JPS5922525B2 - Surgical aids and surgical retractor frames - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention is a method of moving and holding entities such as soft non-skeletal tissues, muscles, organs, etc. in a moved position to allow access to the surgical site during the course of a surgical procedure. This relates to a surgical surgical aid, that is, a surgical retractor, which is used in the surgical procedure.

Currently, the common practice in hospital surgical rooms is to have a surgeon's assistant who manually moves the entity from the surgical site as required by the surgeon, who of course wears surgical gloves. using a sponge or towel applied to the moved entity, or a rigid metal instrument held in the hand.

It is an object of the invention to make unnecessary the use of the assistant's hands and thus to free him or make him unnecessary, as the case may be, to play a more fruitful role during the operation. It is.

However, it should be understood that the surgical aid of the present invention is not limited to use in hospital operating rooms, but may also be used in dental surgery or veterinary surgery.

It is also an object of the present invention to provide a surgical aid that has minimal adverse effects on the moved entity, as opposed to e.g. towels or sponges which may damage the engaged purpuric surfaces or organs due to their rough surfaces. It is.

Towels and sponges can also dry the membrane surface by absorption and thus alter the normal physiology of the organ.

Additionally, towels and sponges often dry the membrane surface without adequately protecting it from exposure to air.

The assistive device of the present invention is free from these drawbacks and the disadvantages exhibited by other surgical assistive devices that have been proposed but have not yet come into widespread use.

Many of these existing devices cannot be repeatedly bent into various shapes, do not maintain their bent shape, or react with body fluids or purpuric membrane coatings, or absorb body fluids and dry out. , or have a relatively rough or hard surface that may damage the organ, or put too much pressure on the organ that is moved and held, or is used and rapidly deteriorates, or is externally supported Therefore, it cannot be fixed and maintained.

Essentially, the present invention is a surgical aid having a main body in the form of a ductile component atomically bonded to a nidistomer component, the main body being flexible. a bundle extending from said main body in the form of a ductile component that is non-toxic and compatible with cellular metabolism and also atomically bonded to an elastomeric component; is malleable, non-toxic, and compatible with cellular metabolism, so that during surgery, the body is placed at the surgical site to move and hold tissue that will not be operated on, and the bundle can be grasped at a point external to the surgical site to maintain it in a desired position, and the main body and the bundle together have a function approximating that of a human hand, wrist, and forearm. It looks like this.

Preferably, the main body and the bundle are comprised of a metal core and an elastomer coating.

The core metal is preferably aluminum, an alloy of aluminum, or stainless steel, and the coating nidistomer can be bonded to the core metal, the currently preferred nidistomer being a dimethylpolysiloxane polymer. .

The metal core may be in the form of a plurality of wires wrapped around the bundle and looped within the main body.

Alternatively, the metal core may include a rigid piece of metal within the main body, a coiled wire extending from the same body into the bundle, and tapering outwardly to increase compliance. The metal piece may be in the form of a plurality of wires extending radially into the main body.

The assistive device of the present invention can be made into a variety of different shapes for use in a variety of surgeries, and the gauge of the metal used in the heart may vary depending on the assistive device and the procedure for which the device is intended. Can be selected to provide the most appropriate strength.

Additionally, the main body of the assistive device may be provided with a soft edge portion or flap to avoid damaging entities at the surgical site that the edges of the assistive device may come into contact with.

Such flaps may be grooved on one side to make it easier to move the flap in one direction than in the opposite direction, and may also be grooved on one side to make it easier for the surgeon to manipulate the flap. It does not matter if there is a small bump that can be pinched.

In other cases, the main body of the assistive device may be subdivided remotely from the bundle to form fingers, which fingers are individually movable and which can be moved at the surgical site. The fingers will maintain the relative positions moved to suit the anatomy.

Such fingers may be provided with small ridges as described above.

It is contemplated that a control device, such as a Bowden cable, may be built into the assistive device to facilitate manipulation of the main body of the assistive device within the surgical site.

It is also contemplated that a suction device and/or light source may be included if desired.

The main body of the surgical aid can be held in place within the surgical site by grasping the bundle of the instrument at a location outside the surgical site, so that the surgeon has free access to the site. and can operate the instrument as desired.

Although this grasping may be accomplished manually by a surgeon's assistant, it is most often preferred to use clamps on a retractor frame that is adapted to be fixed relative to the surgical site. It is to have a bundle that is retained.

Said frame preferably includes first, second and third frame members fixed to each other, said second and third frame members being parallel to each other in the same direction spaced apart and away from said seventeenth frame member. and having a fourth frame member mounted on both the second and third frame members so as to be adjustable toward and away from the first frame member, and in use. and an unlockable locking member that holds the fourth frame member apart from the first frame member, and each of the first and fourth frame members is slidably mounted on each of the first and fourth frame members. a pair of retractor hooks respectively mounted thereon, and at least one of the second and third frame members having the clamp adjustable thereon; It has become.

Slidingly mounting the hook on the frame allows the surgeon greater leeway in choosing the shape of the wound that will allow him to access the surgical site.

In some cases the surgeon may desire a narrow shape, while in other cases a nearly round shape may be preferred.

Engagement of the retractor hook by the musculature surrounding the wound holds the locking member in the locked position and the frame in a fixed position relative to the surgical site, thus making it the main body of the surgical aid. ensuring that the position of the same body remains within the surgical site unless adjusted by the surgeon during surgery.

Embodiments of the invention will now be described, by way of example, with reference to the accompanying drawings, in which: FIG.

As shown in FIG. 1 of the accompanying drawings, the surgical aid according to the present invention has a main body part 1 and a bundle part 2.

Both of these parts are made of an inner core of metal, such as an aluminum alloy, and an outer coating of nidistomer, such as a dimethylpolysiloxane polymer, with the materials bonded together.

Because of this connection, there are no voids inside the assistive device, and the ductility and elasticity of the image components are combined.

Dimethylpolysiloxane polymers are well known for their compatibility with cellular metabolism, and they are chemically inert and therefore resistant to microorganisms in the unlikely event that they are accidentally cut or punctured. It will not be maintained.

Furthermore, the polymer easily withstands repeated sterilization and is a poor conductor of heat and electricity, all of which make it ideal for the purposes of the present invention, although of course other diostomers may also be used. I'm completely satisfied.

FIG. 2 illustrates the functional similarity between surgical aids and the human hand, wrist, and forearm.

Although in some cases it is not necessary for the aid to have cuts 3 subdividing the lower edge of the main body, these cuts serve in this example to illustrate the above-mentioned similarity even more clearly in the drawings.

Therefore, the part 4 defined by the cleft 3 can be compared to a human finger 5, and the upper part 6 of the part 4 can be compared to a thousand 7 of a human hand, and the main part 1 and ...the connection point 8 with the bundle part 2 can be compared with the wrist 9, and the part 10 of the bundle part adjacent to the connection point 8 can be compared with the part 11 of the forearm adjacent to the wrist. can.

Moreover, the assistive device has the advantage that the bundle part can be bent whereas the person's forearm cannot.

The entire assistive device can be straight as in FIG. 1, or parts of the device can be moved into any of a variety of positions as shown in FIG. and these parts will remain in this position until they are forced out of this position.

The surgeon can thus manipulate the parts within the surgical site to give him the exact position he desires in order to properly hold and stabilize the moved entity 12.

The assistive device is held by grasping the bundle portion outside the surgical site so that the main body extends into the surgical site, thus minimizing the obstruction of available space within the surgical site. be able to.

Although it is okay for an assistant to grasp the bundle part with his/her hand,
It is preferred in most cases to grasp it by means of clamps mounted on a frame which is adapted to be held in fixed relation to the surgical site, and thus to assist the surgeon's assistant during the operation. The goal is to either free them up to perform their roles or eliminate the need for such assistants.

As shown in FIG. 3, the frame 13 is connected to the first member 1
4, second and third members 15 and 16, a fourth member 17, and a fifth member 18.

Elements 14, 15, 16 and 18 form a fixed rectangle, but element 17 can be moved along both elements 15 and 16 and between the elements 14 and 18.

A pair of retractor hooks 19 and 20 are mounted on the member 14 in a frictionally slidable manner in the longitudinal direction of the member 14, and a similar pair of retractor hooks 21 and 22 are mounted on the member 17 in a similar frictionally slidable manner. The retractor hooks are mounted on the retractor hooks to engage the edges of the surgical incision and hold the incision open to allow the surgeon access to the surgical site. It has become.

The four hooks are slidably mounted, allowing the surgeon to widen the incision to create any shape of open wound desired.

Therefore, by having each pair of hooks in close proximity,
The surgeon can make the wound elongated, or it can be made almost round by placing the hook relatively far apart.

Each of members 15 and 16 has teeth 2 along its respective outer surface.
3, and these teeth point away from the member 14.

The member 17 has fulcrum pins 26 at opposite ends of the member.
and 27, respectively, with locking members 24 and 25, the fulcrum pins being able to slide in slots 28 and 29, respectively, in member 17.

Each locking member has a certain amount of clearance between member 15.
160 in the form of a block through which passageway 300 is wide enough to pass one.

Therefore, when the surgeon makes the incision, he
The hook can be inserted into the incision site with the two closely spaced apart, and he can then simply push members 14 and 17 apart until the desired width of the wound is obtained.

The stretched muscle tissue surrounding the wound as well as members 14 and 17
5, the pulling force on the hooks 21 and 22 causes the locking member to swing relative to the frame member 17, thus causing the edge of the passageway 30 to Frame member 15° 160 with 31 in contact with tooth 23 and with diagonally opposite edge 32 passing through the same passage.
Make contact with the inner surface.

If the edge 31 engages one tooth 23, the frame member 17
is held in the adjusted position of the same member.

Of course, once the surgery is complete and the surgeon wishes to close the wound, he simply applies pressure to member 17 and the locking member,
5 to the position shown as occupied by member 25, and he can then simply slide both members 14 and 17 back into approximation and remove the frame from the patient.

Referring again to FIG. 3 (which shows the movable state of the clamps before they are attached to the frame members 15 and 16), two clamps 33 and 34 are attached to the frame members 15 and 16, respectively. Each of the surgical aids 35 and 36 can be held by the bundle portion, with the respective main body portion extending to the surgical site to hold the surgical element.

Each of the surgical aids includes a coiled wire 37
It has a metal core in the form of a bundle part and a loop 38 in the main part.

The bundle portion has a square cross section and the main portion is in the form of a substantially rectangular flat pad.

Referring now to FIG. 4, which shows the clamp attached to member 18, the clamp is shown to be easily operated by the surgeon, and which the surgeon wishes to attach. It can be easily adjusted along the frame member.

The clamp has a base portion 39, a fixed jaw 40 extending upward from one end of the base portion, and a movable jaw 41 rotatably mounted on the base portion at 42. There is.

The movable jaw is moved between open and closed positions by a lever 43 attached to two members 44 of a knee link mechanism 45, and the knee link mechanism is rotatably attached at 46 to the top of the jaw 41 and is attached to the knee link mechanism 41. The opposite end of the linkage is rotatably mounted to base portion 39 at 47.

The pivot or fulcrum 48 between the two members 44 and 49 of the knee linkage is moved over-center by operating the lever 43 either upwardly to open the clamp or downwardly to close the clamp. It will be done.

Therefore, it is easy for the surgeon to place the bundle portion of the surgical aid between the jaws of the clamp when these jaws are in the open position and then press down the lever 43 with the thumb to place the aid in the correct position. It is.

The clamp can be mounted to the frame member in any desired position by means of a mounting mechanism 50 which operates on a principle similar to that used for the same clamp, thus lever 51 It is also easy for the surgeon to push down and install the clamp in the desired position on the frame.

The movable jaw 52 of the mounting mechanism may have a padded surface facing the frame member to accommodate various thicknesses of the frame member and to provide a secure grip thereon. I do not care.

Figure 6 shows frame 13 in place, hooks 19 and 2
0 engages the musculature 53 around the margins of the surgical site, one surgical aid 54 holds open the incised bladder 55 at 56, and the other surgical aid 57 is placed under this instrument. The actual surgical site is shown with the intestines 58 being held down so that the vertebrae 59 are present.

It should be understood that each surgical aid is adapted to its own function.

FIG. 7 shows an embodiment of the surgical aid of the present invention in which the metal core is in the form of a rigid metal strip 60 and a metal coil 61 extends upwardly into the bundle. A plurality of wires 62 extend radially outwardly from the metal piece 60 into the main body of the assistive device.

The wires 62 may be tapered as they extend outwardly from the metal piece 60 to provide increasing flexibility to the main body of the assistive device.

8 and 9 show another embodiment of the surgical aid, in which the main body 1 has a flap 63 on the lower edge of the same part and a flap 64 on the upper edge of the same part. , and has ears 65 extending laterally on each side edge of the same portion.

The flaps 63 and 64 are provided with grooves 66 so that they can be bent more easily in the direction indicated by the arrow than in the opposite direction.

These flaps are designed for various surgical space adjustments and tissue retention adjustments.

The function of the ear piece 65 is also similar.

These flaps and ears have no metal core and therefore have a cushioning effect on the tissue they come into contact with.

Figures 10-19 show various other embodiments of the surgical aid of the present invention, each of which is adapted for a specific function.

Accordingly, FIG. 10 shows a surgical aid particularly suitable for restraining the intestine during gallbladder surgery.

FIG. 11 shows a two-sided assistive device particularly suitable for use during brain surgery and provided with a thick cushion of soft nidistomer.

FIG. 12 shows an assistive device designed to hold down the lungs during thoracic aorta surgery.

The bundle portion of the device has increased strength to withstand lung pressure.

Figure 13 shows an assistive device adapted to restrain the lungs, with the protruding edges at the top of the main body engaging the liver lobes.

FIG. 14 shows an assistive device particularly suitable for muscle traction.

Figure 15 shows the esophageal retainer with the bundle section extended for use during peritoneal entry.

The organ enters the abdominal cavity, follows the diaphragm, and wraps around the esophagus.

Figure 16 shows the surgical aid adapted to hold the bladder closed, whereas Figure 17 shows the surgical aid adapted to hold the incised bladder open as in Figure 6. It shows the assistive devices that are used.

Figure 18 shows a surgical aid adapted to keep the base of the lung away from the diaphragm during hiatal hernia surgery, and Figure 19 shows a surgical aid adapted to hold the heart during such an operation. Indicates particularly suitable assistive devices.

It is clear that the surgical aid according to the invention can be used in all body cavity surgeries, for example cardiac, thoracic, cerebral or abdominal surgeries.

The invention can of course also be used in veterinary surgery and dentistry.

Rather than having an operating surgeon move an entity into a desired position and then having an assistant hold it in place and move it when commanded, the surgical aid of the present invention can be combined with the frame described above to allow the surgeon to position the object at the surgical site. to enable him to place them precisely to his own taste and to adjust them from time to time as necessary.

Furthermore, because of the low profile and minimal space occupied by the frame and assistive instruments, the maneuverability afforded to the surgeon even outside the actual surgical site is very large.

The surgical aids of the present invention can be manipulated to closely conform to the shape of the entity being moved and to protect this entity from air, water loss, or heat, or from injury by surgical instruments. .

Furthermore, the surgical aid of the present invention is ideal for use, for example, during brain surgery, where the moved entity may cause acute inflammation due to conductive materials.

While rigid, unbendable instruments can cause lacerations to organs such as the liver and spleen due to careless movement by the assistant holding them, the assistive device of the present invention avoids such lacerations. It will undergo a gentle transformation.

Furthermore, the constantly moving heart and intestinal cells can be injured by materials with high friction surfaces.

Such injuries do not occur using the low friction surfaces of the assistive devices of the present invention.

[Brief explanation of drawings]

FIG. 1 is a perspective view of a surgical aid, FIG. 2 shows the surgical aid of FIG. 1 being used within a surgical area;
In addition, in order to illustrate the similarity of functions, the figure also shows a human hand, hand plate, and forearm. FIG. 4 is a perspective view of the clamp attached to the frame 18 shown in FIG. 3, FIG. 5 is a plan view of the frame, and FIG. 6 is a perspective view of the retractor frame showing its condition. 7 is a perspective view of a surgical site showing two different types of surgical aids, FIG. 7 is a perspective view of a surgical aid having a different heart structure than that shown in FIG. 3; FIG. 9 is a perspective view of another embodiment of the surgical aid instrument of the present invention, FIG. 9 is a sectional view of the main body of the surgical aid instrument shown in FIG. 8, and FIGS. It is a figure which shows other various Examples of an assistive device. 1... "Main part", 2... "Bundle", 7... "Hand", 9... "Hand board",
11... "Forearm", 13... "Frame", 14... "First frame member", 15.
..."Second frame member", 16...[
37L'-arm member J, 17... "Fourth frame member", 19, 20, 21, 22... "Pair of retractor hooks", 23... "Teeth", 24,2
5..."Lock member J, 33, 34...
"Clamp", 35.36,54,57...
Surgical aid equipment”.

Claims (1)

[Claims] 1. A surgical retractor that allows access to a surgical site without an assistant includes a main body 1 inserted into the surgical site and a bundle part 2 protruding from the main body. wherein each of the body portion and the bundle portion is formed of a polymeric material, and at least the body portion and the bundle portion are capable of bending and twisting in any direction and that after deformation. has a core of a malleable material capable of retaining the shape of the bundle, so that the bundle part can be bent and twisted in any direction, and that the bundle part can retain its shape until it is deformed again by bending or twisting it. A surgical retractor characterized in that the bundle portion can be held in a bent or twisted configuration.