1. Field of the Invention
The present invention relates to surgical retractor apparatus and in particular to self-retaining surgical retractor apparatus which retract a surgical incision, retain the incision open and retract organs and tissues inside the body through the open incision.
2. General Background
Surgical "retraction" is the drawing back of body tissue. When the operation involves making an incision, the incision itself often must be retracted, and during surgery, internal organs and tissues are intermittently retracted through the opening created by the retracted incision.
An assistant's fingers are capable retractor paddles; however, greater technical ease should be available through the use of mechanical retractor systems. Mechanical retractor systems can be divided into two major groups: externally mounted "fixed" to the operating table, and self-retaining retractors.
Since the tactile sensitivity present in the assistant's fingers during hand retraction is lacking in mechanical retractor systems, the use of mechanical retraction increases the risk of tissue trauma; however, the mechanical system can be more stable and possesses infinite endurance.
The mechanical retractor systems attached to the operating table present the same type of physical obstruction to the surgeon's movement as presented by the assistant's body, arms and hands since the externally fixed retractor systems mimic the assistant's body, arms and hands through the use of a vertical column, supporting arm(s) or ring and retractor paddles attached thereto. Examples of this art include the systems illustrated in U.S. Pat. Nos. 4,949,707; 4,971,038 and 4,971,037. The retractor paddles, support arms or ring and vertical column in these apparatus are adjustable in multiple planes and axes of motion; however, these retractor paddles are not all independently adjustable in the vertical plane. Movement of a support arm or ring of these apparatus necessitates movement of all retractor paddles attached thereto.
Despite the advantage of adjustability in all planes and axes of motion, the externally mounted retractors all share these disadvantages:
A. Size and location of numerous pieces create an impediment to movement of surgeon and his assistant(s); PA1 B. Length of time required for assembly; PA1 C. Require assistance in assembly, and can break sterile field; PA1 D. Retractor paddles are not independently adjustable in the vertical plane; PA1 E. Planned patient movement requires time consuming disassembly and reassembly; PA1 F. Involuntary patient movement can injure retracted tissue and organs; PA1 G. Packing material (sponges) often required to cushion retractor paddles can cause injury; PA1 H. Size and number of pieces increases cost; PA1 I. Technical surgical ease restricted by height, location, size and multiplicity of pieces; PA1 J. Disassembly in an emergency is time consuming; PA1 K. Size of pieces makes sterilization difficult; and PA1 L. Paddles are not interchangeable between different manufacturers. PA1 A. Internal organ and tissue retractor paddles can neither be moved independently nor in all planes and axes of motion creating risk of tissue injury and limiting technical surgical ease; PA1 B. Incision retractor paddles concentrate stress or overlap or are difficult to set up and move risking tissue injury; PA1 C. Incision retractor paddles and internal organ and tissue retractor paddles are not discrete; therefore, neither the incision retraction function nor internal organ and tissue retraction function are carried out with a high degree of surgical ease. PA1 D. Uneven opening of the incision; PA1 E. Assistance required; PA1 F. Non-conformity to many surgical procedures; PA1 G. Non-conformity to many patient sizes; and PA1 H. Do not accommodate retractor paddles supplied by other manufacturers.
Ideally, mechanical retractors both externally mounted and self-retaining need to provide for internal organ and tissue retraction, be quickly and easily assembled, positioned and repositioned in all planes and axes of motion, present as little obstruction to the surgeon's movement as possible, protect the sterile field, diminish the risk of tissue trauma, and yet be stable enough to function adequately while reducing the need for assistance.
Self-retaining retractors present less obstruction to the surgeon's movement and do not risk breaking the sterile field; however, the state of the art in self-retaining retractors falls far short of satisfying the surgeon's need for internal organ and tissue retractor paddles that can be quickly, independently, easily and safely adjusted without assistance in all planes and axes of motion.
The following patents illustrate self-retaining retractors that are capable of retraction of the surgical incision only or retraction of a body orifice only: U.S. Pat. Nos. 4,924,857; 2,893,378; 2,701,562; and 1,919,120.
The following patents illustrate self-retaining retractors that provide for retraction of an incision plus the retraction of organs and tissue through the opening created by the incision; however, the retraction paddles in these apparatus are not adjustable in more than one plane and perhaps one axis of motion: U.S. Pat. Nos. 4,421,107; 3,394,700; 3,129,706; 2,812,758; 2,623,517; and, 2,053,868.
Certain of the advantages and disadvantages of self-retraining retractors available on the market such as the "Weitlaner" (scissor action); "Brunschwig"; "Wilkinson" and "Wexler" (ring type); and "Balfour" (slide action) are discussed in the medical literature. Fackler, M. L., "Extending the Usefulness of Self-Retaining Retraction," The American Journal of Surgery, Vol. 129, pp. 712-715, June 1975.
Self-retaining retractors that have attempted to provide for internal organ and tissue retraction through the open incision have failed to permit quick, independent, easy and safe adjustment of internal organ and tissue retractor paddles in all planes and axes of motion, and in effect the prior art is either ineffectual or unsafe, or both since these paddles are not easily adjustable in the vertical plane and such internal organ and tissue retractor paddles must traverse over (or through) internal tissue before reaching the desired location along the retractor handle and/or frame. The retractor paddle depth is not highly variable and the retractor paddles' location on the retractor frame is limited.
This invention merges the advantages inherent in the externally mounted retractor systems with the advantages inherent in the self-retaining retractors while eliminating the disadvantages of each.
This invention achieves the above stated advantages while eliminating numerous disadvantages by recognizing that prior self-retaining retractors could not safely and effectively retract an incision and retract organs and tissue through the open incision utilizing paddles which are not discrete and which can only be attached on or inside the retractor frame. Another reason prior self-retaining retractors cannot safely and effectively retract both the incision and internal organs lies in the fact that the incision retractor paddles also stabilize the apparatus, and effective stabilization requires the prior apparatus to use multiple incision retractor paddles occupying a large part of the retractor frame capacity. This limitation is absent in the externally mounted retractors where retractor arms or ring are stabilized some distance away from the incision so that fewer incision retractor paddles are required, and incision retractor paddles are discrete, therefore, the arms or ring have ample space to accommodate incision retractor paddles and internal organ retractor paddles.
Due to the above described inherent design deficiencies, the prior self-retaining retractors share many of the following disadvantages:
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