TISSUE RETRACTOR, RETRACTION MODULES, AND ASSOCIATED METHODS

A modular retractor may include a first body portion that houses a distraction mechanism for opening and closing a first arm and a second arm. A first pivoting member may be coupled to a distal end of the first arm and a second pivoting member may be coupled to a distal end of the second arm, for example. A first blade attachment mechanism may be coupled to the first pivoting member and a second blade attachment mechanism may be coupled to the second pivoting member. The first and second blade attachment mechanisms may be configured to couple to first and second blades and be independently inclinable. Various embodiments may include at least one connection point for connecting to at least one additional retractor module. Various embodiments may include at least one quick connect coupler for connecting to a snap on table mount.

FIELD

The present technology is generally related to medical devices to assist a surgeon during treatment of musculoskeletal disorders, and more particularly to a surgical system and method for accessing a surgical site to facilitate treatment. More particularly, the present disclosure is directed to a surgical retractor system including a primary retractor assembly and a secondary retractor assembly that are configured for various approaches to the spine, including for example, anterior, lateral, and oblique surgical techniques.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, how-ever, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, discectomy, laminectomy and implantable prosthetics. Surgical retractors may be employed during a surgical treatment to provide access and visualization of a surgical site. Such retractors space apart and support tissue and/or other anatomical structures to expose anatomical structures at the surgical site and/or provide a surgical pathway for the surgeon to the surgical site.

SUMMARY

This disclosure describes a plurality of different embodiments and modules for use as a modular retractor system. The system may use any of the variously disclosed blades, extendable blades, and dilators. Additionally, this disclosure describes a quick connect and release coupler for securing the modular retractor system to a table mount.

In an aspect, this disclosure describes a modular surgical retractor system including a modular retractor configured to couple and uncouple from a plurality of different add on modules. The retractor system may be designed for enabling access to a surgical site and/or forming an operative corridor, for example. In various embodiments, the retractor system may include a modular retractor having a longitudinal axis extending in a longitudinal direction and a lateral axis extending from a first lateral end to a second lateral end in a lateral direction, for example. In various embodiments, the modular retractor may include a first body portion that houses a distraction mechanism, a first arm and a second arm pivotally coupled together, and a first handle coupled to the first arm and a second handle coupled to the second arm, for example. In various embodiments, a first pivoting member may be coupled to a distal end of the first arm and a second pivoting member may be coupled to a distal end of the second arm, for example. In various embodiments, a first blade attachment mechanism coupled to the first pivoting member and a second blade attachment mechanism coupled to the second pivoting member, the first and second blade attachment mechanisms being configured to couple to first and second blades, respectively. In various embodiments, a first actuator may be operably coupled to the distraction mechanism for opening and closing the first arm and the second arm, for example. In various embodiments, a second actuator for adjusting the angulation of the first pivoting member, and a third actuator for adjusting the angulation of the second pivoting member may be provided, for example. In various embodiments, the modular retractor may include at least one table mount quick release coupler.

DETAILED DESCRIPTION

In one aspect, exemplary embodiments describe a retractor system100for use with anterior, lateral, and oblique surgical techniques. At least one use of retractor system100is to assist in the preparation of a surgical site to enable a surgeon to access a space between vertebrae of patient's spine. The retractor system100may assist a surgeon in accessing a space between vertebrae by enabling highly controlled dilation of the paraspinous muscles with a set of nested dilators and retraction of the various fibers and tissues at the surgical site with the use of a plurality of independently movable and inclinable blades.

Referring generally toFIGS.1-8exemplary retractor systems for enabling access to a surgical site are disclosed.FIG.1is a perspective view of an exemplary embodiment of a retractor system100including a primary retractor assembly200and a secondary retractor assembly300in accordance with the principles of the disclosure. Retractor system100is highly customizable and modular. For example, the primary retractor assembly200may be used as a standalone retractor system without the use of secondary retractor assembly300. Secondary retractor assembly300is configured to couple and uncouple on as needed basis with the primary retractor assembly200and secondary retractor assembly300can, for example, use one or two arms each having a corresponding blade.

Exemplary embodiments may include a primary retractor assembly200configured to open and close a first arm105and a second arm107along a first path of travel. The first path may be an arcuate path or segment defined by the length and geometry of the arms105and107and a handle pivoting mechanism101c(seeFIG.8) configured to enable first handle101aand second handle101bto open and close. Other paths of travel are contemplated depending upon the geometry of the arms105,107and the relative location of the handle pivoting mechanism101c. The primary retractor assembly200may include a handle assembly having first and second handles101a,101bthat are operably coupled to the first and second arms105,107and configured to open and close the first and second arms105,107. For example, the first handle101amay be coupled to the first arm105and the second handle101bmay be coupled to the second arm107. The first and second arms105,107may be operably coupled to first and second pivoting members105a,107aat a distal end thereof, respectively. The first and second pivoting members105a,107amay be configured to operably couple to first and second blades,205,207(seeFIG.2), respectively, by a corresponding blade attachment mechanism as will be explained in more detail below during the discussion ofFIGS.9-13B.

In the exemplary embodiment, a first actuator105band a second actuator107bare configured to adjust the angulation of first blade205and second blade207, respectively. For example, the first actuator105bmay be configured to actuate the first pivoting member105ato adjust the angulation of first blade205with respect to the first arm105. Similarly, the second actuator107bmay be configured to actuate the second pivoting member107ato adjust the angulation of second blade207with respect to second arm107. In the exemplary embodiment, the first pivoting member105amay be configured to independently adjust the angulation of first blade205with respect to the first arm105upon actuation of the first actuator105b. Similarly, the second pivoting member107amay be configured to independently adjust the angulation of the second blade207with respect to the second arm107upon actuation of the second actuator107b. In disclosed embodiments, the first and second pivoting members105a,107amay each include a corresponding pin and socket mechanism enabling the pivoting members to pivot on a pin aperture199(see, e.g.,FIG.8). Additionally, the first and second pivoting members105a,107amay each include a corresponding blade attachment mechanism at a distal end thereof which will be explained in more detail below when discussingFIGS.9-13.

In the exemplary embodiment, the primary retractor assembly200may include a primary actuator102that is configured to actuate a primary pinion gear mechanism210(seeFIG.7) to provide a precise and controlled mechanical advantage to open and close the first arm105and second arm107. For example, the primary pinion gear mechanism210may include a primary pinion gear210afixedly coupled to the primary actuator102such that the primary actuator102may rotationally translate the primary pinion gear210a. The primary pinion gear210amay be engaged with the secondary pinion gear210b, e.g., the primary pinion gear210aand secondary pinion gear210bmay be toothed gears that are meshed with one another at a contact location (not illustrated). Furthermore, secondary pinion gear210bmay be fixedly coupled to tertiary pinion gear210cwhich may be axially aligned with secondary pinion gear210band disposed directly beneath secondary pinion gear210b(seeFIG.8). For example, secondary pinion gear210bmay share an axis of rotation with tertiary pinion gear210cand secondary pinion gear210bmay be relatively larger in diameter than tertiary pinion gear210c. This arrangement may resemble a two stage gear box or the like that allows for an increase in applied torque. In other embodiments, primary pinion gear mechanism210may be any other similar planetary gear system as would be understood by a person having ordinary skill in the relevant art. For example, those with skill in the relevant art will readily recognize that the particular diameter, tooth sizing, and tooth spacing of the primary pinion gear210arelative to the particular diameter, tooth sizing, and tooth spacing of the secondary pinion gear210brelative to tertiary pinion gear210cmay control the amount of force (mechanical advantage or torque) that is applied to open and close the first and second arms105,107.

In the exemplary embodiment ofFIG.8, tertiary pinion gear210cmay be meshed with a first curved rack portion210a-2and a second curved rack portion210b-2disposed opposite the first curved rack portion210a-2. First curved rack portion210a-2may be fixedly coupled to second arm101band second curved rack portion210b-2may be fixedly coupled to first arm101a. Each of curved rack portions210a-2and210b-2may feature a plurality of teeth extending along the curved body thereof and facing tertiary pinion gear210c. The first curved rack portion210a-2and second curved rack portion210b-2may be meshed with the teeth of tertiary pinion gear210con opposite sides of tertiary pinion gear210c. In this way, when primary actuator102is rotated, primary pinion gear210arotates which in turn rotates secondary pinion gear210band tertiary pinion gear210c. In turn, tertiary pinion gear210cengages teeth on each of curved rack portions210a-2and210b-2and causes handles101a,101bto open or close. In the disclosed embodiment, when tertiary pinion gear210capplies force to first curved rack portion210a-2, the first curved rack portion210a-2may extend through first handle101aat a corresponding first handle aperture210a-1. Similarly, when tertiary pinion gear210capplies force to second curved rack portion210b-2, the second curved rack portion210b-2may extend through second handle101bat a corresponding second handle aperture210b-1.

In disclosed embodiments, the primary pinion gear mechanism210may be operably coupled to the first and second handles101a,101band configured to simultaneously open and close the first and second arms105,107along a first path of travel. For example, the primary actuator102may rotationally translate the primary pinion gear mechanism210in a clockwise direction which in turn rotationally translates the first arm105and second arm107such that they move away from one another, i.e., they open as explained above. Likewise, the primary actuator102may rotationally translate the primary pinion gear mechanism210in a counter clockwise direction which in turn rotationally translates the first arm105and second arm107such that they move towards one another, i.e., they close as explained above. Also as explained above, the particular diameter of primary, secondary, and tertiary pinion gears210a,210b, and210cmay be adjusted to provide the desired amount of mechanical advantage or torque to open and close first and second arms101a,101b.

In disclosed embodiments, primary retractor assembly200may include a primary retention lever104disposed between the first and second handles101a,101bthat is configured to engage the primary retractor assembly200to control opening and closing of the first and second arms105,107and thereby retain the first and second arms105,107in a specific position. In the disclosed embodiment, primary retention lever104may frictionally engage curved rack portion210b-2to control opening and closing of the first and second arms. In other embodiments, the primary retention lever104may engage the primary pinion gear mechanism210at an outside portion of the circumference of the primary pinion gear210a(seeFIG.7) to thereby control and/or prevent rotation of the primary pinion gear210a. For example, the primary retention lever104may lock the primary pinion gear mechanism210in place to control opening and closing of the first and second arms. In some embodiments, the primary retention lever104may have a biasing element (not illustrated) that causes the primary retention lever104to naturally urge an angled tip portion of the body of the primary retention lever104against a portion of the primary pinion gear mechanism210. For example, a spring may naturally urge an angled tip portion of primary retention lever104to engage with a toothed portion of secondary pinion gear210b. Additionally, the primary retention lever104may be moved from an engagement position where primary retention lever104is in direct contact with the primary pinion gear mechanism210to a disengaged position where primary retention lever104is not engaged with the primary pinion gear mechanism210. For example, an end user such as a surgeon may depress primary retention lever104with their thumb to toggle primary retention lever104between the engaged position and the disengaged position. Furthermore, some embodiments may have a toggle feature (not illustrated) for maintaining the primary retention lever104in either of the engaged or disengaged positions.

In disclosed embodiments, the primary retractor assembly200may include a first table mount portion106adisposed adjacent the first handle101aand coupled to a body200a(seeFIG.5) or housing of the primary retractor assembly200. Similarly, the primary retractor assembly200may include a second table mount portion106bdisposed adjacent the second handle101band coupled to the body or housing of the primary retractor assembly200. The first and second table mount portions106a,106bmay each be attached to a surgical table (not illustrated) for fixing the primary retractor assembly200(and/or the retractor system100) in a fixed location in three dimensional space. In example embodiments, the primary retractor assembly200may be attached to a surgical table by at least one of the first and second table mount portions106a,106bor by both.

At least one advantage of securing the primary retractor assembly200to a surgical table may be for enhanced stability and the even transfer of resultant forces from the primary actuator102through the first and second arms105,107to the first and second blades205,207and vice versa. For example, when the primary retractor assembly200is fixed to the surgical table and the primary actuator102is translated to open the first and second arms105,107the primary pinion gear mechanism210may apply a precise controlled amount of force to open the first and second arms105,107to thereby gently retract the tissue of a patient in a controlled manner. Additionally, when the primary retractor assembly200is fixed to the surgical table, it may be easier for an end user to independently move only one of the handles101a,101bwith respect to the surgical table. When moving only one of the handles101a,101bthe corresponding arm105,107may move relative to the other. This scenario and functionality may assist a surgeon with precise surgical techniques where it may be desirable to independently move either of the first and second arms105,107along the first path of travel independently with respect to the other.

Disclosed embodiments described above may be configured to independently open and close the first arm105along the first path of travel by movement of the first handle101arelative to the second handle101band independently open and close the second arm107along the first path of travel by movement of the second handle101brelative to the first handle101a. Additionally, because the primary pinion gear mechanism210includes a primary gear210aand a secondary gear210boperably coupled to the first and second handles101a,101bdisclosed embodiments may be configured to provide a controlled mechanical advantage to open and close the first and second arms105,107along the first path upon actuation of the primary actuator102.

In accordance with disclosed embodiments, a secondary retractor assembly300may be configured to couple and uncouple from the primary retractor assembly200via a first recessed key portion220adisposed on the first arm105and a second recessed key portion220bdisposed on the second arm107(seeFIG.2). Each of recessed key portions220a,220bmay include a groove having a geometry that facilitates engagement of the primary retractor assembly200with the secondary retractor assembly300while also operably allowing the opening and closing of arms105,107. For example, the secondary retractor assembly300may have a corresponding outdent (e.g., dovetail) on an underside thereof configured to mate with an indent (e.g., dovetail groove) of the primary retractor assembly200. Additionally, secondary retractor assembly300may be fixed to primary retractor assembly200by turnkey113. Turnkey113may project from a central portion of the primary retractor assembly200through a central aperture113a(seeFIG.6) of the secondary retractor assembly300. In a first position, turnkey113may urge the primary retractor assembly200and secondary retractor assembly300towards each other and maintain direct contact to fixedly engage them to one another. Conversely, in a second position, turnkey113may be rotated such that turnkey113is aligned with central aperture113aand therefore has no bearing surface to urge the primary retractor assembly200and secondary retractor assembly300towards each other. Thus, in the second position the primary retractor assembly200and secondary retractor assembly300may be disengaged from one another. Other embodiments may use alternate means to securely engage the primary retractor assembly200with the secondary retractor assembly300, e.g., as fasteners, hexagonal grooves, channel locks, magnets, etc. provided that the primary retractor assembly200and the secondary retractor assembly300are securely engaged with one another such that resultant forces acting on the retractor system100may transfer between primary retractor assembly200and secondary retractor assembly300and also by extension to a surgical table via table mount portions106aand/or106b.

Secondary retractor assembly300may have a body portion300agenerally defining a first channel109dand a second channel111d. Secondary retractor assembly300may be configured to independently extend and contract a third arm109and a fourth arm111, respectively. Although two channels109d,111dand two arms109,111are illustrated it is contemplated that secondary retractor assembly300may have any number of suitable channels and arms. Additionally, it is contemplated that only a single arm, e.g., third arm109or fourth arm111will be provided in some surgical settings.

In disclosed embodiments, the secondary retractor assembly300may include a first channel109dhaving a curved or arcuate shape for operably retaining third arm109therein where third arm109has a corresponding curved or arcuate shape. The third arm109may be configured to extend outwards from first channel109dand contract within first channel109d. Similarly, secondary retractor assembly300may include a second channel111dhaving a curved or arcuate shape for operably retaining fourth arm111therein where fourth arm111has a corresponding curved or arcuate shape. The fourth arm111may be configured to extend outwards from first channel111dand contract within second channel111d. The geometry of the first channel109dand third arm109may define a second path of travel, e.g., an arcuate path of travel defined by the arcuate shapes of the first channel109dand third arm109. Similarly, the geometry of the second channel111dand fourth arm111may define a third path of travel, e.g., an arcuate path of travel defined by the arcuate shapes of the second channel111dand fourth arm111.

In disclosed embodiments, the secondary retractor assembly300may include a third actuator109coperably disposed adjacent the first channel109dand operably configured to extend and contract the third arm109via a pinion gear mechanism (not illustrated) having the same or similar components as primary pinion gear mechanism210of primary retractor assembly200. For example, a toothed pinion P1(seeFIG.7) may be coupled to actuator109cand may operably engage a corresponding rack portion (not illustrated) on an adjacent surface of arm109to linearly translate, e.g., curvo-linear, third arm109forward and backward, i.e., extend and withdraw or translate away from the operative corridor. Similarly, the secondary retractor assembly300may include a fourth actuator111coperably disposed adjacent the second channel111dand operably configured to extend and contract the fourth arm111via a pinion gear mechanism (not illustrated) having the same or similar components as primary pinion gear mechanism210of primary retractor assembly200. For example, a toothed pinion P2(seeFIG.7) may be coupled to actuator111cand may operably engage a corresponding rack portion (not illustrated) on an adjacent surface of arm111to linearly translate, e.g., curvo-linear, fourth arm111forward and backward, i.e., extend and withdraw or translate away from the operative corridor. For example, actuator109cmay rotationally translate P1in a clockwise direction which in turn linearly translates the third arm109arm such that it extends outward from channel109d. Similarly, actuator109cmay rotationally translate P1in a counter clockwise direction which in turn linearly translates the third arm109arm such that it contracts inward into channel109d. Likewise, actuator111cmay rotationally translate P2in a clockwise direction which in turn linearly translates the fourth arm111arm such that it extends outward from channel111d. Similarly, actuator111cmay rotationally translate P2in a counter clockwise direction which in turn linearly translates the fourth arm111such that it contracts inward into channel109d. Accordingly, in disclosed embodiments, the third arm109is configured to independently extend and contract along a second path of travel upon actuation of the third actuator109c, and the fourth arm111is configured to independently extend and contract along a third path of travel upon actuation of the fourth actuator111c.

In disclosed embodiments, the third and fourth arms109,111may be operably coupled to third and fourth pivoting members109a,111aat a distal end thereof, respectively. The third and fourth pivoting members109a,111amay be configured to operably couple to third and fourth blades209,211, respectively (seeFIG.3) by a corresponding blade attachment mechanism as will be explained in more detail below during the discussion ofFIGS.9-13B. In the exemplary embodiment, a fifth actuator109band a sixth actuator111bare configured to adjust the angulation of third blade209and fourth blade211, respectively. For example, the fifth actuator109bmay be configured to actuate the third pivoting member109ato adjust the angulation of third blade209with respect to the third arm109. Similarly, the sixth actuator211bmay be configured to actuate the fourth pivoting member211ato adjust the angulation of fourth blade211with respect to fourth arm111. In the exemplary embodiment, the third pivoting member109amay be configured to independently adjust the angulation of third blade209with respect to third arm109upon actuation of the fifth actuator109b. Similarly, the fourth pivoting member211amay be configured to independently adjust the angulation of fourth blade211with respect to the fourth arm111upon actuation of the fourth actuator111b.

In disclosed embodiments, the third and fourth pivoting members209a,211amay each include a corresponding pin and socket mechanism enabling the pivoting members209a,211ato pivot on a pin disposed in a corresponding pin aperture199(see, e.g.,FIG.8). Additionally, the third and fourth pivoting members209a,211amay each include a corresponding blade attachment mechanism at a distal end thereof which will be explained in more detail below when discussingFIGS.9-13.

In disclosed embodiments, the secondary retractor assembly300may include a first retention lever109econfigured to engage the third arm109to control extension and contraction of the third arm109along the second path of travel and a second retention lever111econfigured to engage the fourth arm111to control extension and contraction of the fourth arm111along the third path of travel. First and second retention levers109e,111emay have the same or similar components as described above with respect to primary retention lever104.

First retention lever109eand second retention lever111emay frictionally engage with the third arm109and fourth arm111, respectively, to control and/or prevent the extension and contraction of the third arm109and fourth arm111. For example, first retention lever109eand second retention lever111emay engage with a rack portion on an outside adjacent surface of the third arm109and fourth arm111, respectively, through an aperture302(seeFIG.8) projecting through a portion of channels109d,111d, respectively. In some embodiments, first and second retention levers109e,111emay include a biasing element having the same or similar components as explained above with respect to primary retention lever104. In some embodiments, first retention lever109emay engage a corresponding pinion gear mechanism operably associated with actuator109cto thereby control and/or prevent rotation of the corresponding pinion gear mechanism. Similarly, second retention lever111emay engage a corresponding pinion gear mechanism operably associated with actuator109cto thereby control and/or prevent rotation of the corresponding pinion gear mechanism.

Referring generally toFIGS.1,7, and9-11the pivoting members105a,107a,109a, and111amay each include the same or similar components and features. For example, pivoting members105a,107a,109a, and111amay each include a corresponding pin and socket mechanism. The pin and socket mechanism of pivoting members105a,107a,109a, and111amay be adjustable by way of actuators105b,107b,109b, and111bsuch that an inclination of pivoting members105a,107a,109a, and111amay be independently adjustable with respect to arms105,107,109, and111, respectively. In some embodiments, translation of actuators105b,107b,109b, and111bmay cause a corresponding element, such as an internal pin, set screw or the like, to urge pivoting members105a,107a,109a, and111ato pivot outwards on a corresponding pin within a corresponding socket thereby enabling travel of pivoting members105a,107a,109a, and111ainwards and outwards with respect to arms105,107,109, and111, respectively. In some embodiments, pivoting members105a,107a,109a, and111amay pivot outwards, for example, within a range of 0-25 degrees, and more particularly within a range of 0-15 degrees with respect to arms105,107,109, and111.

Pivoting members105a,107a,109a, and111amay include corresponding blade attachment mechanisms105f,107f,109f, and111f, respectively (seeFIG.7). The blade attachment mechanisms105f,107f,109f, and111f, may each include a dovetail groove having a geometry that facilitates secure engagement with a corresponding one of blades205,207,209, and211. For example, blade attachment mechanisms105f,107f,109f, and111f, may have an indent portion on an inside surface thereof facilitating secure engagement with an outdent portion disposed on an outside surface of blades205,207,209, and211respectively. In some embodiments, the dovetail grooves of the blade attachment mechanisms105f,107f,109f, and111f, are tapered, and may for example be conically tapered, from one end to the other end to further securely retain blades205,207,209, and211. In other embodiments, the blade attachment mechanisms105f,107f,109f, and111f, may take alternate shapes, and have varying configurations provided that the shape thereof can securely engage with a corresponding one of blades205,207,209, and211. For example, an indent such as a square channel, hexagonal channel, or the like dimensioned to match to a corresponding outdent. Additionally, the blade attachment mechanisms105f,107f,109f,111fmay have an outdent portion (rather than an indent portion as illustrated) and blades205,207,209, and211may have an indent portion (rather than an outdent portion as illustrated).

Referring generally toFIGS.9-13Bexemplary blades, shims, and dilators for use with, e.g., retractor system100, are disclosed. Referring toFIGS.9-11, an exemplary blade, e.g., first blade205is illustrated. It shall be understood that characteristics of first blade205may be found throughout each of blades205,207,209, and211and the foregoing description is described with respect to first blade205solely for convenience of explanation. Moreover, although first blade205is illustrated as a relatively long and narrow curved blade205it can take any shape suitable for any particular type of surgery application. Indeed, it is contemplated that retractor system100is suitable for a multitude of different blades having different lengths, widths, and cross-sectional shapes thereof that can couple and uncouple to secondary blades, tools, and shims. For example, relatively shorter and wider blades having generally planar surfaces are contemplated. Furthermore, blade205may feature any number or type of secondary coupling members where shims, for example, may couple thereto. In at least one embodiment, blade205may have a relatively narrow portion at one end and fan out to a relatively wider portion at the opposite end, i.e., the blade205may have a width that increases along the length thereof from one end to the other end. Additionally, blade205may include channels, grooves, indents, outdents, etc. for fixation of secondary members such as shims, light fixtures other diagnostic tools such as endoscopes, electrodes, temperature sensors, suction devices, and etc.

In the exemplary embodiment, blade205has a proximate side205a, a distal side205bopposite the proximate side, an outside surface205cand an inside surface205dopposite the outside surface205c. The proximate side205amay be operably coupled to a distal end of pivoting member105avia an engagement feature205edisposed on the outside surface205cof blade205, for example. In some embodiments, blade205may include an elastic material allowing it to deflect at least partially. Additionally, in some embodiments a blade removal instrument may be required to install and/or remove blade205from a blade attachment mechanism.

In the disclosed embodiment, engagement feature205eis the outdent portion of a dovetail groove, i.e., the dovetail. In other embodiments, engagement feature205emay be a lap joint, tongue and groove type joint, a doweled butt joint, etc. In the exemplary embodiment, engagement feature205efeatures an indent portion205f. Indent portion205fmay be a socketed portion facilitating secured engagement and retention with blade attachment mechanism105f. For example, indent portion205fmay house a spring clip (not illustrated) to hold blade205in secure engagement with blade attachment mechanism105f. In embodiments that include a spring clip, a corresponding release tool or lever may be inserted into the indent portion205fto release the biasing force of the spring and thereby uncouple the blade205from blade attachment mechanism105f. In other embodiments, engagement feature205emay have an aperture for running a diagnostic tool such as an electrode or endoscope there through. In some embodiments, blade205may be conductive such that it may communicate with an external diagnostic tool (not illustrated). For example, blades may include a conductive material such as a metal like copper and be conductive and/or have terminals for electrical conduction between conductive pads placed external to retractor system100. In some embodiments, blade205may include partially conductive features, e.g., a semiconductor and/or other passive electrical devices such as resisters, diodes, and etc. In other embodiments, blade205may be an insulator such that it does not interfere with electrical signal processing of the aforementioned electrical devices.

In the exemplary embodiment, first blade205may include a longitudinal groove205gextending longitudinally along the inside surface205dthat is sized accordingly to house and retain a corresponding pin205ptherein. In at least one embodiment, pin205pmay securely attach to a vertebra of a patient's spine by socketing in to the vertebrae or screwing into the vertebrae. In some embodiments, pin205pmay be a conductive pin having a sensor at a distal end thereof or pin205pmay be a hollow pin that houses electrical components and wiring therein. In other embodiments pin205pis purely mechanical in nature. In at least one embodiment, pin205pmay be used to facilitate attachment of a shim205sto an inside surface205dof blade205. Shim205smay laterally extend from a side surface of the blade205and include a gripping portion at a proximate side thereof. Shim205smay also extend from the blade205to increase the operative length thereof and/or extend laterally to increase the operative width thereof. In some embodiments, the first, second, third, and fourth blades105,107,109,111are each configured to operably couple to a corresponding first, second, third, and fourth shim laterally projecting from a side portion thereof. In other embodiments, diagnostic tools such as an electrode, endoscope, fiber optic, light emitting diode or the like may extend along groove205g. In other embodiments still, a second groove (not illustrated) similar to groove205gmay be provided so that a combination of the above described features may be used. For example, groove205gmay house a corresponding pin205pand the second groove (not illustrated) may enable a diagnostic tool or the like to extend along the second groove (not illustrated).

Referring toFIG.12an exemplary set of nested dilators400is illustrated. Exemplary dilators400may include a neuro monitoring sensor or the like to help guide insertion of the dilators through muscle fibers. The set of nested dilators400may include a series of dilators having alternating circular and ellipsis (oval) cross sectional shapes or oblong cross-sectional shapes. For example, a first dilator401having a relatively small circular cross section is surrounded by a second dilator403having an ellipsis, or oval shaped cross section. The size and shape of the circular cross section of the first dilator401may be defined by a radius extending from a center point thereof and the shape of the ellipsis cross section may be defined by a major axis and a minor axis extending perpendicularly with respect to one another from a center point thereof.

In the exemplary embodiment, the second dilator403may, for example, have an ellipsis or elliptical cross section, or other cross sections, for example bi-convex or elongated and substantially flat sides with convex ends, and may have a curvature but may not be circular or elliptical, some such embodiments having a minor axis roughly corresponding to the radius of the circular cross section of first dilator401. For example, the minor axis of the ellipsis cross section of the second dilator403may only be slightly larger than the radius of the circular cross section of the first dilator401, and the major axis of the ellipsis cross section of the second dilator403may be relatively larger than the radius of the circular cross section of the first dilator401and the minor axis of the ellipsis cross section of the second dilator403. In some embodiments, the major axis of the ellipsis cross section of second dilator403may be roughly twice as large as the radius of the circular cross section of first dilator401. In some embodiments, the major axis of the ellipsis cross section of the second dilator403may be twice as large as the minor axis of the ellipsis cross section of the second dilator403. At least one advantage to this arrangement of alternating cross sections is that the second dilator403may be insert around the first dilator401between fibers of a muscle, e.g., the paraspinous muscle, such that the major axis of the second dilator403is initially arranged parallel with the fibers of the paraspinous muscle and can therefore be insert around the first dilator401. Once inserted around the first dilator401, second dilator403can be rotated such that the major axis of second dilator403is perpendicular to the orientation of the fibers of the paraspinous muscle thereby gently separating the fibers by orienting the second dilator403such that the major axis area of the second dilator403gently and controllably applies pressure to separate the fibers.

A third dilator405having a circular cross section may be insert around the second dilator403. The size and shape of the circular cross section of the third dilator405may be defined by a radius extending from a center point thereof. For example, the third dilator405may have a circular cross-sectional shape having a radius roughly corresponding to the major axis of the second dilator403. The third dilator405can freely rotate around the second dilator403and features a circular cross section having a radius that is only slightly larger than the cross-sectional major axis of the second dilator403. A fourth dilator407having an ellipsis cross section (oval) may be insert around the third dilator405. The fourth dilator407may be defined by an ellipsis cross section having a minor axis that is only marginally larger than the cross sectional radius of the third dilator405, i.e., the cross sectional minor axis of the fourth dilator roughly corresponds to the cross sectional radius of the third dilator405. Additionally, the cross-sectional major axis of the fourth dilator407is relatively larger than the cross sectional radius of the third dilator405and the cross sectional minor axis of the fourth dilator. In some embodiments, the major axis of the ellipsis cross section of fourth dilator407may be roughly twice as large as the radius of the circular cross section of third dilator405. In some embodiments, the major axis of the ellipsis cross section of the fourth dilator407may be twice as large as the minor axis of the ellipsis cross section of the fourth dilator407. At least one advantage to this arrangement of alternating cross sections is that the fourth dilator407may be insert around the third dilator405between fibers of a muscle, e.g., the paraspinous muscle, such that the major axis of the fourth dilator407is initially arranged parallel with the fibers of the paraspinous muscle and can therefore be insert around the third dilator405. Once inserted around the third dilator405, fourth dilator407can be rotated such that the major axis of fourth dilator407is perpendicular to the orientation of the fibers of the paraspinous muscle thereby gently separating the fibers by orienting the fourth dilator407such that the major axis area of the fourth dilator407gently and controllably applies pressure to separate the fibers.

FIG.13Ais a top down view of the set of nested dilators400as explained above. As illustrated a set of nested dilators400that may sequentially gently separate fibers of a muscle are illustrated. The set of nested dilators400may be insert sequentially and rotated on an as needed basis to gently dilate an anatomical feature.FIG.13Bis a top down view of blades205,207,209, and211. As illustrated blades205,207are relatively larger in width than blades209, and211.

FIGS.14-19illustrate various positions and modes of operation of retractor system100in use with the set of nested dilators400. For example, inFIG.14, retractor system100is shown in a closed position where arms105,107are closed and surround, at least partially, the set of nested dilators400. Additionally, arms109,111are fully extended and surround, at least partially, the set of nested dilators400. InFIG.14, the inside surfaces of blades205,207,209, and211(not labelled inFIG.14) together surround and contact an outside surface of a fourth dilator407(not labelled inFIG.14). For example, the blades205,207,209, and211surround and contact a set of nested dilators400. For example still, a side surface of each of blades205,207,209, and211contacts an adjoining side surface of a different adjacent blade of the blades205,207,209, and211thereby forming a closed shape.FIG.17is a side view of the arrangement ofFIG.14.

InFIG.15, the set of nested dilators400is removed and the retractor system100is adjusted to a first partially opened position where arms105,107are partially opened and arms109,111are partially contracted.FIG.18is a side view of the first partially opened arrangement ofFIG.15. InFIG.16, the retractor system is adjusted to a second partially opened position where arms105,107are further opened and arms109,111are further contracted.FIG.18is a side view of the second partially opened arrangement ofFIG.16.FIG.19shows the angulation of each blade being adjusted outward approximately 15 degrees from the side view ofFIG.18.

Additional Retractor Embodiments

Referring generally toFIGS.20-81an example modular retractor system including a modular retractor500and various add on retractor modules600,700,800,900,1000, and1100for use with modular retractor500are disclosed. In some embodiments, modular retractor500may include the same, substantially the same, and/or similar components and functionality as primary retractor100and the associated blades, dilators, and secondary retractor assembly300. Accordingly, those with skill in the art will understand the general principles, modes of operation, and associated methods of each example embodiment may be combined and/or modified in view of the skill of a person of ordinary skill in the art.

With reference toFIGS.20-28Ca modular retractor500for enabling access to a surgical site, an adjustment tool10, a table mount70, and a table mount rack module60are disclosed.FIGS.20-21are perspective views of a modular retractor500andFIG.22is a top down view of the modular retractor500showing various axes and directions of operation.FIG.23is a perspective view of an adjustment tool10for use with disclosed modular retractor500embodiments.FIGS.24-25are exploded parts views of a modular retractor500.FIGS.26A-26Eare various views of a distraction mechanism50for use with disclosed modular retractor500embodiments.FIGS.27A and27Bare various views of a modular retractor500coupled to a table mount70.FIGS.28A-28Care various views of a table mount rack module60.

Modular retractor500is highly customizable and may be considered modular for reasons that will be readily apparent and explained in further detail below. For example, the modular retractor500may be used as a standalone retractor system without the use of additional add on modules or modular retractor500may be used with any of the disclosed modules discussed herein unless the context clearly suggests otherwise.

Modular retractor500may be configured to distract and retract a first arm505along a path of travel and a second arm507along a different path of travel. The various paths of travel may be an arcuate path or segment defined by the length and geometry of the arms505and507, respectively, and a handle pivoting mechanism515(seeFIG.26D). Handle pivoting mechanism515may be configured to enable first handle501aand second handle501bto open and close, for example. Handle pivoting mechanism515may be a pin, screw, or the like, for example. Other paths of travel than those specifically shown are contemplated and those paths of travel may depend upon the geometry of the arms505,507and the relative location of the handle pivoting mechanism515. The modular retractor500may include a handle assembly having first and second handles501a,501bthat are removably coupled to the first and second arms505,507and configured to open and close the first and second arms505,507. For example, the first handle501amay be coupled to the first arm505and the second handle501bmay be coupled to the second arm507. Additionally, the arms505,507may extend through side channels of the body503, respectively, and/or be pivotable relative to body503and/or be operably coupled to body503. In various embodiments, the first handle501aand second handle501bmay be removed and are held in place by first handle connection pin508aand second handle connection pin508b, for example. In various embodiments, the connection pins508a,508bmay be a pin, screw, knob, turnkey, and/or retaining fastener that a surgeon may quickly remove to uncouple the handle501a,501b, for example. Furthermore retractor500may include a table mount506extending in the lateral direction from body503. At least one advantage of having the first and second handles501a,501bbe removable is greater freedom in performing a surgery due to the reduced structure adjacent a target surgical location, for example. For example still, after a surgeon has retracted a patient tissue, the surgeon may remove the handles501a,501bto prevent bumping into them.

In various embodiments, the first and second arms505,507may be coupled to first and second pivoting members505a,507aat a distal end thereof, respectively. The first and second pivoting members505a,507amay be configured to operably couple to first and second blades,40(seeFIG.22), respectively, by a corresponding blade attachment mechanism505c,507cas will be explained in more detail below. In the example embodiment, a first actuator505band a second actuator507bare configured to adjust the angulation of first blade40and second blade40, respectively. For example, the first actuator505bmay be configured to actuate the first pivoting member505ato adjust the angulation of first blade40with respect to the first arm505. Similarly, the second actuator507bmay be configured to actuate the second pivoting member507ato adjust the angulation of second blade40with respect to second arm507. In the example embodiment, the first pivoting member505amay be configured to independently adjust the angulation of first blade40with respect to the first arm505upon actuation of the first actuator505b. Similarly, the second pivoting member507amay be configured to independently adjust the angulation of the second blade40with respect to the second arm507upon actuation of the second actuator507b. In disclosed embodiments, the first and second pivoting members505a,507bmay each include a corresponding pin and socket mechanism enabling the pivoting members to pivot on a pin aperture199(see, e.g.,FIG.8).

As shown inFIG.22, modular retractor500may extend in a longitudinal direction from a proximal end500pto a distal end500din a longitudinal direction (or proximal-to-distal direction) parallel to longitudinal axis A-A. Additionally, modular retractor500may extend in a lateral direction (or widthwise direction) parallel to lateral axis B-B. The longitudinal axis A-A may be perpendicular to the lateral axis B-B and intersect at body503at a medial location of retractor500, for example. In various embodiments, and as shown by the Cartesian coordinate system inFIG.22A, the longitudinal direction may be understood as the X direction and the lateral direction may be understood as the Y direction. Furthermore, a depth and/or thickness of modular retractor may be understood as the Z direction or vertical direction when viewed in a plan view.

FIG.23is a perspective view of an adjustment tool10for use with disclosed modular retractor500embodiments. In the example illustration, adjustment tool10may include a drive end11and a handle end12, for example. Drive end11may have a size and shape configured to rotate various actuators of modular retractor500, for example. In various embodiments, drive end11may take the shape of a hexolobular drive end, a hex drive end, a torx drive end, a polygonal drive end, a square drive end, or the like. Similarly, actuators502,507b,505bmay take any corresponding shape, for example.

FIG.24is a top down exploded parts view of a modular retractor500andFIG.25is a perspective exploded parts view of a modular retractor500. In the example embodiment, arm505may include a rack portion505dat a distal end thereof and arm507may include a rack portion507dat a distal end thereof, for example. In various embodiments, rack portions505d,507dmay be curved and be disposed at different relative distances from the distal end of the respective handle505,507, for example. Additionally rack portions505d,507dmay be meshed with and movable by distraction mechanism50, for example. Distraction mechanism50may be operably drivable by actuator502, for example. Distraction mechanism50may include a plurality of gears to provide a mechanical advantage to open and close the arms505,507as will be explained in further detail below.

FIGS.26A-26Eare various views of a distraction mechanism50for providing a mechanical advantage to distract and retract arms505,507. Distraction mechanism50may principally be formed of a plurality of spur gears51,52,54,55, and a partial spur gear57that are meshed together and sized appropriately for providing a mechanical advantage to distract and/or retract arms505,507. For example, primary actuator502may be connected to first spur gear51and second spur gear52by shaft53, for example. In the example embodiment, primary actuator502, spur gears51,52, and shaft53are coaxially aligned in the vertical direction. Additionally, a partial spur gear57may attached to shaft53. Partial spur gear57may be understood as a portion and/or slice of a relatively large spur gear having a central axis of rotation coincident with shaft53, for example. In the example embodiment, partial spur gear57may have an axis of rotation coincident with shaft53, for example. Additionally, first spur gear51may be meshed with third spur gear54. In turn, third spur gear54may be connected to fourth spur gear55by shaft56. Third spur gear54, shaft56, and fourth spur gear55may be coaxially aligned. In the example embodiment, third spur gear54is a relatively large spur gear and fourth spur gear55is a relatively small spur gear. Those with skill in the art will understand this arrangement may be advantageous for providing a relatively great mechanical advantage to perform distraction and/or retraction of arms505,507, for example. In the example embodiment, fourth spur gear55may be meshed with partial spur gear57. In this way, distraction mechanism50may comprise a plurality of spur gears having various teeth and recesses that are meshed and/or interconnected to one another.

FIG.26Bis a top perspective view of a distraction mechanism50andFIG.26Cis an enlarged top perspective view of distraction mechanism50with some parts removed for ease of understanding. In the example embodiment, third spur gear54may include teeth54asymmetrically radially disposed on a side surface around the circumference of third spur gear54and a rack54bmay be radially disposed on a top surface of third spur gear54proximate the edge of spur gear54, for example. Primary pawl504may be configured to engage circular rack54bto allow spur gear54to rotate in a first direction (counter clockwise direction) and prevent third spur gear54from rotating in a second direction (clockwise direction). For example, primary pawl504may be disposed on a pivoting hinge and be biased such that a hook portion may be pushed downward against rack54bsuch that the hook portion is meshed within a valley between any pair of the teeth of rack portion54b, for example. In operation, an end user may rotate primary actuator502(via tool10, e.g.) counter clockwise such that primary pawl504moves in and out of the various valleys between teeth of rack portion54b. Notably, due to pawl504being biased against rack54b, pawl504may prevent third spur gear54from rotating in the clockwise direction. For example, as arms505,507are opened patient tissue may apply a closing force attempting to push arms505,507back towards a closed position and pawl504may prevent and/or suppress arms505,507from moving into a closed position. Additionally, in various embodiments pawl504may be depressible at a lateral end thereof opposite the hook portion that is engaged with rack54bsuch that the hook portion of pawl504is moved upward in the vertical direction and prevented from engaging with rack54bsuch that arms505,507may be closed if and when desired. Furthermore, inFIG.26Cit is shown that spur gear52is meshed with rack portion505dof arm505and rack portion507dof arm507. For example, rack portion507dis meshed with a distal side of spur gear52and rack portion505dis meshed with a proximate side of spur gear52. Accordingly, rotation of spur gear52in a first direction will cause arms505,507to distract outward by an equal amount and rotation of spur gear52in a second direction opposite the first direction will cause arms505,507to retract inward by an equal amount. Alternatively, an end user may squeeze handles501a,501bto cause distraction and/or retraction by an equal amount which will also cause rotation of the various gears of distraction mechanism50.

FIG.26Dis a bottom perspective view of distraction mechanism50andFIG.26Eis an enlarged bottom perspective view of distraction mechanism50. In the example embodiment, the underside of partial spur gear57is shown as being meshed with spur gear55and being rotatably engaged with drive shaft53. Additionally, suitable cutout portions505z,507zmay be provided in the first handle505and second handle507that allow partial spur gear57to rotate a suitable distance when expanding arms505,507such that partial spur gear57is fully contained within body503and does not clash with handles505,507, for example.

FIG.27Ais a top down view of a modular retractor500coupled to a table mount rack module60which is in turn coupled to a table mount70.FIG.27Bis a perspective view of a modular retractor500coupled to a table mount rack module60which is in turn coupled to a table mount70. In the example embodiment, the table mount70may be connected to and rigidly supported by a surgeons table via table mount portion73, for example. Arms72and71may be adjustable by way of adjustment knob74to position table rack module60at a suitable location, for example.

FIGS.28A and28Bare perspective views of a table mount rack module60.FIG.28Cis an exploded parts view of table mount rack module60. In the example embodiment, table mount rack module60may include an aperture64having a size and shape that corresponds to a size and shape of table mount arm506of modular retractor500, for example. Depressible lever65may be used to lock table mount arm506when table mount arm506is insert inside of aperture64, for example as shown inFIGS.27A and27B. Additionally, table mount arm506may slide in and out of aperture64to facilitate positioning modular retractor500, for example. Table mount module60may include a connection arm63, which may be insert into a corresponding aperture of table mount70, for example as shown inFIGS.27A and27Bto secure table mount rack module60to table mount70. Connection arm63may be rigidly secured to body portion66, for example. Additionally, extendable arm67may slide forward and backward through body66by a rack and pinion mechanism. For example, actuators61,62may be securely coupled to body66and may each have pinion portions61a,62ahaving teeth that engage with rack portion67aof extendable arm67. Accordingly, rotation of actuator61and/or actuator62may rotate pinion portions61aand/or62asuch that teeth of pinion portions61a,62acause extendable arm67to move forward and/or backward depending on the direction actuators61and/or62are rotated. Additionally, table mount rack module60may include a pawl68having a first hook portion68aand/or a second hook portion68b, for example. Pawl68may be pivotally coupled to body portion66at a pivot location66bby a pin, for example. Pivot location66bmay enable pawl68to be toggled between a first position where pawl68allows extendable arm67to move forward but prevents extendable arm67from moving backward in the opposite direction. Similarly, in various embodiments, pawl68may be toggled to a second position where pawl68allows extendable arm67to move backward but prevents extendable arm67from moving forward. In some embodiments, pawl68may be moved to a third position, in the middle of the first position and second position, where pawl68prevents extendable arm67from moving forward and backwards. For example, in some embodiments, and in a third position pawl68may lock extendable arm67from relative motion in the forward and backwards direction. Other embodiments may utilize a locking element (not illustrated) to secure extendable arm67in an appropriate position. In this way, table rack module60may facilitate the relative motion of modular retractor500forward and backward in a direction defined by axis D-D of extendable arm67. Additionally, table rack module60may facilitate the relative motion of modular retractor500from side to side in a direction defined by an extension direction C-C of table mount506(seeFIG.22), for example.

Referring generally toFIGS.29-34a first module600is disclosed.FIGS.29and30are top perspective views of a first module600andFIGS.31A and31Bare bottom perspective views of a first module600.FIG.32is an exploded parts view of a first module600andFIGS.33A-34are various perspective views of first module600coupled to modular retractor500.

In accordance with disclosed embodiments, first module600may be configured to couple and uncouple from modular retractor500at connection points503a, for example (seeFIG.20). In various embodiments, the first module600may have at least one corresponding connection point603aon an underside thereof (seeFIG.31A) configured to couple, connect, and/or mate with a connection point503aof the modular retractor500. In the example embodiment, connection points503aare indented apertures and connection points603aare outdented posts having a corresponding size and shape to one another, respectively. In some embodiments, connection points503a,603a, may have slotted rails and/or grooves to facilitate a connection and/or prevent rotation of first module600relative to modular retractor500, for example. Similarly, and in the example embodiment, one connection point of connection points603amay be shaped like a circular post and the other connection point603amay be shaped like an oval post to facilitate mating the first module600with modular retractor500in an appropriate orientation. Additionally, first module600may be locked to modular retractor500by lock513(seeFIG.20). Lock513may be pivotable such that in a locked position a flange portion of lock513may pivot into a locking aperture603eof first module600, for example. Similarly, in an unlocked position the flange portion of lock513may be unseated from aperture603e. Other embodiments may use alternate means to securely engage the modular retractor500with the first module600, e.g., as fasteners, hexagonal grooves, channel locks, magnets, etc. provided that the modular retractor500and the first module600are securely engaged with one another such that resultant forces acting on the modular retractor500may transfer between modular retractor500and first module600.

First module600may include a first arm605and a second arm607that extend through body603. First arm605may extend through body603through a first contoured channel603band second arm607may extend through body603through a second contoured channel603c, for example (seeFIG.32). In various embodiments, contoured channels603b,603cmay be L shaped channels. First module600may be configured to independently extend first arm605along a first path of travel and independently extend second arm607along a second path of travel by independent rack and pinion mechanisms, for example. The first path and second path may be an arcuate path or segment defined by the length and geometry of the arms605and607, for example. In various embodiments, the first path and second path may symmetrically fan out with respect to one another. Other paths of travel than those specifically shown are contemplated, e.g., a linear path.

First module600may include a table mount606extending laterally from a side surface thereof. Table mount606may facilitate the relative motion of first module600(and/or modular retractor500when coupled thereto) from side to side in a direction defined by an extension direction E-E of table mount606(seeFIG.34), for example. Table mount606may be securely coupled to sliding frame608. Sliding frame608may be configured to slide forward and backward through sliding frame aperture603dof body603, for example (seeFIG.32). Additionally, in various embodiments, sliding frame608may be configured to support first and second arms605,607at a bottom surface of first and second arms605,607proximate first pivoting member605aand second pivoting member607a, respectively (seeFIGS.31A and31B). In various embodiments, support portion609may be pivotable relative to sliding frame608by pivot point609a, for example. In various embodiments, the first arm605may include first post605fand second arm607may include second post607fthat extend through corresponding slotted apertures609b, respectively, of support portion609. In this way, and due in part to the size and geometry of the slotted apertures609b, support portion609may support both first arm605and second arm607while also enabling first and second arms605,607to be independently movable relative to one another, for example. In some embodiments, pivot point609amay be replaced by a non pivoting fastener such that first arm605and second arm607are not independently movable relative to one another (not illustrated) and distract and retract by equal amounts.

First module600may be configured to extend first arm605by activation of actuator601, e.g., by rotation of actuator601. Actuator601may be securely attached to body portion603and include a pinion portion601a(pinion gear and/or spur gear) having teeth that engage with and are meshed with curved rack portion605ddisposed on a side surface of first arm605, for example. Accordingly, rotation of actuator601may rotate pinion portion601asuch that teeth of pinion portion601acauses first arm605to move forward and/or backward depending on the direction actuator601is rotated. Additionally, first module600may include a first pawl604athat may be configured to engage the curved rack portion605edisposed on a top surface of first arm605, for example. First pawl604amay be configured to allow pinion portion601ato rotate in a first direction (counter clockwise direction) and prevent pinion portion601afrom rotating in a second direction (clockwise direction). For example, first pawl604amay be disposed on a pivoting hinge and be biased by a spring or the like such that a hook portion may be pushed downward against rack605esuch that the hook portion is meshed within a valley between any pair of the teeth of rack portion605e, for example. In operation, an end user may rotate actuator601(via tool10, e.g.) counter clockwise such that pawl604amoves in and out of the various valleys between teeth of rack portion605ewhile first arm605extends outward away from body603. Notably, due to pawl604ebeing biased against rack portion605e, pawl604amay prevent first arm605from being pushed in an opposite direction. For example, as arm605is distracted outward patient tissue may apply a closing force attempting to push arm605back towards body603and pawl604amay prevent and or suppress this closing force. Additionally, in various embodiments pawl604amay be depressible at a lateral end thereof opposite the hook portion that is engaged with rack605esuch that the hook portion of pawl604ais moved upward in the vertical direction and prevented from engaging with rack605esuch that arm605may be closed if and when desired.

First module600may be configured to extend second arm607by activation of actuator602, e.g., by rotation of actuator602. Actuator602may be securely attached to body portion603and include a pinion portion602a(pinion gear and/or spur gear) having teeth that engage with and are meshed with curved rack portion607ddisposed on a side surface of second arm607, for example. Accordingly, rotation of actuator602may rotate pinion portion602asuch that teeth of pinion portion602acauses second arm607to move forward and/or backward depending on the direction actuator602is rotated. Additionally, first module600may include a second pawl604bthat may be configured to engage the curved rack portion607edisposed on a top surface of second arm607, for example. Second pawl604bmay operate in the same, substantially the same, and/or similar manner as explained above with respect to first pawl604a. Accordingly, duplicative description will be omitted.

In various embodiments, the first and second arms605,607may be coupled to first and second pivoting members605a,607aat a distal end thereof, respectively. The first and second pivoting members605a,607amay be configured to operably couple to third blade45and fourth blade45, respectively, by a corresponding blade attachment mechanism605c,607c. In the example embodiment, a first blade actuator605band a second blade actuator607bare configured to adjust the angulation of blades45respectively (seeFIG.34). For example, the first blade actuator605bmay be configured to actuate the first pivoting member605ato adjust the angulation of blade233with respect to the first arm605. Similarly, the second actuator607bmay be configured to actuate the second pivoting member607ato adjust the angulation of blade234disposed therein with respect to second arm607. In the example embodiment, the first pivoting member605amay be configured to independently adjust the angulation of a blade with respect to the first arm605upon actuation of the first actuator605b. Similarly, the second pivoting member607amay be configured to independently adjust the angulation of a second blade with respect to the second arm607upon actuation of the second actuator607b. In disclosed embodiments, the first and second pivoting members605a,607amay each include a corresponding pin and socket mechanism enabling the pivoting members to pivot, for example.

Referring generally toFIGS.35-40a second module700for use with modular retractor500is disclosed.FIGS.35-36are various top perspective views of a second module700andFIGS.36-37are various bottom perspective views of a second module700for use with disclosed modular retractor500embodiments.FIG.39is an exploded parts view of a second module700andFIG.40is a top down view of a second module coupled to modular retractor500and a plurality of blades.

In accordance with disclosed embodiments, second module700may be configured to couple and uncouple from modular retractor500at connection points503a, for example (seeFIG.20). For example, the second module700may have at least one corresponding connection point703aon an underside thereof (seeFIG.38) configured to couple, connect, and/or mate with a connection point503aof the modular retractor500in the same, similar, and/or substantially the same manner as explained above. Accordingly, duplicative description will be omitted. Additionally, second module700may be locked to modular retractor500by lock513(seeFIG.20). Lock513may be pivotable such that in a locked position a flange portion of lock513may pivot into a locking aperture703eof second module700, in the same, similar, and/or substantially the same manner as explained above. Accordingly, duplicative description will be omitted.

Second module700may include an arm705that extends through body703. Arm705may extend through body703through a first contoured channel703b. Second module700may be configured to extend arm705along a path of travel by a rack and pinion mechanism, for example. The path of travel may be an arcuate path or segment defined by the length and geometry of arms705, for example. Other paths of travel than those specifically shown are contemplated, e.g., a linear path.

Second module700may include a table mount706extending laterally from a side surface thereof. Table mount706may facilitate the relative motion of second module700(and/or modular retractor500when coupled thereto) from side to side in a direction defined by an extension direction F-F of table mount706(seeFIG.40), for example. Table mount706may be securely coupled directly to arm705(seeFIG.39), for example. Second module700may be configured to extend arm705by activation of actuator701, e.g., by rotation of actuator701. Actuator701may be securely attached to body portion703and include a pinion portion701a(pinion gear and/or spur gear) having teeth that engage with and are meshed with curved rack portion705ddisposed on a side surface of arm705, for example. Accordingly, rotation of actuator701may rotate pinion portion701asuch that teeth of pinion portion701acause arm705to move forward and/or backward depending on the direction actuator701is rotated. Additionally, second module700may include a first pawl704that may be configured to engage the curved rack portion705edisposed on a top surface of arm705, for example. First pawl704may be configured to allow pinion portion701ato rotate in a first direction (counter clockwise direction) and prevent pinion portion701afrom rotating in a second direction (clockwise direction) in the same, similar, and/or substantially the same manner as previously explained. Accordingly, duplicative description will be omitted.

In various embodiments, arm705may be coupled to pivoting member705aat a distal end thereof. Pivoting member705amay be configured to operably couple to a blade35by blade attachment mechanism705c. In the example embodiment, blade actuator705bmay be configured to adjust the angulation of blade35(seeFIG.40). For example, the blade actuator705bmay be configured to actuate the first pivoting member705ato adjust the angulation of blade35with respect to arm705. In disclosed embodiments, the first pivoting member705amay include a corresponding pin and socket mechanism enabling pivot member705ato pivot, for example.

Referring generally toFIGS.41A-44a third module800for use with the modular retractor500is disclosed.FIG.41Ais a top perspective view of a third module800andFIG.41Bis a bottom perspective view of a third module800.FIG.42is an exploded parts view of a third module800.FIG.43is a perspective view of a third module800coupled to a modular retractor500andFIG.44is a perspective view of a third module800coupled to a modular retractor500and a plurality of blades.

In accordance with disclosed embodiments, third module800may be configured to couple and uncouple from modular retractor500at connection points503a, for example (seeFIG.20). For example, the third module800may have at least one corresponding connection point803aon an underside thereof (seeFIG.41B) configured to couple, connect, and/or mate with a connection point503aof the modular retractor500in the same, similar, and/or substantially the same manner as previously explained. Accordingly, duplicative description will be omitted. Additionally, third module800may be locked to modular retractor500by lock513(seeFIG.20). Lock513may be pivotable such that in a locked position a flange portion of lock513may pivot into a locking aperture803eof third module800, in the same, similar, and/or substantially the same manner as previously explained. Accordingly, duplicative description will be omitted.

Third module800may include an arm805that includes a straight portion810and a C shaped curved portion811. Straight portion810of arm805may extend through body803and move forward and backward in a longitudinal direction, for example. As seen best inFIG.43, when third module800is coupled to modular retractor500the C shaped curved portion811extends laterally outward in a lateral direction B-B farther than the farthest lateral edge of arm807. For example, the C shaped curved portion811does not obscure a surgeons viewing area and/or access to a surgical site. Furthermore, third module800may orient and/or support a blade35such that the blade faces the body portion803of third module800, the body portion of modular retractor500, and is also symmetrically disposed relative to the first arm505and second arm507of modular retractor500. For example, the C shaped curved portion811may support a blade35at a distal most position that is aligned in the longitudinal axis A-A of modular retractor500(seeFIG.43). The straight portion810of arm805may extend through body803through a first contoured channel. In various embodiments, the contoured channel803bmay be an L shaped channel, for example. Third module800may be configured to extend arm805along a path of travel by a rack and pinion mechanism, for example. The path of travel may be linear path, for example. Other paths of travel than those specifically shown are contemplated, e.g., an arcuate path.

Third module800may include a table mount806extending laterally from a side surface thereof in a direction defined by an extension direction G-G of table mount806(seeFIG.43), for example. Table mount806may facilitate the secure placement of third module800such that third module800remains fixed in 3D space and/or facilitate the relative motion of third module800(and/or modular retractor500when coupled thereto) in any direction when moving table mount70, for example. Third module800may be configured to extend arm805by activation of actuator801, e.g., by rotation of actuator801. Actuator801may be securely attached to body portion803and include a pinion portion801a(pinion gear and/or spur gear) having teeth that engage with and are meshed with straight rack portion805ddisposed on a side surface of arm805, for example. Accordingly, rotation of actuator801may rotate pinion portion801asuch that teeth of pinion portion801acause arm805to move forward and/or backward depending on the direction actuator801is rotated in the same, similar, and/or substantially the same manner as previously explained. Accordingly, duplicative description will be omitted. Additionally, third module800may include a first pawl804that may be configured to engage rack portion805edisposed on a top surface of arm805, for example. First pawl804may be configured to allow pinion portion801ato rotate in a first direction (counter clockwise direction) and prevent pinion portion801afrom rotating in a second direction (clockwise direction) in the same, similar, and/or substantially the same manner as previously explained. Accordingly, duplicative description will be omitted.

In various embodiments, curved arm portion811of arm805may be coupled to blade attachment mechanism805cat a distal most end. The curved arm portion811may support blade attachment mechanism805csuch that it faces modular retractor500and is aligned with the longitudinal axis A-A of modular retractor500(seeFIG.43). In the example embodiment, blade attachment mechanism805cis fixed and a corresponding blade35does not pivot and/or angulate. However in other embodiments, third module800may include a first blade actuator (not illustrated) that is configured to adjust the angulation of a corresponding blade and a corresponding pivoting member with the same, substantially the same, and/or similar structural and characteristics as explained herein with respect to other embodiments.

Third module800may include a table mount806extending in a first lateral direction along axis G-G from arm805and a module mount809extending in a second lateral direction along axis H-H from arm805. i.e., in an opposite lateral direction (seeFIG.43). For example, table mount806may extend to the left direction and module mount809may extend to the right direction. Additionally, straight portion810of arm805may be supported by body803on the left side of the longitudinal axis A-A of modular retractor500. In this configuration, the module mount809may cross over the longitudinal axis A-A, for example. Module mount809may support a free hand module900, as will explained in further detail below.

Referring generally toFIGS.45A-45Ban alternative third module800aembodiment is disclosed. Third module800amay include the same, substantially the same, and/or similar components and functionality as third module800. Accordingly, duplicative description will be omitted. In the example embodiment, third module800amay be modified such that table mount806and module mount809are aligned. For example, table mount806and module mount809each extend from arm805in opposite directions and are aligned on the same common extension axis. For example still, axis G-G of table mount806and axis H-H of module mount809are aligned and extend in opposite directions.

Alternative third module800amay include a locking actuator850, for example. Locking actuator850may be rotatably secured within body portion803and be disposed above straight portion810of arm805, for example. In various embodiments, locking actuator850may include an outside thread pattern corresponding to an inside thread pattern of body803(not illustrated). In various embodiments, locking actuator850may be rotated in a first direction such that locking actuator850advances towards straight portion810of arm805. As locking actuator850advances, a bottom portion of locking actuator850may contact an upper surface of straight portion810of arm805and apply a downward force to straight portion810. In this way, locking actuator850may provide a frictional force against straight portion810of arm805thereby preventing and/or suppressing arm805from moving forward and backward. For example, the greater the downward force applied to straight portion810, the greater the frictional force between the underside of locking actuator850and the upper surface of straight portion810. At least one advantage of locking actuator850may be that arm805may be locking in position such that it is fixed and is prevented from moving forward and backward, for example. In various embodiments, this may assist a surgeon in placement of third module800and/or modular retractor500. For example, a surgeon may lock arm805via locking actuator850and position modular retractor500and third module800as desired while arm805remains in place. Thereafter, the surgeon may release locking actuator850and extend arm805to distract patient tissue or retract arm805. Additionally, in some surgical settings, it may be advantageous to allow third module800to remain in a distracted position (while third module800is coupled to a table mount via table mount arm806) and remove modular retractor500while the surgical site remains distracted, or at least partially distracted, by third module800, for example. Additionally, any of the various disclosed modules may include a locking actuator850rotatably disposed in a corresponding body portion above a corresponding arm and work in the same, substantially the same, and/or similar manner as explained above.

In other embodiments, locking actuator850may be rotated between a locked position and an unlocked position. For example, in various embodiments, locking actuator850may include at least one locking tooth (not illustrated) that is disposed within locking cutout850aof arm805. For example, at least one locking tooth may jam with rack portion805dand prevent arm805from moving, for example. In other embodiments, locking actuator850may include at least one locking tooth that jams with pinion portion801a, for example. In other embodiments, locking actuator850may lock pawl804such that pawl804is engaged with rack portion805eand prevented from pivoting up and down relative to rack portion805e. For example, by locking pawl804in place such that pawl804is engaged with rack portion805e, arm805may be prevented from moving forward and backward. Moreover, the above described embodiments and functionality of locking actuator850are broadly applicable to all of the disclosed embodiments herein. For example, any of the various modules disclosed herein may include a locking actuator850having at least one locking tooth that jams with a corresponding rack portion of an arm, and/or a pinion portion of an actuator as explained above.

Referring generally toFIGS.46-54a free hand module900and a telescoping blade20for use with the modular retractor500and/or free hand module900is disclosed.FIG.46is a perspective view of a free hand module900andFIGS.47A and47Bare side views of a free hand module900for use with disclosed modular retractor500embodiments.FIG.48Ais an exploded parts view of a free hand module900andFIG.48Bis a removed parts view of free hand module900.FIGS.49A-49Bare various perspective views of a free hand module900in various configurations.FIGS.50-51are various perspective views of a free hand module900and a telescoping blade system20.FIG.52Ais a perspective view of a blade connection channel905dandFIG.52Bis a perspective view of a blade fastener.FIGS.53-54are various perspective views of a third module800coupled to a modular retractor500and a free hand module900coupled to the third module800.

In accordance with disclosed embodiments, free hand module900may be configured to couple and uncouple from third module800(seeFIG.46). For example, the free hand module900may be configured to couple, connect, and/or mate with module mount809. In the example embodiment, gripping arms916may grip onto module mount809, for example. Additionally, gripping arms916may include a plurality of rails and channels extending in the lateral direction on an inside surface thereof. The rails of gripping arms916may have a size and shape corresponding to rails and channels of module mount809, for example. Accordingly, the gripping arms916may securely mate with module mount809by seating rails of gripping arms916in the channels of module mount809and seating the rails of module mount809in the channels of gripping arms916. Furthermore, the gripping arms916may provide a clamping force against module mount809securely coupling the free hand module900to third module800, for example.

In various embodiments, free hand module900may be configured to enable a surgeon to freely extend blade20forward and backward in the longitudinal direction along longitudinal axis A-A, for example. Free hand module900may not include a rack and pinion mechanism to extend the blade20and may rely on the manual operability of a surgeon, for example. In some surgical contexts, a free hand module900may afford a surgeon greater freedom in installation and facilitate the surgeon in retracting delicate patient tissue by hand. For example, when performing a retraction step with free hand module900, patient tissue may resist the retraction and/or opening of a surgical access site. The degree of resistance of the patient tissue may be sensed by the surgeon as a form of haptic feedback informing the surgeon how much pressure has been applied to the patient tissue. In this way, the surgeon can sense and or prevent applying to much retraction force to a patient tissue and/or applying just the right amount of retraction force in delicate situations. Similarly, a free hand module900may be relatively easier for a surgeon to manipulate than a rack and pinion type of motion. This may allow the surgeon to quickly retract specific patient tissue with greater freedom in operation. Additionally, a length and/or height of telescoping blade20may be adjustable. Accordingly, a surgeon can retract various layers of patient tissue that are below (or above) the patient tissue which has been previously retracted by the other blades.

Free hand module900may include a handle901at a proximal end and a blade attachment mechanism905cat a distal end, for example. Handle901may be rigidly secured to a shaft905and shaft905may define a longitudinal axis of free hand module900, for example. Free hand module900may include a moving mechanism910. As illustrated best inFIGS.48A and48B, moving mechanism910may include various components that enable an end user to toggle a lever911to enable the forward and backward movement of handle901, shaft905, and blade attachment mechanism905crelative to moving mechanism910and module mount809, for example. Moving mechanism809may include a body portion913having an aperture913extending therethrough. Shaft905may extend through aperture913aand slotted aperture915bof gripper body915, for example. An upper portion of lever support912may be disposed above body913and be operably coupled to lever911while a lower portion including an annular channel912bmay be disposed within body913. For example, lever support912may be securely attached to lever911by laterally extending posts912athat extend through corresponding apertures911aof lever911. In this way, lever911may be pivotable about posts912aand when depressed an upper surface of body913may act as a support surface such that depressing lever911pulls lever support912upward. For example, lever support912may be pivotable up and down in the vertical direction by depressing and/or rotating lever911. For example still, pressing down on lever911may pull lever support912upward relative to body913. Additionally, the lower portion of lever support912disposed within body913may prevent the over rotation of lever support912due to suitable retaining rails of body913being inset within annular ring912bsuch that lever support912is fixedly retained by body913, for example.

As shown best inFIGS.48A-48B, an uppermost coupling portion915aof gripper body915may be secured within a lower cavity of lever support912. In this way, when lever911is actuated and pulls lever support912upwards, lever support912also pulls gripper body915upwards. In various embodiments, a stop block914may be disposed within body913at a bottom portion thereof. Stop block914may be disposed beneath shaft905, for example. Additionally, stop block914may include inclined surfaces that may bias gripping arms916inwards (towards one another) to provide a gripping force against module mount809, for example. In operation, an end user may actuate lever911such that gripper body915is pulled upwards and gripping arms916are biased inwards towards one another to securely couple to module mount806via clamping force.

In various embodiments, free hand module900via lever911may be adjustable and/or fixed in three modes of operation, for example. In a first mode of operation, and when lever911is in a first position, shaft905is extendable forward and backward through body913and gripping arms916are in an open position (seeFIG.49A). When gripping arms916are in an open position free hand module900may be positioned in place around and/or above module mount809. In the first mode of operation, moving mechanism910and gripping arms916are both fully open, for example. In a second mode of operation, and when lever911is in a second position, shaft905is extendable forward and backward through body913and gripping arms916are in a closed position whereby gripping arms916provide a suitable clamping force to module mount809. In the second mode of operation, moving mechanism910is movable in the longitudinal direction and free hand module900is securely coupled to module mount809due to gripping arms916being in the closed position, for example. In a third mode of operation, and when lever911is in a third position, shaft905is not extendable forward and backward through body913and gripping arms916are in a closed position (seeFIG.49B). In the third mode of operation, moving mechanism910is fixed relative to shaft905and free hand module900is fixed in 3D space due to gripping arms916being in the closed position and securely clamped on to module mount809(seeFIGS.53-54).

With reference toFIGS.50-52B, a telescoping blade20is disclosed. Telescoping blade20may securely connect to blade attachment mechanism905cof free blade module900, for example. Additionally, telescoping blade20may securely connect to any of the other blade attachment mechanisms disclosed herein. Telescoping blade20may include a first blade22and a second blade24that is extending along axis Z-Z, for example. First blade22may include a channel23extending longitudinally down a length thereof from proximal end20pto about the distal end20d. Similarly, second blade24may include a rail25extending longitudinally down a length thereof from proximal end20pto about distal end20d. In various embodiments, the channel23and/or rail25may stop and/or terminate before the distal end20dto prevent the second blade24from extending too far. In various embodiments, the second blade24may slide upward and downward in a proximal-to-distal direction, shown by axis Z-Z inFIG.50. Additionally, an outside surface of blade22may include an engagement feature26for securely coupling to blade attachment mechanism905c, for example. Engagement feature26may include two spring loaded tabs27that are flexible towards one another and naturally biased away from one another, for example. In various embodiments, an end user may slide engagement feature26down into channel905dof blade attachment mechanism905cfrom above and the two spring loaded tabs27may push outward against side surfaces of channel905dto frictionally retain engagement feature26therein. Additionally, channel905dmay include a stop feature905eadjacent a bottom surface thereof. In various embodiments, the stop feature905emay be a curved bottom surface corresponding to the geometry of the spring loaded tabs27, for example. In other embodiments, the two spring loaded tabs27may seat into corresponding channels or indents of blade attachment mechanism905c(not illustrated). Furthermore, in other embodiments the engagement feature26may be rotated about 180 degrees such that the blade20may be insert into blade engagement mechanism905cfrom below.

FIGS.53-54illustrate a modular retractor500with a third module800coupled thereto and a free hand module900coupled to the third module800. In the example embodiment, the telescoping blade20is attached to a distal end of free hand module900and blade30is attached to the distal end of third module800. Additionally, a centerline of telescoping blade20and a centerline of blade30are aligned with longitudinal axis A-A of modular retractor500(seeFIG.22). However, it shall be appreciated that free hand module900is slidable along module arm809and can be positioned alternately than shown. Furthermore, the curved arm811curves out laterally farther than arm507of modular retractor500. As illustrated, blades30,40, and20form an opening for a surgical access location and/or a surgical access site.

FIGS.55-56are various perspective views of a fourth module1000for use with disclosed modular retractor500embodiments.FIG.57is an exploded parts view of a fourth module1000.FIGS.58-59are various views of a fourth module1000coupled to a modular retractor500andFIGS.60-61are various views of a fourth module1000coupled to a first free hand module900and a second free hand module900.

Fourth module1000may include the same, substantially the same, and or similar components as third module800. Accordingly, duplicative disclosure will be omitted and/or minimized. Fourth module1000may be configured to couple and uncouple from modular retractor500at connection points503a, for example (seeFIG.20). For example, the fourth module1000may have at least one corresponding connection point1003aon an underside thereof (seeFIG.56) that is configured to couple, connect, and/or mate with a connection point503aof the modular retractor500in the same, substantially the same, and or similar manner as explained above. Additionally, fourth module1000may be locked to modular retractor500by lock513(seeFIG.20). Lock513may be pivotable such that in a locked position a flange portion of lock513may pivot into a locking aperture1003eof fourth module1000, in the same, substantially the same, and or similar manner as explained above.

Fourth module1000may include an arm1005that includes a straight portion1010and a C shaped curved portion1011. Straight portion1010of arm1005may extend through body1003and move forward and backward in a longitudinal direction, for example. As seen best inFIG.58, when fourth module1000is coupled to modular retractor500the C shaped curved portion1011extends laterally outward in a lateral direction farther than the farthest lateral edge of arm507of modular retractor500. For example, the C shaped curved portion1011does not obscure a surgeons viewing area and/or access to a surgical site. The straight portion1010of arm1005may extend through body1003through an L shaped contoured channel1003b, for example. Fourth module1000may be configured to extend arm1005along a path of travel by a rack and pinion mechanism, for example. The path of travel may be linear path, for example.

Fourth module1000may include a table mount1006extending laterally from a side surface thereof in a direction defined by an extension direction H-H of table mount1006(seeFIG.58), for example. Table mount1006may facilitate the secure placement of fourth module1000such that fourth module1000remains fixed in 3D space and/or facilitate the relative motion of fourth module1000(and/or modular retractor500when coupled thereto) in any direction when moving table mount70, for example. Fourth module1000may be configured to extend arm1005by activation of actuator1001, e.g., by rotation of actuator1001. Actuator1001may be securely attached to body portion1003and include a pinion portion1001a(pinion gear and/or spur gear) having teeth that engage with and are meshed with straight rack portion1005ddisposed on a side surface of arm1005, in the same, substantially the same, and or similar manner as explained above. Additionally, fourth module1000may include a first pawl1004that may be configured to engage the rack portion1005edisposed on a top surface of arm1005, for example. First pawl1004may be configured to allow pinion portion1001ato rotate in a first direction (counter clockwise direction) and prevent pinion portion1001afrom rotating in a second direction (clockwise direction) in the same, substantially the same, and or similar manner as explained above.

Fourth module1000may include a table mount1006extending in a lateral direction along axis H-H away from arm1005and longitudinal axis A-A. Fourth module1000may include a proximal module mount1009extending along axis I-I in a lateral direction away from arm1005towards longitudinal axis A-A. For example, table mount1006may extend to the left direction and proximal module mount1009pmay extend to the right direction. Additionally, in various embodiments, the C shaped curved portion1011may include a distal module mount1009dthat extends along axis J-J from a side surface of curved arm portion1011such that it crosses over longitudinal axis A-A of modular retractor500. The distal module mount1109dand proximal module mount1009pmay be symmetrically disposed relative to one another with respect to longitudinal axis A-A, for example (seeFIG.58). Additionally, straight portion1010of arm1005may be supported by body1003on the left side of the longitudinal axis A-A of modular retractor500. In this configuration, module mounts1009p,1009dmay cross over the longitudinal axis A-A, for example. Module mounts1009p,1009dmay each independently support a free hand module900, in the same, similar, and/or substantially the same manner as explained previously. For example, as shown inFIGS.60-61proximal module mount1009psupports a free hand module900in a proximal position and distal module mount1009dsupports a free hand module900in a distal position.

Referring generally toFIGS.62-65a fifth module1100for use with the modular retractor500is disclosed.FIGS.62-63are various perspective views of a fifth module1100for use with disclosed modular retractor500embodiments.FIG.64is an exploded parts view of a fifth module1100andFIG.65is a top perspective view of a fifth module1100coupled to a modular retractor500.

Fifth module1100may include the same, substantially the same, and or similar components as third module800and/or fourth module1000. Accordingly, duplicative disclosure will be omitted and/or minimized. Fifth module1100may be configured to couple and uncouple from modular retractor500at connection points503a, for example (seeFIG.20). For example, the fifth module1100may have at least one corresponding connection point1103aon an underside thereof (seeFIG.63) that is configured to couple, connect, and/or mate with a connection point503aof the modular retractor500in the same, substantially the same, and or similar manner as explained above. Additionally, fifth module1100may be locked to modular retractor500by lock513(seeFIG.20). Lock513may be pivotable such that in a locked position a flange portion of lock513may pivot into a locking aperture1103eof fifth module1100, in the same, substantially the same, and or similar manner as explained above. Similarly, in an unlocked position the flange portion of lock513may be unseated from aperture1103e.

Fifth module1100may include an arm1105that includes a straight portion1110and a C shaped curved portion1111. Straight portion1110of arm1105may extend through body1103and move forward and backward in a longitudinal direction, for example. As seen best inFIG.65, when fifth module1100is coupled to modular retractor500the C shaped curved portion1111extends laterally outward in a lateral direction farther than the farthest lateral edge of arm1105. For example, the C shaped curved portion1111does not obscure a surgeon's viewing area and/or access to a surgical site. The straight portion1110of arm1105may extend through body1103through an L shaped contoured channel1103b. Fifth module1100may be configured to extend arm1105along a path of travel by a rack and pinion mechanism, for example. The path of travel may be linear path, for example.

Fifth module1100may include a table mount1106extending laterally from a side surface of arm1105adjacent a junction of curved portion1111and straight portion1110. Table mount1106may extend along axis H-H in a direction defined by an extension direction of table mount1106(seeFIG.65), for example. In the example embodiment, table mount1106extends in a perpendicular direction to longitudinal axis A-A and/or a dominant extension direction of straight portion1110. Table mount1106may facilitate the secure placement of fifth module1100such that fifth module1100remains fixed in 3D space and/or facilitate the relative motion of fifth module1100(and/or modular retractor500when coupled thereto) in any direction when moving table mount70, for example. Fifth module1100may be configured to extend arm1105by activation of actuator1101, e.g., by rotation of actuator1101. Actuator1101may be securely attached to body portion1103and include a pinion portion1101a(pinion gear and/or spur gear) having teeth that engage with and are meshed with straight rack portion1105ddisposed on a side surface of straight portion1110of arm1105, in the same, substantially the same, and or similar manner as explained above. Additionally, fifth module1100may include a pawl1104that may be configured to engage the rack portion1105edisposed on a top surface of straight portion1110of arm1105, for example. Pawl1104may be configured to allow pinion portion1101ato rotate in a first direction (counter clockwise direction) and prevent pinion portion1101afrom rotating in a second direction (clockwise direction) in the same, substantially the same, and or similar manner as explained above.

Fifth module1100may include a body1103having a curved body portion1107extending away from longitudinal axis A-A. In the example embodiment, curved body portion1107curves away in an opposite direction from arm1105and defines the distal most portion of body1103. Curved body portion1107may support and orient proximal modular mount1109such that it extends in a lateral direction towards arm1105, and crosses over longitudinal axis A-A. For example, table mount1106may extend to the left direction from a left side of arm1105and proximal module mount1109pmay extend along axis K-K to the left direction from a left side of curved body portion1107and cross over longitudinal axis A-A. Additionally, in various embodiments, the C shaped curved portion1111may include a distal module mount1109dthat extends from a side surface of curved arm portion1111such that it crosses over longitudinal axis A-A of modular retractor500. The distal module mount1109dand proximal module mount1109pmay be disposed opposite one another and each cross over longitudinal axis A-A, for example. Additionally, straight portion1110of arm1105may be supported by body1103on the left side of the longitudinal axis A-A of modular retractor500. Module mounts1109p,1109dmay each independently support a free hand module900, as explained previously. Furthermore, in various embodiments, module mount1109pmay be relatively shorter than module mount1109d.

Referring generally toFIGS.66-75various blades for use with the modular retractor500and any of the various modules disclosed herein are disclosed.FIG.66is a top view of a pair of blades30,FIG.67is a bottom view of a pair of blades30, andFIG.68is a perspective view of a pair of blades30for use with disclosed modular retractor500embodiments. Blades30may be shaped like a half circle, for example. Accordingly, in various embodiments when blades30adjoin one another they may form a common circle in a fully closed position. Additionally, blades30may include an arcuate channel31extending along an inside surface thereof from a proximal end (seeFIG.66) to a distal end (seeFIG.67), for example. Arcuate channel31may have a size and shape corresponding to a size and shape of an arcuate outdent of a dilator, for example arcuate outdent90aof dilator90shown inFIGS.80A,80B. Alternatively, arcuate channel31may have a size and shape corresponding to a size and shape of an arcuate outdent of a shim (not illustrated). Additionally, blades30may include an aperture32extending through a top surface of blade30at the proximal end and penetrating the inside surface of blade30thereby providing access to the surgical access opening created by blades30, for example. Aperture32may provide access for light fixtures and other diagnostic tools such as endoscopes, electrodes, temperature sensors, suction devices, and etc. that may be insert therein and be protected while extending through blade30, for example.

FIG.69is an enlarged view of a top portion of a universal blade fastener33. Universal blade fastener33may be similar to blade fastener26of telescoping blade20(seeFIG.52B) but in reverse. For example, blade fastener33may be configured for top loading blade30to a blade receiving mechanism. Blade fastener33may include a pair of spring loaded tabs34adjacent the upper surface of blade30and a curved support surface35therebelow. For example, spring loaded tabs34may be disposed at an upper region of blade fastener33and curved support surface35may be disposed at a lower portion of blade fastener. In this way, an end user can insert the support surface35within a blade receiving mechanism from above and the spring loaded tabs34can help retain blade30therein by a biasing force applied to sidewalls of a blade receiving mechanism. Furthermore, any other blade disclosed herein may include the same, similar, or substantially the same blade fastener26.

FIG.70is a top view of various blades40and35andFIG.71is a bottom view of the three blades40and35for use with disclosed modular retractor500embodiments.FIG.72is a perspective view of blades35,40for use with disclosed modular retractor500embodiments. In the example embodiment, a first blade40, second blade40, and a third blade35may form an oval shape. For example, when blades40,35are closed together such that they adjoin one another they may form an oval like shape. Blades40may include two arcuate channels41and an aperture42. Similarly, blade35may include two arcuate channels36and an arcuate channel37. Arcuate channels41,37may have a size and shape corresponding to a size and shape of an arcuate outdent of a dilator, for example arcuate outdent81of dilator81shown inFIG.76. Additionally, in the fully closed position where blades40,35adjoin one another, the six arcuate outdents ofFIG.76may be disposed in a corresponding relative position and have a corresponding size and shape to the six arcuate channels36,37shown in the three blade configuration ofFIG.70.

Furthermore, blades40may include an aperture42extending through a top surface of blade40at the proximal end and penetrating the inside surface of blade40and blade35may include an aperture37extending through a top surface of blade35at the proximal end and penetrating the inside surface of blade35. Apertures37and42may provide access for light fixtures and other diagnostic tools such as endoscopes, electrodes, temperature sensors, suction devices, and etc. that may be insert therein and be protected while extending through blades35and40, for example.

FIG.73is a top view of four blades40,45andFIG.74is a bottom view of the four blades for use with disclosed modular retractor500embodiments.FIG.75is a perspective view of the four blades40,45for use with disclosed modular retractor500embodiments. In the closed position, blades40,45may form an oval like shape. Blade45may include an arcuate channel46for securing to an arcuate outdent of a dilator having the same, similar, and or substantially the same attributes and purposes as explained above. Additionally blade45may include an aperture47extending through a top surface of blade45at the proximal end and penetrating the inside surface of blade having the same, similar, and or substantially the same attributes and purposes as explained above.

Referring generally toFIGS.76-81various dilators for use with the modular retractor500and the various blade embodiments disclosed herein are illustrated.FIG.76is a top view of a plurality of nested dilators80andFIG.77Ais a perspective view of the plurality of nested dilators80in a non-nested configuration andFIG.77Bis a perspective view of the plurality of nested dilators80in a nested configuration. In the example embodiment, five dilators are illustrated having progressively increasing sizing. A first dilator85may have a circular shape and a relatively narrow diameter for initiating a dilation process. An outside perimeter of the second dilator84may have an oval like shape and an inside diameter of dilator84may have a circular like shape corresponding to the outer diameter of first dilator85. An outside perimeter of the third dilator83may have an oval like shape and an inside perimeter of the third dilator83may have an oval like shape corresponding to the outer perimeter of second dilator84. Similarly, an outside perimeter of the fourth dilator82may have an oval like shape and an inside perimeter of the fourth dilator82may have an oval like shape corresponding to the outer perimeter of third dilator83. Similarly, an outside perimeter of the fifth dilator81may have an oval like shape and an inside perimeter of the fifth dilator81may have an oval like shape corresponding to the outer perimeter of fourth dilator82. In various embodiments, the dilators may be successively nested within one another to dilate a patient tissue before use of the various disclosed retractor embodiments. Additionally, fifth dilator81may include a plurality of arcuate outdents81a(e.g., an arcuate rail or the like) extending along an outside surface thereof. The arcuate outdent81amay mate with an arcuate channel of various blades as disclosed above.

FIG.78is a top view of a dilator90having an oval like outer perimeter and an oval like inner perimeter andFIG.79is a perspective view of dilator90. Dilator90may include a plurality of arcuate outdents91a(e.g., an arcuate rail or the like) extending along an outside surface thereof. In the example embodiment, arcuate outdents91aare disposed along roughly half of the available radial outer surface and extend in a proximal to distal direction, e.g., about half of the available perimeter includes arcuate outdents91athat extend from the proximal end to distal end. The arcuate outdents91amay mate with an arcuate channel of various blades in the same, similar, and/or substantially the same manner as explained above.FIG.80Ais a top view of a dilator95andFIG.80Bis a perspective view of dilator95. Dilator95may have a circular outer diameter and a circular inner diameter. Dilator95may include a plurality of arcuate outdents95asymmetrically radially disposed along the outer surface. The arcuate outdents95amay mate with an arcuate channel of various blades as disclosed above.

FIGS.80C-80Eshow various perspective and elevation views of a set of nested and cylindrically shaped dilators99. In the example embodiment, an innermost dilator98may be the thinnest and the longest dilator of the set, while the outermost dilator94may be the widest and the shortest dilator of the set. Of course the relative length and width of any dilator of the set of dilators99may be adjusted consistent with the particular surgery being performed. Additionally, there may be any number and size dilators in between the innermost dilator98and outermost dilator94, for example first inner dilator97and second inner dilator96. With reference toFIGS.80D and80E, it is seen that the outside circumferential surface of outermost dilator94has a plurality of rail portions94A that extend down its length in a proximal to distal direction. The rail portions94A generally have a size and shape corresponding to channel portions of various blades disclosed herein. For example, these rail portions94A may be disposed in particular locations along the outside circumferential surface of the outermost dilator94that takes into account the particular surgical approach employed by the surgeon and the location of the corresponding channel portions of the chosen blades, for example.

As seen best in the top down view ofFIG.81, rail portions94A may be shaped like circular, oval, or arcuate outdents, for example. Additionally, pairs of adjacent rails94A may form coupling locations for any of the example blade embodiments disclosed herein. For example, as shown inFIG.81blade1and blade2may couple to respective pairs of rails94A in a first region (approximately upper half area ofFIG.81) and blade3may couple to the remaining respective pair of rails94A in a second region (approximately lower half area ofFIG.81). The illustrated spacing arrangement of rails94A takes into account a specific surgical approach chosen by the surgeon and the functionality of disclosed retractor embodiments, e.g., relative movement of retractor arms in a linear, arcuate, ratcheting, and/or pivoting motion, the types of blades and their relative locations, among other things. Further discussion regarding an example method of use of disclosed retractor and retractor module embodiments and surgical approaches utilizing the outer dilator94is shown in the top down view ofFIG.130and the perspective view ofFIG.131, among other places.

Referring generally toFIGS.82-87a modular blade120and an extendable blade130for coupling to modular blade120is disclosed.FIGS.82and83are various perspective views of a modular blade120andFIGS.84and85are various perspective views of an extendable blade130for coupling to modular blade120.FIG.86is a front view of modular blade120and extendable blade130side by side andFIG.87is a top down view of modular blade120and extendable blade130. In various embodiments, the modular blade120may be referred to as modular because it may couple to various extendable blades130such that extendable blades130may extend relative to modular blade120, e.g., blade120and blade130may be configured as a telescoping blade system.

Modular blade120may extend from a proximal end120pto a distal end120din a proximal-to-distal direction (may also be referred to as longitudinal direction). The proximal end120pmay include an engagement feature126having spring loaded tabs127for coupling to a blade engagement mechanism in the same, similar, and/or substantially the same way as explained above. The distal end120dmay include a tip portion121. In the example embodiment, tip portion121comprises a substantially planar outer surface that tapers towards a centerline of modular blade120and terminates as a blunt chisel shaped end having a relatively smaller thickness than the remaining portions of modular blade120, for example. Modular blade120may include a pair of rails124that extend from proximal end120ptowards distal end120d. For example, a first rail124may extend along a first side of blade120in the proximal-to-distal direction and a second rail124, opposite the first rail124, may extend along a second side of blade120in the proximal-to-distal direction. In various embodiments, rails124may define a receiving channel for receiving extendable blade130as will be explained in further detail below.

Additionally, modular blade120may include an aperture122extending through a top surface of blade120at the proximal end120pand penetrating through the inside surface of blade120at oval shaped opening122a, for example. In various embodiments, aperture122may comprise a passageway (in a cross section view) that is inclined away from the outside surface of blade120and towards the inside surface of blade120such that the passageway forms an oval shaped opening122aon the inside surface of blade120. In cross section, the passageway of aperture122may resemble a circle, oval, pentagon, square, rectangle, and/or any combination thereof. Aperture122may provide access for light fixtures and other diagnostic tools such as endoscopes, electrodes, temperature sensors, suction devices, and etc. that may be insert therein.

Modular blade120may include a contoured channel123for connecting with extendable blade130and facilitating the forward and backward relative motion of extendable blade130in the proximal-to-distal direction, for example. As shown best inFIG.83, contoured channel123may include a relatively large central arcuate channel portion123ahaving a pair of relatively smaller arcuate channels123bon opposite sides of channel portion123a, for example. Additionally, contoured channel123may include a plurality of indentations125extending in a proximal-to-distal direction, for example. In various embodiments, indentations125may be circular shaped indentations, oval shaped indentations, hexagonal shaped indentations, parallelogram shaped indentions, and/or any combination thereof. A distal end of contoured channel123may include a stop feature129for preventing extendable blade130from extending too far in the proximal-to-distal direction.

Extendable blade130may extend from a proximal end130pto a distal end130din a proximal-to-distal direction (also referred to as a longitudinal direction). The distal end may include a tip portion131tapering towards a centerline of extendable blade130and terminating as a blunt chisel shaped end having a relatively smaller thickness than the remaining portion of extendable blade130, for example. In the example embodiment, an outside surface of extendable blade130may include an engagement feature134for connecting with contoured channel123, for example. Engagement feature134may include a proximal engagement rail135having a size and shape generally corresponding to a size and shape of contoured channel123. For example, proximal engagement rail135may have a size and shape generally corresponding to the relatively large central arcuate channel portion123aand the pair of relatively smaller arcuate channels123b, for example. Additionally, engagement feature134may include a medial engagement rail136having a width approximately corresponding to the relatively large central arcuate channel portion123aof modular blade120, for example. In various embodiments, an exposed surface of medial engagement rail136may be substantially planar although in other embodiments the exposed surface may be arcuately shaped to correspond and/or approximate the geometrical profile of contoured channel123, for example.

In various embodiments, engagement feature134may include at least one protrusion133having a size and shape generally corresponding to a size and shape of indentation125. For example, protrusion133may selectively be seated within any one of indentations125to secure extendable blade130in any one position of the plurality of positions defined by indentations125. In various embodiments, protrusion133may be a circular shaped protrusion, oval shaped protrusion, hexagonal shaped protrusion, parallelogram shaped protrusion, and/or any combination thereof. In various embodiments, protrusion133may extend away from extendable blade130in a direction perpendicular to the proximal-to-distal direction a distance that is relatively farther out than medial engagement rail136and/or proximal engagement rail135, for example. In some embodiments, protrusion133may be spring loaded and/or biased. In other embodiments, protrusion133may be a rigid non movable structure.

In various embodiments, engagement feature134may include a distal engagement rail137having a size and shape generally corresponding to a size and shape of contoured channel123. For example, distal engagement rail137may have a size and shape generally corresponding to the relatively large central arcuate channel portion123aand the pair of relatively smaller arcuate rails123b, for example. Additionally, engagement feature134may include a stop feature138that may abut against stop feature129of modular blade120to prevent extendable blade130from disengaging with modular blade120, for example. For example, in a fully extended position, stop feature138of extendable blade may directly contact stop feature129of modular blade120and prevent extendable blade130from extending too far that engagement feature134becomes unseated from contoured channel123.

With reference toFIG.86, the inside surface of modular blade120and the outside surface of extendable blade130is illustrated. In various embodiments, extendable blade130may operably couple to modular blade120by inserting engagement feature134into channel123. As explained above, extendable blade130may move forward and backward in a proximal-to-distal direction within contoured channel123. For example, extendable blade130may extend forward and backward within contoured channel123and protrusion133may be seated within any one of indentations125. For example, when modular blade120and extendable blade130are coupled together as a system, they may be referred to as a telescoping blade system.

With reference toFIG.87, a top down view of modular blade120and extendable blade130is illustrated. In the example embodiment, it is shown that rails124define a cavity and/or channel for receiving extendable blade130. For example, extendable blade130has a width in a lateral direction that corresponds to a distance between rails124and a thickness of extendable blade130corresponds to a depth of the cavity and/or channel between and defined by rails124. In various embodiments, the outside lateral edges1301of extendable blade130may be inset within the receiving cavity defined by rails124such that they frictionally engage and slide across the interior side surfaces of modular blade120, for example. In this way, rails124may provide a bearing surface for retaining extendable blade130therein while also allowing extendable blade130to move forward and backward in the proximal-to-distal direction. Additionally, it is shown that engagement feature134has a size and shape corresponding to contoured channel123. For example, the curved surfaces of proximal engagement rail135may be inset within (mated within) contoured channel123and frictionally engage and slide across the interior surfaces defined by the relatively large central arcuate channel portion123aand/or pair of relatively smaller arcuate channels123bon opposite sides of channel portion123a, for example.

Referring generally toFIGS.88-93a modular blade320and an extendable blade330for coupling to modular blade320is disclosed.FIGS.88and89are various perspective views of a modular blade320andFIGS.90and91are various perspective views of an extendable blade330for coupling to modular blade320.FIG.92is a front view of modular blade320and extendable blade330side by side andFIG.93is a top down view of modular blade320and extendable blade330. In various embodiments, modular blade320and extendable blade330may be configured as a telescoping blade system.

Modular blade320may extend from a proximal end320pto a distal end320din a proximal-to-distal direction (may also be referred to as longitudinal direction). The proximal end320pmay include an engagement feature326having spring loaded tabs327for coupling to a blade engagement mechanism in the same, similar, and/or substantially the same way as explained above. The distal end320dmay include a tip portion321. In the example embodiment, tip portion321comprises a substantially planar outer surface that tapers towards a centerline of modular blade320and terminates as a blunt chisel shaped end having a relatively smaller thickness than the remaining portions of modular blade320, for example. Modular blade320may include a pair of rails324aand324bthat extend from proximal end320ptowards distal end320d. For example, a first rail324amay extend along a first lateral side of blade320in the proximal-to-distal direction and a second rail324b, opposite first rail324a, may extend along a second lateral side of blade320in the proximal-to-distal direction. First rail324amay extend laterally away from extendable blade320farther than second rail324b, for example. For example still, second rail324bmay be inset towards a center of modular blade320relative to first rail324aand324amay be outset relative to second rail324b(seeFIG.93). First rail324amay define a first receiving cavity324yand second rail324zmay define a second receiving cavity324z, for example. Additionally, modular blade may include a channel319extending along the outside surface of modular blade320in the proximal-to-distal direction and/or from a proximal end to a distal end. Channel319may have a size and shape generally corresponding to a size and shape of channel339of extendable blade330, for example. In various embodiments, a stability pin may be positioned within channels319and339, for example. In various embodiments, rails324a,324b, and channel319may define a contoured receiving channel for receiving extendable blade330, as will be explained in further detail below.

Modular blade320may include an aperture322extending through a top surface of blade320at the proximal end320pand penetrating through the inside surface of blade320at oval shaped opening322a, for example. Aperture322may have the same, similar, and/or substantially the same features and functionality of aperture122. Accordingly, duplicative description will be omitted. Modular blade320may include a contoured channel323for connecting with extendable blade330and facilitating the forward and backward relative motion of extendable blade330in the proximal-to-distal direction, for example. Contoured channel may include a relatively large central arcuate channel portion323ahaving a pair of relatively smaller arcuate channels323bon opposite sides of channel portion323a, for example. Additionally, contoured channel323may include a plurality of indentations325extending in a proximal-to-distal direction, for example. In various embodiments, indentations325may be circular shaped indentations, oval shaped indentations, hexagonal shaped indentations, parallelogram shaped indentions, and/or any combination thereof. A distal end of contoured channel323may include a stop feature329for preventing extendable blade330from extending too far in the proximal-to-distal direction.

Extendable blade330may extend from a proximal end330pto a distal end330din a proximal-to-distal direction (also referred to as a longitudinal direction). The distal end may include a tip portion331tapering towards a centerline of extendable blade330and terminating as a blunt chisel shaped end having a relatively smaller thickness than the remaining portion of extendable blade330, for example. In the example embodiment, an outside surface of extendable blade330may include an engagement feature334for connecting with contoured channel323, for example. Engagement feature334may include a proximal engagement rail335having a size and shape generally corresponding to a size and shape of contoured channel323. For example, proximal engagement rail335may have a size and shape generally corresponding to the relatively large central arcuate channel portion323aand the pair of relatively smaller arcuate channels323b, for example. Additionally, engagement feature334may include a medial engagement rail336having a width approximately corresponding to the relatively large central arcuate channel portion323aof modular blade320, for example. In various embodiments, an exposed surface of medial engagement rail336may be substantially planar although in other embodiments the exposed surface may be arcuately shaped to correspond and/or approximate the geometrical profile of contoured channel323, for example.

In various embodiments, engagement feature334may include at least one protrusion333having a size and shape generally corresponding to a size and shape of indentation325. For example, protrusion333may selectively be seated within any one of indentations325to secure extendable blade330in any one position of the plurality of positions defined by indentations325. In various embodiments, protrusion333may be a circular shaped protrusion, oval shaped protrusion, hexagonal shaped protrusion, parallelogram shaped protrusion, and/or any combination thereof. In various embodiments, protrusion333may extend away from extendable blade330in a direction perpendicular to the proximal-to-distal direction a distance that is relatively farther out than medial engagement rail336and proximal rail335, for example. In some embodiments, protrusion333may be spring loaded and/or biased. In other embodiments, protrusion333may be a rigid non movable structure.

In various embodiments, engagement feature334may include a distal engagement rail337having a size and shape generally corresponding to a size and shape of contoured channel323. For example, distal engagement rail337may have a size and shape generally corresponding to the relatively large central arcuate channel portion323aand the pair of relatively smaller arcuate rails323b, for example. Additionally, engagement feature334may include a stop feature338that may abut against stop feature329of modular blade320to prevent extendable blade330from disengaging with modular blade320as explained above, for example.

With reference toFIG.91, the inside surface of modular blade320and the outside surface of extendable blade330is illustrated. In various embodiments, extendable blade330may operably couple to modular blade320by inserting engagement feature334into channel323. As explained above, extendable blade330may move forward and backward in a proximal-to-distal direction within contoured channel323. For example, extendable blade330may extend forward and backward within contoured channel323and protrusion333may be seated within any one of indentations325. For example, when modular blade320and extendable blade330are coupled together as a system, they may be referred to as a telescoping blade system.

With reference toFIG.92, a top down view of modular blade320and extendable blade330is illustrated. In the example embodiment, it is shown that rails324a,324band channel319define a cavity and/or channel for receiving extendable blade330. For example, extendable blade330has a width in a lateral direction that corresponds to a distance between rails324a,324band a thickness of extendable blade330corresponds to a depth of the cavity and/or channel between and defined by rails324aand324b. In various embodiments, the outside lateral edge3301of extendable blade330may be mated within the receiving cavity324ydefined by rail324aand an outside lateral rail332of extendable blade330may be mated within receiving cavity324z, for example. In various embodiments, outside lateral rail332of extendable blade330may extend along the outside lateral edge of extendable blade330in the proximal-to-distal direction until about the tip portion331, for example. Additionally, channel319of extendable blade330may be mated within channel319of modular blade320. In this way, rails324aand324bmay provide a bearing surface for retaining extendable blade330therein while also allowing extendable blade330to move forward and backward in the proximal-to-distal direction. Additionally, it is shown that engagement feature334has a size and shape corresponding to contoured channel323. For example, the curved surfaces of proximal engagement rail335may be inset within contoured channel323and frictionally engage and slide across the interior surfaces defined by the relatively large central arcuate channel portion323aand/or pair of relatively smaller arcuate channels323bon opposite sides of channel portion323a, for example.

Referring generally toFIGS.94-99a modular blade420and an extendable blade430for coupling to modular blade420is disclosed.FIGS.94and95are various perspective views of a modular blade420andFIGS.96and97are various perspective views of an extendable blade430for coupling to modular blade420.FIG.98is a front view of modular blade420and extendable blade430side by side andFIG.99is a top down view of modular blade420and extendable blade430. In various embodiments, modular blade420and extendable blade430may be configured as a telescoping blade system.

Modular blade420may extend from a proximal end420pto a distal end420din a proximal-to-distal direction (may also be referred to as longitudinal direction). The proximal end420pmay include an engagement feature426having spring loaded tabs427for coupling to a blade engagement mechanism in the same, similar, and/or substantially the same way as explained above. The distal end420dmay include a tip portion421. In the example embodiment, tip portion421comprises a substantially planar outer surface that tapers towards a centerline of modular blade420and terminates as a blunt chisel shaped end having a relatively smaller thickness than the remaining portions of modular blade420, for example. As best seen inFIG.95, in some embodiments tip portion421may curve inward and/or arc inward in various embodiments, for example. Modular blade420may include a pair of rails424aand424bthat extend from proximal end420ptowards distal end420d. For example, a first rail424amay extend along a first lateral side of blade420in the proximal-to-distal direction and a second rail424b, opposite first rail424a, may extend along a second lateral side of blade420in the proximal-to-distal direction. In various embodiments, modular blade420may be symmetrical on either side of a centerline extending in the proximal-to-distal direction, for example.

In various embodiments, first rail424amay define a first receiving cavity424yand second rail424bmay define a second receiving cavity424z, for example (seeFIG.99). Additionally, modular blade420may include a first channel419aand second channel419bextending along the inside surface of modular blade420in the proximal-to-distal direction and/or from a proximal end to a distal end, for example. Channels419a,419bmay have a size and shape generally corresponding to a size and shape of channels439aand439bof extendable blade430, for example. In various embodiments, rails424a,424b, and channels419a,419bmay define a contoured receiving channel for receiving extendable blade430, as will be explained in further detail below.

Modular blade420may include at least one aperture422extending through a top surface of blade420at the proximal end420pand penetrating through the inside surface of blade420at oval shaped opening422a, for example. Apertures422may have the same, similar, and/or substantially the same features and functionality of aperture122. Accordingly, duplicative description will be omitted. Modular blade420may include a contoured channel423for connecting with extendable blade430and facilitating the forward and backward relative motion of extendable blade430in the proximal-to-distal direction, for example. Contoured channel may include a relatively large central arcuate channel portion423ahaving a pair of relatively smaller arcuate channels423bon opposite sides of channel portion423a, for example. Additionally, contoured channel423may include a plurality of indentations425extending in a proximal-to-distal direction, for example. In various embodiments, indentations425may be circular shaped indentations, oval shaped indentations, hexagonal shaped indentations, parallelogram shaped indentions, and/or any combination thereof. A distal end of contoured channel423may include a stop feature429for preventing extendable blade430from extending too far in the proximal-to-distal direction.

Extendable blade430may extend from a proximal end430pto a distal end430din a proximal-to-distal direction (also referred to as a longitudinal direction). The distal end may include a tip portion431and extendable blade430may be generally shaped like a rectangle (in a plan view). In the example embodiment, an outside surface of extendable blade430may include an engagement feature434for connecting with contoured channel423, for example. Engagement feature434may include a proximal engagement rail435having a size and shape generally corresponding to a size and shape of contoured channel423. For example, proximal engagement rail435may have a size and shape generally corresponding to the relatively large central arcuate channel portion423aand the pair of relatively smaller arcuate channels423b, for example. Additionally, engagement feature434may include a medial engagement rail436having a width approximately corresponding to the relatively large central arcuate channel portion423aof modular blade420, for example. In various embodiments, an exposed surface of medial engagement rail436may be substantially planar although in other embodiments the exposed surface may be arcuately shaped to correspond and/or approximate the geometrical profile of contoured channel423, for example.

In various embodiments, engagement feature434may include at least one protrusion433having a size and shape generally corresponding to a size and shape of indentation425. For example, protrusion433may selectively be seated within any one of indentations425to secure extendable blade430in any one position of the plurality of positions defined by indentations425. In various embodiments, protrusion433may be a circular shaped protrusion, oval shaped protrusion, hexagonal shaped protrusion, parallelogram shaped protrusion, and/or any combination thereof. In various embodiments, protrusion433may extend away from extendable blade430in a direction perpendicular to the proximal-to-distal direction a distance that is relatively farther out than medial engagement rail436and proximal engagement rail435, for example. In some embodiments, protrusion433may be spring loaded and/or biased. In other embodiments, protrusion433may be a rigid non movable structure.

In various embodiments, engagement feature434may include a distal engagement rail437having a size and shape generally corresponding to a size and shape of contoured channel423. For example, distal engagement rail437may have a size and shape generally corresponding to the relatively large central arcuate channel portion423aand the pair of relatively smaller arcuate channels423b, for example. Additionally, engagement feature434may include a stop feature438that may abut against stop feature429of modular blade420to prevent extendable blade430from disengaging with modular blade420as explained above, for example.

With reference toFIG.98, the inside surface of modular blade420and the outside surface of extendable blade430is illustrated. In various embodiments, extendable blade430may operably couple to modular blade420by inserting engagement feature434into channel423. As explained above, extendable blade430may move forward and backward in a proximal-to-distal direction within contoured channel423. For example, extendable blade430may extend forward and backward within contoured channel423and protrusion433may be seated within any one of indentations425.

With reference toFIG.99, a top down view of modular blade420and extendable blade430is illustrated. In the example embodiment, it is shown that rails424a,424band channels419a,419bdefine a cavity and/or channel for receiving extendable blade430. For example, extendable blade430has a width in a lateral direction that corresponds to a distance between rails424a,424band a thickness of extendable blade430corresponds to a depth of the cavity and/or channel between and defined by rails424aand424b. In various embodiments, the outside lateral rail432aof extendable blade430may be mated within the receiving cavity424ydefined by rail424aand an outside lateral rail432bof extendable blade430may be mated within receiving cavity424z, for example. In various embodiments, outside lateral rail432a,432bof extendable blade430may extend along the outside lateral edge of extendable blade430in the proximal-to-distal direction until about the tip portion431, for example. Additionally, channels439a,439bof extendable blade430may be mated within channels419a,419bof modular blade420. In this way, rails424aand424bmay provide a bearing surface for retaining extendable blade430therein while also allowing extendable blade430to move forward and backward in the proximal-to-distal direction. Additionally, it is shown that engagement feature434has a size and shape corresponding to contoured channel423. For example, the curved surfaces of proximal engagement rail435may be inset within contoured channel423and frictionally engage and slide across the interior surfaces defined by the relatively large central arcuate channel portion423aand/or pair of relatively smaller arcuate channels423bon opposite sides of channel portion423a, for example.

Referring generally toFIGS.100-105a modular blade440and various extendable blades450a,450b, and450cfor coupling to modular blade440is disclosed.FIGS.100-101are various perspective views of a modular blade440andFIGS.102-104are various perspective views of extendable blades450a,450b, and450cfor coupling to modular blade440.FIG.105is a front view of extendable blades450a,450b, and450c. In various embodiments, modular blade440and extendable blades450a,450b, and450cmay be configured as a telescoping blade system. In various embodiments, the extendable blades450a,450b, and450cmay have a relatively long and narrow tip section that may be advantageous for distracting soft tissues of a patient, for example.

Modular blade440may extend from a proximal end440pto a distal end440din a proximal-to-distal direction (may also be referred to as longitudinal direction). The proximal end440pmay include an engagement feature446having spring loaded tabs447for coupling to a blade engagement mechanism in the same, similar, and/or substantially the same way as explained above. The distal end440dmay include a tip portion441. In the example embodiment, tip portion441comprises a substantially planar outer surface that tapers towards a centerline of modular blade440and terminates as a blunt chisel shaped end having a relatively smaller thickness than the remaining portions of modular blade440, for example. Modular blade440may include a pair of rails444that extend from proximal end440ptowards distal end440d. For example, a first rail444may extend along a first side of blade440in the proximal-to-distal direction and a second rail444, opposite the first rail444, may extend along a second side of blade440in the proximal-to-distal direction. In various embodiments, rails444may define a receiving channel for receiving any one of extendable blades450a,450b, and450c, for example.

Modular blade440may include a contoured channel443for connecting with extendable blades450a,450b, and450cand facilitating the forward and backward relative motion of extendable blades450a,450b, and450cin the proximal-to-distal direction, for example. As shown best inFIG.83, contoured channel443may include a relatively large central arcuate channel portion443ahaving a pair of relatively smaller arcuate channels443bon opposite sides of channel portion443a, for example. Additionally, contoured channel443may include a plurality of indentations445extending in a proximal-to-distal direction, for example. In various embodiments, indentations445may be circular shaped indentations, oval shaped indentations, hexagonal shaped indentations, parallelogram shaped indentions, and/or any combination thereof. A distal end of contoured channel443may include a stop feature449for preventing extendable blades450a,450b, and450cfrom extending too far in the proximal-to-distal direction.

Extendable blades450a,450b, and450cmay extend from a proximal end450pto a distal end450din a proximal-to-distal direction (also referred to as a longitudinal direction). The distal end may include a relatively long tip portion451that tapers near a medial portion of extendable blades450a,450b, and450cand then extends towards distal end450dat the same, similar, and/or substantially the same width. Relatively long tip portion451may terminate as an arcuate curved end with chamfered surfaces, for example. As seen best inFIG.105, extendable blades450a,450b, and450care similar and have differently sized tip portions451. For example, extendable blade450ahas a relatively wider tip portion451than extendable blades450band450c, for example. Extendable blade450bhas a relatively narrower tip portion451than extendable blade450aand a relatively wider tip portion451than extendable blade450c, for example. Extendable blade450chas a relatively narrow tip portion451than extendable blades450aand450b, for example. The other remaining features and components may be the same, substantially the same, and or similar.

In the example embodiment, an outside surface of extendable blades450a,450b, and450cmay include an engagement feature454for connecting with contoured channel443, for example. Engagement feature454may include a proximal engagement rail455having a size and shape generally corresponding to a size and shape of contoured channel443. For example, proximal engagement rail455may have a size and shape generally corresponding to the relatively large central arcuate channel portion443aand the pair of relatively smaller arcuate channels443b, for example. Additionally, engagement feature454may include a medial engagement rail456having a width approximately corresponding to the relatively large central arcuate channel portion443aof modular blade440, for example. In various embodiments, an exposed surface of medial engagement rail456may be substantially planar although in other embodiments the exposed surface may be arcuately shaped to correspond and/or approximate the geometrical profile of contoured channel443, for example.

In various embodiments, engagement feature454may include at least one protrusion453having a size and shape generally corresponding to a size and shape of indentation445. For example, protrusion453may selectively be seated within any one of indentations445to secure extendable blades450a,450b, and450cin any one position of the plurality of positions defined by indentations445. In various embodiments, protrusion453may be a circular shaped protrusion, oval shaped protrusion, hexagonal shaped protrusion, parallelogram shaped protrusion, and/or any combination thereof. In various embodiments, protrusion453may extend away from extendable blades450a,450b, and450cin a direction perpendicular to the proximal-to-distal direction a distance that is relatively farther out than medial engagement rail456and/or proximal engagement rail455, for example. In some embodiments, protrusion453may be spring loaded and/or biased. In other embodiments, protrusion453may be a rigid non movable structure.

In various embodiments, engagement feature454may include a distal engagement rail457having a size and shape generally corresponding to a size and shape of contoured channel443. For example, distal engagement rail457may have a size and shape generally corresponding to the relatively large central arcuate channel portion443aand the pair of relatively smaller arcuate channels443b, for example. Additionally, engagement feature454may include a stop feature458that may abut against stop feature449of modular blade440to prevent extendable blades450a,450b, and450cfrom disengaging with modular blade440, for example. For example, in a fully extended position, stop feature449of extendable blade may directly contact stop feature458of extendable blades450a,450b, and450cand prevent extendable blades450a,450b, and450cfrom extending too far that engagement feature454becomes unseated from contoured channel443.

In various embodiments, extendable blades450a,450b, and450cmay operably couple to modular blade440by inserting engagement feature454into channel443. As explained above, extendable blades450a,450b, and450cmay move forward and backward in a proximal-to-distal direction within contoured channel443. For example, extendable blades450a,450b, and450cmay extend forward and backward within contoured channel443and protrusion453may be seated within any one of indentations445. For example, when modular blade440and any one of extendable blades450a,450b, and450care coupled together as a system, they may be referred to as a telescoping blade system and such system may be particularly advantageous for distracting and retracting various soft patient tissue, for example.

In the example embodiment, rails444may define a cavity and/or channel for receiving any one of extendable blades450a,450b, and450c. For example, extendable blades450a,450b, and450cmay have a width in a lateral direction that corresponds to a distance between rails444and a thickness of each extendable blades450a,450b, and450cmay correspond to a depth of the cavity and/or channel between and defined by rails444, for example. In various embodiments, any one corresponding pair of outside lateral edges of extendable blades450a,450b, and450cmay be inset within the receiving cavity defined by rails444such that a pair of lateral edges frictionally engages and slides across the interior side surfaces of modular blade440, for example. In this way, rails444may provide a bearing surface for retaining any one of extendable blades450a,450b, and450ctherein while also allowing any inserted blade to move forward and backward in the proximal-to-distal direction. Additionally, in various embodiments engagement feature454has a size and shape corresponding to contoured channel443. For example, the curved surfaces of proximal engagement rail455may be inset within (mated within) contoured channel443and frictionally engage and slide across the interior surfaces defined by the relatively large central arcuate channel portion443aand/or pair of relatively smaller arcuate channels443bon opposite sides of channel portion443a, for example.

Additional Retractor Embodiments

Referring generally toFIGS.106-108Da modular blade140and an extendable blade150having a pointed end151is disclosed. In some embodiments, extendable blade150may be referring to as an “impact blade” on account of being configured with a pointed end151that may be driven into a disc space, for example.FIG.106is a front view of the modular blade140and extendable blade150slidably coupled together andFIG.107is a rear view of the modular blade140and extendable blade150slidably coupled together.FIGS.108A and108Bare various exploded parts views of the modular blade140and extendable blade150.FIG.108Cis a perspective view of the modular blade140andFIG.108Dis a top down view of the modular blade140.

In the example embodiment, modular blade140may include an engagement feature146having similar functional attributes to blade engagement feature126explained above with respect to blade120. However, in this embodiment, the engagement feature146of modular blade140does not include spring loaded tabs127, for example. Rather, as best seen inFIGS.108B,108C, and108D, engagement feature146comprises a raised rail146B having an arcuately shaped and/or curved shaped uppermost surface146A, for example. The raised rail portion146B may be offset from the outside surface of modular blade140by platform146D. In the example embodiment, a thickness or dimension of platform146D in a lateral direction is less than a thickness or dimension of raised rail146B in the lateral direction. In the example embodiment, channel portions146C are formed on opposite sides of platform146D and are located between the outside surface of modular blade140and the adjacent inside surface of raised rail146B, for example. In this way, engagement feature146may be configured to slidably connect to a corresponding blade coupling portion of an arm of the variously disclosed blade coupling portions having corresponding male/female features. In at least one embodiment, modular blade140may be securely coupled to blade coupling portion535shown inFIGS.119-121Bby sliding the modular blade140from beneath blade coupling portion535upwards into blade coupling portion535. For example, modular blade140may be configured for bottom loading as will be explained in further detail below. Additionally, any blade disclosed herein may be configured with the same, similar, or substantially the same type of engagement feature146. However, consistent with the disclosure herein, modular blade and engagement feature146may also be reversed for top loading.

As seen best inFIGS.108B,108C, and108D, modular blade140may comprise a pair of channels143extending along the interior surface thereof from a proximal end140P to a distal end140D. In various embodiments, the interior surface of modular blade140may be a curved surface148. Additionally, the extendable blade150may comprise a pair of outdented rail portions153extending along the side surfaces thereof from a proximal end150P to a distal end150D thereof. In the example embodiment, the blade surface of extendable blade150has a curved sidewall surface158having a size and shape generally corresponding to the interior curved surface148of modular blade140, for example. In use, the extendable blade150may be configured to couple to the modular blade140by sliding the outdented rails153into the interior channels143of modular blade140, for example. In this way, extendable blade150may be configured to slidably couple to modular blade140in an operable way, for example. However, it shall be understood that other embodiments may rely on a single rail153and a single channel143and that channels143and rails153may take various shapes, for example oblong, square, trapezoidal, dovetail, tongue and groove, etc.

FIG.108Eis a perspective view of a driver149for use with the modular blade140and extendable blade150, for example. In some embodiments, driver149may be a referred to as an impact driver on account of being suitable for sustaining an impact force to drive extendable blade150forward, for example. In the example embodiment, driver149may extend in a longitudinal direction from a proximal end to a distal end. For example, driver149may include a proximal end comprising a striking end or surface149A having a relatively flat or smooth top surface and a circumferential side surface149B having various texturing. In the example embodiment, the texturing of side surface149B extends in a proximal to distal direction along the outside side surface of the proximal end of driver149as raised rails and indented valleys therebetween. The texturing may assist a surgeon in rotating driver149within channel143and in some embodiments, rotating driver149may be used to rotate a threaded pin (not illustrated). In some embodiments, the contouring and/or texturing may correspond to a torx head or a similar driver end, for example. In various embodiments, a shaft149C may couple to or be integrally formed together with the proximal end and distal end, for example. In the example embodiment, shaft149C may have a diameter substantially corresponding in size and shape to a diameter of channel143, for example. Additionally, a distal end of shaft149C may comprise a blunt distal end149D. In operation, the blunt end149D may contact the proximal end of extendable blade150for pushing extendable blade150forward. Additionally, a first and second driver149may be used together to push extendable blade150forward within both of channels143, for example.

FIG.109is a perspective view of a rectangular shaped dilator160. In the example embodiment, dilator160extends in a longitudinal direction from a proximal end160P to a distal end160D. The proximal end160P may include a pair of opposing curvilinear indents165for gripping dilator160, for example. In various embodiments, dilator160may comprise an aperture163or opening extending from proximal end160P to distal end160D through dilator160, for example. In various embodiments, dilator160may have planar side surfaces161extending in a proximal-to-distal direction. In the example embodiment, dilator160may further include a chiseled end or inclined end defining the distal end160D surfaces. For example, planar side surfaces161may terminate into inclined surfaces162which may facilitate insertion of dilator160into an operative corridor for example. In the example embodiment, dilator160is rectangular shaped and in other embodiments dilator160may be square shaped. Dilator160may be used with any type of blade disclosed herein. Dilator160may be particularly advantageous for use with a relatively flat planar blade such as blade130shown inFIG.84and/or the footed tip blades disclosed below. At least one surgical configuration may comprise the utilization of a four-blade configuration comprising four substantially planar blades that generally surround the rectangular shaped dilator160, for example.

Referring generally toFIGS.110-114various example shims170,180are disclosed.FIG.110is a bottom perspective view of a pair of shims170for coupling to various blades disclosed herein.FIG.111is a perspective view of a relatively short shim170having a pointed pin173at a distal end thereof andFIG.112is a perspective view of a relatively tall shim170having a pointed pin173at a distal end thereof.FIG.113is a perspective view of a relatively tall shim170having a blunted distal end.FIG.114is a perspective view of a double-sided shim180for coupling to various blades disclosed herein. In the example embodiments, shim170may extend in a longitudinal direction from a proximal end170P to a distal end170D. The proximal end may include a tab172for gripping shim170and pushing shim170downward or pulling shim170upward, for example. As seen best inFIG.110, shim170may comprise an arcuate rail171having a size and shape generally corresponding to a channel of a blade, for example channel143of modular blade140. Additionally, in various embodiments, tab172may comprise a relatively smooth planar upper surface that is strong enough to sustain an impact for driving or tapping of shim170. For example, a surgeon may provide an impact force to tab172by a mallet or hammer which drives shim170forward while remaining partially constrained within a corresponding channel of a blade. In striking tab172, the shim170may be thrust forward or in a distal direction thereby inserting pin173into patient anatomy such as a bone or disc space, for example. Each shim170may have various dimensioned side surfaces for abutting against patient tissue. As seen inFIG.111, some shim170embodiments may include a working surface175extending for a relatively short distance in the longitudinal direction and for a relatively great distance in a lateral direction substantially perpendicular to the longitudinal direction of shim170, for example. As seen in the example embodiment ofFIG.112, some shim170embodiments may include a working surface176extending for a relatively long distance in a longitudinal direction and for a relatively short distance in a lateral direction substantially perpendicular to the longitudinal direction of shim170, for example. In the example embodiment ofFIG.112, working surface176extends in the longitudinal direction for slightly less than half the length of the shim170in the longitudinal direction. As seen in the example embodiment ofFIG.113, some shim170embodiments may include a working surface177extending for a relatively long distance in a longitudinal direction and for a relatively short distance in a lateral direction substantially perpendicular to the longitudinal direction of shim170, for example. In the example embodiment ofFIG.113, working surface177extends in the longitudinal direction for more than half the length of the shim170in the longitudinal direction.

FIG.114is an example embodiment of a double-sided shim180. In this embodiment, shim180includes a pair of tabs182, and a pair of rails181. In this way, shim180may slidably couple to a pair of corresponding channels of a blade, for example channels143of modular blade140. In the example embodiment ofFIG.114, shim180comprises a first working surface184extending away from shim180in a first lateral direction perpendicular to the longitudinal direction and a second working surface185extending away from shim180in a second lateral direction perpendicular to the longitudinal direction. In this embodiment, working surfaces184,185are disposed on opposite sides of a centerline189of shim180.

Referring generally toFIGS.115A-116Ba blade adjustment and positioning tool250is disclosed.FIG.115Ais a perspective view of a blade adjustment and positioning tool250andFIG.115Bis an exploded parts view of the blade adjustment and positioning tool250.FIG.116Ais an outside surface perspective view of the blade adjustment and positioning tool engaged with a modular blade and an extendable blade andFIG.116Bis an inside surface perspective view of the blade adjustment and positioning tool engaged with a modular blade and an extendable blade, for example. In the example embodiment, tool250may extend in a longitudinal direction from a proximal end250P to a longitudinal end250D, for example. In the example embodiment, the proximal end may be defined by a rotatable turnkey251and the distal end may be defined by a tab256.

In the example embodiment, the first portion250A may comprise a gripping portion255having a plurality of gripping indentations extending along a length thereof, for example. Additionally, the gripping portion may include a centrally disposed shaft extending therethrough in the longitudinal direction between proximal aperture257A and medial aperture257B, for example. Additionally, the second portion may include a matting rail258having a size and shape that corresponds to a size and shape of a channel of modular blade120, for example channel123shown inFIG.83. However, it shall be understood that reference to channel123is by example only, and that matting rail258and the corresponding channel of modular blade120does not necessarily need indentations125and arcuate channel portions123B, for example. In various embodiments, the distal end of first portion250A may be defined by tab256. In the example embodiment, tab256is offset laterally from an extension axis extending through proximal aperture257A and medial aperture257B, for example.

Second portion250B may include a turnkey251and/or a knob at a proximal end thereof. Turnkey251may be coupled to or monolithically formed with primary shaft252and extension shaft253. In various embodiments, extension shaft243may comprise a drive feature or driving head254at a distal end thereof. In operation, second portion250B may be insert inside of first portion250A by inserting the driving head254, extension shaft253, and primary shaft252through proximal aperture257A. Due to the particular design of this embodiment, the primary shaft252may be rotatably disposed within the central shaft of the first portion and primary shaft252may have a size and shape generally corresponding to a size and shape of the central shaft of the first portion, e.g., substantially the same diameter and a length substantially the same as a distance between proximal aperture257A and medial aperture257B. Extension shaft253may be partially mated to and/or disposed within an open channel258C of matting rail258such that it may freely rotate and so can driving end254.

With reference toFIGS.116A and116B, tool250may couple to a modular blade120by inserting matting rail258with channel123. Additionally, as seen best inFIG.116B, due to the offset nature of tab256an inside surface of tab256may be directly adjacent to and/or directly contact an inside surface of extendable blade130. In this way, tool250may provide a fulcrum or handle to manipulate the modular blade120and extendable blade130. At least one particularly advantageous use of tool250may be when modular blade120and extendable blade130are coupled to a free hand module, as explained above, which may not have actuators to cause pivoting and/or angulation, e.g., free hand module900as shown inFIG.49B. Additionally, in some embodiments, an end user may initially mate first portion250A to modular blade120and extendable blade130, then insert second portion into first portion, and slide second portion forward in a distal direction such that it pushes extendable blade130forward. In some embodiments, a chiseled end of second portion, e.g., drive feature254, may unseat a protrusion of extendable blade130from a corresponding indentation of modular blade120, e.g., protrusion133and indentations125(seeFIGS.83-84). In this way, an end user may utilize tool250to extend a position of extendable blade130via second portion250B and may use tool250as a fulcrum or handle for applying a mechanical advantage as a fulcrum to modular blade250and extendable blade230, for example. Additionally, in at least some embodiments, because drive end254may be rotatable, it may facilitate the unseating of the protrusion of the extendable blade130from the corresponding indentation of modular blade120.

Referring generally toFIGS.117A-118E, various views of a modular blade260and an extendable blade262having a footed tip263, a quick connect handle270, and a retractor mount coupler280are disclosed.FIG.117Ais a perspective view of the inside surfaces of the modular blade260and extendable blade262andFIG.117Bis a perspective view of the outside surfaces of the modular blade260and extendable blade262. In the example embodiment, the extendable blade262has a footed tip263and is slidably coupled to the modular blade260similarly as explained above. Accordingly, duplicative description is omitted or only briefly described again. In this embodiment, modular blade260comprises an attachment rail264on the outside surface thereof adjacent the proximal end. Attachment rail264may include various surface texturing on the outside surface thereof, e.g., rail like peaks and channel like valleys therebetween extending in a proximal to distal direction around the outside curved surface of attachment rail264. In at least some embodiments, attachment rail264is integrally formed with modular blade260and in others it may be removably coupled thereto. In various embodiments, attachment rail264may include attachment shaft265extending from the proximal end of modular blade260, for example. The proximal most portion of attachment shaft265may comprise a generally cylindrical extension shaft having a planar indent267, a necked down portion268, and an end266that is wider than the necked down portion268, for example. In various embodiments, the attachment shaft265may quickly couple to and uncouple from a quick connect handle270, for example.

FIG.118Ais a perspective view of a quick connect handle270andFIG.118Bis an exploded parts view of the quick connect handle270. In the example embodiment, quick connect handle270extends in a longitudinal direction from a proximal end270P to a distal end270D. The distal end270D may comprise a coupling aperture269for connecting to an attachment shaft265of a modular blade260when attachment shaft265is inserted therein, for example. Quick connect handle270may include a main body portion275or handle and the distal end270D may comprise a coupling mechanism having various mating features comprising a size and shape generally corresponding to a size and shape attachment shaft265, for example. In the example embodiment, the pin272and mating features274are actuated by actuator271. Quick connect handle270may couple to modular blade260by depressing actuator271and sliding attachment shaft265into aperture269such that sliding barrel276lockingly engages attachment shaft265, for example. In various embodiments, barrel276may be biased towards the proximal end270D by set pins279and springs278. In various embodiments, upon activation of actuator271, e.g., by depressing actuator271button, barrel276may linearly translate forward to securely couple to modular blade260.

FIG.118Cis a perspective view of a retractor mount coupler280. Retractor mount coupler280may have many of the same, similar, and/or substantially the same components and functionality as free hand module900ofFIGS.47B and48A, for example. Accordingly, duplicative description will be omitted and/or only briefly described. In this embodiment, retractor mount coupler280may include a pair of gripping arms916for gripping on to the outside textured surface of rail264, for example. Additionally, retractor mount coupler280may include a lever911and a body913having an aperture913A. Lever911may function in the same or substantially the same way as previously explained with respect to free hand module900. As seen best inFIG.129, retractor mount coupler280may couple and couple to a rod, pole, table mount extension, and/or lateral arm1201of a secondary module1200, for example.FIG.118Dis a perspective view of the modular blade260and extendable blade262ofFIGS.117A-117Bcoupled to the quick connect handle270ofFIGS.118A-118Band the retractor mount coupler280ofFIG.118C.FIG.118Eis a perspective view showing the quick connect handle270uncoupled from the attachment shaft265of modular blade

Referring generally toFIGS.119-122an additional embodiment of a modular retractor530is disclosed. Modular retractor530may have the same, similar, and or substantially the same components and functionality as explained above with respect to modular retractor500and modular retractor530may be used with any of the various add on retractor modules600,700,800,900,1000, and1100that are disclosed herein and shown in the various views ofFIGS.20-81, for example. Accordingly, significant duplicative description will be omitted although some aspects will be repeated for ease of explanation.FIGS.119and120are various perspective views of modular retractor530.FIG.121Ais a top down view of modular retractor530andFIG.121Bis a bottom perspective view of a blade attachment mechanism535.FIG.122Ais an enlarged view of the embodiment ofFIGS.119-121with the top cover removed for ease of understanding of the internal gear system.FIG.122Bis an enlarged view of the embodiment ofFIGS.119-121from a bottom perspective showing various structural features of a table mount quick release coupler533.

In the example embodiment, modular retractor530may include handles501a,501band arms505and507. The handles and/or actuator502may serve to open the retractor530by spreading the arms505,507apart from one another as explained previously. Modular retractor530may differ from retractor500in a few ways. For example, the blade attachment mechanism535may be configured for bottom loading rather than top loading, the blade release actuator537may be disposed on a side surface of blade attachment mechanism535rather than a top surface, a release mechanism531may be relied upon rather than pawl504, and a table mount quick release connection533may be provided rather than table mount arm506, for example.

As seen best inFIGS.120and121B, blade attachment mechanism535may be configured for bottom loading of various blade engagement features, for example blade engagement feature146shown inFIGS.108B,108C, and108D. Generally, blade attachment mechanism535may have a size and shape generally corresponding to a size and shape of a corresponding blade engagement feature146. In the example embodiment, blade attachment mechanism535includes a channel535B that is open to the bottom and closed at the top by a curved top surface535A, for example. The curved top surface may have a curvature generally corresponding to a curvature of the curved uppermost surface146A and the channel535B may have a width, length, and height generally corresponding to a width, length, and height of raised rail portion146B, for example. In some embodiments, the curved top surface535A may be referred to as a stop surface and/or stopping wall. In various embodiments, channel535B may be flanked by supports535C, for example. In use, when blade engagement feature146is securely coupled to blade attachment mechanism535the side surfaces of platform146D may contact the side surfaces535D of supports535C such that the channel portions146C are mated with supports535C, for example. Additionally, in various embodiments the side surfaces535D may be chamfered and/or inclined, for example as seen best inFIG.121B. This arrangement may facilitate insertion of a blade thereon, for example. Furthermore, in various embodiments an outside surface of a corresponding blade and/or platform146D may contact the outermost surface of supports535C. Further still, blade release mechanism537may securely couple and uncouple a blade to blade attachment mechanism535when actuated.

As seen best inFIG.122A, modular retractor530may include a distraction mechanism50. In this embodiment, spur gear54includes a plurality of teeth on a side surface thereof but may not include a plurality of teeth on a top surface thereof like the example modular retractor500embodiment. Additionally, a release mechanism531may include a tooth531A or tip at an end thereof having a size and shape generally corresponding to a valley between adjacent teeth of spur gear54. Release mechanism531may be biased by a spring tab or leaf spring531B which naturally urges tooth531A into a meshed arrangement with the teeth of spur gear54such that the spur gear54is prevented from rotating in a direction which would cause the arms of modular retractor530to collapse or close. Additionally, because release mechanism531may pivot in and out of a meshed arrangement with spur gear54an end user may cause expansion or distraction between arms505,507of modular retractor530without needing to actuate release mechanism531. In this way, release mechanism531functions similarly to a pawl preventing the collapse of arms505,507while simultaneously allowing, for example, an uninhibited expansion of arms505,507.

As also seen best inFIGS.122A and122B, modular retractor530may include a quick connect table mount533. Quick connect table mount533may include an aperture533Z and a tightening knob534. Aperture533Z may have a size and shape corresponding to a square or polygonal driver, for example a drive end of a wrench such as the egg wrench10illustrated inFIG.23. As seen best inFIG.121A, quick connect table mount533may be generally disposed in a central position of the main retractor body and when viewed in a plan view may be aligned along a longitudinal axis bisecting the retractor body. This arrangement may facilitate a symmetrical load distribution, for example. However, it shall be understood that quick connect table mount533may be alternately disposed, for example on a side surface on the left side, medial or central area, and/or right side of the retractor body (with respect to plan view ofFIG.121A). Additionally, a plurality of quick connect table mounts533may be disposed in any viable region of modular retractor530and the various add on modules disclosed herein. As seen best inFIG.122B, quick connect table mount533may be configured to receive a corresponding post363and/or rail362of a quick connect arm360(seeFIGS.124-125). In the example embodiment, quick connect table mount533may include a centrally disposed mating aperture533C accessible from a bottom side of modular retractor530, for example. In some embodiments, mating aperture533C is coaxially aligned with aperture533Z although this is not a requirement. In various embodiments, mating aperture533C may include a circumferential ring surface having a relatively greater diameter than the central portion of aperture533C to facilitate seating of post363(seeFIGS.124-125) in an arrangement similar to concentric circles of varying depths. Additionally, various counter torque mating features may be disposed around and/or surround aperture533C, for example. In the example embodiment, a first groove533A extends in a direction that is substantially parallel with the longitudinal axis of modular retractor530and a second groove533B extends in a direction that is substantially perpendicular with the longitudinal axis of modular retractor530, e.g. second groove533B extends in a lateral direction with respect to modular retractor530. In the example embodiment, the first and second grooves533A,533B may resemble a cross shape and/or an X shape. Additionally, the ends of grooves533A,533B may be open or closed, for example one side of groove533B is closed and has an arcuate end surface which ensures proper alignment quick connect arm360, for example. In various embodiments, the rail363of quick connect arm360may nest within at least one of grooves533A,533B. Accordingly, in this embodiment an orientation of quick connect arm360is adjustable between a direct head on orientation type and a side or lateral orientation type, for example. At least one advantage of this configuration may be providing flexibility in orientation to a surgeon depending on different types of procedures being performed and or changes in orientation mid-procedure.

FIG.123is a perspective view of a table mount system340adapted for use with various retractor components disclosed herein. For example, various armatures of a quick connect table mount system may be used for supporting and manipulating various retractor embodiments disclosed herein. In the example embodiment, table mount system340may include a first armature340A and a second armature340B. The first armature340A may be slidably connected to the second armature340B by armature connection mechanism345. In at least one embodiment, second armature340B may include a table mount channel349and a table mount clamp350. In use the second armature340B may be rigidly and removably secured to an operating table by tightening clamp350such that table mount channel349is tightened to the table and arm348extends in a vertical direction with respect to a horizontal surface or plane of a table (not illustrated). Thereafter, the first armature340A may be coupled to arm348by positioning arm348within the aperture of armature connection mechanism345and tightening turnkey346such that a movable platform345B clamps down on to armature348by closing and/or reducing the size of the aperture, for example. In the example embodiment, movable platform345B has a channel for seating the curved surfaces of arm348and in some embodiments may have grooving or other texturing to facilitate a relatively strong connection.

First armature portion340A may include a first arm341A and a second arm341B that are hingedly connected together by hinge mechanism342, for example. In various embodiments, hinge mechanism342may allow for a full 360 degree rotation, or a subset thereof. At least one embodiment may include corresponding teeth that may mesh together when tightened or clamped together by a tightening knob342A that urges the corresponding teeth into corresponding valleys, for example. In various embodiments, second arm341B may be movably coupled to armature connection mechanism345by a ball and socket joint343, for example. Additionally, first armature341may be coupled to a snap on connector347by a ball and socket joint343, for example. Consistent with the disclosure herein, it shall be understood that any connection between the various armatures of disclosed table mount systems may be a rotatable hinge like connection, a sliding connection, and/or a ball and joint connection. Additionally, these connection types may be readily swapped and our substituted. For example, post351may be inset within a hollow interior of any armature end to change the connection type and/or functionality depending solely on the particular needs of an end user.

FIG.124is a first perspective view of a quick connect coupler360for connecting various retractor embodiments to various quick connect table mount systems disclosed herein.FIG.125is a side view of the quick connect coupler360. Quick connect coupler360may include an arm361supporting a post363and rail362on a first end thereof. In various embodiments, the arm361may follow a diagonal, straight, and/or curved profile, for example. On an opposite end, quick connect coupler360may include an armature coupler365, for example. Armature coupler365may include a post having an inclined, chamfered, and/or dimpled end366, for example. Additionally, armature coupler365may include a grooved portion367to facilitate a rigid and secure engagement with a quick connect coupler of a table mount system, for example connector347shown inFIG.123. Furthermore, a base portion of quick connect coupler360may include a counter torque surface368for resisting a rotation of quick connect coupler360, for example surface368may directly contact a corresponding counter torque surface347B of connector347(seeFIG.123). It shall be appreciated that armature coupler365may take any shape and have any form and type of various indentations, outdents, apertures, posts, slots, and etc. to facilitate attachment to a table mount arm whether in a snap on quick connect style as illustrated in the corresponding FIGS. or by, for example, a clamp on ratcheting style or even a mushroom expansion style.

FIG.126is a perspective view of a modular retractor system including the quick connect couplers ofFIGS.124-125.FIG.127is a top down view of the system ofFIG.126. Consistent with the disclosure herein, modular retractor530is securely coupled to a secondary module, e.g., module1200. Module1200may have the same, similar, and/or substantially the same features and functionality as the various other secondary modules discussed above. However, in this embodiment, secondary module1200is capable of linearly extending a centrally disposed first arm and a C shaped second arm, for example. In this embodiment, the C shaped second arm is supporting a free hand module900and the first arm is securely connected to a quick connect arm360via a table mount quick release coupler533, for example. Additionally, a body portion of module1200includes a table mount quick release coupler533and the second C shaped arm includes a table mount quick release coupler533. Additionally, it is shown that modular retractor530is securely connected to a quick connect coupler360at the table mount quick release coupler533. Accordingly, various modular retractor systems may comprise a plurality of quick release couplers533whether they be on the primary retractor530or secondary module1200, for example. In this way, a surgeon has maximum flexibility in attaching the modular retractor system to a table mount.FIG.128is a perspective view of module1200in an uncoupled position with respect to modular retractor530.FIG.129is a perspective view of module1200coupled to modular retractor530. In the example embodiment, retractor mount coupler280is secured to attachment rail264of the modular blade260and extendable blade262. Additionally, the retractor mount coupler280is coupled to lateral arm1201of retractor module1200.

FIG.130is a top down view of modular retractor530supporting first and second blades and module1200supporting a third blade.FIG.131is a perspective view of three blades being slidably coupled to a dilator94. With reference back to the set of dilators99disclosed inFIGS.80C,80B,80E, andFIG.81an example method of use will be disclosed. In a first step, a surgeon may insert an initial dilator or pin, e.g., innermost dilator98. In some embodiments, and depending on the particular surgical approach dilator98may be insert into a patient from a lateral, anterior, or trans psoas approach, e.g. Once the initial dilator98is insert in the patient, a dilator having a relatively wider size may be insert over the initial dilator98, e.g., dilator97. After dilator97is slipped over innermost dilator98, a dilator having a relatively wider size than dilator97may be slipped over dilator97, e.g., dilator96. Any number of successive and iteratively increasing in size dilators may be slipped over one another in this process. Thereafter, an outermost dilator94having a plurality of rail portions94A may be slipped over the immediately prior dilator, e.g., dilator96.

Next, a surgeon may position modular retractor530and retractor module1200over the outermost dilator94. For example, a surgeon may install first and second blades to the first and second arms of modular retractor530and a third blade may be installed on the proximal arm of retractor module1200. The three blades may be collapsed such that edge portions contact one another and a circular void space is formed by the interior surfaces of the three blades. Next, the surgeon may slip the three blades over the outermost dilator94such that the corresponding channel portions of the blades slidably couples to the rail portions94A of the outermost dilator, seeFIG.81. Thereafter, the surgeon may move the modular retractor530and retractor module1200such that the blades slide down along the length of outermost dilator and into the operative corridor. Once the surgeon has moved the three blades into the operative corridor, and the blades are supporting adjacent tissue, the surgeon may remove the outermost dilator94. After the outermost dilator94has been removed, the surgeon can freely manipulate any one of the three blades in any manner or relative movement as previously explained to enlarge the operative corridor.

It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. For example, features, functionality, and components from one embodiment may be combined with another embodiment and vice versa unless the context clearly indicates otherwise. Similarly, features, functionality, and components may be omitted unless the context clearly indicates otherwise. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques).

Unless otherwise specifically defined herein, all terms are to be given their broadest possible interpretation including meanings implied from the specification as well as meanings understood by those skilled in the art and/or as defined in dictionaries, treatises, etc. It must also be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless otherwise specified, and that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof