US 2693795 A
Description (OCR text may contain errors)
Nov. 9, 1954 Filed Sept. 9, 1950 H. R. GRIESHABER SURGICAL RETRACTOR E Sheets-Sheet l INVENTOR.
N0V- 9, 1954 H; R. GRIESHABER 2,693,795
SURGICAL RETRACTOR Filed Sept. 9, 1950 2 Sheets-Sheet 2 INVENTOR.
adjusted positions along the frame United States Patent O SURGICAL RETRACTOR Herman R. Grieshaber, Chicago, lll. Application September 9, 1950, Serial No. 184,064 Claims. (Cl. 128-20) This invention relates to surgical devices and more particularly to an instrument known as a retractor.
In abdominal surgery, for example, it is particularly important that there be good exposure of the patients abdominal region in order to facilitate the work of the surgeon. To effect this desired exposure a self-retaining surgical retractor is normally employed which engages and holds apart the protective skin and flesh of the patient during the course of the operation.
Various types of retractors have heretofore been proposed which are of such design as to be either awkward to manipulate, not readily alterable to accommodate various surgical conditions encountered, or comprise an excessive number of small disconnectible parts, which are apt to become loosened or disconnected during the operation and thereby seriously impede the work of the surgeon.
Thus it is one of the objects of this invention to provide a retractor which is of such design as to be easily handled and quickly adjusted by the surgeon or his assistant.
It is a further object of this invention to provide a retractor having a plurality of attachments which may be readily employed, thereby increasing the usefulness of the instrument.
It is a still further object of this invention to provide a retractor which has relatively few disconnectible parts thereby minimizing the danger of these parts becoming disconnected or loosened during the course of the operation.
It is a still further object of this invention'to provide a retractor which enables the wound to be readily widened, when desired, in order to compensate for muscular relaxation of the patient or for further exploration by the surgeon during the course of the operation.
It is a still further object of this invention to provide a retractor which prevents accidental collapse of the7 wound once it has been spread apart by the instrument.
It is a still further object of this invention to provide a retractor which may be readily disassembled, when desired, for cleaning.
Further and additional objects will appear from the description, accompanying drawings and appended claims.
In accordance with one embodiment of this invention, a retractor is provided comprising an elongated frame member, a laterally extending spreader arm rigidly mounted on said frame member, and a second laterally extending spreader arm slidably mounted on said frame member for movement towards or away from said first mentioned arm. Detachably mounted on the correspond ing end of each element. and in cooperation with the tomatically locking the second of the second spreader arm towards the rst mentioned spreader arm. Adjustably mounted on the frame member and intermediate the aforementioned spreader arms is a third laterally ex; tending spreader arm which is adapted to move longitudinally and laterally of the frame member. Detachably mounted on the end of the third spreader arm, which end is adjacent the other arms, is likewise a iiesh engaging element.
For a more complete understanding of this invention reference should be made to the drawings, wherein Fig. 1 is a perspective view of the retractor showing portion is shaped so one of the flesh engaging elements detached from one of the spreader arms;
Fig. 2 is a fragmentary sectional view of the third spreader arm taken along line 2 2 of Fig. l;
Fig. 3 is a fragmentary sectional view of the carrier for the third spreader arm taken along line 3-3 of Fig. l;
Fig. 4 is similar to Fig. 3 but shows a modified form of carrier;
Fig. 5 is a fragmentary top plan view of the slidably mounted spreader arm;
Fig. 6 is a fragmentary view of the slidably mounted spreader arm taken along lines 6 6 of Fig. 5;
Fig. 7 is a 'fragmentary top plan view of the flesh engaging element for the third spreader arm;
Fig. 8 is a fragmentary sectional view of the iiesh engaging element for the third spreader arm taken along lines 8-8 of Fig. 7; and
Fig. 9 is a fragmentary bottom view of the esh engaging element shown in Fig. 7.
Referring now to the drawings and more particularly to Fig. l, a retractor is shown for use in abdominal surgery and the like. The various parts of the retractor to be hereinafter enumerated are made of sturdy, durable, non-corrosive material such as stainless steel. The basic parts of the retractor are a frame 10, a laterally extending spreader arm 11 rigidly mounted thereon, a second laterally extending spreader arm 12 slidably mounted on the frame, `and a third laterally extending spreader arm 13 adjustably mounted on the frame intermediate arms 11 and 12.
The frame 10, as seen more clearly in Fig. l, comprises a pair of elongated rods 10a and 10b arranged in a parallel, spaced relationship. The rods serve as guides for spreader arms 12 and 13. A portion 14 of the periphery of rod 10a, adjacent rod 10b, is serrated. These seri-ations 14 cooperate with a locking mechanism 15 which is mounted on spreader arm 12 and will be described more fully hereinafter. Threadably mounted on the end of rod 10a is a stop 16, which prevents spreader arm l12 becoming disengaged from the frame 10. The rods 10a and 10b are held in their proper spaced relationship by arm 11 which is mounted by welding or any other suitable means to the end of the rods.
Spreader arm 12, as heretofore mentioned, s slidably mounted on frame 10 and is adapted to move toward or away from arm 11. One end of arm 12 is provided with a pair of sleeves 17 and 18, which embrace rods 10a and 10b, respectively; see Fig. 5. A slot 20 is formed in the portion 21 of arm 12 which is intermediate rods 10a and 10b and in a portion of sleeve 17. Disposed within slot 20 is the locking mechanism 15 hereinabove mentioned. l
The mechanism comprises a spring-actuated pawl 22 having a pointed tip 23 formed thereon which is adapted to automatically seat in any one of the serrations 14' formed on rods 10a. The pawl 22 is normally held in locking engagement with rod 10a by means of a leaf spring 24. O ne end of the spring is secured to the pawll and the other end thereof engages portion 21 of the arm' l2. The spring causes the pawl 22 to normally pivot counterclockwise about pin 25. A portion 26 of the pawl is exposed and may be depressed by the surgeon to effect unlocking of arm 12. The serrations, as shown more clearly in Fig. 5, are shaped so as to prevent movement of arm 12 towards arm 11, except when pawl 22 is depressed. However, the serrations allow the arm 12 to move away from arm 11 without depressing the pawl. Thus the surgeon may readily effect spreading apart of the wound by pushing outwardly at any point on arm 12.
rThe construction of the remainder of arm 12 is similar to arm 11 and therefore only arm 12 will be described in detail. Extending laterally from frame 10 is the shank portion 27 of the arm. The shank portion 27 is bent outwardly slightly so as to effect greater exposure of the wound. The free end 28 of the shank as to be substantially square in crosssection. Formed in the surface of end 28, which surface is away from arm 11, is a groove 30 which cooperates with a iesh-engaging element 31.
The flesh-engaging element 31 comprises a sleeve por'- a securing device 33 mounted on the' sleeve;
and a blade portion 34 extending inwardly towards the other arm and downwardly from -the-sleeve. The `sleeve portion 32 snugly embraces the shaped end 28 of the arm. Thus once the element 31 has been positioned on end 28 it cannot turn thereabout.
The securing device 33, as seen in Fig. 5, .comprises a-leaf spring 35, which is rivetedat point 36`to-the sleeve. Secured to the ,free yend-of spring 35 ris a detent37 which has the nose portion 38 thereof lprojecting through an opening 40 formed in the sleeve. The Vtip .of "the nose portion V-is adapted to normally rest in a recess ,or groove 30 thereby preventing the element from slipping -endwise `olf the ann once it has been properly positioned thereon. To remove the element from the iend 28, vthe detent is merely `pulled outwardly :by .the ,fingers of surgeon until it is `clear of the groove and then .the element is Aslipped off :the end 28 of the arm. -It is to be noted that the securing device V33 is of unitary construction. This feature is important in that in prior instruments of this type, as above mentioned, the 'esh-engaging '.element was secured to the spreader arm by small detachable -securing devices, such as screws, which .frequently became detached during the course 4of vthe operation and occasionally found their way into the patients f wound.
Various types and sizes of esh-engaging Ielements, two of which are shown in Fig. l, may be 'used ldepending upon the type of surgery to be performed and the condition of the patient. vFor example, if the V,incision is deep, an element having a long blade lis employed. Where the patient has considerable fatty tissue surrounding the infected area, an element having va web-.like blade yis used of the type shown in Fig. l disconnected from lthe arm 12. A second type of flesh-engaging element 39 'is shown mounted on arm 11 and having a substantially U-shaped blade 41. 'Element 39 is used vvwhere there is only a -small amount of fatty tissue surrounding the wound. The blade 41 is constructed of a vsturdy yrodlike material. The -ends 42 and 43 of .the blade '41 are seated in -sockets `43 formed in the sleeve lportion 32"; see Fig. 5, and are welded thereto.
,1n an element having a web-like blade :as shown for arm 12 in Fig. l, thefdepending portion 44 of the blade 34 Ais inclined outwardly a vslight amount vand the lower end 45 thereof is further bent outwardly thus providing more effective means for retaining the fatty'tissue. The lower lend 45 is rounded and the side edges of -the blade are blunt thus Vpreventing any possibility of tearing or injuring the tissue by the blade.
By providing elements of varying size 'and shape the usefulness ofthe retractor is greatly improved.
The third spreader arm 13, comprises yan elongated handle 46'hav`ing a longitudinally extending slot 47 'formed therein. The outer end of the handle is provided with aziinger-engaging loop 48 and laterally extending Jwing portions 50,"which enable the surgeon to readily exert a pulling force on the arm 13 for enlarging the wound. The handle 46 is adjustably mounted on a carrier 51, which vin turn iismounted for longitudinal movement on the frame 10. A bolt 52 protrudes upwardly from ythe center portion 54 of the carrier 51 and extends :through the slot 47 formed in the'handle. A Wing nut '53 threadably engages the bolt 52. The upper end ofthe 'bolt 52 is peened over, as seen in Figs. 2-4, thus preventing disengagement of the wing nut -53 therefrom. Any danger, therefore, of the nut 53 becoming detached and finding its way into the patients wound has been averted. Cutouts 55 are provided in slot y47 through which the wing nut will pass when the ears 56 thereof are aligned longitudinally with the slot 47, and thus allow for disassembling of the spreader arm 13 from `the -carrier for cleaning purposes.
The carrier 51 comprises a pair of sleeves 57 and 58 which slidably embrace rods a and 10b, respectively. A portion 60 approximately the width of handle v-46 is cut out of the upper peripheral vsurface of each oi the sleeves 57 and 58, thus enabling the underside v62 of the handle 46 to engage the peripheryof the'rods 10a and 10b. Shoulders 59 formed by cutout portion 60 off the sleeves serve as guides for Athe handle and 'thus allow only movement of the 'arm 13 transverse o'f the rods 10a and 10b. After `the 'arm has 'been 'withdrawn the desired amount, the wing nut 53 is drawn up tight on bolt 52 thereby causing'handle 46 to assume a 'relatively fixed or locked position with respect 'to "the -rods 10a :and '10b land vthe 'carrier 5-1.
A modified form of carrier 61 is shown in Fig. 4
vwherein 4the -upper Aperipherial surfaces of sleeves '57 and 58' are trimmed so as to be disposed in a plane substantially tangential with respect to the rods 10a and 10b. In this form of carrier no guide shoulders are provided and the arm 13 is free to pivot about stud bolt 52 when the wing nut 53 is not drawn up tight.
To the inner end 63 of arm 13 is detachably secured a center retractor blade or flesh-engaging element 64. The blade 64 is constructed of sturdy non-corrosive, metallic material. The blade k64 is arcuate in form and extends downwardly from the end 63. The side portions 65 of the blade are 'ared a slight amount as shown in Figs. 1, 7 and 8. The lower end 66 of the blade 64 is rounded and blunt. Thus when the blade is withdrawn there is no tearing of the patients flesh by the lower end 66, or the ared side portions 65 of the blade 64.
A :locking mechanism 67 is .provided for vblade 64 ihaving a .cover :piece 68 which is secured by welding ior any other suitable means to one surface :of the .blade. A slot 70 -is formed in the top of the cover piece :68, see Fig. 7. The .cover `piece 68 is adapted to embrace the end 63 of the handle 46. The end 63 of the handle is provided with an opening 71, see Fig. S, which, -when the .blade is positioned thereon, is in registration with an opening 69 formed in the blade. A spring he'ld detent 72 .fis mounted on the upper surface 73 -of vthe handle adjacent .the end 63 thereof and .is adapted to be positioned within the slot 70 when -the kblade -and handle are assembled. Riveted at point '77 to the underside `62 of the handle, adjacent .the end 63 `thereof is 1a ,resilient tongue member '76. 'Formed on free end of ymember 76 Vis anub 75, which is adaptableto normally project into opening 71 formed in the handle `46. When the vblade and handle are assembled, the nub 75 likewise projects through the opening 69 -formed 'in the blade 'and prevents disengagement of the fblade and handle until the detent 72 is depressed. Upon :depression of detent 72, the nose portion 74 thereof projects through openings 71 and 69 and abuts nub 75 thereby causing the latter to be pushed out of Asaid openings. The tip of the nub is rounded, thus enabling the nub to `readily slip out of vopening 69 when the detent is depressedand .the blade is pulled endwiseoif the handle.
The outer vend78 of tongue member V76 is bent vdownwardly a yslight amount so as to facilitate the positioning of the blade onto end 63. A shoulder 79 is formed on the underside 62 of the end 63 ywhich lserves as a stop lfor lthe blade, see Fig. 8. `When the kend #63 abuts the sholuder 79, the openings 69 and71 are in lregistration ,and-,the nub 75 snaps in place y'into said openings.
--Various other types of `center blades, not shown, may be substituted for lthe one shown thereby increasing the usefulness .of the instrument.
Thus `it ,will be seen that a retractor `has been lprovided which is of lsimple design and is adapted to be easily handled and adjusted vto `its desired position b y the surgeon. Furthermore various parts of the 1instrument may be substituted by ,other parts of zvarying size and shape vdepending on the 'conditions encountered during 'the operation. The number of small detachable devices, 'such as screws, has been reduced ,to a minimum 'thereby averting the danger of these ,parts lbecoming loose or iinding their way into the Apatients wound during 'the operation.
While several embodiments'of the invention are shown above, it will be understood, of course, that .the invention is not to be limited thereto, -since Amany 'more modications -may be made and it is contemplated Atherefore by the appended claims lto cover any such pmodiiications as fall within the true spirit and scope of 'this invention.
l. A surgical retractor comprising a pair o'f parallel elongated rods, one of said rods lhaving a portion yof its periphery provided with ratchet teeth, Aa laterally eX- tending elongated arm rigidly mounted on said rods, a second -laterally extending elongated arm slidably ymounted on both of said rods 'for movement longitudinally thereof toward or away from said rigid arm, a springactuated pawl pivotally mounted on said second larm and engageable with said ratchet teeth lfor 'locking vsaid second farm in various positions of longitudinal 'adjustment-on said rods against movement toward said rigid arm, and a third laterally extending elongated arm mounted on said rods intermediate said other arms for movement laterally and longitudinally of said rods.
2. A surgical retractor comprising a pair of elongated spaced parallel rods, one of said rods having ratchet teeth formed on one side thereof, an elongated spreader arm rigidly mounted on both of said rods and extending laterally from the opposite side of said tooth rod, a second elongated spreader arm extending laterally in substantially the same direction as said rigid arm and being slidably and' detachably mounted on both of said rods and movable toward or away from said rst spreader arm, a pawl pivotally mounted on said second spreader arm and adapted to normally mesh with said ratchet teeth and lock said second arm against movement thereof toward said rigid arm, a carriage slidably mounted on both of said rods intermediate said rst and second spreader arm, a third elongated spreader arm adjustably mounted on said carriage and having one end of said third arm disposed intermediate said other arms, and releasable means mounted on said carriage and engaging said third arm for holding said carriage and third arm in a ixed position relative to said rods and said rigid arm.
3. A surgical retractor comprising a pair of elongated substantially linear members disposed in spaced substantially parallel relation, a first elongated arm mounted on both of said members and extending angularly therefrom, a second elongated angularly extending arm mounted on both of said members for movement toward and away from said rst arm, sleeves slidably mounted on said second arm and engaging both of said members for maintaining said second arm in a fixed angular position with respect to both of said members, and spring actuated means disposed intermediate said members and mounted on said second arm and engageable with one of said members for automatically locking said second arm against movement toward said first arm.
4. A surgical retractor as dened in claim 1 in which said arms have their distal ends connected to flesh-engaging elements each including a sleeve portion for embracing a distal arm end when said element is in assembled relation therewith, a blade extending laterally from said sleeve portion, and a spring-biased detent mounted on and affixed to said sleeve portion for independent movement with respect thereto into automatic snap-in engagement with an indentation formed adjacent said distal arm end upon relative endwise movement of said sleeve portion into assembled relation with respect to said distal arm end thereby effecting locking of the latter and said element in said assembled relation.
5. A surgical retractor as dened in claim 2 in which the flesh-engaging elements are removably mounted on the distal ends of the spreader arms; said elements each including an apertured elongated sleeve portion for snugly embracing a distal arm end when said element is in assembled relation therewith, a blade extending laterally from said sleeve portion, and a leaf-spring overlying said sleeve portion and being secured thereto at one end, the free end of said spring being provided with a protuberance projecting through an aperture formed in said sleeve portion and automatically assuming a snapin engagement with an indentation formed in the distal arm end upon relative endwise movement of said sleeve portion into assembled relation with respect to said distal arm end and effecting locking of the latter and said element in said assembled relation.
References Cited in the tile of this patent UNITED STATES PATENTS