Abstract:
An adjustable self retaining retractor ring assembly is provided. The self retaining retractor ring assembly is formed from two half-rings connected together by hinges to form a 360° enclosure or ring. The hinges allow the two half-rings to bend or pivot 180° relative to a plane of the ring. One of the hinges includes a positionable locking mechanism to lock or set the angular orientation of the two half-rings relative to each other. In this manner, fixed angles for the half-rings can be selected and maintained. Each half-ring includes a plurality of axially protruding pegs or posts (relative to a plane of the half-ring) positioned thereabout. The posts are shaped to releasably accept retractors and/or ancillary instruments thereon. Additionally, each post preferably includes a slot configured to allow for the locking of suture material therein.

Description:
TECHNICAL FIELD OF THE INVENTION  
         [0001]    The present invention relates generally to retractors, and more particularly, to a retractor ring assembly.  
         BACKGROUND OF THE INVENTION  
         [0002]    Open and mini-open surgical procedures require a varying amount of instruments for retracting and holding both instruments and the patient&#39;s tissue. More particularly, there are many soft tissue surgical procedures, such as about the shoulder for example, that require an open or mini-open technique, as opposed to an arthroscopic technique. The nature of these open and mini-open procedures typically requires expensive resources (i.e. additional staff such as surgeons and assistants) to assist with retraction by holding the various retraction and/or surgical instruments.  
           [0003]    Unfortunately, additional staff is costly, as well as a source of inconsistency for retraction. In view of this, there have been developed various devices to assist the surgeon in retraction positioning and retention during such open and mini-open surgical procedures. One such device known as the Hawkins Bell® system currently marketed by DePuy Orthopaedics, Inc. of Warsaw, Indiana, uses a shaft bent into a U-shape that can hold three retractors. Two of the retractors must be positioned at the ends of the shaft, and the third retractor is attached to the shaft through a small locking block. The primary disadvantages of this system are: 1) that attachments such as retractors cannot be positioned anywhere (360°) surrounding the wound (opening); 2) the system is not adaptable to a patient&#39;s anatomy; and 3) sutures cannot be retracted using the system. Since the shaft cannot bend, this eliminates the ability to adjust the A/P direction of retraction, as well as S/I and M/L.  
           [0004]    Other devices for retraction holding have been developed such as self-retracting forceps. These forceps allow the attachment of retractor blades to the ends of the forceps. The forceps, thus opening the wound, can thus separate the blades. A disadvantage to these devices is the lack of flexibility, i.e. there is no control over the direction of retraction. Additionally, only two retractors can be mounted to the forceps.  
           [0005]    In sum, these previous devices/attempts, however, have lacked the flexibility to be used in a wide variety of applications, without creating more nuisance than assistance.  
           [0006]    What is therefore needed is a self retaining retractor holder that overcomes one or more of the drawbacks associated with prior art retractor holders. What is also needed is a self retaining retractor ring that is adaptable to the contours of a patient. What is further needed is a self retaining retractor ring that includes functionality in addition to holding retractors.  
         SUMMARY OF THE INVENTION  
         [0007]    The present invention is a retractor holding assembly and, particularly a retractor ring assembly. The retractor ring assembly is articulatable into various angled positions and preferably defines a 360° enclosure. The retractor ring assembly also includes pegs that surround the incision (enclosure) by 360°, and have suture retaining slots.  
           [0008]    In accordance with another embodiment of the present invention, there is provided a retraction retaining device. The retraction retaining device includes a first ring portion defining a first end and a second end, a first plurality of posts disposed on the first ring portion with each post configured to retain an instrument, a second ring portion defining a first end and a second end, and a second plurality of posts disposed on the second ring portion with each post configured to retain an instrument. The retaining device further includes a first hinge coupled to and between the first ends, and a second hinge coupled to and between the second ends. The first and second hinges are configured to allow various angular positions of the first and second ring portions. In accordance with a further embodiment of the present invention, there is provided a retraction retaining device having an articulating ring, and a plurality of posts disposed on a surface of the articulating ring with each post configured to retain a surgical instrument.  
           [0009]    In accordance with yet another embodiment of the present invention, there is provided a method of retracting a surgical opening. The method includes the steps of: (a) providing a hinged ring defining an opening therein and having a plurality of posts disposed on an upper surface thereof; (b) articulating the hinged ring into a particular angular orientation; (c) locking the hinged ring into the particular angular orientation; (d) positioning the opening of the hinged ring over the surgical opening; and (e) attaching a retractor to one of the posts, the retractor operative to retract a portion of the surgical opening.  
           [0010]    In still another form, the present invention is a method of retaining a suture during an open surgery. The method includes the steps of: (a) providing a hinged ring defining an opening therein and having a plurality of posts disposed on an upper surface thereof, each one of the plurality of posts having a slot configured to releasably retain a suture; (b) positioning the opening of the hinged ring over the surgical opening; and (c) placing a suture in the slot of a chosen post.  
           [0011]    In a yet further form, the present invention is a retraction retaining device having a ring, and a plurality of pegs disposed on an upper surface of the ring and spaced thereon so as to encompass 360° of the ring with each peg configured to releasably retain a surgical instrument.  
           [0012]    It is therefore an object of the present invention to provide a new and useful retractor retainer.  
           [0013]    It is moreover an object of the present invention to provide an improved retractor retainer.  
           [0014]    It is a further object of the present invention to provide a new and useful method of providing retraction during surgery.  
           [0015]    It is also an object of the present invention to provide an improved method of retaining a suture during open surgery.  
           [0016]    The above and other objects, features, and advantages of the present invention will become apparent from the following description and the attached drawings. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]    [0017]FIG. 1 is a perspective view of a retractor ring assembly in accordance with the principles of the present invention;  
         [0018]    [0018]FIG. 2 is a top plan view of the retractor ring assembly of FIG. 1;  
         [0019]    [0019]FIG. 3 is a bottom plan view of the retractor ring assembly of FIG. 1;  
         [0020]    [0020]FIG. 4 is a side view of the retractor ring assembly taken along line  4 - 4  of FIG. 2;  
         [0021]    [0021]FIG. 5 is a top plan view of a first retractor ring portion of the present retractor ring assembly;  
         [0022]    [0022]FIG. 6 is a top plan view of a second retractor portion of the present retractor ring assembly;  
         [0023]    [0023]FIG. 7 is an enlarged perspective view of the post of the present retractor ring assembly;  
         [0024]    [0024]FIG. 8 is an enlarged side view of a post of the present retractor ring assembly;  
         [0025]    [0025]FIG. 9 is another enlarged side view of the present retractor ring assembly;  
         [0026]    [0026]FIG. 10 is an enlarged perspective view of the adjustment mechanism of the present retractor ring assembly;  
         [0027]    [0027]FIG. 11 is an enlarged plan view of an adjustment knob of the adjustment mechanism of the present retractor ring assembly;  
         [0028]    [0028]FIG. 12 is a bottom plan view of the retractor ring adjustment assembly of FIG. 11 taken along line  12 - 12  thereof;  
         [0029]    [0029]FIG. 13 is an enlarged side view of a lock washer of the adjustment assembly of the present retractor ring assembly;  
         [0030]    [0030]FIG. 14 is an enlarged bottom view of the lock washer of FIG. 13 taken along line  14 - 14  thereof;  
         [0031]    [0031]FIG. 15 is an enlarged side view of a locking screw of the adjustment assembly of the present retractor ring assembly;  
         [0032]    [0032]FIG. 16 is an enlarged bottom view of the locking screw of FIG. 15 taken long line  16 - 16  thereof;  
         [0033]    [0033]FIG. 17 is a perspective view of the present retractor ring holding a pair of deltoid retractors; and  
         [0034]    [0034]FIG. 18 is a perspective view of the present retaining ring assembly positioned over a patient and holding a pair of retractors of an incision of a patient. 
     
    
       [0035]    Corresponding reference characters indicate corresponding parts throughout the several views.  
       DESCRIPTION OF THE INVENTION  
       [0036]    While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that there is no intent to limit the invention to the particular forms disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims.  
         [0037]    Referring now to FIGS.  1 - 3 , there is shown a retractor holding or ring assembly, generally designated  20 , in accordance with the principles presented herein. The retractor ring assembly  20  includes a first ring portion  22  and a second ring portion  24 . The first and second ring portions  22  and  24  are coupled to one another at first respective ends  50  and  46  (see additionally FIGS. 5 and 6) thereof via a first pivot or hinge assembly  26 . The first and second ring portions  22  and  24  are coupled to one another at second respective ends  48  and  44  (see additionally FIGS. 5 and 6) thereof via a second pivot or hinge assembly  28 .  
         [0038]    The first hinge assembly  26  and the second hinge assembly  28  permit the ring assembly  20  to articulate, swing, or pivot. With additional reference to FIG. 4, such articulating is represented by the double-headed arrow. The first and second ring portions  22  and  24  are articulatable into a common plane define by the ring portions  22  (arbitrarily, 0°) and through 180°The first and second ring portions may be positioned into various angles off of the plane (0°). Additionally, the hinge assembly  26  also allows the two ring portions or halves to “shift” along an axis defined by the hinge assembly  26 . This permits, in one respect, the lockable hinge assembly  28  to release or unlock for an angle change.  
         [0039]    As best seen in FIGS. 5 and 6, the first and second ring portions  22  and  24  are each of an arcuate shape. More particularly, the first and second ring portions  22  and  24  are preferably relatively flat, semi-circular members such that a ring formed thereby is substantially circular. The first and second arcuate portions  22  and  24  may, however, take other shapes so that the resulting union thereof creates a ring that is oblong, elliptical, or the like. Each ring portion  22  and  24  is preferably made of a suitable metal such as stainless steel, a titanium alloy, or the like. Of course, other suitable material may be used.  
         [0040]    The retractor ring assembly  20  further includes a plurality of posts or pegs  30  disposed on a respective upper surface of the first and second ring portions  22  and  24 . Each peg is positioned in a bore or hole in the ring portion. The pegs  30  are preferably spaced about each ring portion such that the pegs encompass 360° about an opening  100  defined by the ring portions  22  and  24  when assembled. Further, while twenty-two (22) pegs  30  are shown, any number may suffice. Each peg  30  extends axially outwardly from its respective ring portion.  
         [0041]    Referring to FIGS.  7 - 9 , a peg  30  representative of all pegs  30  is depicted in greater detail. The peg  30  includes a base or seating portion  72  that is adapted to abut the upper surface of the respective ring portion. Extending axially downwardly from the base  72  is a seating post  74  that is received in a bore or hole of a ring portion. Extending axially upwardly from the base  72  is a center post  76 . A peg head  78  is positioned on the center post  72 . The peg head  78  includes a slot  79 . The slot  79  is configured to releaseably retain a suture therein. Additionally and preferably, the slot  79  is radially aligned with a center point of the opening  100  of the ring assembly  20 .  
         [0042]    The peg  30  is preferably made of a suitable metal such as stainless steel, a titanium alloy, or the like. Each peg  30  is attached to a respective ring portion. Preferably, each slot  79  is tapered so as to enable the slot  79  to retain a portion of a suture from the wound. Each peg  30  is configured to receive and releasably retain an instrument, particularly a surgical instrument, via a complementary hole in the surgical instrument. The surgical instrument is preferably a retractor. Thus, a plurality of surgical instruments are attachable to the retractor ring  20  via the pegs  30 .  
         [0043]    Referring back to FIG. 3, the hinge assembly  26  pivotally couples the end  44  of the ring portion  24  with the end  48  of the ring portion  22 . The hinge assembly  26  includes a first hinge portion  38  that is coupled to a second hinge portion  40  via a hinge pin  42 . The first hinge portion  38  is fixedly attached to the end  44 , while the second hinge portion  48  is fixedly attached to the end  48 . The hinge assembly  26  allows the ring portions  22  and  24  to pivot downwardly, but not upwardly with respect to the plane defined by the ring portions (ref. FIG. 4).  
         [0044]    The hinge assembly  28  pivotally couples the end  46  of the ring portion  24  with the end  50  of the ring portion  22 . The hinge assembly  28  includes a knob  32 , a locking washer  34 , and a locking screw washer  36 . The hinge assembly  28  allows the ring portions  22  and  24  to pivot downwardly, but not upwardly with respect to the plane defined by the ring portions (ref. FIG. 4). Further, the hinge assembly  28  is releasably lockable to releasably fix an angle of articulation of the ring portions  22  and  24 . Particularly, the hinge assembly  28  is releasably lockable in discrete steps to fix various angles of orientation of the ring portions  22  and  24 . Thus, the ring assembly  20  may be configured to adapt to the contours of a patient when the ring assembly is placed on the patient.  
         [0045]    [0045]FIGS. 11 and 12 depict the knob  32  of the hinge assembly  28 . Initially, the knob  32  is preferably made of a suitable metal such as stainless steel or a titanium alloy. Of course, as with all of the parts of the present invention, other suitable materials may be used. The knob includes a round, knurled head  52  adapted to allow a user to easily grip and rotate the knob  32 . Extending from the head  52  is a shaft  54  terminating distal to the head  52  in a beveled portion  56 . The shaft  54  defines an interior cavity  58  that is threaded.  
         [0046]    [0046]FIGS. 13 and 14 depict the lock washer  34  of the hinge assembly  28 . Initially, the lock washer  34  is preferably made of a suitable metal such as stainless steel or a titanium alloy. Other suitable material may also be used. The lock washer  34  includes a washer body  66  having a front side  67  having a plurality of teeth or notches  68  radially, progressively extending from a central bore  70 , the tops of which axially extend from central troughs thereof. The lock washer  34  also defines a rear side  69 .  
         [0047]    The number of teeth  68  may vary according to design preferences, with the number of teeth (i.e. the spacing thereof) defining incremental angles. The incremental angles provide discrete incremental positions or adjustments for the articulation of the ring portions  22  and  24 . In a preferred form, the teeth provide 15°increments. Of course, other fixed angle increments may be provided.  
         [0048]    [0048]FIGS. 15 and 16 depict the locking screw washer  36 . The locking screw washer  36  is again, preferably made of a suitable metal such as stainless steel, a titanium alloy, or the like. The screw washer  36  includes a lock washer body  60  having a front face  61  having a plurality of teeth or notches  62  radially, progressively extending from a screw or threaded shaft  64 , the tops of which axially extend from central troughs thereof. The teeth  62  are configured to mesh with the teeth  68  of the lock washer  34 . The threaded shaft  64  is adapted to extend through the bore  70  of lock washer  34  and be threadedly received in the threaded shaft  58  of the knob  32 .  
         [0049]    Referring to FIG. 10, the hinge assembly  28  is shown in greater detail. In particular, the lock washer  60  of the locking screw washer  36  is attached to either the ring portion  22  or the ring portion  24 , while the lock washer  34  is attached to the other of the ring portion  22  or ring portion  24 . The screw or threaded shaft  64  of the locking screw washer  36  (of which the lock washer portion  60  is seen) extends through the bore  70  of the lock washer  34  and threadedly engages the threaded opening  58  of the knob shaft  54 .  
         [0050]    Tightening of the knob  32  causes the bevel  56  of the shaft  54  of the knob  32  to abut the rear surface  69  of the lock washer  34 . Further tightening causes the teeth  68  of the lock washer  34  to engage the teeth  62  of the lock washer body  60 . Since a ring portion is coupled to one of the lock washers  60  and  66 , the orientation of the lock washers  60  and  66  relative to each other sets the angle of the ring assembly  20 . Loosening of the knob  32  allows at least one of the lock washers  60  and  66  to rotate relative to the other, or both, to reposition the ring portions  22  and  24  into another angle.  
         [0051]    Referring to FIG. 17, the retractor ring assembly  20  is shown having a first retractor  80  attached thereto, and a second retractor  82  attached thereto. The present invention provides the retractors  80  and  82  (and in general all surgical instruments attached thereto) in a radial loading pattern anywhere in the 360° range of pegs  30 . In a manner similar to any instrument that is releasably attachable to the ring assembly  20 , the retractor  80  includes a plurality of bores  88  that are configured to accept a peg  30  therein. The bores  88  are positioned along a shaft  86  of the retractor  80 . In this manner, the retractor  80  may be arcuately positionable on any peg  30  and is radially inwardly or outwardly adjustable for the particular surgical opening. The blade  84  of the retractor  80  may thus be inwardly or outwardly positionable to hold open the surgical opening.  
         [0052]    The retractor  82  likewise includes a plurality of bores  94  that are configured to accept a peg  30  therein. The bores  94  are positioned along a shaft  92  of the retractor  82 . In this manner, the retractor  82  may be arcuately positionable on any peg  30  and is radially inwardly or outwardly adjustable for the particular surgical opening. The blade  90  of the retractor  82  may thus be inwardly or outwardly positionable to hold open the surgical opening. It should be appreciated that more than two instruments may be supported by the present ring assembly  20 , limited only by the amount of room around the ring.  
         [0053]    It should further be appreciated that while the ring portions  22  and  24  are shown in FIG. 17 in a 0° position, they may be angled as shown and described herein in accordance with the principles of the present invention. The ring assembly  20  further defines an opening  100  that is situated over the surgical opening (or area where a surgical opening is to be made) during use.  
         [0054]    It should be appreciated that variations on the above are possible. Particularly, with respect to the pegs  30  and corresponding bores of an instrument, the pegs and bores may be reversed. The pegs may be formed as part of the instrument rather than holes, in which case the holes may be formed on the ring portions rather than pegs. Further, the locking hinge may take many forms other than that shown. The locking hinge may be spring-loaded and/or provide for a quick-change of angles, or for biasing the ring assembly  20  into a “normal” position.  
         [0055]    In addition, since the present ring assembly  20  is very stable once installed, the ring assembly  20  may be used as a baseline alignment device. Thus, various measurements and the like may be made from the ring assembly  20 , as well as the positioning of other instruments/procedures independent of the ring assembly  20 .  
       Operation of the Present Invention  
       [0056]    In operation, and referring to FIG. 18, the ring assembly  20  is placed on a patient  200 , particularly such that the opening  100  of the ring assembly  20  is over a surgical opening or wound  220  of the patient  200 . The angular orientation of the ring portions  22  and  24  are set such that each ring portion contacts the patient. In this manner, the ring assembly  20  almost totally rests upon the patient. The retractors  80  and  82  are positioned on the ring assembly  20  so as to maintain the incision in an open position.  
         [0057]    Further, as shown in FIG. 18, sutures  230  that extend from the incision  220  may be retained by the slots  79  of the pegs  30 . The double-headed arrows indicate that the ring portions  22  and  24  articulate or can be angled appropriately for the patient  200 .  
         [0058]    The present invention is useful during shoulder surgery, such as arthroplasty or the like, as well as other surgical procedures where retraction of an incision, surgical opening, or would is required. As well, although not shown in FIG. 18, the present ring assembly  20  may hold other instruments.  
         [0059]    While the invention has been illustrated and described in detail in the drawings and foregoing description, such an illustration and description is to be considered as exemplary and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.  
         [0060]    There are a plurality of advantages of the present invention arising from the various features of the retractor described herein. It will be noted that alternative embodiments of the retractor of the present invention may not include all of the features described, yet still benefit from at least some of the advantages of such features. Those of ordinary skill in the art may readily devise their own implementations of a retractor that incorporate or more of the features of the present invention and fall within the spirit and scope of the present invention as defined by the appended claims.