Anterior Vaginal Retractor For Vaginal Surgery

Abstract

A triangular base member fits between the flexed thighs and bears downward against the suprapubic area of the lowest part of the abdomen. An adjustable angular extension on the base member has a downturned end portion adjustably connected with an upturned end portion of an L-shaped retractor blade. The blade has a horizontal insertable portion which presses upwardly against the vaginal wall giving the surgeon exposure and operating space and at the same time protecting the urethra and urinary bladder. The inserted portion of the blade underlies the base member and operates in the manner of a clamp wherein the downward pressure exerted exteriorly against the abdomen by the base member applies an upward pressure to the retractor blade. The anterior retractor is used in conjunction with a conventional weighted lower or posterior retractor.

Description

BACKGROUND OF THE INVENTION

This invention relates to an improved anterior retractor for vaginal surgery and is of particular advantage in vaginal hysterectomies.

In a vaginal hysterectomy, separate upper and lower retractors are employed. The lower retractor is a weighted vaginal speculum which maintains its stretching action through gravity. The upper retractor protects and supports the urethra and urinary bladder and also gives the surgeon more exposure and operating space.

Heretofore, the upper retractor has usually been an L-shaped right angle instrument with a long upwardly extending handle which is held in place manually, although its position is virtually static and requires a constant force of only a pound or two in an upward direction. The task of holding the upper retractor is very difficult and tiring because it must be held in place from 30 minutes to over an hour in some cases and when the patient is positioned for vaginal hysterectomy, her thighs and legs are in the way of an assistant standing to either side of the operating table. On the other hand, if the assistant holding the upper retractor sits beside the operating surgeon it is still difficult because of the crowded conditions resulting from two men sitting and working between the patient's legs. When the assistant must at intervals use both his hands in aiding the surgeon, the task of holding a retractor then temporarily occupies one of the instrument nurse's busy hands.

Other types of retractors having both upper and lower blades in a single instrument cannot be used for a hysterectomy because the mechanism obstructs the surgeon's operating space.

Objects of the invention are, therefore, to provide an improved vaginal retractor which does not obstruct the surgeon's operating space, to provide an upper retractor for the purpose described which will maintain itself in position without being manually held and to provide an upper vaginal retractor which is adjustable to fit the anatomy of the patient.

SUMMARY OF THE INVENTION

The present retractor comprises three parts which are adjustable in relation to each other to fit the anatomy of the patient. A triangular base member fits between the thighs when they are flexed on the abdomen in the lithotomy position for the performance of vaginal surgery. This base member bears downward against the superapubic area of the lowest part of the abdomen. An adjustable extension on the base member is of L-shape with a downturned end portion, the extension being made of a malleable material so that its angle may be adjusted when the retractor is applied to a particular patient.

The retractor blade is also of L-shape with an upturned exterior portion adjustably connected to the downturned end portion of the extension member. The device operates in the manner of a C clamp wherein the downward pressure of the base member against the exterior surface of the abdomen applies an upward pressure to the retractor blade. This clamping action holds the retractor securely in place, leaving the assistant and nurse available at all times for their primary duties of aiding and serving the surgeon.

The invention will be better understood and additional objects and advantages will become apparent from the following description of the preferred embodiment illustrated on the accompanying drawing. Various changes may be made in the details of construction and arrangement of parts and certain features may be used without others. All such modifications within the scope of the appended claims are included in the invention.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a fragmentary sectional view of a patient with the thighs flexed on the abdomen in the lithotomy position, showing the application of the present retractor in the performance of a vaginal hysterectomy;

FIG. 2 is a view on the line 2--2 in FIG. 1;

FIG. 3 is a view on the line 3--3 in FIG. 2;

FIG. 4 is a view on the line 4--4 in FIG. 3;

FIG. 5 is a view on the line 5--5 in FIG. 3; and

FIG. 6 is a view on the line 6--6 in FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 shows a step in the performance of a vaginal hysterectomy as the uterus 10 is being pulled out through the vagina 11 by tenaculum forceps 12. A circular incision at 13 has severed the connection between the uterus and the vaginal wall. A conventional weighted speculum 14 is used as a lower retractor to pull the lower vaginal wall downward. The upper vaginal wall is pressed upward by an upper retractor 20 which embodies the invention.

A flat, generally triangular base member 21 fits between the thighs 22 as shown in FIG. 6 and bears against the suprapubic area 23 of the lowest part of the abdomen 24. The pubic bone is indicated at 25, the urinary bladder at 26 and the urethra at 27. In addition to base member 21, the upper retractor 20 further comprises an extension member 30 and a blade member 31.

Extension member 30 and blade member 31 are each of L-shape. The upper part of extension member 30 overlies base member 21 and contains a longitudinal slot 35 which receives a bolt 36 extending through a hole in base member 21. A nut 37 and washer 38 secure the members 21 and 30 together in adjustable relation. Extension member 30 has a downturned end portion 40 extending from a curved angle portion 41. Extension member 30 is preferably made of stainless steel of suitable thickness to provide sufficient malleability in the curved portion 41 so that the surgeon can adjust the angle at 41 to fit the patient.

Blade member 31 is also preferably made of stainless steel but it may also be made of a plastic material if desired. Blade member 31 has an upturned exterior end portion 45 having a tapered slot 46 receiving a bolt 47 in a hole in the downturned end portion 40 of extension member 30. A nut 50 and washer 51 secure the parts 40 and 45 together in adjustable relation. The lower end of slot 46 has a width approximately equal to the diameter of bolt 47 while the upper end of the slot is somewhat narrower, as shown in FIG. 2, in order to retain the parts in assembled relation when the nut is loosened.

End portion 45 is sufficiently resilient to permit bolt 47 to be forced out of the upper end of slot 46 so that members 30 and 31 may be readily separated from each other when desired without removing nut 50. The upper ends of slot 46 are beveled at 55 so that when the bolt is placed in the position indicated at 47a in FIG. 2, it may be forced back into the end of the slot 46.

The separability of members 30 and 31 allows the horizontal portion 56 of blade member 31 to be inserted by itself. Then base member 21 and extension member 30 may be assembled on and removed from the blade member 31 repeatedly, if necessary, while adjusting the malleable bend at 41 by trial and error to fit the patient. While this is being done, base member 21 and bolt 36 are adjusted along slot 35 and this connection is secured by tightening nut 37. Finally, nut 50 is tightened at a point in slot 46 that will produce the desired upward pressure on the inserted portion 56 of the blade member 31.

The inserted portion 56 of the blade member 31 is directly under the upper arm of extension member 30 and base member 21 to form a C clamp when the parts are properly adjusted. The curved channel-shape of blade member 31 is shown in FIGS. 4 and 5. This provides a concave under surface on the inserted portion 56 to provide as much operating space as possible and at the same time, the inserted portion 56 underlies and protects the urethra 27 and bladder 26 during the operating. The angle between the exterior and inserted portions 45 and 56 of the blade is preferably somewhat less than 90.degree. to aid in keeping the blade inside the patient and under the public bone 25 when upper traction is applied. The end 57 of the retractor blade is bluntly pointed for ease of insertion into the first small opening made in the peritoneum.

Also to aid in keeping the blade inside the patient, the angle at 41 is adjusted to cause the toe end 60 of base member 21 to bear most firmly against the abdomen with heel end 61 slightly elevated as shown in FIG. 1. This places base member 21 and blade portion 56 in near parallelism and slightly convergent at their ends 60 and 57. The base member is prevented from sliding to the right by the patient's thighs as shown in FIG. 6.

Claims

Having now described my invention and in what manner the same may be used, what I claim as new and desire to protect by Letters Patent is:

1. An anterior vaginal retractor comprising a generally triangular base member adapted to fit between the thighs of a patient, when the thighs are flexed forward toward the patient's head, and bear against the superapubic area of the lowest part of the abdomen, a malleable and resilient L-shaped extension arm adapted for positioning between the patient's thighs, an adjustable length connection between one end of said arm and the apex of said triangular base member, an L-shaped blade member having one end adapted to be inserted into the vagina of said patient and an exterior end adapted for positioning between the patient's thighs and overlapping the other end of said extension arm, and an adjustable length connection between the overlapping parts of said extension arm and blade member.

2. A retractor as defined in claim 1, said retractor being adjustable by said adjustable connections and by the malleability and resilience of said extension arm to cause said base member to bear against the abdomen primarily at the broad end of said base member which is remote from said apex.