U.S. patent number 3,894,601 [Application Number 05/441,847] was granted by the patent office on 1975-07-15 for surgical support.
This patent grant is currently assigned to Technibiotics, Inc.. Invention is credited to Gidon F. Gestring.
United States Patent |
3,894,601 |
Gestring |
July 15, 1975 |
Surgical support
Abstract
A self-powered mobile support structure for use by a surgeon
wherein the surgeon's arms and legs are supportable in one of a
plurality of positions to facilitate comfort and steadiness during
surgery. A provision for attaching various optical devices, such as
a microscope for use during micro-surgery, is included.
Inventors: |
Gestring; Gidon F. (Maplewood,
NJ) |
Assignee: |
Technibiotics, Inc. (Brooklyn,
NY)
|
Family
ID: |
23754536 |
Appl.
No.: |
05/441,847 |
Filed: |
February 12, 1974 |
Current U.S.
Class: |
180/214; 180/253;
297/344.12; 297/344.18; 297/344.2 |
Current CPC
Class: |
A61B
90/60 (20160201) |
Current International
Class: |
A61B
19/00 (20060101); B62d 061/06 () |
Field of
Search: |
;180/26R,26A,27,42
;297/345,347,348 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
225,214 |
|
Mar 1926 |
|
GB |
|
1,066,691 |
|
Apr 1967 |
|
GB |
|
967,305 |
|
Aug 1964 |
|
GB |
|
Primary Examiner: Friaglia; Leo
Assistant Examiner: Siemens; Terrance L.
Attorney, Agent or Firm: Darby & Darby
Claims
What is claimed is:
1. A support for use by a surgeon during a surgical operation
comprising:
a frame mounted on wheels;
means positioned on said frame for supporting the body and limbs of
said surgeon, said supporting means including a mounting assembly
located over said frame, a seat fastened to said mounting assembly,
a pair of foot supports fixed to said mounting assembly, means for
positioning said foot supports at any one of a plurality of desired
positions on said mounting assembly, a pair of arm supports fixed
to said mounting assembly, means for adjusting the position of said
arm supports on said mounting assembly, the positions of said seat,
foot supports and arm supports relative to each being
adjustable;
means for moving said mounting assembly in the vertical direction
relative to said frame so that said seat, foot supports and arm
supports are moved together as a unit; and
a source of power for driving at least one of said wheels, means
for controlling the direction of rotation of said at least one of
said wheels, and means for steering at least one of said
wheels.
2. A surgical support as recited in claim 1 wherein said means for
controlling the direction of rotation of said wheel includes a
housing mounted on said frame, a control arm pivotally mounted
within and extending partially outside said housing, and switch
means provided within said housing including means for activating
said switch means in one mode when said control arm is pivotted in
one direction and means for activating said switch means in another
mode when said control arm is pivotted in the other direction.
3. A surgical support as recited in claim 1 wherein said steering
means includes a housing comprising a cylindrical portion rotatably
mounted on said frame, said at least one of said wheels being
mounted in said housing cylindrical portion, and handle means for
rotating said housing thereby steering said wheel.
4. A surgical support as recited in claim 1 wherein said means for
moving said mounting assembly includes a screw element rotatably
mounted on said frame, a carriage member threadedly cooperating
with said screw element, means rigidly fastening said carriage
member to said mounting assembly, and means for rotating said screw
element.
5. A surgical support as recited in claim 4 wherein said means for
rotating said screw element includes a reversible motor, a source
of power for driving said motor, and a pair of switch means
associated with each foot support for activating said motor in a
particular direction.
6. A surgical support as recited in claim 1 wherein said mounting
assembly comprises a first mounting member, said seat and said foot
supports being mounted on said first mounting member, and a second
mounting member rigidly attached to and extending upwardly from
said first mounting member, said arm supports being mounted on said
second mounting member.
7. A support for use by a surgeon during a surgical operation
comprising:
a frame;
means positioned on said frame for supporting the body and arms of
said surgeon, said supporting means including a mounting assembly
located over said frame, a seat fastened to said mounting assembly,
a pair of arm supports fixed to said mounting assembly, means for
adjusting the position of said arm supports on said mounting
assembly, the positions of said seat and arm supports relative to
each other being adjustable;
adjustable drive means for propelling said support along the ground
in a particular desired direction;
means journalled to said mounting assembly and slidably associated
with said drive means for mounting a pair of foot supports
thereon;
a pair of foot supports mounted to said foot support mounting means
at one of a plurality of positions;
means for moving said mounting assembly in the vertical direction
relative to said frame so that said seat, foot supports and arm
supports are moved together as a unit.
8. A support as recited in claim 7 wherein said foot support
mounting means are telescopically positioned over said drive
means.
9. A foot support as recited in claim 8 wherein said foot support
mounting means has a vertical slot formed therein and said drive
means has a pin fixed thereon which extends through said slot so
that said foot support mounting means is movable in the vertical
direction relative to said drive means and is fixed thereto upon
rotation.
Description
BACKGROUND OF THE INVENTION
This invention relates generally to surgical supports and, more
particularly, to an adjustable support for a surgeon to facilitate
comfort and steadiness during a surgical operation.
It is not unusual for certain surgical operations to require many
hours for their completion. As more complex surgical procedures are
developed, the duration of operations have increased. During the
course of such surgery, the surgeon, who normally assumes a
standing position adjacent the operating table, inevitably becomes
somewhat fatigued.
For example, open heart surgery in particular is a procedure which
is necessarily of lengthy duration. Rendering such surgery even
more tedious is the fact that micro-surgical techniques which
inherently involve the surgeon executing extremely delicate manual
manipulations are often necessary. As the duration of the operation
increases, the ability of the surgeon to precisely manipulate his
instruments correspondingly decreases. Even during microsurgery of
relatively short duration, unavoidable involuntary body movements
of the surgeon contribute to the difficulty of precisely
manipulating the surgical instruments especially when the area is
viewed under the magnification of a microscope. In fact, these
problems are encountered during macrosurgery as well as
microsurgery.
In the past, surgeons have sought to alleviate these problems by
resting their arms either on the side of the operating table, on
some other convenient fixed object, or on the patient himself. This
of course is not efficient in that an adequate supporting structure
may not always be available in the operating room. Recently,
however, there have been attempts to provide operating supports for
surgeons. Such supports are exemplified in U.S. Pat. Nos. 3,557,791
and 3,754,787 issued Jan. 26, 1971 and Aug. 28, 1973, respectively.
While these devices have at least shown recognition of the problems
described above, they do not provide the most practical answers.
For example, the device shown in U.S. Pat. No. 3,754,787 is not
mobile and cannot, among other things, be precisely repositioned by
the surgeon during the operation to relocate himself at a more
convenient location adjacent the operating table. All of the
supporting surfaces of the device illustrated in U.S. Pat. No.
3,557,791 are not adjustable either individually or as a unit.
Further, specific apparatus for automatically controlling the
relative position of the supporting surfaces with respect to each
other as well as specific means for moving the structure as a unit
are not disclosed.
SUMMARY OF THE INVENTION
Accordingly, one object of the present invention is to provide a
new and improved operating support for a surgeon for use during
surgical operations.
Another object of the present invention is to provide a new and
improved operating support for a surgeon having various supporting
surfaces which are adjustable both individually and as a unit.
Still another object of the present invention is to provide a new
and improved operating support for surgeons which can be
self-propelled in any desired direction.
A further object of the instant invention is to provide a
supporting structure for surgeons on which at least one optical
device may be mounted whose position is both individually
adjustable and adjustable as a unit together with the supporting
structures.
Briefly, in accordance with the present invention, these and other
objects are attained by providing a body support whose height
relative to the ground is automatically adjustable to one of a
plurality of positions by the surgeon supported thereon. Arm and
leg supports are also provided in a similarly adjustable manner.
The body, arm and leg supports are adapted to be individually
positionable relative to each other and/or positionable as a unit
in the vertical direction relative to the ground. A self-contained
power source is provided which together with steering apparatus,
enables the surgical support to be maneuvered by the surgeon toward
or away from the operating table during the operation.
DESCRIPTION OF THE DRAWINGS
A more complete description of the invention and many of the
attendant advantages thereof will be readily appreciated by
reference to the following detailed description when considered in
connection with the accompanying drawings, in which:
FIG. 1 is a perspective view of the surgical support according to
the present invention;
FIG. 2 is an elevation view in partial section of the surgical
support according to the present invention; and
FIG. 3 is a plan view taken in section along line 3--3 of FIG.
2.
FIG. 4 is an elevation view in partial section of another
embodiment of the surgical support according to the present
invention;
FIG. 5 is a section view taken along line 5--5 of FIG. 4;
FIG. 6 is a front view of a transport accessory for use with the
present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring now to the drawings where like reference numerals
designate identical or corresponding parts throughout the several
views and more particularly to FIG. 1, the surgical support
generally denoted as 10, includes a supporting frame 12 which is
itself supported on a tricycle wheel arrangement (FIGS. 2 and 3). A
power source is contained within a housing 14 mounted at the rear
of frame 12 while a drive mechanism 18 is mounted at the forward
end of frame 12 and a body and limb supporting mechanism 16 is
mounted between the housing and drive mechanism. The term "body and
limb supporting mechanism 16" (hereinafter support mechanism 16)
includes all support structure (for example, arm, leg and seat) and
the apparatus to which this structure is mounted.
A brief description of the operation of the surgical support 10
will enable a clearer and more precise description of the structure
of the same. The physician seats himself on a saddle 20 fixed to
the top of a fairing 22 which encloses the various mechanical
elements which are associated with the body and limb supporting
mechanism 16 (hereinafter referred to as support mechanism 16). The
physician then positions his forearms in respective ones of a pair
of arm supports 24 mounted on a support column 25 and his feet on
respective ones of a pair of foot supports 26. In order to
comfortably accommodate physicians of all physical sizes, the
relative positions of the saddle 20, arm rests 24 and foot rests 26
are all adjustable individually with respect to each other in a
manner described in detail hereinbelow. After the relative
positions of the supports have been set by the physician,
preferably prior to commencement of the operation, the entire
supporting mechanism 16 which includes saddle 20, arm rests 24, and
foot rests 26 may then be automatically raised or lowered as a unit
in order to position the physician in the most advantageous
location relative to the operating table. This may be done during
the operation itself. The surgeon may steer the entire surgical
support 10 toward or away from or to a new position adjacent to the
operating table through the manipulation of drive mechanism 18,
i.e., by pulling back or pushing forward on a yoke 28 fastened to a
control bar 30. When the support 10 is used for specialized
applications such as microsurgery, optical devices such as a
microscope 32 (and other suitable devices such, for example, as a
television camera, still camera or movie camera and the like) may
be fastened to the support mechanism 16.
Referring now to FIGS. 2 and 3 the support mechanism 16 will now be
described in greater detail. A pair of spaced cylindrical rods,
conveniently denoted as tracking rod 34 and guide rod 36, are
vertically mounted on frame 12, with their lower ends connected
thereto by a conventional bolt 38 and a mounting block 39 having a
set screw 40, respectively. The upper ends of rods 34 and 36 are
received within cylindrical openings formed in a plate 42. These
rods support plate 42 and are held fast in the openings by
conventional fasteners such as by bolts 44.
An elongated ball screw 46, that is, a shaft having a helical ball
race, is vertically mounted between rods 34 and 36. The lower and
upper ends of the screw 46 are respectively mounted in a ball
bearing 48 fixed to frame 12 and a bearing 50 mounted within plate
42. This permits the screw 46 to rotate about its longitudinal
axis. Screw 46 passes through a carriage 52 having a stepped
diameter bore 54. A ball nut element 56, that is, a bushing whose
inner surface has a helical ball race formed in it, is captured
between a shoulder 58 of bore 54 and a threaded collar 60. A
plurality of balls 61 are captured within ball nut 56 and cooperate
with the respective races formed in the screw and nut. Thus, when
screw 46 is rotated, carriage 52 is either raised or lowered
depending upon the direction of rotation. A bearing 62 is mounted
on each of a pair of stub shafts 64 which extend from the rear of
the carriage on each side of rod 34. The outer rim of each bearing
62 cooperates with the surface of the tracking rod 34 (FIG. 3)
thereby maintaining the carriage angularly fixed relative to the
support mechanism 16.
A pair of ball bushings 66 are retained within a bore 67 formed in
the forward end of carriage 52. These receive guide rod 36 and
reduce the friction between the carriage and the guide rod during
movement of the former over the latter. The combined action of the
tracking rod 34, guide rod 36 and screw 46 serve to insure that the
carriage moves freely upon rotation of the screw without binding or
jamming.
Fairing 22 is a sheet metal piece suitably formed to provide a
wider rear portion 69 connected to a forward narrower portion 68 by
a tapered middle portion 70 (FIG. 3). Saddle 20 is supported on
both the rear and middle portions 69 and 70 of the fairing, this
placement affording sufficient stability and strength. The
particular shape of fairing 22 provides space for the legs of the
physician when he is seated in saddle 20.
A pair of hollow columns 76 (FIG. 3) are rigidly fastened to
opposed inner surfaces of fairing 22 by rivets 77. These columns
provide structural rigidity for the support mechanism 16 by
reinforcing the sides of the fairing since it must withstand the
weight of the physician. Additionally, the columns 76 indirectly
connect carriage 52 to the support mechanism 16. This is
accomplished by rigidly connecting the lateral sides of carriage 52
to the columns 76 as by bolts 79 so that as the carriage is raised
and lowered it moves the columns and therefore the entire support
mechanism 16 along with it.
A pair of channels 78 are vertically mounted on opposed outer
surfaces of the forward portion 68 of fairing 22. Each channel has
a plurality of key slots 80 formed in it spaced along its
longitudinal axis at different heights relative to frame 12. These
slots are adapted to be coupled to tangs (not shown) which are part
of foot supports 26. Thus, each foot support 26 may be positioned
in any desired one of the slots 80 according to the preference of
the physician.
A support column 25 extends vertically from the forward portion of
fairing 22. The lower end of column 25 is received within a bushing
74 fastened to the fairing as by welding. A locknut 75 is provided
to frictionally lock the column in place. This arrangement allows
the support column to be removed from the apparatus if so desired.
Each arm support 24 (FIG. 1) comprises a trough-shaped channel
universally positionable via a ball-socket coupling 86 on a short
arm 84. Each arm 84 terminates in an adjustable cylindrical collar
90 which is received over the end of a longer tubular arm 88. The
collar 90 may be loosened and re-tightened on arm 88 in order to
selectively position arm support 24 relative to arm 88 in the
direction of arrow 92. The other end of each arm 88 is affixed to a
second collar 94 which is slidably mounted over column 25 and
selectively positionable at any point along its length in the
direction of arrow 96 by turning a knob 97 which loosens or
tightens collar 94. Thus, by suitably rotating and sliding the
abov-identified collar elements 84, 90, and 94, each arm support 24
is positionable in one of a plurality of positions so as to
accommodate a physician of any physical size in any particular
situation. Of course, if the physician desires that the arm support
move upon the application of sufficient pressure the appropriate
collar element may be so adjusted as by not tightening it to its
maximum extent. Thus, while the physician's forearm may be
constrained at a particular height, he may, if desired, be free to
rotate the arm support in any desired oblique plane.
Turning now to FIGS. 2 and 3 the drive mechanism 18 of the present
invention will now be described. A housing 98 at the forward end of
the frame has an upper tubular portion 99 with a square cross
section. This is rigidly connected to a lower cylindrical portion
101 which in turn is rotatably mounted at its lower end in the
forward end of frame 12 within a bearing 100. A wheel 102 which
serves as the steering wheel for the surgical support is mounted
within housing 98 and partially extends through an opening in the
frame to bear against the ground. The top of the upper portion 99
of housing 98 extends to the approximate height of the fairing 22
when the latter is in its lowermost position as shown in FIG.
1.
Housing 98 contains a reversible electric motor 106 which drives a
first sprocket 108. Sprocket 108 is coupled by a chain 109 to a
second sprocket 110 which is fixed to the drive shaft on which
wheel 102 is mounted. A rectangular tube 111 comprises control bar
30 which extends into housing 98 through an opening 104 formed in
its upper end and is pivotally mounted to the housing by a pin 114.
A flexible sheet metal band 115 has its ends fixed to opposed sides
of housing 99 and extends across its interior. A depression is
formed in the band. As control bar 30 is pivoted about pin 114, pin
117 is urged against a side of the flexible band 115 which thereby
tends to urge the bar back to its vertical position.
A pair of microswitches 116, 116a are mounted opposite each other
on the upper ends of opposed walls of housing 98. As seen in FIG.
2, when tube 111 is in a vertical position, it is located precisely
midway between the microswitches 116, 116a not closing either. When
tube 111 is drawn back it will close switch 116a which is adapted
to activate motor 106 to drive wheel 102 backward causing the
support 10 to move backwards. When tube 111 is moved forward,
microswitch 116 is closed thereby causing wheel 102 to rotate
forward and to now move the surgical support in the forward
direction. Since the physician may raise the support mechanism 16
to an elevated position as shown in FIG. 2, a tube 122 is provided
in telescoping relationship with tube 111 and a yoke 28 (FIG. 1) is
fixed at the top end of tube 122. Thus control bar 30 may be
extended vertically as shown in phantom in FIG. 2 so that the
surgeon may easily reach it. In order to steer the surgical
support, the yoke need only be turned in the direction of arrow 124
(FIG. 1) which causes housing 98 together with wheel 102 to rotate
in bearing 100.
The particular design of the drive mechanism is advantageous in
that it allows the movement of the surgical support 10 toward or
away from or to a new position relative to the operating table with
a minimum of inconvenience. It is often necessary for a surgeon to
relocate himself during an operation. If he is using extraneous
supports for his arms this relocation entails an awkward movement
of these supports to the surgeon's new location. The present device
enables the surgeon to accomplish simple and quick change of
position together with the supports without his ever leaving his
seat.
Referring to FIG. 2 a housing 14 at the rear end of the frame 12
houses a storage battery which powers both the reversible motor 106
and a second reversible motor 130 which drives a sprocket 132 on
its output shaft. A chain drive connects sprocket 132 to another
sprocket 136 fixed to screw 46. A microswitch 138 is provided on
the inner end of each foot support 26 (only one shown) flush
against channel 78. Each microswitch is electrically connected to
motor 130 and, when closed, causes the motor 130 to rotate sprocket
132 in a particular direction. The physician closes a selected
microswitch by pushing it with his respective foot. Upon closing
one of the microswitches, motor 130 is activated in one direction
or the other causing screw 46 to rotate in a particular direction.
For example, if the right foot activates its associated
microswitch, screw 46 is rotated to cause carriage 52 to move up.
This causes the support mechanism 16 including the limb supports,
seat and column 25 along with it to be elevated. Correspondingly,
when the left microswitch is closed the motor 130 is rotated in the
opposite direction causing the support mechanism to descend. Thus,
the physician may raise or lower all supporting surfaces as a unit
automatically when desired. It should be noted that all of the
electrical circuitry involved in this invention is deemed to be
conventional and, accordingly, is not shown for the sake of
clarity.
The storage battery may also provide the power for other equipment
needed during an operation. For example, during brain surgery, a
vacuum line of relatively low vacuum (that is, not too far below
atmospheric pressure) is needed to drain fluids from the cranial
area. The battery may power a pump mounted on the surgical support
to provide a completely self-contained vacuum system.
As seen in FIG. 1, the microscope 32 is mounted on a conventional
universal ball-socket swivel adjustment 142 at the top of column 25
and may be loosened or removed by merely rotating wheel 144. It
should be noted that the design of the supporting structure for the
optical instruments provides that upon raising the support
mechanism 16, the optical device is also raised. This is
advantageous since the surgeon may adjust his vertical position
several times during the course of an operation without having to
readjust the position of the optical device.
Thus, it is seen that the subject invention provides a surgical
support whereby a physician may adjust the height of the seat, the
individual arm supports and foot supports independently of each
other. Additionally, all the elements may be elevated as a unit
relative to the ground. The particular design of the supports
provides the additional advantage of adjustability both
individually and as a unit while preserving sterility during the
operation. Typically, the supports are draped under a sterile
plastic skirt in order to prevent contamination of the area
proximate to the patient. According to the design of the invention,
all the supporting surfaces of the support 10 may be moved both
individually and as a unit without removing the sheet so that
sterility is not broken. Specifically, microswitches 138 may be
closed to raise and lower the supporting surfaces as a unit while
the position of the arm supports may be changed without lifting the
protective sheet.
In those situations where it is desireable for the surgeon to be
located immediately adjacent to the operating table, the surgical
support 10 shown in FIGS. 1-3 has a slight disadvantage in that the
drive mechanism 18 extends forwardly of the support mechanism 16
thus preventing the latter from being positioned contiguous with
the table. A second embodiment of the surgical support designated
10' is shown in FIGS. 4 and 5 where the drive mechanism 18' is
positioned rearwardly on frame 12 relative to its position in the
embodiment shown in FIGS. 1-3. In order to accommodate drive
mechanism 18' in this position, the forward portion 68' of fairing
22' has a recess 200 on which the drive mechanism 18' is
situated.
As the only substantial modification in the surgical support of the
second embodiment relative to the one shown in FIGS. 1-3 is in the
drive mechanism 18', it may be assumed that the support shown in
FIGS. 5 and 5 is identical in all other respects to the first
disclosed embodiment. The drive mechanism 18' comprises a
cylindrical housing 202 having a lower section 204 journalled in a
bearing 206 mounted in frame 12. The drive motor, sprocket
transmission, and drive wheel are disposed within housing 202 in an
identical manner as before. Positioned over housing 202 in
telescoping relationship with it is a tubular member 208 whose
upper end is rotatably journalled in a bearing 210 fixed to fairing
22'. The tubular member 208 is movable longitudinally with respect
to housing 202 so that when support mechanism 16' is raised,
tubular member 208 ascends with it. However housing 202 is
rotatably fixed to tubular member 208 by a pin 212 fixed to housing
202 which extends through a vertical slot 214 formed in tubular
member 208. Thus, tubular member 208 may be raised but not rotated
relative to housing 202. Channels 216 (analogous to channels 78 in
the first embodiment) are mounted on opposite sides of tubular
member 208. These channels have key slots 218 similar to slots 80
which receive arms 220 on which are mounted foot supports 222. Two
sets of microswitches 224 and 226 are provided on the outside and
inside edges respectively of the foot supports whose functions are
analogous to the pairs of microswitches 116 and 138.
In operation, the position of the foot supports 222 on each channel
is determined prior to the commencement of the operation. During
the operation, if the support mechanism 16' is desired to be
raised, the microswitch 224 on, for example, the left foot support
is activated by the surgeon's foot. Correspondingly, should it be
desired to lower the support mechanism, the microswitch 224 on the
right foot support is activated. It is clear from the foregoing
that when the support mechanism is raised, the tubular member
ascends with fairing 22' thereby raising the foot supports as a
unit together with the support mechanism 16'. By activating the
appropriate one of microswitches 226, the surgical support 10' may
be propelled toward or or away from the operating table. To steer
the support 10', appropriate pressure is exerted by the surgeon on
the foot supports to rotate tubular member 208 which causes housing
202 to rotate thereby directing the steering and drive wheel 102'
in the desired direction.
It has been found to be impractical to transport the surgical
support through hallways, onto elevators, etc., by "driving" it as
described above in relation to positioning the surgeon relative to
the operating table during the operation. This is due to the fact
that the motor 106 provides a large gear reduction whereby the
support can only be drawn slowly. To assist in the transport of the
surgical support, it is advantageous to lift the drive wheel 102
from the ground. This may be accomplished using the apparatus shown
in FIG. 6 which includes a frame 150 adapted to fit over a lip 152
provided on the front of the support. The frame is secured to the
lip 152 by screw 151. A wheel 154 is rotatably mounted on a
threaded shaft 156 which is received in a threaded bore formed in a
flange 158 extending from frame 150. When it is desired to move the
surgical support a substantial distance, frame 150 is slipped over
lip 152 and secured by screw 151. Shaft 156 is then rotated until
wheel 154 contacts the ground and further rotated until drive wheel
102 is raised. The support is then ready to be transported.
Obviously, numerous modifications and variations are possible in
light of the above disclosure. It is therefore to be understood
that within the scope of the appended claims the invention may be
practiced otherwise than as specifically described herein. For
example, the foot operated microswitches may be placed in another
location (such as in the yoke) other than as specifically shown.
Also, other configurations for the arm and foot supports are
possible.
* * * * *