US 3612509 A
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United States Patent  Inventors Don W. Boston 3700 Oak Haven, Ft. Worth, Tex. 761 19; Charles R. Boston, 3801 Carmen Drive, Ft. Worth, Tex. 76116; Paul D. Suhovy, 3255 Mary's Lane, Ft. Worth, Tex. 76108  Appl. No. 14,519  Filed Feb. 26, 1970  Patented Oct. 12, 1971  APPARATUS FORADJUSTING LITHOTOMY POSITION OF A PATIENT 13 Claims, 5 Drawing Figs.
 US. Cl 269/328, 128/71  Int. Cl A6lg 13/00  Field of Search 269/322, 328; 108/68, 137; 128/71; 312/207 [5 6] References Cited UNITED STATES PATENTS 2,290,191 7/1942 Karlson H 269/322 Primary ExaminerWiIliam S. Lawson Attorneywotford and Felsman ABSTRACT: A patient support facilitating examination of a patient in the lithotomy position characterized by a longitudinally reciprocally movable belt for effortlessly positioning a reclining patient with feet in the usual stirrups to properly position the intercrural portion of the patients anatomy at the stirrup end of the patient support; the belt moving away from the patients anatomy at the stirrup end to facilitate examination. Also disclosed are preferred structural embodiments including the positive drive mechanism, with limit switches for safety; the belt and upholstery interconnections; the pillow support and paper fastener arrangement; and the optimum thickness of a top structure for use as a replacement top for conventional examining tables. I
PATENTEnncr 12 197i SHEET em 2 3.612.509
ATTORNEYS 1 APPARATUS FOR ADJUSTING LITIIOTOMY POSITION OF A PATIENT BACKGROUND OF THE INVENTION 1.. Field of the Invention This invention relates in general to supports; such as, tables and beds; for examining patients. More particularly, it relates to an improved patient support for properly positioning the intercrural portion of a patients anatomy for making an examination; for example, for making a standard pelvic excal use.
In the lithotomy position, the patient will have her legs bent at an acute angle at the knee and the feet fixed in metal stirrups with the intercrural portion of the anatomy, exposing the region to be examined, at the very brink of the end of a patient v support. While discussion herein may be directed specifically to giving a pelvic examination to a female patient, the problems are common to other medical specialists and related medical problems. For example, a urologist may have similar problems in examining the urinary organs of either a male or female patient; a proctologist may have the same problem in examining the rectal structure of a patient, and even a general practitioner may have a similar problem in examining the anal area of a patient.
One recurring structure that is repeatedly suggested in the prior art is a two-piece patient support in which one end drops down from beneath the patients legs to facilitate access to the intercrural portion of the anatomy. The other piece having the patient thereon may be movable, with or without swinging stirrups into position. None of the prior art devices have been successful, however, in moving the patient with respect to the stirrups or, more to the point, with respect to the support on which the patient was lying; but, rather, moved both the patient and support with respect to another obstruction.
Thus, in the prior art, the patient must position herself on the examining patient support, such as an examining table. This ordinarily has been accomplished heretofore by having the patient lie back upon the examining table, place her feet in the stirrups, and then, by grasping the edge of the table, forcefully and often with a great deal of difficulty and effort scoot or slide down the table. For many women this is most difficult to do. Often they do not come to the proper position to enable a satisfactory examination to be performed by the physician, since the instrument employed in giving a pelvic examination to a female patient may hit the end of the examining table. A repositioning of the patient is then required. The physician will have to instruct the female patient to slide down just a little bit more. In her attempts to do this the patient may only raise her hips slightly and come back to essentially the same position occupied before the last effort. In addition, the patient has a fear of falling, not knowing just exactly where she is in relation to the end of the table. Moreover, some older patients are quite weak and unable to accomplish the muscular effort necessary to do these things and assistance from the doctor and nurses is required. Frequently, because of the awkward position of the legs with the feet in the stirrups, many patients, both old and young will develop muscular cramps in the legs while exerting themselves in attempting to achieve a satisfactory position.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an isometric view of one embodiment of this invention illustrating a reclining patient having her feet in stirrups, but not yet positioned for examination.
FIG. 2 is a partial side-elevational view, partly in cross section and partly schematic, illustrating the patient having been properly positioned for examination.
FIG. 3 is a bottom isometric view illustrating a replacement top in accordance with one embodiment of this invention.
FIG. 4 is a partial side-elevational view showing the interconnection between the ends of the belt, and the ends of the upholstery material.
FIG. 5 is a schematic diagram of the electrical interconnection of components of the embodiment of FIG. 1.
DESCRIPTION OF PREFERRED EMBODIMENTS It is a primary object of this invention to provide apparatus for effortlessly positioning a patient for examination of the intercrural portion of the patients anatomy. It is a particular object of this invention to provide apparatus for effortlessly positioning a patient into or out of the lithotomy position for a standard pelvic examination.
It is also an object of this invention to provide, in the apparatus for efiortlessly positioning a patient, specific structural features that provide positive smooth movement of the patient with safety and without discomfort because of the apparatus.
It is also an object of this invention to provide apparatus having a sanitary surface for each individual patient and enable effortless movement of the patient to achieve the desired position without interference between any portion of the apparatus or the sanitary covering.
It is also an object of this invention to provide a top having a thickness of the same dimensions as an original top on a standard piece of furniture for an examining room such that the original top can be removed and the replacement top installed; the replacement top effecting effortless movement of a patient for proper positioning of the patient for examination of the intercrural portion of the anatomy.
Referring to FIG. 1, patient support 11 is illustrated as an examining table facilitating the examination of a patient in the lithotomy position. It has a support structure 13 having a pair of stirrups 15 at the stirrup end thereof. Ordinarily, stirrups 15 are vertically adjustable by way of rod 17 extending through conforming cylinder 19 having a set screw 21 for fixing the stirrups once the desired vertical adjustment has been achieved. In addition, stirrups 15 are horizontally adjustable by way of reciprocally movable member 23. Once the stirrups are adjusted for an individual patient they ordinarily remain fixed for that patient. Support structure 13 has footrest 25, which may be pulled out by an appropriate handle to serve as a step and facilitate seating the patient on patient support 11.
Belt 27 generally defines an upper patient-supporting surface. Belt 27 is longitudinally and reciprocally movable for moving a patient thereon with respect to the stirrups I5 and is operable to move the patient to extend the intercrural portion of the patients anatomy beyond the stirrup end of the patient support to facilitate examination, as illustrated in FIG. 2. As can be seen therein, the examination instrument 29 will strike the end of the patient support beneath the buttocks upon in sertion and manipulation if the patient has not been positioned far enough toward the stirrups. As indicated hereinbefore, a patient in such an awkward position as the lithotomy position frequently is unable to move further downwardly. Accordingly, it is very advantageous to be able to move the patient downwardly simply by movement of suitable actuation means such as switch 31 in an appropriate direction.
A belt-moving mechanism 33 is connected with belt 27 for moving the belt and any patient thereon in a direction responsive to the actuation means. Specifically, the belt-moving mechanism comprises a reciprocally movable member such as chain 35 and a connector 37 connected with the chain 35 and the belt 27.
Work with earlier models has indicated that it is desirable to provide a positive drive for moving the belt, and avoid slippage. Accordingly, the belt 27, FIGS. 2 and 3, is connected via connector 37 with chain 35. Chain 35 engages and is suspended intermediate sprocket wheels 39 and 41. The sprocket wheels are rotatably supported on support structure 13 and sprocket wheel 39 is adjustably mounted for maintaining the desired amount of tension in chain 35. As illustrated, sprocket wheel 39 is movable longitudinally along patient sup port 11 by way of threaded shaft 43 and wingnut 45. Sprocket wheel 41 serves as a power sprocket wheel and is mounted, as by suitable key and slot, on a shaft for delivering power to effect reciprocal movement of a predetermined part of chain 35. Shaft 47 has a similarly mounted sprocket at its other end engaging a second chain 49. Chain 49 engages a second power sprocket wheel 51. Second power sprocket wheel 51 is also mounted on a power shaft 53 driven by way of gears in gearbox 55 and reversible motor 57. While choosing the motor and reduction unit illustrated by gearbox 55 is within the skill of the art, earlier work has demonstrated that 0364 Bodine motor and reduction unit effecting an output of 12 rpm. on shaft 53, and consequently, on shaft 47, effects satisfactory results. Motor 57 is suitably supported by support member 59 on support structure 13.
An actuation means is connected intermediate motor 57 and a power source such as a conventional AC outlet for controllably connecting the motor with the power source so as to effect the desired rotation of the motor and position that patient as desired. Specifically, switch 31 electrically connects the motor with the power source when manually operated by the doctor to properly position the patient.
Because of the positive drive characteristics of the beltmoving mechanism as illustrated, it is desirable to incorporate limit switches 61 and 63 in series with switch 31 serving as the actuation means. In this way, should the doctor be momentarily inattentive when moving the patient, or should the switch 31 malfunction, the movement of the patient will be stopped by the appropriate limit switch before the patient is in danger of falling from either the stirrup end or the head end of patient support 11. Specifically, safety stop 65 will strike an appropriate plunger arm on limit switches 61 or 63 to disconnect motor 57 and stop movement of the patient within a safe zone of movement that is defined by the location of limit switches 61 and 63.
Belt 27 is passed over roller 67 mounted on shaft 69 and is moved away from the patients anatomy for allowing unobstructed access to the intercrural portion thereof. To effect movement of belt 27 in the opposite direction, it is passed over roller 71 mounted on shaft 73. Rollers 67 and 71 are located on each side of a zone of movement of the center of gravity of the patient.
A pillow support surface 75, having suitable cantilever structural support, is provided at the head end of the patient support 11. First roller 67 is mounted at the stirrup end of the patient support facilitate examination of a properly positioned patient. On the other hand, second roller 71 is positioned intermediate first roller 67 and pillow support surface 75. A pil low 77 is normally supported at the head end of the support structure with bearings 79 supported on the pillow support surface. Bearings 79 may simply be readily slidable nylon or Orlon bushings or may comprise suitable rollers or any other structure facilitating the longitudinal movement of the pillow. The pillow 77 is attached to the belt and moves reciprocally with the belt 27. The pillow is attached to the belt at one extremity of movement as determined by the location of limit switch 61. Thus, proper operation of the pillow 77 is assured, without overrunning of the point of attachment around roller 71.
Paper dispenser 83 is supported at the head and of the support structure for dispensing sanitary paper to be spread over the pillow and belt before a patient lies thereon. The roll of paper 85 is illustrated in place in paper dispenser 83.
With the construction as illustrated, paper 87 may be passed over the top of the patientsupporting surface of belt 27 and end 89, FIG. 2, of paper 87 passed through paper fastener member 91 and looped back thereover for retaining the paper in place. Paper fastener member 91 extends transversely across belt 27 and moves adjacent and in the same direction as chain 35, enabling the end 89 of the paper that has been folded back thereover to retain the paper in place because of its close proximity to chain 35.
Instead of employing expensive material such as leather for belt 27 to preserve the desired decor in a doctors examining room, it is advantageous to employ a belt of a strong material such as nylon web or canvas, and to have a layer of an upholstery material covering the belt. As illustrated in FIG. 4, belt 27 will have an additional layer of upholstery material 93 over its top surface. Upholstery material 93 is not attached to belt 27 at any region that will passover the respective rollers such as roller 67, since the stitching thread with which the two are stitched together is broken in reciprocally passing over roller 67. Superior performance and durability is obtained when upholstery material 93 and belt 27 are individually passed over the respective rollers, and then joined together. As illustrated, they are joined together at the same location where they are connected to a suitable rigid structural member such as angle iron bar 95. The rigid structural member 95 and the respective layers of belt 27 and upholstery material 93 may be fastened together by suitable means such as rivets 97. Any number of rivets or brads may be employed along structural member 95 for the necessary structural strength to effect the requisite longitudinal movement of belt 27 and upholstery material 93.
The respective ends of belt 27, and upholstery material 93 and rigid structural member 95 when employed, are connected together by appropriate means which enable maintaining the desired degree of tension in belt 27. For example, rigid structural members 95 and 99 may be bolted together by a plurality of bolts 101 having nuts 103 thereon for adjusting the tension of belt 27. As indicated hereinbefore, it is ordinarily sufficient to connect one end of belt 27 to a reciprocally movable member such as a link of chain 35 via connector 37, since the other end of belt 27 is connected with the first end and, consequently, is also connected with chain 35.
A schematic diagram of the interconnection employing an electric outlet as a power source is illustrated in FIG. 5. Reversible electric motor 57 may be suitably connected with the power source as indicated by the ground connections on each. An additional conductor 105 and 107 is also provided for cffecting directional rotation of reversible motor 57 when suitably connected to power source 109. Switch 31 is appropriately connected via conductor 111 with the power source. Switch 31 may be moved in one direction to effect rotation of motor 57 in one direction and move belt 27 longitudinally along patient support 11 in one direction. Alternatively, switch 31 may be moved in the opposite direction to effect opposite rotation of motor 57 and opposite movement of belt 27. As indicated hereinbefore, limit switches 61 and 63 are employed in series with a switch 31 and provide a positive safety factor, both for the patient and the apparatus. Expressed otherwise, if either switch 61 or switch 63 are triggered by safety stop 65, the circuit is broken and reversible motor 57 is stopped whether or not switch 31 is released. FIG. 5 is schematic only and the exact electrical interconnection will, of course, depend upon the power source and motor selected. Any other interconnection effecting the results described hereinbefore may be employed. For example, if desired, the limit switches may be connected in series in the ground circuit.
A particularly preferred replacement top embodiment of this invention is formed when the thickness of the belt, rollers and operating mechanism are maintained in the range of 3-7 inches; the same thickness as an original top on conventional examining tables. By having the same thickness, the distance from the footrest to the upper patient-supporting surface remains the same and prevents discomfort to patients for ordinary examinations. Accordingly, the original top which required, in order to properly position to patient, a large amount of effort on the part of the nurses, doctor, and the patient and sometimes pain on the part of the patient, can be replaced with the replacement top and a patient, even in the lithotomy position, can be effortlessly and painlessly moved to properly position the intercrural portion of the anatomy for examination.
Operation of the patient support may be seen in FIG. l5. Paper 87 from roll 85 in paper dispenser 83 is pulled downwardly over the top surface of the patient support and end 89 is inserted through paper fastener member 91 and folded backward. Thereafter, the patient steps onto footrest 25 and is seated on belt 27 defining the upper patient-supporting surface of patient support 11. The patient lies back, resting her head on pillow 77 and places her feet in stirrups 15. The stirrups are adjusted for the patient, the doctor takes his position at the stirrup end of the patient support 11 and by operating switch 31 moves belt 27 and the patient downwardly, toward the stirrup end of the patient support.
Switch 31 is held in a given direction until the intercrural portion of the patients anatomy is positioned for examination by the doctor. As indicated, when the switch is pressed in a given direction, reversible motor 57 rotates, turning via gears in gearbox 55 shaft 53. In turn, sprocket wheel 51 is rotated, moving chain 49, ultimately moving power sprocket wheel 41 via power shaft 47. Thus, as to top of chain 35 is drawn toward the head end of the support, belt 27 moves the intercrural portion of the patientss anatomy toward the stirrup end of the patient support 11.
The examination is completed with or without supplemental adjusting movement of the patient by a short movement of switch 31 to the desired position, and the patient is returned to the normal position by the reverse movement of switch 31. Thereafter the patient may remove her feet from the stirrups, resume her sitting position for discussion with the doctor or for stepping from the examining table serving as patient support 11.
In the foregoing descriptive material, the term belt is employed to mean any flexible means for conveying a patient to a desired position and includes articulated belts.
From the descriptive material and figures, it can be seen that this invention provides apparatus that is beneficial in positioning any patient into a position at the end of a patient support for examination of the intercrural portion of the patients anatomy, regardless of the medical problem. The forgoing discussion has been directed to female patients being give a pelvic examination since the lithotomy position is so awkward and it is in this position that the greatest difficulties have been encountered with the prior art apparatus and where the greatest benefits are obtained from this invention, even though it may be beneficial in a variety of medical problems.
Equivalent structures will occur to one skilled in the art once this invention has been explained to them. For example, several other reciprocable members will occur to one for attaching to and moving the belt longitudinally of the patient support. For example, hydraulic cylinders having an extensible shaft attached to an internal piston could be employed in conjunction with high-pressure hydraulic fluid. Similarly, pneumatic system could be employed. In such events, the actuation means may not be an electric switch but a valve for connecting the power moving means for moving the reciprocal member with a source of high-pressure fluid for effecting the desired direction and amount of movement. Such other embodiments could be employed although they will ordinarily be less satisfactory for a doctors examining room than an electrically operated unit such as described hereinbefore. Likewise, any other belt guide means with sufficiently low friction can be substituted for one or both rollers, although a less desirable patient support may thereby be effected.
Although the invention has been described with a certain degree of particularity, it is understood that the present disclosure has been made only by way of example and that numerous changes in the details of construction and the combination and arrangement of parts may be resorted to without departing from the spirit and scope of the invention.
1. A patient support facilitating examination of a patient in the lithotomy position comprising:
a. support structure having a pair of stirrups mounted at a stirrup end thereof;
b. a longitudinally reciprocally movable belt defining an to patient-supporting surface for moving a patient thereon with respect to said stirrups and operable to extend the intercrural portion of a patients anatomy beyond the end of said patient support;
c. belt-moving mechanism connected with said belt and adapted to move said belt and any patient thereon in a direction responsive to an actuation means; and
d. actuation means connected with said belt-moving mechanism and being operable to effect via said beltmoving mechanism a desired direction and amount of movement of said belt and any patient thereon;
whereby a patient reclining upon said support with feet in the stirrups can be readily and painlessly moved as desired to position the intercrural portion of the anatomy to be examined at and even beyond the edge of the patient support.
2. The patient support of claim 1 wherein said actuation means is operable from said stirrup end.
3. The patient support of claim 1 wherein said belt is passed over a belt guide means at the stirrup end and away from the patients anatomy for allowing unobstructed examination of the intercrural portion of the patients anatomy.
4. The patient support of claim 1 wherein said belts is passed over a roller at the stirrup end and away from the patients anatomy for allowing unobstructed examination of the intercrural portion of the patients anatomy.
5. The patient support of claim 4 wherein said belt-moving mechanism comprises a reciprocally movable member and a connector; and said belts is passed over a pair of rollers, on roller being located on each side of a zone of movement of the patient, and has each of its ends connected with said belt-moving mechanism via said connector.
6. The patient support of claim 5 wherein said reciprocally movable member comprises a chain engaging and intermediate a pair of sprocket wheels and being moved responsively to at least on of said sprocket wheels.
7. A patient support facilitating examination of a patient in the lithotomy position comprising:
a. support structure having a pair of stirrups mounted at a stirrup end thereof;
b. a longitudinally reciprocally movable belt defining an upper patient-supporting surface for moving the patient with respect to said stirrups and operable to extend the intercrural portion of a patients anatomy beyond the end of said patient support;
c. a roller at the stirrup end having said belt passing thereover and away from the intercrural portion of the patients anatomy;
d. a layer of upholstery material over the top side of said belt for receiving a patient, said upholstery material being connected with said belt only near an end thereof such that the connected portions of said belt and said upholstery material do not travel over said roller;
e. belt-moving mechanism connected with said belt and adapted to move said belt and any patient thereon in a direction responsive to an actuation means; and
f. actuation means connected with said belt-moving mechanism and being operable to effect via said beltmoving mechanism a desired direction and amount of movement of said belt and any patient thereon;
whereby a patient reclining upon said support with feet in the stirrups can be readily and painlessly moved as desired to position the intercrural portion of the anatomy to be examined at or beyond the edge of the patient support without damaging the connected portions of the belt and upholstery material or any consequent pinching of the patient because of torn upholstery material.
8. The patient support of claim 7 wherein each end of said upholstery material and said belt are connected to respective rigid members; said rigid members are connected together by an adjustable linkage for adjusting the tension in said belt and said upholstery material; and one of said rigid members is connected with said belt-moving mechanism.
9. A patient support facilitating the examination of a patient in the lithotomy position comprising a. support structure having a pair of stirrups at a stirrup end thereof;
b. a longitudinally reciprocally movable belt defining an upper patient-supporting surface for moving said patient with respect to said stirrups and operable to extend the intercrural portion of a patients anatomy beyond the edge of said patient support;
c. belt-moving mechanism having positive drive characteristics and comprising:
l. a pair of sprocket wheels rotatably supported on said support structure, at least one of said sprocket wheels being adjustably mounted so as to maintain a chain in tension therebetween and at least one of said sprocket wheels being a power sprocket wheel mounted on a power shaft for being rotated in response to torque delivered by said power shaft;
2. a chain engaging and intermediate said pair of sprocket wheels and being moved responsively to said power sprocket wheel, said chain being connected with said belt for effecting the desired movement thereof; and
3. a reversible motor drivingly connected with said power shaft; and
d. an actuation means connected intermediate said motor and a power source for controllably connecting said motor with said power source so as to effect desired rotation of said motor;
whereby a patient reclining on said patient support with feet in said stirrups can be moved smoothly, efi'ortlessly, and painlessly to position the intercrural portion of the anatomy to be examined at and even beyond the edge of the patient support.
10. The patient support of claim 9 wherein limit switches are provided to define a safe zone of movement and stop said motor when said belt has been moved to position a patient at either extremity of said safe zone of movement, and thereby avoid the danger of a patient falling when being moved near either end of said patient support.
11. A patient support facilitating examination of a patient in the lithotomy position comprising:
a. support structure having a pair of stirrups at a stirrup end thereof;
b. pillow support surface at a head end of said support structure;
c. a first roller at the stirrup end of said support structure;
d. a second roller intermediate said first roller and said pillow support surface;
e. a longitudinally reciprocally movable belt passed over said rollers and defining an upper patient-supporting surface for moving said patient with respect to said stirrups and operable to extend the intercrural portion of a patient's anatomy beyond the stirrup end of said support structure;
f. upholstery material covering said belt;
g. pillow normally at the head end of said support structure, supported on said pillow support surface and attached to said belt for reciprocal movement therewith;
h. a paper dispenser at the head end of said support structure for dispensing sanitary paper to be spread over said pillow and said belt before a patient lies thereon;
i. belt-moving mechanism connected to at least one end of said belt and connected with each end of said belt and adapted to move said belt and any patient thereon in a direction responsive to an actuation means; and
j. actuation means connected with said belt-moving mechanism and being operable to effect via said beltmoving mechanism a desired direction and amount of movement of said belt and any patient thereon;
whereby said patient may be readily and painlessly moved to effect the desired position without mutual interference of said paper, said pillow, and the other elements of said patient support, and with the patients head adequately supported on said pillow.
12. The patient support of claim [1 herein a lineal paperfastening member extends transversely across said movable belt beneath said upper surface and moves adjacent and in the same direction as a portion of said belt-moving mechanism, enabling said paper to be spread over said patient support, and inserted between said lineal paper fastener member and said belt and doubled back for being maintained in place.
13. A replacement top adapted to be substituted for an original top having a thickness in the range of 3-7 inches and employed on a patient support having a built-in footrest and a pair of stirrups at a stirrup end and facilitating examination of a patient in the lithotomy position comprising:
a. a top structural frame having padded edges and having a thickness in the range of 3-7 inches;
b. a reciprocally movable belt within said padded edges and passed over a pair of rollers, one being located at the stirrup end of said structural frame and the other intermediate the stirrup end and the head end;
c. belt-moving mechanism including a reciprocally movable member connected with said movable belt and with a power operated moving device for moving said reciprocally movable member;
d. actuation means connected with said power operated moving device and with a power source for controllably connecting said power operated moving device with said power source so as to effect the desired movement of said belt and any patient thereon;
whereby an original top frequently requiring, in order to properly position a patient, a large amount of effort on the part of the nurses, doctor and patient and pain on the part of the patient, can be replaced; and with said replacement top a patient can be effortlessly and painlessly moved to the desired position.