US 3858578 A
A device for holding surgical instruments firmly in place. A surgical instrument is attached to a retaining arm, the rigidity of which is controlled by a fluid actuated operating apparatus. By activating the operating apparatus, the arm can be made flexible as the instrument is being positioned and rigid once the instrument is in place.
Description (OCR text may contain errors)
United States Patent 1191 Milo Jan. 7, 1975 SURGICAL RETAINING DEVICE 1.279.803 9/1918 Watson .1 2411/1611 1,460,697 7 1923 B dl' ['75] lnventor: SImcha MllO, Haifa, Israel 2,334841 11943 t z u  Assignee: Pravel, Wilson & Matthews, g'ggg'gf g i p O C l Houston a part Interest 3,643,655 2/1972 Peronti 1. 1212/20  Filed: Jan. 21, 1974  Appl No: 435,235 Primary Examiner-Lucie H. Laudenslager  US. Cl. 128/20  ABSTRACT: I [51 m 17 02 A devlce for holdmg surg1cal Instruments firmly 1n 158 Field 61 Search 128/20, 3; 248/160, 276; P A Surgical instrymem is attached to a retaining 2 5 4 arm, the rigidrty of whlch is controlled by a flurcl actuated operating apparatus. By activating the operating [5 References Cited apparatus, the arn can be macle flexible as the instru- UNITED STATES PATENTS ment 1s bemg posmoned and rlglcl once the mstrument 205,069 6/1878 Farnsworth 285/166 m piace' 1,276,117 8/1918 Riebe 64/4 9 Claims, 2 Drawing Figures Patented Jan. 7, 1915 3,858,578
SURGICAL RETAINING DEVICE BACKGROUND OF THE INVENTION The field of this invention is surgical devices.
It is frequently necessary for a surgeon to employ retractors during an operation in order to hold the sides of an incision open or to gain access to a particular part of the patients body. The retractors must be properly positioned and held very securely to avoid possible injury to the patient.
In the past, a few mechanical holding devices, such as those described in U.S. Pat. Nos. 3,278,207 and 3,638,973, have been available, but they were not used extensively because they did not allow proper positioning of the surgical instrument and did not hold the instrument firmly in place once it was positioned. Neither did the support and conduit devices, such as described in U.S. Pat. Nos. 1,276,117; 1,279,803; and 1,460,697 overcome the placement and holding problems. As a result, the job of holding retractors in place has been accomplished by surgical assistants who manually hold the retractors. The job is a tiresome one, and the assistants congest the area around the operating table.
SUMMARY OF THE INVENTION It is an object of this invention to provide a new and improved surgical retaining device. The device in cludes a retaining arm comprised of a plurality of arm members having a central bore therethrough, a cable attached to one end of the retaining arm and extending through the bores of the arm members, a fluid actuated operating apparatus for adjusting tension on the cable to control the rigidity of the retaining arm, and a means for connecting a surgical instrument to the retaining arm. During the positioning of the surgical instrument, the operating apparatus exerts no force on the cable and the retaining arm is highly flexible. However, once the surgical instrument is in place, the operating apparatus exerts a force on the cable sufficient to make the retaining arm rigid and thereby prevent the surgical instrument from moving.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a top view showing a mode of employing the surgical retaining device; and
FIG. 2 is a sectional view of the invention which also includes a schematic representation of a valve in the operating apparatus.
DESCRIPTION OF THE PREFERRED EMBODIMENT In the drawings, the letter A designates generally the surgical retaining device wherein a surgical retractor T is joined to retaining arm B by a surgical instrument connector C. A cable D is affixed at one end to connector C and extends through a central bore in arm B to operating apparatus E. As will be described in more detail below, arm B is flexible until a tension is placed on cable D by operating apparatus E; however, when tension is placed on cable D, the retaining arm B becomes rigid and holds the surgical retractor T firmly in place.
Considering the invention in more detail, a surgical instrument, such as surgical retractor T, is attached to connector C in a conventional manner. FIG. 2 illustrates one such method where the surgical retractor T has a threaded bottom shaft which is screwed into a first threaded cavity 12 of connector C. In a similar manner, connector C may be joined to cable D by screwing a threaded shaft 14, which is attached to cable D, into a second threaded cavity 16 of connector C.
Retaining arm B is positioned between connector C and a base member 18. The arm B includes a plurality of arm members 20 which are identical in structure. However, for descriptive purposes only, two of the arm members are designated as an outermost arm member 20a and an innermost arm member 20b.
Each of the arm members 20 has an arcuate head portion 22, and a conical tail portion 24 with an arcuate annular surface 26 formed to receive the arcuate head portion 22 of another arm member in retaining arm B. Each of the arm members also has a central conical bore 28 which forms an aperture 30 having a lip 31 at the arcuate head 22. The conical bore 28 extends completely through the conical tail 24 of arm member As shown in FIG. 2, the arm members are positioned head to tail between the connector C and base 18. The lower portion of connector C has an arcuate annular surface 32 formed to receive the arcuate head 22 of the outermost arm member 20a. The base 18 has an arcuate top portion 34 which is received in the arcuate annular surface 26 of the innermost arm member 20h.
Cable D, which is attached to connector C at shaft 14, extends through a connector cavity 36, the central conical bore 28 of each arm member, and a cylindrical bore 38 in base 18.
The shape of arm members 20 makes them capable of substantially universal movement with respect to each other when cable D has no tension on it. The arcuate head portion 22 and the arcuate surface 26 of the arm members 20 have the same curvature. Thus, when cable D is slack and exerts no force on the arm members, arcuate head 22 of one arm member is received at arcuate surface 26 of another arm member, thereby placing the two arm members in relatively frictionless sliding contact with each other. In a somewhat similar manner, the shape of base 18 permits innermost arm member 20b to move with respect to base 18, and the shape of the lower portion of connector C permits movement of the outermost member 20a with respect to connector cap C. The arcuate top 34 of base 18 and the arcuate annular surface 26 of innermost arm member 20b have the same curvature, and when arcuate top 34 is received in the arcuate surface 26 the two members are placed in frictionless sliding contact. Similarly, the arcuate surface 32 in the lower portion of connector cap C has the same curvature as arcuate head 22 of outermost arm member 20a. When the arcuate head 22 of outermost member 20a is received in the arcuate surface 32 of connector C, the outermost arm member 200 and the connector C are placed in frictionless sliding contact.
The shape of bore 28 is also an important factor in achieving freedom of movement between arm members 20. As the arm members 20 move with respect to each other, the lip 31 of aperture 30 will deflect tension free cable D. The central bore 28 is conical to prevent cable D from becoming wedged between lip 31 and tail 24 and thereby assures unrestricted sliding contact between adjacent arm members 20. In a somewhat similar manner, connector C has cavity 36 which is substantially larger in diameter than cable D to permit deflection of tension free cable D as outermost member 20a moves with respect to connector C.
From the above description, it can be seen that retaining arm B is very flexible when cable D is slack.
Each of the arm members is in relatively frictionless contact with its adjacent arm members, and the structure of the arm members 20 permit substantially universal movement of the members 20 with respect to each other. Moreover, since cable D is made of metal or any other suitable flexible material which can withstand repeated use without wear, cable D will not lessen the flexibility of retaining arm B. However, if cable D is under tension, a force is applied to connector C and to each of the arm members 20. This force causes arcuate surface 32 to be moved into firm contact with arcuate head 22 of outermost arm member 20a. It also causes the arcuate head portion 22 of each of the other arm-members 20 to be placed in firm contact with the arcuate surface 26 of an adjacent arm member. The arcuate surface 26 of innermost arm member 20b placed in firm contact with the arcuate top 34 of base 18 by the same force. In this manner, each of the arm members 20 is frictionally engaged and thereby rendered immobile with respect to each other, the connector C, and the base 18. Retaining arm B thus becomes rigid to hold surgical retractor T in place.
The tension on cable D is controlled by operating apparatus E. Cable D extends through central bore 38 of base 18 and into cylinder 40 through a first cylinder aperture 42. The cylinder 40 is mounted beneath base 18 in such a way that aperture 42 is aligned with bore 38. In actual practice, of course, the base 18 and the cylinder 40 may be constructed as a single element of this invention to avoid any alignment problems.
A piston 44 within cylinder 40 is attached to an end 46 of cable D. The piston 44 has a diameter very slightly less than the inside diameter of cylinder 40 and divides cylinder 40 into a first fluid-tight chamber 48 and a second fluid-tight chamber 50.
A second cylinder aperture 52 receives a communicating means, such as flexible hose 54, to connect chamber 50 to valve means 56. In FIG. 2, an additional hose 55 is shown connected to line 54 for a purpose to be hereinafter explained. The valve means 56 is a conventional three-way valve which alternately connects chamber 50 to the outside atmopshere and to a supply of pressurized fluid. A communicating means, such as flexible hose 58, is provided to connect valve means 56 with the supply of pressurized fluid such as a compressed air tank 88 (FIG. 1), as will be more fully explained. Normally, the fluid used will be air, but any suitable fluid may be employed.
When valve means 56 is in the position schematically represented in FIG. 2, pressurized fluid will pass into chamber 50 of cylinder 40. The fluid is prevented from escaping through aperture 42 by sealing means 60. The pressure of the fluid in chamber'50 will cause piston 44 to move downward until the pressures in chambers 50 and 48 have been equalized. As piston 44 moves downward, it places cable D under tension and thereby causes retaining arm B to become rigid.
As previously mentioned, valve means 56 can also connect chamber 50 to the outside atmosphere. In the schematic representation of valve means 56 in FIG. 2, this is accomplished by rotating the valve 56 to move the passage 62 of valve means 56 ninety degrees clockwise. In this position, the valve permits the pressurized fluid in chamber 50 to exhaust through hose 54 and an exhaust line 64 into the atmosphere. As the fluid leaves chamber 50, the piston 44 is moved upwardly until the pressure in the chamber 50 is essentially atmospheric pressure. When piston 44 has moved up, cable D will no longer be under tension and retaining arm B will be flexible.
The operating apparatus E is also provided with. adjustable mounting means 66 to permit the placement of the surgical retaining device at any point along the edge of a table 68 or other working surface. An upper mounting member 70 and a lower mounting member 72 extend from cylinder 40. The lower mounting member 72 has a threaded aperture 74 which receives threaded bolt 76. An operator may position the surgical retaining device by placing upper mounting member 70 over a top surface 78 of table 68 and sliding the surgical retaining device to a desired position along table 68. The bolt 76 is then tightened until it comes into contact with a lower surface 80 of table 68. In this manner, the surgical retaining device is held at the desired position.
FIG. 1 illustrates the preferred use of the surgical retaining device. However, other arrangements of the apparatus are within the scope of this invention as are other uses of the disclosed device.
In FIG. 1, two retaining arms B holding surgical retractors T are mounted on table 68 by the adjustable mounting means 66. Hoses 54 and 55 connect each chamber 50 of each cylinder 40 to the valve means 56 (FIG. 2) which is enclosed in a valve housing 82 (FIG. 1). The hose 58 connects valve means 56 in the housing 82 to the supply of pressurized air 88 or a similar source of fluid under pressure. Foot pedals 84 and 86 which protrude through valve 82 are exemplary of means to actuate valve means 56. When foot pedal 86 is depressed, valve means 56 is rotated or otherwise moved to connect chambers 50 to the supply of pressurized air 88 causing the pistons 44 to move downward or in a direction to tighten the cable D, thereby causing each of the arm members B to become rigid. When foot pedal 84 is depressed, the valve means 56 connects chambers 50 and exhaust line 64. When that occurs, since the air or other fluid in chambers 48 is then greater than atmospheric pressure, the pistons 44 are moved upwardly or in a direction to loosen or slacken the cable D. The slackening of the cable D causes retaining arms B to become flexible and movable to various selected positions.
Before a surgeon makes an incision 90 in the body of a patient 92, foot pedal 84 is momentarily depressed to make arms B flexible. The arms B are then placed along the edges of table 68. However, once the incision 90 has been made and the retractors T are to be employed, the surgeon positions the retractors T so that they will hold the sides of incision 90 apart. Foot pedal 86 is then momentarily depressed to make retaining arms B rigid and hold retractors T firmly in place. Once the retaining arms B are rigid, the surgeon may take his foot off the pedal 86, and the arms B will remain rigid until pedal 84 is actuated. The surgeon can thus move around without concern for holding the retractors, and he is free to work on the patient without anyone in his way.
As an alternative, it should be recognized that the valve means 56 may be of a spring-loaded type which would always return to the rigid or holding position shown in FIG. 2. In such case, only pedal 84 would be needed to rotate or move valve 56 when it was desired to make the arms B flexible and movable for changing the positions of the retractors T. Also, it is to be noted that each arm B may be separately controlled with a separate valve 56 for each arm B, if so desired. Any number of arms B and retractors T therewith may be employed at a time, and they may be separately or jointly operated. Also, various types of retractor members T may be used, depending upon the area of the incision or other factors. For this reason, the retractors T are preferably replaceable and are also illustrated.
The foregoing disclosure and description of the invention are illustrative and explanatory thereof, and various changes in the size, shape, and materials as well as in the details of the illustrated construction may be made without departing from the spirit of the invention.
I claim: 1. A surgical retaining device for holding a surgical instrument in place, comprising:
a base having a bore therethrough; a surgical instrument connector adapted to be attached at its top portion to a surgical instrument; a plurality of arm members, each having a bore therethrough, an arcuate head portion, and a conical tail portion with an arcuate annular surface to receive the head portion of another arm member, said arm members being positioned head to tail between the connector and the base and with adjacent members pivotable with respect to each other; and a flexible cable affixed at its first end to the bottom portion of the connector and extending through the bores of the arm members and base whereby exerting a force on a second end of said cable holds the arm members rigidly together and the surgical instrument in place. 2. The structure set forth in claim 1, wherein: said base has an arcuate top portion; and said surgical instrument connector has an arcuate annular surface in its bottom portion. 3. The structure set forth in claim 1, wherein: said arcuate head portions and said arcuate annular surfaces of said arm members have the same curvature to provide sliding contact between adjacent arm members. 4. The structure set forth in claim 1, wherein: said bores through said arm members are conical. 5. A fluid actuated apparatus for controlling the rigidity of a hollow, jointed surgical arm comprising:
a flexible cable attached at its first end to an end of a surgical arm and extending through the hollow portion of said arm; a piston attached to a second end of the cable; a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure;
valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and
means for communicating fluid between the valve means and the second cylinder aperture whereby supplying pressurized fluid to the second cylinder aperture depresses the piston, exerts a force on a second end of the flexible cable, and holds the surgical arm rigid.
6. A surgical apparatus for holding a surgical instrument in place, comprising:
a plurality of arm members each having a central bore therethrough and each being pivotable relative to other arm members;
a surgical instrument having a connector attached thereto and positioned at one end of the plurality of arm members;
a flexible cable having a first end and a second end,
with the first end affixed to said connector and extending through the bores of said arm members; and
fluid actuated means operably connected to the second end of said cable for alternately pulling and slackening said cable to hold said arm members frictionally in contact with each other so that they cannot move relative to each other when the cable is tightened, but permitting said arm members to move relative to each other when the cable is slackened for thereby controlling the mobility of said arm members and the surgical instrument therewith.
7. The structure set forth in claim 3, wherein said fluid actuated means comprises:
a piston attached to the second end of said cable;
a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure;
valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and
means for communicating fluid between the valve means and the second cylinder aperture.
8. The structure set forth in claim 6, wherein:
said valve means is actuated by a foot pedal.
9. The structure set forth in claim 6, further comprismeans for adjustably mounting one extremity of said arm members on a surgical table.