U.S. patent number 3,709,215 [Application Number 05/101,911] was granted by the patent office on 1973-01-09 for anterior vaginal retractor for vaginal surgery.
Invention is credited to Stanley M. Richmond.
United States Patent |
3,709,215 |
Richmond |
January 9, 1973 |
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.
Inventors: |
Richmond; Stanley M. (Eugene,
OR) |
Family
ID: |
22287126 |
Appl.
No.: |
05/101,911 |
Filed: |
December 28, 1970 |
Current U.S.
Class: |
600/206; 600/215;
600/235; 606/205 |
Current CPC
Class: |
A61M
29/00 (20130101); A61B 1/32 (20130101); A61B
17/02 (20130101); A61B 17/42 (20130101) |
Current International
Class: |
A61M
29/00 (20060101); A61B 17/02 (20060101); A61B
1/32 (20060101); A61B 17/42 (20060101); A61b
017/02 (); A61m 029/00 () |
Field of
Search: |
;128/3,20,242,243,244,345,346,341 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
179,309 |
|
Nov 1906 |
|
DD |
|
481,798 |
|
Aug 1929 |
|
DD |
|
Primary Examiner: Pace; Channing L.
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.
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.
* * * * *