US 3570475 A
Description (OCR text may contain errors)
0 United States Patent [111 3,570,475  Inventor Mandel Weinstein  References Cited 30 Deepdene Road, Forrest Hills, N.Y. UNITED STATES p ATENTS 11375 1,944,009 1/1934 Homer 128/20  P 7755 2,724,117 11/1955 Oelbaum 128/570  Filed Nov. 14,1968  Patented Mar 16 1971 2,899,681 8/1959 Oscard 2/132 3,288,131 11/1966 Garland 128/20 Primary Examiner-Channing L. Pace Attorney-Amster and Rothstein ABSTRACT: A surgical retractor particularly suited for use in  :grF a Z gT surgical procedures involving the lower pelvic region is conrawmg structed of a resilient partially deformable strip of material  U.S.Cl. 128/20 having rounded edges. The retractor is adapted to be flexed  Int. Cl..., A6lb l/32, and inserted horizontally into a surgical wound whereby the A61b 17/02 resiliency of the material serves to retract body portions. In a-  Field 01' Search 2/132, 256; preferred embodiment, the length of the retractor may be adjustable.
Patented 16, 1971 3,570,475
5 4 P 4 1 m I?! 1 2a up a; 64670? FIG. 4
INVICNIOR. him 0&4 M/A STE/A/ ATTORNEYS SURGICAL RETCTOR SURGICAL RETRACTOR This invention relates generally to surgical retractors and more specifically to a surgical retractor particularly suited for use in surgical procedures requiring exposure of the lower pelvic region.
The lower pelvic region is one of the most difficult areas of the abdomen to expose for surgery. First, the lower pelvic region is confined by the thick pelvic bones which establish an anatomical limit to the size of the operating field no matter how large an incision is made. Second, the loops of intestine which normally occupy this area interfere with the surgeon and must be kept away from the operating field during the entire course of the operation. In view of the confined area and the tendency of the intestine to seek their natural resting place, conventional retractors normally used on other portions of the body are not fully satisfactory for surgery in the pelvic region.
The prior retractors have their use in this type of surgery for maintaining the wound in an open position, but they are not well adapted to hold the intestines out of the operating field .when the surgeon is working on the large' colon, gallbladder,
etc. In fact, it has become standard practice to supplement the inadequate results of standard retractors by using surgical assistants to hold the intestines out of the field by hand.
It has also been necessary to aid retraction in the lower pelvic region by use of the high Trendelenberg position wherein the patient is sloped head down so that the forces of gravity assist in keeping the intestines out of the operating field. However, this position has certain medical disadvantages since it forces the abdominal contents upwards against the diaphragm and mediastinum creating significant danger, particularly for older patients. Muscle relaxing drugs, often in combination with deep anesthesia, are also used to help prevent invasion of the surgical field by the intestinal loops. They create additional dangers.
Generally, it is an object of the present invention to provide a new retractor which eliminates one or more of the disadvantages mentioned above. More specifically, it is an object of the invention to provide a new type of retractor useful to hold intestines out of an operating field in the lower pelvic region.
It is within the contemplation of the present invention to provide a retractor having the capacity to be formed into a shape desired by the surgeon and used in an abdominal wound to gently hold the small intestines out of the lower pelvic region.
A still further object of the present invention is to reduce the need for cumbersome retractors in lower abdominal surgery.
In accomplishing these and other objects and in accordance with the invention, a surgical retractor is constructed of a strip of resilient, flexible, but nevertheless partially deformable material which is several times longer than it is wide. The strip preferably has smooth lateral blunt ends so as not to injure internal tissue. In accordance with a feature of the invention, the retractor may be constructed of two strips of such material secured together one above the other in sliding relation so that the length of the retractor may be varied to suit the particular need.
In use the retractor is flexed and completely inserted in the abdominal cavity in a horizontal position with one lateral edge of the retractor facing upward. The ends of the retractor are then permitted to spring apart slightly in a horizontal plane with one end gently forcing up against the coils of intestine and the other forcing downward against the anterior bladder wall for example. In this manner the retractor maintains the coils of intestine away from the surgical field without itself obstructing the surgeon.
The above brief description, as well as further objects, features and advantages of the invention will be more fully appreciated by reference to the following detailed description of several illustrative embodiments in accordance with the present invention, taken in conjunction with the accompanying drawings, wherein:
FIG. I is a perspective view of a first embodiment of a retractor constructed in accordance with the invention;
FIG. 2 is a side view of another embodiment in accordance with the invention which is shown in a partially flexed position;
FIG. 3 is a top view of the retractor of FIG. 2 in a flexed position; and
FIG. 4 shows a retractor of this invention in a surgical procedure.
The surgical retractor shown in FIG. 1 is designed in accordance with the invention for use primarily in the lower abdominal region. Unlike conventional retractors it is constructed of flexible material and is designed to be partially deformed by the surgeon and then flexed and completely inserted horizontally into the abdomen. In this position, which will be described in greater detail hereinafter, the spring force exerted by the retractor-maintains the coils of intestine and other internal organs away from the operating field without requiring external support. Substantial success has resulted from the experimental use of these retractors and they are now referred to as Weinstein retractors.
In its simplest form, a retractor 10 in accordance with the invention comprises a single length of flexible material 12, several times longer than it is wide. The lateral edges 14 of the retractor are preferably rounded smooth to avoid injury to adjacent tissue, and the ends 16 of the retractor, which exert the greatest force against the retracted material, may be provided with extra material to form a broad smooth bead 18 to produce an increased and smooth contact area.
In a preferred embodiment of the invention, the retractor may be constructed of thin stainless steel which provides adequate resiliency and great durability. Preferably the material used is flexible so as to be easily flexed for insertion and sufficiently resilient to provide gentle spring force upon the organ being retracted. While stainless steel is particularly suited for this purpose, it is to be understood that numerous other materials including resilient synthetic resins of various types may be employed. In one embodiment of the invention, the retractor may be constructed of presterilized synthetic resin so that the retractor may be used once and discarded.
Because of the variations in size between individuals and between the pelvic regions of the male and female, various length retractors will normally be required. In accordance with one embodiment of the invention, a retractor of variable length may be constructed as shown in FIGS. 2 and 3. Such a variable length retractor may comprise two strips of flexible material 20 and 22 secured together one above the other in sliding relation. Each strip includes a broad bead 24 at the outer end thereof and has smoothly rounded lateral edges 28.
The strips may be maintained in sliding relation by thin bands which encircle both strips at various points along their length. The embodiment shown in FIG. 2 includes three such bands 26a, 26b and 260, two respectively secured to the inner ends of strips 20 and 22 and a third riding free and located intermediate the first two so as to prevent the strips from separating when the retractor is flexed. To increase the length of the retractor, the thick ridges may be pulled apart such that one strip slides relative to the other thus increasing the length. To shorten the retractor, the opposite sliding movement is arranged.
The retractor has been found particularly useful in rectosigmoid surgery, in gallbladder surgery and in hysterectomy operations and in the surgical treatment of hiatus hernia conditions. The use of a retractor in accordance with the invention is shown in FIG. 4 in rectosigmoid surgery.
In the normal sequence of events, the patient is placed in a horizontal or moderate Trendelenberg position. An appropriate incision is made and two large size hand retractors forcibly spread and raise the sides of the abdominal wall. Four or five moist laparotomy pads are introduced within the upper abdomen to retain the loops of bowel proximally. The pads may be placed over the cecum on the right and continue to the left, ending just to the right of the descending colon. They are completely hidden under the intact proximal abdominal wall; only the attached tapes and rings 42 are seen emerging onto the upper abdomen and chest. To finalize this step, a long roll may be made of one laparotomy pad that covers all individual pads thus keeping them all together. This entire mass reaches transversely across the abdomen. In this manner, a bulwark of pads retaining all the intestinal coils is created, against which the horizontal retractor will exert its upward pressure.
The retractor is then adjusted to its proper length, depending on the size and obesity of the patient. In most patients the smallest size is adequate.
The retractor 44 is then bent somewhat and is formed to a shape close to the shape it will assume in the operating field. It is then flexed into a tighter bend and lowered into the abdominal cavity. In a male patient, the surgeon places one end of the retractor firmly against the anterior bladder wall, just to the left of the patients bladder region. The surgeon then places the second end of the retractor against all the padded loops of intestine proximally. At the end of this maneuver, the proximal end of the instrument should lie on the left, just to the right of the descending colon. The operative exposure may then be completed for example by spreading the wound widely apart with a self-retaining Balfour retractor having two side pieces 40 and 46 and a pelvic attachment 48. The use of the self-retaining Balfour retractor is well known in the surgical art. The retractor in accordance with the present invention thus provides significantly improved exposure of the lower abdominal region, without requiring additional external support.
it is to be noted that in using a retractor in accordance with the invention additional precautions may be taken to safeguard the delicate internal tissue. For example, the ends of the retractor, or event the whole device, may be wrapped in stockinette 50 or other soft material so as to provide an additional cushion.
It is to be understood that the above described arrangement is merely illustrative of the principles of the invention. Other embodiments may be devised by those skilled in the art without departing from the spirit or scope of the invention.
1. A surgical retractor for use primarily in lower abdominal surgery comprising a thin substantially flexible member several times longer than it is wide and having smooth edges and blunt ends so as not to damage internal tissue, said member being fabricated of a resilient and partially deformable material compatible with living animal tissues, said retractor being adapted to be formed into a flexed condition for insertion into an abdominal surgical wound and upon being released within the wound assume a tensed, flexed position with its ends bearing springably against selected internal body portions to retract said internal body portions and hold them away from the operative field with the flexure of said retractor varying as the patient breathes to reduce surgical trauma.
2. A surgical retractor particularly suited for exposing the pelvic region, said retractor comprising a plurality of flexible, resilient, partially deformable strips of material compatible with living animal tissues, each of said strips being several times longer than it is wide, each of at least two of said strips having one relatively blunt end so as not to damage internal tissue, said two strips being superimposed upon each other in sliding relationship with said blunt ends extending beyond the area of superposition, and connecting means for securing said strips together in sliding relation whereby the length of said retractor may be varied.
3. A surgical retractor as defined in claim 2 wherein said connecting means comprises a plurality of bands secured around said flexible strips at various positions along their length so as to retain the strips adjacent one another in sliding relation.
4. An adjustable surgical retractor comprising two flexible, resilient and partially deformable strips of material compatible with living animal ti ssue s each of said strips bein several times longer than it is wide and having an inner en and an outer end, said outer end including a smooth broad bead of material, said strips being maintained one above the other in sliding relation by two bands which encircle both said strips, a first of said bands being attached to the inner end of a first of said strips with the second of said strips sliding therethrough, and a second of said bands being attached to said inner end of a second of said strips with the first strip sliding therethrough whereby the length of the retractor may be adjusted.
5. An adjustable surgical retractor as defined in claim 4 having a third band which encircles both said strips and travels freely upon said strips intermediate said first and second bands so as to prevent said strip from separating when said retractor is flexed.