US 2807259 A
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Description (OCR text may contain errors)
Sept. 24, 1957 F. D. c. GUERRIERO VAGINAL SPECULUM AND' SURGICAL RETRACTOR Filed Feb. 24, 1955 IJVVEIVTOR: e-fie a ez z'a'o 3; aguern'era dztanzeys United States Patent O VAGINAL SPECULUM AND SURGECAL RETRACTOR Federico D. C. Guerriero, Chicago, Ill. Application February 24, 1955, Serial No. 490,263 7 Claims. (Cl. 128-20) This invention relates to gynecological, obstetrical and surgical instruments and more particularly to improvements in such devices whereby there is afforded a highly articulated instrument which may be used as an abdominal retractor as well as a vaginal speculum.
The construction and use of conventional instruments of the type which comprises the subject matter of this invention, are well known. Vaginal specul-ae are used as gynecological examining instruments, and surgical retractors are used in surgery. In abdominal surgery such instruments are necessary in order to expose the patients internal abdominal region to facilitate the operation by the surgeon. This is effected by the use of the surgical retractor to spread and hold apart the protective skin and muscles of the patient during the course of the operation.
A large variety of instruments have heretofore been employed for the purposes set forth hereinabove, some of them special purpose instruments and others allegedly having general applications in abdominal surgery and the like. However, all of these instruments have been characterized by a plurality of objectional features. Most important of such objectional features was the fact that when the instrument was placed in operational position a portion of the same invariably blocked the entrance to the incision or organ opening in such a manner that the surgeon or gynecologist experienced considerable difliculty in performing the operation or examination.
It is therefore a principal object of this invention to provide a gynecological and surgical instrument which will overcome the disadvantage mentioned hereinabove.
Another important object of the invention is to afford an instrument of the character described in which the parts are so constructed and assembled that the supporting framework may be pivoted and moved away from the entrance to the incision or organ thereby affording complete freedom of action and unobstructed visibility to the surgeon or diagnostician.
Other disadvantages of the numerous types of retractors which have heretofore been proposed include the awkwardness of manipulation of the instrument and the inflexibility of the instrument in adapting it to accommodate the various surgical conditions which are sometimes unexpectedly encountered.
lt istherefore another important object of this invention to provide a combination vaginal speculum and surgicalretractor which will overcomethe disadvantages mentioned hereinabove.
A further object is to afford an instrument of the character described which is highly flexible and readily adapted to being quickly adjusted to meet the various conditions encountered during surgery and the like.
It is often necessary to widen or spread apart the bottom of the wound while at the same time exerting the least possible strain on the skin and flesh of the upper part of the wound. To do this it is necessary to afford an instrument in which the retractor elements are so constructed and assembled that they may be pivoted and r 2,807,259 Patented Sept. 24, 1957 2 moved to an oblique outwardly and downwardly diverging position thereby spreading the bottom portion of the incision without spreading the top portion thereof.
It is therefore still another important object of this invention to provide an instrument in which the retractor elements of the blade are pivotally mounted for accomplishingthe functions mentioned hereinabove.
Still a further object of this invention is to provide a retractor which enables the incision 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.
Yet another object of 'the invention is to alford an instrument of the character described having retracting elements which may be extended as the need may arise during the surgery.
Yet a further object is to provide an abdominal retractor which is self-retaining, thereby preventing accidental collapse of the instrument and wound once it has been spread apart by the instrument.
Another object of the invention is to provide an embodiment of the device affording means for supporting a flexible blade of the type sometimes used by surgeons.
Heretofore another disadvantage of many conventional retractors was the necessity for providing the same with an excessive number of disconnectable parts in order to accomplish various functions of the device. These parts are apt to become loosened or disconnected during the operation, sometimes resulting in serious consequences and usually interfering with the work of the surgeon.
It is therefore still another important object of the in- .vention to provide a highly adaptable and flexible instrument in which none of the parts are disconnectable but are nevertheless so constructed and arranged that they need not be placed in operational position unless so desired.
Finally another object of the invention is to provide a sturdy, effective instrument composed of a minimum number of parts, simply constructed and adapted for ready cleansing and ease of care.
With the foregoing and other objects in view which will appear as the description proceeds, the invention consists of certain novel features of construction, arrangement and a combination of parts hereinafter fully described, illustrated in the accompanying drawings, and particularly pointed out in the appended claims, it being understood that various changes in the form, proportion, size and minor details of the structure may be made without departing from the spirit or sacrificing any of the advantages of the invention.
For the purpose of facilitating an understanding of my invention, I have illustrated in the accompanying drawings preferred embodiments thereof, from an inspection of which, when considered in connection with the following description, my invention, its mode of construction, assembly and operation, and many of its advantages should be readily understood and appreciated.
Referring to the drawings in which the same characters of reference are employed to indicate corresponding or similar parts throughout the several figures of the drawlugs:
Fig. l is a front elevational view of an instrument embodying the principles of my invention showing the retractor elements in several positions in solid and dotted outline;
Fig. 2 is a fragmentary side elevational view again showing the retractor elements in several positions in solid and in dotted outline;
Fig. 3 is an enlarged exploded front elevational view of the retractor blade or element with the same rotated through an arc of in respect to the blade position illustrated in Fig. 2 of the drawings;
Fig. 4 is a sectional view of the retracfor'ele'm'ent taken on the plane of line 4-4 in Fig. 3 of the drawings and viewed in the direction indicated;
Fig. 5 is a fragmentary exploded view showing the construction and assembly of the retracto'r'elements ito'the frameworkofthe instrument; and
Fig. 6 isv a'sectional view showing in elevation a modified form-of the instrument.
Referring first to Fig. '1 of the drawings, reference numeral 10 indicates generally a vaginal speoiilu'm and'surgical retractor for use in gynecological examination and abdominal surgery. Instrument 10 comprises a pair of arms 12 and 14 each having a central arcu'ate portion 16 and 18 with the outer end portions 20 and 22 disposed in a plane aligned with the straight'opposite end portions 24 and 26. The arm portion 26 is permanently mounted on the end of a bar 28 which may be of substantially square cross-section and the other arm end 24 may be afiixed to a hollow tubular member 30 of complementary cross-section which is slidably mounted on the bar 28 so that the arm 12 may be moved with respec't to the arm 14. A flat knurled disc such as 32 may bea-ffixed to the outer end of the bar 28 to facilitate handling of the instrument. It should be noted that the tube 30 may be provided with means or so constructed that the same is self-retaining, i. e. it is 'frict'ionally retained in the position to which it is 'moved along the bar 28 without requiring any auxiliary tightening or fastening ineans.
In Fig. 2 of the drawings it will be noted that the ends 20 and 22 of the arms 12 and 14 are thickened and an opening 32 is provided therethrough. Withinthis open ing may be positioned, in rotatable relationship, a reduced diameter portion 34 of a shaft 36; the reduced diameter portion 34 being bent at right angles to the major axis of the shaft 36. It may be retained within the opening 32 byrneans ofa threaded bolt such as 38.
Adjacent the bent end 354 a cup-shaped collar suchas 40 is provided having positioned therein a ratchet-toothed ring such as 42. The shaft 36 protrudes through a hollow tubular sleeve 44 which in turn may be affixed to the bottom portion of a retractor arm 46 'as' b'y the bracket 48 and bolts 50. The retractor arm 46 will be described in greater detail as the description proceeds.
The end of the sleeve 44 adjacent the cup-shaped collar 40 is formed with a flange 52, the outer edge of which is serrated to afford ratchet teeth '54 as shown in Fig. 5 of the drawings. The ratchet teeth '54 are adapted to cooperate with the ratchet teeth 42 for a purpose which will be disclosed as the description proceeds.
In Fig. 5 of the drawings it will be noted that the sleeve 44 is formed with an internally positioned shoulder 56 spaced from the end of the sleeve'. The shaft '36 is centrally apertured and the walls screw-threaded at the outer end portion thereof as at 58. Surrounding the outer end 60 of the shaft 36 and abutting the shoulder 56 may be a coil-spring 62 which is retained in position by means of a bolt such as 64 threaded into the threaded end 58 of the shaft 36. When so assembled it will be noted that the spring urges the ratchet flange 52 against the cooperating ratchet ring 42 of the collar 40. This controls the pivotal movement of the retractor elements 46 which will now be described in greater detail.
In Fig. 4 of the drawings it will be noted that the retractor element 46 comprises an elongated hollow arcuately curved blade element 66 having an elongated slot '68 formed in the inner wall thereof. The inner wall is extended and flanged outwardly around the sleeve 44 to afford the flange 70. A complementary arcuately-shaped blade 72 is positioned within the retractor element 66 in loose-fitting relationship and is provided with a pin 74 adapted to protrude through the slot 68 in loose-fitting relationship. Thus the blade 72 may be slid in and out of the retractor element 66 thereby extending the length thereof. The movement is limited by the pin 74 abutting the opposing ends of the slot 68, It will further be noted that'th'e outer end ofthe blade 72 is arena-61 bent outwardly as at 76 as shown in Fig. l of the drawings.
It will thus be noted from the several Figures of the drawings that the retractor elements 46-66 are pivoted to rotate about the axis of the shaft 36 so that when they are inserted within the incision, the bottom of the wound may be spread apart while the top portion adjacent the sleeves 44 remain in their same position. It will also be noted that the blades are further rotatable in another plane on the axis of the shaft segment 34 whichis positioned at right angles to the axis'of rotation of the blade as shown in Fig. l of the drawings. Rotation about this axis permits the entire framework, including the arms 12, 14 and bar 28, to be pivoted out and away from the mouth of the incision or opening of the organ within which may be positioned the retractor blades 66. This of course effectively moves these elements aside so that they no longer obstruct the part of the body upon which the surgeon or gynecologist 'is concentrating his efforts.
In Fig. 6 of the drawings there is illustrated a modified form of the invention representing another embodiment. In this embodiment similar parts are designated by like numerals with the added suflix a.
During surgery it is often necessary for the surgeon to insert a thin, flexible blade into the incisionfor the purpose of cutting within the wound itself. For this pur-' pose it is necessary to provide some means for steadying or supporting the blade without disturbing the position of the retractor and the work which is taking place within the incision. For this purpose the modified form of the retraetor blade illustrated in Fig. '6, is provided. It will be noted that in this case the flange 70a of the retractor element 66a is reversed so that it protrudes inwardly rather than outwardly as in the previous embodiment. The retr'actor extension 72 is removed so that the vacated space 80 thereby provided in the retractor element 66a may be utilized for inserting therethrough a flexible blade such as 82. Obviously the walls of the hollow pr'otractor blade element 66a provide the necessary support For the blade 82, which may thus be inser'ted therein and used as desired by the surgeon. It, of course, can be removed at will and at the same time does not interfere with the primary function of the retractor elements 66a.
It will thus be perceived -from the above description and drawings that I have provided a highly flexible and adaptable medical instrument which may be used either as'a gynecological vaginal speculum or as a surgical retractor'. The retrac'tor blades may be positioned in any of a number of positions in several planes since the same are rotatable about two axes perpendicular to each other. Thus the device is much more adaptable than any of the instruments heretofore known and moreover permits ready access to the incision or organ while oflering minimum interference with the work of the surgeon or gynecologist. This is especially true since the entire framework may be moved out of the position which it would ordinarily occupy but which interferes with both the vision and the work of the surgeon,
It will further be noted that I have provided a novel and ingenious means forsupporting and for admitting into the incision itself instruments, such as flexible blades which are often used by surgeons. I have further increased the utility of the instrument by providing novel means for adjusting the length of the retractorlblades so that they may either be extended to permit deep retraction or may be left in their unextended positionwithout necessitating their removal from the instrument itself.
I have further provided novel ratchet means controlling the pivotal movement of the r'etractor blades. If desired this movement may be limited to one direction, by inclining 'theratchette'eth. However, it should be-readily appreciated that other means may be substituted for the ratchet construction, such as for example a toothed device hand-tightened by clamp means, or other appropriate and conventional means. It should also be readily apparent that the structure of the retractor blades themselves may also be varied if desired, the only limitation being that such blades should be mounted so that they are rotatable in the various planes as revealed by the hereinabove description and drawings.
It is believed that my invention, its mode of construc tion and assembly, and many of its advantages should be readily understood from the foregoing without further description, and it should also be manifest that While preferred embodiments of the invention have been shown and described for illustrative purposes, the structural details are nevertheless capable of wide variation within the purview of my invention as defined in the appended claims.
What I claim and desire to secure by Letters Patent of the United States is:
1. In an instrument of the character described comprising a pair of arms mounted in lateral spaced relationship one with the other on a crossbar, one of said arms afiixed to a slideable mounting member, a pair of shafts each having an end rotatably mounted one in the free end of each of said arms, a retractor blade having a sleeve laterally attached near one end thereof, said shaft rotatably journalled through said sleeve, and means attached to said shaft for controlling the rotation of said sleeve and shaft with respect to each other.
2. The instrument of claim 1 in which means for con trolling the pivotal rotation of said retractor-arms about the axes of said shafts is attached thereto, said means comprising a pair of ratchet discs spring-urged into cooperating relationship.
3. A combination vaginal speculum and surgical retractor comprising a cross-bar, an arm fixedly mounted on one end of said cross-bar and extending in a plane substantially at right angles to the plane of said crossbar, a ferrule slidingly positioned on said cnoss-bar, an arm afixed to said ferrule and extending in a plane parallel to said first-mentioned arm, the free ends of each of said arms formed with an opening therethrough, a pair of shafts each having one end thereof bent at rightangles to the major axis of the shaft, each of said ends rotatably mounted one in each of said openings, a pair of elongated transversely-arcuate hollow retractor blades each having a sleeve laterally attached near one end thereof, each of said blades formed with an elongated closed-end central slot, each of said shafts rotatably mounted one Within each of said sleeves, means attached to the shaft for controlling the rotation of said shaft within said sleeve, and extension retractor blades slideably mounted in said retractor arms, each of said blades formed with a pin adapted to loosely fit within said central slot.
4. A combination vaginal speculum and surgical retractor comprising a pair of arms mounted in lateral spaced relationship one with the other on a cross bar, one of said arms afiixed to a slideable mounting member, a pair of shafts each having an end rotatably mounted one in the free end of each of said arms, each of said shafts integrally formed on the end of a larger-diameter shaft the axis of said larger-diameter shaft disposed at right angles to the axis of said first-mentioned shaft, a pair of retractor arms each having a sleeve laterally positioned and permanently afiixed near one end thereof, each of said larger-diameter shafts rotatably journalled one through each of said sleeves, and means attached to said shafts for controlling the rotation of said sleeves about the shafts.
5. A combination vaginal speculum and surgical retractor comprising a cross-bar of square cross-section, an arm fixedly mounted on one end of said cross-bar and extending in a plane substantially at right angles to the plane of said cross-bar, a ferrule slidingly positioned on said cross-bar, an arm aflixed to said ferrule and extending in a plane parallel to said first-mentioned arm, both of said arms formed with thickened free-ends and intermediate outwardly-bowed segments, said free-ends each formed with an aligned opening therethrough, a pair of shafts each integrally formed with a reduced-diameter stub-shaft bent at right-angles to the major axis of said shaft, said stub-shafts each rotatably mounted in one of said aligned openings, a pair of elongated transverselyarcuate hollow retractor-arms each comprising an integrally formed inner wall, outer wall and two end walls, said inner wall having an outwardly flanged portion and an elongated closed-end central slot, a sleeve mounted in the apex of the inner wall and outwardly flanged portion, said shaft rotatably mounted within said sleeve, means attached to the shaft for controlling the rotation of said shaft within said sleeve, and extension retractor blades slidably mounted in said retractor arms, each of said blades formed with a pin adapted to loosely fit within said central slot.
6. The instrument of claim 1 in which retractor-arm extension blades are slidably mounted one in each of said retractor-arms.
7. The instrument of claim 1 in which each of said retractor-arms are provided with a knife-supporting passageway formed longitudinally therethrough.
References Cited in the file of this patent UNITED STATES PATENTS 1,157,202 Bates et al. Oct. 19, 1915 1,706,500 Smith Mar. 26, 1929 2,474,857 Newman July 5, 1949 2,670,731 Zoll et a1. Mar. 2, 1954 FOREIGN PATENTS 1,019,217 France Oct. 29, 1952