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Lone Star Retractor System

The Lone Star is a self-retaining ring-and-elastic-stay system supplied by CooperSurgical. Hooks engage tissue, while elastic leads secure in slots around the frame. Moving a stay to another slot changes its direction of pull; repositioning the hook changes which layer is exposed. Different frames and stay tips support perineal, urethral and vaginal exposure.[1][2][3]

Components and configurations​

Frame. The disposable range includes articulated plastic frames in several shapes and sizes. The listed frames are model examples; no single frame is specified for every operation.[2]

ModelListed dimensionsConfiguration or kit example
3307G14.1 × 14.1 cmSquare frame; included in the 3707 colorectal kit
3304G32.5 × 18.3 cmLarge snowman-shaped frame; two catheter clips; included in the 3704 gynecology kit
3308G28.3 × 18.3 cmArticulated frame with two catheter clips
3301G / 3302G25.3 × 11.3 / 22.0 × 11.3 cmAlternative elongated configurations
3310G25.0 × 25.0 cmLarger frame

The APS variant has an open end, backing to assist positioning, catheter clips and attachment holes. Its open end accommodates a weighted speculum or posterior access. The linked APS guide was revised in 2012, despite its newer website upload path.[4]

Elastic stays. There is a tissue-engaging tip at one end and an elastic lead that attaches to the ring; there is no tissue hook at both ends. The illustrated pocket guide distinguishes sharp, blunt, rake and blade patterns:[5]

Stay patternExamples in the manufacturer's guide
Sharp hook3 mm (3314-8G), 5 mm (3311-8G)
Blunt hook5 mm (3316-8G), 12 mm (3350-8G)
Semi-blunt PRO-Stay5 mm (3205-8G)
Rake patternsTwo-, three- and four-finger variants
Solid blade6.5 × 16 mm (3338-4G), 13 × 16 mm (3330-4G)

Elongated- and dual-lead variants are also listed. Select the actual tip and frame needed for the exposure. Hook configuration and the amount of elastic stretch are separate considerations.

Setup and adjustment​

The manufacturer's IFU describes three core maneuvers:[1]

  1. Position and balance. Place the ring around the site; attach stays in opposing quadrants with balanced tension to stabilize it.
  2. Follow the dissection. As the working plane deepens, reposition the stays. Add or redirect stays to maintain balanced exposure.
  3. Maintain exposure during closure. Keep opposing traction while suturing, adjusting the stays as the field changes.

The illustrated IFU shows this sequence.

Reconstructive applications​

SettingPractical role and source
Male and female urethroplasty; urethral repairAdjustable exposure around the operative field; specifically listed in CooperSurgical's reconstructive-urology sheet.[3]
Posterior urethroplastyGomez and Scarberry describe static ring retractors, including Scott/Lone Star, Denis Browne and Bookwalter–Jordan, during the perineal approach.[6]
Artificial urinary sphincter and male sling insertionPerineal exposure; both are listed manufacturer applications.[3]
Vaginal and pelvic-floor proceduresThe APS guide illustrates use for anterior/posterior repair, sling procedures, mesh excision, vaginal hysterectomy, biopsy and episiotomy repair.[4]
Vaginal fistula surgeryThe teaching video below demonstrates application in a fistula field. Use the relevant repair page for the reconstruction itself.

For deep perineal reconstruction, compare Perineal Bookwalter and Denis Browne. Frame geometry, blade reach and the ability to redirect traction are useful selection considerations. The posterior urethroplasty review provides examples of the operative setting in which these systems are used.[6]

Surgeons also use the system for circumferential exposure in hypospadias and buried-penis repair, scrotoplasty and perineoplasty, urethral diverticulectomy, and vulvar or introital reconstruction.

Practical handling and limitations​

  • Place skin-edge hooks according to tissue layer. CooperSurgical’s head-and-neck procedure guide describes engaging sufficient subcutaneous soft tissue to avoid excessive point force and avoiding vessels and nerves. The system IFU directs repositioning stays into deeper tissue as dissection progresses.[8][1]

  • Sequence the stays. In perineal urethroplasty, surgeons commonly retract the skin edges first, then the bulbospongiosus, then the corpus spongiosum, replacing stays as the plane deepens.

  • Match the tip to the tissue. Blunt tips are generally preferred on vaginal mucosa, urethral edges and thin or irradiated skin. Use the least elastic tension that holds the exposure.

  • Use it as the shallow layer. For deep perineal or pelvic exposure, surgeons pair the ring with a Bookwalter-type frame that holds deep blades. The ring is a circumferential retractor with limited force.

  • Counsel about hook marks. Puncture marks at hook sites can be visible.

  • Adjust the vector before adding force. Repositioning a stay or frame may improve exposure without stretching an existing stay further, which is a practical application of the IFU's balanced-retraction instructions.[1]

  • Reassess tissue purchase during dissection. Hook tips and elastic leads still transmit force.

  • Choose around the working space. Consider catheter management, instrument entry and posterior access.[2][4]

  • Check the exact device label. The disposable-system IFU prohibits reuse, reprocessing and resterilization, and excludes damaged devices or compromised sterile packaging. Historical reusable metal frames are a separate category with their own processing instructions.[1][3]

  • Keep rare reports in their original setting. Tranchart and colleagues reported two perianal recurrences at hook sites after rectal-cancer surgery. Tranchart's colorectal report gives no incidence estimate for reconstructive urology or comparison of blunt hooks for implantation prevention.[7]

Perineal Bookwalter (Jordan / Brooke) · Bookwalter · Turner-Warwick · Adson-Beckman · Heaney · Breisky · Weighted Speculum.

Videos​

Lone Star Retractor in Fistula Surgery
Masterclass in Obstetric Fistula

References​

1. CooperSurgical. Lone Star Retractor System: Retractors and Elastic Stays—Instructions for Use. 39731, Rev. A, December 2021. Manufacturer IFU.

2. CooperSurgical. Lone Star Self-Retaining Retractors—Disposable. Product specifications. Accessed September 20, 2026.

3. CooperSurgical. Lone Star Retractor System and Elastic Stays: Reconstructive Urology. C-US-LON-000031, February 2025. Manufacturer application and specification sheet.

4. CooperSurgical. Lone Star APS Retractor for Obstetric and Gynecologic Procedures. 81710, Rev. April 2012. Manufacturer guide.

5. CooperSurgical. Lone Star Pocket Reference Guide. C-US-LON-000038, May 2025. Illustrated ring and stay guide.

6. Gomez RG, Scarberry K. Anatomy and techniques in posterior urethroplasty. Transl Androl Urol. 2018;7(4):567–579. doi:10.21037/tau.2018.03.05. Full article.

7. Tranchart H, Benoist S, Penna C, et al. Cutaneous perianal recurrence on the site of Lone Star retractor after J-pouch coloanal anastomosis for rectal cancer: report of two cases. Dis Colon Rectum. 2008;51(12):1850–1852. doi:10.1007/s10350-008-9338-9. PubMed.

8. CooperSurgical. Lone Star Retractor System: Head and Neck Procedure Guide. Safety and Basic Skin Incision sections. Manufacturer procedure guide.