Note: Descriptions are shown in the official language in which they were submitted.
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This invention relates to surgical aids for use in displacing
material such as non-skeletal soft tîssue, muscles, organs and the like to
permit access to a surgical site and to retain such material in displaced
pOSition while the surgical operation is proceeding.
The normal procedure today in hospital operating theatres is to
have a surgeon's assistant displace material by hand from the surgical site,
as called for by the surgeon, the assistant, of course, wearing surgical
gloves and perhaps using sponges or towels or hand-held rigid ~etal instru-
ments against the displaced material.
It is an object of the present invention to eliminate the need for
use of the assistant's hands, thus freeing the assistant to assume a more
productive role in the operation or completely dispensing with the need for
the assistant, as the case may be. It is to be understood, however, that the
surgical aids of the present invention are not limited to use in hospital
operating theatres but may be adapted for use in dental surgery or veterinary
; surgery.
It is another object of the present invention to provide a surgi-
cal aid which will have min-imal adverse effects on the material displaced thbre-
- by, as opposed, for example, to towels or sponges which, by virtue of their
rough surface, can damage the serosal surface or organs with which they are in
engagement. The towels and sponges can also cause drying of the serosal
surface by absorption, thereby changing the normal physiology of the organ.
Also, the towels and sponges often do not adequately protect the serosal
surface from exposure to air, which also causes drying. The aids of the
present invention do not suffer from any of these disadvantages nor from the
disadvantages exhibited by other surgical aids which have been proposed
hitherto but have not come into common use. Many of such previous devices
cannot be repeatedly bent into various shapes, or they do not maintain the
shape to which they are bent, or they react with the body fluids or the
serosal covering, or they absorb the body fluids, causing d~ying, or they
have a relatively rough or hard surface which can damage the organ, or they
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exert too much pressure on the displaced and retained organs, or they deter-
iorate too rapidly with use, or they are not adapted to be supported exter-
nally and therefore do not remain stationary.
Basically thepresent invention is a surgical retractor at
least part of which comprises an elongated metallic core and a surrounding
elongated body of polymeric material which is non-toxic to cells, said core
and body being three-dimensionally deformable merely by bending and being
capable of retaining any shape into which they are bent.
The invention may be embodied in a surgical retractor for use in
retraction of parts of a patient's body during surgery, comprising a handle
- which is bendable as an integral part of said retractor at any region along
said handle in each of two directions at right angles to each other and to
; said handle's longitudinal axis in said region, and which retains the shape
of the bend produced; said handle having a metallic core and a surrounding
body which is polymeric and non-toxic to cells; and a body pOTtion at one
end of said handle and integral therewith; said body portion being bendable
and retentive of the shape of the bend produced and having a metallic core
and a surrounding body of polymeric material which is non-toxic to cells.
The body may be placed in a surgical site to displace and retain tissue
- 20 not being operated upon and the handle may be grasped at a point outside of
the surgical site to maintain the body of the surgical aid in a desired
position during the operationJ the combined body and handle having a function
approximating that of a human hand, wrist and forearm.
The core metal is preferably aluminum or an alloy thereof or
stainless steel and the polymer of the covering is capable of being organo-
metallically bonded thereto, the presently preferred polymer being dimethyl
polysiloxane polymer.
, The metallic core may be in the form of a plurality of wires
intertwined in the handle and forming loops in the body. Alternatively, it may
be in the form of a solid piece of metal in the body, a coiled wire extending
from the solid piece into the handle and a plurality of wires, which may taper
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outwardly for increased malleability, radiating from the solid piece into
the body.
The aid may be made in various different shapes for use in
different operations and the gauge of metal used for the core may be selected
to give the most appropriate strength to the aid for the operation for which
it is intended. Moreover, the body of the aid may be provided with a soft
edge portion or flaps to avoid bruising of material in the surgical site with
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which the edge of the aid might come in contact. Such flaps may be grooved
on one face to make it easier to move them in one direction than in the oppo-
site direction and they may be provided with small ridges to provide finger
grips for the surgeon to facilitate his manipulation thereof. In other cases,
the body of the aid~ at a region remote from the handle, may be subdivided to
form fingers which are individually movable and will maintain the relative
positions to which they are moved to adapt to the anatomy in the surgical site.
Such fingers may also be provided with small ridges as aforesaid.
; It is contemplated that, to facilitate manipulation of the body of
the aid within the surgical site, controls such as Bowden cables may be built
; into the aid. It is also contemplated that a suction device and/or a light
source may be built in, if desired.
The body of the surgical aid may be held in position in the surgical
site by grasping its handle at a position outside of ~he site, thus giving
the surgeon free access to the site and allowing him to manoeuvre the aid as
he desires. Such grasping may be effected manually by the surgeon's assistant
but it is preferred, in most instances, to have the handle held by a clamp
on a retractor frame adapted to be fixed relative to the surgical site. Said
frame preferably comprises first, second and third frame members fixed rela-
tive to each other with the second and third members spaced apart and extend-
ing in parallel in the same direction away from said first member, and a
fourth member mounted on said second and third frame members for adjustment
- toward and away from said first frame member, releasable locking members hold-
ing said fourth frame member, in use, away from said first frame member,
each of said first and fourth frame members having mounted thereon a pair of
retractor hooks longitudinally slidably mounted thereon and at least one of
; said second and third frame members ha~ing a said clamp adjustably mounted
thereon.
The slidable mounting of the hooks on the Erame permits the surgeon
great leeway in his choice of the configuration of the wound permitting access
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to the surgical site. In some instances he may wish a narrow configuration
but in others he may prefer an almost circular configuration. The engagement
of the retractor hooks by the musculature surrounding the wound retains the
locking members in locking position and holds the frame in a fixed position
relative to the surgical site, thus ensuring that the body of the surgical
aid will maintain its position in the site during the operation unless adjusted
by the surgeon.
Embodiments of the present invention will now be described, by way
of example, with reference to the accompanying drawings, in which:
Figure 1 is a perspective view of a surgical aid;
Figure 2 shows the surgical aid of Figure 1 in use in a surgical
site and also shows a human hand, wrist and forearm to illustrate graphically
the similarity in function;
Figure 3 is a perspective view of a retractor frame having two sur-
gical aids clamped thereto;
Figure 4 is a perspective view of a clamp used with the frame shown
in Figure 3;
Figure 5 is a plan view of the frame;
Figure 6 is a perspective view of a surgical site, showing two
different types of surgical aid in use;
Figure 7 is a view of a surgical aid having a different core con
struction than those shown in Figure 3;
Figure 8 is a perspective view of another embodiment of the surgical
aid of the present invention;
Figure 9 is a cross-sectional view of the body of the surgical aid
shown in Figure 8; and
Figures 10 to 19 show various other embodiments of the surgical aid.
,
As shown in Figure 1 a surgical aid according to the invention has
i a body portion 1 and a handle portion 2. Both of these are made of an inner
core of metal, such as aluminum alloy, and an outer covering of an elastomer
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such as dimethyl polysiloxane polymer, the two being organo-metallically
bonded to each other. Because of such bond there are no cavities within the
aid and the ductile and resilient properties of the two components are blend-
- ed. The dimethyl polysiloxane polymer is well known for its compatibility
witn cell metabolism and, by virtue of its chemically inert nature, it will
not sustain micro-organisms in the event that it is accidentally cut or punc-
tured. Moreover, it easily withstands repeated sterilization and is a poor
conductor of heat and electricity, all of which make it ideal for the present
purposes, although, of course, other elastomers may be quite satisfactory.
Figure 2 illustrates the functional similarity of the surgical aid
and the human hand, wrist and forearm. Although the aid need not in some
-~ cases have the slits 3 subdividing the lower edge of the body portion, these
serve in the present embodiment to illustrate even more graphically the afore-
said similarity. Thus, the portions 4 defined by slits 3 can be compared
with the human fingers 5, the part 6 above the portions 4 can be compared
;ith the human palm 7, the junction 8 between the body 1 and handle 2 can be
- compared with the wrist 9 and the portion 10 of the handle adjacent the
junction 8 can be compared with the portion 11 of the forearm adjacent the
wrist. In addition, the aid has the advantage that the handle can be bent
whereas the human forearm can not.
The entire aid can be straight, as in Figure 1, or its various parts
can be moved to any of various positions, such as those shcwn in Figure 2,
and they will retain such positions until forcibly displaced therefrom. Thus,
the surgeon can manipulate the various parts within the surgical site to give
him the exact positions that he wants in order to properly retain and shield
` the displaced material 12.
The aid can be held by grasping the handle at a position outside
of the surgical site with the body extending into the surgical site, thus
providing minimum interference with the space available in the surgical site.
Such grasping may be done by the hand of an assistant, but in most cases it is
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preferred that the grasping be done by means of a clamp mounted on a frame
which is adapted to be held in fixed relation to the surgical site, thus
freeing the surgeon's assistant for a more productive role in the operation,
or dispensing with the need for such assistant entirely. As shown in Figure
3, the frame 13 comprises a first member 14, second and third members 15 and
16, a fourth member 17 and a fifth member 18. The members 14, 15, 16 and 18
form a fixed rectangle whereas the member 17 is movable along members 15 and
16 between members 14 and 18. A pair of retractor ho~bs 19 and 20 are
mounted on member 14 for frictional sliding movement longitudinally thereof
and a similar pair of retractor hooks 21 and 22 are likewise frictionally
slidably mounted on member 17, such retractor hooks being adapted to engage
the edges of a surgical incision and retain same in an open condition to allow
the surgeon access to the surgical site. By virtue of the slidable mounting
of the four hooks the surgeon may expand the incision to form an open wound
of any desired configuration. Thus by having the hooks in each pair close
together he can have an elongated wound configuration or, by spacing the
hooks relatively far apart, he can achieve an almost circular wound configur-
ation.
` Each of the members 15 and 16 has teeth 23 along the outer face
thereof, such teeth being pointed away from member 14. The member 17 has
locking members 24 and 25 mounted at the opposite ends thereof on pivot pins
, 26 and 27 respectively, these pins being slidable in slots 28 and 29 in the
member 17. Each locking member ~ssin the form of a block having a passage
30 extending therethrough of sufficient width to accommodate one of the mem-
bers 15, 16 with some play. Thus, when the surgeon has made the incision
he may insert the hooks thereinto with the members 14 and 17 closely spaced
and he may then simply push the members 14 and 17 apart until he has achieved
the desired width of wound. The stretched musculature around the wound will,
of course, attempt to bring the members 14 and 17 together again but, as
shown in Pigure 5, the pull on hooks 21 and 22 will effect a pivoting action
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of the locking members relative to the frame member 17, thus bringing the
edge 31 of passageway 30 into contact with the teeth 23 and bringing the
diagonally opposite edge 32 into contact with the inner face of the frame
member 15, 16 which passes through the passageway. The engagement of the
edge 31 with one of the teeth 23 holds the frame member 17 in its adjusted
position. Of course, after the operation has been completed and the surgeon
wishes to close the wound, he simply exerts pressure on the member 17 and the
locking members to bring them into position shown as occupied by member 25
in Figure 5 and he can then simply slide the two members 14 and 17 together
again and remove the frame from the patient.
Returning again to Figure 3, it can be seen that two clamps 33 and
34 can be mounted on frame members 15 and 16 respectively to hold surgical
aids 35 and 36 by their handle portions with their body portions extending
into the surgical site to retain surgical matter, as required. Each of the
surgical aids has a metallic core in the form of intertwined wires 37 in the
handle and loops 38 in the body portion. The handle is of square cross-section
and the body portion is in the form of a substantially rectangular flat pad.
Referring now to Figure 4, a clamp is shown therein which is easily
manipulated by the surgeon and which can be easily adjusted along the frame
member to which the surgeon wishes to attach it. The clamp comprises a base
portion 39, a fixed jaw 40 extending upwardly from one end of the base portion
and a movable jaw 41 pivotally mounted at 42 on the base portion. The movable
jaw is moved between opened and closed positions by means of a lever ~3 which
is attached to one member 44 of a knee linkage 45 which is pivotally attached
at 46 to ~he top of the jaw 41 and is pivotally attached at its other end at
47 to the base 39. The pivot 48 between the two members 44 and 49 of the knee
linkage is moved over-center by actuation of the lever 43 either upwardly to
open the clamp, or downwardly to close the clamp. It will be appreciated,
therefore, that it is a simple matter for the surgeon to place the handle
of the surgical aid between the jaws of the clamp when they are in open
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position and then simply depress the lever 43 with his thumb to secure the
surgical aid in proper position. The clamp can be mounted on a frame member
at any desired location by means of securing mechanism 50 which operates on
a principle similar to that used in the clamp so that again it is a simple
matter of the surgeon depressing lever 51 to secure the clamp in its desired
position on the frame. The fixed jaw 52 of the securing mechanism may have
a padded surface facing the frame member so as to adjust to different thick-
nesses of frame member and to give a secure grip thereon.
Figure 6 shows an actual surgical site with the frame 13 in position,
the hooks 19 and 20 engaging the musculature 53 around the edge of the site,
one surgical aid 54 holding the bladder 55 open, it having been incised at
56, and another surgical aid 57 holding back the intestine 58 with the verte-
brae 59 below it. It will be seen that each of the surgical aids is specially
adapted to its own function.
Figure 7 shows an embodiment of the surgical aid of the invention
wherein the metallic core is in the form of a solid piece of metal 60, a
` coil 61 of metal extending upwardly within the handle and a plurality of wires
,~ 62 radiating outwardly from the solid piece 60 into the body portion of the
surgical aid. The wires 62 may be tapered as they extend away from the solid
piece 60 so as to impart increased malleability ~o the body of the aid.
Figures 8 and 9 show another embodiment of the surgical aid wherein
the body 1 has flaps 63 at the lower edge thereof, further flaps 64 at the
upper edge thereof and transversely extending tabs 65 at each side edge thereof.
The flaps 63 and 64 are provided with grooves 66 so that they may be more
readily bent in the direction indicated by the arrow than in the opposite
direction. The flaps allow for adjustment to various surgical spaces and to
retain tissue. The tabs 65 perform the same function. The flaps and tabs
are free of metallic core and thus have a cushioning effect upon the tissues
with which they come in contact.
Figures 10 to 19 show various other embodiments of the surgical aid
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of the present invention, each of which is adapted for a special function.
Thus, Figure lO illustrates a surgical aid specially adapted for retaining
intestine in gall bladder surgery. Figure 11 shows an aid specially adapted
for use in brain surgery and has one side heavily cushioned with a soft elas-
tomer. Figure 12 shows an aid adapted to retain the lung in thoracic aorta
surgery. Its handle has increased strength to resist the pressure of the
lung. Figure 13 shows an aid adapted to retain the liver and the projecting
edge on the top of the body portion engages the lobe o the liver. Figure 14
shows an aid specially adapted for muscle retraction. Figure 15 shows a long-
handled oesophagus retainer for use in abdominal approaches. It is adaptedfor entering the abdominal cavity, coursing along the diaphragm and then curl-
ing around the oesDphagus. Figure 16 shows a surgical aid which is adapted
to retain a closed bladder whereas Figure 17 shows an aid adapted for retain-
ing open an incised bladder, as in Figure 6. Figure 18 shows a surgical aid
adapted for holding the base of the lung away from the diaphragm, in hiatus
hernia surgery, and Figure 19 shcws an aid specially adapted to hold the heart
during such surgery.
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- It will be apparent that surgical aids according to the invention
can be used for all body cavity surgery, for example, heart, chest, brain or
abdominal surgery. The invention, of course, can also be used in veterinary
surgery and dentistry. Rather than have the operating surgeon displace
material to a desired position and then have an assistant hold it there,
moving the material on command, the surgical aids of the present invention,
in combination with the described frame, allow the surgeon to arrange the
surgical site exactly to his own liking and to adjust from time to time as
the need arises. Moreover, because of the low profile and minimum spaco
occupied by the frame and aids, there is much more manoeuvrability afforded
the surgeon even outside the actual surgical site. The surgical aids of the
invention can be manipulated to follow closely the contours of the material
displaced and protect such material from air, loss of moisture, or heat, or
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damage from surgical tools. Moreover, they are ideal for use in, for example,
brain surgery where electrically conductive materials might acutely inflame
the displaced material.
Rigid, inflexible instruments may, by inadvertent action of a hold-
ing assistant, cause rupture to organs such as the liver and the spleen
whereas the aids of the present invention will gently yield to avoid such
rupture. Moreover, heart and intestinal cells constantly in motion may be
damaged with materials that have a high frictional or abrasive surface. This
will not occur with the low friction surface of the present aids.
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