AN ENDOSCOPIC-RELEASE SURGICAL RETRACTOR

Abstract

This invention relates to an endoscopic-release surgical retractor (1) comprising a blade (2) having an arch-shaped cross section and a handle (3) extending upwardly from the proximal end of the blade. The handle (3) is adapted to removably receive an L-shaped endoscope-retainer (5). The vertical arm (52) of the endoscope-retainer is adapted to receive an endoscope such that in use the endoscope is retained at the apex of the arch of the blade.

Claims

1. An endoscopic-release surgical retractor (1), said retractor comprising: a blade (2) having an arch-shaped cross section; and a handle (3) extending upwardly from the proximal end of said blade (2), said handle being adapted to removably receive a L-shaped endoscope-retainer (5); wherein the vertical arm (52) of said retainer is adapted to receive an endoscope such that in use the endoscope is retained at the apex of the arch of the blade.

2. The endoscopic-release surgical retractor (1) according to claim 1, wherein said blade (2) comprises a distal taper with a degree of taper up to 2.5°.

3. The endoscopic-release surgical retractor (1) according to claim 2, wherein said distal-tapered blade further comprise a profile taper with a degree of taper up to 2.5°.

4. The endoscopic-release surgical retractor (1) according to claim 1, wherein said blade (2) comprises a non-distal taper.

5. The endoscopic-release surgical retractor (1) according to claim 4, wherein said non-distal-tapered blade further comprises a profile taper with a degree of taper up to 2.5°.

6. The endoscopic-release surgical retractor (1) according to claim 1, wherein said blade (2) comprises a semi-circular arch-shaped cross section.

7. The endoscopic-release surgical retractor (1) according to claim 1, wherein said blade (2) comprises a stilted arch-shaped cross section.

8. The endoscopic-release surgical retractor (1) according to claim 1, wherein said blade (2) comprises a horseshoe arch-shaped cross section.

9. The endoscopic-release surgical retractor (1) according to claim 1, wherein the length of said blade (2) ranges from 4 cm to 6 cm.

10. The endoscopic-release surgical retractor (1) according to claim 1, wherein said handle (3) includes a slot (4) disposed approximate to the proximal end of said blade (2) such that the horizontal arm (51) of said L-shaped endoscope-retainer (5) is receivable within said slot and is securable therein.

11. The endoscopic-release surgical retractor (1) according to claim 10, wherein the shape of said slot (4) corresponds the cross section of the horizontal arm (51) such that said L-shaped endoscope-retainer (5) is receivable within said slot.

12. The endoscopic-release surgical retractor (1) according to claim 1, wherein the vertical arm (52) of said L-shaped endoscope-retainer (5) is provided with an aperture (53) suitably sized and shaped such that an endoscope is receivable and rigidly held therein.

13. The endoscopic-release surgical retractor (1) according to claim 11, wherein the length of said horizontal arm (51) is greater than the length of said vertical arm (52).

14. The endoscopic-release surgical retractor (1) according to claim 11, wherein the length of said horizontal arm (51) corresponds to the length of said vertical arm (52).

15. The endoscopic-release surgical retractor (1) according to claim 12, wherein the length of said horizontal arm (51) is greater than the length of said vertical arm (52).

16. The endoscopic-release surgical retractor (1) according to claim 12, wherein the length of said horizontal arm (51) corresponds to the length of said vertical arm (52).

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0027] The invention is illustrated, although not limited, by the following description of embodiments made with reference to the accompanying drawings in which:

[0028] FIGS. 1a to 1d show the perspective views of a distal-tapered blade together with a handle according to a preferred embodiment of the present invention.

[0029] FIG. 2 is a front view of FIGS. 1a to 1d.

[0030] FIG. 3 is a side view of FIGS. 1a to 1d.

[0031] FIGS. 4a to 4d show the perspective views of a non-distal-tapered blade together with a handle according to another embodiment of the present invention.

[0032] FIG. 5 is a front view of FIGS. 4a to 4d.

[0033] FIG. 6 is a side view of FIGS. 4a to 4d.

[0034] FIG. 7 shows a perspective view of an endoscope-retainer according to an embodiment of the present invention.

[0035] FIG. 8 shows a side view of the surgical retractor before the endoscope-retainer is attached.

[0036] FIG. 9 shows an exploded perspective view of the surgical retractor of FIG. 8.

[0037] FIG. 10 shows a perspective view of the surgical retractor of FIG. 9 after the endoscope-retainer is attached.

[0038] FIG. 11 shows a front view of FIG. 10.

[0039] FIG. 12 is a schematic view of a hand of a patient with the labels of Kaplan's cardinal line and the hook of hamate.

[0040] FIG. 13 is a schematic view in which the blade of the surgical retractor of FIG. 1a is inserted into the supraretinacular space through a transverse incision made at the radiocarpal wrist flexion crease.

[0041] FIG. 14 is a schematic view in which the endoscope-retainer is attached to the handle of the surgical retractor.

[0042] FIG. 15 is a schematic view in which an endoscope is inserted into the arch via the aperture of the endoscope-retainer.

[0043] FIG. 16 is a schematic view in which a cutting tool is subsequently inserted into the is supraretinacular space via the clearance beneath the endoscope of FIG. 15.

DETAILED DESCRIPTION OF THE EMBODIMENTS

[0044] The present invention provides an endoscopic-release surgical retractor 1 suitable for use in release surgery of ligaments, tendons and bones in different parts of the body.

[0045] The retractor mainly comprises a blade 2 having an arch-shaped cross section and a handle 3 extending upwardly from the proximal end of the blade 2. The handle is adapted to removably receive a L-shaped endoscope-retainer 5, wherein the vertical arm 52 of the endoscope-retainer is adapted to receive an endoscope such that in use the endoscope is retained at the apex of the arch of the blade.

[0046] The blade 2 may be in any suitable configuration and size depending on the type of release surgery, the part of the body which the endoscopic-release surgical retractor is to be used, the size of the patient and the size of the available supraretinacular space (for carpal tunnel release surgery).

[0047] Given the above, the blade 2 may have any suitable configuration of arch-shaped cross section, for example a semicircular, a stilted or a horseshoe arch-shaped cross section. The blade is arch-shaped in cross section such that an arch 21 is defined at its ventral face. The arch includes a crown 23 and longitudinal edges 22 disposed substantially parallel to each other. An endoscope and ligament cutting tools are insertable within this arch.

[0048] FIGS. 1a to 1d show an embodiment of an endoscopic-release surgical retractor 1 according to the present invention, whereby the blade 2 is a distal taper. In this embodiment, the arch 21 tapers gradually from the proximal end of the blade 2 towards the distal end. The blade 2 may be tapered up to 2.5°, preferably at 1.9°. This results in the width of the arch being greater at its proximal end than its distal end. The width at the proximal end may be ranging from 1.10 cm to 1.20 cm, preferably at 1.20 cm, and the width at the distal end may be ranging from 0.7 cm to 1.2 cm, preferably at 0.9 cm.

[0049] FIGS. 4a to 4d show another embodiment of an endoscopic-release surgical retractor 1 according to the present invention, whereby the blade 2 is a non-distal taper. In this embodiment, the arch 21 is uniform in size, namely, the width at the proximal end and distal end of the blade is the same, ranging from 0.7 cm to 1.20 cm.

[0050] In any one of the above embodiments, the distal-tapered blade or the non-distal-tapered blade may further include a profile taper. The longitudinal edges 22 of the blade tapers gradually from the proximal end of the blade 2 towards the distal end (FIGS. 3 and 6), with a degree of taper up to 2.5°, preferably at 1.9°. Optionally, the crown 23 of the blade may taper gradually from the proximal end of the blade 2 towards the distal end, with a degree of taper up to 1.5°, preferably 1.3°. This results in the height of the blade being greater at its proximal end than its distal end. The height of the blade 2 at the proximal end may be ranging from 5 mm to 11 mm, preferably at 10.28 mm, and the height at the distal end may be ranging from 3 mm to 11 mm, preferably 8.2 mm.

[0051] The blade 2 may be provided in different length configurations ranging from 4 cm to 6 cm. As would be understood by a skilled person, the length depending on the type of release surgery. For example, for SRECTR surgery, the length of the blade 2 is preferably 4.5 cm.

[0052] The handle 3 extends upwardly from the proximal end of the blade 3. It may be angled to tilt towards the distal end of the blade 2 by 12.4° to 12.6°, from the vertical.

[0053] The handle 3 may be of any suitable configuration that enables gripping by a surgeon such that the endoscopic-release surgical retractor 1 can be easily manipulated as desired during surgery.

[0054] Further, the handle 3 is adapted to removably receive a L-shaped endoscope-retainer 5. Any form of adaptation may be employed, provided it allows the endoscope-retainer 5 to be removably attached to the handle 3 and then firmly secured thereat to prevent oscillation of the endoscope-retainer 5 during surgery. This could be realised by way of fastening, stowing, clipping, hooking or mounting. For this purpose, the handle 3 may include a slot 4, disposed approximate to the proximal end of the blade 2 (FIGS. 3 and 6). The slot 4 may be structured in any suitable configuration. In the embodiment of FIG. 8, the slot is a through-hole. Primarily, the through-hole may be of any shape that corresponds to the cross section of the horizontal arm 51 of the endoscope-retainer 5.

[0055] The L-shaped endoscope-retainer 5 is provided separate from the endoscopic-release surgical retractor 1 and functions as a support to stabilize and to retain an endoscope in position during surgery.

[0056] As denoted by the name, the L-shaped endoscope-retainer 5 comprises a horizontal arm 51 and a vertical arm 52. The dimension of the endoscope-retainer 5 may be varied. The length of the horizontal arm 51 and the vertical arm 52 may be the same is or may be different. Furthermore, the horizontal arm 51 and the vertical arm 52 may have a rectangular, square or circular cross section.

[0057] In the embodiment of FIGS. 8 and 10, the horizontal arm 51 of the L-shaped endoscope-retainer 5 is inserted into the slot 4 and can be secured rigidly therein so as to prevent oscillation of the endoscope-retainer 5 during surgery.

[0058] The vertical arm 52 of the endoscope-retainer 5 is configured with a structure suitable for receiving and retaining an endoscope at the apex of the arch 21 of the blade 2. For example, the structure may be a dip or clamp or any other configurations that allows insertion of an endoscope into the arch 21 and retains the endoscope at the apex of the arch 21 of the blade 2 once it has reached certain depth within the arch 21. In the embodiment of FIG. 7, an aperture 53 is provided at distal end of the vertical arm 52. In use, when the endoscope-retainer 5 has been attached to the handle 3, the aperture is positioned such that it aligns with the apex of the arch 21 of the blade (FIG. 11). This enables passage of the endoscope through the aperture 53 into the arch of the blade, as shown with the dashed arrow in FIG. 8.

[0059] The aperture 53 may be of varying diameter dependent on the type or size of the endoscope used. However, the aperture 53 should be sized to allow passage of an endoscope, but at the same time to retain the endoscope at the apex of the arch of the blade during surgery.

[0060] The L-shaped endoscope-retainer 5 may be made of any suitable material which is safe for use in surgery and allows for sterilization (if it is to be re-used). Preferably, the L-shaped endoscope-retainer 5 is made of a surgical stainless steel. However, the L-shaped endoscope-retainer 5 may be disposable. Thus, any suitable medical grade plastic materials may be used.

[0061] As mentioned at the beginning of this section, the endoscopic-release surgical retractor 1 of the present invention may be used in release surgery of ligaments, tendons and bones in different parts of the body, for example, carpal tunnel release surgery, plantar fascia release surgery, gastrocnemius release surgery.

[0062] The use of the endoscopic-release surgical retractor 1 of this application will now be explained with the example of carpal tunnel release surgery. This in no way limits the scope of the claims, but Is provided herein as an exemplary explanation of the endoscopic-release surgical retractor 1 when in use. The same technique is equally applicable when it is used for other release surgery such as plantar fascia release surgery and gastrocnemius release surgery.

[0063] During carpal tunnel release surgery, a transverse incision of about 2 cm is made over the radiocarpal wrist flexion crease, between the palmaris longus tendon and the ulnar border of the ring finger.

[0064] A supraretinacular space between the flexor retinaculum and overlying subcutaneous fat and skin is created using a Metzenbaum scissors by blunt dissection along the axial line between the middle and ring finger and ends at the Kaplan's cardinal line as shown in FIG. 12. The width of the supraretinacular space made is about 2 to 3 cm to allow easy insertion of the endoscopic-release surgical retractor 1.

[0065] With reference to FIGS. 13 and 14, the endoscopic-release surgical retractor 1 is inserted into the supraretinacular space via the transversion incision and the L-shaped endoscope-retainer 5 is subsequently attached to the handle 3.

[0066] Next, an endoscope is inserted into the arch of the blade via aperture 53 of the endoscope-retainer 5. Due to the firm attachment of the endoscope-retainer 5 to the handle 3 and alignment of the aperture 53, the endoscope is retained rigidly at the apex of the arch. This allows visualization of the entire transverse carpal ligament. Metzenbaum scissors is inserted beneath the L-shaped endoscope-retainer 5 (FIG. 15) to dissect the proximal part of the transverse carpal ligament to visualize the median nerve underneath. The transverse carpal ligament is then divided along the longitudinal axis of the radial border of the ring finger with Metzenbaum scissors under endoscopic vision. This is performed in a series of small sequential cuts, dissecting tissues beneath the transverse carpel ligament to ensure that all structures, is especially the median nerve, are not adherent to it before a cut is made. The steps are repeated until the entire transverse carpal ligament is released. Thereafter, the endoscopic-release surgical retractor 1 can be withdrawn through the incision.

[0067] All directional statements such as front/forward, back/rear, top, bottom, lateral, inward, outward, made herein are relative to the orientation of the device, in use.

[0068] As will be readily apparent to those skilled in the art, the present invention may easily be produced in other specific forms without departing from its scope or essential characteristics. The present embodiments are, therefore, to be considered as merely illustrative and not restrictive, the scope of the invention being indicated by the claims rather than the foregoing description, and all changes which come within therefore intended to be embraced therein.