Tension retaining device for surgical procedures

The device includes a pair of rollers through oppositely disposed notches through the wall of a tubular section to engage opposite sides of the shaft of a surgical instrument that is through the bore of the tubular section. The tubular section is slideable in a sleeve element and the ends of the rollers are rotatably received in the respective slots of two pairs of slots in the walls of the sleeve element. A pad removably mounted on one end of the sleeve element has a central opening for the instrument shaft to pass through. The pairs of slots converge in the direction of the end of the sleeve element on which the pad is mounted to a distance apart not less than the distance between the bottoms of the notches in the tubular section. Releasable spring means urge the rollers toward the converging ends of the pairs of slots so that the shaft of the instrument may be drawn out through the device in the direction in which the slot pairs diverge, but not in the opposite direction in which they converge, unless the spring means releases it. The device is used in combination with a surgical instrument for procedures in which the instrument engages material within a body and is drawn out to stretch the material outward under tension. The device grips the instrument to retain the tension until the release mechanism is actuated.

BACKGROUND AND SUMMARY OF THE INVENTION 
The present invention is a releasable one way clutch type tension retaining 
device for use in surgical procedures, such as arthroscopy, for example, 
wherein an instrument which has a shaft portion and a working end is 
inserted through a body surface to engage and stretch under tension 
material, such as cartiledge, muscle or fatty tissue, for example, either 
to hold the material to be worked on by another instrument or to hold the 
material away from underlying material that is to be worked on. The 
instrument applies tension to the material by being drawn outward from the 
body. 
The device of this invention is adapted for use with a number of different 
surgical instruments in a variety of surgical procedures. For example, it 
is particularly adapted for use with different types of grasping forceps 
for retaining tension during knife cutting or shaving procedures. It is 
also used with fat pad retractors for holding pads of fat out of the way 
for cutting, shaving or suturing in areas under the fat pad. It has also 
been used to hold a retrograde marking hook in position during 
arthroscopic reconstruction. 
The device includes a tubular section through the bore of which the shaft 
of a surgical instrument is received. The tubular section is slideably 
received within the bore of a sleeve element and a one way type of clutch 
mechanism is provided by at least one roller through and movable up and 
down in a notch that is in the wall of the tubular section. The notch is 
across the axis of the tubular section and opens into its bore. The notch 
is of a depth such that the space between the the roller resting in the 
bottom of the notch and an opposite surface, which may be the opposite 
wall of the bore of the tumular section or, preferably, another roller in 
another notch through the opposite side of the tubular section, is less 
than the diameter of the shaft of an instrument that is to be used with 
the device. 
The ends of the roller, or rollers, are rotatably received respectively in 
slots in opposite walls portions of the bore of the sleeve element. The 
slots extend generally longitudinally of the bore of the sleeve element, 
but at an angle with respect to the axis of the bore so that the plane of 
the slots converges toward the opposite wall of the sleeve element bore in 
one direction and diverge from it in the opposite direction. Thus when the 
notched tubular section is moved within the sleeve element relatively in 
the direction in which the plane of the slots converges toward the 
opposite surface within the sleeve element the notch carries the roller 
toward that opposite surface, and hence toward the opposite surface within 
the bore of the tubular section. The latter surface may be the opposite 
wall of the bore of the tubular section or, in the preferred form, the 
surface of another roller in another, oppositely disposed notch in the 
opposite wall of the tubular section, the end portions of this other 
roller being received in another pair of slots in the walls of the sleeve 
element. The plane of such a second pair of slots would converge toward 
the opposite wall of the sleeve element in the same direction as the plane 
of the first pair of slots and at the same longitudinal location relative 
to the length of the sleeve element. 
In any case the relative movement of the tubular section within the sleeve 
element in the slot converging direction causes the roller or rollers to 
pinch an instrument shaft that is through the bore of the tubular section 
between it and the opposite surface, which is either the bore wall or 
another roller. 
Spring means is connected to urge the parts in relative directions in which 
the roller, or rollers, are urged into instrument shaft gripping position. 
Thus an instrument whose shaft is through the bore of the tubular section 
is prevented from being drawn further through the tubular section in the 
converging direction of the slots by the pinching action of the roller or 
rollers , but may be drawn in the opposite direction, the direction in 
which the slots diverge. 
The spring means is releasable to enable an instrument shaft to be moved 
freely through the bore of the tubular section in either direction when 
desired. In a preferred form of the device of this invention the spring 
means is a spring loaded lever pivotted on the sleeve element and having 
an arm connected to an end of the roller, or to one of the rollers, if 
there are two, to urge the roller in the converging direction. 
A broad circular pad is mounted on the end of the sleeve element toward 
which the plane, or planes, of the slots therein converge toward the 
opposite side of its bore. This pad is removable and replaceable for 
hygenic purposes and is adapted to bear against the surface of the body 
against which the device is placed in use in order to distribute the load 
exerted by the device on the body surface and thus cushion the device. 
With the device placed with its pad against a body surface the shaft of a 
surgical instrument, such as grasping forceps, is through the tubular 
section and the working end of the instrument, e.g. the jaws of grasping 
forceps, projects through the body surface to the inside of the body where 
it is applied to grip or hook onto material--tissue, muscle or cartiledge, 
for example--within the body. The instrument is then drawn outward through 
the device is stretch or pull the material outward to the desired degree 
of tension. The slots, notch and roller clutch mechanism then operates to 
hold the instrument and the material held by it in the desired position by 
means of the tension created by the stretched material pulling inward on 
the instrument. The device then maintains the instrument in the tension 
position and frees the hands of the doctor or nurse for other work. When 
the work is completed the tension is relieved to allow the instrument to 
be move inward to detach it from the material in the body and then 
withdraw if from the body, by actuating the spring means to release the 
grip of the roller, or rollers, on the instrument shaft.

DETAILED DESCRIPTION 
Referring now to the drawings a preferred form of the tension retaining 
device 10 of this invention is provided by an open ended tubular section 
11 which has a bore 12 that is dimensioned for a shaft 13 of a surgical 
instrument 14, such as a graping forcep as illustrated in FIG. 3, to pass 
through. 
The tubular section 11 is slideably received within the bore 15 of a sleeve 
element 16 and has a pair of notches 17 and 18 respectively in opposite 
sides and opening into its bore 12. The notches 17, 18 are opposite each 
other in alignment across the bore and are of depths such that their 
bottoms are apart a distance less than the diameter of the shaft 13 of an 
instrument with which the device 10 is intended to be used. 
The notches 17,18 each have a roller, rollers 19 and 20 respectively, 
received through them. The ends of the rollers 19, 20 are rotatably 
received in pairs of slots 21a, 21b and 22a, 22b, respectively, that are 
in the walls of the sleeve element 16. The slots 21a, 21b and 22a, 22b of 
each pair are in alignment with each other at opposite sides of the bore 
15 of the sleeve element 16. The lengths of the slots are angularly 
disposed relative to the axis of the bore 15 so that the plane of each of 
the pairs of the slots converges toward the opposite in one direction, and 
diverges therefrom in the opposite direction. As indicated in FIGS. 1 and 
3 the planes of the pairs of slots 21a, 21b and 22a, 22b converge to a 
distance apart less than the diameter of the shaft 13 of an instrument 
with which the device is to be used. Also the tubular section 11 is 
axially positioned within the sleeve element 16 so that the notches 17, 18 
are adjacent to the slots as necessary for the ends of the rollers 19,20 
through the notches to be received in the slots. Thus, when the tubular 
section 11 is moved longitudinally within the bore 15 of the sleeve 
element 16 in the direction in which the slot pairs 21a,21b and 22a, 22b 
converge, i.e. to the left in FIGS. 1 and 3 the rollers 19, 20 being 
carried by the notches 17, 18 are moved along in the respective slot pairs 
21a, 21b and 22a, 22b to converge and bear against and grip the shaft 13 
of an instrument that is through the bore 12 of the tubular section 12. As 
the shaft 13 or the tubular section 11 move relatively in the slots 
converging direction the grip of the rollers on the shaft increases to the 
point at which further movement of the shaft in that direction is 
prevented. On the other hand movement of the shaft 13 or the tubular 
section 11 relatively in the opposite, slot diverging, direction, to the 
right in FIG. 3, causes the rollers to diverge and release their grip on 
the shaft 13 and permit free movement of the shaft in that direction. 
The tubular section 11 is resiliently urged in the slots converging 
direction, in which it carries the rollers 19, 20 toward the converging 
ends of the slot pairs by spring means illustrated in FIGS. 1 and 2. An 
aligned pair of L shaped levers 25, 26 consisting of lever arms 25a, 25b 
and 26a, 26b are at opposite sides of the sleeve element 16 and are joined 
together as a unit by a web 27 between the arms 25a, 26a, which are the 
top arms of the levers, across the top of the sleeve element The levers 
25, 26 are pivotally mounted on the sleeve element 16 by a shaft 28 
through the elbow of the levers 25, 26 and journalled through a pair of 
posts 29, 30 projecting upward from opposite edges of the sleeve element 
16. The shaft 28 is held in place through the posts and levers by caps 
28a, 28b pinned on the outer ends of the shaft 28, respectively. 
The levers 25, 26 are resiliently urged to pivot in the clockwise 
direction, as viewed in FIGS. 1 and 4, by a coil spring 31 around the 
shaft 28 with one tail end 31a projecting under and bearing against the 
web 27 which joins the levers 25 and 26. The other tail end 31b of the 
coil spring 31 extends over and bears down against the top of the sleeve 
element 16. 
The lower ends of the lever arms 25b, 26b are loosely connected to the 
lower roller 20 by the ends of the roller 20 extending through slots 34a, 
34b in the lower end portions of the lever arms 25b, 26b. Caps 35a, 35b on 
the ends of the roller 20 hold the roller in place. 
The slots 34a, 34b in the lever arms 25b, 26b extend radially of the pivot 
point of the levers 25, 26 defined by the 28, and are made a sufficient 
radial length to permit the ends of the roller 20 move freely up and down 
therein as the levers 25, 26 swing about the the shaft 28. Thus when the 
levers 25, 26 are pivotted the lever arms 25b, 26b move the roller 20 
along in the pair of slots 22a, 22b, which are straight. 
When the levers 25, 26 pivot about the shaft 28 they, acting through the 
roller 20, cause the roller 20 to move along in the pair of slots 22a, 22b 
and bear against sides of the notch 18 in the tubular section 11 and 
thereby move the tubualar section longitudinally in the bore 15 of the 
sleeve element 16. This causes the rollers 19 and 20 to converge or 
diverge, depending upon the direction of movement. As shown the spring 31 
is arranged and biased to cause the levers 25, 26 to swing in the 
clockwise direction as viewed in the drawings. When the levers thus swing 
in the clockwise direction they cause the rollers 19, 20 to converge and 
grip a shaft 13 that is between them. 
To release the spring pressure, and hence release the grip of the rollers 
19, 20 on a shaft 13, the levers are moved in the opposite, 
counterclockwise, direction by pressing down on the web 27 that is between 
the tops of the levers 25, 26. This causes the lower arms 25b, 26b of the 
levers 25, 26, acting through the roller 20, to move the tubular section 
11 to the right, as viewed in the drawings, in the direction in which the 
slots diverge, so that the rollers 19,20 are caused to diverge away from a 
shaft 13 between them therby releaseing the shaft to be moved in either 
direction through the bore 15 of the tubular section 11 of the device. 
The end of the sleeve element 16 toward which the lots 21a, 21b and 22a, 
22b converge--the left end as viewed in FIGS. 1 and 3--has a resilient 
dish shaped pad 36 removably mounted on it to bear against a surface 37 of 
a body which is to undergo a surgical procedure. The pad 36 has a larger 
circumference than the end of the sleeve element and thus provides a 
cushion that distributes the pressure of the device 10 over a relatively 
large area of the body surface 37 when the device is in use. The pad 36, 
which is suitably made of PVC, is removably mounted on the sleeve element 
by a boss portion 38 of the pad frictionally received in the end portion 
of the bore 15 of the sleeve element. Thus the pad 36 can be removed from 
the device for sterilization. The center of the pad 36 has an opening 
through it into the bore 15 to permit a shaft 13 and the working end 41 of 
a surgical instrument with which the device is to be used to pass through 
the device to be inserted into a body for a surgical procedure. 
In use the device 10 is placed with its pad 36 against an area of a 
patient's body surface through which the working end 41 of a surgical 
instrument, such as a grasping forcep as shown in FIG. 3, is to be 
inserted. The levers 25,26 are rotated by pressing down the web 27 which 
connects them at the top to cause the rollers 19,20 to move apart and let 
the shaft 13 of a surgical instrument 14 pass through into the interior of 
the patient's body. The instrument passes into the patient's body through 
an opening 42 previously made in the body surface by another instrument or 
by the instrument with which the device 10 is being used. With the rollers 
19,20 held apart by depressing the web 27 the instrument inserted into the 
patient's body can be moved back and forth as necessary to bring the 
instrument's working end 41 into position to engage material within the 
body for drawing the material outward toward the surface 37 to a position 
in which the performance of the surgical procedure is facilitated. When 
the working end of the instrument, and the material engaged thereby, have 
been moved outward to the desired position the levers 25, 26 are released, 
by letting up on the web 27, so that the rollers 19, 20 are moved to the 
converging ends of the slots 21a, 21b and 22a, 22b and thus grip the shaft 
13 under the pressure exertd by the coil spring 31. This pressure of the 
rollers 19, 20 holds the shaft 13 so that it can not move further inward 
but can be drawn outward. 
The instrument 14 illustrated in FIG. 3 is a grasping forcep whose working 
end 41 is a pair of jaws 43a, 43b which grip the material (not shown) 
within the body. With the jaws 43a, 43b gripping material, such as 
cartilage, muscle or a fat pad, for example, the instrument is drawn 
outward through the device 10--to the right as viewed in FIG. 3--until the 
material is stretched outward the desired amount. The gripped material 
which is thus drawn outward under tension applies inwardly directed 
tension on the instrument, drawing the shaft 13 of the instrument inward 
throught the tubular section 11--to the left as viewed in FIG. 3--against 
the one way clutch action of the rollers 19, 20 produced by the 
cooperation of the coil spring 31 and the converging slots 21a, 21b and 
22a, 22b in which the rollers move. The shaft 13 is thus retained in its 
tensioned position, holding the material engaged by the working end of the 
instrument stretched outward, for as long as necessary for the procedure 
being performed. To release the grip of the instrument on the material and 
remove the instrument from the body, the levers 25, 26 are rotated against 
the bias of the coil spring 31 by pressing the web 27 which joins the tops 
of the levers. This releases the spring pressure from the rollers and 
moves them apart from the shaft of the instrument 14. The instrument is 
then free to be moved in and/or out as necessary to free its working end 
from engagement with the body material and then to be withdrawn from the 
body and out through the device 10.