U.S. patent number 3,782,370 [Application Number 05/271,037] was granted by the patent office on 1974-01-01 for surgical retractor.
Invention is credited to Bernard McDonald.
United States Patent |
3,782,370 |
McDonald |
January 1, 1974 |
SURGICAL RETRACTOR
Abstract
This surgical retractor has a pair of opposed slat-like sides
interconnected by an elastic V-shaped end piece so that the side
slats are elastically bowed in arcuate paths with the concave sides
of the slats facing each other. Each of the slats has cooperating
ratchet and pawl arrangements to permit substantially free
lengthwise extension and restricted lengthwise retraction for
enlarging the size of the retractor. An extensible inflatable tube
extends around the retractor and is intermittently connected
thereto for extending the retractor in response to increasing fluid
pressure in the tube.
Inventors: |
McDonald; Bernard (Malibu,
CA) |
Family
ID: |
23033930 |
Appl.
No.: |
05/271,037 |
Filed: |
July 12, 1972 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
230299 |
Mar 1, 1972 |
|
|
|
|
Current U.S.
Class: |
600/207; 600/208;
600/215 |
Current CPC
Class: |
A61B
17/0293 (20130101); A61B 2017/00557 (20130101); A61B
2017/00539 (20130101) |
Current International
Class: |
A61B
17/02 (20060101); A61B 17/00 (20060101); A61b
017/02 () |
Field of
Search: |
;128/17,18,20,344,345 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Attorney, Agent or Firm: Robert L. Parker et al.
Parent Case Text
This application is a continuation-in-part of my copending
application, Ser. No. 230,799, filed Mar. 1, 1972.
Claims
What is claimed is:
1. A surgical retractor comprising:
a first elongated elastic side slat;
a second elongated elastic side slat facing the first slat;
means for freely extending the length of the first and second slats
and resisting contraction thereof; and a V-shaped end piece at
least partially elastically deflectible at each end of the
retractor connecting each end of the first slat to the respective
end of the second slat with mutual divergence of the two slats at
each end so that the slats elastically bow in mutually spaced apart
arcuate paths between their ends with the concave sides of the
slats facing each other.
2. A surgical retractor as defined in claim 1 wherein the means for
extending comprises an extensible inflatable tube on the outside of
the slats and intermittently connected thereto.
3. A surgical retractor as defined in claim 2 further comprising
means for inflating the tube.
4. A surgical retractor as defined in claim 1 wherein each slat
comprises a pair of interengaging side pieces slidable lengthwise
relative to each other, and wherein the means for extending
comprises:
ratchet means on one of the side pieces and pawl means on the other
side piece cooperating for substantially free lengthwise extension
and restricted lengthwise contraction.
5. A surgical retractor as defined in claim 4 wherein each of the
side pieces comprises a curved transverse web, the two webs having
their concave sides facing each other and wherein the ratchet means
comprises a plurality of teeth spaced along the length of the
concave side of one web and the pawl means comprises at least one
tooth on the concave side of the other web for engaging the ratchet
teeth.
6. A surgical retractor as defined in claim 5 wherein one of the
side pieces comprises a pair of opposed hook-like flanges extending
lengthwise along the side edges on the concave side of the lip and
wherein the web of the other side piece fits between the
flanges.
7. A surgical retractor as defined in claim 5 wherein each of the
side slats includes a pair of spaced apart ribs extending along the
length thereof for forming a channel for receiving tissue adjacent
a surgical incision or the like.
8. A surgical retractor as defined in claim 7 wherein the means for
extending further comprises means for slidably extending the side
pieces relative to each other in response to increasing fluid
pressure.
9. A surgical retractor as defined in claim 8 wherein the means for
slidably extending comprises an extensible inflatable tube in the
channel and connected to each side piece.
10. An extension side piece for a surgical retractor of the type
having at least a pair of side slats interconnected by a pair of
end pieces that cause the side slats to mutually diverge
comprising:
an elastic slat having a male cross section for about half its
length and a female cross section for about half its length;
ratchet means extending along one of the half lengths; and
pawl means on the other half length, said ratchet means and pawl
means for cooperating with corresponding pawl means and ratchet
means respectively, for substantially free lengthwise extension and
restricted lengthwise contraction.
11. An extension piece as defined in claim 10 wherein the female
cross section comprises:
a transverse web; and
a pair of opposed hook-like flanges extending along opposite edges
of the web; and the male cross section comprises:
a transverse web fittable between the flanges of a female member
having a cross section like that of the female half; and wherein
the ratchet means is along one web and the pawl means is on the
other web.
12. An extension piece as defined in claim 11 further comprising an
extensible inflatable tube connected to one face of the elastic
slat on one of its half lengths.
Description
BACKGROUND OF THE INVENTION
Surgical retractors are used for spreading apart or separating the
walls of natural body orifices or for spreading the margins of
surgical incisions. With the edges of an incision spread apart, the
surgeon has access to the underlying tissues or organs permitting a
clear view of the surgical site and access for a desired surgical
or medical treatment. Thus, for example an abdominal retractor may
be used in an abdominal incision to hold back the skin,
subcutaneous fat and the internal peritoneal wall for ready access
to the many abdominal organs.
In the past, a variety of surgical retractors have been employed.
Hand retractors are typically steel instruments with a broad
hook-like flap at one end for fitting over the tissue to be
retracted. These are then pulled apart by hand and may be held or
clamped during the surgical procedure. Some surgical retractors
have arms that are interconnected by a gear or rack and pinion
arrangement so that they can be cranked apart and locked in
position. Another surgical retractor has four pivotally connected,
rigid, curved links which can be clamped in any desired position to
hold an incision open. Still another surgical retractor has a rigid
peripheral ring with multiple detachable and movable blades that
can be clamped at any point on the ring to hold a surgical site
open.
Typically, such instruments have been made of stainless steel so as
to be sterilizable between surgical procedures. The instruments are
relatively heavy and stout because, in some cases, substantial
forces may be involved in opening an incision and keeping it open.
Since specially made, the instruments are expensive and it is
costly to repetitively sterilize them and maintain sterility for
surgery. Some of the more complicated retractors need to be taken
apart for cleaning after surgery and reassembled before use.
It is desirable to provide a retractor that is sufficiently
inexpensive that it can be disposed of after a single use thereby
obviating cleaning and sterilization between uses. Such an
instrument should be simple, rugged and versatile. Preferably such
a retractor is enlarged without excessive effort on the part of the
surgical staff.
BRIEF SUMMARY OF THE INVENTION
There is, therefore, provided in practice of this invention
according to a presently preferred embodiment a surgical retractor
having a pair of elongated elastic slats interconnected at their
respective ends by a V-shaped end piece with divergence at each end
so that the slats elastically bow in arcuate paths therebetween.
Ratchet means are provided for freely extending the length of the
slats and resisting longitudinal contraction thereof. An extensible
inflatable tube may be used around the retractor for extension
thereof in response to fluid pressure.
DRAWINGS
These and other features and advantages of the present invention
will be appreciated as the same becomes better understood by
reference to the following detailed description of a presently
preferred embodiment when considered in connection with the
accompanying drawings wherein:
FIG. 1 illustrates in a general plan view a surgical retractor
constructed according to principles of this invention;
FIG. 2 is a transverse cross section of one extendible side arm of
the retractor of FIG, 1;
FIG. 3 illustrates in side view a side piece for the surgical
retractor;
FIG. 4 is a fragmentary longitudinal cross section of an extension
ratchet on the side piece; and
FIG. 5 is a fragmentary perspective view of an inflatable extension
tube on the retractor.
DESCRIPTION
FIG. 1 illustrates in plan view an embodiment of surgical retractor
constructed according to principles of this invention. As
illustrated in this embodiment, a pair of elastically bendable and
freely extensible side slats are each formed of a pair of extension
pieces 10. At each end of the surgical retractor, there is a
somewhat V-shaped end piece 11 so that the retractor has a
generally elongated double curved outline approximately as
illustrated in FIG. 1. The elastically bent side pieces 10 are
interconnected by the end pieces 11 which are also elastic but with
a somewhat higher section modulus adjacent the tip of the V to
maintain the desired shape.
Each of the side slat pieces 10 has a male cross section for about
half its length and a female cross section for about half its
length. An outside view of one of the side slats is seen in FIG. 3.
One end 12 has a male cross section and the other end 13 has a
female cross section illustrated in the transverse cross section of
FIG. 2.
FIG. 2 is a transverse cross section of a pair of the side slats in
the portion where the male and female portions 12 and 13,
respectively, are engaged. The female member 13 has a curved web 14
forming its principal vertical extent. On its inner or concave
side, that is, the side facing the male portion 12 of the other
side slat of the surgical retractor, the female end has a raised
lip 16 along the top and bottom edges. On its outside face, the
female end has a pair of hook-like flanges 17 extending along the
length. Very broadly, the female end thus has a transverse cross
section somewhat like an I-beam.
The male end 12 also has a curved web 18 extending as the principal
portion of its height. The curvature of the two webs 14 and 18 is
such that they bow apart from each other. The opposite edges of the
web 18 fit into the re-entrant channel formed by the hook-shaped
flanges 17 on the female portion. Thus, the male end is kept
captive in a transverse direction but is free to slide in a
longitudinal direction along the female end of an adjacent piece. A
pair of ribs 19 extend outwardly from the web 18 along the length
of the male portion. The ribs 19 are spaced a short distance apart
from the edges of the web 18 so as to clear the tips of the
hook-shaped flanges 17. Thus, the male portion of the side slat
piece has a transverse cross section somewhat in the shape of a
bench or Greek letter pi.
A series of ratchet teeth 21 extend along the length of the inside
of the web 18 on the male end. A short row of pawl teeth 22 are
provided on the outer face of the web 14 on the female end as may
be seen in FIG. 4 which comprises a fragmentary longitudinal cross
section thereof.
As best seen in FIG. 2, the pawl teeth 22 engage the ratchet teeth
21 between the webs 14 and 18 of the female and male ends of
adjacent pieces. The teeth of the ratchet and pawl are oriented to
permit motion in a direction tending to extend the length of the
side slat formed of the interconnected male and female ends of the
extension pieces. The teeth inhibit or restrict lengthwise
contraction of the side slat. The pawl teeth can ride over the
ratchet teeth due to elastic deformation of the webs 14 and 18 as
cammed apart by the teeth.
The end V-shaped pieces 11 are also provided with male and female
end portions analagous to those on the side slat extension pieces.
This permits assembly of any desired combination of end and side
pieces and relative extension of the end piece relative to a side
piece as well as extension between a pair of adjacent side
pieces.
When it is desired to release the ratchet and pawl arrangement thus
provided, one need only pinch the female portion at its side edges
adjacent the flanges 17. Such pinching causes the curved webs to
bend further and be spaced apart a greater distance at their mid
section thereby disengaging the pawl teeth from the ratchet teeth
and permitting the side slats to be contracted in a lengthwise
direction.
A pair of stop teeth 23 are provided on the web 14 of the female
portion and a corresponding pair of stop teeth 24 are provided on
the web 18 of the male portion. These teeth 23 and 24 face
oppositely to the ratchet and pawl teeth. This permits the male end
of one extension piece to be inserted into the female end of
another extension piece, however, it limits the extent of
withdrawal of the two parts so that over-extension of the side
slats is avoided.
In order to use the surgical retractor in, say, an abdominal
incision, the incision is made and the retractor inserted in a
contracted state. Typically, the side slats are substantially
straight or only slightly curved when made and when inserted into
the incision. The side slats may be held close to each other when
the retractor is inserted. The flesh to be retracted fits between
the two ribs 19 on the male portions of the slat length and the
flanges 17 on the female member along the rest of the slat length
and is, hence, held substantially captive in the channels adjacent
the webs 18 and 14.
After positioning the retractor in the incision, the two side slats
may be spread apart. As the slats diverge adjacent their ends as
they are spread apart, they elastically bend along their length in
a plane transverse to the webs. This elastic bowing of the side
slats forms a double curved opening between the sides of the
retractor approximately as shown in FIG. 1. In addition to
increasing divergence of the side slats, their length may also be
increased merely by forcing the two end portions of the surgical
retractor away from each other. This activates the ratchet and pawl
arrangement between the male and female portions and permits
longitudinal extension of the retractor. Such longitudinal
extension may be employed for lengthening the available surgical
site or may merely provide the additional length required as the
side slats are bowed apart. It will be noted that as the stresses
due to tissue being retracted increase as the surgical site is
opened, the curvature of the side slats typically increases as well
thereby strengthening the slats against buckling. Since both the
angle at the end of the slats and the length of the slats is
adjustable, the retractor is quite versatile and may be used in
long narrow openings or short wide ones.
When it is desired to close the surgical site, the retractor can be
collapsed quite readily. The length of the side slats is decreased
by pinching the upper and lower edges of the side slats adjacent
the pawl teeth towards each other thereby further bowing the webs
14 and 18 and disengaging the pawl teeth 22 from the ratchet teeth
21. The male portion can then slide into the female portion freely
for contracting the side slats.
A surgical retractor as described can be enlarged by manually
spreading the sides and extending the slats. It may be desirable,
however, for minimized effort to provide means for extending the
retractor in response to increasing fluid pressure. An extensible
inflatable tube 26 is therefore provided around the outside of the
surgical retractor. As best seen in FIG. 2, the tube 26 lies
against the web 18 between the ribs 19 on the outside of the
retractor. Preferably the cross section of the tube is flattened to
fit rather closely between the ribs without extending outwardly a
great distance. In those portions of the periphery of a surgical
retractor where the tube is adjacent a female portion of the side
or end pieces it lies between and is generally held captive by the
flanges 17. Preferably the peripheral tube 26 has a bellows-like
configuration over much of its length as illustrated in FIG. 5.
Intermittent smooth portions 27 are provided along the length of
the tube and these smooth portions are adhesively bonded to the web
18 of the male portion of the retractor. The bellows portions 28
between the smooth parts 27 span the intersection between adjacent
male and female portions of the retractor and may extend along the
entire female portion.
A tube 29 is connected to the peripheral tube 26 and leads to a
source of fluid pressure 31. This fluid pressure may be a simple
hand squeeze bulb and release valve so that pneumatic pressure may
be applied within the peripheral tube 26. If desired the connecting
tube 29 can be terminated with a sealing plug through which the
needle of a syringe may be inserted. This permits the tube 26 to be
inflated with a sterile saline solution, for example, so that in
case of rupture of the tube there is no hazard to the patient.
When the inflatable tube is used on a surgical retractor the
retractor is inserted in an incision as hereinabove described in a
collapsed or retracted state. Fluid is then added to the tube and
the inflation causes the bellows portions 28 to extend thereby
causing the pieces of the retractor to slide relative to each other
and enlarge the retractor. Enlargement of the retractor is thus
readily obtained by simple application of fluid pressure.
Retraction of the edges of an incision is thereby made easier for
the surgical team.
The inflatable tube 26 is on the outside of the retractor and
engages the flesh at the edge of the incision thereby cushioning it
from the retractor. Typically, sterilizable silicone rubber or the
like is used for the inflatable tube. It is preferred that the tube
be on the outside of the retractor so as to be remote from the
surgical site, thereby providing a greater assurance against
accidental puncture of the tube during the course of surgery. When
it is desired to remove the retractor from the surgical site the
fluid pressure in the tube is relieved and the retractor ratchets
collapsed in the same manner hereinabove described.
It will also be apparent that if desired the ratchets can be
deleted from the several pieces of the surgical retractor and it
can be maintained in its opened position by the fluid pressure
alone. In that case gradual release of the fluid pressure permits
contraction of the retractor due to the forces of the tissues. Such
retraction may be manually assisted if desired. The end and side
pieces of the retractor are preferably made by die casting or
rubber mold casting of any of a variety of modern plastic or
synthetic materials which have already come into wide use in
hospitals and other medical practice. Many such materials are
readily sterilizable at the time of manufacture and assembly and
are then individually packaged, not to be opened until required for
surgery. Since such retractors can be made economically, they can
be used once and then discarded, thereby obviating cleaning and
resterilization.
The choice of plastic materials is also advantageous in providing
an appropriate degree of elastic bowing of the side slats when the
retractor is used. The shapes of the male and female members
forming the side slats are such that substantial changes in section
modulus can be made without substantial changes in the overall
dimensions of the side slats. If desired, steel strips can be
imbedded in the plastic for controlled stiffness and strength. With
such possible variations, retractors for symmetrical or
asymmetrical opening of surgical sites can readily be provided, and
substantial changes in size and the stiffness of the surgical
retractor can be made in the course of design for particular
applications.
Although limited embodiments of surgical retractor constructed
according to principles of this invention have been described and
illustrated herein, many modifications and variations will be
apparent to one skilled in the art. It is therefore to be
understood that within the scope of the appended claims, the
invention may be practiced otherwise than as specifically
described.
* * * * *