Abstract:
An apparatus for holding a surgical instrument relative to a base is provided having a mounting portion configured and dimensioned to engage a portion of a base, a jaw assembly including first and second jaw members which define a retaining area therebetween configured and dimensioned to retain the shaft of a surgical instrument therein and thereby fix the length of the instrument shaft relative to the base and an operative site, and an instrument position adjustment mechanism which includes an adjustment member rotatably disposed in relative to the mounting portion to facilitate selective position adjustment of the jaw assembly with respect to the mounting portion.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
   This application is a continuation of U.S. application Ser. No. 09/779,021 filed on Feb. 7, 2001 now U.S. Pat. No. 6,610,009 which is a continuation of U.S. application Ser. No. 09/235,593 filed on Jan. 22, 1999 now U.S. Pat. No. 6,200,263 which claims priority to U.S. Provisional Application Ser. No. 60/072,406 filed on Jan. 23, 1998, the contents of which are hereby incorporated by reference in their entirety. 

   BACKGROUND 
   1. Technical Field 
   The subject disclosure relates to minimally invasive surgical procedures and apparatus, and more particularly to apparatus for holding surgical instrumentation during surgery associated with the thoracic cavity. 
   2. Background of Related Art 
   It is well established that the performance of various types of surgical procedures using less invasive techniques and instrumentation has provided numerous physical benefits to the patient while reducing the overall cost of such procedures. One area, for example, which has experienced a great increase in the performance of less invasive procedures is in the area of heart surgery. In particular, coronary artery bypass graft (CABG) procedures have been performed using less invasive techniques with much success. 
   Access to the patient&#39;s thoracic cavity for such procedures in the past was typically achieved by a large longitudinal incision in the chest. This procedure, referred to as a median sternotomy, requires a saw or other cutting instrument to cut the sternum and allow two opposing halves of the rib cages to be spread apart. U.S. Pat. No. 5,025,779 to Bugge discloses a retractor which is designed to grip opposite sternum halves and spread the thoracic cavity apart. The large opening which is created by this technique enables the surgeon to directly visualize the surgical site and perform procedures on the affected organs. However, such procedures that involve large incisions and substantial displacement of the rib cage are often traumatic to the patient with significant attendant risks. The recovery period may be extended and is often painful. Furthermore, patients for whom coronary surgery is indicated may need to forego such surgery due to the risks involved with gaining access to the heart. 
   U.S. Pat. No. 5,503,617 to Jako discloses a retractor configured to be held by the surgeon for use in vascular or cardiac surgery to retract and hold ribs apart to allow access to the heart or a lung through an operating window. The retractor includes a rigid frame and a translation frame slidably connected to the rigid frame. Lower and upper blades are rotatably mounted to the rigid frame and the translation frame respectively. Such a “window” approach requires instrumentation that can be inserted into and manipulated within the limited space available in and around the surgical site. 
   Therefore, a continuing need exists for more versatile and varied surgical instrumentation which facilitates performing surgical procedures in limited access cavities of a patient during less invasive surgical procedures. A need also exists for instrument holding apparatus to retain surgical instruments in place during surgical procedures and free the surgeons hands. 
   SUMMARY 
   The present disclosure addresses the above-noted needs while providing various embodiments of an apparatus for holding surgical instruments that have many unique features and advantages over the prior instrumentation. The presently disclosed apparatus for holding surgical instruments provides greater versatility during surgical procedures which are less invasive than traditional procedures. 
   For example, in one embodiment, the present disclosure provides an apparatus for holding a surgical instrument relative to a base, which includes a mounting portion configured and dimensioned to engage a portion of a base, a jaw assembly including first and second jaw members which define a retaining area therebetween configured and dimensioned to retain the shaft of a surgical instrument therein and thereby fix the length of the instrument shaft relative to the base and an operative site, and an instrument position adjustment mechanism which includes an adjustment member rotatably disposed in relative to the mounting portion to facilitate selective position adjustment of the jaw assembly with respect to the mounting portion. 
   The instrument position adjustment mechanism may include a lock member such that when positioned in a locked position, the adjustment member is prevented from moving relative to the mounting portion and when the lock member is positioned in an unlocked position, the adjustment member is permitted to move relative to the mounting portion. The jaw assembly preferably includes a jaw approximation control member which controls movement of one of the first and second jaw members relative to the other of the first and second jaw members. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     Various preferred embodiments are described herein with reference to the drawings, wherein: 
       FIG. 1  is a perspective view of a surgical retraction system incorporating a variety of retractors, a heart manipulator and a heart stabilizer, all positioned on a base; 
       FIG. 2  is a perspective view of the instrument holder of the present disclosure showing an instrument shaft retained in the horizontal position and the jaws in the open position; 
       FIG. 3  is a side view of the instrument holder in the position of  FIG. 2 ; 
       FIG. 4  is a perspective view of a first section of a base mounting assembly of the present disclosure; 
       FIG. 5  is a perspective view of a second section of the base mounting assembly; 
       FIG. 6  illustrates the ball for enabling maneuverability of the jaw assembly; 
       FIG. 7  illustrates a side view of the shaft which is connected at one end to the ball and at the opposite end to the jaw assembly; 
       FIG. 8  is a side view of the locking screw which retains the ball in a fixed position; 
       FIG. 9  illustrates the handle which attaches to the locking screw for rotating the screw; 
       FIG. 10  is a side view showing the handle attached to the locking screw to form a ball locking assembly; 
       FIG. 11  is a perspective view illustrating the instrument holder with the jaws in the closed position and maneuvered to hold the instrument shaft at an angle; 
       FIG. 12  is a side view illustrating the instrument holder maneuvered to position the instrument shaft perpendicular to the base of the retraction system; 
       FIGS. 13A and 13B  are perspective and side views, respectively, of the stationary jaw for holding the instrument shaft; 
       FIG. 14  is a perspective view of the movable jaw; 
       FIG. 15  is a perspective view of an alternative embodiment of an instrument holder constructed in accordance with the present disclosure; and 
       FIG. 16  is a side view of the instrument holder embodiment of  FIG. 15 . 
   

   DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
   The instrument mounting holder of the present disclosure is designed to mount various accessory instruments to the ring base disclosed in U.S. patent application Ser. No. 08/718,283, filed Sep. 20, 1996, the entire contents of which are incorporated herein by reference.  FIG. 1  is a drawing from the &#39;283 patent application and shows a base  50 , retractors  60 ,  70  and  80 , a heart stabilizer  90  and a heart manipulator  100 . A detailed description of these instruments, how they are mounted to the base  50 , and their surgical function is disclosed in the &#39;283 application. 
   The present disclosure is directed to an instrument holding apparatus, which is removably positionable on base  50 , and can mount a variety of instruments such as an illumination instrument, a grasper, a retractor, a heart stabilizer or any other instrument that would be useful in performing the surgical procedure. Only the shaft of the accessory instrument is shown in the drawings and is represented generically by reference letter “S”. 
   Referring to  FIGS. 1–5 , instrument holder  1  includes a mounting portion, such as a base mounting assembly  10  composed of a first section  12  and a second section  14 , an instrument position adjustment mechanism  30 , and a jaw assembly  51  for supporting the instrument shaft S. As best shown in  FIG. 4 , first section  12  includes a neck  19  having a socket  15  formed therein for receiving a ball  32 , described below. A lip  18  is formed to hook around a front edge  45 ,  FIG. 1 , of base  50 . An extension  16  extends through a groove  22  formed in second section  14 , shown in  FIG. 5 . A lip  20  of second section  14  is configured to mount to an outer edge  46  of base  50 . A biasing spring, not shown, is attached at one end to first section  12  and at the opposite end to second section  14  to help retain the sections  12  and  14  together while allowing first section  12  and second section  14  to be pulled slightly away from each other, against the force of the spring, to facilitate mounting to and release from base  50 . 
   Referring to  FIGS. 6–12 , position adjustment mechanism  30  includes a ball  32 ,  FIG. 6 , a ball shaft  34 ,  FIG. 7 , a lock member such as a locking screw  36 ,  FIGS. 8 and 10 , and a locking screw handle  38 ,  FIGS. 9 and 10 . Ball  32  is attached to end  35  of ball shaft  34 . Alternatively, ball  32  and shaft  34  could be integral. End  37  of ball shaft  35  is attached to jaw assembly  51 . Ball  32  is maneuverable by rotational and pivotal movement trough a multitude of positions within neck  19  in order to maneuver the jaws to position the shaft S (and associated instrument) in a variety of orientations. Such maneuverability is shown for example by comparing  FIGS. 3 ,  11  and  12 . Once the jaw assembly  51  is maneuvered to the desired position, handle  38 , which is attached to locking screw  36  via arm  39  extending through aperture  41 , is rotated to advance locking screw  36  so that abutment end  33  tightly presses against ball  32 . This locks ball  32  in position and prevents movement thereof. 
   Referring to  FIGS. 13A ,  13 B and  14 , jaw assembly  51  includes a movable jaw  64  having an internally threaded opening  71  to receive mounting screw  58  of a stationary jaw  52 . Arm  66  of movable jaw  64  is mounted within a groove  56  formed on stationary jaw  52 . Ball shaft  34  is adhesively mounted within a recess (not shown) of stationary jaw  52 , although other means of connection are also contemplated. A jaw approximation control member, such as locking knob  72 , as best shown in  FIGS. 3 and 10 , is attached to a mounting screw  58  such that rotation of locking knob  72  rotates threaded mounting screw  58  to advance movable jaw  64  towards a stationary jaw  52 . Spring  59  biases movable jaw  64  to the open position, away from stationary jaw  52 . Approximation of jaws  52  and  64  grasps and retains instrument shaft S therebetween. Referring back to  FIG. 2 , in conjunction with  FIGS. 13A ,  13 B and  14 , a pair of friction enhancing members such as rubber pads  54  and  69  are mounted within grooves  61  and  68  formed on stationary jaw  52  and movable jaw  64 , respectively, to facilitate atraumatic grasping of instrument shaft S. 
   In use, instrument shaft S is placed between movable jaw  64  and stationary jaw  52  with the jaws in the open position as shown in  FIG. 2 . Knob  72  is rotated to close the jaws  64 ,  52  to clamp and securely hold instrument shaft S. Jaw assembly  51  is manually movable to position the instrument shaft S at the desired angle relative to base  50  as ball  32  pivots within socket  15  of neck  19 . Once pivoted to a desired position, for example, the position shown in  FIG. 11  or  FIG. 12  (other positions are clearly contemplated), locking screw handle  38  is rotated to advance locking screw  36  against ball  32  to lock ball  32  in place. This prevents further movement of the jaw assembly  51 . 
   Referring to  FIGS. 15 and 16 , an alternative embodiment of the presently disclosed apparatus for holding instruments is designated as instrument holder  100 . Instrument holder  100  is similar to instrument holder  1 . Therefore, the following description will only focus on those aspects of instrument holder  100  which differ from instrument holder  1 . In contrast to base mounting assembly  10  of instrument holder  1 , instrument holder  100  includes a mounting portion, such as a base mounting assembly  110  which is in the form of a clip having first and second lips  118 ,  120  which extend from a bottom surface of mounting assembly  110 . Mounting assembly  110  is preferably fabricated from flexible material and includes a cantilevered extended portion  111  which deflects upon the application of a generally vertically directed force. Thus, in order to mount instrument holder  110  to base  50 , lip  118  is fitted over the inner rim of base  50  and instrument holder  100  is moved into closer approximation with base  50  so that lip  120  cams outwardly and flexes extended portion  111  upwardly until lip  120  passes over the outer edge of base  50  and snaps back to its normal configuration as shown in  FIG. 16 . Once positioned on base  50 , instrument holder  100  functions in the same way as instrument holder  1  described above to retain surgical instruments therein. 
   Another difference between instrument holder  100  and instrument holder  1  is the configuration of the locking knob. In particular, screw handle  38  of instrument holder  1  is in the form of a rotatable lever whereas screw handle  138  of instrument holder is in the form of a wing having extended portions  138   a  and  138   b  extending radially outwardly from the center along a plane. 
   It will be understood that various modifications may be made to the embodiments of the apparatus for holding surgical instruments shown and described herein. Therefore, the above description should not be construed as limiting, but merely as examples of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure.