US1275520A - Gauze-dam surgical instrument. - Google Patents

Gauze-dam surgical instrument. Download PDF

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Publication number
US1275520A
US1275520A US17471317A US17471317A US1275520A US 1275520 A US1275520 A US 1275520A US 17471317 A US17471317 A US 17471317A US 17471317 A US17471317 A US 17471317A US 1275520 A US1275520 A US 1275520A
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gauze
spreader
surgical instrument
dam
jaws
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US17471317A
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William L Bell
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William L Bell
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/2812Surgical forceps with a single pivotal connection
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A61B2017/0225Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/2812Surgical forceps with a single pivotal connection
    • A61B17/2833Locking means
    • A61B2017/2837Locking means with a locking ratchet

Description

W. L. BELL.

GAUZE DAM SURGICAL INSTRUMENT.

APPLICATION FILED JUNE 14. 1911.

1,275,520. Patented Aug. 13, 1918.

l X X 6 U I l g 2 WITNESS: INVENTOR.

22 WilliamLBeLL.

ATTORNEY Z n45 Nanms PETERS CO.,FNDTO-LITNO..WASHING7UN1 11c.

WILLIAM I1. BELL, OF SANTA CRUZ, CALIFORNIA.

GAUZE-DAM SURGICAL INSTRUMENT.

Specification of Letters Patent.

Patented Aug. 13, 1918.

Application filed June 14,1917. Serial No. 174,713.

To all whom it may concern Be it known that I, VVILLIAM L. BELL, a citizen of the United States, and a'resident of the city and county of Santa Cruz, State of California, have made a new and useful inventionto wit, Gauze-Dam Surgical Instruments; and I do hereby declare the fol lowing to be a full, clear, concise, and exact description of the same.

This invention relates particularly to gauze dams for controlling'the internal organs during abdominal operations, to avoid the necessity of packing the cavity with gauze, sponges and the like, to prevent the obtrusion of surrounding organs interfering with the field of surgical operation.

In this specification and the annexed drawings the invention is illustrated in the form considered to be the best, but it is to be understood that the invention is not limited to such form because it may be embodied in other forms, and it is also to be understood that in and by the claims following the description it is desired to cover the invention in whatever form it may be embodied. V In the accompanying one sheet of draw- 1ng:

Figure 1 is a plane view from above of a surgical instrument constructed in accordance with this invention.

Fig. 2 is a side elevation of the spreader, the gauze bag being omitted.

It is the particular function of this instrument in abdominal surgery, to provide a fiat' wall or dam for holding back the intestines within the abdominal cavity after the incision is made, to provide an unobstructed cavity surrounding the determined field of operation.

Y The construction illustrated in the drawings includes:

A spreader composed of a pair of handles 1 and 2, havin overlapping mortised lugs joined by a plvot pin 3 passing freely through one of said lugs and screwed into the other. The pin 3 is provided with the enlarged knurled head 4 to facilitate assembling of the instrument. These handles preferably terminate in the loop finger grips 1' and 5 for handling the instrument. On

1 the opposite side of the pivotal point the practice.

tensions 6 and 7, in practice extending about six or seven inches. These extensions are bent down at an angle of about 20 degrees from the plane of the handles, as shown in Fig. 2. The extensions 6 and 7 are approximated or closed by spreading the grips 4: and 5; the jaws 6 and 7 are spread by the reverse action of the grips 4: and 5 and are held in the closed or spread position by the spring detent 8, preferably forming a continuation of the loop 5 and provided with the notches 9 engaging the bent over end 10 of the loop 4'. In the retracted position the end 10 engages the notch 11 to hold the jaws 7 and 6 together. The detent 8 can be disengaged by pressure downward on the end 12 thereof.

This instrument is used in combination with a bag like covering of sterile gauze 13, formed of a double thickness of gauze stitched on the opposite edges 14 and 15 and open along the selvage edge 16, or otherwise cut and formed most economically with respect to the consumption of gauze. The retracted aws 6v and 7 of the instrument are then inserted through the opening of the apex of the bag at 17. The bag 15 is then wrapped about the retracted jaws to form as compact a mass as possible for insertion through incision. When properly inserted up to approximately the pivotal point 3, the grip 4 and 5 are compressed extending the jaws 6 and 7 and pulling the bag taut when arrested by the edges 14 and 15. The instrument is automatically locked in the extended position by the engagement of the end 10 with the notches 9 in the detent 8. The handle portionl and 2 of the instrument is then manipulated by an attendant to accomplish the function of the instrument as previously described. When the opera tion is complete the finger grip 4 and 5 are separated which retracts the jaws 6 and 7 within the bag, which is then removed with the spreader.

By the use of this instrument many yards of gauze pack are saved in the performance of an operation in accordance with surgical the gauze bag is obviously superior to the packing of the cavity to perform the same function. The use of this instrument also obviates the danger of leaving gauze,

The use of this instrument with sponges and the like within the cavity after the operation is completed and the incision stitched.

Having thus described this invention, what I claim and desire to secure by Letters Patent is:

1. A surgical instrument including a spreader having two jaws joined by a pivot; a gauze member attached to said spreader; a notched detent formed integral with one of said jaws and engaging said other jaw.

2. A surgical instrument including a pivoted spreader, and a gauze member attached to said spreader.

3. A surgical instrument including a spreader consisting of pivoted jaws and a gauze member attached to said spreader.

4. A surgical instrument including a pivoted spreader, a gauze member attached to said spreader, and means for holding said spreader in the extended position and said gauze taut.

5. A surgical instrument including two jaws joined by a pivot; a detent engaging said jaws; anda gauze member extending between said jaws.

6. A surgical instrument including a gauze bag substantially triangular in plan and means for extending said bag taut.

7. A surgical instrument including a pivoted spreader, handles on said spreader at an angle to said spreader; and a gauze member attached to said spreader.

8. A surgical instrument including a pivoted spreader; handles on said spreader at an angle to said spreader, a gauze member attached to said spreader; and means for holding said spreader in the extended position and said gauze taut.

In testimony whereof I have hereunto set my hand at San Francisco, California, this 4th day of June, 1917.

WILLIAM L. BELL.

In presence of BALDWIN VALE, A. .J. HENRY.

Copies of this patent may be obtained for five cents each, by addressing vthe Commissioner 41! Patents, Washington, D. 0.

US17471317A 1917-06-14 1917-06-14 Gauze-dam surgical instrument. Expired - Lifetime US1275520A (en)

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US17471317A US1275520A (en) 1917-06-14 1917-06-14 Gauze-dam surgical instrument.

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US17471317A US1275520A (en) 1917-06-14 1917-06-14 Gauze-dam surgical instrument.

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Cited By (44)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2841148A (en) * 1957-06-21 1958-07-01 Godfrey J Kadavy Viscera retainer for use in abdominal operations
US3407816A (en) * 1966-02-16 1968-10-29 Curutchet Pedro Domingo Surgical instrument handle
US3654930A (en) * 1970-06-18 1972-04-11 James C Hobbs Expendable hemostat
US3863639A (en) * 1974-04-04 1975-02-04 Richard N Kleaveland Disposable visceral retainer
US3908661A (en) * 1974-01-31 1975-09-30 Steven G Kramer Surgical instruments
US4356821A (en) * 1980-09-17 1982-11-02 Bruce Rind Airway
US4365625A (en) * 1980-09-17 1982-12-28 Bruce Rind Expandable oral airway
US4964417A (en) * 1985-08-22 1990-10-23 Clini-Med Ltd. Wound closure device
US5122155A (en) * 1990-10-11 1992-06-16 Eberbach Mark A Hernia repair apparatus and method of use
US5141515A (en) * 1990-10-11 1992-08-25 Eberbach Mark A Apparatus and methods for repairing hernias
US5271385A (en) * 1990-03-29 1993-12-21 United States Surgical Corporation Abdominal cavity organ retractor
US5301658A (en) * 1992-04-27 1994-04-12 Loma Linda University Medical Center Membrane endoscopic retractor
US5309896A (en) * 1991-05-29 1994-05-10 Origin Medsystems, Inc. Retraction methods using endoscopic inflatable retraction devices
US5402772A (en) * 1991-05-29 1995-04-04 Origin Medsystems, Inc. Endoscopic expandable retraction device
US5431173A (en) * 1991-05-29 1995-07-11 Origin Medsystems, Inc. Method and apparatus for body structure manipulation and dissection
US5450843A (en) * 1991-05-29 1995-09-19 Origin Medsystems, Inc. Retraction apparatus and methods for endoscopic surgery
WO1996002195A1 (en) * 1994-07-19 1996-02-01 Jako Geza J Retractors, tool, and method for direct access endoscopic surgery
US5501653A (en) * 1991-05-29 1996-03-26 Origin Medsystems, Inc. Abdominal wall lifting retractor with hinged cross-member
US5527264A (en) * 1991-05-29 1996-06-18 Origin Medsystem, Inc. Methods of using endoscopic inflatable retraction devices
US5562603A (en) * 1991-05-29 1996-10-08 Origin Medsystems, Inc. Endoscopic inflatable retraction device with fluid-tight elastomeric window
US5632761A (en) * 1991-05-29 1997-05-27 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue, and methods of using
US5656012A (en) * 1994-10-06 1997-08-12 United States Surgical Corporation Surgical retractor
US5704372A (en) * 1991-05-29 1998-01-06 Origin Medsystems, Inc. Endoscopic inflatable retraction devices for separating layers of tissue, and methods of using
US5716327A (en) * 1991-05-29 1998-02-10 Origin Medsystems, Inc. Body wall retraction system for wide cavity retraction
US5728119A (en) * 1991-05-29 1998-03-17 Origin Medsystems, Inc. Method and inflatable chamber apparatus for separating layers of tissue
US5779728A (en) * 1991-05-29 1998-07-14 Origin Medsystems, Inc. Method and inflatable chamber apparatus for separating layers of tissue
US5803902A (en) * 1994-10-06 1998-09-08 United States Surgical Corporation Surgical retractor
US5803901A (en) * 1991-05-29 1998-09-08 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue and methods of using
US5865728A (en) * 1991-05-29 1999-02-02 Origin Medsystems, Inc. Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space
US6080168A (en) * 1997-08-28 2000-06-27 Levin; John M. Compression pad for laparoscopic/thorascopic surgery
US6361543B1 (en) 1991-05-29 2002-03-26 Sherwood Services Ag Inflatable devices for separating layers of tissue, and methods of using
US20030187472A1 (en) * 1999-10-08 2003-10-02 Peartree Kenneth A. Balloon dissection apparatus
US20030236544A1 (en) * 1991-05-29 2003-12-25 Lunsford John P. Method and inflatable chamber apparatus for separating layers of tissue
US20050070765A1 (en) * 2003-09-18 2005-03-31 Howmedica Osteonics Corp. Surgical retractor with removable scissor arms
US20060052669A1 (en) * 2003-01-24 2006-03-09 Hart Charles C Internal tissue retractor
US20070021656A1 (en) * 2005-01-07 2007-01-25 Stryker Spine Three-prong retractor with elastomeric sheath
US20070088189A1 (en) * 2003-11-17 2007-04-19 Gil Levy Pelvic implant with anchoring frame
US20090012521A1 (en) * 2007-07-06 2009-01-08 Howmedica Osteonics Corp. Augmentation delivery device
US20110021879A1 (en) * 2009-07-21 2011-01-27 Applied Medical Resources Corporation Surgical access device comprising internal retractor
US20110213207A1 (en) * 2006-01-05 2011-09-01 Depuy Spine, Inc. Non-rigid surgical retractor
US8062217B2 (en) 2007-01-26 2011-11-22 Theken Spine, Llc Surgical retractor with removable blades and method of use
US8517935B2 (en) 2006-01-04 2013-08-27 DePuy Synthes Products, LLC Surgical retractors and methods of minimally invasive surgery
US8550995B2 (en) 2006-01-04 2013-10-08 DePuy Synthes Products, LLC Surgical access devices and methods of minimally invasive surgery
US8602984B2 (en) 2003-12-18 2013-12-10 DePuy Synthes Products, LLC Surgical retractor systems and illuminated cannulae

Cited By (80)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2841148A (en) * 1957-06-21 1958-07-01 Godfrey J Kadavy Viscera retainer for use in abdominal operations
US3407816A (en) * 1966-02-16 1968-10-29 Curutchet Pedro Domingo Surgical instrument handle
US3654930A (en) * 1970-06-18 1972-04-11 James C Hobbs Expendable hemostat
US3908661A (en) * 1974-01-31 1975-09-30 Steven G Kramer Surgical instruments
US3863639A (en) * 1974-04-04 1975-02-04 Richard N Kleaveland Disposable visceral retainer
US4365625A (en) * 1980-09-17 1982-12-28 Bruce Rind Expandable oral airway
US4356821A (en) * 1980-09-17 1982-11-02 Bruce Rind Airway
US4964417A (en) * 1985-08-22 1990-10-23 Clini-Med Ltd. Wound closure device
US5271385A (en) * 1990-03-29 1993-12-21 United States Surgical Corporation Abdominal cavity organ retractor
US5366460A (en) * 1990-10-11 1994-11-22 Cook Incorporated Apparatus and method for laparoscope hernia repair
US5122155A (en) * 1990-10-11 1992-06-16 Eberbach Mark A Hernia repair apparatus and method of use
US5141515A (en) * 1990-10-11 1992-08-25 Eberbach Mark A Apparatus and methods for repairing hernias
US20070162067A1 (en) * 1991-05-29 2007-07-12 Lunsford John P Method and inflatable chamber apparatus for separating layers of tissue
US5309896A (en) * 1991-05-29 1994-05-10 Origin Medsystems, Inc. Retraction methods using endoscopic inflatable retraction devices
US5402772A (en) * 1991-05-29 1995-04-04 Origin Medsystems, Inc. Endoscopic expandable retraction device
US5431173A (en) * 1991-05-29 1995-07-11 Origin Medsystems, Inc. Method and apparatus for body structure manipulation and dissection
US5450843A (en) * 1991-05-29 1995-09-19 Origin Medsystems, Inc. Retraction apparatus and methods for endoscopic surgery
US5454367A (en) * 1991-05-29 1995-10-03 Origin Medsystems, Inc. Method of using endoscopic inflatable retraction device with fluid tight elastomeric window
US5465711A (en) * 1991-05-29 1995-11-14 Origin Medsystems, Inc. Surgical procedures using endoscopic inflatable retraction devices
US5531856A (en) * 1991-05-29 1996-07-02 Origin Medsystems, Inc. Endoscopic inflatable retraction devices
US5501653A (en) * 1991-05-29 1996-03-26 Origin Medsystems, Inc. Abdominal wall lifting retractor with hinged cross-member
US20030236544A1 (en) * 1991-05-29 2003-12-25 Lunsford John P. Method and inflatable chamber apparatus for separating layers of tissue
US5520609A (en) * 1991-05-29 1996-05-28 Origin Medsystems, Inc. Apparatus and method for peritoneal retraction
US5522790A (en) * 1991-05-29 1996-06-04 Origin Medsystems, Inc. Retraction apparatus and methods for endoscopic surgery
US5527264A (en) * 1991-05-29 1996-06-18 Origin Medsystem, Inc. Methods of using endoscopic inflatable retraction devices
US5925058A (en) * 1991-05-29 1999-07-20 Origin Medsystems, Inc. Method and inflatable chamber apparatus for separating layers of tissue
US5562603A (en) * 1991-05-29 1996-10-08 Origin Medsystems, Inc. Endoscopic inflatable retraction device with fluid-tight elastomeric window
US5632761A (en) * 1991-05-29 1997-05-27 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue, and methods of using
US5634883A (en) * 1991-05-29 1997-06-03 Origin Medsystems, Inc. Apparatus for peritoneal retraction
US5643178A (en) * 1991-05-29 1997-07-01 Origin Medsystems, Inc. Method for peritoneal retration
US20100174149A1 (en) * 1991-05-29 2010-07-08 Covidien Ag Endoscopic inflatable retraction device, method of using, and method of making
US6605037B1 (en) 1991-05-29 2003-08-12 Sherwood Services Ag Endoscopic inflatable retraction device
US5716327A (en) * 1991-05-29 1998-02-10 Origin Medsystems, Inc. Body wall retraction system for wide cavity retraction
US5722986A (en) * 1991-05-29 1998-03-03 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue, and methods of using
US5728119A (en) * 1991-05-29 1998-03-17 Origin Medsystems, Inc. Method and inflatable chamber apparatus for separating layers of tissue
US5738629A (en) * 1991-05-29 1998-04-14 Origin Medsystems, Inc. Self-retracting endoscope
US5743850A (en) * 1991-05-29 1998-04-28 Origin Medsystems, Inc. Endoscopic inflatable retraction device with additional inflatable chamber
US5779728A (en) * 1991-05-29 1998-07-14 Origin Medsystems, Inc. Method and inflatable chamber apparatus for separating layers of tissue
US6361543B1 (en) 1991-05-29 2002-03-26 Sherwood Services Ag Inflatable devices for separating layers of tissue, and methods of using
US5803901A (en) * 1991-05-29 1998-09-08 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue and methods of using
US20040097792A1 (en) * 1991-05-29 2004-05-20 Moll Frederic H. Endoscopic inflatable retraction device, method of using, and method of making
US5823945A (en) * 1991-05-29 1998-10-20 Origin Medsystems, Inc. Endoscopic inflatable retraction device with additional inflatable chamber
US5865728A (en) * 1991-05-29 1999-02-02 Origin Medsystems, Inc. Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space
US5704372A (en) * 1991-05-29 1998-01-06 Origin Medsystems, Inc. Endoscopic inflatable retraction devices for separating layers of tissue, and methods of using
US7766823B2 (en) 1991-05-29 2010-08-03 Covidien Ag Endoscopic inflatable retraction device, method of using, and method of making
US7744617B2 (en) 1991-05-29 2010-06-29 Covidien Ag Method and inflatable chamber apparatus for separating layers of tissue
US5301658A (en) * 1992-04-27 1994-04-12 Loma Linda University Medical Center Membrane endoscopic retractor
WO1996002195A1 (en) * 1994-07-19 1996-02-01 Jako Geza J Retractors, tool, and method for direct access endoscopic surgery
US5813978A (en) * 1994-07-19 1998-09-29 Atlantis Surgical, Inc. Method and apparatus for direct access endoscopic surgery
US5503617A (en) * 1994-07-19 1996-04-02 Jako; Geza J. Retractor and method for direct access endoscopic surgery
US5803902A (en) * 1994-10-06 1998-09-08 United States Surgical Corporation Surgical retractor
US5656012A (en) * 1994-10-06 1997-08-12 United States Surgical Corporation Surgical retractor
US6080168A (en) * 1997-08-28 2000-06-27 Levin; John M. Compression pad for laparoscopic/thorascopic surgery
US7695487B2 (en) 1999-10-08 2010-04-13 General Surgical Innovations, Inc. Balloon dissection apparatus
US20030187472A1 (en) * 1999-10-08 2003-10-02 Peartree Kenneth A. Balloon dissection apparatus
US8172869B2 (en) 1999-10-08 2012-05-08 Tyco Healthcare Group Lp Balloon dissection apparatus
US20060052669A1 (en) * 2003-01-24 2006-03-09 Hart Charles C Internal tissue retractor
US20090227844A1 (en) * 2003-01-24 2009-09-10 Applied Medical Resources Corporation Internal tissue retractor
US8308638B2 (en) 2003-01-24 2012-11-13 Applied Medical Resources Corporation Internal tissue retractor
US7182729B2 (en) 2003-09-18 2007-02-27 Stryker Spine Surgical retractor with removable scissor arms
US20070123753A1 (en) * 2003-09-18 2007-05-31 Stryker Spine Surgical retractor with removable scissor arms
US7988625B2 (en) 2003-09-18 2011-08-02 Stryker Spine Surgical retractor with removable scissor arms
US20050070765A1 (en) * 2003-09-18 2005-03-31 Howmedica Osteonics Corp. Surgical retractor with removable scissor arms
US7981024B2 (en) * 2003-11-17 2011-07-19 Prolapse Inc. Pelvic implant with anchoring frame
US20070088189A1 (en) * 2003-11-17 2007-04-19 Gil Levy Pelvic implant with anchoring frame
US8920302B2 (en) 2003-11-17 2014-12-30 Prolapse Inc. Pelvic implant with anchoring frame
US8602984B2 (en) 2003-12-18 2013-12-10 DePuy Synthes Products, LLC Surgical retractor systems and illuminated cannulae
US8622897B2 (en) 2003-12-18 2014-01-07 DePuy Synthes Products, LLC Surgical methods and surgical kits
US20070021656A1 (en) * 2005-01-07 2007-01-25 Stryker Spine Three-prong retractor with elastomeric sheath
US7618367B2 (en) 2005-01-07 2009-11-17 Stryker Spine Three-prong retractor with elastomeric sheath
US8517935B2 (en) 2006-01-04 2013-08-27 DePuy Synthes Products, LLC Surgical retractors and methods of minimally invasive surgery
US8550995B2 (en) 2006-01-04 2013-10-08 DePuy Synthes Products, LLC Surgical access devices and methods of minimally invasive surgery
US20110213207A1 (en) * 2006-01-05 2011-09-01 Depuy Spine, Inc. Non-rigid surgical retractor
US9254126B2 (en) 2006-01-05 2016-02-09 DePuy Synthes Products, Inc. Non-rigid surgical retractor
US8062217B2 (en) 2007-01-26 2011-11-22 Theken Spine, Llc Surgical retractor with removable blades and method of use
US20090012521A1 (en) * 2007-07-06 2009-01-08 Howmedica Osteonics Corp. Augmentation delivery device
US8821507B2 (en) * 2007-07-06 2014-09-02 Howmedica Osteonics Corp. Augmentation delivery device
US20110021879A1 (en) * 2009-07-21 2011-01-27 Applied Medical Resources Corporation Surgical access device comprising internal retractor
US9867604B2 (en) 2009-07-21 2018-01-16 Applied Medical Resources Corporation Surgical access device comprising internal retractor
US8469883B2 (en) 2009-07-21 2013-06-25 Applied Medical Resources Corporation Surgical access device comprising internal retractor

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