Galaxy ii in the words of surgeons

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.”

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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.

Introducing…

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.”

Unique design

“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.”

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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.

Introducing…

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.

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A simple switch brings benefits to surgical procedures

The Female Pelvic Health Center in Pennsylvania is a specialist urogynaecology facility led by Dr Stephanie Molden. She explains why, in early 2021, she made the switch to the Galaxy II retractor for urogynaecology procedures, and the advantages of doing so. 

Introducing…

The Female Pelvic Health Center in Newtown is one of a small number of medical facilities in the region that specialises in urogynaecology. Under the guidance of Medical Director and President Dr Stephanie Molden, it offers treatment for a wide variety of pelvic conditions, including prolapse, incontinence, menopausal symptoms and sexual dysfunction. Stephanie said: “We use our experience to make sure that patients with urogynaecology symptoms receive the best possible evaluation and treatment, delivered with the compassion that they need.”

The power of social media

“I'm always interested in new products, looking to see whether they offer a better or more cost-effective alternative to the tools I am currently using. When I saw a social media post from Angela Spang about the Galaxy II retractor, I immediately wanted to learn more. The fact that JUNE Medical is a female-led company also captured my attention, and so I got in touch to see what benefits there might be in switching to the Galaxy II. We struck up a dialogue, then I started to use and evaluate the company’s snowman-shaped retractor early in 2021. It was an easy trial to consider.”

Ease of use 

“I use the Galaxy II Snowman Shape retractor for vaginal procedures, as having the two circles allows the retractor to be positioned at the correct angle and sit properly. I can also attach the stay hooks in a more even circumferential pattern.  While it is very similar in shape to the retractor I used previously, the Galaxy II is easier to use, with cam locks rather than a screw mechanism to secure it, allowing single-handed operation. This was one of the reasons that I was drawn to it. I often operate in a surgery centre where I do not have a surgical assistant, and the Galaxy II’s simple, single-handed operation means that it is easier to adjust and readjust the retractor during a surgery. I can make changes faster and without assistance, which saves time and allows the procedure to be completed more quickly and efficiently.” 

A clear view

“When you're working with an assistant manually holding the retractor, there are times when the tissue is not held in place exactly as you would like. Often, you have to keep readjusting or reminding the assistant to retract appropriately, and their arms can get in the way and be a hinderance. With the Galaxy II, you have several stay hooks that can be used in different fashions, and continually and easily changed as necessary, to provide a clear view. This also has potential benefits in a training environment; without a surgical assistant performing manual retraction, there is more room for a trainee to observe the surgery closely. Being able to use the stay hooks in several different dimensions – and having more than two hooks – allows you to expose the surgical site in a way that offers better visualisation.”

Straightforward switchover

“Making the decision to switch to the Galaxy II was quite straightforward, and we now use it routinely. As a physician and surgeon that frequently operates solo, it has clearly become my assistant. It is easier to use than other products I’ve tried, aesthetically  pleasing and priced competitively – so it also makes my surgical centre happy!  All-round, it's a win-win situation.”

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