U.S. patent application number 11/025283 was filed with the patent office on 2005-05-26 for four-blade surgical speculum.
Invention is credited to McKinley, Laurence M., Obenchain, Theodore G..
Application Number | 20050113644 11/025283 |
Document ID | / |
Family ID | 34375095 |
Filed Date | 2005-05-26 |
United States Patent
Application |
20050113644 |
Kind Code |
A1 |
Obenchain, Theodore G. ; et
al. |
May 26, 2005 |
Four-blade surgical speculum
Abstract
A speculum system with four blades is provided. The blades
project in approximately the same direction, and each blade is
connected to a handle linearly or at an angle The handles are
coupled together. In one embodiment, the distance between the
blades is changeable so that a field of view defined as the
viewable area between the blades can be increased or decreased. In
another embodiment, the blades include texture, such as ribs, holes
or teeth to grip onto surrounding muscle fiber. In yet another
embodiment, a stabilizing arm attaches to a stabilizing object,
such as a table or heavy or immovable object, and to one of the
handles to stabilize the speculum system.
Inventors: |
Obenchain, Theodore G.;
(Escondido, CA) ; McKinley, Laurence M.;
(Escondido, CA) |
Correspondence
Address: |
CHRISTIE, PARKER & HALE, LLP
PO BOX 7068
PASADENA
CA
91109-7068
US
|
Family ID: |
34375095 |
Appl. No.: |
11/025283 |
Filed: |
December 29, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11025283 |
Dec 29, 2004 |
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10337613 |
Jan 6, 2003 |
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6869398 |
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Current U.S.
Class: |
600/222 |
Current CPC
Class: |
A61B 17/0206 20130101;
A61B 1/32 20130101 |
Class at
Publication: |
600/222 |
International
Class: |
A61B 001/32 |
Claims
What is claimed is:
1. A surgical speculum system for insertion into a surgical cavity
defined by surrounding muscle tissue comprising: a first blade
having an inner surface and an outer surface, the first blade
coupled to a first handle; a second blade having an inner surface
and an outer surface, the second blade coupled to a second handle,
wherein the first handle is coupled to the second handle such that
the inner surface of the first blade faces the inner surface of the
second blade; a third blade having an inner surface and an outer
surface, the third blade coupled to a third handle; and a fourth
blade having an inner surface and an outer surface, the fourth
blade coupled to a fourth handle, wherein the third handle is
coupled to the fourth handle such that the inner surface of the
third blade faces the inner surface of the fourth blade, wherein at
least one of the third handle and fourth handle is coupled to at
least one of the first handle and the second handle, and wherein at
least two of the first, second, third and fourth blades is shaped
to grip said surrounding muscle tissue when the speculum system is
inserted, such that the speculum system can be secured against
extrusion forces within said surgical cavity primarily by the at
least two of the first, second, third and fourth blades gripping
said muscle tissue.
2. The surgical speculum system of claim 1, wherein at least one of
the handles is coupled to at least one of the blades at an
angle.
3. The surgical speculum system of claim 1, wherein the first
handle and the second handle are coupled such that a space between
the first blade and the second blade is changeable.
4. The surgical speculum system of claim 3, wherein the third
handle and the fourth handle are coupled such that a space between
the third blade and the fourth blade is changeable.
5. The surgical speculum system of claim 1, wherein at least one of
the blades is convex along a width of its outer surface.
6. The surgical speculum system of claim 1, wherein the outer
surface of at least one blade is textured to provide friction
against a direction of extrusion.
7. The surgical speculum system of claim 6, wherein the texture
includes a rib.
8. The surgical speculum system of claim 1, further comprising
teeth on a free end of at least one blade, the teeth projecting at
least partially away from the inner surface.
9. The surgical speculum system of claim 1, wherein the first blade
is adjacent to the third and fourth blades, and the second blade is
adjacent to the third and fourth blades, and wherein the adjacent
blades are spaced such that a surgical instrument can be inserted
between the adjacent blades.
10. The surgical speculum system of claim 1, wherein at least one
inner surface ifs substantially non-reflective.
11. The surgical speculum system of claim 1, further comprising a
stabilizer coupled to at least one of the handles to substantially
stabilize movement of the speculum.
12. The surgical speculum system of claim 11, further comprising a
stabilizing object coupled to the stabilizer.
13. The surgical speculum system of claim 12, wherein the
stabilizing object is a table and the stabilizer includes flexible
linkage.
14. The surgical speculum system of claim 1, wherein at least one
blade has a length sufficient to reach from a surgical incision to
a location of operation.
15. The surgical speculum system of claim 1, further comprising an
attachment post coupled to at least one handle for attaching at
least one instrument.
16. The surgical speculum system of claim 1, wherein at least one
blade comprises an at least partially radiolucent material.
17. The surgical speculum system of claim 1, wherein at least one
blade includes an opening on its inner surface.
18. The surgical speculum system of claim 1, wherein the coupler is
configured such that the at least one of the third handle and
fourth handle can be uncoupled from the at least one of the first
handle and second handle.
19. The surgical speculum system of claim 3, wherein the first and
second handles are couplable such that the space between the first
and second blades can be around 1.5 inches.
20. The surgical speculum system of claim 4, wherein the third and
fourth handles are couplable such that the space between the third
and fourth blades can be around 1.5 inches.
21. The surgical speculum system of claim 1, wherein the first
handle and the second handle curve upward.
Description
CROSS-REFERENCE TO RELATED APPLICATION(S)
[0001] This application is a continuation of allowed application
Ser. No. 10/337,613 filed Jan. 6, 2003, the disclosures of which
are incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The invention relates to a speculum system, more
particularly a surgical speculum system.
BACKGROUND OF THE INVENTION
[0003] Medical professionals frequently employ specula to view or
dilate areas within the body. Specula are well known. The first
reference to a speculum occurred in 1597 and related to a device
for dilating the eyelids. A century later, oral and vaginal specula
were disclosed "wherewith the womb or mouth is dilated or opened."
William A. Smellie describes in his 1752 treatise on midwifery a
"speculum matricis" for spreading open the cervix to look into the
womb. Nearly a century later, Robert Graves disclosed the Grave's
speculum, a bivalve vaginal speculum that is still in use today. By
1862, a catalog produced at an international exhibit in Britain
disclosed specula for dilating the eye, ear, vagina, rectum and
nose.
[0004] These specula typically have smooth surfaces capable of
slipping comfortably into and dilating a bodily orifice for viewing
by a medical professional. The medical professional typically views
the area of interest by looking down the center of the smooth,
dilating surface, which is frequently constructed as bivalve
blades, a hollow cone, or a cylinder. The inside surface of the
specula are also typically highly reflective, so that light from a
head light or ambient light in the room reflects off of the surface
and illuminates the area of interest.
[0005] More recently, several specula useful in spinal surgery have
been disclosed. The Cloward speculum, described in the 1950's,
includes a rigid, hollow cylinder fixed to a perpendicular plane,
or "foot." The foot has a cut-out on the overlapping area so the
view down the center of the cylinder is unobstructed. The foot also
includes metal prongs. These prongs can be hammered into a cervical
vertebral body to stabilize the speculum. The surgeon can then
drill near affected cervical discs and insert a dowel cut from the
iliac crest to distract the disc space of the affected discs.
[0006] Parviz Kambin used a two-portal speculum system for spinal
surgery, with a hole on both sides of a patient's spine. In this
design, a speculum dilates each hole. A surgeon "works down" one
hole with surgical instruments and looks down the second hole with,
for example, an endoscope to view what he or she is doing. However,
one of the disadvantages of this approach is that endoscopes do not
accurately indicate depth, and surgeons frequently may damage the
lens of the endoscope with the surgical instruments or could damage
sensitive neurological tissue by feeling around the cavity with the
instruments to determine "depth of field."
[0007] Another speculum used in spinal surgery is the Michelson
speculum. It includes a rigid, hollow cylinder with teeth
projecting outwardly from one end. The teeth are driven into the
vertebrae adjacent to a distracted intervertebral space. The
rigidity of this speculum can be a problem, however, as the size
and shape of the dilation cannot be easily changed, if at all.
Additionally, surgeons may use "cottonoids," small structures the
size of postage stamps with strings attached, to control bleeding.
These cottonoid strings may obstruct vision inside of the Michelson
speculum and are easily dislodged or snared by the passage of
instruments through a rigid speculum.
[0008] A standard posterior approach to the spine with these
specula entails stripping the muscles off of the back of the spine,
traumatizing the muscles. Stretching and tearing of the muscles can
cause inflamation and extreme pain. Sometimes up to two or three
days of IV narcotic pain medication are necessary to aid such
post-surgical recovery. This traditional approach to the spine
results in denervation of the paraspinous muscles, which may be the
reason for some residual post-surgical back pain. When muscles are
denervated, they do not function normally and the biomechanical
stability of the spine can be damaged. The multifidus muscle, the
large muscle in the center of the back, is made in layers and
attached in layers to the inferior edge of the lamina. This muscle
functions inside its cylindrical fascia as a stiffener and
stabilizer, supporting axial loads, and helping to control
rotational and torsional movement of the lumbar spine. Damage to
the multifidus muscle thus greatly weakens the structural integrity
of the back.
[0009] Another disadvantage with these specula is that the specula
are not held rigidly in place, either because they are manually
held in place or are secured by gripping into bone or other parts
of a subjects' body. Because these specula are not held rigidly in
place, the specula cannot be effectively used as a reference point
in techniques like image guided surgery.
[0010] Accordingly, a need exists for a new, improved surgical
speculum capable of assisting a surgeon in performing spinal
surgery without the above-mentioned disadvantages.
SUMMARY OF THE INVENTION
[0011] The present invention is directed to a surgical speculum
system. One embodiment includes four blades, each coupled to a
handle. The term "blade" refers to any rigid material that is
substantially long and thin. Each blade has an inner surface and an
outer surface. In this embodiment, the inner surface of each blade
faces the inner surface of one other blade, and the handles of the
facing blades are coupled together.
[0012] In this embodiment, one of the handles also includes a
coupler for removably coupling a handle of a non-facing blade, so
that all of the blades can be coupled together, projecting in a
substantially parallel direction. This arrangement of the blades
allows a surgeon to dilate a surgical opening in four directions.
The blades can extend from the handles linearly or at an angle, so
a surgeon's field of vision down the center of the blades is not
obstructed.
[0013] In another embodiment, the distance between the facing
blades is changeable. By adjusting the distance between the facing
blades, the surgeon is able to easily insert the speculum into a
narrow surgical opening and then separate the facing blades to
dilate that opening. Additionally, the surgeon can adjust the
spacing between the different facing blades to most effectively
illuminate or view an area of interest.
[0014] In several embodiments, the speculum system facilitates a
surgical approach with smaller incisions. Such "minimally invasive
surgery" can reduce tissue trauma and post operative pain for the
patient, which will facilitate a quicker than normal recovery.
Also, this type of surgery may be more cost-effective than
traditional open surgical techniques, while permitting safe surgery
because all of the relevant anatomical structures can be clearly
seen.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] These and other features and advantages of the present
invention will be better understood by reference to the following
detailed description when considered in conjunction with the
accompanying drawings where:
[0016] FIG. 1 is a side perspective view of one embodiment of an
exemplary speculum system according to the invention.
[0017] FIG. 2 is a side perspective view of the blades of the
embodiment shown in FIG. 1.
[0018] FIG. 3 is a plan view of another exemplary embodiment of the
speculum system according to the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0019] FIG. 1 shows an embodiment of a speculum system 1 with four
blades 10, 12, 14, 16 attached to four handles 20, 22, 24, 26. The
first and second handles 20, 22 are attached by a hinge 30 and
curve upward. It is also within the scope of this invention for the
handles 20, 22 to be straight. Although the handles may be designed
with a fixed distance therebetween, in this embodiment, a screw 32
is threaded through a hole 34 in the first handle 20 to push
against the adjacent solid surface of the second handle 22. This
screw 32 thereby sets a distance between the first and second
handles 20, 22. Any other mechanism for distancing the first and
second handles 20, 22, such as a latch, variable spacer, or the
like can also be used.
[0020] Again, although not required in this embodiment, an optional
stabilizing arm 40 grips the second handle 22 to stabilize the
speculum system 1 to a fixed position. The stabilizing arm 40 may
alternatively grip onto any other suitable portion of the speculum.
The stabilizing arm 40 is attached at another end to a stabilizing
object (not shown), such as a table or heavy or immovable object.
Because the stabilizing arm can hold the blades rigidly in place,
the blades can become an ideal reference point for image guided
technology. The tops of the blades can be marked with "fiducials,"
or little reflective balls or domes to give reference points in
image guided surgery. This embodiment also includes an optional
attachment post 42 protruding upward from the first handle 20 for
attaching surgical tools and the like.
[0021] The first and second handles 20, 22 are molded to a first
and second blade 10, 12, respectively. The blades 10, 12 can also
be attached to the handles 20, 22 in any other way, such as by a
clamp, hinge, screw or the like. The first and second blades 10, 12
project at an angle of approximately 70 degrees from the handles
20, 22 so the handles 20, 22 do not crowd the field of view of a
surgeon, but it is also within the scope of the invention for the
blades 10, 12 to project linearly from the handles 20, 22 or at any
other angle including a variable angle. In this embodiment, the
first and second blades 10, 12 are outwardly curved and have flared
openings 50, 52 adjacent to the handles 20, 22. Hooks 60, 62 are
fixed on the first and second handles 20, 22 and partially surround
the third handle 24, although any other suitable blade design may
be used.
[0022] The third and fourth handles 24, 26 of the exemplary
embodiment are connected to a connecting rod 70 and have hinges 72,
74 to vary the angle of the third and fourth blades 14, 16. The
connecting rod 70 can be supported by the stabilizing arm 40. The
distance 76 between the third and fourth handles 24, 26 can be
changed by sliding the third handle 24 toward or away from the
fourth handle 26 on the connecting rod 70 and locking it in place
with a lock 78.
[0023] The third blade 14 is connected by a movable clamp 80 to the
third handle 24 and projects parallel to and between the first and
second blades 10, 12. The third blade 14 and the movable clamp 80
can slide along the third handle 24 and be locked into place at
multiple locations along the handle 24. The fourth blade 16 is
rotatably connected to the fourth handle 26 by a screw 82 or the
like and projects parallel to and between the first and second
blades 20, 22 and opposite the third blade 24. Fiducials (not
shown) may also be added to areas on the speculum, such as movable
clamp 80, screw 82, and/or the flared openings 50, 52, to be used
as reference points in image-guided surgery.
[0024] This embodiment may dilate a small surgical opening (not
shown) to 1.5 inches in both directions, allowing a surgeon to
adjust the size and shape of the opening to provide suitable
illumination, viewing angle and operating leverage at the area of
interest. Because of the potentially large dilation capability,
this speculum system embodiment can also be used with a microscope,
endoscope, or the like.
[0025] Also possible with this embodiment is a posterolateral
approach to the spine. Two of the blades can be inserted and
brought apart to dilate the space between two groups of muscles.
Then, the other two blades can be inserted between the first two
blades, coupled to them and dilated. This approach can limit the
damage to the back muscles caused by spinal surgery and greatly
reduce the time needed to recover.
[0026] Regarding the embodiment shown in FIG. 2, the first and
second blades 100, 102 include texture such as ribs 110 or barbs
along their outer surfaces. The first and second blades 100, 102
also include openings 112. These ribs 110 and openings 112 can grip
onto muscle fiber (not shown), or the like, to counter the body's
natural extrusion and hold the blades 100, 102, 104, 106 within a
surgical opening. Because these ribs 110 and openings 112 allow the
speculum system to grip onto muscle fiber, it can be used for many
medical purposes in addition to spinal surgery. For example, a
biopsy of a bone tumor on a thigh bone could be completed
percutaneously with this speculum system and the tumor can be taken
out in minimally invasive surgery. The speculum system could also
be used, for example, in ear, nose and throat surgery,
obstetrics/gynecology, general surgery, orthopedics, etc.
[0027] The blade ends 120, 122 on the outer surfaces of the third
and fourth blades 104, 106 flare outward. The blade ends 120, 122
also include teeth 130, 132 for gripping onto muscle fiber or the
like to keep the blades 100, 102, 104, 106 sufficiently deep,
allowing an appropriate surgical view.
[0028] A plan view of the above-described embodiment is shown in
more detail in FIG. 3. As discussed, the field of view 200, defined
as the viewable area between the inner surfaces of the blades 10,
12, 14, 16, can be widened by adjusting the screw 32 between the
first and second handles 20, 22 or by sliding the fourth handle 26
away from the third handle 24 on the connecting rod 70. The fourth
blade 16 can also be rotated about the axis of the screw 82 to
extend the field of view 200. The angle of the field of view 200
can also be adjusted by loosening the stabilizing arm 40, bending
the third and fourth handles 24, 26 at their hinges 72, 74, and
reconnecting the stabilizing arm 40 to the second handle 22. This
embodiment also includes spaces 210 between adjacent blades that
allow access to the exposed bodily cavity (not shown) for surgical
tools. These spaces can also securely hold cottonoids, which can be
tucked behind the blades for safety, security and protection.
[0029] The blades 10-16, 102-108 can be made from a substantially
nonreflective metal. This is possible because the field of view 200
in this speculum system can be large enough to allow ambient light
to illuminate the surgical cavity, so reflection of the light off
of the speculum blades is largely unnecessary. The blades 10-16,
102-108 can also be made of a radiolucent material, such as carbon
fiber or titanium, to allow the speculum system 1 to be used with
fluoroscopy.
[0030] Although specific embodiments are disclosed herein, it is
expected that persons skilled in the art can and will design
alternate instruments and methods that are within the scope of the
following claims either literally or under the Doctrine of
Equivalents.
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