Surgical retractor

A surgical retractor and a method of minimally invasive surgery, wherein the surgical retractor includes ribs and a mechanism for microns-resolution transferring of linear and rotational movements of the ribs and wherein each rib can be easily replaced without use of any additional tools.According to an embodiment of the present invention the transmission is simpler. Likewise, an auxiliary handle is added to facilitate the insertion of the ribs into the body of the operated patient, and the vast majority of components of the surgical retractor are made with biocompatible, and FDA approved material ULTEM HU 1000 RESIN transparent (radiolucent) to X-ray radiation and are designated for single use.

FIELD OF THE INVENTION

The present invention relates to apparatus and techniques for performing minimally invasive surgery and, in particular to a retractor device for minimally invasive surgery, more particularly to a new expanding retractor for spinal minimal invasive neurosurgery.

BACKGROUND OF THE INVENTION

A concentrically expansible needle retractor for minimally invasive surgery, of one the present inventors, is described in PCT/IL2000/00387, filed Jul. 4, 2000, the full disclosures of which are incorporated herein by reference.

An improved radial expansible retractor for minimally invasive surgery, of the present inventors, is described in PCT/IL2006/001250, filed Oct. 30, 2006, which has significant improvements which can benefit patients, the full disclosures of which are incorporated herein by reference.

FIG. 1aof the prior art is a perspective view schematic illustration of the improved radial expansible retractor, which will be referred to in the present application as a prior art radial expansible retractor (PARER)100.

The illustrations show PARER ribs141touching each other, forming a hollow cylinder.

The prior art radial expansible retractor100is equipped with a PARER adaptor169and with a mechanism for transmitting gentle rotational mechanical movement from a PARER rotating wheel161to a PARER grooved disc152, (not shown in the present illustrations).

FIG. 1bof the prior art is a perspective view schematic illustration of a PARER cover151, of the prior art radial expansible retractor, in whose center is a PARER cover central perforation151aof a suitable diameter for inserting a tubule and performing the medical procedure.

FIG. 1cof the prior art is a perspective view schematic illustration of a PARER grooved disc152, of the prior art radial expansible retractor, in whose center is a PARER grooved disc central perforation152a, of a suitable diameter for inserting the tubule and performing the medical procedure, and PARER grooves152b, in the present case eight, designated to grant continuous forced movement to rib carrier pins.

In the case of need to open a shape other than a circle, the PARER grooved disc152can be used with at least part of the grooves having a different curve, and ends at different distances from the center. This difference necessarily results in different movement of each of the ribs, forming a lateral section, which is not circular.

Namely, the desired opening shape to be achieved by means of prior art radial expansible retractor must be determined prior to commencement of the medical operation.

FIG. 1dof the prior art is a perspective view schematic illustration of a of PARER channeled disc153, of the prior art radial expansible retractor100, in whose center is a PARER channeled disc central perforation153a, of a suitable diameter for inserting the tubule and performing the medical procedure, and PARER channels153b, in the present case eight, designated to grant continuous forced movement to the rib carrier, (not shown in the present figure). The PARER channels153bare completely straight, and are pointed in the directions of the radiuses from a joint center of the PARER channeled disc153. Their dimensions conform to those of rib carrier, and they are designated to enable strictly radial movement of PARER rib carrier144, (not shown in the present figure), with regard to the aforementioned center.

Combination of the PARER channeled disc153and the PARER cover disc151is done by means of geometrically conforming both to each other, together forming a casing suitable for carrying PARER grooved disc152and granting it smooth rotational movement.

FIG. 1eof the prior art is lateral section schematic illustrations of the prior art radial expansible retractor100.

The figure clearly showing PARER rib carrier144disposed within PARER channel153bof the PARER channeled disc153, with a PARER rib carrier pin145disposed within PARER groove152bof the PARER grooved disc152. The PARER rib carrier144connects to PARER rib base142, which is the integral base of PARER rib141, by means of PARER rib carrier bolt147.

FIG. 1fof the prior art is a perspective view schematic illustration of a PARER rib141of the prior art radial expansible retractor.

At one end of PARER rib141, the PARER rib's base142is disposed, into which the PARER rib base hole143is perforated. PARER rib141is formed as an elongated rod whose cross section can have many various geometrical shapes, also including the shape of a section of the wall of a cylinder.

FIG. 1gof the prior art is a perspective view schematic illustration of a PARER rib carrier144of the prior art radial expansible retractor. Its shape conforms for connection to the PARER rib's base142and it includes PARER rib carrier hole146, and PARER rib carrier pin145.

As far as minimal invasive methods of treatment of spinal stenosis are concerned, they are commonly performed with the assistance of tubular retractors.

A tubular retractor for minimally invasive surgery, of Bartie et al., is described in U.S. Pat. No. 6,210,325, granted Apr. 3, 2001, the full disclosures of which are incorporated herein by reference.

Use of tubular retractors for the performance of treatment of spinal stenosis has some very grave drawbacks, also including:

Over traumatization (disruption of muscles and nerves roots) of soft tissues upon insertion of a retractor, in most cases hammering is required to insert the retractor between muscle fibrils, resulting in destruction and disruption of soft tissues. During postoperative recovery, this kind of iatrogenic damage can inflict pain more severe than that caused by the pathology itself.

The tubular retractor frequently causes postoperative hemorrhaging and compression of the spinal cord, with motor function deterioration of the patient's extremities.

Uncontrolled soft tissue retraction (without measurement of retracted tissue pressure (RTP) and retracted tissue oxygen saturation (RTOS)) causes ischemic muscular degeneration-IMD and development of extremely rough postoperative scar tissue, resulting in circular compression of nerve roots and thus severe postoperative pain.

Very fast insertion of such tubular retractors causes splitting of muscles from vertebral bones and hemorrhaging. Surgeons must be aware that even though the surgery is completed effectively in a narrow space, symptoms can occur immediately if even a small hematoma is generated in this space.

Appropriate surgical tools and manual skills are required since surgeons must work in a narrow space. Further, there may be confusion regarding anatomical structures in such a limited space. Another problem is the limitations of effective decompression due to limited and constant (unchangeable, non-adjustable) diameters of tubular retractors.

Due to differing curvatures of vertebral lamina, tubular retractors don't enable the surgeon to approach lateral parts of lamina, including vertebral facets, and vision may be obstructed or disrupted by the use of tools in a narrow space with limited light.

Non-simultaneous unidirectional retraction of muscles causes uneven distribution of pressure to the soft tissues. Uncontrolled soft tissue retraction (without measurement of retracted tissue pressure (RTP) and retracted tissue oxygen saturation (RTOS)) causes ischemic muscular degeneration (IMD), and development of extremely rough postoperative scar tissue, resulting in circular compression of nerve roots and thus severe postoperative pain.

There is thus a widely recognized need for, and it would be highly advantageous to have, a surgical retractor for performing minimally invasive surgery, that will not have the aforementioned drawbacks, that will also enable working with massive tissue pressures to the extent that body tissues can apply, that will enable creating openings of various section shapes which can be changed in the course of operation, and that will be equipped with ribs of various shapes and sizes, that can be easily replaced without use of additional tools.

SUMMARY OF THE INVENTION

The surgical retractor according to the present invention further improves the performance currently available with the prior art. It enables creating openings in the human body in locations in which the tissue pressure on its ribs is significantly more powerful than in brain surgery, such as in operations in close proximity with to the spine, with the ribs of the surgical retractor subject to pressure of the adjacent muscles.

An additional improvement is enabling the option of determining the shape of the opening in the operated body created by the surgical retractor when opening, and even changing the shape as necessary throughout the operation. This is achieved by a combination of opening all ribs of the surgical retractor simultaneously as a circle and subsequent individual control of each separate rib's inclination angle. Another major improvement is in enabling the replacement, prior to commencement of use of the surgical retractor, of the ribs of the surgical retractor without any need for any additional tools.

Yet another significant improvement is the addition of a light source to the surgical retractor, which grants the operating surgeon high visibility of the working area.

Yet another significant improvement is the addition of a video camera to the surgical retractor, which grants the operating surgeon high visibility of the working area.

Yet another significant improvement is to receive integrated pictures on one screen from a video camera and outside microscope, inserted endoscopically or laparoscopically into the retractor channel and wound cavity.

The surgical retractor can also have a flexible sleeve, made for example of rubber or silicone, to prevent entry of surrounding tissue into the working channel.

Yet another significant improvement, according to embodiments of the present invention, is that most of the components of the surgical retractor are made of materials transparent to Röntgen rays (x-rays).

Yet another significant improvement is that retractor is made by fully biocompatible and FDA approved materials like ULTEM HU 1000 RESIN.

Yet another significant improvement is that retractor is fully disposable.

According to the present invention there is provided a surgical retractor including: (a) a ribs assembly, the ribs assembly including at least two ribs; (b) a mechanism for transferring of radial linear and rotational movement adapted to apply mechanical forces and moments to the ribs assembly; (c) a casing, the casing including: (i) a channeled disc wherein the mechanism for transferring of linear and rotational movement and the ribs assembly are mounted on the channeled disc; and (ii) a cover disc, wherein the cover disc is connected to the channeled disc; (d) a grooved disc mounted inside the casing, wherein the grooved disc has a grooved disc body, wherein in the grooved disc body, there are a grooved disc central perforation and at least two curved grooves, and wherein the grooved disc has a grooved disc teeth on the grooved disc outer surface; and (e) a transmission, for granting rotational movement to sais grooved disc, the transmission being mounted on the casing, wherein the transmission includes: (i) a transmission first cog wheel; and (ii) a transmission bolt head mechanically connected to the transmission first cog wheel, wherein the transmission first cog wheel is engaged with the grooved disc teeth.

According to further features of an embodiment of the present invention the transmission further includes: (iii) a transmission shaft mechanically connected to the transmission first cog wheel; and (iv) a transmission ring mechanically connected to the transmission bolt head, wherein the transmission is made of one cylindrical part.

According to further features of an embodiment of the present invention the channeled disc has a channeled disc upper surface and a channeled disc wall and a channeled disc transmission niche located on the channeled disc upper surface and on the channeled disc wall and wherein the transmission first cog wheel is at least partially located inside the channeled disc transmission niche.

According to further features of an embodiment of the present invention the surgical retractor further includes: (f) a wrench mounted on the transmission bolt head.

According to still further feature of an embodiment of the present invention the surgical retractor further including: (f) a central rod, the central rod includes: (i) a central rod tail having two central rod screws; and (ii) a central rod head dome having a central rod head dome interior thread, wherein the central rod head dome is connected to the a central rod tail, and wherein most of the central rod tail is located between the least two ribs; and (g) an auxiliary handle, the auxiliary handle has a auxiliary handle interior thread, wherein the auxiliary handle is connected to the central rod tail.

According to still further features of an embodiment of the present invention the surgical retractor further including: (f) at least one lamp mounted inside the casing; and (g) a camera mounted inside the casing.

According to still further features of an embodiment of the present invention the surgical retractor further including: (f) at least two sliders located inside the casing; (g) at least two angular adjustment bolts wherein each one of the angular adjustment bolts is screwed in another one of the least two angular adjustment bolts; and (h) a guarding cover mounted on the casing.

According to still further features of an embodiment of the present invention each one of cover disc, the channeled disc, the grooved disc, the ribs, the at least two sliders, the angular adjustment bolts, and the guarding cover is composed of material transparent to x-ray radiation.

According to still further features of an embodiment of the present invention each one of cover disc, the channeled disc, the grooved disc, the ribs, the at least two sliders, the angular adjustment bolts, and the guarding cover is composed of material fully biocompatible.

According to still further features of an embodiment of the present invention each one of the angular adjustment bolts has a linear adjustment bolt tail having a non-circular cross section shape.

According to still further features of an embodiment of the present invention the surgical retractor further includes: (f) at least two opening mechanism third type cog wheels, wherein each one of the least two opening mechanism third type cog wheels is mounted on another one of the bolt tails, wherein each one of the least two opening mechanism third type cog wheels has a opening mechanism third type cog wheel central hole having a non-circular cross section shape; and (g) an opening mechanism third type, for facilitating a uniform rotational movement opening of the ribs the opening mechanism third type is mounted on the least two opening mechanism third type cog wheels.

According to still furthers feature of an embodiment of the present invention the opening mechanism third type includes: (i) a opening mechanism third type bevel gear ring.

According to still further features of an embodiment of the present invention the opening mechanism third type includes: (ii) an opening mechanism third type housing having an opening mechanism third type housing wall and at least two opening mechanism third type housing wall holes located in the opening mechanism third type housing wall, wherein the each one of the least two linear adjustment bolt tail is located inside another one of the at least two opening mechanism third type housing wall holes.

According to the present invention there is provided a method of minimally invasive operation, the method including the stages of: (a) making an incision of skin until superficial fascia; (b) holding an auxiliary handle of a surgical retractor; (c) inserting ribs and a central rod of the surgical retractor into a patient body; (d) removing the auxiliary handle from the surgical retractor; (e) rotating a wrench for granting rotational movement to a grooved disc causing radial linear opening movement of the ribs; (f) removing the central rod from the surgical retractor; and (g) removing the wrench from the surgical retractor.

According to further features of an embodiment of the present invention the method of minimally invasive operation further includes: (h) performing a medical procedure selected from a group consisting of replacing intravertebral discuses, removal of intravertebral discuses, fusion of vertebra, operations of anterior cervical discectomy and fusion, operations of trans laminar burr hole and discectomy, far lateral discectomy and discoplasty, multi level spinal stenosis, multi level uni-lateral and bilateral laminotomy, and trans-oral vertebral fusion; (i) closing the surgical retractor's ribs; (j) taking out the surgical retractor from the patient body; and (k) suturing a patient's skin.

According to still further feature of an embodiment of the present invention the method of minimally invasive operation further including: (h) making a burr hole lateral of lamina; (i) inserting additional instruments via the burr hole; (j) performing discectomy; (k) closing the surgical retractor's ribs; (l) taking out the surgical retractor from the patient body; and (m) suturing a patient's skin.

DETAILED DESCRIPTION OF EMBODIMENTS

The present invention is a surgical retractor. The principles and operation of a surgical retractor according to the present invention may be better understood with reference to the drawings and the accompanying description.

Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings.

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The materials, dimensions, methods, and examples provided herein are illustrative only and are not intended to be limiting.

The following list is a legend of the numbering of the application illustrations:2surgical retractor10mechanism for transferring of linear and rotational movements11cover disc11acover disc base11bcover disc base11ccover disc wall11dcover disc wall hole11ecover disc wall openings11fcover disc supports11gcover disc base hole11icover disc perforation11jcover disc holding pin12grooved disc12agrooved disc central perforation12aogrooved disc central perforation center12bcurved groove12bogroove radius origin12cgrooved disc outer surface12dgrooved disc hole12egrooved disc teeth12fgrooved disc body13channeled disc13achanneled disc base13bchanneled disc wall13cchanneled disc wall niche13dchanneled disc wall hole13echanneled disc perforation13fchanneled disc long slot13gchanneled disc short slot13htrack13itrack side wall13jtrack upper wall13kchannel13lchannel upper opening13mchanneled disc wall tenon13pchanneled disc wire hole13qchanneled disc lamp housing13rchanneled disc camera housing13schanneled disc transmission niche13tchanneled disc upper surface14aangular adjustment bolt14aaangular adjustment bolt head14blinear adjustment bolt14clinear adjustment bolt head14dlinear adjustment bolt tail14enon-circular cross section shape15slider15aslider main body15bslider upper body15cslider pin hole15clmovement toward closing15dslider arm15eslider pivot hole15fslider among arms surface15gslider niche15hslider friction reducer15islider pin15jslider pivot15mslider first interior thread15nslider second interior thread15opmovement toward opening15pmain slider upper portion15qmain slider mid portion15rmain slider lower portion15sslider back portion15tslider bolt15uslider bolt hole15wslider third interior thread16carrier16acarrier bow16bcarrier bow bottom hole16ccarrier bridge16dcarrier bridge first hole16ecarrier bridge second hole16fcarrier arm16gcarrier back wall16hcarrier back wall hole16icarrier bow side hole16jcarrier arm hole17transmission17atransmission knob17btransmission shaft17ctransmission worm17etransmission tubular17ftransmission first cog wheel17gtransmission second cog wheel17htransmission third cog wheel17itransmission bolt head17jtransmission ring18base disc19external disc19hexternal disc stair20ribs assembly21rib21aconcave segment of a rib front surface21brib back surface21cconvex segment of a rib back surface21drib shoulder21erib shoulder concave segment21frib front surface21farib force arm21grib top end21hrib bottom end21irib bottom end projection21jrib force arm front surface21krib working arm front surface21mrib hole21mdmovement direction (of a rib)21nrib hook21oconcave segment of a rib front surface origin21prib hook pin21qrib segment21rcable tensioner21rmrotational movement (of a rib)21scable21tanchoring point21warib working arm23flexible sleeve30central rod30acentral rod tail30bcentral rod tail slot30ccentral rod head dome30scentral rod tail symmetrical line31acentral rod screw32acentral rod head dome interior thread40adaptor40aadaptor rod40block first part40clock second part40dlock connector40elock fastener screw40fclip47clamp48holding arm50lighting assembly51lighting source51alighting source supporter base51blamp51cpower source51delectricity conductors51elight reflector51flamp window51gelectric wire52lighting source supporter52alighting source supporter base52blighting source supporter wall52clighting source supporter wall slots52dlighting source supporter wall shoulder52elighting source supporter wall groove53camera53acamera cable58guarding cover58aguarding cover disk58bguarding cover perforation58cguarding cover niche58dguarding cover wall segment58eguarding cover wall hole59aauxiliary handle59aaauxiliary handle interior thread59bwrench (such as ratchet wrench)60aopening mechanism first type60bopening mechanism second type60copening mechanism third type60caopening mechanism third type cog wheel60cbopening mechanism third type cog wheel central hole60ccopening mechanism third type bevel gear ring60cdopening mechanism third type housing60ceopening mechanism third type housing wall60cfopening mechanism third type housing wall hole61aopening mechanism pole61bopening mechanism cylinder61baopening mechanism cylinder external thread61D opening mechanism cylinder internal diameter62opening mechanism arms ring62aopening mechanism arms ring central hole62bopening mechanism arms ring arm63opening mechanism arm63aopening mechanism arm upper pivot63bopening mechanism arm lower pivot64opening mechanism slider64aopening mechanism slider upper channel64bopening mechanism slider bottom channel64copening mechanism slider side channel64dopening mechanism slider pushing portion65opening mechanism base65aopening mechanism base hole65bopening mechanism base groove65copening mechanism base track66opening mechanism nut66aopening mechanism nut body66bopening mechanism nut internal thread66copening mechanism nut handle70casing70acasing bolt80apressure sensor80btissue oxygen saturation sensor80ctransparent window80delectrical conductor80epressure transducer80foxygen saturation sensor90body tissue90amuscle90bspinal canal90cvertebra90dincision line of lamina90ebone90fskin90klumbar vertebrae90ldiscus90mburr hole91wedgefasciaF force (general)F1adjustment bolt forceF2body tissue forceF3slider pivot forceF4test forceF5axial forceF6radial forced1guarding ring interior diameterd2lighting source supporter base ring interior diameterd3lighting source supporter wall shoulder outer diameterd4lighting source base interior diameterd5slider pivot hole diameterd6gap between the slider pivot and the slider among arms surfaced7concave segment of a rib front surface diameterd8rib force arm lengthd9rib working arm lengthd10rib working arm projection to the centerd11rib force arm widthd12rib working arm widthd13rib bottom end deflectiond14slider arms gapd15rib cross section head cut off lengthd16rib thicknessd17central rod tail diameterd18ribs interior diameterd19(μ) slider pin distance from the grooved disc central perforation centerd20slider pivot distance from the grooved disc central perforation centerd21upper portion lengthd22mid portion lengthd23lower portion lengthr1groove radiusr2channeled disc perforation radiusr3slider among arms surface radiusr4convex segment of a rib back surface radiusr5rib shoulder concave segment radiusα angle between the slider and the channeled discβ angle between the rib force arm front surface to the rib working arm f front surfaceγ rib cross section head angleμ grooved disc rotational angleδ rib opening angle100prior art radial expansible retractor (PARER)141PARER rib142PARER rib base143PARER rib base hole144PARER rib carrier145PARER rib carrier pin146PARER rib carrier hole147PARER rib carrier bolt148PARER central rod151PARER cover disc151aPARER cover central perforation152PARER grooved disc152aPARER grooved disc central perforation152bPARER groove153PARER channeled disc153aPARER channeled disc central perforation153bPARER channel161PARER rotating wheel169PARER adaptor

Note: when there is need for distinction of association of a reference number to one of the three embodiments of the present invention, a reference number associated with the first embodiment will be marked with a single apostrophe, a reference number associated with the second embodiment will be marked with double apostrophes, and a reference number associated with the third embodiment will be marked with three apostrophes; for example: surgical retractor2′, (in accordance with the first embodiment of the present invention), surgical retractor2″, (in accordance with the second embodiment of the present invention) and surgical retractor2′″, (in accordance with the second embodiment of the present invention).

Additional note: when, in the present patent application, there is use of terminology referring to the surgical retractor and/or its components, such as top, bottom, side, front, etc., the reference is to the relative axes of the surgical retractor, and is strictly for the purpose of facilitating understanding, and is not in any way limiting the present invention.

The first embodiment of the present invention will be described with reference toFIGS. 2ato19b, the second embodiment of the present invention will be described with reference toFIGS. 29ato44b, and the third embodiment of the present invention will be described with reference toFIGS. 45 to 57b.

The remaining illustrations refer to all the various embodiments of the present invention. These illustrations demonstrate that many elements and their combinations are common to the various embodiments of the present invention.

Referring now to the drawings,FIG. 2a, is an isometric side top view schematic illustration of a surgical retractor2′ according to a first embodiment of the present invention.

The surgical retractor2′ is shown in an assembled state.

FIG. 2b, is exploded, isometric side top view schematic illustrations of a surgical retractor2′, up to main assemblies, according to the first embodiment of the present invention.

The active assembly, which practically creates the opening in the operated patient's body for the purpose of performing the operation, is a ribs assembly20, which can have an integrated central rod30′, which leads the penetration into the body. The ribs assembly20has a wide range of opening states, which will be described in further detail in the following. These opening states are commanded and controlled by a mechanism for transferring of linear and rotational movements10′. In addition, the surgical retractor2′, according to the present invention, can include a lighting assembly50′ for the purpose of illuminating the operation area, a guarding cover58′ to prevent entry of foreign objects, dust, dirt, etc., into the surgical retractor2′, and adaptor40for the purpose of connection to a holder device.

FIG. 2c, is exploded, isometric side top view schematic illustrations of a surgical retractor2′, up to elements, according to the first embodiment of the present invention.

The lighting assembly50′, according to the first embodiment of the present invention, includes lighting source51and lighting source supporter52. The mechanism for transferring of linear and rotational movement10′, according to the first embodiment of the present invention, includes cover disc11′, grooved disc12, channeled disc13′, six angular adjustment bolts14a, six sliders15′, a carrier16, and a transmission17′. The ribs assembly20, according to the first embodiment of the present invention, includes six ribs21.

According to another variant of the present invention the quantity of ribs21is other than six, and therefore the quantities of the other elements, quantified as six in the present illustration, are correspondingly quantified.

The central rod30′, according to a variant of the present invention, includes central rod tail31′, and central rod head dome30c′. The adaptor40, according to a variant of the present invention, includes one or more adaptor rods40a, lock first part40b, and lock fastener screw40e.

As noted, the quantities of elements noted above are in no way limiting the present invention, and there may be other variant of quantities, such as eight ribs21. The positions and connections of these assemblies, also with regard to each other, their functions, and methods of operation, will be specified in the following.

While the general preference is for a surgical retractor2′ suitable for repeated use, made such that it can be sterilized, sterilization of the components can be avoided by integration of certain single-use components. Examples of possible single-use components are ribs21and lighting source51.

FIG. 3ais a top view schematic illustration of a surgical retractor2′, without an adaptor, according to the first embodiment of the present invention, upon which a section plane a-a is marked.

FIG. 3bis a cross sectional view a-a, isometric top illustration of a surgical retractor2′, according to the first embodiment of the present invention.

The section shows the positions of elements relative to each other. Rib21is engaged within a slider15′. The cover disc11′ encases the slider15′ and the grooved disc12from the outside, and is connected to the channeled disc13′. An angular adjustment bolts14ais engaged with the cover disc11′ and can be in contact with rib21.

FIG. 4ais a top view schematic illustration of a guarding cover58′, according to the first embodiment of the present invention, upon which a section plane b-b is marked.

As noted, the guarding cover58′ is meant to prevent the entry of foreign objects, dust, dirt, etc., into the surgical retractor.

The guarding cover58′ is shaped as a flat ring, having a guarding ring interior diameter d1. This inner diameter must be of a sufficient size to enable passage of the operating tools, as well as to provide the surgeon with a wide enough visual field. The value of this diameter should preferably be no smaller than 50 millimeters.

FIG. 4bis a side view schematic illustration of the guarding cover58′, according to the first embodiment of the present invention.

FIG. 4cis a top view schematic illustration of a lighting source supporter52, according to the first embodiment of the present invention, upon which a section plane c-c is marked.

FIG. 4dis an isometric front bottom view schematic illustration of a lighting source supporter52, according to the first embodiment of the present invention.

The lighting source supporter52includes a lighting source supporter base52a, which can be shaped as a ring, having a lighting source supporter base ring interior diameter d2.

This diameter must also be of a sufficient size, similarly to the diameters of other elements to be described in the following, for the same reasons given with regard to the size of guarding ring interior diameter d1, (not shown in the present drawings).

Surrounding the lighting source supporter base52ais a lighting source supporter wall52bwith a walled cylinder shape, on which are lighting source supporter wall slots52c, which are meant to prevent disruption of the movement of other elements.

The lighting source supporter wall52bin the configuration shown in the present illustrations protrudes slightly above and beneath the lighting source supporter base52a, and the part that protrudes beneath has lighting source supporter wall grooves52e.

FIG. 4eis an exploded side view schematic illustration of a lighting assembly50′, according to the first embodiment of the present invention.

The lighting assembly50′ shown in the present illustration is composed of the lighting source supporter52and lighting source51; however other configurations can also be used, with the lighting assembly50′ being composed of a single unit.

The lighting source51includes a lighting source base51aand one or more lamps51b, which can also be light emitting diode (LED) lights.

According to one variant of the present invention, at least one lamp51bis an ultra violet (UV) LED, which provides disinfection during the surgical procedure.

The lighting source51, if not suitable for repeated sterilization, is a disposable component, meant for single-time use. All other elements must be composed of materials suitable for medical standard repeated sterilization.

FIG. 4fis an exploded isometric front top view schematic illustration of a lighting assembly50′, according to the first embodiment of the present invention.

The lighting source51has a lighting source base interior diameter d4. The external shape of the lighting source51at least partially conforms to the internal shape of the lighting source supporter52, so that they are fastened to each other by force of friction, which is no smaller than the weight of each of these elements.

FIG. 4gis a side view schematic illustration of a lighting assembly50′, according to the first embodiment of the present invention.

The present illustration shows the lighting source supporter wall52band the lighting source supporter base51a, engaged with each other. In another possible configuration, the lighting assembly50′ is composed of one unit whose shape is practically identical to that of the engaged units, other than lamps51b. The lamps51bare electrically fed from power source51cby means of electricity conductors51d.

Attached to each lamp51b, according to the first embodiment of the present invention, is a light reflector51e, shown magnified in circle C, which reflects the light so as to facilitate the surgeon's good view of the working area, without glaring directly into the surgeon's eyes.

FIG. 4his a cross sectional view b-b illustration of a guarding cover58′ and a cross sectional view c-c illustration of a lighting source supporter52according to the first embodiment of the present invention.

The top part of the lighting source supporter52has a lighting source supporter wall shoulder52d, shown magnified in circle A, which has a lighting source supporter wall shoulder outer diameter d3.

The lighting source supporter wall shoulder outer diameter d3and the guarding ring interior diameter d1are practically of the same value, so that when the guarding cover58′ is engaged with lighting source supporter52, a friction force occurs between them, preventing the guarding cover58′ from separating as a result of gravity or of movement. There are other possible methods of connecting the guarding cover58′ with the lighting source supporter52, such as by means of screwing, riveting, etc., and even by means of a fixed connection, when they are composed as a single unit.

FIG. 5ais an isometric front top view schematic illustration of a cover disc11′, according to the first embodiment of the present invention.

The cover disc11′ includes a cover disc base11ahaving several cover disc base interior threads11band cover disc base holes11g.

The presence of the cover disc base holes11gserves the purpose of reducing weight and enables effective penetration of materials such as detergents during rinsing and disinfection.

The cover disc base11ais shaped as a flat ring, the internal part of the ring being disposed with cover disc supports11f, and its external circumference is mounted within a cover disc wall11c.

The cover disc wall11cis shaped as a walled cylinder, having cover disc wall holes11d, and cover disc wall openings11e.

The cover disc supports11fprotrude into a cover disc perforation11i.

FIG. 5bis a side view schematic illustration of a cover disc11′, according to the first embodiment of the present invention.

FIG. 5cis an isometric bottom view schematic illustration of a cover disc11′ and lighting source supporter52, according to the first embodiment of the present invention.

In the configuration shown in the present illustration, the entire cover disc support11fis within lighting source supporter wall52b, conforming to a lighting source supporter wall groove52e.

FIG. 5dis an isometric front top view schematic illustration of a cover disc11′, and of lighting source supporter52, according to the first embodiment of the present invention.

Both elements are engaged in each other, with their shapes and dimensions conforming for the purpose of this engagement.

FIG. 6ais an isometric front top view schematic illustration of a grooved disc12, according to the first embodiment of the present invention.

The grooved disc12is shaped like a flat ring, with a grooved disc central perforation12ain its center, and a grooved disc outer surface12c, some of which comprises grooved disc teeth12e. The grooved disc teeth12eserve the purpose of providing the grooved disc12with rotational movement.

FIG. 6bis side view schematic illustration of a grooved disc12, according to the first embodiment of the present invention.

FIG. 6cis bottom view schematic illustration of a grooved disc12and a central rod30′, according to the first embodiment of the present invention.

This view shows curved grooves12bwhose depth, in the present case, is smaller than the thickness of the grooved disc12, however can, in other configurations according to the present invention, be for the entire depth of the grooved disc12. If the depth of the curved grooves12bis smaller than the thickness of the grooved disc12, grooved disc holes12dcan be added to facilitate a better flow of disinfectant material through them into the curved grooves12b.

The grooved disc12serves for opening and closing the aperture created by the ribs21, (not shown in the present illustration). Each curved groove12bcorresponds with one rib21, and if all of the curved grooves12bhave the same curve shape, the distance of each rib21from the grooved disc central perforation center12aois consistently the same, in every state of rotation of the grooved disc12, namely all of the ribs21, at every cross section, are on a common circle.

According to another variant of the present invention, not all of the curved grooves12bhave the same curve shape. The curved grooves12bcan have many curve shapes. In the case shown in the present illustration, the curve shape of each one of them is a segment of a circle, having a groove radius r1. When viewing the grooved disc12, the groove radius origin12bois not at the same point as the grooved disc central perforation center12ao.

The grooved disc central perforation center12aois practically positioned on the central rod tail symmetrical line30s.

The grooved disc12has a grooved disc body12f, whose general shape is that of a flat ring, on part of whose circumference are grooved disc teeth12e.

FIG. 7ais side view schematic illustration of a central rod30′, according to the first embodiment of the present invention.

The central rod30′ has a central rod tail30a′, having a central rod tail diameter d17and in the configuration shown in the present illustration, it is slotted with central rod tail slots30b, and has, at its end, central rod head dome30cwhose tip is tapered toward its end, from a side view.

The slots30bserve the surgeon for the purpose of measuring penetration depth. For example, slots30bcan be marked at regular intervals of one centimeter each, and the measure of penetration can then be determined according to the numbers marked outside of the patient's body.

The central rod tail30a′has a central rod tail symmetrical line30s. This line is disposed in a fixed location relative to the various components of the surgical retractor, according to the present invention, which do not move relative to each other when the central rod30′ is disposed between the ribs21, (not shown in the present illustration), when they are in a closed mode, as they are at the beginning of insertion into the patient's body. This line can serve as a reference line for measurement of angles and distances, even when the central rod30′ is not in the position presently described.

The central rod30′ is designated as the leader guiding the penetration into the body of the operated patient. At the beginning of the procedure, it is centered between the ribs21(not shown in the present illustration), which are closed, while the central rod head dome30cprotrudes from them, and is first to come into contact with the operated patient's body.

The central rod30′ is taken out and removed from the operated area, after achieving sufficient opening of the ribs21.

FIG. 7bis bottom view schematic illustration of a central rod head dome30c, according to the first embodiment of the present invention.

In the configuration shown in the present invention, from a bottom view, the central rod head dome30chas an oval shape; however it can have other shapes as well.

FIG. 8ais an isometric front top view schematic illustration of a channeled disc13′, according to the first embodiment of the present invention.

The channeled disc13′ includes a channeled disc base13a, which has at its circumference the channeled disc wall13b, which has several channeled disc wall niche13c, as well as channeled disc wall tenons13m.

This shape of the circumference of the channeled disc13′ serves the purpose of conforming to other component at the time of assembly; however other shapes can also be used according to the present invention. Furthermore, for the purpose of connecting components, there are several channeled disc wall holes13d, having internal screw threading.

FIG. 8bis side view schematic illustration of a channeled disc13′, according to the first embodiment of the present invention.

FIG. 8cis bottom view schematic illustration of a channeled disc13′, according to the first embodiment of the present invention, upon which a section plane d-d is marked.

In the center of the channeled disc13is channeled disc perforation13e, which is shaped as a circle having channeled disc perforation radius r2. The channeled disc perforation radius r2disc is likely to be the element most limiting the maximal visual field of view that can be achieved during an operation, and the element most limiting the dimensions of the operating tools, therefore its size should preferably be no smaller than 15 millimeters.

The channeled disc13′ is slotted for its entire depth with channeled disc long slots13fin order to enable positioning and movement of the ribs21, (not shown in the present illustration), and in the channeled disc short slots13g, which create cavities for the positioning of the lamps51b, (not shown in the present illustration).

FIG. 8dis cross sectional view d-d illustration of a track13h, according to the first embodiment of the present invention.

The channeled disc13′ also engages a component that can make radial linear movement relative to a single point, the slider15′, (which, along with other elements mentioned in the description of the present illustration, is not shown in the present illustration). For this purpose, the channeled disc13′ has tracks13h. Every track13his closed on its bottom, in view of the orientation of the present illustration, by the channeled disc base13a, on both of its sides by two track side walls13i, and on its top by track upper wall13j.

The track upper wall13jhas a channel upper opening13l, which has suitable dimension for longitudinal movement of the slider upper body15b. The space created between the elements described, as shown in the present illustration, comprises the channel13k, whose dimensions are suitable for those of a slider15′ so as to enable its radial longitudinal movement, and to prevent its movement in any other undesired direction.

FIG. 9ais an isometric front top view schematic illustration of casing70′, according to the first embodiment of the present invention.

FIG. 9bis a side view schematic illustration of casing70′, according to the first embodiment of the present invention.

FIG. 9cis an exploded side view schematic illustration of casing70′, according to the first embodiment of the present invention.

According to the variant shown in the present illustration, the engagement of the cover disc11′ with the channeled disc13′ is done by means of geometrically conforming both to each other, together forming a casing70′ suitable for carrying grooved disc12, (not shown in the present illustration), and granting it smooth rotational movement, as well as for carrying and granting smooth movement of other components. The present illustration shows that the cover disc wall11cand the cover disc wall hole11drespectively conform with the channeled disc wall niche13cand the channeled disc wall hole13d, thus enabling a successful connection of the cover disc11′ with the channeled disc13′.

FIG. 9dis a side view schematic illustration of a casing bolt70a, according to the first embodiment of the present invention.

Casing bolt70a, one of which is shown in the present illustration magnified relative to the previous illustration, completes the connection of the cover disc11′ together with the channeled disc13′.

FIG. 10ais an isometric side top view schematic illustration of a rib21and a slider15′ combined together, according to the first embodiment of the present invention.

All the ribs21and sliders15′ are arranged in engaged pairs. Every slider15′ is designated to linearly move one of the ribs21.

Rib21has a rib back surface21band a rib front surface21f. The rib front surfaces21fof all the ribs21all face inwards relative to the spatial shape that they form together.

The rib back surface21band a rib front surface21fare each divisible into several segments according to the structural parts of the type of rib21to which they belong.

FIG. 10bis an exploded isometric side top view schematic illustration of a slider15′, according to the first embodiment of the present invention.

The slider15′ includes a slider main body15a, whose shape and dimensions are suitable for maintaining back and forth linear movement within a channel13k, (not shown in the present illustration).

From the top part of the slider main body15a, protrudes slider upper body15b, whose shape and dimensions are suitable for maintaining back and forth linear movement within a channel upper opening13l, (not shown in the present illustration).

Above slider upper body15b, protrudes a slider pin15i, whose shape and dimensions are suitable for maintaining back and forth linear movement within curved groove12b, (not shown in the present illustration).

The slider pin15ican be an integral part of the slider upper body15band of the slider main body15a, or can be partially engaged within slider pin hole15c.

The part of slider15′ designated to be engaged with rib21, (not shown in the present illustration), has two slider arms15d, the space between which is suitable to contain a rib21, so as to enable it rotational movement while preventing its lateral movement. Between both arms15dis a slider pivot15j, within two slider pivot holes15e.

At the bottom of the slider main body15a, near the end farther from the slider arms15d, is an optional slider niche15g, within which is a slider friction reducer15hthat protrudes very slightly relative to the dimensions of the slider15′, from beneath the slider15′. The slider friction reducer15his composed of a material, such as silicone, having a smaller friction coefficient than the friction coefficient of the material, for example steel, composing the slider15′.

FIG. 10cis a top view schematic illustration of a slider main body15a, according to the first embodiment of the present invention, upon which a section plane e-e is marked.

Between both slider arms15d, is a perpendicularly disposed slider among arms surface15f. The present illustration shows a view from the top of the slider among arms surface15f. Between both of the slider arms15d, is a slider arms gap d14.

FIG. 10dis a cross sectional view e-e illustration of a slider main body15a, according to the first embodiment of the present invention.

The present illustration indicates three dimensions of special significance for the purpose of conforming with a rib21, (not shown in the present illustration), which are a slider pivot hole diameter d5, a gap between the slider pivot and the slider among arms surface d6and a slider among arms surface radius r3.

FIG. 10eis a partial side view schematic illustration of a rib21, according to the first embodiment of the present invention.

The present illustration shows details and dimensions of special significance for the purpose of conforming with slider15′, (not shown in the present illustration). A concave segment of a rib front surface21aserves to transmit force during opening movement of rib21from the slider pivot15j, (not shown in the present illustration). The preferred shape of concave segment of a rib front surface21ais a half circle whose center is defined as a concave segment of a rib front surface origin21o, having a concave segment of a rib front surface diameter d7

The convex segment of a rib back surface21chas a section shape of a circle, whose center is concave segment of a rib front surface origin21o, and which has a convex segment of a rib back surface radius r4.

The maximum value of the convex segment of a rib back surface radius r4is at most equal to the value of the gap between the slider pivot and the slider among arms surface d6, (not shown in the present illustration), so as to enable replacement of rib21.

A rib shoulder21dserves to transmit force from the slider main body15a, (not shown in the present illustration), in order to perform closing. Part of rib shoulder21dhas a rib shoulder concave segment21e, having a rib shoulder concave segment radius r5.

The value of the rib shoulder concave segment radius r5corresponds with the slider among arms surface radius r3, (not shown in the present illustration).

FIG. 10fis a partial side view schematic illustration of a rib21and a slider15′ partially sectioned, according to the first embodiment of the present invention.

The present illustration shows a state of movement toward opening15op, in which the slider pivot15jis moving to the right, in the orientation shown in the present illustration, and applies force to rib21in the area of contact with the concave segment of a rib front surface21a.

FIG. 10gis a partial side view schematic illustration of a rib21and a slider15′ partially sectioned, according to the first embodiment of the present invention.

The present illustration shows a state of movement toward closing15cl, in which slider15′ moves to the left, in the orientation shown in the present illustration, and applies force, to rib21in the area of contact with the slider among arms surface15f, which acts on the rib shoulder21d. The rib shoulder21d, also limits the rotational movement of rib21clockwise, according to the view shown in the present illustration, prevention of the rotational movement occurs during contact between the rib shoulder21dwith the slider among arms surface15f.

FIG. 10his a side view schematic illustration of a rib21, an angular adjustment bolt14aand a slider15′, partially sectioned, according to the first embodiment of the present invention.

The present illustration describes forces affecting rib21when it is inside the operated patient's body when body tissue90applies pressure to it, the resultant force of which, the body tissue force F2, is applied to a specific point on a rib working arm21waof the rib21. Conversely, in the state shown in the present illustration, the angular adjustment bolts14aapplies adjustment bolt force F1on a rib force arm21fa. Both the adjustment bolt force F1and the body tissue force F2are balanced by a slider pivot force F3, which is applied in the opposite direction.

The concave segment of a rib front surface origin21ocomprises a possible rotational center for rib21, and its location determines which part of the rib21acts as the rib working arm21waand which acts as the rib force arm21fa.

Furthermore, when the angular adjustment bolts14aapplies adjustment bolt force F1to the rib force arm21fa, rib21rotates counterclockwise, in the view shown in the present illustration, and a gap is formed between the rib shoulder concave segment21eand the slider among arms surface15f.

The rib force arm21fahas a rib force arm length d8and the rib working arm21wahas a rib working arm length d9.

FIG. 10iis a side view schematic illustration of a slider15′, according to the first embodiment of the present invention.

When the slider15′ moves toward opening, to the right in the orientation of the present illustration, angle α is formed between the slider and the channeled disc and the contact between slider15′ with the surface upon which it moves is only in the area of the slider friction reducer15h.

FIG. 11is a side view schematic illustration of a rib21, an angular adjustment bolt14aand a slider15′, partially sectioned, in six stages of separation, according to the first embodiment of the present invention.

These stages are part of a method for replacing rib21, and they demonstrate the manner of removing rib21from its place, from a state suitable for operation, engaged with slider15′. Similarly, but with reversal of the order of stages, rib21is engaged with a slider15′.

The stages are:

Starting, showing one possible starting state, in which the angular adjustment bolt14ais in contact with rib21(stage A);

retreating of the angular adjustment bolt14a(stage B);

rotating clockwise of the rib21(stage C);

pulling up the rib21as much as possible (stage D)

rotating counter-clockwise of the rib21(stage E); andseparating the rib21from the slider15′ by pulling up the rib21all the way out (stage F).

In order to enable this removal there cannot be any width dimension of rib21, required to go through the gap between the slider pivot and the slider among arms surface d6, which is wider than this gap.

FIG. 12ais a side view schematic illustration of a rib21, according to the first embodiment of the present invention.

The present illustration shows the division of the rib21into two arms. In a state in which the concave segment of a rib front surface21apractically serves as a support point and both ends, the rib bottom end21hand the rib top end21g, are subject to forces F, which are horizontal according to the orientation of the present illustration; the part of rib21in which there is a counterclockwise twisting effort is defined as rib force arm21faand the part in which there is a clockwise twisting effort is defined as rib working arm21wa.

Close to the rib bottom end21h, there is a rib bottom end projection21i, which is designated to facilitate prevention of rib21being pushed outward and upward as a result of forces applied to it by the operated patient's body tissue.

FIG. 12bis a side view schematic illustration of a rib21, according to the first embodiment of the present invention.

The present illustration defines additional features of rib21. Rib21, according to the present invention, is practically rigid, considering the forces that may be applied to it during performance of an operation on a human body. The term “rigid” is to indicate that the rib practically does not bend, or deflect, when a reasonable force, moment, or torque from the tissue is applied. Proper design and production of rib21with use of suitable materials such as steel or titanium, can ensure meeting the required test criterion for a rib21having a rib working arm length d9and a maximum rib bottom end deflection d13, under the activation of test force F4at a predefined level on the rib bottom end21h, with the rib force arm21faharnessed.

A practical example of such a test is the following data:

One effective way of obtaining the required rigidity, without adding unnecessary weight, is by selecting a shape in which rib working arm21wahas a rib working arm width d12having a size that tapers toward the rib bottom end21h.

Similarly to rib force arm21fa, there is a rib force arm width d11, which tapers toward rib top end21g.

Another feature is the rib working arm projection to the center d10, which is designated to remove the rib force arm21fafrom the doctor's visual field. The value of the rib working arm projection to the center d10should preferably be at least 10 millimeters, when this distance is measured from the concave segment of a rib front surface origin21o, perpendicular to the plane on which rib working arm front surface21kis disposed.

FIG. 12cis a side view schematic illustration of two ribs21, according to the first embodiment of the present invention.

The two ribs21in the present case are on the same plane and are shown as mirror images of each other.

Rib21has a rib force arm front surface21jand a rib working arm front surface21k, which are for most of their lengths in side view, straight. The present illustration shows each one of both ribs21at a rib opening angle δ at which the rib force arm front surface21jis parallel to a symmetry line between both ribs21. In this state, the angle between the rib force arm front surface and the rib working arm front surface β is equal to rib opening angle δ.

The rib opening angle δ is measured between the symmetrical line30sand the rib working arm front surface21k.

FIG. 13ais a side view schematic illustration of a rib21, according to the first embodiment of the present invention, upon which a section plane f-f is marked.

FIG. 13bis a cross sectional view f-f, view illustration of a rib21, according to the first embodiment of the present invention.

Rib21has a rib thickness d16, which conforms to the dimensions of the slider arms gap d14, so as to enable rotational movement between the two, but to enable practically no sideways movement of rib21. The side of the section facing forwards is tapered, and has a rib cross section head angle γ, a preferred value of which is 360 degrees divided by the number of ribs21included in the retractor. The tapered part end is cut off, and has a rib cross section head cut off length d15.

FIG. 13cis six cross sectional views f-f illustration of six ribs21, according to the first embodiment of the present invention.

According to a variant of the present invention the retractor includes six ribs21, however other numbers can be used.

The ribs21are shown in the present illustration in a state referred to in the present invention as a closed state, and each one touches the adjacent ones for most of its length rib working arm21wa, (not shown in the present illustration). In this closed state, the ribs21bind an internal circle (dashed line in the illustration), having a ribs interior diameter d18, which conforms to the dimensions of the central rod tail diameter d17.

FIG. 14ais a side view schematic illustration of a rib21, according to the first embodiment of the present invention.

According to a variant of the present invention, the rib21includes a rib hole21m. The rib hole21mis assembled such that a slider pivot15j, (not shown in the present illustration), is engaged within it, and their dimensions conform so as to enable effective rotational movement between both.

According to this variant, replacement of a rib21requires removing and then reinserting the slider pivot15j, (not shown in the present illustration), in place.

FIG. 14bis a side view schematic illustration of a rib21with a rib hook21n, according to the first embodiment of the present invention.

In order to prevent penetration of the patient's skin into the wound cavity, the rib21, according to a variant of the present invention, is equipped with a rib hook21n. In order to prevent the addition of the rib hook21nfrom hampering the replacement of rib21, the rib hook21nmust either be sufficiently small, detachable from the rib21, or foldable, for example around rib hook pin21p, in this case, the rotation ability is upward, in the orientation shown in the present illustration, while downward rotation is not possible beyond the state shown in the illustration.

FIG. 14cis a side view schematic illustration of a rib21, according to the first embodiment of the present invention.

According to a variant of the present invention, the rib21is somewhat flexible, and does not need to meet the definition and test requirement for rigidity given with regard to the description ofFIG. 12b. As such, the rib working arm length d9can have a relatively high value, and there is no requirement for any large change in values of rib working arm width d12according to their positions along the rib working arm21wa, to the extent that their values can be fixed.

FIG. 14dis an isometric view schematic illustration of six ribs21, and a flexible sleeve23, according to the first embodiment of the present invention.

The flexible sleeve23externally encases the six ribs21along their rib working arms21wa, for their entire length or part of it, and is designated to prevent tissue from entering the opening created for the purpose of performing the medical procedure.

The material composing the flexible sleeve23can be polyisoprene, a natural polymer, for example, however this material is in no way limiting the present invention.

Polyisoprene is strong and elastic, is transparent after expansion, is inert, and does not cause allergic reactions.

FIG. 14eis a side view schematic illustration of rib21, having rib segments21q, in a relaxed state, according to the first embodiment of the present invention.

The rib working arm21waof the rib21is divided into several rib segments21q, three in the case of the present illustration.

A cable21sis connected at one end to an anchoring point21t, disposed within the lower rib segment21q.

The cable21sis shown in the present illustration as if running through a series of perforations for the length of all parts of a transparent rib21and connects at the other end to a cable tensioner21r. When the cable tensioner21ris in a proper state, the cable21sis relaxed and enables minimal distancing of the rib segments21qfrom each other, thus enabling creation of a rotational angle in any direction, if there is no specific device to limit it, between every pair of adjacent rib segments21q. Even though the present illustration shows only one cable21sand only one cable tensioner21r, this is in no way limiting the present invention, and different quantities of these elements are also possible.

FIG. 14fis a side view schematic illustration of rib21, having rib segments21q, in a flexed state, according to the first embodiment of the present invention.

The cable tensioner21rapplies tensioning force on the cable21s, thus causing the rib segments21qto join so as to create the desired external shape of rib21.

The cable21smust be composed of a sufficiently strong material such as carbon nanotubes.

FIG. 14gis an isometric view schematic illustration of a rib21, having rib segments21q, in a flexed state, according to the first embodiment of the present invention.

FIG. 14his an isometric view schematic illustration of rib21, having rib segments21q, in a relaxed state, according to the first embodiment of the present invention, with the rib segments21qdistanced from each other.

The distances between the rib segments21qshown in the present illustration are exaggerated, for the purpose of demonstrating the upper part of each rib segment21q, which is one of many possible shapes enabling partial engagement of each rib segment21qin the lower part of the rib segments21qabove it. The present invention is not limited to any specific number of rib segments21q, or any specific position of them.

FIG. 15ais an isometric top view schematic illustration of a transmission17′, partially exploded, according to the first embodiment of the present invention.

The transmission17′ is designated to grant rotational movement to grooved disc12. The movement starts with manual rotation of at least one of the two transmission knobs17a, which transmit rotational movement through a transmission tubular17eto a transmission shaft17b′, and through that to a transmission worm17c. The transmission worm17crotates a transmission first cog wheel17f′, which is rigidly connected on a shaft with a transmission second cog wheel17g. The transmission second cog wheel17grotates a transmission third cog wheel17h, which, at the end of the process, grants the necessary rotational movement to grooved disc12by means of the grooved disc teeth12e. The engagement of the transmission first cog wheel17f′ by rigid connection on a shaft with the transmission second cog wheel17gis for the purpose of obtaining the desired transmission ratio, and to provide a convenient distance for users' hands when forming the opening operation.

Use of the transmission third cog wheel17h, other than its effect on the transmission ratio, is to distance the transmission knobs17afrom the grooved disc12.

FIG. 15bis an isometric bottom view schematic illustration of a transmission17′, partially exploded, according to the first embodiment of the present invention.

This transmission can enable controlled opening at a slow rate of 50 micrometers per second by applying force of the fingers.

According to the present invention, transmission systems of various different structures can be used. Likewise, a suitable mechanical engine can be used instead of manual force.

FIG. 16ais a top view schematic illustration of a carrier16, according to the first embodiment of the present invention.

The carrier16includes a carrier bow16a, a carrier bridge16c, two carrier arms16f, and a carrier back wall16g.

The carrier16connects the channeled disc13′ with the adaptor40, (both not shown in the present illustration), and carries the transmission17′, (not shown in the present illustration).

Carrier bow16ahas carrier bow bottom holes16band carrier bow side holes16i(not shown in the present illustration), for the purpose of connection to the channeled disc13′, (not shown in the present illustration).

In the carrier bridge16cthere are two holes, a carrier bridge first hole16d, designated to carry the shaft of the transmission third cog wheel17h, (not shown in the present illustration), and a carrier bridge second hole16e, designated to carry the common shaft of the transmission first cog wheel17f′and the transmission second cog wheel17g, (both not shown in the present illustration).

FIG. 16bis a back view schematic illustration of a carrier16, according to the first embodiment of the present invention.

Carrier back wall holes16hin the carrier back wall16gare designated for connection to the adaptor rods40a, (not shown in the present illustration).

FIG. 16cis a side view schematic illustration of a carrier16, according to the first embodiment of the present invention.

The transmission shaft17b′, (not shown in the present illustration), in an assembled state, runs through carrier arm hole16jin the two carrier arms16f.

FIG. 16dis an isometric top view schematic illustration of a carrier16, and a transmission17′, according to the first embodiment of the present invention.

One transmission knob17ais not shown in the present illustration. The transmission worm17cis mounted upon the transmission shaft17b′, between both carrier arms16f.

The transmission first cog wheel17f′, the transmission second cog wheel17gand the transmission third cog wheel17hare mounted above the carrier bridge16c, according to the orientation of the present illustration.

FIG. 16eis an isometric bottom view schematic illustration of a carrier16, and a channeled disc13′, according to the first embodiment of the present invention.

Their joint connection can be by means of screws through the carrier bow bottom holes16band the carrier bow side holes16i. The screws can be such as the casing bolts70a, (not shown in the present illustration), with suitable holes, having internal screw threading in the channeled disc base13aand the channeled disc wall13b.

FIG. 17ais an isometric side top view schematic illustration of a carrier16, and an adaptor40, according to the first embodiment of the present invention.

FIG. 17bis an exploded isometric top view schematic illustration of a carrier16, and an adaptor40, according to the first embodiment of the present invention.

FIG. 18ais an isometric side top view schematic illustration of six ribs21in a closed state, according to the first embodiment of the present invention.

The number of ribs21shown in the present illustration is six, however this is not limiting the present illustration specifically to this number. In this state, the ribs21are inserted into the operated patient's body, while they are as tightly close to each other as possible, thus creating an entry puncture of the smallest diameter that can be achieved with them. This diameter, which is determined by the widest section created by the six ribs21, should preferably be no larger than 8 mm, while in any case the diameter should be as small as it enabled by the mechanical strength of the ribs21.

The arrows at the upper part of the present illustration indicate movement directions21mdof each one of the ribs21, if linear opening is required.

FIG. 18bis an isometric side top view schematic illustration of six ribs21in an open state, according to the first embodiment of the present invention.

The opening performed in order to achieve this state was with uniform linear movement of each one of the six ribs21, such that all six are, at every possible lateral section, on a circle together.

FIG. 18cis an isometric side top view schematic illustration of six ribs21in a closed state, according to the first embodiment of the present invention.

The arrows at the lower part of the illustration indicate the possibility of rotational movement21rmof ribs21, two in this case.

FIG. 18dis an isometric side top view schematic illustration of six ribs21in an open state, according to the first embodiment of the present invention.

This state was achieved after performance of rotational movement in opposite directions and equal distance of two ribs21.

FIG. 18eis an isometric side top view schematic illustration of six ribs21in an open state, according to the first embodiment of the present invention.

This state was achieved after performance of uniform linear opening of all six ribs21, followed by rotational movement in opposite directions and equal distance of two ribs21, both on the same plane of movement.

FIG. 18fis a bottom view schematic illustration of six ribs21in an open state, according to the first embodiment of the present invention.

This state was achieved after performance of uniform linear opening of all six ribs21, followed by rotational movement in opposite directions and equal distance of two ribs21, both on the same plane of movement.

The six ribs21, at each lateral section, are all on an ellipse.

FIG. 19ais a bottom view schematic illustration of a grooved disc12, and six sliders15′, in closed state, according to the first embodiment of the present invention.

In the closed state of the present illustration, all six of the slider pivots15jare each on a curved groove12bdesignated for it, in a location in which the slider pins' distance from the grooved disc central perforation center d19(μ) is minimal.

FIG. 19bis a bottom view schematic illustration of a grooved disc12, and six sliders15′, in opened state, according to the first embodiment of the present invention.

After the grooved disc12performs rotational movement of a grooved disc rotational angle μ, the slider pins' distance from the grooved disc central perforation center d19(μ) is maximum. Between both of these end states, the slider pins' distance from the grooved disc central perforation center d19(μ) depends on the grooved disc rotational angle μ.

The movement performed by each one of the six sliders15′ is a radial linear movement.

As used herein the specifications and claims sections, the terms radial linear movement, linear movement, radial movement, and the like, all refers to movements causing rib21to move along a straight line going through the grooved disc central perforation center12ao.

FIG. 20is a side view schematic illustration of a rib21having sensors, and a block diagram of transducers, according to the first embodiment of the present invention.

For the purpose of pressure and saturation measurement monitoring during the operation, at least one rib21is mounted with a pressure sensor80aand a tissue oxygen saturation sensor80b, disposed near the rib back surface21b, and each connected to an electrical conductor80d. The pressure sensor80atransmits signals to a pressure transducer80e, and the tissue oxygen saturation sensor80btransmits signals to an oxygen saturation sensor80f.

The pressure sensor80aserves the purpose of measuring pressure according to the type of tissue applying the pressure, such as intra-cranial pressure, intra-tissue pressure, or retracted tissue pressure

The tissue oxygen saturation sensor80bcan also be composed of an infrared diode emitter that emits infrared radiation and a receiver for receiving the infrared radiation returned from the tissue.

The infrared diode emitter and the receiver are disposed behind a transparent window80c, which can also be made of ceramic material or glass.

According to anther variant of the present invention the pressure sensor80aand the tissue oxygen saturation sensor80bare mounted separately, each on a different rib21.

FIG. 21is a side view schematic illustration of a surgical retractor2, after insertion and opening for the purpose of performing spinal minimal invasive neurosurgery, according to the embodiments of the present invention. Even though the present illustration includes a surgical retractor2′ of the first embodiment of the present invention, the action described here can also be performed with the surgical retractors2″,2′″ of the second and third embodiment of the present invention. This also applies to the following illustrations, throughFIG. 27f.

The ribs21were inserted through the muscle90aand opened, in the case shown in the present illustration, with the opening movements of all of the ribs21being strictly linear.

The insertion was toward the vertebrae90c, more specifically toward the spinal canal90c. Subsequently, an incision line of lamina90dwas made. Due to the external shape of the bone90e, use was made of ribs21of varying lengths, with the rib21shown as the central one being longer.

A wedge91, shown here magnified relative to the dimensions of the surgical retractor2′, can serve for opening-distraction and fusion of lamina vertebralis.

FIG. 22is a side view schematic illustration of two surgical retractors2′ after insertion and opening, for the purpose of performing spinal minimal invasive neurosurgery, according to the first embodiment of the present invention.

During performance of the operation, use was made of two surgical retractors2′ and two incision lines of lamina90dare made.

When necessary, one retractor can be used to perform an operation on one side and, after completion on one side, to perform the same operation on the other side. However, it is optimally preferable to perform a simultaneous bilateral laminotomy (SBL) with minimal time delay, to prevent future anatomical asymmetry in lamina and any unnecessary movement of the excised lamina, which can cause iatrogenic damage to neural roots and ligaments. Likewise, simultaneous insertion of bilateral wedges for symmetric spinal channel decompression (SSCD) is also preferable.

The present illustration clearly shows the different lengths of ribs21relative to each other.

FIG. 23is a side view schematic illustration of a rib21, having a rib hook21n, inside skin and muscle, according to the first embodiment of the present invention.

The present illustration demonstrates the manner in which the rib hook21nsupports skin90fand is above fascia92, while the muscles90aare in contact with rib21.

FIG. 24is a side view schematic illustration of a surgical retractor2′ at three different angles, according to the first embodiment of the present invention.

This illustration demonstrates the option of inserting a surgical retractor2′ through one single incision and positioning it at different angles relative to the spine for the purpose of performing several different operations. Between subsequent operations, the ribs21can be replaced to be of a suitable length for each different purpose.

FIG. 25is a side view schematic illustration of a surgical retractor2′ at two different angles, according to the first embodiment of the present invention.

According to a variant of the present invention, the ribs21are curved. This illustration demonstrates the option for performing bilateral spinal cord decompression via a single incision.

FIG. 26is an isometric view schematic illustration of a surgical retractor2′ connected to holding arms48, according to the first embodiment of the present invention.

The present illustration demonstrates connection and carrying of the surgical retractor2′ without use of an adaptor40, (not shown in the present illustration).

The surgical retractor2′ according to a variant of the present invention includes cover disc holding pins11j, for example, three, each of which can be connected to a holding arm48, with a clamp47, or any other suitable device, at its end, for the purpose of connection to the operation bed.

The holding arm48is an arm which can be bent and geometrically adapted, and is capable of steadily carrying a load. This arm can be continuous or composed of segments.

FIGS. 27a-27fare side view schematic illustrations of a surgical retractor2′ at six different stages of opening in the operated patient's body, according to the first embodiment of the present invention.

All six illustrations show only two ribs21for each retractor2′.

FIG. 27ashows a stage of insertion of a retractor2′, having ribs21, with the length of each one being different from the other.

These lengths are selected according to the anatomic structure of the operated patient.

FIG. 27bshows a stage of linear opening, toward the left according to the orientation of the present illustration, of the longer rib21.

FIG. 27cshows a stage of angular opening, clockwise according to the orientation of the present illustration, of the longer rib21.

FIG. 27dshows a stage of angular opening, counterclockwise according to the orientation of the present illustration, of the shorter rib21.

FIG. 27eshows a stage after replacement of the shorter rib21with a longer rib21, which requires removal and subsequent reinsertion of the retractor2.

FIG. 27fshows an additional stage of angular opening, counterclockwise according to the orientation of the present illustration, of the new rib21.

It is important to note that these stages, as shown above are not in any way limiting the present invention, and opening can be performed in many various forms and stages.

FIG. 28is a flow chart that schematically illustrates a method of operation for minimal invasive (MI), bilateral symmetric decompression (BSD) of spinal stenosis (SS), in accordance with the embodiments of the present invention.

In the first stage of the method of operation for decompression of spinal stenosis, a surgical retractor is inserted through the bilateral projection of lamina vertebralis, wherein the surgical retractor has ribs and a mechanism for transferring of linear and rotational movements of the ribs, (stage201).

In the second stage of the method of operation for decompression of spinal stenosis, the ribs are moving in linear movements, (stage202).

In the third stage of the method of operation for decompression of spinal stenosis at least one rib is moving in a rotational movement, (stage203).

In the fourth stage of the method of operation for decompression of spinal stenosis an incising a lamina proximal to vertebral facets is done with a micro drill or circular micro saw, (stage204).

In the fifth stage of the method of operation for decompression of spinal stenosis a wedge is inserting for a distraction of bilateral vertebral lamina, (stage205).

FIG. 29ais an isometric front top view schematic illustration of a surgical retractor2″ according to a second embodiment of the present invention.

This embodiment is simpler than the first embodiment. It includes less part, can be more lightweight, and can likewise be less expensive. As such, it can be suitable for single-time use, as a whole or the majority of its parts.

This embodiment includes the same ribs21, for all features, as described so far according to the present invention. The ribs21of all the embodiments can be made of material or materials transparent to x-rays.

The channeled disc13″ and the slider15″ of the surgical retractor2″ according to second embodiment differ in shape from the channeled disc13″ and the slider15″ of the surgical retractor2′ according to first embodiment. However, in both embodiments, the sliders15′,15″ are assembled into channeled discs13′,13″ so as to enable linear radial movement relative to the centers channeled discs13′,13″.

FIG. 29bis a side view schematic illustration of a surgical retractor2″, according to the second embodiment of the present invention.

The present illustration shows ribs21that are all identical in shapes and dimensions, in a state following angular opening. Channeled disc13″ is attached to a base disc18, under which the illustration shows lamps51b.

FIG. 30is an exploded, isometric front top view schematic illustration of a surgical retractor2″, according to the second embodiment of the present invention.

The surgical retractor2″, according to the second embodiment, includes several assemblies, the mechanism for transferring of linear and rotational movements10″, the ribs assembly20, and the lighting assembly50″.

The mechanism for transferring of linear and rotational movements10″ includes the sliders15″, slider pivots15j, angular adjustment bolts14a, linear adjustment bolts14b, channeled disc13″, and a base disc18.

The channeled disc13″ can be made of various materials, also including various metals or materials transparent to x-rays, such as a plastic material, and it can be designated for single-time use.

The base disc18is connected to the bottom of the channeled disc13″ and serves as a cover for electric wires (not shown in the present illustration), which provide electrical power supply to lighting assembly50″, and can also be made of various materials, also including various metals or materials transparent to x-rays.

Each rib21engages with a slider15″ by means of a replaceable slider pivot15jand can be made of various materials, also including various metals or materials transparent to x-rays.

Slider15″ includes a slider first interior thread15minto which is screwed an angular adjustment bolt14a, and a slider second interior thread15ninto which is screwed a linear adjustment bolt14b, by means of which the linear and angular opening of the ribs21can be adjusted.

FIG. 31ais a side view schematic illustration of a segment of a channeled disc13″, an angular adjustment bolt14a, a linear adjustment bolt14b, a slider15″, a slider pivot15j, and a rib21of the surgical retractor2″, according to the second embodiment of the present invention.

The screwing of the angular adjustment bolt14ainto the slider first interior thread15m(not shown in the present drawing), of the slider15″ applies moment on the rib21, resulting in its rotational movement around the slider pivot15jrelative to the slider15″. Screwing the linear adjustment bolt14binto the slider second interior thread15n(not shown in the present drawing), of the slider15″ applies force to the channeled disc13″ resulting in linear movement of the slider15″ along with the rib21relative to the channeled disc13″.

The shapes and sizes of the slider pivot hole15e, the gap between the slider pivot and the slider among arms surface d6, the slider among arms surface15f, and the slider among arms surface radius r3as shown inFIG. 10dalso apply to the slider15″ shown in the present illustration.

FIG. 31bis an isometric front top view schematic illustrations of a channeled disc13″, an angular adjustment bolt14a, a linear adjustment bolt14b, a slider15″, and a rib21of the surgical retractor2″, according to the second embodiment of the present invention.

The present illustration shows that channel13kcan have a lateral section shape that is closed in all directions.

FIG. 32ais a top view schematic illustration of a channeled disc13″ of the surgical retractor2″, according to the second embodiment of the present invention, upon which a section plane g-g is marked.

FIG. 32bis a cross sectional view g-g illustrations of the channeled disc13″ of the surgical retractor2″, according to the second embodiment of the present invention.

The present illustration shows channeled disc wire holes13p, which can be threaded with electric wire to provide electric power to the lighting system.

FIG. 33is a top view schematic illustration of a surgical retractor2″, according to the second embodiment of the present invention, upon which a section plane h-h is marked.

FIG. 34is a cross sectional view h-h illustration of the surgical retractor2″, according to the second embodiment of the present invention.

The section plane shows two ribs21, the left one of which having a larger rib working arm length d9. The dimensions of its rib opening angle δ and slider pivot distance from the grooved disc central perforation center d20are also larger.

The dimensions of the rib opening angle δ and the slider pivot distance from the grooved disc central perforation center d20are respectively determined by the extent to which the angular adjustment bolt14aand the linear adjustment bolt14bare screwed in relative to slider15″.

The combination of dimensions given here is one private case of many possible cases and combinations, as well as occasional replacement of ribs21.

FIG. 35ais a top view schematic illustration of a slider of the surgical retractor2″, according to the second embodiment of the present invention, upon which a section plane i-i is marked.

FIG. 35bis a cross sectional view i-i illustrations of a slider15″ of the surgical retractor2″, according to the second embodiment of the present invention.

The slider15″ of the surgical retractor2″ of the second embodiment has three portions, a slider upper portion15p, a slider mid portion15q, and a slider lower portion15r.

In the upper portion15p, there is a perforation, all or part of which comprises slider first interior thread15m. In the mid portion15q, there is a perforation, all or part of which comprises slider second interior thread15n.

The three portions have an upper portion length d21, a mid portion length d22, and a lower portion length d23, respectively. The dimension of the upper portion length d21is smaller than that of lower portion length d23, and the dimension of the mid portion length d22is smaller than those of both. This serves the purpose of conforming the shapes and dimensions of the slider15″ to those of other components with which it is engaged, for smooth and efficient use.

FIG. 36ais an isometric front top view schematic illustration of a surgical retractor2″, equipped with an opening mechanism first type60a, according to the second embodiment of the present invention.

FIG. 36bis a side view schematic illustration of a surgical retractor2″, equipped with an opening mechanism first type60a, according to the second embodiment of the present invention.

This variant includes an opening mechanism first type60a, which facilitates linear opening of the ribs21, and an external disc19to prevent undesired linear closing.

The present illustration shows the opening mechanism first type60aslightly separated upwards from the other assemblies of the surgical retractor2″. The present illustration also shows lamps51b.

FIG. 37is an exploded, isometric front top view schematic illustration of a surgical retractor2″, according to the second embodiment of the present invention.

The surgical retractor2″ according to the second embodiment includes several assemblies, the mechanism for transferring of linear and rotational movements10″, the ribs assembly20, the lighting assembly50″, and the opening mechanism first type60a.

The mechanism for transferring of linear and rotational movements10″ includes the sliders15″, slider pivots15j, angular adjustment bolts14a, the channeled disc13″, and a base disc18.

The channeled disc13″ can be made of various materials, also including metals or materials transparent to x-rays, such as plastic material, and can be designated for single-time use.

The base disc18is attached to the bottom of the channeled disc13″ and serves as a cover for electrical wires, (not shown in the present illustration), which provide electrical supply to lighting assembly50″, which can also be composed of various materials, also including metals or materials transparent to x-rays.

Each rib21engages with a slider15″ by means of a replaceable slider pivot15j, which can be made of various materials, also including metals or materials transparent to x-rays.

Slider15″ includes a slider first interior thread15m, into which is screwed an angular adjustment bolt14a, and by means of which the angular opening of rib21can be determined. The linear opening of ribs21can be done by means of activating pushing forces, directly by an operator's hand, in an opening direction, upon the sliders15″. After obtaining sufficient opening, the external disc19is rotated into a state that prevents unwanted closing back.

An additional option for performing opening is by means the opening mechanism first type60a. Downward force, (in the orientation of the present illustration), on the opening mechanism ring64causes opening mechanism arms63to activate linear opening force upon the opening mechanism sliders64, and when these are engaged with the sliders15″, the sliders15″ are subject to linear opening forces. After performance of the linear opening, the external disc19is rotated to a state that prevents closing back and the opening mechanism first type60ais removed from the area in which the medical procedure is performed.

Following is a list of possible materials that can be used for various components of the surgical retractor2″ according to the embodiments of the present invention. This list is in no way limiting the present invention to the use of any specific materials.

The channeled disc13and the external disc19can be made of nylon 6/10 or polycarbonate.

The ribs21can be made of nylon 6/10+20%-30% carbon fiber or stainless steel such as stainless steel 316L.

The slider15can be made from stainless steel such as stainless steel 316L or from brass.

The opening mechanism first type60acan be made from stainless steel such as stainless steel 316L.

FIG. 38is a top view schematic illustration of a surgical retractor2″ equipped with an opening mechanism first type60a, according to the second embodiment of the present invention, upon which a section plane j-j is marked.

FIG. 39is a cross sectional view j-j illustration of the surgical retractor2″, equipped with an opening mechanism first type60a, according to the second embodiment of the present invention.

Outward linear movement, in the present illustration leftwards, of the slider15″, which is shown on the left in the present illustration, will result in linear opening motion of the left rib21, as a result of force applied by the slider pivot15j, which is connected to the slider15″.

Rotation of the linear adjustment bolt head14cassembled to the angular adjustment bolt14ain a direction that will screw it inward, will result in applying torque to the upper part of rib21, resulting in rotational opening.

The present illustration shows that the opening mechanism first type60aincludes an opening mechanism pole61a, upon which is mounted an opening mechanism arms ring62, which can move along its length.

The opening mechanism arms ring62is connected to opening mechanism arms63by means of opening mechanism arm upper pivots63a. The other end of each opening mechanism arm upper pivot63ais connected by means of an opening mechanism arm lower pivot63bto an opening mechanism slider64which conforms to the opening mechanism base65, so as to enable its linear radial movement.

When an axial force F5is applied to the opening mechanism arms ring62, downward movement, in the view shown in the present illustration, of the opening mechanism arms ring62is achieved, which is transmitted into radial force F6activated upon opening mechanism slider64. This force can serve to move the slider15″ in linear outward movement.

FIG. 40is a side view schematic illustration of an angular adjustment bolt14a, a slider15″, a slider pivot15j, and a rib21, according to the second embodiment of the present invention.

Screwing the angular adjustment bolt14ainto the slider first interior thread15m(not shown in the present drawing), of the slider15″ causes the activation of moment upon the rib21, resulting in rotational movement of rib21around the slider pivot15jrelative to the slider15″.

The shapes and dimensions of the slider pivot hole15e, the gap between the slider pivot and the slider among arms surface d6, the slider among arms surface15f, and the slider among arms surface radius r3, as described inFIG. 10dalso apply to the slider15″ shown in the present illustration.

FIG. 41is an isometric front top view schematic illustration of a slider15″, and an opening mechanism slider64of a surgical retractor2″, according to the second embodiment of the present invention.

The opening mechanism slider64, during the execution of linear opening, activates radial force F6, upon the slider15″, in the direction of the arrow shown in the present illustration.

FIG. 42is an isometric front top view schematic illustration of a slider15″, and a segment of the external disc19of a surgical retractor2″, according to the second embodiment of the present invention.

External disc19includes, for every slider15″, an external disc stair19hwhich after linear opening and after the rotation of the external disc19to the desired state prevents the slider15″ from moving back in the direction of linear closing.

The external disc19, shown in the present illustration, includes for each slider15″, one external disc stair19hdesignated for it, however there is no prevention, according to the present invention, from including more than one external disc stair19hfor each slider15″ in the external disc19, so as to be suitable for various degrees of linear opening.

Upon completion of the surgical procedure, the external disc19can be rotated back so that the external disc stairs19hdo not prevent linear movement in a closing direction of the sliders15″. In this state, as a result of the pressure of the body tissue in the area of the procedure, and the pressure of the flexible sleeve23, if it is assembled, the ribs21, (not shown in the present illustration), close, namely they draw closer to each other, thus facilitating their removal from the patient's body.

FIG. 43is an exploded, isometric front top view schematic illustration of an opening mechanism first type60aof a surgical retractor2″, according to the second embodiment of the present invention.

The opening mechanism arms ring62has an opening mechanism arms ring central hole62a, which grants it the ability to move along the length of the opening mechanism pole61a, when the opening mechanism pole61ais engaged within the opening mechanism arms ring central hole62a. Furthermore, the opening mechanism arms ring62is equipped with pairs of opening mechanism arms ring arms62b, each pair being connected, by means of an opening mechanism arm upper pivot62a, to an opening mechanism arm63, near one of its ends. Near its other end, the opening mechanism arm63is connected, by means of an opening mechanism arm lower pivot63b, to an opening mechanism slider64.

The opening mechanism arm63has ability for rotational movement relative to opening mechanism arm upper pivot63aand to an opening mechanism arm lower pivot63b.

The opening mechanism base65has an opening mechanism base hole65a, which serves for its connection to the opening mechanism pole61a.

The opening mechanism base65includes opening mechanism base grooves65b, each of which serves to enable and guide movement within and along opening mechanism slider64.

Both sides of opening mechanism base groove65bhave two opening mechanism base tracks65c.

The opening mechanism slider64has an external shape and dimensions that are suitable to receive force by means of an opening mechanism arm lower pivot63bfrom an opening mechanism arm63, in order to perform linear movement within an opening mechanism base groove65bupon a pair of opening mechanism base tracks65c, and in order to transmit force to a slider15″ (not shown in the present illustration).

This external shape also includes an opening mechanism slider upper channel64a, an opening mechanism slider bottom channel64b, two opening mechanism slider side channels64c, and an opening mechanism slider pushing portion64d.

All of the features of the ribs21, the flexible sleeve23and the central rod30as shown inFIGS. 2a-2c,3b,7a,10a,10e-10h,11,12a-12c,13a-13c,14a-14h,18a-18f,20-25,27a-27f, and28, and their accompanying descriptions, also apply to their use in the surgical retractors2″ in accordance with all the embodiments of the present invention.

FIG. 44ais an exploded, isometric top view schematic illustration of an opening mechanism second type60bof a surgical retractor2″, according to the second embodiment of the present invention.

The opening mechanism second type60boperates in a similar manner to that of the opening mechanism first type60a, (not shown in the present illustration), however it is constructed so as to enable the surgeon to view through its center when opening. For this purpose, an opening mechanism cylinder61breplaces the opening mechanism pole61a, (not shown in the present illustration).

The opening mechanism cylinder61bhas an opening mechanism cylinder internal diameter61D of a predetermined minimum value which ensures a sufficiently large visual range. On the external side of the opening mechanism cylinder61bthere is an opening mechanism cylinder external thread61ba. The opening force is transmitted manually or by means of an engine, (not shown in the present invention), to opening mechanism nut66, which in turn presses on the opening mechanism arms ring62.

The opening mechanism arms ring central hole62ais large enough, and conforms to the external dimensions of the opening mechanism cylinder61b.

The opening mechanism nut66includes an opening mechanism nut body66acontaining an opening mechanism nut internal thread66b, which conforms to opening mechanism cylinder external thread61ba.

FIG. 44bis an isometric front top view schematic illustration of an opening mechanism second type60bof the surgical retractor2″, according to the second embodiment of the present invention.

Both the opening mechanism first type and opening mechanism second type can also be composed of various materials, also including metals, plastics, and materials transparent to x-rays.

FIG. 45ais a front view schematic illustration of a surgical retractor2′″ according to a third embodiment of the present invention.

The third embodiment includes, as will be further shown, mechanisms for generation of radial, linear, and angular movement of the ribs21, similar to the mechanisms of the surgical retractor2′ according to the first embodiment of the present invention, however the transmission17′″ of the third embodiment is much simpler. Likewise, an auxiliary handle59ais added to facilitate the insertion of the ribs21into the body of the operated patient.

The auxiliary handle59acan be composed of metal and is removed from the surgical retractor2′″ after insertion is completed.

FIG. 45bis an isometric top view schematic illustration of a surgical retractor2′″ according to a third embodiment of the present invention.

The present illustration shows a wrench59b(such as ratchet wrench) mounted on the surgical retractor2′″. The wrench59bserves for transmission of manual force to initiate rotational movement, causing the linear radial movement.

The wrench59bcan be composed of metal, and can be removed and taken away, and even returned during performance of the medical procedure.

FIG. 46, is an exploded, isometric side bottom view schematic illustration of a surgical retractor2′″, up to elements, according to the third embodiment of the present invention.

The lighting assembly50′″, according to the third embodiment of the present invention, also includes lamps51b, five in the configuration shown in the present illustration. The lamps51bcan also be of liquid emitting device (LED) type, and are fed electric power from electric wires51g. Under each lamp51b, there can be a a lamp window51f.

Likewise, the surgical retractor2′″ according to the third embodiment includes a camera53, which is connected to camera cable53a. Camera53can also be a video camera, which provides the surgeon with real time visual display. The lighting for camera53is provided by lamps51b.

The mechanism for transferring of linear and rotational movement10′″, according to the third embodiment of the present invention also includes

The mechanism for transferring of linear and rotational movement10′″, according to the third embodiment of the present invention also includes cover disc11′″, grooved disc12, channeled disc13′″, six angular adjustment bolts14a, six sliders15′″ and a transmission17′″. The ribs assembly20, according to the third embodiment of the present invention, includes six ribs21.

According to another variant of the third embodiment of the present invention the quantity of ribs21is other than six, and therefore the quantities of the other elements, quantified as six in the present illustration, are correspondingly quantified.

The central rod30′″, according to a variant of the present invention, includes a central rod tail30a′″, and central rod head dome30c.

As noted, the quantities of elements noted above are in no way limiting the present invention, and there may be other variant of quantities, such as eight ribs21. The positions and connections of these assemblies, also with regard to each other, their functions, and methods of operation, will be specified in the following.

The majority of components of the surgical retractor2′″ according to the third embodiment of the present invention are transparent to X-ray radiation and are designated for single use.

FIG. 47a, is an isometric front top view schematic illustrations of a grooved disc12, a slider15′″, an angular adjustment bolt14aand a transmission17′″, according to the third embodiment of the present invention.

The present illustration demonstrates the method of engagement of the grooved disc12, the slider15′″, the angular adjustment bolt14a, and a transmission17′″, according to the third embodiment of the present invention.

FIG. 47bis an isometric front bottom view schematic illustrations of a grooved disc12, a slider15′″, an angular adjustment bolt14a, and a transmission17′″, according to the third embodiment of the present invention.

The present illustration demonstrates the method of engagement of the grooved disc12, the slider15′″, the angular adjustment bolt14aand a transmission17′″, according to the third embodiment of the present invention.

The illustration shows that the grooved disc teeth12eare engaged with transmission first cog wheel17f′″ and that angular adjustment bolt14ahas an angular adjustment bolt head14aa.

FIG. 48is an isometric front top view schematic illustration of a transmission17′″, according to the third embodiment of the present invention.

The transmission17′″ according to the third embodiment of the present invention is extremely simple, made of one cylindrical part, including a transmission shaft17b′″, a transmission first cog wheel17f′″, a transmission ring17j, and a transmission bolt head17i.

FIG. 49ais an isometric front top view schematic illustration of a channeled disc13′″, according to the third embodiment of the present invention.

The channeled disc13′″ according to the third embodiment has a structure similar to that of the channeled disc13′ according to the first embodiment, and both have common features. Channeled disc wall13b′″ has channeled disc wall holes13dand the present illustration shows channels13k. Furthermore, it has channeled disc transmission niche13s. The spatial shape of the channeled disc transmission niche13sconforms to the transmission first cog wheel17f, enables rotational movement of, and provides a resting point for transmission first cog wheel17f(not shown in the present drawing).

The channeled disc upper surface13tis etched with channel upper opening13l. The channeled disc perforation13e, the channeled disc lamp housing13q, of which there are five in the present illustration, and a channeled disc camera housing13rpierce all the way through the channeled disc13′″.

The channeled disc13′″ can be made as one piece.

FIG. 49bis an isometric front top view schematic illustration of a channeled disc13′″ and a transmission17′″, according to the third embodiment of the present invention.

The transmission17′″ is in its proper place relative to channeled disc13′″, and the transmission first cog wheel17fis within the channeled disc transmission niche13s.

FIG. 49cis an isometric front bottom view schematic illustration of a channeled disc13′″, according to the third embodiment of the present invention.

Alongside the channeled disc base13a, the illustration shows channeled disc long slots13f.

FIG. 50is an isometric front top view schematic illustration of a guarding cover58′″, according to the third embodiment of the present invention.

The guarding cover58′″ have a guarding cover disk58aand guarding cover wall segments58d, of which there are two in the present illustration.

In the center of the guarding cover disk58athere is a guarding cover perforation58bthrough which the operating surgeon can see, and through which the operating tools are inserted. Likewise, guarding cover disk58ahas a guarding cover niche58c, which conforms to the diameter size of the transmission bolt head17i.

Each guarding cover wall segment58dhas a guarding cover wall hole58e, through which a casing bolt70a(not shown in the present drawing) passes. Casing bolt70aserves to connect the guarding cover58to the casing70′″ (not shown in the present drawing).

FIG. 51aan isometric front top view schematic illustration of a slider15′″ and an angular adjustment bolt14a, according to the third embodiment of the present invention.

Rotation of the angular adjustment bolt head14aacauses linear movement of the angular adjustment bolt14arelative to the slider15′″, resulting in a rotational movement around the slider pivot15jrelative to the slider15″ of a rib21(not shown in the present drawing), such as was described with regard toFIG. 31a.

FIG. 51bis an exploded, isometric front top view schematic illustration of a slider15′″, according to the third embodiment of the present invention.

The slider15′″ includes a slider main body15a, the top part of which has a slider upper body15b, and one end of which has two slider arms15d. Likewise, it has a slider pin hole15cfrom which a slider pin15iprotrudes, and two slider pivot holes15einto which a slider pivot15jis assembled.

This resembles the structure of the slider15′, according to the first embodiment of the present invention, as shown inFIG. 10b, and according to the description provided forFIG. 10b.

The slider15′″ can also include a slider friction reducer15h, (not shown in the present drawing). Furthermore, the slider15′″, on its more distant end from the slider arms15d, has a slider third interior thread15w, which is designated to receive, by screwing, a slider bolt15t, for the purpose of connection to a slider back portion15s.

The slider back portion15sis connected to a slider upper portion15p, both of which have a slider first interior thread15m, which is designated to receive, by screwing, the angular adjustment bolt14a(not shown in the present drawing).

The slider back portion15shas a slider bolt hole15uthrough which a slider bolt15tmoves for the purpose of connection to the slider main body15a.

According to a variant of the third embodiment of the present invention, the slider back portion15sand the main slider upper portion15pare composed as one piece.

According to another variant of the third embodiment of the present invention, the slider back portion15s, the main slider upper portion15p, and the slider main body15aare composed as a one piece.

The slider pin15iis designated to be engaged within a curved groove12bof a grooved disc12(not shown in the present drawing), for the purpose of taking part in generating a radial linear movement of a rib21, as described inFIGS. 19aand19band in their accompanying descriptions.

FIG. 52is a side view schematic illustration of a casing70′″, according to the third embodiment of the present invention.

The casing70′″ is composed of a cover disc11′″ and a channeled disc13′″.

FIG. 53ais a top view schematic illustration of the surgical retractor2′″, according to the third embodiment of the present invention, upon which a section plane k-k is marked.

FIG. 53bis a cross sectional view k-k illustration of the surgical retractor2′″, according to the third embodiment of the present invention.

The state shown in the present illustration is prior to insertion of the surgical retractor2′″ into the body of the patient about to be operated on.

Every angular adjustment bolt14atouches a rib21, and every slider pin15iis engaged within the grooved disc12.

The auxiliary handle59ais connected to the central rod tail31, which is connected to the central rod head dome32.

The auxiliary handle59aand the central rod head dome32are in contact with the ribs21in the manner shown in the present illustration, so that relative linear movement between the auxiliary handle59aand the surgical retractor2′ is prevented.

During performing insertion of the surgical retractor2′″ into the patient's body, the surgeon can hold the auxiliary handle59aby hand, activate inserting force, and direct it. After completing insertion, the auxiliary handle59ais disconnected from the central rod tail31and taken away, and afterward, radial opening of the ribs21is performed, and the central rod tail31and central rod head dome32are removed and taken away.

The central rod tail31and the central rod head dome32according to another variant are composed as one piece.

The auxiliary handle59a, the central rod tail31and the central rod head dome32can be composed of metal.

FIG. 53cis a cross sectional view k-k illustration of three elements of the surgical retractor2′″, according to the third embodiment of the present invention.

To enable connection and disconnection of the auxiliary handle59aand the central rod head dome32to and from the central rod tail31, both ends of the central rod tail31are equipped with central rod screws31a, the auxiliary handle59ahas an auxiliary handle interior thread59aa, and the head dome32has a central rod head dome interior thread32a.

FIG. 54is a side view schematic illustration of the surgical retractor2′″, equipped with an opening mechanism third type60c, according to the third embodiment of the present invention.

The opening mechanism third type60cfacilitates a uniform rotational movement opening of the ribs21. Rather than having each angular adjustment bolt14arotate separately and generate a rotational movement opening of one specific rib21, the opening mechanism third type60cenables uniform rotation of the angular adjustment bolts14a.

FIG. 55ais a side view schematic illustration of an angular adjustment bolt14a, according to some variant of the third embodiment of the present invention, upon which a section plane l-l is marked.

The angular adjustment bolt14a, shown in the present illustration, is missing a linear adjustment bolt head14chowever has a linear adjustment bolt tail14d.

FIG. 55bis a cross sectional view l-l illustration of the angular adjustment bolt14a, according to some variant of the third embodiment of the present invention.

The linear adjustment bolt tail14dmay have a circular cross section shape14e, shown here magnified relative to the previous illustration.

FIG. 56is an isometric side top view schematic illustration of a opening mechanism third type cog wheel60ca, according to some variant of the third embodiment of the present invention.

The opening mechanism third type cog wheel60cahas an opening mechanism third type cog wheel central hole60cb, which has dimensions and shape such as those of the non-circular cross section shape14e.

Every opening mechanism third type cog wheel60cais a component of a bevel gear that serves for uniform rotation of all of the angular adjustment bolts14aof a surgical retractor2′″ (not shown in the present drawing).

The non-circular cross section shape14eand the identical dimensions of the sections of the linear adjustment bolt tail14d(not shown in the present drawing) and the opening mechanism third type cog wheel central hole60cbare designated to enable transmission of rotational movement from an opening mechanism third type cog wheel60cato a linear adjustment bolt tail14d, while concurrently enabling linear movement between the two, which is required when the angular adjustment bolt14arotates within the main slider upper portion15p(not shown in the present drawing), thus shifting its location.

FIG. 57ais an exploded isometric front bottom view schematic illustration of an opening mechanism third type60c, and angular adjustment bolts14a, according to some variant of the third embodiment of the present invention.

All the opening mechanism third type cog wheels60cacan be engaged with an opening mechanism third type bevel gear ring60cc.

All the linear adjustment bolt tails14dcan be each disposed within one separate opening mechanism third type housing wall hole60cfof an opening mechanism third type housing wall60ce, of an opening mechanism third type housing60cd.

FIG. 57bis an exploded isometric front top view schematic illustration of an opening mechanism third type60c, and angular adjustment bolts14a, according to some variant of the third embodiment of the present invention.

Rotation, whether manual or motor-powered, of the opening mechanism third type bevel gear ring60cc, generates the uniform rotational movement opening of the ribs21.

The structure of the surgical retractor2′″, according to the third embodiment of the present invention, enables its manufacture at sufficiently low costs in order to be viably used for single use, and including almost no components capable of blocking x-ray radiation. In particular, the cover disc11′″, the channeled disc13′″, the angular adjustment bolts14a, the angular adjustment bolt heads14aa, the slider15′″, the ribs21, and the guarding cover58′″ are all composed of material or materials transparent to x-ray radiation.

These structural materials, in addition to being transparent to x-ray radiation, must also have mechanical qualities suitable for their purpose, such as mechanical strength, elasticity, and environmental durability. Likewise, they must be suitable for medical use in surgical procedures on human tissue.

A good example of a suitable material is ULTEM HU1000 Resin, which is a Polyetherimide, a material defined as biocompatible, namely a material that is nontoxic and does not pose any risk of damage to biological systems.

FIG. 58ais a side view schematic illustration of a surgical retractor2′″, according to the third embodiment of the present invention, after insertion and opening for the purpose of performing far lateral micro discectomy and discoplasty (FLMDD).

Use of surgical retractor2′″, according to the third embodiment of the present invention for the purpose of this operation also provides the following advantages:minimal distraction and disruption of soft tissues (such as muscles, ligaments, nerves),saving height of intravertebral space,increasing sizes of intravertebral foramina,lowering of radicular pains,decreasing facet intra articular pressure,preventing facet osteoarthritis and development of future spinal stenosis,sparing unnecessary future vertebral fusion,maximal saving vertebral function, concerning motional freedom,less foreign bodies in to the patient's body,less infectious complications,less postoperative scar,less postoperative pain syndrome, andless delayed intravertebral discuses herniations on the different levels.

FIG. 58bis a side view schematic illustration of a surgical retractor2′″, according to the third embodiment of the present invention, after insertion and opening for the purpose of performing a translaminar micro discectomy.

Use of surgical retractor2′″, according to the third embodiment of the present invention for the purpose of this operation also provides the following advantages:minimal damage of ligaments and muscles, involving vertebral fixation,prevention of postoperative additional operations for vertebral fixations,prevention of delayed postoperative additional herniations of discuses (due to vertebral instability) on the other levels of vertebrae.

FIG. 59is a flow chart that schematically illustrates a method of operation for minimal invasive (MI), using a surgical retractor2′″, according to the third The method shown here details the steps for performance of several types of operations using the surgical retractor2′″, according to the third embodiment however this is in no way limiting the method of the present invention to these two types of surgery.

The method includes the stages of:

making an incision of skin until superficial fascia; (stage301); the incision is made at a length suitable for the type of surgery, such as in the case of far lateral micro discectomy and discoplasty, the incision is typically 1.5 to 3.0 centimeters, while for translaminar micro discectomy, an incision typically of 0.5 to 1.0,

holding an auxiliary handle59aof a surgical retractor2; (302)

inserting ribs21and a central rod30of said surgical retractor2into a patient body; (303)

for the translaminar micro discectomy operation the insertion is until paravertebral and intravertebral space, and for the translaminar micro discectomy operation the insertion is

rotating a wrench59for granting rotational movement to a grooved disc12causing radial linear opening movement of the ribs21; (305)

removing said central rod30from the surgical retractor2′″; (306)

removing said wrench59from the surgical retractor2′″; (307)

performing a medical procedure selected from a group consisting of replacing intravertebral discus, removal of intravertebral discuses, fusion of vertebra, operations of anterior cervical discectomy and fusion, operations of trans laminar burr hole and discectomy, far lateral discectomy and discoplasty, multi level spinal stenosis, multi level uni lateral and bilateral laminotomy, and trans oral vertebral fusion; (308) for a translaminar micro discectomy operation:

making a burr hole lateral of lamina; (309a)

inserting additional instruments via said burr hole; (309b)

taking out the surgical retractor2′″ from the patient's body (311)