JPS58133246A - Surgical retractor - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to surgical instruments and to an improved surgical retractor.

Surgical retractors are well known and have been widely used for many years. They are extremely useful and necessary for keeping the body fully open 7' during various types of major surgical procedures;
Occasionally, their use may cause accidental damage to the patient's internal organs by movement during the procedure and/or rupture of the wound area if the patient "resists" under general anesthesia. It has the disadvantage that accidental and dangerous dehiscence may occur as a result of the procedure. Also, simple breathing may cause dehiscence in the position of the device, especially in the flank. This rapid closure of the wound often occurs at a critical time during the surgical procedure, which may have severe consequences.

U.S. Patent Nos. 1,311,313 and 19 issued to BrixJ on July 29, 1919.
Some known pitch tractors do not have any precise locking means and the retractor does not have any precise locking means, as shown in U.S. Pat. relies solely on a slightly angled sliding arm to hold it in the desired position. Kon
During a surgical procedure, the retractor is under very high loads and is extremely dangerous due to constant movement of the patient (i.e., breathing) and the retractor should not be accidentally struck or pried. If it does, it may release immediately during a critical or delicate part of the surgery, causing irreversible damage. F'L American Patent No. 1.706,500 issued to Smith J. on March 26, 1929 and NFC National Patent No. 1 issued on June 19, 1934 to Marin VC.
．． '763,173 presents an attempt to overcome this problem using ratchet means, which was an improvement but still not sufficient. Another attempt to overcome this problem has been to provide a retractor with a screw lock, but this is also not quite complete;
Inconvenient to use and free during the procedure and abdominal cavity'! !
- or may have been left in the retroperitoneal space. Another solution, although not completely satisfactory, was proposed by Gauthler on January 4, 1966.
No. 3,227,156, issued in 1999.

No. 2,450,194 issued to Glaser on September 28, 1948.
As such, lachitic retractors also have the disadvantage that excessive force may be applied to the body orifice resulting in permanent damage to the surrounding area. Mechanically assisted forced dilation of body orifices has also been known to result in rib fractures and organ damage. It is usually desirable to spread the wound apart as long as the incision can be made without causing any damage.

Therefore, the surgeon can accurately feel the force being applied by the retractor arm during expansion and also
It is essential that the locking device can be quickly, conveniently and precisely secured when the desired position is achieved.

Another important source of potential damage from the tractor occurs if the cross member of the tractor is not positioned against the patient's abdomen or flank during use. Although this problem does not normally occur during abdominal surgery, it is currently an accepted problem during visceral surgery. In a standard nephrectomy procedure, the surgeon stands behind the patient and leans back, effectively touching the cross member of the retractor as the arm extends posteriorly from the incision.

If the surgeon's body accidentally exerts a downward force on the cross member of the retractor, it may cause a retractor grade wound resulting in damage to major blood vessels or internal organs such as the human heart, liver, and lungs. The effect of downward rotation within the section tl'ff. Occasionally, this results in the retractor twisting out of the 11'' angle sufficiently to cause the retractor to close abruptly. To make matters worse, this usually occurs during critical portions of the surgery when the surgeon is concentrating on his performance and may be leaning slightly more than normal or out of fatigue.

Accordingly, it is an object of the present invention to at least partially overcome these disadvantages by providing an improved surgical retractor having improved spring restraint means.

6- To this end, in one of its aspects, the invention includes a pair of arms attached to an elongated cross member, one arm being secured to the cross member adjacent one end of the other. A surgical retractor is provided in which an arm is slidably mounted on a cross member. Each arm has blade means extending from the arm adjacent to its free end such that opposing edges of the surgical incision are secured by the blade means and the other arm is separated from the fixed arm by a cross member. It can be pulled apart by sliding it along. A plurality of aligned holes are spaced apart along the cross member and include locking means.
The other arm can be selected from a plurality of positions 7'c along the cross member and fixedly held at one position. The locking means is pivoted back to the other arm! a locking member, the detent member being adapted to engage and be received in the trigger portion and one of the apertures; It is spring-loaded so as to bias it against. The other arm is
holding the trigger portion of the detent member by sliding said other arm along the cross member and releasing the trigger portion such that the pin portions are released and engage the holes of @1; Lock position IM selected by
can be fixed to. The other arm is thus held fixed in the locked position against the pressure of the incision on the arm until the trigger part is released.

In another aspect, the present invention provides for the retractor to be bent in a direction such that the grade means extends into the incision to the extent that the retractor is contoured in position relative to the patient's flank when the arms are used in renal surgery. This surgical retractor is provided.

Further objects and advantages of the present invention will become apparent from the following description with reference to the accompanying drawings.

First, referring to FIGS. 1 to 3, a cross member 12 and a pair of arms 14, 16'x and a retractor (
Retractor) 10 is shown. Arms 14 and 16 face each other and removably engage slots 22.
each having a shaped wire spring blade member 18,20. As can be seen in the figure, one arm 14 is secured to the cross member 12 at one end, while the other arm 16 is locked in a selected position by a locking mechanism 24. It slides along the cross member 12 until the end. A stop 26 is provided at the other end of the cross member 12 to avoid the risk of the arm 16 sliding off completely. The grade members 18, 20 are bent in the same direction for insertion into the wound, and the arms 14, 16 are both bent in the same direction for insertion into the wound.
It is bent in the same direction as above, transverse to 2.

Both arms 14, 16 also have slightly bent knob retainers 28.50 projecting downwardly from the cross member 12.

Sliding arm 16 has a throughbore 62 and includes a detent member 34 pivotally mounted within throughbore 32 by a pin 36, as shown clearly in FIG. Sliding arm 1
6 is cast with a hollow sleeve portion 58 extending below detent member 34 and shaped to slidably fit cross member 12 therein. The detent member 34 has a projecting pin portion 40 at one end and a trigger portion 42 at the other end. Spring 44
is seated within detent member 64 and abuts sleeve 38 to bias pin portion 40 against planar member 46 of cross member 12. - the row of holes 48 are arranged in the flat wU 46 in alignment with the protruding pin portion 40 of the detent member 64; The protruding pin portion 40 is shaped to be securely seated within the first hole 48 under the force of the spring 44 so that the arm 16 can slide along the cross member 12. In this embodiment, all components of retractor 10 are fabricated from stainless steel, which has the combination of high strength and corrosion resistance necessary for surgical instruments. The stainless steel has a brushed finish to reduce reflections from surgical lighting.

In use, the surgeon makes an incision in the patient's body at a desired location and inserts into said incision the grade sections 18, 20 of the retractor 10, both having proximal arms 14,16. The grade members 18, 20 are interchangeable and made of different lengths, and a grade of appropriate length is selected.
! ! Care must be taken to position the bamboo organs so as not to damage them.

Surgeon's beam tractor 10f: Holds the cross member 12 facing him and directs the arms 14, 16 toward the wound away from him. The surgeon's left hand holds the fixed arm 14 and his right hand holds the sliding arm 16, and the arms are gradually pulled apart to widen the wound to the required extent.
Ru. Normally, each toga finger (first finger) of both hands is placed on the knob holding part of the lower part of the cross member 12, and the cross member 12 is
The upper finger arm 14,16 is positioned to extend between the index and middle fingers of each hand.

In this position, the third and fourth fingers of the right hand automatically rest on the trigger portion 42 of the detent member 34, which is depressed during expansion.

When the wound opening reaches the required size, the trigger portion 42 is released and the pin portion 40 of the detent member 34 fits into the appropriate hole 48 and the retractor 10ft is inserted into that position. Securely locks.Even if the retractor 10 is pulled out, assisted, or accidentally released, the spring 4
A force of 4 automatically engages the pin portion 40 within the first hole in the closing direction.

During wound expansion, the resistance of the body expansion site must be carefully felt in the surgeon's hands to avoid excessive applied tension. If excessive force is required before the necessary expansion is obtained, the incision must be increased to avoid damage to internal organs, organs and ribs, and a retractor facilitates this. for quick and convenient locking in any intermediate position. If adjustments to the size of the expansion are required during the surgery, this can be easily done without the risk of the retractor being removed or released.

This particular embodiment is particularly adapted for renal surgery, with the patient, incision, retractor and surgeon oriented in the normal position shown in FIG. As can be seen, the bent arms 14-16 are shaped to resemble the patient's flank with the cross member 12 positioned adjacent the patient's flank in the inserted position 7'. This has two different advantages. In the first vC, the cross member 12 of the retractor gives the surgeon improved access to the wound area [7
This method eliminates the worry of accidentally hitting the pull tractor and rotating the blade entirely within the wound, or even accidentally pulling the pull tractor away from the wound and tapping it. nru. @2vC, even if the surgeon applied the retractor as well, it would not be possible to make a full rotation because the retractor is already upright relative to the patient's body.

Furthermore, in this position there is a slight risk that the locking mechanism 24 will be accidentally released because the trigger portion 40 is adjacent to the cross member 12 and in the plane of the arm at that point.

FIG. 5 shows the construction of a second embodiment of the beam tractor and, since many features correspond to those of the first embodiment, features common to both embodiments are described using the same reference numerals.

In this embodiment, the cross 16 has a cut 12, a locking mechanism 24 and a blade side 18°20.
corresponds to that of the first embodiment, but the arms 14-16 are straight rather than curved and an intermediate visceral grade 50 extends from the cross section 12. The intermediate visceral blade 50 also slides over the cross member 12 and has a curved diamond-shaped portion 52 and a curved finger portion 54 at its opposite ends. wing nut 56
is a slot 58 with an enlarged j'i: 1 min 60 provided for removing the intermediate internal grade 50 from the retractor.
Gold penetrates.

This embodiment is used as a ventral retractor for kidney transplants in the general surgery, gynecology, general surgery areas and also for the lower part of the ureter. The method of use is that following insertion, the intermediate visceral grade is pulled back and the wing nut 5 is inserted to hold the intestinal tract away from the direction of the surgeon during the procedure.
This is essentially the same as described above in connection with the first embodiment, except that it is locked by 6. The location of the incision in the abdomen must be determined by comparing the appearance of the arm to the patient's body.
4- It will be appreciated that the cross member 12 is normally positioned in a stable position relative to the patient's body without the need for the same.

FIG. 6 shows the structure of a sixth embodiment of the present invention, which is a larger abdominal retractor for use in major surgical procedures such as peritoneal lymphadenectomy or radical cancer surgery such as cystectomy and bowel procedures for bladder cancer. This shows that.

Again, the same reference numerals as in the first embodiment are used. In this embodiment, the grade 18.20 is cast integrally with the arms 14 and 16, resulting in a more rigid construction. Locking mechanism 24 is similarly cast in a slightly different shape, but is substantially identical. As will be appreciated, the arms 14, 16 are upright since the incision is usually in the abdomen into which the retractor can be inserted so that it is in a stable position relative to the patient's body.

The use of this instrument limits the size and duration of the surgery.
For example, and more importantly, positioning the retractor reliably and safely in the wound is substantially the same as described above. As mentioned above, especially during long-term surgeries, the patient may sometimes ``rebelle'' under the action of the anesthetic with unfortunate consequences if the retractor is not rigid.

Viewing within the wound site is another advantageous aspect that can be improved by increasing the stability of the retractor and improving the surgeon's access to the retractor.

Although the disclosure has set forth some preferred tractor embodiments, this should not be construed in a limiting sense.

Many variations and modifications may occur to those skilled in the art. For example, it will be apparent that the fixed and sliding arms can be reversed to provide a retractor with a locking mechanism that can be operated with the left hand.

[Brief explanation of drawings]

1 is a perspective view of a surgical retractor according to a preferred embodiment of the present invention, FIG. 2 is an end view of the tractor shown in FIG. 1, and FIG. 6 is a view of the locking mechanism of the tractor shown in FIG. FIG. 4 is a schematic diagram showing typical positions of a patient, retractor and surgeon during renal surgery; FIG. 5 is a perspective view of a retractor according to another embodiment of the invention; FIG. FIG. 7 is a perspective view of a retractor according to still another embodiment. In the figure, numeral 10 is a retractor, 12 is a cross section system, and 14 is a retractor.
．． 16 is an arm, 18.20 is a grade member, 24 is a locking mechanism, 64 is a detent member, 40 is a pin portion, 42 is a trigger portion, and 48 is a row of holes. =17-

Claims (2)

[Claims] (1) a pair of arms attached to a cross member, one of which is fixed to the cross member adjacent to one end of the cross member, and the other arm is slidably attached to the cross member; arranged at intervals along the cross member
a plurality of apertures, and locking means capable of securely retaining said other arm in a plurality of selected positions along said cross member, each said arm being adjacent to its free end; blade means extending therefrom so that opposing edges of the surgical incision engage said blade means and slide said other arm away from said fixed arm and along said cross member; the locking means includes a detent member pivotally connected to the other arm, the detent member being received in engagement with the trigger portion and one of the apertures; and a protruding pin portion configured to push the other arm away from the detent, the detent member being spring-loaded to bias the pin portion relative to the cross member. holding the trigger portion of the member, sliding the other arm along the cross member and releasing the trigger portion with the result that the pin portion engages the first of the holes reached after release; the other arm being held fixed in the locking position against the pressure of the incision on both arms until the trigger portion is released. A surgical retractor characterized in that: n;6. (2) said arms are bent in a direction in which said grade means extends into the incision to the extent that the retractor is contoured to the side of the body when used in renal surgery; A surgical retractor according to claim 1, characterized in that: