US 3873081 A
A surgical support, especially for use in prone position operations on an operating table having a kidney rest, has a transverse base bar with a transverse series of apertures therein. Clamps secure the base bar removably to the kideny rest. A left support has a first approximately arcuately curved plate arranged with a lower portion near the mid-portion of the kidney rest and rising to an upper portion near one end of the kidney rest. A pair of uprights form a column secured to the first plate and have lugs engageable with selected pairs of the apertures. Similarly, a right support has a second, arcuately curved plate arranged with its lower portion near the mid-portion of the kidney rest and rising to an upper portion near the other end of the kidney rest. Another pair of uprights form a column secured to the second plate and have lugs engageable in apertures in the base bar. The supports can receive massive pads, can be raised and lowered with the kidney rest, and can be moved transversely toward and away from each other.
Description (OCR text may contain errors)
United States Patent [191 Smith 1 1 Mar. 25, 1975 1 1 SURGICAL SUPPORT Robert H. Smith, 538-48 Ave, San Francisco, Calif. 94121 221 Filed: Jan. 7, 1974 21 Appl. No: 431,385
Primary E.\'aminer-Roy Lake Assistant Examiner-Neil Abrams Attorney, Agent, or FirmLothrop & West [57 ABSTRACT A surgical support, especially for use in prone position operations on an operating table having a kidney rest, has a transverse base bar with a transverse series of apertures therein. Clamps secure the base bar removably to the kideny rest. A left support has a first approximately arcuately curved plate arranged with a lower portion near the mid-portion of the kidney rest and rising to an upper portion near one end of the kidney rest. A pair of uprights form a column secured to the first plate and have lugs engageable with selected pairs of the apertures. Similarly, a right support has a second, areuately curved plate arranged with its lower portion near the mid-portion of the kidney rest and rising to an upper portion near the other end of the kidney rest. Another pair of uprights form a column secured to the second plate and have lugs engageable in apertures in the base bar. The supports can receive massive pads, can be raised and lowered with the kid ney rest, and can be moved transversely toward and away from each other.
2 Claims, 3 Drawing Figures 1 SURGICAL SUPPORT In performing surgical operations with the patient in the prone or face down position, the hazards are always serious and are substantially increased for patients that are overweight or even obese. Pressure on nerves and blood vessels in the area of the inguinal ligaments is seriously adverse. There is considerable extra difficulty in gas anesthetizing such patients because of undue pressure upon and transmitted by the diaphragm. There is also considerable danger of excessive local support pressures which may affect the adjacent tissues and vascular system permanently and adversely.
It is therefore an object of the invention to provide a surgical support for use in patient-prone operations which will support the patients body in a much more favorable condition than has her'efore been generally available.
Another object of the invention is to provide a means which can be utilized in connection with existing equipment to afford an improved prone position support for operative patients.
Another object of the invention is to provide a surgical support that is very simple and straightforward and can easily be utilized by anyone without any substantial prior instruction.
A further object of the invention is to provide a surgical support thatwill effectively support a patient in a fashion which does not produce deleterious results.
An additional object of the invention is to provide a surgical support that is particularly useful in connection with prone patient operations and on patients of extra size or of obese character.
A further object of the invention is in general to provide an improved surgical support especially for protracted, prone position operations.
Other'objects, together with the foregoing, are attained in the embodiment of the invention described in the accompanying description and illustrated in the accompanying drawings, in which:
FIG. 1 is a perspective view of a broken-away portion of an operating table showing the surgical support of the invention utilized therewith;
FIG. 2 is a partial, transverse section on a vertical plane of the structure of FIG. 1 of some anatomical references being included; and
FIG 3 is a partial plan of the structures shown in FIG. 2.
The surgical support pursuant to this invention can be embodied in alarge number of ways depending upon the particular equipment with which it is to be utilized and depending somewhat on thepreferences of individual operators. In the main, however, the fundamental arrangement is designed for use with the customary operating table, generally designated 6, having intermediate its end portions a kidney rest 7 of the usual kind. This is primarily a curved plate of rectangular plan which extends transversely of the table and occupies a small fraction of the table length and in the general region of the kidneys of a patient utilizing the table in the usual position. The kidney rest 7. is an elevator member for it is mounted on an elevating arrangement 8, so that it can be moved out of the plane of the operating table to a position extending a substantial distance above the table.
In accordance with the present invention, I provide for use with the kidney rest a base bar 9 which conveniently is a metallic member of rather rigid characteristics having provided through its top face a plurality of apertures 10 arranged transversely of the operating table and preferably being evenly spaced and located midway between the sides of the base bar.
To secure the detachable base bar in position. there are provided hooked screw clamps 11 disposed near the ends of the base bar and arranged with clamp plates 12 and adjusting fastening nuts 13 so that the base bar can be firmly secured to the kidney rest or can easily be detached therefrom.
Adapted to be disposed in a selected, transverse position on the base bar is a first or left support, generally designated 16. This includes a smoothly curved or arcuate plate 17 having a length of about 7 inches and of about in arcuate extent and having a width W; that is, a dimension along the length of the operating table of about 2 to 2V2 inches. The plate is curved about a center to one side of the center of the operating table, in most instances, so that the lower portion of the plate is near the center of the kidney rest whereas the upper or higher portion of the plate is adjacent one end of the kidney rest. The plate is carefully curved to a radius R of about six inches and has rounded corners and edges. The plate is supported on a pair of uprights 21 and 22 constituting a column at the upper part permanently fixed to the left plate 17 and at the lower end turned down to provide lugs 23 defining shoulders acting as stops to support the weight imposed on the left support.
In a similar fashion, there is likewise provided a second or right support 26 having a plate 27 also arcuate about a center and having a width of about 2 to 2% inches and occupying about a sixth of a circle in extent. The plate 27 is in symmetrical relationship with the plate 17. Secured to the plate 27 and supporting it at any desired transverse location, are uprights 28 and 29, constituting a column and each having a lug 31 forming a shoulder at the bottom so that the uprights can be introduced into selected pairs of apertures and will rest on the base bar 9. ln this way the plate 27 can be position'ed as desired toward or away from the center of the operating table. Both of the members 17 and 27 in use are provided with very soft covering pads 33 (FIG. 2).
When the table is being prepared for operation in prone position on a regular or especially on a relatively obese patient, the columns are positioned with respect to each other and with respect to the center of the table in such locations that the transverse distance between the plates 17 and 27 will be approximately correct for the individual. The plates are relatively narrow and when so positioned are effective to engage the patients body only along the iliac crests 34 and the overlying tissue and the pads which overlie the metal are so arranged that they go along the iliac crests themselves and to but not medial to the anterior superior iliac spine 36. The positions and dimensions especially the width, and the angles are situated carefully to aviod putting any pressure on the area of the inguinal ligament. The kidney rest is raised or lowered to such an extent that preferably, and especially in the case of an obese person, the body of the patient is supported on the iliac crest as a sort of fulcrum and his abdomen is lifted to an elevation above the table. Thus, the abdomen is supported against gravity by suspension muscle power alone and the abdomen is not subject to any compression. The patients chest is usually supported at a relatively high elevation ona transverse pile of sheets or the like, the whole aim being to leave the abdominal wall unrestricted and to permit the abdomen to hang freely. Then it is easy to ventilate the patient and to administer anesthesia. The patients back, in side elevation, is changed from its normal, concave, lordotic curvature into a relatively flat or even slightly convex curvature. The kidney rest can be raised or lowered in an appropriate amount to produce this indicated result. The relatively heavy weight taken by the plates 17 and 27 is not deleteriously experienced since the weight is immediately borne by the pads and these pads are away from critical points of the body that might be seriously adverse.
The narrow width of the support plates and the location, extent, curvature and positioning are such as to prevent them restricting or compressing any of the adjacent blood vessels or nerves so that even a protracted operation with this equipment does not interfere with the blood supply nor does it produce localized pressure points from which nerve damage and eventual necrosis might be expected.
When the operation has been completed and the patient removed, the added base bar can readily be removed by removing the clamps so that the usual operating table remains for subsequent use. The entire mechanism is subject to sterilization and the pads themselves can readily be changed between operations so that the present device not only assists substantially in improving the welfare of patients undergoing prone l. A surgical support for use with a patient in prone position on an operating table having a transverse kidney rest including a vertically movable elevator member comprising a base bar having a plurality of apertures therein in a line transversely of said table, means for securingsaid base bar in transverse alignment on said elevator member, a left support including a first upwardly concave curved plate having a lower end near but spaced upwardly from and laterally of the center of said base bar and extending to an upper end generally over one end of said base bar, a right support including a second upwardly concave curved plate having a lower end near but spaced upwardly from and laterally of the center of said base bar to leave a gap between said lower ends of said first and second plates and extending to an upper end generally over the other end of said base bar, each of said first and second plates having dimensions restricting said plates to engagement from below with said prone patient substantially only in the areas of his iliac crests, and support means secured to 'said first and second plates including columns extending from the lower faces of the plates engageable in selected ones of said apertures and having a height effective to position said plates above said base bara distance sufficient to support above said base bar said prone patients abdomen when depending by gravity toward said gap.
2. A device as in claim 1 in which each of said means including a column has a pair oflugs engagable in a pair of said apertures,