JP2003523229A - Universal instrument base assembly for retractors - Google Patents

Abstract

A universal instrument base assembly selectively engageable with a surgical retractor includes at least one mechanical interface releasably engageable with the surgical retractor. And a device base plate (20) having a first portion releasably engaging the mounting plate and a second position releasably engaging the surgical instrument. The mechanical interface of the mounting plate is adjustable for releasable engagement with a variety of different surgical retractors.

Description

Detailed Description of the Invention

TECHNICAL FIELD OF THE INVENTION The present invention relates to cardiovascular and thorax retractors, and more particularly, to a variety of different devices for carrying surgical instrument holders, sutures, and / or other devices during surgery. A universal mounting assembly that can be used with a surgical retractor.

BACKGROUND OF THE INVENTION During the last few decades, modern medicine has made tremendous progress in terms of less invasive and less traumatic surgical procedures, resulting in many patients in recent years. You will receive physical and financial benefits. One of the fields of medicine that has made great progress is cardiac surgery, especially cardiac bypass surgery. For example, in coronary bypass surgery or coronary bypass graft (“CABG”) surgery, the saphenous vein is removed from the patient's leg, one end of which is the ascending aorta using an artificial blood source and the other end is the end of the arterial occlusion. It can be implanted in the coronary artery at one point to reestablish blood flow to the heart muscle. Alternatively, the internal mammary artery adjacent to the sternum and within the thoracic cavity is likewise suitable for implantation in a coronary artery, such as the left anterior descending artery (“LAD”).

Access to the heart, blood vessels, and related tissues is usually required to perform CABG procedures. Access to the patient's chest cavity can be achieved through an open procedure that involves a large, longitudinal incision in the chest. This procedure, called a midline sternotomy, cuts the sternum and separates the two opposing halves of the rib cage from each other, exposing the internal organs of the thoracic cavity with a saw or other cutting instrument. is necessary. To spread the two dissected halves apart from each other, for example, a sternum retractor with a retractor blade is placed in the muscularis.

Bagge US Pat. No. 5,025,779 discloses a retractor devised for grasping opposite sternum halves to divide the chest cavity. The large opening created by this technique allows the surgeon to view the surgical site directly and operate on the affected organ. However, procedures involving such large incisions and significant displacement of the rib cage often cause sequelae for the patient and are associated with great risk. Recovery takes a long time and is often painful. further,
Patients who are advised of coronary surgery may have to stop surgery because of the risks associated with accessing the heart.

US Pat. No. 5,503,617 to Jako is of a surgeon-held and vascular or cardiac surgical configuration for pulling up and holding ribs for access to the heart or lungs through a surgical “window”. Discloses the retractor. The retractor includes a rigid frame and a translational frame slidably connected to the rigid frame. Lower and upper blades are rotatably mounted on the rigid frame and the translation frame, respectively. This "window" approach allows the surgeon access with a relatively small incision and relatively few rib displacements, and therefore less patient sequelae.

Once access to the chest cavity is obtained, surgery can be performed on the heart. Some procedures require stopping the heartbeat while maintaining blood circulation to various parts of the body. Alternatively, some GABG procedures can be performed while allowing the heart to beat. When such procedures are performed by thoracotomy, they are now commonly referred to as minimally invasive direct coronary artery bypass (MIDCAB) (when performed by sternotomy, the procedure is generally open coronary artery bypass (OPCAB)). Called). Cardiac stabilizers, such as the stabilizer described in US Pat. No. 5,947,896 entitled "Heart Stabilizer and Method of Use Therefor" and the U.S. patent application entitled "Surgical Device and Method" filed on October 13, 1999 in Faracioni. Serial numbers, as well as other surgical instruments, can be used to stabilize the heart and limit blood flow through the coronary arteries during the transplant procedure.

During a bypass procedure, the surgeon may use several different instruments, including those described above, such as retractor assemblies (ie, base / arm, blade, and blade separation mechanisms), cardiac stabilizers, It is not uncommon to use instrument holders, suture holders, etc. Moreover, it is not uncommon for surgeons to utilize different instruments from different manufacturers according to particular preferences or hospital guidelines. However, experience has shown that many of these surgical instruments are incompatible and / or incompatible in terms of size, shape / section and / or mounting attachment of each instrument. These instruments lack the ability to work together in a way that contributes to efficiency, practicality, or optimality, and as a result, surgeons are forced to use compatible instruments manufactured by the same manufacturer. The current situation.

[0008] For example, some manufacturers have manufactured retractors designed to expose the chest cavity (either by a midline sternotomy or by expanding ribs to form a surgical window). As far as is known, these retractors only work with instruments manufactured by the same manufacturer. Thus, the surgeon's desire to use different, more effective instruments made by different manufacturers is hampered.

That is, by developing a universal instrument base assembly that mounts a variety of different surgical retractors, surgeons have the option of using a variety of different surgical instruments manufactured by different manufacturers. There is a need to do so.

The present invention provides a universal instrument base assembly that is selectively engageable with a surgical retractor, wherein at least one machine releasably engages the surgical retractor. Universal base including a mounting plate having a mechanical interface and an instrument base plate having a first portion releasably engaging the mounting plate and a second portion releasably engaging a surgical instrument. Regarding assembly. Preferably, the mechanical interface of the mounting plate is sized and / or adjustable for releasable engagement with a variety of different surgical retractors.

In one embodiment, the mechanical interface includes a plurality of opposing flanges that hang downwardly from a mounting plate to engage a surgical retractor. Preferably, at least one of the flanges includes a locking pin or screw for securing the mounting plate to the surgical retractor.

[0012] In another embodiment, the mounting plate includes a plurality of opposing notches disposed therein, the notches corresponding to a plurality of opposing notches disposed on the instrument base plate. Engage with the stop. Preferably, the instrument base plate engages the mounting plate in a push-fit manner.

In yet another embodiment, the instrument base plate includes a pair of opposing flanges, the flanges projecting outwardly from opposite sides of the base plate and engaging surgical instruments. Do / Place it. Preferably, the instrument base plate includes a suture mount to facilitate the surgical procedure. In another embodiment, the instrument base plate includes a plurality of openings for mounting various different surgical instruments at different locations along the instrument base plate.

In yet another embodiment, the instrument base plate is sized to support the instrument holder. In another embodiment, a mounting bridge is supported between two universal instrument base assemblies and one surgical instrument is mounted at an angle substantially perpendicular to the two base assemblies. To support. Preferably, the instrument holder and / or the mounting bridge are locking members, such as screws, tabs,
Or a flange, the locking members selectively securing each of them to the instrument base plate.

DETAILED DESCRIPTION OF THE INVENTION Throughout FIGS. 1-5, similar or identical elements are designated with the same reference numerals. Figure 1
With reference to FIG. 5, a universal instrument base assembly 10 for use with a variety of different surgical retractors includes a mounting plate 30 and an instrument base plate sized to selectively engage a surgical retractor 40. Including 20. More particularly, and as can be seen in particular from FIG. 1, the base assembly 10 is sized to engage the surgical retractor 40 such that the surgical retractor, sutures, etc., are placed in close proximity to the surgical site. <RTIgt; / or </ RTI> are fixed to facilitate surgical procedures.

Throughout the figures, the state-of-the-art Ankeny surgical retractor is shown by way of example. However, the universal base assembly 10 disclosed herein can be used with a variety of different surgical retractors 40 that vary in size and operation. In addition, the universal base assembly 10 is described, for example, in US patent application Ser. No. 09 / 235,593 entitled “Surgical Instrument Holder”, in US Pat. No. 5,947,896 entitled “Heart Stabilizer Device and Method of Use Thereof”, And as a low mount for a variety of instruments used in surgical procedures, such as instrument holders such as those described in US patent application Ser. No. No. Ser. It preferably has dimensions. The entire texts of the above documents are attached to the present application as reference materials.

As best shown in FIGS. 2 and 3, the Ankeny surgical retractor 40 includes a retractor base 56, the retractor base 56 comprising:
It has a pair of arms 41a and 41b that project substantially vertically therefrom. The arm 41a is fixed to the base 56, while the arm 41b is selectively movable by the ratchet assembly 50 with respect to the retractor base 56 and the arm 41a. Each arm 41a, 41b also includes a plurality of retractor blades 44a, 44b, respectively, which blades are
Each arm 41a, 41b is suspended in the surgical incision 90 from the distal end. Arm 4
The movement of the arm 41b with respect to 1a biases the opposing blades 44a and 44b against each other, causing the surgical incision 90 to spread apart. Preferably, each retractor blade 44a, 44b exhibits a generally C-shaped configuration and has inwardly projecting flanges 45a and 45b, respectively. These flanges 45a, 45b are used to form the incision 90, internal tissue,
And help keep the bones apart and spread. Also, each retractor blade 45a, 45b is selectively adjustable and / or selectively removable by screws 43a, 43b.

As best shown in FIG. 3, the ratchet assembly 50 includes a lever arm 52, which is discrete along a plurality of teeth 4 disposed along a retractor base 56. In this movement, a pole (not shown) is selectively advanced. This allows the incision 90, ribs or other body structure to be pulled up in small increments and also prevents slippage and loss of pulling force during the surgical procedure.

As best shown in FIG. 2, the mounting plate 30 is sized to selectively engage the arms 41 a, 41 b of the retractor 40. More specifically, the mounting plate 30 is sized to hang downwardly from opposite sides of the mounting plate 30 and releasably engage opposite sides of the retractor arm, eg 41a. It includes a plurality of opposed flanges 33 and 36. Preferably, at least one of the flanges, eg 33, is for urging a flange, eg 36, arranged on opposite sides of the mounting plate 30 to secure the mounting plate 30 to the arm 41a. Includes locking pin or screw 34. The flanges 33, 35 are movable (vertically, horizontally, and / or radially) with respect to the mounting plate 30 to receive a variety of different surgical retractors. The locking pin or screw 34 is also sized to accommodate retractors 40 of different widths.

The mounting plate 30 further comprises a plurality of mechanical interfaces or notches 31 and 37, which notches 31 and 37 are press-fitted onto the respective respective stops of the instrument base plate 20. Alternatively, it is sized to releasably engage tabs 21 and 27. Further, the mounting plate 30 is
It includes a pair of openings 32 located at its opposite ends which are aligned with a corresponding pair of locking pins or screws 22 located at opposite sides of the instrument base plate 20. ing. The screw 22 engages the opening 32 and locks the two components 20 and 30 together on the surgical retractor 40.

The base assembly 10 further includes an instrument base plate 20 sized to selectively engage the mounting plate 30. More specifically, as previously mentioned, the instrument base plate 20 includes a plurality of stops or tabs 2 that selectively engage a plurality of corresponding notches 31 and 37, respectively, defined in the mounting plate 30.
1 and 27 are included. In addition, the instrument base plate 20 has a corresponding opening 32.
Includes a pair of locking pins or screws 22 that engage with to releasably lock the two components 20 and 30 together on the retractor 40.

As best seen in FIGS. 1, 4 and 5, the instrument base plate 20.
Engage the mounting plate 30. However, the instrument base plate 20 may partially surround the mounting plate 30 (or vice versa) to reduce the overall profile of the base assembly 10. In addition, any combination of mechanical interfaces between the instrument base plate 20 and the mounting plate 30 can be used to engage the two components 20 and 30. Instrument base plate 20 also includes a pair of opposed flanges 25 and 29 disposed along the inner and outer perimeters of instrument base plate 20, respectively. Each of these flanges 25 and 29 is sized to facilitate quick and accurate centering and engagement of the surgical instrument with the instrument base plate. For example, as best shown in FIG. 4, the instrument holder 60 can be quickly and easily placed on the instrument base plate 20. More specifically, the instrument holder 60 includes a mounting bracket 62 and a movable flange 64, which in combination cooperate with the opposing flanges 29 and 25 of the instrument base plate 20. To secure the instrument holder 60 onto the instrument base plate 20. Other surgical instruments other than these can be similarly engaged on the instrument base plate 20. The instrument holder 60 also includes an adjustment arm 63 slidably mounted on a mounting bracket 62. The fixing screw 67 arranged in the slot 65 in the adjusting arm 63 is for fixing the position of the adjusting arm 63 with respect to the mounting bracket 62 and the surgical site.

The position of certain surgical instruments can be easily moved around the surgical site.
For example, as best shown in FIG. 4, the cardiac stabilizer 70 can be selectively moved to various positions along the base assembly 10 by moving the instrument holder 60 along the instrument base plate 20. it can. The height of the stabilizer 70 can be selectively adjusted by loosening the fixing screw 61 and sliding the bar 74. Stabilizer 70 is secured by tightening screws 61 against bar 764 when applying sufficient pressure to the heart to substantially stabilize the heart. Movement of the heart is limited by the legs 72a, 72b and the non-slip structure of the legs 72a, 72b. Various surgical instruments may be slidably received within the adjustment arm 63, much like the cardiac stabilizer 70, to achieve a particular surgical purpose.

Returning to FIG. 2, the instrument base plate 20 also includes a plurality of suture mounts 26 that serve as attachment and / or anchor points for the ends of the suture defined therein and extending from the surgical site. . The nuclear suture mount 26 includes a tightly wound spring 17 disposed within the suture mount 26, which spring 17 releasably retains each suture (not shown) during a surgical procedure. Have a function. A triangular ramp 19 is formed on the inner surface of the suture mount 26, and a notch or slit 23 is formed on the outer surface of the suture mount 26. The configuration of the ramp 19 and the slit 23 facilitates positioning of the suture thread inside the spring 17. It is also possible to use other suture mounts such as those described in U.S. Pat. No. 5,947,896 mentioned above and U.S. Pat.

On top of the instrument plate 20, there are different ways, for example US Pat.
Engage with one or more suture mounts 26 or openings 28 disposed within instrument base plate 20 as described in detail with respect to various surgical instruments disclosed in US Patent Application Serial No. 47,896 and Faracioni Application. By doing so, it is possible to engage other surgical instruments.

It is also possible to use a mounting bridge 80 above the surgical site between two universal base assemblies 10, as best shown in FIG. The mounting bridge 80 includes an upper surface 83 having a pair of opposed flanges 86 and 88,
The flanges 86 and 88 are sized to engage a surgical instrument, eg, instrument holder 60, in much the same manner as described above for instrument base plate 20.
A pair of locking screws 82 are located in slots 84 located in the face 83 and provide a mounting bridge 80 and thus a mounting bridge 80 at a desired position between the base assembly 10.
It is configured to lock surgical instruments. As will be appreciated from the present disclosure, the mounting bridge 80 allows the surgeon to perform various and / or additional surgical instruments in a direction generally perpendicular to the base assembly 10 and the retractor arms 41a, 41b. Can be supported.

Preferably, the locking screw 82 engages the opening 28 located inside the instrument base plate 20, but the mounting bridge 80 is different from the instrument base plate 20, eg as described above with respect to the instrument holder 60. It is also possible to engage in a similar manner. Further, the securing screw 82 secures the mounting bridge 80 on the instrument base plate 20 but allows the mounting bridge 80 to slide between the universal base assembly 10. It is also possible to move the mounting bridge 80 to a second position which locks the mounting bridge 80 with respect to the instrument base plate 20.

From the above description made with reference to the drawings, it will be understood that those skilled in the art can make certain modifications to the present invention without departing from the scope of the invention. For example, the mounting plate 30 and the instrument base plate 20 are shown as linear, but each of these components could be differently shaped based on the shape of the particular surgical retractor. Alternatively, the mounting plate may be shaped according to the shape of the instrument base plate and the instrument base plate may have a different shape corresponding to the mechanical interface to ensure engagement with the mounting plate.

It would also be preferable to manufacture the mounting plate and / or the instrument base plate with an adjustable mechanical interface to accommodate a wide variety of surgical retractors and / or instruments. Further, it may be desirable to manufacture the mounting plate and the instrument base plate from a semi-flexible material to match the shape of the particular surgical retractor.

Although some embodiments have been disclosed above, the present disclosure is not limited thereto, and the present disclosure includes a wide range possible in the art, and the present specification also includes the same. Should be understood as. For example, although the preferred embodiment described above is described from the perspective of a device for cardiac surgery, the subject matter of the invention is not so limited. The present disclosure may be broadly applicable to surgery where a surgical site is accessed through a relatively small incision in which relatively small retractors and / or relatively small surgical instruments are used.

Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Other modifications may occur to those skilled in the art without departing from the scope and spirit of the appended claims.

[Brief description of drawings]

1 is a perspective view of a universal instrument base assembly engaged over the arm of a surgical retractor according to the present invention. FIG.

FIG. 2 is an exploded view of two universal instrument base assemblies engaged over two opposing arms of a surgical retractor.

FIG. 3 is a top view of two universal instrument base assemblies engaged over two opposing arms of a surgical retractor, with the two universal instrument base assemblies mounted on one of the two universal instrument base assemblies. Figure 2 shows two opposing arms of a combined surgical retractor.

FIG. 4 is a perspective view of two universal instrument base assemblies engaged over two opposing arms of a surgical retractor, with one universal instrument base assembly on one of the two universal instrument base assemblies. Figure 3 shows a combined surgical instrument holder.

FIG. 5 is a perspective view of two universal instrument base assemblies engaged over two opposing arms of a surgical retractor, mounted between the two universal instrument base assemblies. 2 shows an instrument placement bridge and a surgical instrument.

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Claims (21)

[Claims] 1. A universal instrument base that is selectively engageable with a surgical retractor.
A mounting plate having at least one mechanical interface for releasably engaging a surgical retractor, a first portion releasably engaging the mounting plate, a surgical instrument and a releasable assembly A universal instrument base assembly having an instrument base plate having a second position for engaging with at least one mechanical interface sized to selectively engage a variety of different surgical retractors. 2. The universal instrument base assembly of claim 1, wherein the mechanical interface of the mounting plate is selectively adjustable. 3. The universal instrument of claim 1, wherein the at least one mechanical interface includes a plurality of opposing flanges that are suspended downwardly from the mounting plate to engage the surgical retractor. Base assembly. 4. The universal instrument base assembly of claim 3, wherein at least one of the flanges includes a locking screw for selectively securing the mounting plate to the surgical retractor. 5. The universal instrument base assembly of claim 1, wherein the instrument base plate includes at least one mechanical interface for selectively securing the instrument base plate to a mounting plate. 6. The universal instrument base assembly of claim 1, wherein the instrument base plate is push fit with the mounting plate. 7. The mounting plate of claim 1, wherein the mounting plate includes at least one notch disposed therein, the notch engaging a corresponding at least one stop disposed on the instrument base plate. Universal instrument base assembly as described. 8. The mounting plate includes a plurality of opposing notches disposed therein, the notches engaging corresponding plurality of opposing stops disposed on the instrument base plate. Universal instrument base assembly according to item 7. 9. The universal instrument base assembly of claim 5, wherein the mechanical interface on the instrument base plate includes a locking screw. 10. The universal instrument base assembly of claim 1, wherein the instrument base plate includes a flange, the flange projecting outwardly therefrom and sized to engage a surgical instrument. . 11. The instrument base plate of claim 1, wherein the instrument base plate includes a plurality of flanges, the flanges extending outwardly from opposite sides of the instrument base plate and dimensioned to engage a surgical instrument. Universal instrument base assembly as described. 12. The universal instrument base assembly of claim 1, wherein the instrument base plate includes a plurality of suture mounts disposed thereon. 13. The universal instrument base assembly of claim 11, wherein the instrument base plate is sized to selectively engage a surgical instrument holder. 14. The universal instrument base assembly of claim 13, wherein the instrument holder includes a base having first and second opposing flanges dimensioned to engage a flange of an instrument base plate. 15. The universal instrument base assembly of claim 14, wherein one of the flanges of the instrument holder is selectively movable relative to the other of the flanges of the instrument holder. 16. The universal instrument base assembly of claim 1, wherein the instrument base plate is sized to selectively engage one end of an instrument mounting bridge. 17. The universal instrument base assembly of claim 16, wherein the instrument mounting bridge is engaged between two universal instrument base assemblies. 18. The universal instrument base of claim 17, wherein the instrument mounting bridge is sized to support a variety of different surgical instruments between the universal instrument bases.
Assembly. 19. The universal instrument base assembly of claim 17, wherein the mounting bridge is selectively moveable with respect to the universal instrument base. 20. The universal instrument base assembly of claim 19, wherein the instrument mounting bridge includes at least one locking member that secures one of the universal instrument bases to the other. 21. The universal instrument base assembly of claim 19, wherein the instrument mounting bridge includes two locking members that secure the mounting bridge to each universal instrument base.