WO1996041572A1

WO1996041572A1 - Shielded surgical retractor

Info

Publication number: WO1996041572A1
Application number: PCT/AU1996/000342
Authority: WO
Inventors: Michael Maros; Kathleen Anne Maros
Original assignee: Tinos Surgical Instruments Pty. Ltd.
Priority date: 1995-06-09
Filing date: 1996-06-07
Publication date: 1996-12-27

Abstract

A surgical implement that can be used as a retractor which includes a shield (20) and a support member (21) by which an assistant can hold the implement so as to be both protected behind the shield (20) and to allow for control of the implement in a more effective way. There is described a knob allowing in one case the support part to be held between the fingers (23) of the assistant and there are described a number of surgical implements incorporating the features of a shield (20) with a support member (21) behind the shield (20).

Description

SHIELDED SURGICAL RETRACTOR.

This invention relates to surgical retractors and to surgical procedures using retractors.

When invasive surgery is performed, a surgeon often requires retraction of parts of the body to assist the surgeon in access.

Generally three types of retraction are available, these being:

Firstly, manual retraction which is provided by a surgical assistant where the assistant uses a gloved hand or hands to hold the tissue and organs away from a surgical site.

Secondly, surgical retractors which are grasped by a surgical assistant and which include parts such as a hook which is used to engage parts of the body to hold these apart for access thereto by the surgeon.

Thirdly, self-retaining retractors which use various mechanical means such as clamps or lockable scissor assemblies to hold two or more surgical retractors apart. This invention is directed to the first two forms of retraction described herein.

Manual retraction by a surgical assistant's hands is hazardous due to the close proximity of sharp surgical implements including scalpels, suture and hypodermic needles and parts of the bodies of both the patient and surgeon or assistant. Studies show that even with modern surgical precautions, at least 5% of all surgical gloves are pierced during operative procedure (risk to surgeons) Mattah et al British Journal of Surgery 1988 September 75(9)931-2.

Unfortunately, with existing retractors, their use requires that the surgical assistant shall grasp one or both of these and because of their design and because it is safer, in any event, the surgical assistant will grasp such an existing retractor at a distance substantially away from the location of the incision. If two retractors are involved which have to be held with pressure in opposing directions, this action is awkward and, indeed, can be tiring for an assistant for any period of time. Further, the need to grasp the retractor is tiring. This can lead either to mistakes being made or reluctance by an assistant to continue to perform the task.

A further difficulty is that implicitly, the surgical assistant is not well placed to see where the end of the retractor is positioned or the total result of the pressure being applied so that this can be also disadvantageous.

The present invention arises from an understanding of the above problems and results from discoveries which have led to the above problems being able to be reduced with equipment which embody the invention which can be both reasonably economic to manufacture and somewhat easier and better to use and of greater assistance in the surgical process.

In a broader sense, the invention can apply to manual retraction in that it has been found that an apparatus can be provided which can act as a shield and which can be held by the hand of a surgical assistant in a convenient and safe way so that the hand itself can continue to be useful for the purpose of manual retraction while, however, the shield protects the hand against accidental piercing.

According to one form of this invention there is provided a surgical retractor which has a shield part and an operative part and a support member extending from an inner side of the shield part, the support member being shaped and positioned so as to be adapted to be held by engagement therewith of two or more fingers of the said hand.

In preference, the surgical retractor has a body which includes a shield part and an operative part and behind the shield a further part of the body shaped and of a size such that at least one of the fingers of a surgical assistant can engage therewith in such a way as to thereby support and provide that by bending of the finger or fingers, orientation of the body can be thereby controlled while, however, the hand is protected behind the shield.

What has been discovered is that the type of physical action needed for existing retractors to hold these and to push these into retracting locations is that of an awkward full arm action at some distance from the wound which will normally result in fatigue developing quickly and, hence, offer fluctuating effectiveness from a surgical assistant.

Further, existing retractors are designed so that they have to be grasped by the hand of the surgical assistant with the position being required of the hand grasping the retractor being awkward for maintaining this for any substantial period of time especially when this has to be combined with an awkward full arm pressure as well.

Using the invention it becomes very much easier and less tiring for the surgical assistant to firstly support a retractor but secondly the location of the retractor to provide a retraction force is achievable by a much less tiring action of the hand than has hitherto been necessary.

In relation to a preferred instance, where the support member is adapted to be located between and held by two fingers of the one hand of an assistant which in preference are the index finger and the middle finger of the hand, then the mere bending of those fingers relative to the dorsum of the hand can enable orientation of the retractor appropriate for assisting in applying retraction forces.

As well, because the retractor itself can have a protective part behind which the hand of the assistant is located, the hand of the assistant can now be located safely very much closer to the location at which the surgeon is operating with significantly reduced risk of injury to the hand of the assistant.

Furthermore the finger flexing action is mechanically advantageous.

Also, because the assistant can be much closer to the wound the assistant is able to watch more closely the surgeons actions and adjust the retraction as required. In the case of existing retractors before this invention, the assistant may very often be obliged to lean away from the wound in order to exert effective and sufficient pull. The surgeon then has to interrupt his work frequently in order to replace the end of the retractor.

There are an almost infinite variety of retractor ends that can be applicable with this invention. Typically but not intending to be restrictive, a surgical assistant can be asked to place an open hand deeply into the wound in order to directly retract bowel with the palm of the hand. Normally this would expose the hand to substantial risk of accidental injury. With this invention however the manual retraction technique is appropriate and the implement can then comprise the support member and the shield part only.

*

Examples of different shapes and sizes of retractors can now be envisaged. One example is a large abdominal retractor having an extension straight down from the shield part. This would be most useful, where wide access is required for the surgeon the variation being in the form of an end, at right angles at the bottom of the shield, dipping down again two or three inches (five to seven and one half centimetres) along.

A further preferred arrangement can be a retractor appropriate for an assistant in gynaecological operations where the assistant is standing at the side of the patient while the surgeon is sitting on a stool placed between the patients legs in the lithotomy position, for example, a vaginal hysterectomy. In this instance, the shield will be held facing outward from the pubic bone, with the retractor tongue extending, at right angles, backwards into the vagina, holding back the bladder and protecting it from the surgeons knife. Small grooves will be located in the top of the shield part so that sutures on clips can be slung over and held in these awaiting the surgeons need to tie them. This would free the assistant's other hand for other manoeuvres.

Many stick injuries occur during final suturing of the layers of the wound. The assistant in this procedure is required to gently part the edges of the various layers in order for the surgeon to suture to the deeper layers. The shield part in this instance would have a slight prolongation at its lower end with a curve end on it to pick up the tissues.

A further embodiment is where fine hooks and "cats paws" are used to part tissues, using two retractors on opposite sides of the wound, for particular us in vascular or plastic surgery. In this instance, the extension would be at the bottom of the shield part, emerging at right angles to a plane defined by the planar shape of the shield part, so that the assistant's hand could rest along the skin surface. Two shields would be used facing each other, one on each edge of the wound. The long extensions would allow the assistant's hands t be adequately separated for the surgeons to have access. In this case, the support member is in a specific form of a knob the grasp using two fingers with the palmar aspects of the fingers laying against the shield, as one can imagine holding two cymbals. This variation in grasp is not only more appropriate, but it is possible because only very light retraction is required in this procedure.

During caesarean section operations, the bladder must be protected from the surgeons knife, often in cases of great emergency. The bladder must be effectively separated from the uterine body and the current retractor used necessitates the assistant pulling hard sideways towards the patients toes in an awkward manner. According to this invention the retracting part of a retractor can be curled over the pubic bone (as is customary anyway) with however the shield part arising out of the way with a stepped curve to allow access. The assistant would be able to hold the shield, comfortably and effectively, by a posterior knob from a position at the patients side. In this case, the advantage would be mainly ergonomic, but also, the existing retractor lies along the sheets between the patients legs where other instruments lie, whereas the embodiment could be held upwards away from the table.

In construction of the implement the support means can be detachable from the rest of the retractor.

For instance with an aperture through the shield part, clamping means can extend from one side of the shield part to the other side to which the knob is to be attached.

Alternatively, there can be a part of the knob passing through the aperture which is screw threaded and can be held by a nut or similar on the other side.

In another preferred example, there is a body comprising a knurled head of substantial diameter, with a centrally positioned screw threaded protruding finger which is adapted to pass through an aperture in the shield part which then can engage with screw threaded engagement a bore within a centre part of the knob.

In preference, the knob includes a base that is of a sufficient diameter to provide a wide support against the shield, a narrower part around which the index and middle fingers of a hand are to be located and a head which is of a larger diameter than the narrower part which is adapted to be comfortably engaged between the fingers of an assistant.

According to a further preferred arrangement there is provided a support member by which the fingers of the hand of an assistant can be used to hold the retractor and turn the retractor by simple rotation of the fingers with respect to the remainder part of the hand and provide that by rotation of the hand as a whole there can be exerted effective rotational force about an axis transverse to the axis about which the fingers of the hand can effect a rotational force.

In a further preferred arrangement there is provided a support member which can be gripped in the manner of a handle by most or all of the fingers of one hand and therefore if the hand rotates about its supporting wrist in a direction laterally to the direction of the palm of the hand, then this pressure can be additionally and effectively exerted on the retractor as a whole.

For a better understanding of the invention it will now be further described with respect of specific embodiments with the assistance of drawings.

Accordingly

FIGS 1 , 2, 3 and 4 are views of a first embodiment,

Where FIG 3 is a cross sectional view through the embodiment alon the lines 3-3 as shown in FIG 1 ,

FIG 5 is a perspective view of a second embodiment,

FIG 6 is a perspective view of the first embodiment in an appropriat manner for its usage by the hand of a surgical assistant,

FIG 7 is a perspective view of the second embodiment showing als the hand of a surgical assistant holding this is an appropriate position for usage,

FIG 8 is a perspective view of a third embodiment, FIGS 9 and 10 are a side view of a first embodiment showing in each case a hand of a surgical assistant from the side showing how the change of position of fingers of the hand of the surgical assistant can control the relative position and orientation of the operative part of the shield,

FIG 11 is a more graphic illustration of the way in which two retractors in accord with the fourth embodiment might be used inside a body opening to hold appropriate parts of the body during an operation,

FIG 12 is a plan view of a fifth embodiment,

FIG 13 is a cross sectional view of the fifth embodiment along the lines 13-13 of FIG 12,

FIG 14 is a side elevation of a sixth embodiment,

FIG 15 is a perspective view of the sixth embodiment,

FIG 16 is a plan view of a seventh embodiment,

FIG 17 is a cross sectional view along the lines 17-17 of FIG 17,

FIGS 18 and 19 are further views of the third embodiment as originally shown in perspective view in FIG 8,

FIGS 20, 21 , 22, and 23 are variously further details of embodiments appropriate to apply the invention.

FIG 24 is a perspective view of a next embodiment,

FIG 25 is a side elevation illustrating the same embodiment as in

Figure 24,

FIG 26 is a perspective view of another embodiment,

FIGS 27 and 28 are views respectively from above and below of a further embodiment, and FIG 29 is a part cutaway side view of a further embodiment.

We refer now in detail to the drawings, and referring specifically to FIGS 1 , 2, 3 and 4, a surgical retractor includes a shield part 1 and a support member 2 extending from an inner side of the shield part, the support member 2 being shaped by reason of its having a larger outer end 5, a narrower waist 6 and a larger inner part 7 the size, position and shape of which are such that the middle two fingers of a surgeons assistant can be located to be positioned therearound and by this way, both grasp and support the support member 2 and thereby the shield 1. The shape of the shield part 1 includes a broader end 3 and a narrower end 4.

The cross sectional shape of the waist or narrower part 6 is such as to enable with comfort, the fingers of an assistant to engage therearound.

In a second embodiment shown in FIG 5, the shield part in this case is shown at 8 and this comprises a planar part to which is attached at its centre a support part 9.

This extends from an inner part of the shield part 8 and has a narrower waist 10 and a larger end 11 again shaped, sized and positioned for the purpose of enabling capture by the fingers of an operator to assist in control of the shield. In this particular case, the purpose is to predominantly shield and the hand is expected to provide capture of the body parts. However, this is more clearly shown in FIG 6 in relation to the first embodiment 7.

In relation to the second embodiment it will be seen how the support member 2 in the one case and 9 in the other can be grasped by the hand of the assistant but allowing at the same time the hand (noting that of course this wil be gloved) can be positioned and curled so as to hold and capture appropriate parts of the body while the back of the hand and fingers are essentially protected by the shield shape from accidental piercing by a surgeons actions.

However, the concept is especially suited to proceed from the use of the han only to capture the body parts to being able to control the shield so that this becomes a more useful implement acting as a retractor and enabling the ha of the assistant to hold this in a much more restful and convenient and effective way. A number of such shapes are now to be described but the first of these is shown in FIG 8 which is also shown in FIGS 18 and 19. In this case, there is a shield part 12 which is generally of planar shape but has a plurality of notches 13 located across an upper periphery.

Extending from an inner side of the shield part 12 is a support member 14 which has an outer bulbous end 15, a middle smaller waist 16, and a base 17 to which is attached the shield part 12 by an appropriate means.

As in the previous embodiments, the shape of the support part 14 is intended to be appropriate for capture between two fingers of an assistant's hand and as with the action shown in FIGS 9 and 10, so this embodiment is also intended to be able to be used in this way. However this also includes as a dedicated part an inwardly turned tongue 18.

This retractor has for its most useful purpose the ability for the tongue 18 to project into the vagina and to keep this open and accessible for surgical procedures.

During this procedure, untied sutures can be temporarily held by notches 13.

In the next embodiment, this shows the action of a further retractor where the shape of the bottom tongue at 19 is curved inwardly while a top at 20 acts as a shield and there is an inwardly extending support member 21 appropriate to be held between the fingers of a surgeons assistant's hands 22.

By bending the fingers 23 relative to the back of the hand 24, and to some extent allowing the fingers to engage against the backside of the shield part 20, this enables and has been found to provide a very comfortable way in which the retraction effect of the tip 25 can be effected either in one direction as shown in FIG 9 or in the other as shown in FIG 10.

FIG 11 is no more than an illustration of two retractors being used together by the same assistant and of course in each case the retractor being shown is in accord with the examples shown in FIGS 9 and 10.

Now referring to embodiment shown in FIGS 12 and 13, again this includes the elements of a shield part 26, a support member 27 of a shape and position adapted to be held by engagement therewith with two fingers of a hand of a surgical assistant, and the retractor shape in this case is shown at 28 which is bent to extend at 30° to the planar orientation of the shield part 26. This obviously is a reversed direction from that shown in FIGS 9 and 10 and 11.

The retractor shape can be varied as in FIGS 16 and 17 in which the shape is curved as shown at 29 and finally quite complex shapes as shown in FIGS 14 and 15 which can be useful for the purpose of an abdominal retractor. In this case the retractor shape is of a complex curved shape as shown at 30 and perhaps most graphically at FIG 15.

Finally the examples as in FIGS 20,21 , 22, and 23 illustrate further examples of how the retractor part can be varied but always now much more useful as far as the surgical assistant is concerned because of the shield and support member arrangement.

Examples of support parts in combination with the shield and a retractor part will now be disclosed to illustrate the further improvement and development.

These improvements are now further illustrated by reference to additional drawings in which:

FIG 24 is a perspective view of a next embodiment,

FIG 25 is a side elevation schematically illustrating the same features as in FIG 24,

FIG 26 is a perspective view of another embodiment, and

FIGS 27 and 28 are views respectively from above and below of a further embodiment.

Referring to these in detail, the retractor shown in FIGS 24 and 25 include a shield at 31 , the size of which is adequate to extend across the area that would normally be the location of the hand of an assistant using the retractor, and supported by a leg 32 is a support part 33 which extends both sides of th leg 32 and which is based apart sufficient distance from the shield 31 this spaced area being shown at 34 so as to allow for the entry therebetween of fingers of an assistant's hand, the support part 33 being of a substantial width and having a rounded front edge at 35 and a rounded back edge at 36 so as to provide for a comfortable gripping position for the fingers of assistant's hand.

The remainder of the retractor 31 such as the tongue at 37 is shown as being typical but of course many different types of ends can be located at this position in conjunction with the support part described.

According to the second embodiment shown in FIG 26, the retractor 42 includes a leg 43 which has a much narrower arm projecting at 44 in the one case and 45 in the other to form a T-bar which is similar to the first described embodiment except that the cross sectional area in shape as shown at 46 is smaller. Again there is provided however this ability to effect rotational action transverse to the forward-to-aft direction of the retractor 42.

Finally the third embodiment as shown in Figures 27 and 28 there is shown at 47 a metal strip 48 which secured at each end shown therefore at 49 in the one case and 50 in the other leaving thereby a gap at 51 through which the fingers of the assistant's hand can be passed and therefore gripping the strip at 52 so that the hand is again protected behind the shield part 53 of the retractor 47.

Referring in detail to FIG 29, which in relation to a further embodiment this includes a shield part 61 through which exists a circular aperture 62.

A knob 63 the view of which includes a piped cut away section to show the screw threaded bore at 64 which is engaged by the screw threaded finger 65 which protrudes from the knurled head at 66.

The knob 63 includes a broader base 67, a narrow waist 68 and a somewhat broader head at 69 which is shaped so as to facilitate the engagement by being eatable between any two fingers of an operators hand and to allow for relative rotational pressure to be capable of being applied therethrough to the shield part 61.

The value of the larger diameter of the knurled head 66 is that this can facilitate effecting a substantial closure pressure and therefore clamping action between the knob 63 and the head 66 so that the knob 63 can be captured and be held fairly firmly with respect to the shield part 61.

One of the advantages of this arrangement is that the parts can be disassembled and they can therefore be readily sterilised.

Further, it means that the knob can be applied in either of two sides of a shield part so that depending upon the other end of the shield part, the shield part can be more usefully held depending upon the requirement.

The size of the knob is chosen so that it will fit in the described position in a users hand.

The size chosen can therefor be changed but as an example of the sizes found to be best these are referred to in Figure 31 with references from 70 to 75.

Accordingly, 70 refers to the full height of the knob which is 35 mms. 71 refers to the maximum diameter of the somewhat broader head 69 of the knob 63 which is 34 mms.

72 refers to the distance of the maximum diameter shown by 71 from the outer end of the knob 63 which is 7 mms. 73 refers to the distance of the maximum diameter from the minimum diameter 75 which is 17 mms. 74 refers to the radius of the shape between a base and the somewhat broader head 69 the value of the radius being 10 mms.

In other words, this makes the knob a more universally applicable device and the shield part is somewhat easier to manufacture because simply a slot or in preference a hole simply needs to be drilled through the sheet material forming the shield part.

From the examples now shown, it will be seen how broadly the invention can be put into practise and how useful it can now be.

In trials conducted so far, the retractors have been able to be used by a surgical assistant for a much longer period than has hitherto been the case and the surgical assistant has been in many cases been able to get quite close to the operation area and by physically viewing the location, can be of greater assistance to the surgeon operating.

Claims

1 ) A surgical implement having a body having a member adapted to provide a shielding effect for a surgical assistant, and, behind the member acting as a shield part, a support member shaped and of a size such that the fingers of a surgical assistant can engage therewith in such a way as to thereby support the implement for surgical retraction purposes and provide that by bending of the fingers of the hand of the surgical assistant, orientation of the body can be controlled and retraction forces applied with the hand of the assistant protected behind the member and be protected thereby.

2) A surgical implement for a hand when within or alongside a human body cavity during a surgical procedure being performed by a surgeon within the body cavity, the apparatus having a shield part and a support member extending from an inner side of the shield part and adapted to be located and held by two fingers of the said hand when within the cavity and located in a protected position behind the shield part and being supported thereby.

3) A surgical implement as in claim 2 further characterised in that the shield part is shaped so as to have an outer side of convex shape.

4) A surgical implement as in any one of the preceding claims further characterised in that the shield part is comprised of a sheet of protective material which is shaped to provide an outer side which is convex and an inner side which is concave and wherein the support member is attached to the shield part at about the central part of the inner side of the shield part and extends further inwardly from the attachment location.

5) A surgical implement as in any one of the preceding claims further characterised in that the shape of the inner side of the shield part is such as t conform approximately with the outer shape of a partially closed hand and th support part is such as to be locatable between the two central fingers on a hand and such that the shield can be supported in such location by engagement with the support part.

6) A surgical implement as in any one of the preceding claims further characterised in that the shield and support member are made from stainles steel.

7) A surgical implement as in any one of the preceding claims further characterised in that the shield part is of substantially frusta spherical shape and the support member extends diametrically with respect to the spherical shape.

8) A manual surgical retractor for a hand when within a human body cavity during surgical procedures being performed by another person within the cavity, the retractor having a shield part and a support member extending from an inner side of the shield part shaped and positioned so as to be adapted to be held by two fingers of the said hand when within the cavity and adapted to located in a protected position behind the shield part and being supported thereby.

9) A surgical implement as in claim 1 further characterised in that the shield part is shaped so as to have an outer side of convex shape.

10) A surgical implement as in any one of the preceding claims further characterised in that the shield part is comprised of a sheet of protective material which is shaped to provide an outer side which is convex and an inner side which is concave and wherein the support member is attached to the shield part at about the central part of the inner side of the shield part and extends further inwardly from the attachment location.

11 ) A surgical implement as in any one of the preceding claims further characterised in that the shape of the inner side of the shield part is such as to conform approximately with the outer shape of a partially closed hand and the support part is such as to be locatable between the two central fingers on a hand and such that the shield can be supported in such location by engagement with the support part.

12) A surgical implement as in any one of the preceding claims further characterised in that the shield and support member are constituted stainless steel.

13) A surgical implement as in any one of the preceding claims further characterised in that the shield part is of frusta spherical shape and the support member extends diametrically with respect to the spherical shape.

14) A surgical implement as in any one of the preceding claims further characterised in that the support means are detachable from the rest of the retractor.

15) A surgical implement as in any one of the preceding claims further characterised in that there is an aperture through the shield part and clamping means extending through the shield part to the other side to which the support means are attached.

16) A surgical implement as in any one of the preceding claims further characterised in that a part of the knob passing through the aperture which is screw threaded is held by a nut .

17) A surgical implement as in any one of the preceding claims further characterised in that there is a body comprising a knurled head of substantial diameter, with a centrally positioned screw threaded protruding finger which passes through an aperture in the shield part which engages with screw threaded engagement a bore within a centre part of the knob.

18) A surgical implement as in any one of the preceding claims further characterised in that the support means comprise a knob which includes a base, a waist narrower than the base and a head wider than the waist.

19) A surgical implement as in any one of the preceding claims further characterised in that there is provided a support member by which the fingers of the hand of an assistant can be used to hold the retractor and turn the retractor by simply rotation of the fingers with respect to the remainder part of the hand and provide that by rotation of the hand as a whole there can be exerted effective rotational force about an axis transverse to the axis about which the fingers of the hand can effect a rotational force.

20) A surgical implement as in any one of the preceding claims further characterised in that there is provided a support member which can be gripped in the manner of a handle by most or all of the fingers of one hand and therefore if the hand rotates about its supporting wrist in a direction laterally to the direction of the palm of the hand, then this pressure can be additionally and effectively exerted on the retractor as a whole.

21 ) A surgical implement substantially as described in the specification with reference to and as illustrated by the accompanying illustrations.

22) In a surgical procedure, having with respect to at least one of the hands within a body cavity a surgical implement supported by the hand to be also positioned as a protection barrier between the hand and the location of use of any sharp instrument for operating procedures.

23) In a surgical procedure as characterised in the immediately preceding claim further characterised in that the surgical implement used is as characterised in any one of the preceding claims.