U.S. patent number 3,863,639 [Application Number 05/457,906] was granted by the patent office on 1975-02-04 for disposable visceral retainer.
Invention is credited to Richard N. Kleaveland.
United States Patent |
3,863,639 |
Kleaveland |
February 4, 1975 |
DISPOSABLE VISCERAL RETAINER
Abstract
A collapsible disposable retainer device for insertion beneath
an abdominal incision for temporarily retaining viscera inside the
abdominal cavity of a patient during closure of an abdominal
incision following surgery. The retractor is in the form of a flat
oval-shaped piece of transparent flexible plastic or rubber
material which has a peripheral tubular bladder inflatable with air
or other gas from an inflation device to impart rigidity to the
structure during use. Following use the bladder is emptied of gas
and the retractor collapsed, permitting its ready withdrawal from a
small opening left in the abdominal incision.
Inventors: |
Kleaveland; Richard N.
(Spokane, WA) |
Family
ID: |
23818537 |
Appl.
No.: |
05/457,906 |
Filed: |
April 4, 1974 |
Current U.S.
Class: |
128/850; 606/148;
600/207; 600/208 |
Current CPC
Class: |
A61B
17/0493 (20130101); A61B 17/0293 (20130101); A61B
2017/00557 (20130101); A61B 2017/0225 (20130101); A61B
2017/0212 (20130101) |
Current International
Class: |
A61B
17/02 (20060101); A61B 17/00 (20060101); A61b
017/00 (); A61b 019/00 () |
Field of
Search: |
;128/20,132,255,341,344,33R,334R |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Comprehensive Guide to Purchasing, V. Mueller & Co., 1956, page
829, Items SU-15800-15807..
|
Primary Examiner: Medbery; Aldrich F.
Attorney, Agent or Firm: Chernoff & Vilhauer
Claims
What is Claimed is:
1. A collapsible retainer including means for temporarily retaining
the body contents inside a patient during the suture of an incision
following surgery, comprising:
a. a biologically sterile sheet of flexible, crushable material
configured to fit within and beneath said incision;
b. an inflatable rib-like bladder formed in said sheet;
c. inflation means connected to said bladder for forcing gas into
said bladder to render said sheet substantially flat and rigid;
and
d. exhusting means connected to said bladder for releasing said gas
therefrom to collapse said sheet.
2. The retainer of claim 1 wherein said inflatable bladder is
tubular in shape.
3. The retainer of claim 1 wherein at least a portion of said
inflatable bladder is formed in said sheet near a peripheral
portion thereof.
4. The retainer of claim 3 adapted for abdominal surgery wherein
said sheet includes a narrow flange portion formed along the
periphery thereof for providing a flap-like surface adapted for
tack-stitching said retractor to the peritoneal surface of the
patient's abdomen.
5. The retainer of claim 1 wherein the shape of said sheet is
substantially oval.
6. The retainer of claim 1 wherein said sheet material is
transparent.
7. The retainer of claim 1 wherein said sheet is of a material
sterilizable by gas autoclaving.
8. The retainer of claim 1 wherein said inflation means comprises a
tube connected to sand bladder and injecting means for forcing gas
into said bladder through said tube.
9. The retainer of claim 1 wherein said exhausting means comprises
a tube connected to said bladder and valve means associated with
said tube for controllably releasing gas from said bladder through
said tube.
10. The retainer of claim 9 wherein said tube portion of said
exhausting means is non-collapsible and comprises a first segment
having a plurality of spaced vents disposed interior to said
bladder and a non-vented second segment disposed exterior to said
bladder, and said valve means is connected to said second segment
at the end thereof which is opposite the connection of said tube
with said bladder.
11. The retainer of claim 10 wherein said vale means is a
bidirectional control valve and said inflation means comprises said
tube, said valve means, and a pressurizer means disposed at the end
of said tube opposite its connection with said bladder for
increasing the pressure of said gas interior thereto.
12. The retainer of claim 11 wherein said bidirectional control
valve comprises a stopcock.
13. The retainer of claim 11 wherein said bidirectional control
includes a flutter-valve.
14. The retainer of claim 11 wherein said pressurizer means
comprises a piston syringe.
15. The retainer of claim 11 wherein said pressurizer means
comprises a bulb syringe.
16. The retainer of claim 1 wherein all of the components forming
said retractor are comprised of materials sterilizable by gas
autoclaving.
17. The retainer of claim 1 wherein said inflation means and said
exhausting means are detachably connected to said bladder.
18. A collapsible visceral retainer, including means for
temporarily retaining the visceral contents inside the abdominal
cavity of a patient durint the suture of an abdominal incision
following surgery, comprising:
a. a biologically sterile sheet of flexible, crushable material
configured to fit within and beneath said abdominal incision;
b. an inflatable tubular-shaped bladder rib formed in said sheet
near a peripheral portion thereof;
c. inflation means connected to said bladder rib for forcing gas
into said bladder rib to render said sheet substantially flat and
rigid; and
d. exhausting means connected to said bladder rib for releasing
said gas therefrom to collapse said sheet.
19. The retainer of claim 18 wherein said tubular bladder rib is
arranged to extend along substantially the entire length of said
sheet adjacent the periphery thereof.
20. A collapsible visceral retainer, including means for
temporarily retaining the visceral contents inside the abdominal
cavity of a patient during the suture of an abdominal incision
following surgery, comprising:
a. a biologically sterile sheet of flexible, crushable material
configured to fit within and beneath said abdominal incision;
b. an inflatable bladder rib formed in said sheet; and
c. inflation means connected to said bladder rib for forcing gas
into said bladder rib to render said sheet substantially flat and
rigid and for releasing said gas therefrom to collapse said
sheet.
21. A method for using a visceral retainer of the type comprised of
a sheet of flexible, collapsible material having an inflatable
bladder formed therein, for temporarily retaining the visceral
contents inside the abdominal cavity of a patient during the suture
of an abdominal incision following surgery, comprising:
a. placing said retainer while in a collapsed state in the
patient's abdomen between the incision and the viscera so that the
edges of the incision overlap said retainer;
b. inflating said retainer by forcing gas into said bladder to
cause said sheet to lie substantially flat and rigid;
c. partially suturing the incision by closing it over substantially
the entire length thereof but leaving a small opening therein;
d. collapsing said retainer by deflating said bladder subsequent to
said partial suture of the incision; and
e. removing said retainer from the patient's abdomen through said
opening.
22. The method of claim 21 further characterized in that said
retainer includes a gas conducting tube connected to said
inflatable bladder and having a segment extending exterior thereto,
and wherein said step (a) of placing said retainer while in the
collapsed state within the patient's abdomen includes disposing
said exterior tube segment through the incision so as to protrude
outside the patient's body and said step (e) of removing said
collapsed retainer from the patient's abdomen through said opening
is initiated by pulling on said tube.
Description
BACKGROUND OF THE INVENTION
This invention relates to a collapsible disposable shield or
retainer, sometimes known as a retractor device for insertion
beneath an abdominal incision for temporarily retaining viscera
inside the abdominal cavity of a patient during suturing of an
abdominal incision following surgery.
IN the closure of an abdominal incision of a patient following
surgery, the intestines of the patient tend to protrude up through
the incision, thereby interfering with the suturing operations of
the surgeon and there is a danger that the suturing needle may
lacerate or puncture viscera. Thus, it would be advantageous to
provide a retainer device which would both temporarily retain the
intestines and other viscera while the abdominal incision is being
closed and protect them from damage during suture.
Heretofore a reusable piece of thick, flexible material, typically
an oblong piece of latex rubber approximately 8 inches long, 4
inches wide and 1/16th of an inch in thickness with a center
reinforcing piece, referred to as a "fish" in the surgical
profession, has been placed between the abdominal incision and
viscera during suture to minimize the aforementioned problems.
However, the prior art "fish" device is not large enough to utilize
in some incisions and its edges are flexible and floppy, allowing
the intestines to find a way, between the material and the
pertioneal surface, to protrude into the incision. Furthermore, if
a large piece of rubber were used it would necessarily have so much
mass that upon being withdrawn near completion of the suture, a
large opening would necessarily remain through which bowel could
protrude thus hampering prompt and effective closing of the
incision.
SUMMARY OF THE PRESENT INVENTION
In order to overcome the aforementioned difficulties in the closing
of an abdominal incision, the present invention utilizes a sheet of
strong, light, filexible, transparent material of appropriate size
and shape, depending upon the dimensions of the incision, having an
inflatable peripheral tubular bladder. Air or other gas for
inflating the bladder portion is introduced and expelled through a
non-collapsible vented tube disposed within the peripheral bladder
which connects at one end of the retractor to a pump or other
device for injecting gas into the bladder portion. The retractor
piece also has a thin flap formed entirely around its perimeter
which may be used to retain it in place during suture, if necessary
or desired, by temporarily tack-stitching the flap to the
peritoneal surface of the abdomen with a fine absorbable
suture.
Once the retractor is placed inside the abdoment, its bladder
portion is inflated by forcing gas, typically air, into it through
the vented tube disposed therein, thus imparting sufficient
rigidity to the retractor to blockingly retain any intestines which
might otherwise tend to protrude through the incision. At the same
time the retractor, being made of a flexible material, is not
easily expelled from the abdomen by movements of the patient. The
viscera are protected from damage by the suturing needle because
the inflated peripheral bladder holds the closure in such a
position that there is a sizeable clearance space created between
the incision closure and the intestine material pressed beneath the
center of the retractor, and the thickness of the retractor
material itself acts as a shield against accidental puncture of the
intestines by the needles used for suture. In addition, the
retractor entirely closes the incision opening, thereby preventing
heat from escaping, and, since the retractor is of transparent
material, the surgeon can easily view the viscera during closure of
the abdominal opening to determine if there is any bleeding.
With the retractor in place the incision is sewn up, leaving an
opening of approximately one-half inch diameter at the point where
the exterior portion of the air tube connects to the bladder of the
retractor. The retractor is then collapsed to reduce its mass to a
very small size by exhausting the gas therefrom and, being of
flexible material, it can then readily be pulled out through the
small remaining opening by utilizing the tube as a means of
withdrawal. The entire retractor may then be discarded since it is
readily and economically fabricated in high volume production from
inexpensive plastic material.
It is therefore a principal objective of this invention to provide
a novel and improved abdominal contents retractor for temporarily
retaining the viscera of a patient during suture of an abdominal
incision following surgery.
It is another principal objective of this invention to provide an
abdominal retractor of the type described which is collapsible to a
small mass for permitting its ready removal through a small opening
in the incision.
It is a principal feature of this present invention to provide a
novel abdominal contents retractor of inexpensive manufacture which
may be economically disposed of following a single use.
It is another feature of this invention to provide an inflatable
and collapsible bladder-like abdominal retractor of the type
described which integrally incorporates means for inflating and
deflating the bladder portion thereof.
It is yet another feature of this invention to provide an
inflatable bladder-like abdominal retractor of the type described
having a peripheral sewing flap for its temporary retention in
place by tack-stitching of the retractor to the peritioneal surface
of the abdomen.
It is a principal advantage of the retractor of the present
invention that the intestines of a patient are prevented from
moving around the edges of the retractor and protruding into the
abdominal incision.
It is another principal advantage of the retractor of this
invention that the patient's viscera are protected from damage by
the suturing needle.
It is still another principal advantage of the present invention
that the retractor, being made of transparent material, enables the
surgeon to view the patient's viscera, while closing the incision,
for detection of bleeding.
And it is yet another advantage of this invention to provide a
retractor which will completely isolate an abdominal incision from
the viscera in order to facilitate suturing and prevent heat loss
from within the patient's abdomen.
The foregoing and other objectives, features, and advantages of the
invention will be more readily understood upon consideration of the
following detailed description of the invention, taken in
conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a top view of an embodiment of an abdominal retractor in
accordance with the present invention.
FIG. 2 is a top view of the abdominal retractor positioned in the
abdomen of a patient.
FIG. 3 is a sectional view taken along lines 2--2 of FIG. 2.
FIG. 4 is a side view of the retractor in the process of removal
from the abdomen of a patient.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to FIG. 1, the abdominal contents retractor or retainer
10 is an oblong, generally oval-shaped flat and thin piece of
strong flexible material such as plastic film having a continuous
tubular gas-inflatable bladder 12 formed in the material near its
perimeter. A relatively small-diameter gas tube, of a
non-collapsible, flexible material such as polyethylene (e.g.,
Bardic 1711 Levin-type stomach tube), is connected to the bladder
at one end 15 of the retractor and has an interior portion 14 with
spaced vents 16 disposed within the bladder 12, and an exterior
portion 18 without vents which provides a path for entry and exit
of gas to and from the bladder. The tube portion 14 with the spaced
vents 16 provides a non-collapsible conduit, therby permitting gas
in all parts of the bladder to readily escape when the bladder is
deflated. This arrangement thus prevents trapped air pockets from
forming during deflation which would otherwise render the retractor
too large to be conveniently removed through a small, approximately
one-half inch diameter opening in the incision. In addition, a
plurality of stiffener ribs (not shown) may also be provided, if
desired, in the center of the retractor to furnish additional
rigidity to the center of the retractor. These ribs should fan out
radially from the end 15 to which the exterior portion 18 of the
gas tube connects so that they do not hinder removal of the
retractor from the small opening left in the incision. The ribs may
be bladder-like, similar and connnected to the peripheral bladder,
or, in order to avoid accidental puncture during suturing, they may
be made of a solid flexible material such as nylon strips.
The exterior portion of the gas tube 18 connects to an operating
apparatus such as an aspirator syringe bulb 22 (e.g., Travenol
Medaseptic MP syringe, 2 oz. neonatal size, code no 202194) with an
associated control and venting valve 24 for forcing gas, typically
air, into the bladders of the retractor and releasing it therefrom.
Alternately a gas cartridge or piston-type syringe could be
utilized instead of the bulb-type syringe 22 as the means for
inflating the retractor. The inflation and venting devices may be
an integral part of the retractor so that the entire unit can
undergo sterilization prior to use by a method such as gas
autoclavation, or it may also be feasible, for example, to have the
pressurizing device 22 and control valve 24 reusable, with the rest
of the retractor disposable after a single use.
The retractor may be fabricated, for example, by stamping two
similar oval-shaped pieces out of polyethylene, vinyl, rubber
(e.g., Latex as used for disposable rubber gloves), or other
appropriate material, and then gluing or heat-sealing them together
in a pattern which defines the tubular bladder portion. If adhesive
polyethylene such as Steri-Drape No. 1050 (3M Company) is used, the
oval bladder shape may be formed separately as a tubular body from
non-adhesive polyethylene material and then sandwiched between two
larger adhesive sheets to form the inflatable chamber. The vented
portion of the gas tube 14 is most easily installed by placing it
between the two pieces of material forming the bladder prior to
sealing the sandwich-like combination, the gas tube extending
through an opening in the material at one end 15 of the retractor
and connecting to either the inside edge, as shown, or the outside
edge of the bladder.
In practice, an appropriate retractor 10 should be chose from among
a group of standard sizes and shapes, depending upon the size and
shape of the patient's incision, and, as shown in FIGS. 2 and 3,
temporarily placed in the patient's abdomen 25 between the incision
26 and the viscera 28, a typical incision for abdominal surgery
extending from the xyphoid 30 to the pubis 32. The retractor is
placed so that the end 15 to which the exterior portion 18 of the
gas tube connects is at the end of the incision which will be
closed last, the tube extending through the last portion of the
incision to be closed.
In order to insure that the retractor remains in place during
sutura, a sewing flange 34 is provided around the periphery of the
retractor for tack-stitching it to the pertioneal surface of the
abdomen if deemed necessary. Once the retractor is in place, gas is
forced into the bladder to inflate it and suture of the incision
may proceed. The retractor may also be used in a similar manner to
temporarily seal off the chest cavity during lung surgery in order
to permit inflation of a lung.
When the retractor 10 is installed, the edges 36 of the incision
overlap it, sealing off the viscera. This prevents the intestines
38 from moving over the edges of the retractor and protruding into
the incision, and also reduces heat loss from the patient's body.
By making the retractor wholly or partially from transparent
material a window 40 is centrally provided therein, as shown in
FIGS. 1 and 2, permitting viewing of the internal organs to
determine if there is any bleeding. The gas-filled bladder of the
retractor is protected from puncture because suturing takes place
over the center of the retractor where there is no inflated bladder
portion, and the space between the incision edges and the retractor
surface, as well as the retractor material itself, protect the
viscera from puncture by the suturing needle. As a convenience in
abdominal surgery where, as shown in FIG. 2, the top edge of the
retractor is inserted underneath the sternum, the end of the
exterior tube 18 connecting to the bladder is configured to fold
down and lie against the face of the retractor.
Suture is accomplished by sewing the incision together, leaving an
opening 42 approximately 1/2 inch in length adjacent the end 15 to
which the exterior portion of the tubing 18 is connected, as shown
in FIG. 4. The gas in the bladder is then released through opening
of the vent valve 24, deflating the retractor and reducing its
mass. The retractor 10 is next withdrawn from the abdomen initially
using the tubing 18 to pull it out through the small opening 42
which is subsequently closed with little or no interference from
intestines. The retractor may then simply be discarded.
The terms and expressions which have been employed in the foregoing
abstract and specification are used therein as terms of description
and not of limitation, and there is no intention in the use of such
terms and expressions of excluding equivalents of the features
shown and described or portions thereof, it being recognized that
the scope of the invention is defined and limited only by the
claims which follow:
* * * * *