US 3038468 A
Description (OCR text may contain errors)
June 12, 1962 R. R. RAEUCHLE 3,038,468
SURGICAL RETRACTOR Filed Nov. 15, 1960 2 Sheets-Sheet l INVENTOR Randal R. Roeuchle UMLMW ATTORNEYS FIG. 2. BY
June 12, 1962 R. R. RAEUCHLE 3,038,468
SURGICAL RETRACTOR Filed Nov. 15, 1960 2 Sheets-Sheet 2 I. 'lil llllmlllllll llllll llllllllllllllllllIlllllllllllllllll INVENTOR Randal R. Raeuchle BY CBMQLMW ATTORNEYS United States Patent 3,038,468 SURGICAL TRACTOR Randal R. Raeuchle, 203 Pine St, Harrisburg, Pa. Filed Nov. 15, 1960, Ser. No. 69,312 4 Claims. (Cl. 128-29) This invention relates to self-restraining, adjustable surgical retractors.
In surgical operations involving the opening of large areas of the body for a considerable period of time, such as in abdominal operations, such devices are used to assist in retracting the various organs and layers of skin, fat and muscles. It is obvious from the nature of its use that versatility and ease and quickness of adjustment are primary requisites of any such retractor device. Many such devices have been developed in the past, most of them consisting of a frame on which are mounted retractor blades, with the frame or the blades or both being adjustable. One of the more successful of these prior art devices, and one commonly in use in hospital operating rooms today, comprises an adjustable frame of four pivotally mounted arms with two permanently attached pivoted blades mounted at two opposite verticles and with means at the other two opposite. vertices for mounting detachable retractor blades. Means for positively maintaining the arms in adjusted position is located at the ratchet end only. Successful as it has been, this device has several shortcomings. During the course of an operation, with the retractor in place and holding open the sides of the incision and/or various internal organs as the case may be, it frequently becomes necessary to change the extent of the incision opening by adjusting the retractor. If this requires, as it often does, an adjustment of the configuration of the frame, as soon as the ratchet tightening means is loosened to effect the change, the frame tends to collapse, with the resiliency of the retracted portion acting to close the incision. Also, it frequently happens that the patient coughs, disengaging the intestines, and it becomes necessary to reengage them and again spread or retract the intestines and the incision. This is awkward to do with this device and with others now available. The use of fixedly attached blades limits the versatility of any instrument; the use of two such fixedly attached, relatively shallow retractor blades for the retraction of skin and fatty tissue as in this instrument makes no provision for variations in the thickness of the fatty layer from person to person. The fixedly attached blades extending below the plane of the frame also make an awkward package for sterilization.
The construction and deficiencies of this retractor have been mentioned because it was a desire to overcome the deficiencies in this widely used device which led to the present invention. However the invention is also directed to other improvements in the prior art.
In general, the retractors available also are not versatile, i.e. they are not usable in a wide range of incision sizes and shapes. Retractors are made in various sizes, each of which is convenient or useful only for a certain size range of incisions. Retractors for small incisions cannot be used for large incisions, and those for large incisions cannot conveniently be used for small incisions. There is a need for a versatile retractor which provides easy and adequate exposure in small as well as large incisions.
Some retractors are taken apart completely for sterilization because they are too unwieldy and would take up too much sterilizer space. These take time and are cumbersome to put together, and some of the small parts get lost. There is a need for a surgical retractor which is not only versatile but which is easy to handle and to sterilize.
The present invention is directed to the elimination of the indicated prior art deficiencies, and to meeting the indicated needs.
It is an object of this invention to provide a surgical retractor of greater versatility and adaptability to all sizes and shapes of incisions, and one which is easier to use, and more conveniently designed for sterilization.
It is a further object of the invention, by using a retractor frame of pivotally connected sides or arms, to provide improved ease and increased speed of adjustment, and in addition to provide improved means for quick readjustment of the frame, once it is in place and retracting, without danger of the entire retracted incision collapsing.
Another object is to provide a pivoted retractor frame joint having means for adjustably and detachably mounting a retractor blade, and independent means for quickly locking the frame arms in selected position without releasing the retractor blade.
It is a further object to provide a surgical retractor all of whose retracting blades are removably and adjustably mounted, permitting the use of blades of selected size and shape, thus greatly increasing the versatility of the apparatus, and providing a retractor which is more convenient to sterilize.
It is a further object to provide a surgical retracting frame which can be folded so as to present a flat compact assembly which takes a minimum of space in a sterilizer, and does not need to have its frame disassembled, as do present art devices, in order to provide a small enough package for placing in a sterilizer.
It is a further object to provide an improved retract r blade which can be swung closer to the retractor frame.
It is a further object to increase the ease of adjustment of the frame by providing instantaneously operating locking mechanisms which are independent of the blade clamping means at at least two of the vertices of the frame.
The preferred embodiment of this invention, which will be described below in detail, is shown in the drawings, in which:
FIGURE 1 is a plan view of the retractor with the retractor blades mounted on the frame;
FIGURE 2 is a plan view of the frame in a folded position with the retractor blades removed;
FIGURE 3 is an elevation of the frame folded and with the retractor blades removed;
FIGURE 4 is an enlarged perspective view of one of the improved retractor blades;
FIGURE 5 is an enlarged section taken along the line 5-5 of FIGURE 1;
FIGURE 6 is an enlarged fragmentary plan view of one of those frame vertices which is provided with a snap lock, with the retractor blade, wing nut, and part of the pivot removed to expose the series of teeth peripherally arranged on the end of arm 13;
FIGURE 7 is a section taken along line 77 of FIG- URE 6, with the wing nut and the top of the pivot in place;
FIGURE 8 is an enlarged fragmentary section through a typical frame vertex having a wing nut locking arrangement: and
FIGURE 9 is a section taken along the line 9-9 of FIGURE 8.
Referring now to the drawings, in which like characters indicate the same or similar parts, FIGURE 1 shows an improved retractor which comprises a hexagonal frame 10 on which are mounted six retractor blades 14 and 15. Retractor frame 10 comprises two pairs of end arms, each pair consisting of arms 12 and 13 pivotally connected by an end pivot 16, and two side arms 11, which are pivotally connected at each end by a side pivot 17 to an end of a pair of end arms.
Retractor blades 14 and 15 are removably and interchangeably mountable at any or all vertices of frame 10. Each has an arm portion with an elongated slot 24- which fits over the end of end pivot 16 or side pivot 17. A wing nut 18 is screwed down on the threaded end of the pivot to clamp the blade against the frame. Each blade 14 or 15 may thus be slidably and angularly adjusted with respect to the frame. An enlarged portion 25 of the elongated slot 24- is big enough to allow wing nut 18 to pass through it, so that blade 14 or 15 can be attached to or removed from frame 10 without removing wing nut 18.
Blades 14 and 15 are standard configuration retractor blades except for recesses 27 (FIG. 4) located in the top of the broad depending blade portion 26. FIGURE 4 shows blade 14. Blade 15 has similar recesses. Part of the outline of a standard blade configuration is shown (in broken lines) in FIGURE 4. It will thus be seen that depending blade portion 26 has a broad lower portion which extends well below a frame upon which it is mounted, and a narrower upper portion, between recesses 27, which latter portion is abreast the frame, so that the center of the depending blade portion 26 may be swung closer to the frame, as illustrated in the upper right hand portion of FIGURE 1, and in FIGURE 5. As shown in FIGURE 5, side arm 11 fits into one recess 27, and the incision engaging lower portion of blade 26 may be adjusted so as to partially underlie the frame, as illustrated in FIGURE 1. Such blades may, of course, be used with other frames. The retractor frame of this embodiment is not restricted to use with blades 14 and 15, but is adapted for use with many types of standard retractor blades; this adds greatly to the versatility of the retractor, allowing it to be used, with the appropriate blades, for either very small or very large incisions, and for deep or shallow incisions.
Provision is made at each vertex of frame 10 for locking or clamping the two arms forming the vertex against relative motion. Each pair of end arms, 12 and 13, may be almost instantaneously locked or released from lock, by means of a snap lock mechanism located at their vertex, vertex 12-13. Portion 21 of this snap lock may be seen adjacent to vertices 12-13 at the top and bottom of FIGURE 1, and the complete device is shown in detail in FIGURES 6 and 7. It comprises a spring loaded bolt 21, having a button 37 for finger actuation, and slots 31 through which screws 30 are inserted to fasten it to arm 12. The cooperation of screws 30 with slots 31 allows sliding motion of bolt 21 along the long axis of arm 12. Spring loading is provided by spring 32 located in cavity 33 in the underside of bolt 21. When the pointed end 36 of bolt 21 is engaged with teeth 20, which are peripherally disposed on the rounded end of arm 13, arms 12 and 13 are locked; when bolt 21 is retracted against the spring, end 36 is disengaged from teeth and arms 12 and 13 are free to move relative to each other.
As may be seen in FIGURE 7, end pivot 16 has annular flange 38 attached to its stem by welding or the like. The ends of arms 12 and 13 are thus contained between annular flange 38 and annular head 39 of pivot 16, but are free to move pivotally about pivot 16 when not locked by the snap lock mechanism. The only function of wing nut 18 at the two vertices 12-13 of the end arm pairs is to attach a retractor blade (not shown in FIG. 7) and clamp it in adjusted position.
At the other four vertices, 11-12 and 11-13, details of which are shown in FIGURES 8 and 9, the wing nut 18 functions not only to attach a retractor blade (not shown in these figures) to side pivot 17 but to compress together the ends of the two arms forming the vertex and thus clamp them against relative motion. Crisscross grooves 41, located on the abutting surfaces of the ends of the W0 arms making up the vertex, provide greater contact friction and more positive locking action.
The use of the two snap lock mechanisms (FIGS. 6 and 7) at opposite points of the frame permits easy and rapid retractor frame adjustment. Once in place and retracting an incision, the retractor may be easily readjusted to change the position of either vertex 12-13. For instance, to go' from the broken line to the solid line position of the upper end arm pair in FIGURE 1 requires only that the wing nuts 18 locking vertices 11-12 and 11-13 at the ends of the pair be loosened slightly, and that the snap lock at vertex 12-13 be released. (Blade 14 in the upper left hand portion of FIGURE 1 would of course be in a position similar to that of blade 14 in the upper right hand portion of FIGURE 1, rather than as shown.) While arms 12 and 13 are being moved to change the position of vertex 12-13, the remainder of the retractor frame will remain relatively rigid, without any danger of collapse from. the contracting pressure of the incision. Normally, wing nut clamps 18 at vertices 11-12 and 11-13 at the ends of the other end arm pair will allow whatever slight movement of side arms 11 may be caused by this adjustment. If not, those wing nuts 18 may be loosened very slightly, and this can be done without releasing blades 14.
In the adjustment from the broken line to the full line position described above it will be seen that the lower latch 21 securely holds the lower three retractor blades in position, thus preventing collapse of the incision even if all three of the upper pivot locking means 18, 21, 18 are released.
It is to be noted that the joint comprising means such as 18 for clamping a blade, and the entirely independent means such as 21-20 for quickly adjusting and locking the frame arms at the same joint is widely useful in other types of sungical retractors.
The broken line and full line positions of FIG. 1 show one example of the ease with which retractor frame 10 may be adapted to incisions which vary widely in size. As will be apparent, it may likewise be adjusted to a long, narrow incision. As pointed out above, retractor blades of different sizes, shapes and depths may be substituted, so that the apparatus as a whole is very versatile.
FIGURES 2 and 3 show that with the blades removed, the folded retractor frame 10 forms a compact package for insertion in a sterilizer. As may be seen from the plan view of FIGURE 2, having each of the two side arms 11 longer than the other arms allows the two pairs of end arms to jackknife into a nested folded position.
1. A hexagonal surgical retractor frame, comprising six elongate arms each pivotally connected at its ends by pivot means to the adjacent arms, means for securing said arms against motion relative to each other, two side arms at opposite sides of said frame being of equal length and longer than the other arms, said other arms comprising two pairs of end arms, the arms of each said pair being pivotally connected at one end of each by an end pivot, each of said end arms being pivotally connected at its other end to a side arm by a side pivot, whereby both said pairs of end arms may be folded between said side arms to provide a compact assembly for sterilization.
2. A hexagonal surgical retractor frame as defined by claim 1, comprising means at each of said pivot means for pivotally and slidingly attaching a retractor blade to said frame, and clamping means at each said pivot means for clamping said retractor blade to said frame.
3. A hexagonal surgical retractor frame as defined by claim 2 in which said means for securing said arms against motion relative to each other comprises locking means adjacent each of said end pivots for locking each of said pairs of end arms together independently of said clamping means. 5 4. A hexagonal surgical retractor frame as defined by claim 3, each said locking means comprising teeth on one of the arms of the pair and a spring biased bolt on the other one of the arms of the pair, said bolt having means to engage at least one of said teeth to lock the pair of arms 10 together.
References Cited in the file of this patent UNITED STATES PATENTS Freedline July 5, 1921 OConnor et a1. July 18, 1933 Wexler June 14, 1949 Zoll et a1. Mar. 2, 1954 Borsetti Feb. 16, 1960 FOREIGN PATENTS France Nov. 18, 1937