Abstract:
A retractor ring assembly includes a ring holder that has a first selectively engaged connection and a second selectively engaged connection. A first and second ring portion each has a proximal end and a distal end. The proximal end of the first and second ring portions are selectively connected to the respective first and second selectively engaged connections of the ring holder. The distal end of the first ring portion has a third selectively engaged connection. The distal end of the second ring portion has a fourth selectively engaged connection. The third selectively engaged connection and the fourth selectively engaged connection are connectable to form a reinforced closed ring configuration, and are disconnectable to form an open ring configuration.

Description:
FIELD OF THE INVENTION 
     The present invention relates to methods and devices for an adjustable retractor ring system having interchangeable rings. 
     BACKGROUND OF THE INVENTION 
     During surgery, retractors, such as those found in the BOOKWALTER™ retractor kit, which is commercially available from Codman &amp; Shurtleff, Inc. of Raynham, Mass., are often used to assist the surgeon and other operating room personnel to provide exposure to the surgical site for a broad range of surgical procedures. In surgical operations of the chest or abdomen, for example, it is often necessary to use a retraction apparatus to retain tissue away from the operative site. Typically, the refraction apparatus includes a housing member configured to lock onto a circumferential ring  10  located above the operative site (see  FIG. 1 ). To maintain ring  10  in a fixed position, ring  10  can be connected to a support post  12  adjacent to the site by a horizontal bar  14  that has a flexible joint  16  (horizontal flex bar) to permit ring  10  to be oriented in various positions, as shown in  FIG. 1 . A horizontal extension arm may also be attached to the support post for supporting the circumferential ring. Within the housing member a refraction blade can usually be found for grabbing the tissue around the surgical incision. The housing member can also include a ratcheting mechanism and/or a tilting mechanism to draw the retraction blade away from the incision, thereby effecting the pulling away and/or lifting of the tissue around the incision to expose the desired surgical area. Examples of such retractor systems are disclosed in U.S. Pat. Nos. 4,254,763, 4,424,724, 5,375,481 and 6,808,493, the disclosures of which are hereby incorporated by reference in their entirety. During open surgical operations, such as, for example, open bariatric, ALIF procedures, hepatic resections, transplant procedures, abdominal aortic aneurysms, hernia repair, appendectomy and others, many different instruments are used, such as, for example, a retractor blade with ring attachment systems are used. In some medical procedures, different size rings are required to accommodate different procedures, different size patients, different doctor preference, etc. In addition, in some medical procedures, the doctor may want to separate the ring so that one half ring is in one plane and the other half ring is spaced from and in a different plane from the other half ring. 
     Thus, despite these refraction systems, there continues to be a need for a retraction system that can securely hold a retractor ring while permitting the size of the ring to vary. 
     SUMMARY OF THE INVENTION 
     The present invention includes a retractor ring assembly includes a ring holder that has a first selectively engaged connection and a second selectively engaged connection. A first and second ring portion each has a proximal end and a distal end. The proximal end of the first and second ring portions are selectively connected to the respective first and second selectively engaged connections of the ring holder. The distal end of the first ring portion has a third selectively engaged connection. The distal end of the second ring portion has a fourth selectively engaged connection. The third selectively engaged connection and the fourth selectively engaged connection are connectable to form a reinforced closed ring configuration, and are disconnectable to form an open ring configuration. 
     The present invention also includes a retractor ring kit. The kit includes a ring holder having a first selectively engaged connection and a second selectively engaged connection. A first ring portion has a proximal end and a distal end. The proximal end is selectively connected to the first selectively engaged connection of the ring holder. A second ring portion has a proximal end and a distal end. The proximal end is selectively connected to the second selectively engaged connection of the ring holder. The first and second ring portions have approximately the same shape. A third ring portion has a proximal end and a distal end. The proximal end is selectively connected to the first selectively engaged connection of the ring holder. A fourth ring portion has a proximal end and a distal end. The proximal end is selectively connected to the second selectively engaged connection of the ring holder. The third and fourth ring portions have approximately the same shape and that shape is different from the shape of the first and second ring portions. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which: 
         FIG. 1  is a plan view of a conventional ring holder; 
         FIG. 2A  is a plan view of the ring holder and a pair of ring portions in accordance with the present invention; 
         FIG. 2B  is a plan view of the ring holder and a pair of ring portions in accordance with the present invention; 
         FIG. 3  is an exploded view of the ring holder and the sets of ring pairs; 
         FIG. 4A  is a top view of the first set of ring pairs; 
         FIG. 4B  is a top view of the second set of ring pairs; 
         FIG. 4C  is a top view of the third set of ring pairs; 
         FIG. 5  is an enlarged top view of one of the distal end of one of the sets of ring pairs; 
         FIG. 6A  is cross-sectional view taken along line  6 - 6  of  FIG. 5  and looking in the direction of the arrows; 
         FIG. 6B  is cross-sectional view taken along line  6 - 6  of  FIG. 5  and looking in the direction of the arrows; 
         FIG. 7  is a top view of the ring holder; 
         FIG. 8A  is cross-sectional view taken along line  8 - 8  of  FIG. 7  and looking in the direction of the arrows; 
         FIG. 8B  is cross-sectional view taken along line  8 - 8  of  FIG. 7  and looking in the direction of the arrows; 
         FIG. 9  is cross-sectional view taken along line  9 - 9  of  FIG. 8B  and looking in the direction of the arrows; 
         FIG. 10  is cross-sectional view taken along line  10 - 10  of  FIG. 9  and looking in the direction of the arrows; 
         FIG. 11  is a side view, with parts broken away, of the ring holder; 
         FIG. 12  is cross-sectional view taken along line  12 - 12  of  FIG. 11  and looking in the direction of the arrows; 
         FIG. 13  is cross-sectional view taken along line  13 - 13  of  FIG. 11  and looking in the direction of the arrows; 
         FIG. 14  is an enlarged side view, with parts broken away, of the starburst connection; 
         FIG. 15A  is an enlarged side view, with parts broken away, of the ring holder; 
         FIG. 15B  is an enlarged side view, with parts broken away, of the ring holder; 
         FIG. 16  is cross-sectional view taken along line  16 - 16  of  FIG. 15A  and looking in the direction of the arrows; and 
         FIG. 17  is cross-sectional view taken along line  17 - 17  of  FIG. 15A  and looking in the direction of the arrows. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention. 
     The present invention provides methods and devices for an adjustable retractor ring system having interchangeable rings. A retractor ring holder  20  is illustrated in  FIGS. 2 ,  3 ,  7  and  11 . Ring holder  20  includes a post connecting portion  22  and a ring holder portion  24 . Post connecting portion  22  has a proximal end  26  and a distal end  28 . Proximal end  26  connects to a table post  12  or to a horizontal extension bar (not shown) in a manner known to those skilled in the art. Distal end  28  of post connecting portion  22  is fixedly connected to ring holder  24  by an annual mating serrated saw-like connection  30 , which may also be referred to as a starburst connection. Connection  30  is selectively loosened and tightened by moving collar  32  either toward or away from the distal end  28  of post connecting portion  22 . In the loosened position, ring holder portion  24  is free to rotate 360 degrees with respect to bar portion  22 . In the tightened position, however, ring holder portion  24  is fixedly connected to bar portion  22 . 
     Ring holder portion  24  includes a first ball joint connection  34  and a second ball joint connection  36 . Referring now to  FIGS. 2-7 , the quick connection/disconnection of a plurality of sets of ring portions  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  are illustrated. Rotation of a handle  44  in either a clockwise or counter-clockwise direction, will selectively lock the position of portions  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  in place or unlock the ring portions so that they can be selectively positioned in any desired location by the user and thereafter locked in place by rotation of handle  44 . If should be noted that the ring pairs  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  may be utilized so that rings of the same size are used together as shown in  FIG. 2A  with ring pair  38   a ,  38   b , or ring pairs of different sizes may be used as shown in  FIG. 2B  with ring pair  38   a ,  42   b , for example. A plurality of retractor blades  41  may be affixed to the rings  38   a ,  38   b ,  40   a ,  40   b ,  42   a  and  42   b , as shown in  FIGS. 2A and 2B . 
     Referring now to  FIGS. 4-7 , each ring portion pair  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  are movable between a selectively engaged position and a selectively disengaged position. When in the selectively engaged position, as shown in  FIGS. 5 and 6   a , the ring pairs form a reinforced closed ring. When in the selectively engaged position, as shown in  FIGS. 2 ,  4   a ,  4   b ,  4   c  and  6   b , the ring pairs are disconnected to form an open ring position. To assist in connecting and disconnecting the ring pairs, a sliding latch is provided on distal end of each ring portion  38   b ,  40   b  and  42   b . Latch  46  has a distal free end  48 . The distal end of each ring portion  38   a ,  40   a ,  42   a  has a locking pin  50  rigidly fixed in place. To disconnect the ring pair from the selectively engaged position, the user will push latch  46  in the direction indicated by arrow A in  FIG. 6B  thereby moving the distal end  48  of latch  46  to the open position as shown in  FIG. 6B . The user can then angle the respective ring portion  38   a ,  40   a ,  42   a  upwardly in the direction indicated by arrow B to the position illustrated in  FIG. 6B , and remove the respective ring portion  38   a ,  40   a ,  42   a  from being selectively engaged from ring portion  38   b ,  40   b  and  42   b.    
     The user will utilize the opposite steps to connect the ring pairs. For example, the user will push latch  46  in the direction indicated by arrow A in  FIG. 6B  thereby moving the distal end  48  of latch  46  to the open position as shown in  FIG. 6B . The user can then angle the respective ring portion  38   a ,  40   a ,  42   a  downwardly in the opposite direction than that indicated by arrow B in  FIG. 6B . Latch  46  can be released. Latch  46  is spring biased by spring  52  into the position shown in  FIG. 6A . As shown in  FIG. 6A , the respective ring portion  38   a ,  40   a ,  42   a  is selectively engaged with the respective ring portion  38   b ,  40   b  and  42   b.    
     Referring now to  FIGS. 7-10 , the mechanism for selectively connecting a ring portion  38   a ,  38   b ,  40   a ,  40   b ,  42   a  and  42   b  to the ring holder portion  24  of ring holder  20  is shown. Ring holder portion  24  has a first sleeve  54  and a second sleeve  56 . Each sleeve  54 ,  56  has a respective opening  58 ,  60  on its top surface. Each sleeve has an internal blind bore or channel  62  (the blind bore for sleeve  56  is not shown, but it has the same shape as bore  62 ). Each ring portion  38   a ,  38   b ,  40   a ,  40   b ,  42   a  and  42   b  has a proximal end  64 ,  66  and a distal end  68 ,  70 . Proximal end  64 ,  66  is selectively connected to the ring holder portion  24  of ring holder  20 . The proximal end of each ring portion has a spring biased button  72 . Preferably, as shown in  FIG. 10 , four springs  74  are utilized to bias button  72  into the connected position of  FIG. 8 . To disconnect a ring portion from the ring holder  20 , the user will push down on button  72  and substantially simultaneously pull on the ring portion in the direction indicated by arrow C in  FIG. 8B  to remove the ring portion proximal end  64  from sleeve  54 ,  56 . 
     The user will utilize the opposite steps to connect the ring portion to the ring holder  20 . For example, the user will push the desired ring portion  38   a ,  38   b ,  40   a ,  40   b ,  42   a  and  42   b  in the direction opposite to that indicated by arrow C in  FIG. 8B  thereby moving the proximal end  64  of the ring portion into channel  62 . As the proximal end  64  enters channel  62 , pin  72  will be biased into the ring portion as shown in  FIGS. 8B and 9 . The user will continue to push the proximal end of the ring portion into sleeve  62  until button  72  snaps up into opening  58 ,  60 , thereby connecting or locking the ring portion into engagement with the ring holder  20 . 
     Referring now to  FIGS. 11-14 , once a desired ring portion pair  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  are connected to the ring holder  20 , the user can then adjust the position of the ring portion pair by rotating the ring holder  20  360° by use of collar  32  and starburst connection  30 . As discussed above, connection  30  is selectively loosened and tightened by moving collar  32  either toward or away from the distal end  28  of post connecting portion  22 . In the loosened position, as shown in  FIG. 14 , ring holder portion  24  is free to rotate 360 degrees with respect to bar portion  22 . In the tightened position, however, ring holder portion  24  is fixedly connected to bar portion  22 . Collar  32  is spring biased into the tightened position by a plurality of springs  76 . Connection  30  is formed by a pair of mating annular serrated teeth  78 ,  80 . 
     Referring now to FIGS.  11  and  15 - 17 , the ring portion pair  38   a ,  38   b ;  40   a ,  40   b ; and  42   a ,  42   b  that is connected to the ring holder  20 , can be further adjusted by the user by rotating handle  44  to adjust the position of the ring portion pair by moving the first ball joint connection  34  and the second ball joint connection  36  into the position desired by the user. Referring now to  FIGS. 15A and 15B , rotation of rod  44  causes threaded rod  82  to rotate within a bushing  84  that has a mating threaded inner surface  86 . Bushing  84  is fixedly connected to the housing wall  88  of the ring holder  20 . The lower portion of rod  82  has a toggle lever bearing  92  protruding downwardly therefrom. A pair of toggle levers  92 ,  94  each have one end received in a recessed surface  96  of the toggle lever bearing  92 . The other end of toggle levers  92 ,  94  are received in a notch  98  in a disc spring bushing  100 ,  102 . A disc spring  104 ,  106  is disposed on the opposite side of the disc spring bushing  100 ,  102 . A socket  108 ,  110  is disposed between the ball  112 ,  114  and the disc spring  104 ,  106 . A ball washer  116 ,  118  is disposed between the opposite side of ball  112 ,  114  and the housing wall  88 .  FIG. 15A  shows the ball joint connection in the locked position, and  FIG. 15B  shows the ball joint connection in the unlocked position, as evidenced by the space between ball  112  and ball washer  116 , and socket  108 . In the unlocked position the user may adjust the position of each ring portion, and then rotate handle  44  to lock the ring portions in the desired position. In the unlocked position ball  112  is prevented from being removed from housing  88  by ball washer  116 , and socket  108 . Thus, there is a preset load on handle  44  that prevents the ball and sleeve mechanism from being removed from the housing and permitting the ball and sleeve mechanism to be quickly locked in place by rotation of handle  44 . 
     One skilled in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.