US 1157202 A
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Description (OCR text may contain errors)
U. C. BA'TES &1. MCLELAND.
APPLICATION FILED ocT. 14. 1913.
1,157,202. Patented 0ct.`19, 1915.
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' i TocZZ whom *it may concerti.'
rn srarns *l URI'C. BATES AND JERGME IVICLELAND, 0F SEATTLE, WASHINGTON.
i'Be it known that we, URI GQ Barnsv and JEROME McLnLA-ND, citizens of` the United States, residing at Seattle, in thecountyof yKing and- State ofy Washington, have invented certain new and useful'lniprovements in Surgical Apparatus, of which thevfollowging is a specification.
Thisinvention relates to surgical apparatus'and particularly to devices for retracting the sides 0f anincision inthe abdominal walls to enable the surgeonlto work upon the deeper tissues.
One'of the objects of ythe invention is the lprovision ofv novelzretractile means whereby the'opera'tor may adjustably'retain the sides ofy an incision in suitably'openfcondition.
Another object ofthe invention is thev pro-V vision Vof rvertically adjustable elementsk associated with said retractile means whereby, whenv retracted and first .engaged,'the abdominal walls may be raised to assist the ,insertion of packing gauze to keep the operating field clear of intestines. f A still further objectof the invention is the provision ofy an elastic lining for the opening made by thev operatorwhereby the edges of the incision are protected rfrom infection and a heinostatic effect produced whichA avoids a large element of danger `due from hemorrhage. i
The'invention consists in the novel con- A struction ofthe mechanical retractor devices and their. combination, together 'with the adaptation therewithof said elastic lining, which will'be fullvv described in' the following specification, illustrated in the accompanying drawings, an d finally :set forth in the appended claims.
In said drawings, view of apparatus embodying our invention. Fig, 2 is a longitudinal vertical sectional view of thesame. `Fig. Sisa curved sectional view through-'S-S of'Fi'g. 1.1 Figa is a detail detached perspective view of one,
of the retractile elements. Fig'. 5 is at simi.-
lar` view ofa vertical slide attached to each said retractile feleinent, slightly modified from the form shown in Fig; 2.k Fig.- G isa perspective View. of an elastic lining for the instrument, shown in'end section. f Referring to said views7 the referenceniinieral Ldesignates a frameof any` suitable configuration, but preferably formed as shown, as an oval or an ellipse,.comprise`dof a c'ontinuousplane metal strip', flat yin cross.L
Figure v1 iva-top plan-v Speccaton of Letters Patent. f Patntgd 061;, 19, 1915;`
l'Application filed Octobe` 14, 1913.. Serial No. 795,078.
section. The opposite'inner and outer edgesof the frame have apertured up-turned integral lugs Qarranged in pairs to afford supv l, bar 3 engages the upper side of saidframestrip, and isy formed with a plurality of ratchet-notches i 5. formed with an arcuate slot 6 subjacent said retained` bar and spaced from-said slot at one end is an aperture 7.l A bent spring 8 Said kframe-strip is is secured at one end in said aperturean'd is extended symmetrically with said frame into said slot pressing resiliently upward upon said bar 8 and thence extends by an upward bend 9 above the frame and beyond" said slot. A tooth 10 extends from the upper face of said spring and engages with vsaid ratchet notches 5 ofthe bar and secures the retractorrin predetermined retractedposi-V tion. To advance the retractors, the end9 of the spring 8 is depressed to disengage the tooth 10 from said notches. rlhe inner end of said retractors comprises a shield 11 arv ranged at right angles to said bars and hav-P f ing a curvature substantially corresponding to that ofthe adjacent portion of the frame.l
As indicated in Fig. 1 the shields 111 ,of said retractors in alinement with the major axis of the frame maybe of less width than those laterally adjacent.V The lateral vertical edges cf each said shield are formed to provide guideways 12 for the slidable reception of an extension-plate V13.
with engaging devices upon said extension.
Referring to Fig. 2, said extension is seen to Said shieldl isgfurther provided with ratchet notches la on its inner concave face adaptedto ycoactv guideways 12 and a horizontally extending integral ledgeY or foot 16 along its bottom edge. Said plate 13is vertically vslotted to afforda spring-tongue 17'v formed with a tooth 15 adapted to engage in said notches 11i and retaining the extension in adjusted vertical positions. In Fig. 5 is shown a` modied form of said extension plate.
A lining 18 of elastic material, preferably rubber-,is provided to complete the appara'- y 'in F ig.. 6, to obtain greaterelasticity, and
tus comprising a diaphragm 19 of similar' superficial configuration as lsaid frame and of somewhat larger dimensions in thehorizontal plane. An elongated opening-2Q is p formed in its middle portion with-its lengthV in alinement with the major axis of vthe frame. ,The material of said lining iseXtended downwardly integrally .froml the diaphragm to form an elongated-tubular neck 21, Awhich may be verticallyribbed, as shown terminates at its v.bottoni edge lin an out-v wardlyrdirected fold 22l furnishing: a con-v tinuous internally opening crease 23Q'for the rreception of. the respective extension-feet 16."
A'fcircular hole 24risfformed near the outer extremity of each said bar 3 to aiord a seat for a pin 25 upon one end ofa springfmetal bow-clip 26 which straddles each'said bari extremity. Said'clip is further' vprovided with a projection 27 upon its opposite .end
l adapted to protrude within, the underside of.
said hole andyieldingly pinch the peiiph lso ' tions of'said retractors therein while the lateraledge of the diaphragm 19-and securethe .same in plane ycondition by slight tension.
vThe apparatus is assembled by engaging the retractors with the frame, vas described,V and adjusting the lining l8therewith so that the diaphragm 19 will underlie theframe strip and said bars 3 of the retractors whiletlie shields 11 are extended Vdo W-nwardly within the tubular neck 21l and the foot 16 of.l each extension-plate thereof is entered said crease 23, as clearly-V shownin Fig.2.
VUpon making anincision `in the abdominal wall of a patient, the surgeon introduces the neck 21 andthe contained dependent p'orter are in their advanced positionsand the jneck under slight,- if any, tension. vThe inajor aXis of said frame will be, of course, 1n
alinement with the length of thelincision.v The extension plates 13 may thenbe de' pressed to `extend below the abdominal wall' Y wherebythe severallayers of saidrwall, in-
cluding skin, fascia,muscle and peritoneuin, Vare included between the rubber-incased foot V16,'and thelining diaphragm. Theseve'ral retractors are then slidably movedv inl outvward directions against thepressure of thef elastic lining, stretching the edges of the incision to any suitable degree to Vobtain the necessary openingfor convenient work withy in the abdominal cavity.l Before the `operatorfproceeds with his work it inaygbedesir.- able to closelyengage the lower extending fold 22 of the neck 21 with theunder portion oftheperitoneal surface Vofthe'abdominalcavity tofully isolate the yinarg'fins of the woundv from any source of infection.,v This is accomplished'by the operator extending" his lingers beneath the respective feet 16 and pressing the plate 13 upwardwhere itis Vretained by the laterally eXtendingratchet-devices, thus closely-associating the portion of the tubular neck 21 with the peritoneuinand allowing space for the insertionof packing .gauzer to insure a-clear operating iield. Y
Of `the advantagesrresulting from the use of; our apparatus, we particularly Vindicate its'functions as an abdominal incision lor wounderetractor wherein the'incision'is distended to enable the surgeon to workv upon the-deeper tissues.1 Again, as a 'wound proA tector the elastic lining: is employdto `C O'Yel" the edges of the lincision yincluding-thevarious layers. (5f-which the abdominal wall is' composedkrfromV contact'with infective mat ter from without o'r within, thus keeping the f wound aseptic;"and lastly l as 'a-lhemostatic,
-s where, byfmeans ofpressure on' the sidesofthe Vincision exerted through the Vrubber orV l other material by the retrarztors, the VVhemorrhage :is controlled, thus, saving thetinie'of 4 V,and the leaking oftheblood into Ythe abdoIni-; Y Y y nal cavitv where itfinay dodamage tolthe the surgeon andpreventingtheloss of blood patientsv Y *Y f.
" lThat weclaini-as our invention, is;` L
. :i i" 1. In apparatus; `ofi the 'classJ'described,,Y a frame havinganinterior space, an elastic lining adapted tounderlie` said frame ^and formed with anl opening arranged syinmetri#V cally relative to said ,frame-space," and means slidably connected v to said frame and ex-V Ytending through said opening whereby the Y said opening., may be adjustablydistended. 1 2. In apparatus ofthe class described,"a frame having an unobstructed interiorsp ace, 7
f an elasticlining adapted. to underlie said n frame comprised Vof adiaphragmhaving a centrally disposed yopening yhaving a tubular connection, and means slidablyconnected to 'said frame and extending into said tubular portionfwhereby the latter inaybe'distended. In apparatus of theclass described, a
.Tics Y framehavingan'unobstructedfinterior space, i an elastic liningadapted to' underlie said` frame comprisedfof 'a diaphragm having a- Q centrally disposed opening having tubulaiconnectioIn-a ffplurality'of retractors slid-Y ably connected toY 'the'l frame'-havingjftheir inner end extending within saidspace, each i f said endadapted to engagesaid tubular por- Y tion andadjustably `retain .the sanieV in distende'd condition.
4. InY apparatus of the class describ'ed,ran.
iisv 'Y annular frame provided ,withfradia'lly di-'f frame, saidlining adaptedto be engaged by Y said shield-to adjustablydistend said. openn apparatus of the class i annular frameprovided with i radially rected guide apertures, retractor devices eachv comprisinga bar slidably-receivable in said apertures-and formed with a downwardly directed shield on their-inner ends, springpressed-means securing said devices in adjusted positions, a lining adapted to be interposed between said frame and the patient justably distend said opening.
having an opening therein arranged symmetrically relativeto said frame, said lining adapted to be engaged by said shield toadv `.6. In apparatus of the class described, an annular frame provided'with radially directed guideways therein, retractors slidably mounted in said guideways and formed with downwardly directed shields on their inner ends, extension plates slidably connected to f said shields each provided with a laterally extending foot, an elastic'lining having a.
diaphragm underlyingsaid Yframe and formed with an opening in its central portion, anV integral tubular neck extending ydownwardly from saidy openingV and provided with means in its lower portion engageable with saidextension-foot. f
7. 'Inapparatusof the class described, an annular yframe vprovided with radially directed guideways therein, retractors slidably mounted in said guideways and formed with downwardly directed shields ontheir inner ends, extension plates slidably connected to said shields each provided with a laterally extending foot, means to secure said extension in adjusted vertical positions, an elastic lining having a diaphragm underlying said frame and formed with an opening in its central portion, an integral tubular neck extending downwardly from said opening and ing in its central portion, an integral tubularv neck extending downwardlyv from said opening and provided with means inV :itsy
lower portion engageable with said extension-foot.
9. In apparatus of the class described, an
'Copies of this patent Ymay be obtained for annular frame provided with radially dilrectedguideways therein, retractors vslidably mounted in said guideways and formed with downwardly directed shields on their inner ends, extension-plates slidably connected to said'shields each provided with a laterally extendedfoot, means to secure said extension in adjusted vertical position,`means for retaining said retractors in adjusted retracted positions, an elastic lining having a diaphragm underlying vsaid frame and formed with an opening in its central portion, an integral tubular neck extending downwardly from said opening and provided with means in its lower portion engageable with said extension-foot.
10. In apparatus of the class described, an
lelliptical frame provided with radially directed guideways therein, retractors slidably mounted in said guideways and formed with downwardly directed shields on their inner ends, extension-plates slidably connected to said shields each provided with a laterally extending foot, an elastic lining having a formed with an elongated opening in the majorv axis of said frame, an integral tubularneck extending downwardly from said opening and provided with means in its Vlower portion engageable with said extension-foot. n
11. In apparatus of the class described, an elliptical frame provided with radially directed guideways therein, retractors slidably mounted in said guideways and formed with downwardly directed shields on their inner ends, extension-plates slidably connected to said shields each Vprovided with a laterally extending foot, means to secure said extension in adjusted vertical positions, means for retaining said retractors in adjusted retracted positions, an elasticlining having a diaphragm underlying said :trame and vformed with an elongated opening in the major axis of said frame, an integral-tubular neck extending downwardly lfrom said opening and provided with means in' its ylower portion engageable with said extension-foot.
Signed at Seattle, `Wash.,..this 9th day of October, 1913.
URI C. BATES. JEROME MCLELAND.
Witnesses E. PETERSON, HORACE BARNES.
five cents each, by `faddressing the Commissioner of Patents, Washington, D. C.
'diaphragm underlying said :trame and