Surgical retractor and method of retracting

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BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to retractors for use during surgery and, more particularly, for use in retracting ribs and adjacent tissue during surgery of the thorax.

2. Description of Related Art

During surgery it is frequently necessary to retract tissue, bone or other body material in order to facilitate access to and visualization of the surgical site. This is particularly true in surgery of the thorax. If access to the chest cavity is sought between the ribs, both the chest wall tissue and the ribs must be retracted to provide an opening large enough for insertion of surgical instruments and to allow visualization of the chest cavity, either directly through the incision or through an endoscope, microscope or other visualization device. In certain surgical procedures, such as coronary bypass grafting, it may be desirable to both lift the chest wall anteriorly and spread the ribs superiorly and inferiorly, for example, to harvest one or both of the internal mammary arteries located on the interior of the chest wall. During the same surgical procedure, it may be desirable, in addition to lifting and spreading the ribs, to only spread the ribs, depending upon the surgical manipulations to be performed.

Although many surgical retractor designs have been proposed, there remains a need in the art for a retractor that is able to perform various functions while having minimum size, few parts, and high ease of use.

SUMMARY OF THE INVENTION

A surgical retractor constructed according to the invention comprises a frame and first and second retractor blades coupled to the frame, the retractor blades having retraction surfaces configured to engage an incision in a patient's body. The first and second retractor blades are relatively movable toward or away from each other along a first axis to position the blades closer to or farther away from each other. A foot is coupled to the frame or one of the blades and has a support surface configured to engage a surface of the patient's body adjacent the incision. An actuator is provided for imparting relative movement to the retractor blades along the first axis. The foot acts as a support base and one of the blades moves relative to the frame to lift one side of the incision above the other, thereby facilitating a variety of surgical procedures, including, for example, accessing the underside of the chest wall to harvest the right or left internal mammary artery, repair or replacement of the mitral and aortic valves, proximal anastamosis of arterial conduits to the aorta and distal anastamosis of the conduits to coronary arteries, and any of various other procedures requiring access to the heart, great vessels, lungs, or other thoracic contents.

According to one specific preferred embodiment, at least one of the retractor blades is coupled to the frame so as to be rotatable with respect thereto about a second axis which is generally perpendicular to the first axis. The actuator moves the blades apart which, due to the foot acting a support base, causes the one blade to rotate with respect to the frame, such rotation occurring in a direction that lifts the side of the incision engaged by the rotating blade.

According to another specific embodiment, the foot preferably is movable with respect to the frame to permit adjustment of the relative position of the foot and the frame, such adjustment occurring along a third axis which is transverse, and preferably perpendicular to the first and second axes.

According to yet another specific embodiment, one of the retractor blades is rotatable about a second axis with respect to the frame and is coupled thereto so as to be movable between rotatable and non-rotatable positions. Locating the retractor blade in the non-rotatable position configures the retractor for spreading of the ribs (i.e., without lifting), while locating the blade in the rotatable position configures the retractor for lifting and spreading of the ribs.

A method of retracting a portion of a patient's body according to the invention comprises steps of positioning first and second retractor blades against opposite sides of an incision formed in a patient's body, the retractor blades being coupled to a frame so as to be relatively movable toward or away from each other along a first axis, and providing a foot configured to contact a surface of the patient's body adjacent the incision, the foot being coupled to the frame so as to be adjustable with respect thereto along a direction which is transverse to the first axis. The position of the foot is adjusted with respect to the frame to place the foot against the surface of the patient's body adjacent the incision, and relative movement is imparted to the first and second blades to simultaneously move the blades apart along the first axis and lift one side of the incision with respect to the other side of the incision.

Other features, benefits and advantages of the invention will become apparent from the following detailed description of preferred embodiments thereof, taken in conjunction with the accompanying drawing Figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a surgical retractor constructed according to a preferred embodiment of the invention, the retractor configured for use in lifting one side of an incision formed in a patient's body with respect to an opposite side of the incision;

FIG. 2 is an exploded perspective view of the retractor of FIG. 1;

FIG. 3 is a perspective view of the surgical retractor of FIG. 1 configured for use in spreading the opposite sides of an incision formed in a patient's body, wherein an accessory clamp supporting an instrument is attached to the retractor;

FIG. 4 is an exploded perspective view of the retractor of FIG. 3, without the accessory clamp;

FIG. 5 is a sectional schematic view showing the retractor of FIG. 1 inserted into an incision formed in a patient's body;

FIG. 6 is a sectional schematic view showing the retractor of FIG. 5 being used to lift one side of the incision with respect to the other side of the incision;

FIG. 7 is a sectional schematic view showing the retractor of FIG. 3 inserted into an incision formed in a patient's body;

FIG. 8 is a sectional schematic view showing the retractor of FIG. 7 being used to spread the opposite sides of the incision;

FIGS. 9A is an enlarged perspective view of the accessory clamp and instrument shown in FIG. 3;

FIGS. 9B and 9C are perspective views of additional instruments that may be used with the accessory clamp of FIG. 9A;

FIG. 10 is a perspective view of an accessory clamp constructed according to an alternative embodiment of the invention and various auxiliary instruments which may be supported by the clamp;

FIG. 11 is a perspective view of a retractor blade and blade coupling component constructed according to an alternative embodiment of the invention; and

FIG. 12 is a perspective schematic view of the retractor of FIG. 1 being used to lift one side of an incision formed in a patient's chest so as to provide access to the internal mammary artery.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

With reference to FIGS. 1 and 2, a surgical retractor constructed according to a preferred embodiment of the invention is indicated generally by the reference numeral 10. The retractor 10, as depicted in FIG. 1, is configured to lift one side of an incision formed in a patient's body with respect to an opposite side of the incision, for example, an incision formed between adjacent ribs in a patient's chest. The retractor 10 includes a frame 20 and first and second retractor blades 30, 40 configured to engage opposite sides of the incision. The retractor blades 30, 40 are coupled to the frame 20 so as to be relatively movable toward or away from each other. A foot 100 for contacting the patient's body adjacent the incision is also coupled to the frame 20.

In the preferred and illustrated embodiment, the frame 20 comprises a frame member 22 which may be in the form of an elongated bar having opposite ends 24, 26. The retractor blades 30, 40 are coupled to the frame member 22 so as to be relatively movable toward or away from each other along a first axis A1. The frame member 22 preferably is straight, although it may have a curved, bent or other configuration.

The preferred configuration of the first retractor blade 30 comprises a generally C-shaped blade element 32 having a lower retraction surface 34, a central retraction surface 36, and an upper end 38. The upper end 38 of blade element 32 is preferably shaped with a curvature extending away from the lower surface 34 to allow pivoting motion of the blade with minimal trauma to tissue. The illustrated blade element 32 is configured to engage a portion of a rib and adjacent body tissue located at one side of the incision. To facilitate such engagement, the retraction surface 36 of the blade element 32 is preferably provided with one or more indexing tabs 39 which project away from surface 36 and effectively divide the surface into upper and lower sections. In use, the section of the retraction surface 36 disposed below the tabs 39 (as viewed in FIG. 1) cooperates with surface 32 to receive and retract a portion of a patient's rib, while the section of the retraction surface 36 disposed above the tabs 39 cooperates with surface 32 to receive and retract soft tissue of the chest wall located anterior to the ribs.

The preferred configuration of the second retractor blade 40 comprises a generally L-shaped blade element 42 having a lifting surface 44, a retraction surface 46, and an upper end 48. The illustrated blade element 42 is designed to lift one side of the incision with respect to an opposite side of the incision and is configured to engage a portion of a rib and adjacent body tissue located at the side of the incision to be lifted. The retraction surface 46 of the blade element 42 is preferably provided with one or more indexing tabs 49 which are formed the same as tabs 39 of blade element 32 and project away from surface 46 to define upper and lower sections thereof. Thus, in use, the section of the retraction surface 46 disposed below the tabs 49 receives and retracts and lifts a patient's ribs while the section of the retraction surface 46 disposed above the tabs 49 receives and retracts soft tissue of the chest wall located anterior to the ribs.

The first and second retractor blades 30, 40 are coupled to the frame 20 by coupling structure extending between each blade and the frame. In the preferred construction, the blade element 32 is coupled to the frame member 22 by a coupling arm indicated at reference numeral 50 having one end 52 secured to the frame member 22 and another end 54 detachably secured to the blade element 32. The coupling arm 50 preferably has an articulated construction and includes an inner portion 56 adjacent frame member 22 and an outer portion 58 pivotally attached to portion 56 by a hinge 60. The outer portion 58 pivots relative to the inner portion 56 about an axis passing through the hinge 60 which, in the illustrated embodiment, is generally parallel to the axis A1. The end 54 of the coupling arm is pivotally attached to the outer portion 58 by a hinge 62 so as to pivot about an axis generally parallel to that of hinge 60. The end 54 is provided with an opening 64 configured for detachably securing a mounting pin 66 provided on the blade element 32. Any suitable detachable connection may be used to mount the blade element 32 to the end 54 of the coupling arm 50. For example, the opening 64 may contain a spring-biased detent (not shown) that snaps into a circumferential groove provided on the mounting pin 66. Other mechanisms may be used to lock the blade element 32 to the coupling arm 50, for example, a bayonet-type connection. The blade element 32 is preferably rotatable relative to the end 54 about an axis passing through pin 66 to positively engage the ribs and soft tissue and evenly distribute the load thereon.

The blade element 42 is coupled to the frame member 22 by a coupling arm indicated at reference numeral 70. The coupling arm 70 has one end 72 movably coupled to the frame member 22 and an opposite end formed as a link member 74 configured to detachably mount the blade element 42. The coupling arm 70 preferably has an articulated construction and includes an inner portion 76 located adjacent frame member 22 and an outer portion 78 pivotally attached thereto by a hinge 80. The outer portion 78 pivots relative to the inner portion 76 about an axis passing through the hinge 80 which, in the illustrated embodiment, is generally parallel to the axis passing through the hinge 60 and the axis A1. The link member 74 has an opening 88 configured for detachably receiving a mounting pin 90 provided on the blade element 42. The pin 90 of the blade element 42 may be attached to the link member 74 in the same manner that pin 66 of blade element 32 is attached to the opening 64 of coupling arm 50. The blade element 42 also is preferably rota