GB2248016A

GB2248016A - Day surgery trolley

Info

Publication number: GB2248016A
Application number: GB9119571A
Authority: GB
Inventors: Ivor Schofield
Original assignee: PORTSMOUTH SURGICAL EQUIPMENT
Current assignee: PORTSMOUTH SURGICAL EQUIPMENT
Priority date: 1990-09-22
Filing date: 1991-09-13
Publication date: 1992-03-25
Anticipated expiration: 2011-09-13
Also published as: GB2248016B; GB9119571D0; GB9020685D0

Abstract

A day surgery trolley 1 has a wheeled base 2, a high adjustable support structure 3, an upper portion 5 having a telescopic foot section 52, a Trendelenburg tilting mechanism 7 and a removable head support platform 8. <IMAGE>

Description

Day Surgery Trolley The present invention relates to a day surgery trolley.

For minor surgical operations, such as simple gynaecological, dental, minor E.N.T., foot, leg, hand, or arm operations, it is possible for the operation to be performed on the same day as the patient is both admitted and discharged. For this, it is convenient for the patient to remain on the same trolley throughout the day in hospital; whereas for a conventional operation involving staying in hospital over at least one night, the patient would be admitted to a bed, transferred to a trolley to be taken to the operating theatre, transferred onto the operating table, then after the operation re-transferred to a trolley and then to the bed. This involves four transfers and three equipments, namely bed, trolley and operating table.It is to avoid these transfers and the need for all three equipments that it has been proposed to use a so-called day surgery trolley on which the patient remains throughout the stay in hospital.

The distinction between a day surgery trolley and on the one hand a bed or operating table and on the other hand a mere transport trolley is not clear cut in the context of what features are included in which; however in practice the different devices are recognisably distinct. For instance, a day surgery trolley is better equipped for use with accessories such as lithotomy brackets and tends to be stronger and more stable than a transport trolley. Beds on the other hand are less mobile and operating tables are generally immobile.

A known day surgery trolley is adapted for movement of the patient longitudinally of the trolley, by longitudinal movement of part of its mattress. This introduces complication in structural design of the trolley, due to movement of the patient's centre of gravity, particularly where Trendelenburg tilting is required as is not available in the known day surgery trolley.

It is known for hospital beds, trolleys and operating tables to be variously adapted for: (i) raising and lowering, (ii) tilting - to a head down attitude known as Trendelenburg and a head up attitude known as Reverse Trendelenburg, and (iii) shortening - particularly for childbirth.

The object of the invention is to provide an improved day surgery trolley and on which the patient would not normally be moved bodily along the trolley.

A day surgery trolley of the invention comprises: a wheeled base, an upper portion of the trolley for supporting a mattress, the upper portion having a body section and a foot section telescopically arranged with respect to the body section, the body section being adapted for fixed support of a central part of the mattress, a support structure for the upper portion of the trolley attached to and extending up from the base and supporting the upper portion of the trolley at the body section beneath the central part of the mattress, a Trendelenburg mechanism for tilting the upper portion of the trolley about an axis at the upper, supporting end of the support structure.

Preferably, the Trendelenburg axis is situated in the trolley in the lower back region of a typical adult patient with respect to the patient's longitudinal position along the trolley when in a lithotomy position at the foot end of the body section. Conveniently, the base has a central region from which the superstructure extends and a foot-end region open to the central region. Preferably the support structure is generally columnar.

This arrangement of the trolley has the advantages of: (i) allowing a patient to be placed in a lithotomy position without the patient having to be moved appreciably if at all with respect to the body portion of the trolley, (i) allowing a surgeon access from within the foot-end region of the base to the perinaeal region of the patient in the lithotomy position with the foot section of the trolley in its telescopically collapsed position, and (ii) allowing the upper portion of the trolley to be readily tilted, since the patient's centre of gravity remains close to the pivot axis in both the prone and the lithotomy position.

Preferably the support structure comprises a central actuator, conveniently hydraulic, and a pair of telescopic stabilising units on opposite sides of the actuator. Whilst the stabilising units may conceivably be arranged longitudinally in front of and behind the actuator, they are preferably arranged laterally to either side of the actuator. Lower, preferably outer, members of the stabilising units can be fixed to the base to give the support structure stability.

In accordance with a particularly preferred feature, a cross-pin is arranged at the top of the support structure which performs all of the following functions: (a) interconnecting the actuator to upper members of the stabilising units, (b) interconnecting the support structure and the upper portion of the trolley, and (c) providing the pivot axis between the support structure and the upper portion of the trolley.

The actuator can incorporate a pump at its bottom end, actuated by pedals extending either sideways or to the head end of the trolley for ease of operation by the anaesthetist.

The Trendelenburg mechanism preferably comprises at least one manually operable, resilient catch mounted on the body section opposite a respective number of rotationally fixed quadrant member(s) centred on the Trendelenburg axis and adapted for engagement at a plurality of angular positions with the catch(es). Two quadrant members can be provided,each being fixed to a respective one of the upper members of the stabilising units of the support structure.

Preferably, the Trendelenburg mechanism includes a helper spring acting to urge the head end of the upper portion of the trolley upwards when the mechanism is released of adjustment.

The telescopic foot section of the upper portion of the trolley is preferably a U-shaped member, the parallel limbs of which are received in side-members of the body section.

The foot section is adapted to receive a removable foot section mattress with a hard base. The hard base and the foot section are complementarily formed, whereby the hard base stiffens the foot section in its plane.

Conveniently the side-members of the body section are upper ones of respective pairs of side-members at each side of the body section. A body section mattress can be supported on the upper side-members to allow positioning of an X-ray plate beneath the body section mattress on a shelf supported on the lower side-members. Preferably, the day surgery trolley includes side rails to which accessories can be clamped.

An angularly adjustable head support can be fitted to the side-members.

To help understanding of the invention, a specific embodiment thereof will now be described by way of example and with reference to the accompanying drawings, in which: Figure 1 is a side view of a day surgery trolley of the invention with covers for its support structure omitted for clarity, Figure 2 is a cross-sectional view on the line II-II in Figure 1 of the plan of the base of the trolley, Figure 3 is an end view from the foot of the trolley, with the upper portion of the trolley raised, Figure 4 is a scrap side view on a larger scale of the support structure and Trendelenburg mechanism, Figure 5 is a similar scrap side view of a foot section of the trolley in its telescopically collapsed position, Figure 6 is a further scrap side view of a head support.

Referring to the drawings, the day surgery trolley 1 has a base 2, a support structure 3, an upper portion 5, a Trendelenburg tilting mechanism 7 and a removable head support platform 8. The trolley is largely fabricated from welded stainless steel tube, which is finished by electropolishing. It should be noted that, in the following description, reference to the "foot" and "head" ends of the trolley and its components refers to the respective ends of the trolley occupied by a patient's feet and head when lying on a multi-part mattress 10 of the trolley.

The base has two side-members 21,22 having castor wheels 23 at their ends. The wheels can be locked by either of two foot controls 231 at the head end of the side-members. An internal linkage (not shown) connects the two controls to each of the wheels. At a head end of the trolley, a cross-member 24 extends between the ends of the side-members 21,22. A pair of similar cross-members 25,26 also extend between the base side-members 21,22 slightly to the head end of the base 2 from their mid-points, that is to say in a central region 27 of the base, leaving a foot-end region 28 of the base open between the base side-members 21,22 as far as the central region 27.

Welded in spaced, upright positions between the cross-members 25,26 are two outer telescopic members 31,32 of two stabilizing units 33,34 of the support structure 3.

Internally on pins 35 secured across the internal voids of the outer telescopic members 31,32 are rollers, which are not shown, but which guide inner telescopic members 36,37 for vertical movement. The rectangular shape of the members 31,32,36,37 and the disposition of the pins 35 and the rollers prevent rotation of the inner members 36,37, which therefore have freedom of movement only in the vertical direction with respect to the base 2. The outer telescopic members 31,32 via interconnecting pieces 38 at their bottom ends support a central hydraulic actuator 39. This is operated by a pair of pedal levers 40,41 extending beneath and beyond the base side-members 21,22 for raising and lowering the upper portion of the trolley. A cross-pin 42 is secured to the upwardly extending rod 43 of the actuator.

It will be appreciated that if the rod is free to rotate in the actuator, the latter's seals would quickly wear out.

The cross-pin 42 is irrotationally held in the inner telescopic members 36,37 at their upper ends. Thus the cross-pin 42 can be raised or lower, but is restricted from other movement.

The upper portion 5 of the trolley has a body section 51 and a foot section 52. The former has at each side lower and upper side-members 53,54. These are interconnected at their ends by light section, end cross-members 56,57, which are sandwiched between the upper and lower members 53,54 at each side and extend between the sides of the body section 51. The lower members 53 are also interconnected by a heavy section member 58, which has four downwardly extending lugs 59. These are apertured to receive the cross-pin 42, which carries the upper portion 5 of the trolley, controls its height and allows it freedom of movement only in pitch or tilt as described below under control of the Trendelenburg mechanism 7.

The foot section 52 has side-members 60 and a foot-end cross-member 61 arranged in a U shape. The side-members 60 are telescopically received inside the upper side-members 54 of the body section with nylon bearing pads 62 attached to the inner end of the members 60 and further pads 63 incorporated in the mouth of the upper side - members 54.

The foot section is freely movable between its extended position as shown in Figure 1 and its retracted position as shown in Figure 5. When the foot section is extended, a foot-section part 102 of the trolley's mattress can be fitted. The mattress part has an X-ray permeable rigid base (not shown). To this is fixed a frame 1021 which engages in the foot section between the side-members 60. This arrangement provides stiffness to the foot section against possible damage on collision of the trolley. As a further collision precaution, the side-members 60 are provided at their free ends with wheels 601.

The Trendelenburg tilting mechanism 7 includes a pair of triangular frames 71 fixed to the upper end of the inner telescopic members 36,37 of the support structure 3 on the head side of the structure. The frames each carry an apertured strip 72, which is circularly curved in a quadrant about the cross-pin 42. A lower cross-member 73 is welded between the lower side-members 53 of the body section 51 towards its head end. Pivoted on this at both ends is a triangulated, tilt-release lever 74, having a pair of grips 75 arranged at the two sides of the head end of the body section of the trolley. The grips are arranged beneath the ends of a handle 76 for manoeuvring of the trolley, the handle being fixed to the head-end cross-member 57.

Opposite the curved strips 72, the tilt-release lever 74 carries a bar 77 having a pair of pins 78 positioned for engagement in selected ones of the apertures of the strips.

Lifting of the grips 75 towards the handle 76 frees the pins 78 from the apertures and allows the upper portion 5 of the trolley to be tilted to the desired Trendelenburg angle, at which release of the grips causes the lever 74 to drop under the action of a compression spring 79 and cause the pins 78 to engage in the appropriate apertures. A compression spring helper unit 80 is provided between a cross-member 801 between the lower side-members 53 and a cross-member 802 between the triangular frames 71. When the foot section is telescoped in, the centre of gravity of the upper portion of the trolley is to the head end of the upper portion. The helper spring unit has a preloading such as to substantially balance the upper portion when the Trendelenburg mechanism is released for tilting.

The removable head support platform 8 has studs 81 which are engageable in sockets 82 in the cross-member 57.

An angularly adjustable pivot 83 connects the studs to the platform 8 so that the latter can be tilted to the desired angle. The platform is equipped with VELCRO (registered trade mark) strips for fitting of a head rest 84 as required.

In use of the trolley, mattress parts 101,102 are fitted to the two sections 51,52 of the upper portion. The foot section mattress part 102 is fitted as described above.

The body section mattress part 101 is centrally hinged at 1011 to provided a fixed part 1012 and a tiltable part 1013.

The upper side-members 54 in a lower back region of the trolley, that is over the pivot pin 42, have a Bakelite (trade mark) sheet 1014 fixed between them. This sheet carries self-adhesive Velcro strips 1015. The bottom of the mattress part 1012 carries complementary Velcro strips, whereby this part of the mattress is removably fixed in position on the trolley. The lower back Bakelite sheet 1014 has hinged to it a tiltable sheet 1016 which can be support at a selected tilt angle by a support rack 1017 on the inside of the upper side-members 54.

Should X-ray analysis be required, a film cassette can be passed beneath the patient by insertion between the lower and upper side-members 53,54. It is supported there on an X-ray impervious steel plate 90 extending between the lower side-members 53. If an image intensifier is required it can be accommodated beneath the foot section 52. For its use there, it may be necessary for the patient to turn end for end on the trolley.

For gynaecological operations lithotomy supports, and for other operations other instruments, can be clamped to rails 91 provided on the outside of the lower side-members 53. The lithotomy supports can be clamped at the foot end of the rails 91. With the patient's legs raised, the foot end mattress part 102 is removed and the foot end section 52 telescopically collapsed. The surgeon is then able work close to the patient with his stool accommodated in the foot-end region between the base side-members 21,22. The anaesthetist can remain at the head end of the trolley since the patient has not had to be moved along the trolley. If the patient has to be placed in Trendelenburg tilt, her/his centre of gravity will be close to the cross-pin 42 and the tilting of the upper portion 5 is easily effected. The patient can of course be easily raised or lowered by use of the actuator 39.

Claims

CLAIMS:

1. A day surgery trolley comprising: a wheeled base, an upper portion of the trolley for supporting a mattress, the upper portion having a body section and a foot section telescopically arranged with respect to the body section, the body section being adapted for fixed support of a central part of the mattress, a support structure for the upper portion of the trolley attached to and extending up from the base and supporting the upper portion of the trolley at the body section beneath the central part of the mattress, a Trendelenburg mechanism for tilting the upper portion of the trolley about an axis at the upper, supporting end of the support structure.

2. A day surgery trolley as claimed in claim 1, wherein the Trendelenburg axis is situated in the lower back region of a typical adult patient with respect to the patient's longitudinal position along the trolley when in a lithotomy position at the foot end of the body section.

3. A day surgery trolley as claimed in claim 1 or claim 2, wherein the base has a central region from which the support structure extends and a foot-end region open to the central region.

4. A day surgery trolley as claimed in claim 1, claim 2 or claim 3, wherein the support structure is generally columnar.

5. A day surgery trolley as claimed in claim 4, wherein the support structure comprises a central actuator and a pair of telescopic stabilising units on opposite sides of the actuator.

6. A day surgery trolley as claimed in claim 5, wherein the central actuator is hydraulic.

7. A day surgery trolley as claimed in claim 5 or claim 6, wherein the the stabilising units are arranged longitudinally of the trolley in front of and behind the actuator

8. A day surgery trolley as claimed in claim 5 or claim 6, wherein the stabilising units are arranged laterally of the trolley to either side of the actuator.

9. A day surgery trolley as claimed in claim 8, wherein a cross-pin is arranged at the top of the support structure which performs all of the following functions: (a) interconnecting the actuator to upper members of the stabilising units, (b) interconnecting the support structure and the upper portion of the trolley, and (c) providing the Trendelenburg pivot axis between the support structure and the upper portion of the trolley.

10. A day surgery trolley as claimed in any one of claims 5 to 9, wherein lower, preferably outer, members of the stabilising units are fixed to the base to give the support structure stability.

11. A day surgery trolley as claimed in as claimed in any one of claims 6 to 10, wherein the actuator incorporates a pump at its bottom end, actuated by pedals extending either sideways or to the head end of the trolley.

12. A day surgery trolley as claimed in any preceding claim, wherein the Trendelenburg mechanism comprises at least one manually operable, resilient catch mounted on the body section opposite a respective number of rotationally fixed quadrant member(s) centred on the Trendelenburg axis and adapted for engagement at a plurality of angular positions with the catch(es).

13. A day surgery trolley as claimed in claim 12 as appendant to claim 9, wherein there are two quadrant members and each is fixed to a respective one of the upper members of the stabilising units of the support structure.

14. A day surgery trolley as claimed in any preceding claim, wherein the Trendelenburg mechanism includes a helper spring acting to urge the head end of the upper portion of the trolley upwards when the mechanism is released for adjustment.

15. A day surgery trolley as claimed in any preceding claim, wherein the telescopic foot section is a U-shaped member, the parallel limbs of which are received in side-members of the body section.

16. A day surgery trolley as claimed in claim 15, wherein the foot section is adapted to receive a removable foot part mattress with a hard base, the hard base and the foot section being complementarily formed, whereby the hard base stiffens the foot section in its plane.

17. A day surgery trolley as claimed in any preceding claim, wherein the body section has at each side upper and lower side-members, the upper side-members supporting body part(s) of the mattress, the separation of the side-members being such as to allow passage of X-ray plates.

18. A day surgery trolley as claimed in any preceding claim, including an angularly adjustable headrest.

19. A day surgery trolley as claimed in any preceding claim, including side rails to which accessories can be clamped.

20. A day surgery trolley comprising: an upper portion of the trolley for supporting a mattress, the upper portion having a body section and a foot section telescopically arranged with respect to the body section, the body section being adapted for fixed support of a central part of the mattress, a wheeled base having a central region and a foot-end region open to the central region, a height adjustable support structure for supporting the upper portion of the trolley above the base, a Trendelenburg mechanism for tilting the upper portion of the trolley.

21. A day surgery trolley substantially as hereinbefore described with reference to the accompanying drawings.