Breisky-Navratil Retractor
The Breisky-Navratil, often called a Breisky, is a long handheld vaginal retractor used for deep vaginal and paravaginal exposure. Its elongated working blade reaches beyond the introitus while the angled handle remains accessible to the assistant. A concave blade supports the vaginal wall rather than gripping it with teeth.[1][2]
Design and available sizes
The name covers several lengths and widths. Teleflex lists P15933 with a 130 × 35 mm concave blade and 32 cm overall length. The Aesculap catalog includes 130 mm blades in widths from 20 to 40 mm and additional longer and shorter patterns.[1][2]
Choose blade reach and width separately: the exposure may be deep but narrow, or shallow with a broad wall requiring support. A tip extending beyond the visible plane can put pressure on structures outside the operative target.
Uses in vaginal reconstruction
Breisky and Heaney-Simon patterns both offer deep vaginal exposure; Teleflex lists a 120 mm Heaney-Simon blade, while KLS Martin lists a 100 mm Breisky blade, so reach depends on the pattern.[4][5] For superficial exposure (cervix, lower vaginal wall) a Heaney or Sims is preferable.
Apical suspension
- Sacrospinous fixation: lateral and pararectal exposure while identifying the ischial spine and sacrospinous ligament. In Enemchukwu’s technical review, two narrow retractors such as Breisky-Navratil can be placed to protect the rectum and expose the ligament.[6] The corridor is deep and narrow, which suits a long narrow blade.
- Uterosacral suspension and McCall culdoplasty: directed wall retraction for ligament identification and suture placement, and deep posterior cul-de-sac exposure.
Vaginal hysterectomy and cuff
- Vaginal hysterectomy: lateral and posterior wall retraction during deep pedicle dissection, particularly after the cervix has been mobilized.
- Cuff closure: deep exposure while closing the apex and incorporating the uterosacral ligaments.
Vaginal reconstruction
- Anterior and posterior repair: adjustable lateral wall retraction when a fixed speculum obscures the operative plane.
- High vaginal fistula repair: supplementary exposure when a fistula or mobilized flap lies beyond a shorter blade.
- Female urethroplasty: deep vaginal exposure when dissection extends proximally.
- Mesh revision or excision: a defined dissection corridor when retrieving high mesh limbs.
These are conventional applications. Selection depends on the patient's anatomy and the exposure the procedure needs.
Practical setup and handling
- Have more than one blade width and length available for deep cases. Narrower blades (about 2.5 cm) suit very deep, narrow corridors; wider blades (about 4 cm) give broader lateral exposure.
- Establish the dissection plane before placing the tip deeply. For sacrospinous ligament exposure, manually dissect space for the first narrow blade, place it against the lateral pelvic sidewall, and rotate it 180° to retract the rectum; insertion alongside the rectum can cause a tear.[7] Position the blade on the tissue being retracted, with the target visible beyond it.
- Blades are commonly used in pairs, one on each side, held by assistants or one by the surgeon. A posterior weighted speculum can supply gravity-supported posterior retraction while the Breisky retracts laterally.
- When a Magrina-Bookwalter or other frame is in place, a Breisky can supplement it for deep apical exposure the frame blades cannot reach (see Bookwalter).
- Keep the handle out of the needle or dissection path. Coordinate changes in direction with the surgeon rather than silently rotating or advancing the blade.
- Water-soluble lubricant on the blade reduces mucosal friction in sustained retraction.
- Use minimal effective pressure and periodically reassess tissue under the blade. Change position or size if exposure requires escalating force.
- Release traction before removing or changing blades; protect suture loops and the adjacent wall during withdrawal.
Limitations
- Handheld: it needs an assistant and fatigues over long cases. For prolonged retraction supplement or replace it with a self-retaining system (Magrina-Bookwalter, Lone Star).
- Narrow blades concentrate pressure: sustained force on the lateral vaginal wall can cause focal mucosal ischemia, so release periodically in long cases.
- Vaginal insertion. The Breisky is placed through the vagina, including when it delineates the vaginal wall for laparoscopic or open sacrocolpopexy. It is not a blade for retraction through an abdominal incision.[3]
Comparison with other vaginal retractors
| Instrument | Useful distinction |
|---|---|
| Breisky | Long handheld blade for directed deep exposure; among the deepest vaginal patterns |
| Heaney | Angled vaginal blade; dimensions vary, including deeper Heaney-Simon patterns |
| Sims | Curved wall retraction with an open working channel |
| Auvard | Gravity-supported posterior retraction |
| Bookwalter / Lone Star | Sustained exposure with a frame or elastic stays |
Historical note
The name honors the Vienna gynecologist August Breisky (1832–1889). In operative use the instrument is simply called a Breisky.
References
1. Teleflex/Pilling. Breisky vaginal retractor P15933. Manufacturer product specifications.
2. Aesculap. Obstetrics/Gynecology instrument catalog, pp. 706–707. Breisky vaginal specula configurations. Sources accessed September 20, 2026.
3. American Urogynecologic Society and International Urogynecological Association. "Joint report on terminology for surgical procedures to treat pelvic organ prolapse." Female Pelvic Med Reconstr Surg. 2020;26(3):173–201. doi:10.1097/SPV.0000000000000846
4. Teleflex/Pilling. "Heaney-Simon Retractor 212305." Pilling Surgical Instruments Catalog. Manufacturer specifications.
5. KLS Martin. "Vaginal speculum, acc. to Breisky, 100 × 20 mm, length 29.5 cm (32-323-20-07)." Online Catalog. Manufacturer specifications.
6. Enemchukwu EA. "Transvaginal suture-based repair." Urol Clin North Am. 2019;46(1):97–102. doi:10.1016/j.ucl.2018.08.004
7. Sajadi KP, Vasavada SP. "Complications of transvaginal apical repairs: evaluation and management." In: Goldman HB, ed. Complications of Female Incontinence and Pelvic Reconstructive Surgery. Springer; 2013:49–58. doi:10.1007/978-1-61779-924-2_5