Adjustable locking surgical retractor

Abstract

A surgical retractor assembly for providing surgical exposure. The surgical retractor assembly consists of multiple ring segments connected by adjustable ratchet mechanisms to form a complete ring. The ratchet mechanisms are attached to tissue retractor blades which provide exposure of the wound when expanded, without the requirement of a direct connection/attachment to an operating table. The tissue retractor blades are attached in a manner which is adjustable and facilitates the ability of the overall surgical retractor assembly (ring segments and connectors) to be raised or lowered with respect to the patient. The ring segments also allow attachments of additional retractor blades or other surgical retractor accessories for additional surgical exposure.

Claims

1. An adjustable surgical retractor comprising, a retractor frame having an adjustable perimeter comprising: a plurality of frame segments, each frame segment having a long axis and a plurality of arm portions, the plurality of arm portions comprising a first straight arm portion and a second straight arm portion, and a curve portion extending between the first straight arm portion and the second straight arm portion, where the long axis of the frame segment bends at the curve portion to form an angle between the first straight arm portion and the second straight arm portion, each frame segment having a top and bottom face with an inner edge and an outer edge, each frame segment forming a series of notches or teeth extending continuously along the curve portion between the first straight arm portion and the second straight arm portion, the curve portion being configured to receive at least one of a plurality of retractor blades at any point along the curve portion, and a plurality of connectors, each connector being configured to receive a straight arm portion of each of two adjacent frame segments when the straight arm portions are parallel to form at least a portion of the retractor frame, wherein each connector can be in (i) an unlocked configuration that allows movement of the received arm portions of the adjacent frame segments with respect to one another, thereby allowing the retractor frame to expand or contract by adjustment of a perimeter of the retractor frame or (ii) a locked configuration that restricts the movement of the received arm-portions of the adjacent frame segments with respect to one another, thereby restricting at least one of expansion and contraction of the retractor frame; and the plurality of retractor blades coupled to the retractor frame where the coupling of at least one the plurality of retractor blades engages the series of notches or teeth along the curve portion.

2. The retractor of claim 1, wherein the frame segments each further comprise an expansion stop at one end of the frame segment that is configured to stop expansion of the retractor frame prior to a frame segment passing completely out of the connector.

3. The retractor of claim 1, wherein at least one of the arm portions further comprises a removable expansion stop coupled with a prescribed slot or pattern of holes formed in the frame segment that together are configured to stop expansion of the retractor frame prior to the frame segment passing completely out of a connector.

4. The retractor of claim 1, wherein at least one of the connectors when in the locked configuration does not allow the retractor frame to be expanded or contracted.

5. The retractor of claim 1, wherein at least one of the connectors is configured to position the ends of the adjacent frame segments in a stacked configuration.

6. The retractor of claim 1, wherein at least one of the connectors is configured to position the ends of the adjacent frame segments in an offset configuration.

7. The retractor of claim 1, wherein the retractor frame is a rounded polygon.

8. The retractor of claim 1, wherein the retractor frame is a rounded quadrilateral.

9. The retractor of claim 1, wherein the arm portions of adjacent frame segments are positioned having the inner edge of one straight arm portion aligned parallel to the outer end of an adjacent frame segment.

10. The retractor of claim 1, wherein the arm portions are 10 to 30 centimeters in length.

11. The retractor of claim 1, wherein the angle between the first straight arm portion and the second straight arm portion is approximately 90 degrees.

12. The retractor of claim 1, wherein the plurality of retractor blades comprise 2, 3, or 4 retractor blades are coupled to the retractor frame.

13. The retractor of claim 1, wherein the plurality of retractor blades comprise 2, 3, or 4 retractor blades are configured to be decoupled from the retractor frame.

14. The retractor of claim 1, wherein at least one retractor blade is coupled to a connector.

15. The retractor of claim 1, wherein at least one retractor blade is coupled to the frame segment at one of the plurality of arm portions.

16. The retractor of claim 15, wherein at least one retractor blade is configured to be moveable along the curve portion of each frame segment.

17. The retractor of claim 1, wherein the retractor is coupled to a bed frame.

18. The retractor of claim 1, wherein the retractor frame is configured to be attached to patient solely by the plurality of retractor blades after being expanded.

19. A method of using the surgical retractor of claim 1, comprising: coupling a plurality of retractor blades on the frame of the retractor, at least one of the blades being coupled to the curve portion of a frame segment of the frame; inserting the retractor blades of the retractor of claim 1 in a wound or incision of a patient body; and expanding the surgical retractor in one or more superior, inferior, or lateral direction to engage the retractor blades with the patient body and expose a body cavity; and locking the connectors so as to prevent contraction of the frame.

20. The retractor of claim 1 the plurality of frame segments being four segments.

21. An adjustable surgical retractor comprising, a retractor frame having an adjustable perimeter comprising: a plurality of frame segments, each frame segment having a long axis and a plurality of arm portions, the plurality of arm portions comprising a first straight arm portion and a second straight arm portion, and a curve portion extending between the first straight arm portion and the second straight arm portion, where the long axis of the frame segment bends at the curve portion to form an angle between the first straight arm portion and the second straight arm portion, each frame segment having a top and bottom face with an inner edge and an outer edge; and a plurality of connectors, each connector being configured to receive at least one of the plurality of arm portions of two adjacent frame segments to form the retractor frame, wherein each connector can be in (i) an unlocked configuration that allows movement of the received arm portions of the adjacent frame segments with respect to one another, thereby allowing the retractor frame to expand or contract by adjustment of a perimeter of the retractor frame or (ii) a locked configuration that restricts the movement of the received arm-portions of the adjacent frame segments with respect to one another, thereby restricting at least one of expansion and contraction of the retractor frame; and a plurality of retractor blades, each of the plurality of retractor blades being coupled to the retractor frame by one of said plurality of connectors, wherein the face of each of the plurality of retractor blades is perpendicular to and below a plane of the retractor frame; each of the plurality of retractor blades being adjustably coupled to a connector among the plurality of connectors, said connector being configured to translatably receive a proximal portion of a retractor blade coupled thereto and to reversably fix a position of said retractor blade with a locking mechanism incorporated into said connector, wherein the proximal portion of said retractor blade is translatable in said connector so as to move said retractor blade up and down until locked by a retractor blade locking mechanism.

22. A surgical retractor frame segment comprising: a plurality of arm portions, the plurality of arm portions comprising a first straight arm portion and a second straight arm portion and a curve portion there between where the long axis of the frame segment bends to form an angle between the two arm portions, the frame segment having a top and bottom face with an inner edge and an outer edge, the outer edge of each frame segment forming a series of notches or teeth extending continuously along the curve portion between the first straight arm portion and the second straight arm portion, the curve portion being configured to receive at least one of a plurality of retractor blades at any point along the curve portion; and a connector coupled to a straight arm portion of the plurality of arm portions, the connector being configured to receive, when placed in parallel with the arm portion to which the connector is coupled, an arm portion of a separate surgical retractor frame segment, wherein the connector can be in (i) an unlocked configuration that allows movement of the received arm portion with respect to the arm portion to which the connector is coupled, or (ii) a locked configuration that restricts the movement of the received arm portion with respect to the arm portion to which the connector is coupled.

23. The frame segment of claim 22, further comprising an expansion stop that can be reversibly connected to the frame segment at or near one or both ends of the frame segment.

24. An adjustable surgical retractor comprising, a retractor frame having an adjustable perimeter comprising: a plurality of frame segments, each frame segment having a long axis and a plurality of arm portions, the plurality of arm portions comprising a first straight arm portion and a second straight arm portion, and a curve portion extending between the first straight arm portion and the second straight arm portion, where the long axis of the frame segment bends at the curve portion to form an angle between the first straight arm portion and the second straight arm portion, each frame segment having a top and bottom face with an inner edge and an outer edge; the plurality of frame segments being four frame segments; and a plurality of connectors, each connector being configured to receive at least one of the plurality of arm portions of two adjacent frame segments to form the retractor frame, wherein each connector can be in (i) an unlocked configuration that allows movement of the received arm portions of the adjacent frame segments with respect to one another, thereby allowing the retractor frame to expand or contract by adjustment of a perimeter of the retractor frame or (ii) a locked configuration that restricts the movement of the received arm portions of the adjacent frame segments with respect to one another, thereby restricting at least one of expansion and contraction of the retractor frame; and a plurality of retractor blades coupled to the retractor frame, wherein a face of each of said plurality of retractor blades is perpendicular to the plane of the retractor frame.

25. The retractor of claim 24, wherein at least one of the arm portions further comprises a removable expansion stop coupled with a prescribed slot or pattern of holes formed in the frame segment that together are configured to stop expansion of the frame prior to the frame segment passing completely out of a connector.

26. The retractor of claim 24, wherein at least one of the connectors when in the locked configuration does not allow the retractor frame to be expanded or contracted.

27. The retractor of claim 24, wherein at least one of the connectors is configured to position the ends of the adjacent frame segments in a stacked configuration.

28. The retractor of claim 24, wherein at least one of the connectors is configured to position the ends of the adjacent frame segments in an offset configuration.

29. The retractor of claim 24, wherein the retractor blades are adjustable and each connector is configured to translatably receive a proximal portion of the retractor blade and to reversibly fix the retractor blade position with a locking mechanism incorporated into the connector, wherein the proximal portion of the retractor blade is translatable in the connector until locked by a retractor blade locking mechanism.

30. The retractor of claim 24, wherein the retractor frame is a rounded polygon.

31. The retractor of claim 24, wherein the retractor frame is a rounded quadrilateral.

32. The retractor of claim 24, wherein the outer edge of the frame segment forms the series of notches or teeth.

33. The retractor of claim 24, wherein the arm portions of adjacent frame segments are positioned having the inner edge of one straight arm portion aligned substantially parallel to the outer end of an adjacent frame segment.

34. The retractor of claim 24, wherein the arm portions are 10 to 30 centimeters in length.

35. The retractor of claim 24, wherein the angle between the first straight arm portion and the second straight arm portion is approximately 90 degrees.

36. The retractor of claim 24, wherein the plurality of retractor blades comprise 2, 3, or 4 retractor blades are coupled to the retractor frame.

37. The retractor of claim 24, wherein the plurality of retractor blades comprise 2, 3, or 4 retractor blades are configured to decouple from the retractor frame.

38. The retractor of claim 24, wherein at least one retractor blade is coupled to a connector.

39. The retractor of claim 24, wherein at least one retractor blade is coupled to the frame segment at one of the plurality of arm portions.

40. The retractor of claim 24, wherein at least one retractor blade is configured to be moveable along the curve portion of each frame segment.

41. The retractor of claim 24, wherein the retractor is coupled to a bed frame.

42. The retractor of claim 24, wherein the retractor frame is configured to be attached to patient solely by the plurality of retractor blades after being expanded.

Description

DESCRIPTION OF THE DRAWINGS

(1) The following drawings form part of the present specification and are included to further demonstrate certain aspects of the present invention. The invention may be better understood by reference to one or more of these drawings in combination with the detailed description of the specification embodiments presented herein.

(2) FIG. 1A is a perspective illustration of one embodiment of an adjustable retractor assembly in a collapsed configuration.

(3) FIG. 1B is a top-down illustration of a second embodiment of an adjustable retractor assembly in a collapsed configuration.

(4) FIG. 1C is a perspective illustration from the top of the second embodiment of an adjustable retractor assembly in a collapsed configuration.

(5) FIG. 1D is a perspective illustration from the bottom of the second embodiment of an adjustable retractor assembly in a collapsed configuration.

(6) FIG. 1E is a side illustration of a second embodiment of an adjustable retractor assembly in a collapsed configuration.

(7) FIG. 2A is a perspective illustration of one embodiment of an adjustable retractor assembly in an expanded configuration.

(8) FIG. 2B is a perspective illustration of a second embodiment of an adjustable retractor assembly in an expanded configuration.

(9) FIG. 2C is a top-down illustration of the second embodiment of an adjustable retractor assembly in an expanded configuration.

(10) FIG. 3A is a perspective illustration of one embodiment of an extended retractor.

(11) FIG. 3B is a perspective illustration of a second embodiment of an extended retractor

(12) FIG. 3C is a perspective view from the bottom of a second embodiment of an extended retractor.

(13) FIG. 3D is a side view illustration of a second embodiment of an extended retractor

(14) FIG. 4 is an illustration of one embodiment of a connector.

(15) FIG. 5 is an illustration of a frame segment.

(16) FIG. 6A is an illustration of one embodiment for a segment/connector assembly.

(17) FIG. 6B is an illustration of a second embodiment for a segment/connector assembly.

(18) FIG. 7 is an exploded view of one embodiment of the surgical retractor.

DESCRIPTION

(19) Attachment of the retractor described herein to an operating table or other support is not necessary, but can be an option, and therefore use of the retractor described herein does not require involvement of any non-sterile member of the operating team. In addition, the lack of an obtrusive fixed metal frame allows the surgeon increased mobility and positioning at the sides of the patient during the operation. The system remains sterile, and its simple and rapid deployment can be applied to emergency and time sensitive situations.

(20) The adjustable/expandable system comprising multiple segments expanded on connectors or locking ratchet mechanisms allows full exposure of the surgical wound, as the multiple ratchet mechanisms attached to the ring segments allow the wound to be maximally retracted in both the transverse and longitudinal axes. This design allows the incision to be retracted to its maximal possible dimensions, as it is not limited by the use of a pre-determined ring size (as in the Bookwalter retractor). In addition, retraction of the wound edges in multiple directions (as opposed to only the transverse axis with the Balfour retractor) better engages the abdominal wall, allows for greater tension against the abdominal wall, and provides better stabilization of the retractor mechanism thereby improving surgical exposure. Lastly, the improved wound exposure obtained with retraction in multiple axes may reduce the necessary size of the incision required to obtain the same degree of exposure, thereby reducing scarring and unnecessary trauma to the tissues.

(21) In addition to allowing maximal retraction of the incision in not only the transverse but also the longitudinal axes, the expandable locking circumferential frame system allows the subsequent attachment of multiple retractor blades to provide additional surgical exposure (similar to the Bookwalter retractor). The frame also allows the use of lighting options which attach directly to the frame, improving surgical visualization and illumination of deep wounds and/or spaces.

(22) The surgical retractor comprises multiple frame segments forming a retractor frame by connecting adjacent segments with a connector. In certain aspects the retractor comprises four segments joined by four connectors. In certain embodiments a segment will have two arm portions joined by a curved portion. The segments are configured to be assembled to form a rounded polygon frame. In certain aspects the frame assembly can be a triangle, square, rectangle, pentagon, or other regular polygon. In certain embodiments the frame is a rounded rectangle, square, rhombus or irregular quadrilateral, which can depend on how each segment is positioned with respect to the adjacent segment. Each segment comprises a top and bottom surface/face with an inner edge facing the inside of the assembled frame and an outer facing outward.

(23) FIGS. 1A-1E shows certain embodiments of an assembled retractor frame in a retracted or collapsed configuration. In certain embodiments the frame comprises four frame segments 100. Each segment 100 has two ends 101 and 102 connected by a connecting segment 103 (see also FIG. 5). The segments can have teeth 104 along one or more edges, and/or ridges or grooves along one or more face. In certain aspects the inner edge of segment 100 is configured to interact with a ratchet mechanism (112 and 113), portions of segment 100 can have ratchet teeth 105. The inner edge faces the interior of the opening formed by assembly of segments 100. In other aspects segment 100 can have notches, grooves, or teeth 104 that can be utilized for securing attachments and the like. In certain aspects notches, grooves, or teeth can be positioned in the outer edge of segment 100, the upper face of segment 100, the lower face of segment 100, or combinations thereof. Segment ends 101 and 102 can be connected by connector 106. In certain embodiments connector 106 comprises a ratchet mechanism that interacts with ratchet teeth 105 to adjustably secure segment ends 101 and 102 and allowing expansion and contraction of the assembled frame as well as stabilizing the frame once a desired configuration is achieved. In certain aspects connector 106 can have a fixed or removable retractor blade 107. In certain aspects the frame segment 100 has an expansion stop 117. The expansion stop can be a screw, a clip, a pin, or other mechanism that is configured to not allow the frame segment to pass through connector 106.

(24) Referring to FIGS. 1B to 1D show an embodiment of the invention where the retractor blades can be moved up and down with respect to the frame. In this embodiment the connector is configured to provide for movement of retractor blade 107. Connector 106 is configured to receive the proximal portion of the retractor blade 114. The proximal portion of the retractor blade 114 is reversibly locked by using retractor blade locking mechanism 115. The proximal portion of the retractor can form a retractor blade locking mechanism receiver 116. The locking mechanism receiver 116 can be a notch, a hole, a cavity or other structure to receive the locking mechanism 115. When the locking mechanism is engaged the retractor blade is reversibly fixed at that particular position. If one wanted to adjust the retractor blade one would disengage locking mechanism 115, move the retractor blade 107 to a new position, and fix that position by engaging locking mechanism 115 with the locking mechanism receiver 116.

(25) FIG. 2A-2C and FIG. 3A-3D show an assembled retractor frame in an expanded configuration. Connector 106, 206, 306 are configured with a release/locking mechanism that allows a person to release segment 100, 200, 300 and allow expansion or contraction of the frame as well as providing a locking mechanism to secure the segments in place when desired. In certain aspects connectors 106, 206, 306 comprise a locking, ratchet mechanism (see also FIG. 4 and FIG. 6). In another embodiment the frame segment has a stop mechanism that will stop the expansion of the frame at a certain point. The expansion stop 217, 317 is an elevated portion that cannot pass through the connector resulting the stopping of the frame expansion at the point to the expansion stop 21,317. Expansion stop 217, 317 can be a screw or a pin that can be engaged or disengaged as needed. Typically the expansion stop would be engaged during use to prevent over extension. FIG. 2B-2C and

(26) FIG. 3B-3C show an embodiment where not only does the frame have a mechanism for adjustment, but so does the retractor blade portion of the device. The retractor blade can have a portion that is proximal to the frame (proximal portion 214, 314) that passes through next to the connector and can engage a retractor blade locking mechanism 215, 315 to be reversibly fixed in position. Reversibly fixed means that it will maintain its position until a locking mechanism is disengaged or the engagement is reversed allowing freedom of movement when disengaged. In certain aspects the proximal portion can have one or more locking mechanism receivers 216, 316 which receive the locking mechanism.

(27) FIG. 4 shows one embodiment of connector 106, 206, 306 in isolation. Each connector 106, 206, 306 can have two receiving openings, a top opening 410 and a bottom opening 411 for receiving the ends of two adjacent segments, e.g., 101 and 102. In certain aspects opening 410 and 411 can be offset, stacked, or side-by-side. In certain aspects the openings are offset. In other aspects the openings are stacked. In certain aspects a connector has 1 (e.g., when a connector is a fixed, integral part of one end of a frame segment), 2, or more openings. In certain embodiments one frame segment is attached to two consecutive connectors, for example, when the connector has 2 openings, a first frame segment is attached to a first opening in a first connector and a first opening in a second connector, the second connector can be attached to an adjacent frame segment. The adjacent frame segment is attached through the second opening in a shared connector (second connector) and a second opening of the non-shared connector (third connector) and so forth until a retractor is formed. Connector 406 can comprise ratchets 412 and 413, which are configured to ratchet in opposite directions. Ratchets 412 and 413 can be configured to interact with a toothed surface of two adjacent segments (e.g., see FIG. 5 part 505). The ratchets can be configured to allow the frame to be expanded by applying a force away from the centerpoint of the retractor without disengaging the ratchet. In other aspects the ratchet is configured to not allow contraction of the frame unless the ratchet is disengaged. Other release/locking mechanisms can be integrated into the current design, so the ratchet mechanism is just one example. The position of the connector along a segment can be fixed by engaging a lock mechanism that can engage the teeth or grooves for locking purposes. In other embodiments the connector can be integrated into one end of the frame segment, in this case the connector may only have one opening and one ratchet mechanism since the connector is fixed at one end of the segment. A retractor blade need not be associated with the connector. A retractor blade or other implement can be fixed to one or more connector or can be an accessory implement that attaches to the frame at positions other than the connector points. A plurality of retractor blades or other implements can be attached to the frame, in certain aspects 2, 3, 4, 5, 6, 7, 8, 9, 10 or more retractor blades and/or other implements can be attached to the frame. The only limiting factor for attachment is the space available along the frame and physical interference between attachments.

(28) FIG. 5 shows an illustration of a frame segment in isolation. Frame segment 500 comprises various regions or portions. Frame segment 500 has first end 501 and second end 502. Each end of frame segment 500 is configured to interact with a connector in a way that allows assembly and adjustment of the assembled frame of the retractor. The inner edge of the ends can be configured to allow connector release/locking. In certain aspects the outer edge can be configured to interact with the connector, alone or in combination with the inner edge. Connecting segment 503 is the portion of the frame segment between end 501 and 502. Connecting segment 503 provides for angle to be formed between the ends and allow a plurality of frame segments to be positioned with respect to each other in order to form a closed retractor frame with each segment being connected by a connector. In certain aspects connecting segment 503 is in the form of a curve or an angle. The connecting segment can be characterized by the angle formed between the long axis of end 501 and 502 (segment angle). In certain aspects this segment angle is between 45 and 180 degrees. In certain aspects the segment angle is or is about 90 degrees.

(29) FIGS. 6A and 6B illustrate embodiments of a connector assembly connecting two adjacent frame segments. In FIG. 6A, this particular embodiment shows frame segments 600 being positioned in opening in connector 606. Connector 606 being configured with ratchet 612 and 613. Each frame segment 600 has ratchet teeth 605 being angle in opposing directions with respect to the long axis of the frame segment ends. The ratchet mechanism can be disengaged by pressing the ratchet at the end opposite the ratchet, pivoting the ratchet away from contacting the ratchet teeth and allowing movement of the frame segment in either direction. FIG. 6B illustrates an embodiment where the retractor blade can be adjusted using the adjusting mechanism incorporated into connector 606 and the proximal portion of the retractor blade 614.

(30) FIG. 7 illustrated an exploded view of the surgical retractor. Shown are frame segments 700 having a first end 701 and a second end 702 connected by a curved portion 703. The outer edge of segment 700 having grooves 704 and the inner edge having ratchet teeth 705. Also shown are connector 706, ratchet arm 712 and 713, expansion stop 717, retractor blade 707, retractor blade arm 714 with receiving mechanisms 714, retractor blade locking mechanism 715.

(31) The segment, connector, and retractor blade can be metallic, metallic alloy, plastic, or combination thereof. In certain aspects the retractor is made of material that can be autoclaved or otherwise sterilized (e.g. irradiated, etc.). The frame segment can be a formed rod (having a bend or angle) with circular, oval, square, or rectangular cross section. The connectors are configured to receive and reversibly engage the frame segments and connecting adjacent segments in the frame. The segments are coupled connectors to form a retractor frame. Each connector couples two segments.