Breisky-Navratil Retractor
Long, narrow, right-angled handheld vaginal retractor — the deep-vaginal-exposure workhorse for sacrospinous-ligament fixation, vaginal-vault prolapse repair, uterosacral suspension, and deep vaginal RU/urogyn reconstruction. Named for August Breisky (1832–1889, Vienna gynecologist) and Josef Navratil (19th-century European surgeon). Routinely called just "Breisky" in operative practice; the Breisky-Navratil name acknowledges both contributors.[2]
Design
- Elongated narrow flat blade with a smooth curved tip — reaches deep vaginal recesses (apex, sacrospinous ligament, ischial spine).
- Right-angled handle perpendicular to the blade — keeps the assistant's hand outside the operative field.
- Smooth rounded blade edges — minimize mucosal trauma during prolonged retraction.[2]
- Widths: typically 2.5–4 cm; multiple lengths available — match the blade to the depth of exposure.
- Some variants have a slight weight in the handle to assist with sustained gravity-supported positioning.
- Material: surgical-grade stainless steel, autoclavable.
- No locking mechanism — handheld.
Reconstructive-Urology and Urogyn Uses
The Breisky-Navratil is the default deep-vaginal handheld retractor for urogyn cases that go beyond the depth a Heaney retractor can reach:
Vaginal vault prolapse and apical-suspension procedures
- Sacrospinous-ligament fixation (SSLF) — exposing the ischial spine and sacrospinous ligament for needle / capio / suture placement. The narrow elongated blade is essential here because the corridor to the sacrospinous ligament is deep and narrow.[1]
- Uterosacral-ligament suspension — deep-apical exposure for ligament identification and suture placement.
- McCall culdoplasty — deep posterior cul-de-sac exposure during the apical step of vaginal hysterectomy.
- Vaginal sacrocolpopexy adjuncts — when vaginal-approach apical suspension is part of a combined procedure.
Vaginal hysterectomy and deep cuff work
- Vaginal hysterectomy — lateral and posterior vaginal-wall retraction during cardinal-uterosacral pedicle dissection; particularly useful in the deep / apical phase after the cervix has been mobilized.
- Vaginal-cuff closure — deep cuff exposure during apical closure with incorporation of uterosacral ligaments for apical support.
Vaginal-approach RU/urogyn reconstruction
- Anterior and posterior colporrhaphy — deep-vagina lateral exposure during prolapse repair.
- High vaginal-wall VVF and urethrovaginal-fistula repair — when the fistula sits high on the anterior vaginal wall and requires deep exposure beyond what a Sims or Heaney can deliver.
- Female urethroplasty — deep-vaginal exposure when the dissection extends proximally.
- Mesh excision / revision — deep vaginal-wall retraction during retrieval of high mesh limbs.
Pelvic-floor reconstruction
- Combined prolapse-and-continence procedures — deep exposure for the apical step paired with anterior-wall slings.
For more superficial vaginal exposure (cervix, lower vaginal-wall colporrhaphy), the Heaney or Sims retractor is preferable.
Technique
- Use in pairs — typically one on each side for bilateral lateral retraction; both held by assistants or one held by the surgeon and one by an assistant.
- Combine with the Auvard weighted speculum posteriorly to deliver circumferential deep-vaginal exposure: Auvard for posterior gravity-self-retaining retraction, Breisky-Navratil for lateral.
- Combine with a self-retaining system — when a Magrina-Bookwalter is in place, Breisky-Navratil retractors supplement the ring for specific deep-apical exposures that the ring blades cannot reach.
- Width selection by depth of exposure: narrower (2.5 cm) for very deep / narrow corridors; wider (4 cm) for broader lateral exposure.
- Lubricate the blade with water-soluble lubricant to reduce mucosal friction and abrasion during sustained retraction.
- Minimum effective force — sustained excessive pressure on lateral vaginal walls produces ischemic mucosal injury; periodic release recommended in long cases.
Comparison Within the Vaginal-Retractor Family
| Retractor | Profile | Depth | Best fit |
|---|---|---|---|
| Breisky-Navratil | Long narrow right-angle | Deepest | Deep apical / sacrospinous exposure |
| Heaney retractor | Right-angle, shorter | Anterior / posterior vaginal wall | Standard vaginal-wall retraction |
| Sims retractor | Concave spoon, double-ended | Mid-vaginal | VVF / RVF / colporrhaphy / hysterectomy |
| Auvard weighted speculum | Single posterior blade + weight | Posterior wall, gravity-self-retaining | Operative gynecology hands-free posterior retraction |
| Magrina-Bookwalter | Vaginal ring + blades | Variable, self-retaining | Long vaginal cases needing hands-free apical / lateral retraction |
| Lone Star | Elastic stays + ring | Soft-tissue circumferential | Perineal / vaginal traction with no metal-blade pressure |
Limitations
- Handheld — requires an assistant; fatigues over long cases. For prolonged retraction switch to or supplement with a self-retaining system (Magrina-Bookwalter, Lone Star).
- Narrow blade can concentrate pressure — focal lateral-vaginal-wall ischemia in long cases; periodic release.
- Limited to vaginal approach — not for abdominal / pelvic open exposure.
Historical Context
August Breisky (1832–1889) was Chair of Gynecology at the University of Vienna in the late 19th century — one of the founding figures of European obstetric and gynecologic surgery. His combined work with Josef Navratil is the source of the Breisky-Navratil instrument name; in operative parlance the retractor family is referred to simply as "Breisky" but the full attribution acknowledges both 19th-century European contributions.
See also: Heaney Retractor, Sims Retractor, Auvard Weighted Speculum, Bookwalter, Lone Star, Heaney Clamp.
References
1. Vitale SG, Laganà AS, Noventa M, et al. "Transvaginal bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: efficacy and impact on quality of life and sexuality." Biomed Res Int. 2018;2018:5727165. doi:10.1155/2018/5727165
2. Kirkup J. "The history and evolution of surgical instruments. VII. Spring forceps (tweezers), hooks and simple retractors." Ann R Coll Surg Engl. 1996;78(6):544–52.