliers where possible.”
“The cost of retractors came to my attention a few years ago. They are an important tool to use during our procedures, because they free up the hands of the technician assisting the surgeon, and are very efficient at clearing the surgical site – they can retract in eight directions whereas I only have two hands. However, the cost of the retractors we were using was extremely high for single-use disposable items, and so I looked around for more cost-effective alternatives.”
Finding a better, cheaper option
Kriston found JUNE Medical’s Galaxy II from an online search and hasn’t looked back. She added: “I discovered the Galaxy II retractor and was amazed to discover that it is nearly half the cost of the product we had previously used, which is hugely significant for us. I was even more surprised to find that it is actually a better product too and, most importantly, the nine top tier surgeons who routinely come here are very happy with it. To start with, it is a lot more malleable, making it easier to bend into place, and fits well against our patients in a lithotomy position, exposing the vaginal area and perineum, and simultaneously holding the drape pocket. The clips then lock the retractor into place on either side, and the hooks also work really well; I attach the tissue, hand the band to the surgeon and they can slide it to wherever it needs to be, which wasn’t possible with the previous retractor we used.”
A great deal all round
“We've been using the Galaxy II Snowman retractors for some time now, and the support we get from the company is great. Whenever I reach out and place an order, I get an immediate response and stock shows up in a timely fashion. Even through the COVID crisis, we haven’t had any supply chain issues, which is quite impressive considering the current environment. Overall, this has been an amazing cost-saving measure for us, as well providing us with a great product.”
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"The cost of the (old blue sic) retractors we were using was extremely high for single-use disposable items, and so I looked around for more cost-effective alternatives. I found Galaxy II from an online search, and we haven't looked back! The support we get from the company is great!"
Materials Manager Kriston Bertelsen
University College London Hospitals (UCLH) Trust has one of the largest urology departments in Europe and performs thousands of different procedures a year, with many of its vaginal surgeries using Galaxy retractors. Tamsin Greenwell, Consultant Urological Surgeon at UCLH and Honorary Associate Professor at UCL, is the Clinical Lead for the Female, Functional and Restorative (FFR) Urology Unit UCLH and has worked at the hospital since 2002, witnessing the evolution of technology is this field.
UCLH provides first-class acute and specialist services in six hospitals across central London, including urology, where the Trust performs the largest number of procedures for male artificial urinary sphincters, ureteral re-implants, and female lower urinary tract fistula and urethral diverticulum in the country. Tamsin said: “We currently have 36 urology consultants in the department, four in my specific niche of FFR urology. I have a particular interest in urinary tract fistulas, which includes those following gynaecological, urological and colorectal surgery. We also perform a lot of post-radiotherapy upper and lower urinary tract reconstruction – this seems to be a growth area at the moment. We have a significant practice in male and female urinary incontinence; we mainly look after women with recurrent stress incontinence who have already had failed surgery elsewhere and need our specialist input in terms of investigation and surgical options. UCLH also has one of the busiest robotic prostatectomy groups in the UK – performing around 700 robotic radical prostatectomies per year. Most studies report about a 10 % urinary incontinence rate after this type of surgery, meaning we see a significant number of men requiring artificial urinary sphincters and slings for their continence problems. The sheer number of operations we carry out in FFR urology – and in urology in general – at
UCLH means surgical equipment that is both functional and cost effective is essential.”
"We currently have 36 urology consultants in the department, four in my specific niche of FFR urology. I have a particular interest in urinary tract fistulas, which includes those following gynaecological, urological and colorectal surgery. We also perform a lot of post-radiotherapy upper and lower urinary tract reconstruction – this seems to be a growth area at the moment." Tamsin Greenwell says.
A more economical option
Surgical retractors are simple devices that can have a significant impact on these kinds of procedures, freeing up the hands of technicians and surgeons and efficiently clearing the surgical site. However, many single-use disposable instruments like this are expensive, which led Tamsin to look for a more cost-effective solution. Tamsin added: “Myself and my colleagues have used various retractors that come in different shapes for specific procedures over the years, but we were asked if we could look at saving money for the Trust without affecting outcomes. After looking at all the other retractors on the market, it was the Galaxy that stuck out above the rest, and it was cheaper too. There’s currently a big push for hospital departments to become more ‘green’, so we had to weigh up the environmental costs of buying re-usable sets, washing and sterilising them after each use, versus buying single-use items. We swapped over to the Galaxy retractor and loved that JUNE Medical was also donating one out of every 10 to third world countries, which is an incredible gesture."
Responding to need
Tamsin continued: “Angela, CEO of JUNE Medical visited our hospital and watched a procedure to see how we use the retractor and to hear our opinions on what could be improved. This gave the company an excellent idea of what we really need, and from there they could see what they could do to produce the best product for us ergonomically. JUNE Medical has been proactive and responsive to all of the things that we thought would be nice to have as features for the next generation of instruments. The result was the Galaxy II, which has an attachment to hold the urinary catheter and extra hooks packaged separately in addition to the standard eight. Before this, we used to have to open another set of eight if we wanted one or two extra hooks, so it’s much more convenient and produces less waste. The elasticated part of the hook is also now longer and easier to use; if you want to put a little bit more tension on things then you can also do so with the added elasticity in the new cord. I also like that the Galaxy II now ‘clicks’ – rather than screws – to hold itself in position. It is particularly useful for a novice in providing a clear view of the surgical site and perhaps would minimise risk for those who are less experienced in performing procedures. JUNE really has made a lot of improvements to the new retractor and it’s now one of my favourites. There is also now a male kit for specific surgery and, once we start doing sphincter surgery and urethroplasty again following the current COVID-19 pandemic, I’m definitely going to try this out.”
Tamsin Greenwell, Consultant Urological Surgeon at UCLH and Honorary Associate Professor at UCL UK
Consultant Obstetrician and Gynaecologist Dr Alex Digesu has been using Galaxy retractors during his surgical procedures since they were first developed. He explains what prompted the change to using Galaxy devices in the first place and describes their many benefits.
Dr Alex Digesu is a Consultant Obstetrician and Gynaecologist at Imperial College Healthcare NHS Trust in London. A specialist in urogynaecology, his area of interest lies in oncology and includes complex reconstructive pelvic surgery. He also mentors trainee clinicians and surgeons to improve their technical skills, helping to teach the surgeons of the future.
The need for a superior product
Alex explained: “Most of the surgery I perform is of course vaginal surgery, and the retractors I was using before the Galaxy products were extremely traumatic on the mucosa, especially for older patients with more fragile tissue. The problem with that is that the more damage you cause to the tissue, the greater the inflammatory response and the greater the pain experienced by the patient, so I began searching for an alternative, and came across JUNE Medical and the Galaxy retractor.”
In those early days, Alex first used the Galaxy prototype product, but he soon welcomed the opportunity to give the company feedback on how the design could be improved, leading to the development of the Galaxy II. He continued: “The Galaxy II offers lots of advantages over other brands of retractors on the market. Firstly, there is a variety of stay hooks available to suit different layers of tissue that might need to be pulled back, all of which are designed to minimise trauma. While the various options are less applicable to vaginal surgery, other surgical specialties that operate on regions with more anatomical layers benefit enormously from this.”
“However, what is really unique about the Galaxy retractors is the cam-lock mechanism that replaces the traditional screw-locks and allows simple single-handed adjustment. The design makes it far easier for surgeons to optimise the retractor shape for different procedures, and to modify it for each individual patient; patients are all different sizes so being able to place the retractor accordingly is a great advantage. The locks can also be easily readjusted by the surgeon as many times as necessary throughout the procedure itself, which is especially useful when there are fewer assistants around, such as in private practice settings.”
The retractors are extremely helpful in the teaching environment. Alex added: “Having a retractor is very important during my educational courses. Historically, surgical trainees and students would assist in the operation by standing next to the surgeon and manually retracting the tissue. However, I am now able to use the retractor instead, which means that trainees and students can observe directly from behind me, giving them a better view for learning the anatomical structures and surgical steps.”
Weighing in better for the environment
Alex continued: “It’s not only the design that makes Galaxy the preferred range of retractors; they are cheaper than other models, which means they are an attractive choice for healthcare providers, and they are lightweight and use less plastic than other brands, helping to reduce waste, save costs, and adopt a more environmentally-friendly approach. This was an important consideration that we discussed with JUNE Medical when we were advising on the development of the Galaxy II. Having a supplier who listens to our advice and suggestions to enable us to operate more successfully is a rather unique, but great, asset to have.”
Dr Alex Digesu is a Consultant Obstetrician and Gynaecologist at Imperial College Healthcare NHS
Dr Wael Agur, a urogynaecologist working in Ayrshire and Arran on the west of Scotland, began using Galaxy self-retaining retractors during his surgical procedures shortly after they were launched in 2015. He discusses the benefits of these devices to surgeons and to patients, and describes how they can help in training the surgeons of the future.
Dr Wael Agur is a lead urogynaecologist with NHS Ayrshire and Arran. He is also an honorary senior clinical lecturer at the University of Glasgow, and is involved in helping trainee surgeons to improve their practical skills in the operating theatre.
A gentler choice
Wael explained: “I’ve been using self-retaining retractors for many years, but the challenge has always been to try to minimise any trauma to the tissue. The beauty of the Galaxy retractors is that they are designed to do just that. We were among the first people to use the original Galaxy I model, and moved to the improved, lighter Galaxy II as soon as it was launched. The Galaxy II’s cam locks make it easier to adjust than many other retractors, it has a clip for a urinary catheter, which is a big advantage and, importantly, the hooks are gentler and cause less damage to the surrounding tissue.”
Striking a balance
The stays and hooks on a retractor are incredibly important, as any trauma inflicted on the tissue during surgery can result in considerable pain during the patient’s recovery.
Wael continued: “The hooks supplied with other retractors are available in standard sharp or blunt
varieties, but I found that the sharp hooks caused too much tearing and the damaged areas needed suturing, whereas the blunt hooks didn’t hold the tissue well at all. In contrast, the hooks with the Galaxy II are pointed enough but not too sharp, and provide just the right balance between adequately retracting the tissue and avoiding unnecessary trauma.”
A more patient-centric option
“With the Galaxy II, the degree of tension is under my control, giving me adequate retraction of tissues while minimising the degree of trauma to allow faster healing and avoid any long-term problems for the patient. The tissue damage has never been extensive enough to require suturing, and I’ve never had to give additional painkillers to a patient as a result of using it; it’s a huge benefit for the patient.”
Better training for the surgeons of the future
Before the introduction of self-retaining retractors, many surgeons relied on assistants to hold tissue in place and expose the surgical site. “If I have a trainee surgeon with me, it’s better for them to stand near to me so that they have a good view of the procedure. The use of the self-retaining retractor makes the field clear and accessible, with no hands in the way. Assistants are free to focus on what’s going on and can perform important steps of the surgery themselves, rather than being on standby to adjust screws.
Saving valuable theatre time
Theatre time is precious, and the use of self-retaining retractors can help surgeons to optimise their procedures. “If you use a handheld retractor, then your assistant’s hands are constantly in the way and moving, and the retractor is unstable. This is particularly true if it’s a difficult and complex procedure. The assistant will naturally get tired, which may result in the surgeon having to intervene and readjust the retractor. This not only takes up additional theatre time, but also takes the surgeon’s focus away from the task at hand, often on several occasions during the surgery. Using the Galaxy II self-retaining retractor makes the surgical site much more accessible and gives you a clearer working space. It gives the surgeon the optimal conditions for performing the procedure as he or she wants to without having to worry about the issues associated with handheld retractors, and saves valuable time in theatre. I would not want to operate without one,” Wael concluded.
Dr Wael Agur is a lead urogynaecologist with NHS Ayrshire and Arran.
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