Offset Hohmann

Abstract

A surgical retractor tool includes a handle and a blade extending transversely from a front end of the handle. The blade includes a proximal portion and a distal portion with respective proximal and distal tissue engaging surfaces. The distal tissue engaging surface may be skewed relative to the proximal tissue engaging surface such that the handle may be angled relative to a direction of retraction when the surgical retractor tool is used. A distal tip of the retractor may include a curved tongue that may be curved in a direction opposite the direction of retraction.

Claims

1. A surgical retractor tool comprising: a handle; and a blade extending from an end of the handle, the blade having a length extending from a proximal end of a proximal portion of the blade to a distal end of a distal portion of the blade, the proximal portion having first and second lateral edges and the distal portion having third and fourth lateral edges, wherein the proximal portion has a first central longitudinal axis and the distal portion has a second central longitudinal axis parallel to the first central longitudinal axis, wherein the first and second lateral edges are coincident with a first plane and the third and fourth lateral edges are coincident with a second plane, the first plane being transverse to the second plane, and wherein, in a third plane orthogonal to the first and second planes, a front surface of the distal portion extends transversely from the first plane toward one of the third or fourth lateral edges such that the front surface is at an acute angle relative to the first plane.

2. The surgical retractor tool of claim 1, wherein the second lateral edge and the fourth lateral edge are coincident with a first linear axis.

3. The surgical retractor tool of claim 1, wherein the blade includes a tongue that defines a distalmost portion of the distal portion, the tongue curving into a first side of the second plane opposite a second side of the second plane, the handle being on the second side.

4. The surgical retractor tool of claim 3, wherein a surface of the tongue facing away from the second side is concave and a tip of the tongue is curved.

5. The surgical retractor tool of claim 1, wherein the distal portion is partially on and extends from one side of the first plane.

6. The surgical retractor tool of claim 1, wherein a central longitudinal axis of the handle is at an angle relative to the first plane.

7. The surgical retractor tool of claim 1, wherein a minimum distance between the first and second lateral sides is less than a minimum distance between the third and fourth lateral sides.

8. The surgical retractor tool of claim 7, wherein the blade includes a transition region between the proximal portion and the distal portion, the transition region having a front surface including a concave surface and a convex surface, the front surface being opposite a tissue contacting surface of the transition region.

9. The surgical retractor tool of claim 1, wherein the handle includes an elongate slot enclosed within a length of the handle, the elongate slot extending at least partially into the handle and having opposite ends with a wider dimension than a central segment in between the opposite ends.

10. The surgical retractor tool of claim 1, wherein the distal portion is skewed relative to the proximal portion such that an angle between the first plane and the second plane is in a range from 5 to 55 degrees.

11. A surgical retractor tool, comprising: a handle adapted for holding the retractor tool; and a blade extending from a front end of the handle at a non-zero angle relative to the handle, the blade comprising a proximal portion and a distal portion, a first front surface extending across a width of the distal portion being skewed relative to a second front surface extending across a width of the proximal portion.

12. The surgical retractor tool of claim 11, wherein the second front surface of the proximal portion passes through a first plane and the first front surface of the distal portion passes through a second plane, the second plane crossing the first plane along an axis through a length of the blade.

13. The surgical retractor tool of claim 11, wherein the distal portion has a first central longitudinal axis and the proximal portion has a second central longitudinal axis, the first central longitudinal axis being laterally offset from the second central longitudinal axis.

14. The surgical retractor tool of claim 11, wherein the distal portion of the blade is wider than the proximal portion of the blade.

15. The surgical retractor tool of claim 12, wherein the blade further comprises a distal end with a tapered tip curving out of the second plane such that the tapered tip and the handle extend from the same side of the second plane.

16. The surgical retractor tool of claim 12, wherein the blade further comprises a distal end with a tapered tip curving out of the second plane such that the tapered tip is on a first side of the second plane and the handle is on a second side of the second plane.

17. The surgical retractor tool of claim 11, wherein the distal portion is skewed relative to the proximal portion such that an angle between a first plane through lateral sides of the first front surface and a second plane through lateral sides of the second front surface is in a range from 25 to 35 degrees.

18. A method of retracting tissue during a surgical procedure, the method comprising: pressing a first tissue contact surface on a distal portion of a blade of a retractor against tissue of a patient; and pulling a handle extending from the blade in a retraction direction that is substantially normal to a first plane coincident with lateral edges of the blade laterally adjacent to the first tissue contact surface such that tissue is retracted in the retraction direction, wherein the handle is outside of a second plane coincident with a central longitudinal axis of the distal portion and the retraction direction.

19. The method of claim 18, wherein pulling the handle involves pulling the handle while an elongate dimension of the handle is transverse to the second plane.

20. The method of claim 18, wherein pulling the handle further comprises pulling a proximal portion of the blade to retract tissue, the proximal portion of the blade having a second tissue contact surface transverse to the first tissue contact surface.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0081] FIG. 1 is an oblique perspective view of a tissue retractor according to an embodiment of the disclosure.

[0082] FIG. 2 is an elevation view of the tissue retractor of FIG. 1 on a plane perpendicular to a plane on which a front face of a distal portion of a blade of the retractor extends.

[0083] FIG. 3 is a top plan view of the tissue retractor of FIG. 1.

[0084] FIG. 4 is a partial perspective view of an underside of a handle of the tissue retractor of FIG. 1.

[0085] FIG. 5 is a partial perspective view of the tissue retractor of FIG. 1 with a cable disposed therein.

[0086] FIG. 6 is a perspective view of a retractor with a cable disposed therein according to an embodiment of the disclosure.

[0087] FIG. 7 is a side elevation view of a tissue retractor according to another embodiment of the disclosure.

[0088] FIG. 8 is an oblique perspective view of a tissue retractor according to an embodiment of the disclosure.

[0089] FIG. 9 is a side view of a tissue retractor according to an embodiment of the disclosure.

[0090] FIG. 10 is an exploded view of a tissue retractor according to an embodiment of the disclosure.

[0091] FIGS. 11A, 11B and 11C are top views of a retractor in different settings according to an embodiment of the disclosure.

[0092] FIGS. 11D and 11E are partial perspective views of a retractor in different settings according to an embodiment of the disclosure.

[0093] FIG. 12A is an end view of a retraction achieved with the retractor of FIG. 7 in one step of an embodiment of a method of the disclosure.

[0094] FIG. 12B is a plan view of the retraction shown in FIG. 12A.

DETAILED DESCRIPTION

[0095] As used herein, the term “distal” refers to that portion of the instrument, or component thereof which is farther from the user while the term “proximal” refers to that portion of the instrument or component thereof which is closer to the user. As used herein, the terms “about” or “approximately” mean that the numerical value is approximate and small variations would not significantly affect the practice of the disclosed embodiments. As used herein, “tissue” refers both to soft tissue and to hard tissue, such as bone. As used herein, “laterally” means horizontally and either to the left or right, such that lateral directions are horizontal but transverse to a horizontal forward-backward axis.

[0096] In a first aspect, the present disclosure relates to a retractor for use in surgery. One embodiment of a retractor is shown in FIGS. 1-3. Referring now to FIG. 1, a retractor for surgical use includes a handle 14 and a blade 18. In some non-limiting examples, the blade in this and other embodiments of the present disclosure may be made of titanium or stainless steel. Blade 18 further includes a proximal portion 22 and a distal portion 26. Proximal portion 22 extends between and connects handle 14 and distal portion 26. Distal portion 26 ends in a claw or back lip 30 that defines a distal end of distal portion 26. Back lip 30 curls back toward an end of distal portion 26 to create a small hook at the distal end of blade 18, as shown in FIG. 2. The direction in which back lip 30 curls defines the direction that blade 18 is best suited to pull tissue, as pulling retractor transversely to the curl of back lip 30 will increase the likelihood that back lip 30 will slide along the tissue's surface instead of engaging and pulling the tissue.

[0097] In the illustrated example, distal portion 26 of blade 18 is generally flat, planar, or plate-like in shape except for channel 34, discussed in greater detail below, and back lip 30, which curls toward a direction normal, or at least approximately normal, to a back surface of distal portion 26. “Normal” is used in the geometric sense herein. Thus, “normal” in this case refers to perpendicularity or orthogonality. The shape of at least the back surface of distal portion 26 also facilitates pulling tissue in the direction toward which back lip 30 curls by distributing force across contacted tissue in the same or about the same direction. In alternative arrangements, slightly curved blades 18 or blades 18 having flat or slightly curved back surfaces of distal portion 26 function similarly. Curved, round, pointed, or otherwise non-flat distal portions 26 are also contemplated. In some embodiments, the back lip 30 may be shallower or steeper than that shown in FIG. 1.

[0098] Retractor 10 is illustrated with a number of optional features. A channel 34 extends along a center of a front surface of distal portion 34. Channel 34 may be used, for example, to receive and guide surgical tools, lights, or endoscopes. A proximal connector 38 and a distal connector 42 provide attachment points by which retractor 10 may be connected to mechanical retracting assemblies, manual rigid arms to fix the retractor to a stationary point, or robotic arms. In some applications, such connectors may even provide points of leverage during manual use of retractor 10. Connectors 38, 42 in the illustrated example are threaded elements engaged within respective threaded bores extending into handle 14, though connectors of any other variety may be used in alternative arrangements. Ergonomic grips 46, which may be made of a more easily gripped or friction-conducive material than the rest of handle 14, such as rubber or textured metal, extend along either side of handle 14, though only one grip 46 is visible from the perspective of FIG. 1. These features along with certain others shown in FIG. 1 such as the back lip 30 discussed above may be omitted or reconfigured individually or in any combination in alternative arrangements. In some examples, back lip 30 may be omitted when retractor 10 may perform a required retraction without a curved lip at its tip.

[0099] With continued reference to the handle, handle 14 also includes an elongate slot 80 that may be used to hold objects, such as cable, as described in greater detail elsewhere in the present disclosure. The slot 80 includes an enlarged proximal segment 82, central segment 84, and enlarged distal segment 86, as shown in FIG. 3, for example. Lateral ridges 85A, 85B protrude inward along a length of the central segment such that the central segment is narrower than enlarged proximal and distal segments 82, 86. Viewed from below, as shown in FIG. 4, lateral ridges 85A, 85B may be shallower than a depth of the handle such that lateral ridges 85A, 85B only protrude inward from an upper part of an enclosed internal wall 87 that defines an outer bound of slot 80. In this manner, an underside of slot 80 may have a generally uniform width along its length. In the depicted embodiment, a shape of the underside of slot 80 is defined by peripheral edge 88 with an elongate dimension having a uniform width and with semi-circular enclosures at ends in respective end segments 82, 86.

[0100] As shown in FIGS. 2 and 3, handle 14 extends along a handle axis 50. Handle axis 50 is laterally centered along handle 14 and in the illustrated example extends through the center points of the proximal and distal ends of the portion of handle 14 that is adapted to be gripped. Handle axis 50 may alternatively be defined to be collinear with the volumetric centerline of the portion of handle 14 intended to be gripped. In alternative arrangements wherein handle 14 is not adapted to be gripped by hand, handle axis 50 may be aligned along mechanical connectors 38, 42 if two connectors are present or, if only one mechanical connector 38, 42 exists, handle axis 50 may be aligned with the single connector and the point where blade 18 connects to handle 14. Relationships between other features and handle axis 50 described throughout this disclosure are intended to apply equally or in the alternative to any of the foregoing definitions of handle axis 50 unless specified otherwise. Handle 14 of the illustrated arrangement is straight such that handle axis 50 travels through, or at least near, a centerpoint of each cross-section of handle 14 on any plane normal to handle axis 50, each cross-section meaning any number of cross-sections measured at intervals along the length of the handle. In some arrangements, the handle itself may be non-linear over its length. In such cases, the handle axis will be defined by an overall alignment of the handle over its length accounting for all sub-sections. References to the handle axis elsewhere in the disclosure would refer to an axis established in such manner for these particular handle configurations.

[0101] Proximal portion 22 of blade 18 extends along a proximal blade axis 54 that is the volumetric centerline of proximal portion 22 excluding transitional structures at the proximal and distal ends of proximal portion 22 that connect proximal portion to handle 14 and distal portion 26, respectively. Proximal blade axis 54 is transverse to handle axis 50 by a handle-to-proximal blade angle 58. A front surface 24 of proximal portion 22 is shown in FIG. 1 and partially shown in FIG. 3. Handle to proximal blade angle 58 specifically refers to the true acute angle between handle axis 50 and proximal blade axis 54.

[0102] The term “acute angle” here refers to the narrower of the two angles formed between any two non-parallel lines or directionless axes in three-dimensional space, with the wider of the two angles being an obtuse angle equal to the absolute difference between 180° and the acute angle. However, reference to an acute angle is not intended to foreclose the possibility of two lines being perpendicular to each other in alternative arrangements. A “true” angle as used anywhere in the present disclosure refers to an angle that may be obtained by taking the inverse cosine of the dot product of two unit vectors, each of the unit vectors being along the respective lines or axes being compared. Thus, finding the “true acute angle” between any two axes or lines herein refers to selecting a unit vector along each of the compared axes such that the dot product between the selected unit vectors is positive. Similarly, the “true obtuse angle” between any two axes or lines herein refers to selecting a unit vector along each of the compared axes such that the dot product between the selected unit vectors is negative.

[0103] Handle-to-proximal blade angle 58 is therefore the narrowest angle defined by the intersection between handle axis 50 and proximal blade axis 54 on any plane of reference. It should be noted that handle-to-proximal blade angle 58 is projected onto the planes of FIG. 2, and therefore the appearance of handle-to-proximal blade angle 58 in FIG. 2 is somewhat distorted. That is, measurement of the angle between handle axis 50 and proximal blade axis 54 as projected onto the plane of FIG. 2 would not result in the true value of handle-to-proximal blade angle 58. Additionally, a proximal blade plane passes through front surface 24 of proximal portion 22. It should be appreciated that although proximal blade plane is defined in the applicable Figures and in certain arrangements as passing through the front surface of the proximal portion 22, it is contemplated that in some arrangements, the proximal blade plane may also pass through a width dimension of the proximal portion along an axis that bifurcates a body of the proximal portion and is generally parallel with the front surface. Handle axis 50 and proximal blade axis 54, to the extent such axis 54 is central along a length of the proximal portion 22, pass through a plane that is orthogonal to the proximal blade plane. This is because the proximal portion 22 and handle 14 of the retractor 10 are in alignment in such plane (referring to a plane into the page of FIG. 3 on axis 50 and normal to the proximal blade plane).

[0104] Distal portion 26 extends from proximal portion 22 and includes a front surface 28 that lies on a distal blade plane 64. A back surface of distal portion 26 may have one or more flat surfaces, or may have a convex shape. If the back surface of distal portion 26 is flat, the back surface may extend parallel to distal blade plane 86. If the back surface has multiple facets or is otherwise convex, distal blade plane 86 may be parallel to a tangent plane defined at a center or rearmost portion of the back surface of distal portion 26. As with the proximal portion, it should be appreciated that although distal blade plane is defined in the applicable Figures and in certain arrangements as passing through the front surface 28 of the distal portion 26, it is contemplated that in some arrangements, the distal blade plane may also pass through a width dimension of the distal portion along an axis that bifurcates a body of the distal portion and is generally parallel with the front surface. Due to the overall cross-sectional shape of the distal portion, even with varying configurations of the back surface, an overall orientation of the distal portion in the width direction would remain similar or the same as that of the front surface. Front surface 28 of distal portion 26 is skewed and laterally offset relative to front surface 24 of proximal portion 22. Front surface 28 of distal portion 26 may optionally also be skewed and laterally offset relative to handle axis 50 as shown in the example illustrated in FIG. 3. As shown through FIGS. 2 and 3, front surface 28 of distal portion 26 is in an X-Y plane, coincident with distal blade plane 64. The skew, or twist, between the distal portion 26 and the proximal portion 22 is evidenced by the fact that the front surface 24 of the proximal portion 22 passes through the X-Y plane and is at a non-zero angle with respect to it. As shown in FIGS. 1-3, the front surface 28 of distal portion 26 is at an angle of approximately 30 degrees relative to the front surface 24 of the proximal portion 22. In some arrangements, this angle may be any angle in a range from 5 degrees to 55 degrees. In some examples, the angle is in a range from 20 to 40 degrees. In some examples, the angle is in a range from 25 to 35 degrees. It should be appreciated that in arrangements where the handle 14 extends orthogonally, as measured in the X-Z plane, from a front surface 24 of the proximal portion 22, an angle between the front surface 28 of the distal portion 26 and a central axis 50 of the handle 14 is the angle between the proximal and distal front surfaces 24, 28, noted above, plus 90 degrees when measured in the same direction from the X-Y plane. Thus, if the angle between front surface 28 and front surface 24 is 30 degrees, then the angle between front surface 28 of distal portion and the central axis 50 of the handle 14 is 120 degrees.

[0105] As shown in FIGS. 1-3, distal portion 26 may have a length approximately equal to a length of the proximal portion 22 so that each portion represents about 50% of a length of blade 18. In some arrangements, the distal portion 26 may be any amount in a range from 30% to 70% of an overall length of blade 18. As shown in FIG. 2, distal portion 26 has a width greater than a width of proximal portion 22. Such relative dimensions of the blade 18 may be advantageous when employed in antero-lateral spinal access applications. In some arrangements, a width of the distal portion 26 is the same as the width of the proximal portion 22. In other arrangements, the width of the distal portion 26 is narrower than the width of the proximal portion 22.

[0106] An overall lengthwise direction that blade 18 extends from its point of connection to handle 14 in a vertical or Y direction. Distal blade plane 64 is therefore normal to certain axes that extend on a different horizontal trajectory than handle axis 50. Stated another way, a projection of handle axis 50 onto an X-Z plane as shown in FIG. 3 is not normal to distal blade plane 64. Moreover, no plane exists that contains both handle axis 50 and any axis normal to distal blade plane 64.

[0107] Distal blade plane 64 is illustrated as a dashed line in FIGS. 2 and 3 because the perspectives of FIGS. 2 and 3 are parallel to distal blade plane 64. Specifically, the perspective of FIG. 3 is along an X-axis, i.e., into the page, and the perspective of FIG. 3 is along the Y axis according to the coordinate system annotated on FIGS. 2 and 3. As stated above, distal blade plane 64 is an X-Y plane with no Z component. For this reason, distal blade plane 64 appears as a straight line in FIGS. 2 and 3.

[0108] Distal blade plane 64 is parallel to, but offset from, proximal blade axis 54 in the illustrated example, though in other arrangements, proximal blade axis 54 may lie on distal blade plane 64. Regardless, proximal blade axis 54 has no X or Z component, while handle axis 50 has at least an X and a Z component. Handle axis 50 may optionally also have a Y component as shown in the illustrated example. Because handle axis 50 includes an X and a Z component while proximal blade axis 54 has no X or Z component and distal blade plane 64 has no Z component, the plane on which handle axis 50 and proximal blade axis 54 lie is not normal to distal blade plane 64, but rather at an acute angle. Handle-to-distal blade angle 68, which is the true acute angle between handle axis 50 and distal blade plane 64, is therefore necessarily less than the handle-to-proximal blade angle 58. It should be noted that handle-to-distal blade angle 68 is projected onto the planes of FIGS. 2 and 3, and therefore the appearance of handle-to-distal blade angle 68 in FIGS. 2 and 3 is somewhat distorted. That is, measurement of the angle between handle axis 50 and distal blade plane 64 as projected onto the plane of FIG. 2 or FIG. 3 would not result in the true value of handle-to-distal blade angle 68.

[0109] Hook direction 60, which is the direction that back lip 30 points, is also shown in FIGS. 2 and 3. Hook direction 60 extends backward from back lip 30 along an axis that has no X component. The axis along which hook direction 60 extends may have a positive, negative, or zero Y component, according to various arrangements of retractor 10. Hook direction 60 is the direction that retractor 10 is best able to apply retracting force to tissue as pulling retractor 10 in hook direction 60 force the point of hook 60 directly into the retracted tissue rather than across the tissue's surface. In some arrangements, the hook direction is simply an axis normal to front surface 28 of distal portion 26. Because hook direction 60 is spaced from handle axis 50 along the Y axis at the location of blade 18 and has a different X-Z trajectory than handle axis 50, in that handle axis 50 has an X component while hook direction 60 does not, hook direction 60 neither runs parallel to handle axis 50 nor intersects handle axis 50 at any point. Moreover, no plane exists that contains both handle axis 50 and the axis along which hook direction 60 extends.

[0110] The non-parallel and non-intersecting relationship of hook direction 60 to handle axis 50 suits retractor 10 for different usage than typical preexisting Hohmann blades. Typical preexisting Hohmann blades have handles aligned over the engaging direction in which their distal point, blade, or other tissue engaging end is directed except that the handle may be inclined either up or down relative to said engaging direction. Typical preexisting Hohmann blades are therefore configured to best engage tissue when pulled straight backward or only slightly upward or downward relative to the length of the handle. Retractor 10, by contrast, is configured to best retract tissue at a skew angle 76 relative to handle axis, wherein skew angle 76 is the true acute angle between hook direction 60 and handle axis 50. As shown in FIG. 3, skew angle 76 extends laterally relative to handle axis 50. Retractor 10 therefore engages tissue best when pulled both back and to the side in contrast to preexisting Hohmann blades.

[0111] Turning specifically to FIG. 3, distal portion 26 is horizontally offset from proximal portion 22. That is, a central axis 54 of proximal portion is offset from a central axis 32 of distal portion. Distal portion 26 and central axis 32 of distal portion 26 may optionally also be laterally offset from handle axis 50. The projection of handle axis 50 onto a horizontal or X-Z plane as shown in FIG. 3 does not pass through a center of distal portion 26 as projected onto the same horizontal or X-Z plane. Retractor 10 during use will therefore contact tissue that to the side of the point where handle 14 transitions to blade 18 in contrast to preexisting Hohmann blades that typically contact tissue directly below the transition of handle 14 to blade 18.

[0112] In the illustrated example, if the projection of handle axis 50 onto the plane of FIG. 3 defines the forward-backward axis with blade 18 being at the forward end of handle 14, distal portion 26 is both offset to the right of handle 14 and is skewed to the right such that back lip 30, hook direction 60, and the back surface of distal portion 26 face a direction to the right of handle 14 on a first side of axis 54. In alternative arrangements, distal portion 26 may instead be offset and skewed to the left of handle 14, i.e., on a second side of axis 54 opposite the first side. In further arrangements, distal portion may be skewed to the left of handle 14 without any offset. In other alternative arrangements, distal portion 26 may be offset to the left of handle 14 while remaining skewed to the right. More generally, in various arrangements, distal portion 26 may be any combination of offset to the right, offset to the left, or horizontally centered on handle axis 50 and skewed to the left or right of handle 14.

[0113] Another embodiment of a retractor according to the first aspect is shown in FIG. 7. Retractor 110 is generally similar to retractor 10 shown in FIGS. 1-3 except for differences shown in FIG. 7 or specifically noted herein. Where numerals are indicated, reference numerals of the 100 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Retractor 110 includes a handle 114 extending along a handle axis 150 with optional grips 146 on either side, a mechanical connection point 138 at a proximal or back end of handle 114, and a blade 118 extending downward or at least generally downward from a distal or forward end of handle 114. Blade 118 includes a proximal end 122 extending along a vertical proximal blade axis 154 and a distal portion 126 with a channel 134 running down a center of a front face of distal portion 126. The proportions, relative angles, properties, and possible variations of all of the foregoing features of retractor 110 of the illustrated example are identical to those illustrated and described above with regard to retractor 10 of FIGS. 1-3, except that no distal connector 42 exists on retractor 110 and retractor 110 includes an elongate tongue 131 instead of back lip 30.

[0114] The perspective of FIG. 7 is normal to both handle axis 150 and proximal blade axis 154. That is, both handle axis 150 and proximal blade axis 154 extend parallel to the plane on which FIG. 7 is illustrated. Handle-to-proximal blade angle 158 as visible in FIG. 7 is therefore equal to the true acute angle defined between handle axis 150 and proximal blade axis 154. Moreover, handle-to-proximal blade angle 158 of the illustrated example of retractor 110 may be the same as handle-to-proximal blade angle 58 of retractor 10 of FIGS. 1-3. In alternative arrangements, the angle between handle 114 and proximal portion 122 may vary from that shown.

[0115] In retractor 110, distal connector 42 is omitted while proximal connector 138 remains. In other arrangements of either retractor 10 or retractor 110, distal connector 42 may remain while proximal connector 38 or 138 is omitted. In further arrangements, more than two such connectors may be provided, or no connectors may be provided.

[0116] A front surface of distal portion 126 extends along a distal blade plane that is identical in orientation relative to other features of retractor 110 and in all other transferrable respects to distal blade plane 64 of retractor 10. Thus, a true acute angle between handle axis 150 and the distal blade plane of retractor 110 is equal to handle-to-distal blade angle 68 described above. A true acute angle between the plane of front surface 124 of proximal portion 122 and distal blade plane 164 is also the same as the angle between the plane of front surface 24 of proximal portion 22 and distal blade plane 64 as described above.

[0117] Tongue 131 extends mostly downward and slightly in a direction away from the distal blade plane on a side of the distal blade plane opposite the handle 114. Tongue 131 is thus laterally aligned both in direction with the distal portion 126. However, in contrast to back lip 30 which extended obliquely backward and somewhat horizontally toward handle 14, tongue 131 extends obliquely forward and somewhat horizontally away from handle 114. However, a shape of tongue 131 is adapted to optimize access and contact with anatomical surfaces and may be advantageous in circumstances different from those most suited to a retractor with back lip 30. It should be appreciated that either of the illustrated embodiments are well adapted for use in lateral and antero-lateral spinal procedures.

[0118] Another embodiment of a retractor according to the first aspect, in the form of an offset retractor 210, is shown in FIG. 8. Where numerals are indicated, reference numerals of the 200 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Offset retractor 210 of the illustrated arrangement includes many features generally similar to retractors 10, 110, including a handle 214 extending along a handle axis 250 with optional grips 246 on either side, a mechanical connection point 238 at a proximal or back end of handle 214, and a blade 218 extending downward or at least generally downward from a distal or forward end of handle 214. Blade 218 includes a proximal portion 222 extending along a vertical proximal blade axis 254 and a distal portion 226. A channel 234 is disposed along a center of a front face of proximal and distal portions 222, 226 and a tongue 231 extends downward and slightly forward from a distal end of distal portion 226.

[0119] Offset retractor 210 includes a middle portion 276 connecting proximal portion 222 to distal portion 226. Like distal portion 26 of retractor 10 and distal portion 126 of retractor 110, distal portion 226 of offset retractor 210 includes a back surface facing generally backward and under handle 214 that is, at its distal end at least, adapted to engage tissue. Middle portion 276 extends along a jog axis 280 that is transverse to both proximal blade axis 254 and a distal blade axis 264 along which distal portion 226 extends. Jog axis 280 extends laterally relative to proximal blade axis 254, distal blade axis 264. In this configuration, each axis 254, 264, 280 lie in a single plane. Distal portion 226 is offset laterally relative to proximal portion 222 on a first side of proximal blade axis 254. Distal portion 226 may be anywhere from half as long to twice as long as proximal portion 222 and anywhere from one third to two thirds of an overall length of blade 218. Middle portion 276 may be anywhere from one tenth to one third of an overall length of blade 218. According to various arrangements, the true acute angle between jog axis 280 and proximal blade axis 254 may be 45° anywhere from 30° to 60°, anywhere from 15° to 75°, or anywhere up to 90°. According to various arrangements, the true acute angle between distal blade axis 264 and proximal blade axis 254 may be 0°, as shown in the illustrated example, up to 30°, up to 60°, or anywhere up to 90°. In some examples, a distance between proximal axis 254 and distal axis 264 may be between 5 and 15% of a length of blade 218. In alternative arrangements, distal portion 226 may be offset laterally relative to proximal portion 222 on a second side of proximal blade axis 254, opposite to that shown in FIG. 8. In still further arrangements, distal portion 226 may be offset in a direction away from handle 214 such that a plane through the front face of distal portion 226 is further from the handle than a plane through the front face of proximal portion 222, such planes being spaced apart and parallel to one another.

[0120] Offset retractor 210 may therefore be used somewhat similarly to retractor 10 and retractor 110 such that handle 214 will be clear of space directly above tissue contacted by distal portion 226 to enable trajectories for an arm of a surgeon or other tools that would be obstructed if a conventional Hohmann blade 190 were used to pull the same tissue in the same direction. Unlike distal portion 26 and distal portion 126, distal portion 226 is not skewed or turned laterally relative to handle 214, meaning that the illustrated arrangement of offset retractor 210 is adapted to function best when pulled straight backward or slightly upward of straight backward, rather than when pulled at least partially laterally relative to handle 214. However, in alternative arrangements of retractor 210, distal portion 226 or at least a back, tissue engaging surface of distal portion 226 may be skewed laterally relative to handle 214 to be better suited to pull tissue laterally.

[0121] Further embodiments of the first aspect are shown in FIGS. 9, 10 and 11A-E, respectively. In FIG. 9, retractor 310 is shown. Where numerals are indicated, reference numerals of the 300 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Retractor 310 includes a handle 314 and a blade 318 extending therefrom. The blade includes tongue 331 with a concave inner surface tapering in a direction away from a central longitudinal axis of the blade and away from a direction of the handle extending from the blade. Handle 314 is oriented transverse to a length of the blade and is short in length relative to the length of the blade. In one example, the length of the handle may be similar to a length of proximal portion 322 of blade 318. In other examples, the length of the handle may be shorter than a length of either proximal portion 322 or distal portion 326 of the blade. In still further examples, the length of the handle may be longer than the length of either the proximal portion or the distal portion. An upper surface of handle 314 may include a connector 338.

[0122] In FIG. 10, retractor 410 is shown. Where numerals are indicated, reference numerals of the 400 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Retractor 410 includes a handle 414 and a blade 418 extending therefrom, where the blade is removably attached to the handle. In addition to the blade having proximal and distal portions 422, 426, the blade also includes a blade extension 437 extending proximally from proximal portion 422 and oriented transverse to an elongate dimension of the proximal portion. Blade extension 437 includes a free end defined by an engagement feature for engagement with the handle. The engagement feature may be positive or negative for engagement with a complementary feature on the handle. In the depicted embodiment, the engagement feature on blade extension 437 is an engagement head 439. With continued reference to the depicted embodiment, handle 414 includes an engagement portal 415 at one end for releasable engagement with engagement head 439 of the blade. While one particular set of engagement features is shown in FIG. 10, the details of the engagement features may vary from that shown.

[0123] In FIGS. 11A-C, retractor 510 is shown. Where numerals are indicated, reference numerals of the 500 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Retractor 510 includes a handle 514 and a blade 518 extending therefrom. Optionally, the blade may be removably attached to the handle. The retractor may include a blade extension 537 extending transversely from blade 518, and may further include a distal connector 542. Handle 514 may be attached to blade 518 in a manner such that handle 514 is pivotable relative to blade 518, as shown by the different positions of the handle relative to the blade in FIGS. 11A and 11B. Further, when the handle is rotatably adjusted relative to the blade, the new relative position of the components may remain set in place until force is applied to change them again. In this manner, the retractor may be used with a desired position of the handle relative to the blade. Thus, for example, retractor 510 may be used with the handle arranged as shown in FIG. 11A, with the handle arranged as shown in FIG. 11B, and in other positions in between, for example. The adjustable relationship between the handle and the blade may be such that the handle is continuously adjustable relative to the blade based on the force applied to the rotation of the handle relative to a held-in-place blade. Alternatively, the retractor may include an interface between the handle and the blade that facilitates adjustment of the handle relative to the blade in predetermined increments.

[0124] In examples with a continuously adjustable interface between the handle and blade, the retractor may include a friction-based interface between the handle and the blade with properties such that the resistance between the two may be overcome with force. In such arrangements, once force is no longer applied, the relative position between the handle and blade may remain static and will not change unless rotational force is applied again.

[0125] In examples where the interface supports adjustment of the handle relative to the blade in predetermined increments, one or a combination of a rotatable engagement region 592 on the handle and a rotatable engagement region 594 on the blade extension may include a gear and a pawl adapted such that the handle may be rotated in predefined increments in either a clockwise or counterclockwise direction. One non-limiting example of a mechanism that performs such a function is described in U.S. Pat. No. 6,116,580, the disclosure of which is hereby incorporated by reference herein in its entirety. Other arrangements with gears and other mechanical parts may also be used and are also contemplated for inclusion in the interface.

[0126] Another example of an interface adjustable in predetermined increments is that included in retractor 610 shown in FIGS. 11D and 11E. Where numerals are indicated, reference numerals of the 600 series of numerals are the same as like numerals of the 10 series of numerals, unless otherwise indicated. Although only a portion of the retractor is depicted in FIGS. 11D and 11E, it should be appreciated that such retractor may include a twist or skew in a distal portion of the blade relative to a proximal portion of the blade, as described in other embodiments of the present disclosure. A connection assembly may include a pin 678, a knob anchor 679 and an insert 676, in addition to handle 614 and blade 618. A rotatable engagement region of the handle includes a cylindrically shaped opening to receive insert 676 and pin 678. Insert 676 may include a threaded outer surface 675 for engagement with a complementary thread on an inner surface of the cylindrically shaped opening of the handle. In some examples, insert 676 may be pre-attached to the handle through the threaded connection. A small transversely oriented pin may be disposed through the handle onto the insert for increased engagement between the components. Further, the insert may include a hirth joint 674 at a blade-facing end oriented to be received on a complementary hirth joint 672 on the blade and may have an elongate opening therethrough sized for disposal of pin 678 therein. Pin 678 may include a transverse opening to receive knob anchor 679, as shown in FIG. 11E and may be threaded at one end for securement to the blade. Materials used for the connection assembly may be one or more of steel, stainless steel, aluminum and titanium.

[0127] The connection assembly is configured for use as follows. In one example, a starting condition may have a threaded end (not shown) of pin 678 rotatably engaged with a complementary thread on an inner receiving surface (not shown) of blade 618. Other forms of engagement may also be used. On handle 614, insert 676 may be rotatably engaged to the inner threaded surface of the cylindrically shaped opening of the handle. With knob anchor 679 removed from pin 678, the cylindrically shaped opening of the handle may be placed over pin 678 so that the inner wall of insert 676 slides over pin 678 and the respective hirth joints 672, 674 may be engaged such that a desired angle between handle 614 and blade 618 is realized. Knob anchor 679 may then be slid through pin 678 as shown in FIG. 11E, and knob 642 may be secured into place over pin 678. When knob 642 is secured in place, a rotational position of handle 614 relative to blade 618 is set until the knob is removed. The handle may be secured in different positions relative to the blade by engaging the respective hirth joints at different positions with respect to each other.

[0128] In variations where the blade is removably attached to the handle, rotatable attachment region 592 of handle 514 may include an engagement feature that is either a projection or a receiving portal and rotatable attachment region 594 of blade extension 537 may include the other of a projection or a receiving portal to complement the feature on the handle. In this way, the handle may be detached and reattached to the blade. In some examples, the engagement features on the handle and blade extension may be oriented along a longitudinal axis of the handle. In other examples, the engagement feature of the blade extension may be on an underside surface of blade extension 537 opposite distal connector 542 and the engagement feature on the handle may be oriented to complement the engagement feature on the blade extension. In these examples, a central axis through the respective engagement features may be parallel to a longitudinal axis of blade 518, passing through distal connector 542.

[0129] In another aspect, a kit is contemplated that may include one or more Hohmann blade as described in the present disclosure. For example, a kit may include one or more blades 10 and one or more blades 110. In other embodiments, a kit may include one or more Hohmann blades and a retractor frame, rigid arm, or both. In some embodiments, a kit may include any number of Hohmann blades and a manual with directions on the use of one or more items included in the kit. Optionally, such kits may also include one or both of a retractor frame and a rigid arm to hold the Hohmann blade.

[0130] In any one of the above embodiments, the kit or individual items and combinations thereof may be disposed within a packaging or a plurality of packages. It is contemplated that the items of a given kit may be sorted into any subgroups desired, where each subgroup may be packaged separately. Of course, each item of a kit may also be individually packaged. For example, each Hohmann blade in a kit may be packaged separately. Through packaging each item in the kit separately or in separate combinations, sterility may be controlled for each item within the kit.

[0131] In yet another aspect, a system that includes a Hohmann blade is contemplated. In one embodiment, a system includes a rigid arm with a connector at an attachment end and a Hohmann blade with a connector to receive the connector of the rigid arm. In another embodiment, a system includes a retractor frame with a connector and a Hohmann blade, where the Hohmann blade has a connector that receives the connector on the retractor frame. It is contemplated that the embodiments of the system may include any Hohmann blade contemplated by the present disclosure.

[0132] In another aspect, the present disclosure relates to a method of using a retractor such as those shown in FIGS. 1-11E. In one embodiment, a retractor, such as retractor 10, 110, 210, is used as part of a procedure to create access to a spine, such as from an antero-lateral access direction. Specifically, this may be done to prepare for an anterior lumber interbody fusion. In some examples, this procedure may be performed in the L5-S 1 space. In such a procedure, the retractor, i.e., Hohmann blade, may be used to remove vessels away from a spinal disc space. With the blades contemplated by the present disclosure, the skew and offset of the blade allow for the blade to be held in place to pull vessels out of the target site, here, the intervertebral disc space, while still allowing space at the same time for an instrument or an arm of a surgeon to be inserted to access the same disc space. These principles may also be applied in other surgical settings where blood vessels or other tissue is intended to be retracted, while additional instruments must be inserted in the vicinity of the Hohmann blade once the Hohmann blade is in place and the tissue is retracted. Accordingly, one advantage of the present disclosure is that the contemplated Hohmann blade reduces the need to move or adjust a position of the blade during surgery. Additionally, because there is a reduced need to move the blade, risk of vascular injury due to such movement is reduced.

[0133] One example of a Hohmann blade retractor used during a surgical method is shown in FIGS. 12A and 12B and utilizes retractor 110. Retractor 110 is used in cooperation with two conventional Hohmann blades 190 to retract tissue and hold open an opening 194. Specifically, with reference to the perspective of FIG. 12B, Hohmann blades 190 are used to pull tissue laterally and anteriorly and retractor 110 is used to pull tissue laterally in a direction opposite to opposing blade 190. Retractor 10, 110 may be pulled so that distal portion 26, 126 of blade 18, 118 moves along axis 60. In some examples, retractor 10, 110 may be pulled so that the distal portion moves along a direction that is at an angle relative to the axis 60. For instance, retractor 10, 110 may be pulled so that the distal portion moves in a direction five, ten, fifteen or twenty degrees off of axis 60. Advantageously, because blade handle and proximal portion of blade 110 are skewed relative to distal portion retracting tissue, extra space is provided for placement of cobb tool 198, as shown in FIG. 12B. In particular, tool 198 can be advanced into opening 194 directly from the lateral side shared with retractor 110 according to the perspective of FIG. 12B. More generally, reference to both FIGS. 12A and 12B show that tool 198 can extend through a space that would be obstructed by a conventional Hohmann blade 190 if a conventional Hohmann blade 190 were used instead of retractor 110 pull the same tissue in the same direction. The procedure and arrangement of devices 110, 190, 198 of FIG. 12A and 12B is merely one example, and it is contemplated that a wide variety of potential use cases exist wherein a useful trajectory for any type of tool may be cleared by using a retractor 110 that is either or both of offset and skewed instead of a conventional Hohmann blade 190. Retractor 110 may also be used simply for convenience or ergonomic purposes where manually pulling tissue in an intended direction would be inconvenient with a conventional Hohmann blade 190. Retractor 10, offset retractor 210, or retractors 310, 410, 510 may be used in generally similar ways to the manner of use of retractor 110 as illustrated in FIGS. 12A and 12B and described herein with respect thereto.

[0134] In another aspect, the present disclosure relates to cable management for retractors. Generally, this means keeping cables that are placed in and around a surgical access portal out of the way of the working space so that the working space remains unobstructed. Surface features on a handle of the retractor are shaped to receive and hold cable, thereby keeping such cable out of the way of the access portal and/or other areas, as needed. It should be appreciated that the cable contemplated for use with the retractors of the present disclosure may be light cable or other types of cable typically placed into a surgical field. Other types of cable that may be used may be of a size similar in scale to light cable.

[0135] In one embodiment, cable management is facilitated through slot 80 in handle 14 of retractor 10, as shown in FIG. 5. Retractor 10, partially depicted in FIG. 5, is also shown in FIGS. 1-4. From its source, cable 91 may be first disposed into enlarged proximal segment 82 of slot 80, then run through or under lateral ridges 85A, 85B within the slot before exiting from the slot through enlarged distal segment 86. Passing the cable through the slot holds a portion of the cable in place on the handle and prevents it from drifting away from its location in the handle. In other exemplary applications, cable 91 may simply be pressed into slot 80 by pressing the cable in along central segment 84. If desired, cable 91, already positioned within slot 80, may be run through an engagement surface on a blade of the retractor, in between walls defining channel 34, for example. In such arrangements, an end of the cable 91 (not shown) may be positioned on the blade. The cable used may be any type of cable, such as light cable. Where light cable is used, a light emitting diode (“LED”) may be positioned on a free distal end of the cable so that when it is positioned on the blade, light may emanate from the blade.

[0136] In another embodiment, cable management is facilitated through slot 80′ in handle 14.sup.1 of retractor 10.sup.1, as shown in FIG. 6. In retractor 10.sup.1, like reference numerals refer to like elements of retractor 10, unless otherwise indicated. For the avoidance of ambiguity, slot 80.sup.1 may be the same as slot 80. When cable 91.sup.1 is passed through or pressed into slot 80.sup.1, it may then be further directed through an elongate channel 21.sup.1 in blade 18.sup.1, as shown in FIG. 6. Channel 21 may be defined by a space between elongate ridges 23A.sup.1, 23B.sup.1 on the blade. Cable 91.sup.1 as shown is a light cable with an LED 92.sup.1 at its distal end. If desired, a free end of cable 91.sup.1 may be run through channel 21.sup.1 until the LED 92.sup.1 is at a desired position for use on blade 18.sup.1.

[0137] Although the concepts herein have been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present disclosure. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present disclosure as defined by the appended claims.