Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
  • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements

Definitions

• the present invention generally refers to the field of devices used in surgery.
• the invention is applicable to any field where one such device can be advantageously used, but preferably this regards the field of front neck surgery and specifically thyroid and parathyroid surgery.
• MIVAT Minimally-Invasive Video-Assisted Thyroidectomy
• thyroidectomy operations regard the treatment of those thyroid pathologies with an abnormal development of the upper pole and/or the presence of plurinodular goiters, which render modern surgical technologies characterized by minimal incisions unusable.
• the operation can only be carried out by means of wide skin incisions and wide muscle sections with relative functional, symptomatic and esthetic consequences.
• the object of the present invention is to solve or at least minimize the abovementioned problems, at the same time respecting the improved use characteristics already present in the preceding techniques.
• the innovative concept underlying the present invention generally consists of making an autostatic retractor with screw closure mechanism that is capable of brilliantly solving the abovementioned problems.
• Said inventive autostatic retractor is characterized in that it is constituted by anatomic- shaped valves, which are adjustable, slidable and capable of being ideally adapted to the anatomic spaces of the neck, allowing an excellent, atraumatic, stable and wide exposure simultaneously at several points of the operating site.
• said surgical device capable of optimizing the anatomic exposure and hence magnifying the exposure of the zone to be operated, on one hand facilitates the various above-listed operating steps, in particular the display and preparation of the recurrent nerves and the parathyroids, and on the other hand drastically reduces surgery times and consequent tissue traumatism.
• said characteristic is advantageously implemented in that said inventive retractor allows supporting at least one mini-telecamera capable of advantageously assisting the various operation steps.
• a further object is to provide said inventive surgical device, capable of autonomously and constantly maintaining its own function and position in complete safety, so as to solve the abovementioned problems by means of the management of the same directly by the operator, thus requiring a lower number of health personal at the operating table.
• a further characteristic of the inventive autostatic retractor is that, due to the numerous intrinsic adjustments, this allows an extreme anatomic adaptability and hence a smaller skin incision. But it also above all allows a reduced traumatism of the tissues affected by the surgical operation, i.e. of the muscular and nervous bundles which must be moved in order to allow a correct surgical exposure and hence a much faster post-operative recovery phase and a considerable reduction of the post-operative pain with respect to that encountered with current instruments.
• inventive autostatic retractor Another important characteristic of the inventive autostatic retractor is that, due to the magnification of the zone to be operated, one can operate with greater ease in all those thyroid pathology cases with an abnormal development of the upper pole and/or presence of plurinodular goiters.
• Another, not less important characteristic of the inventive autostatic retractor is that which consists of the reduction of the instrumentation necessary for carrying out the surgical operation, and hence in the drastic reduction of the complications associated with the use, the wear and the sterilization of the same. It must also be noted that even if the main testing of said autostatic retractor predominantly regarded front neck surgery, such characteristic must be considered as non-limiting of the invention, since by virtue of the simplicity of application and possible multi-adjustments of the inventive retractor, the latter can be effectively employed in multiple surgery applications.
• the materials composing the aforesaid inventive autostatic retractor can be selected by the man skilled in the art so as to meet the technical characteristics in this particular field and mainly deriving from the multiuse, including solidity, strength, anti- corrosiveness, lightness and easy sterilizability - nevertheless, said materials can comprise polymers of plastic type and those of metal type.
• a preferred embodiment of the present invention provides that said autostatic retractor is made of stainless steel.
• FIGURE 1 is a plan view of the autostatic retractor according to the present invention, completely assembled
• FIGURE 2 is a plan view of the autostatic retractor of Fig. 1 lacking relative retractors;
• FIGURE 3 is a side view of the retractors, relative valves and vertical rod.
• FIGS. 1 and 2 show an innovative autostatic retractor with screw closure mechanism for the front surgery of the neck characterized by the presence of a base plate 100 constituted by two symmetric arms 110 capable of opening wide with respect to each other and wherein each of the distal portions thereof is connected to the contralateral portion by means of a central pin 150, received in suitable seats of the same symmetrical arms 110, capable of ensuring their turnability.
• the particular profile of said symmetric arms 110 shown in Figures 1 and 2, i.e. a semicircular conformation terminating with a proximal rectilinear segment, constituting a jaw of closure pliers of "Bernard" type 140 made in such position, allows such symmetric arms 110 a wide, coplanar opening.
• said closure pliers of "Bernard" type 140 once the transverse skin incision has been executed, allow coupling the two skin flaps and then opening wide the incision itself by means of the divarication of the aforesaid symmetrical arms 110.
• the divarication movement is actuated by means of a screw mechanism 180, i.e. by means of two opposite screws 181 screwable in an internally- threaded cylindrical hollow element 185, respectively connected to the base plate 100 by means of the lateral pins 160, received in suitable seats placed on opposite positions of the two symmetric arms 110.
• Said screw mechanism 180 is capable of finely adjusting the divarication or approaching movements of the two symmetric arms 110 of the inventive autostatic retractor, by simply rotating (with the fingers) a knurled element 186 made on the aforesaid internally-threaded cylindrical hollow element 185.
• the present invention comprises a central retractor 200, whose valve 210 is right-angle shaped with rounded edges and whose stem 211 is characterized by the longitudinal groove 213 made along nearly the entire height of the same.
• Such central retractor 200 is connected to the base plate 100 by means of the interaction of said longitudinal groove 213 with the aforesaid central pin 150, which respectively allows, by means of a screw/nut system, the sliding or the in situ locking as needed.
• the possible movements of said central retractor 200 are coplanar to those of the aforesaid symmetric arms 110, and consist of sliding and/or rotation movements with respect to the aforesaid central pin 150.
• the task reserved to said central retractor 200 is that of allowing, by means of the valve 210, a wide initial exposure of the carotid jugular region, on the side of the thyroid lobes.
• the present invention further comprises two lateral retractors 300 constituted by two separate portions, i.e.
• each lateral retractor 300 is connected to the base plate 100 by means of the interaction of said longitudinal groove 313 with the respective lateral pin 160, which respectively allows, by means of a screw/nut system, the sliding or in situ locking as needed.
• the movements of said lateral retractors 300 are coplanar with those of the aforesaid symmetric arms 110, and exclusively consist of sliding and/or rotation movements with respect to the aforesaid lateral pins 160.
• the versatility of the invention is particularly implemented by the aforesaid apical pins 350 (Fig. 3) engaged in the longitudinal groove 313, which allow a wide adjustment possibility of the aforesaid rotatable valves 310, i.e. respectively allowing their sliding and/or in situ locking, by means of a nut/screw system, as needed.
• said apical pins 350 allow a rotation coplanar to that of the aforesaid symmetrical arms 110, equal to a round angle and hence a high adaptability to the tissues on which the traction is made.
• the above is also achieved by the particular oblique anatomic shape of the rotatable valves 310, which allows the latter to be ideally inserted in the corner behind the trachea, the upper lobe of the thyroid and the ribbon-like muscles and thus obtain optimal exposure of the upper pole of the thyroid, avoiding traumatisms, above all at the outer branch of the upper laryngeal nerve and the cricothyroid muscle.
• the autostatic retractor complete with the central retractor 200 and lateral retractors 300 and the closure pliers of "Bernard" type 140, allows obtaining an optimal exposure of the entire thyroid area, facilitating all of the aforesaid surgical operation steps.
• a further aspect in addition to all of the technical solutions described up to now but of particular importance in the achievement of the invention, is that which can also be applied to the execution of the aforesaid mini-invasive/video-assisted surgery called MIVAT.
• connection device 410 placed on at least one symmetric arm 110 of the base plate 100, capable of engaging a vertical rod 400, preferably with biconcave cross section, equipped with a rotating support head 440 for small-size optical systems or mini-telecameras.
• valves possess an anatomic, oblique shape and are adjustable over three anatomical planes, thus allowing an excellent exposure of the operating site, specifically of the thyroid area and still more specifically of the upper pole of the thyroid with its vascular-nervous connections.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Heart & Thoracic Surgery (AREA)
• Engineering & Computer Science (AREA)
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• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
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• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
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• Surgical Instruments (AREA)

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• 2009
  • 2009-04-29 IT ITRM2009A000205A patent/IT1393859B1/it active
• 2010
  • 2010-04-23 WO PCT/IT2010/000176 patent/WO2010125598A1/en active Application Filing
  • 2010-04-23 EP EP10727969A patent/EP2432398A1/en not_active Withdrawn

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