Abstract:
A surgical support system including a primary telescoping support; and a secondary telescoping support that is telescopically mounted to the primary support and is configured for telescopically mounting a surgical tool thereto, such that such that telescoping of the secondary support with respect to the primary support repositions the secondary telescoping support. The secondary support is mounted to the primary support telescopably along a first telescoping axis and is configured for mounting the surgical tool telescopably along a second telescoping axis that is oriented at a non-parallel angle to the first telescoping axis. The secondary support includes a first mounting portion; a second mounting portion configured for telescopically mounting the surgical tool; and an articulable joint disposed for adjusting the angle between the first and second telescoping axes. The articulable joint is releasably lockable for locking the angle. The secondary support comprises a flared end for facilitating reception of the surgical tool.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]    The present application is a divisional of U.S. patent application Ser. No. 12/895,850, filed on Sep. 30, 2010, which claims the benefit of priority to U.S. patent application Ser. No. 61/329,537, filed on Apr. 29, 2010, each of which are herein incorporated by reference in their entirety. Further, the present application also hereby incorporates by reference the entire contents of U.S. patent application Ser. No. 11/166,170 and U.S. patent application Ser. No. 11/165,064 and U.S. Pat. Nos. 4,796,846 and 6,315,260. 
     
    
     TECHNICAL FIELD  
       [0002]    The present disclosure relates generally to an adjustable system for supporting surgical tools. 
       BACKGROUND  
       [0003]    Surgical tool support systems are used to securely and stably maintain surgical tools, such as surgical retractors, in a fixed position so that a physician or physician&#39;s assistant does not have to manually hold the tools throughout the duration of the surgical procedure. Some known surgical tool support systems include adjustable components which are removably mounted or other wise attached to a surgical tool support or a horizontal bar, which is positioned over the patient and further connects in a fixed manner to the operating room table. An example of a surgical tool support is described in U.S. Pat. No. 4,143,652, the content of which is hereby incorporated herein by reference thereto. 
         [0004]    Surgical tools that are commonly held by such surgical tool support systems include, for example, retractors for retracting internal organs, and other structures, such as a patient&#39;s ribcage. The Stieber Rib Grip Kit™ sold by Automated Medical Products Corp. is used, for instance, for retracting the ribs during abdominal surgery to retract the upper middle abdomen of a patient. 
         [0005]    U.S. Pat. No. 6,302,843 described a tool holder platform that can be mounted to horizontal bar that is positioned above a patient to hold a hydra, which, with various support arms, supports other tools such as a retractor to retract and maintain organs in the retracted position. 
       SUMMARY  
       [0006]    The present disclosure relates generally to an adjustable system for supporting surgical tools. A surgical support system including a primary telescoping support; and a secondary telescoping support that is telescopically mounted to the primary support, the secondary support being configured for telescopically mounting a surgical tool thereto, such that such that telescoping of the secondary support with respect to the primary support repositions the secondary telescoping support. The secondary support is mounted to the primary support telescopably along a first telescoping axis; and the secondary telescoping support is configured for mounting the surgical tool telescopably along a second telescoping axis that is oriented at a non-parallel angle to the first telescoping axis. The secondary support includes a first mounting portion; a second mounting portion configured for telescopically mounting the surgical tool; and an articulable joint disposed between and associating the first mounting portion and the second mounting portion for adjusting the angle between the first and second telescoping axes. The articulable joint is releasably lockable for locking the angle. The secondary support comprises a flared end for facilitating reception of the surgical tool into the telescopic mounting with the secondary support. 
         [0007]    The system may further include a retractor telescopically mounted to the secondary support. Each of the primary supports comprises an engagement member configured for selectively preventing telescopic extension of the second support and surgical tool, respectively. At least one of the engagement members has a configuration in which it allows telescopic retraction of the secondary support or surgical tool, respectively, while preventing the telescopic extension thereof. The secondary support comprises a rack that includes teeth, and the primary support include the at least one engagement member, which engagement member comprises a ratchet engageable with the teeth to selectively prevent telescopic extension thereof while allowing retraction thereof. Each engagement member has a configuration in which it allows telescopic retraction of the second support and surgical tool, respectively, while preventing the telescopic extension thereof. The secondary support comprises a rack that includes teeth, and the primary support includes a ratchet member engageable with the teeth to selectively prevent telescopic extension thereof while allowing retraction thereof; and the secondary support member comprises a ratchet member configured for engagement with teeth of a rack of the surgical tool to selectively prevent telescopic extension thereof while allowing retraction thereof. 
         [0008]    The system may further include a handle configured for telescopically mounting the surgical tool thereto and including an engagement member for selectively preventing telescopic extension of the surgical tool rack. The secondary support comprises a rack including teeth, and the primary support includes the engagement member, which comprises a pinion for telescopically drawing or extending the rack. The system may further include a base member to which the primary support is mountable and which is configured for securing to a surgical table. The base member comprises a rail clamp that is configured for clamping to a surgical-table rail. The primary support comprises a support rod configured for securing to the rail clamp and positioning the secondary surgical support over the table. 
         [0009]    Further disclosed herein is a method of conducting surgery, including retracting tissue with the retractor of the surgical support system of claim  6 ; and conducting robotic surgery wile the tissue is retracted. 
         [0010]    Further disclosed herein is a retractor, including a substantially straight retractor blade having a length of at least about 20 centimeters and configured for retracting tissue; a supporting portion extending in a first direction for supporting and pulling the retractor blade; and an elbow having a radius of less than about 7 millimeters that connects the mounting portion to the blade at an angle to each other. The blade is substantially flat. The retractor may further include an end portion extending at an angle from the blade and including a surgical instrument mounted to the end portion and configured for performing an operation. The supporting portion comprises a rack for telescopic mounting to a surgical support system. The supporting portion may include a holding portion extending away from an abutting surface of the blade, which is configured for abutting and retracting tissue; and a diagonal portion disposed between the elbow and the blade at an acute angle with respect to the blade to over at least about 20% of the blade length from the elbow. 
         [0011]    Further disclosed herein is a retractor, including a retractor blade having an abutting surface configured for abutting and retracting tissue; a surgical instrument disposed on the blade configured for performing an operation; and an instrument connector extending along the abutting surface to the surgical instruments. It may also include a lip extending at an angle from a tip of the blade, wherein the surgical instruments are mounted on the lip. 
         [0012]    Further described herein is a surgical support, comprising a telescoping support defining a telescopic bore configured for telescopically receiving a surgical tool, the support including a flared inlet guide leading to the telescopic bore for facilitating reception of a surgical tool into telescopic association with the support. 
         [0013]    Further described herein is a retractor holder, including a handle shaft configured for grasping with a hand, the handle shaft defining an internal telescopic bore configured for receiving and guiding a surgical retractor along a telescopic axis; and a ratchet member associated with the handle shaft for racheting engagement with teeth of a mounting portion of the surgical retractor to selectively prevent telescopic extension thereof while allowing telescopic retraction. 
         [0014]    While multiple embodiments are disclosed, still other embodiments of the present disclosure will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments. As will be realized, the invention is capable of modification in various aspects, all without departing from the spirit and scope of the present disclosure. Accordingly, the drawings and detailed descriptions are to be regarded as illustrated in nature, and not restrictive. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES  
         [0015]    While the specification concludes with claims particularly pointing out and distinctly claiming the subject matter that is regarded as forming the various embodiments of the present disclosure, it is believed that the embodiments will be better understood from the following description taken in conjunction with the accompanying Figures, in which: 
           [0016]      FIG. 1  depicts one embodiment of an adjustable surgical support system in accordance with the present disclosure; 
           [0017]      FIG. 2  depicts another embodiment of an adjustable surgical support system in accordance with the present disclosure; 
           [0018]      FIG. 3  depicts an example horizontal support component of the surgical support system shown in  FIG. 1 ; 
           [0019]      FIG. 4  depicts the interior of a horizontal bar guide component thereof; 
           [0020]      FIG. 5  depicts an example surgical retractor support component the surgical support system shown in  FIG. 1 ; 
           [0021]      FIG. 6  depicts an example surgical retractor support component the surgical support system shown in  FIG. 2 ; 
           [0022]      FIG. 7  depicts an example surgical retractor suitable for use with an adjustable surgical support system in accordance with the present disclosure; 
           [0023]      FIG. 8  depicts another of the surgical retractor shown in  FIG. 7 ; and 
           [0024]      FIGS. 9   a - c  are diagrams of the surgical retractor shown in  FIG. 1 . 
           [0025]      FIG. 10  depicts an embodiment of a retractor handle suitable for use with the adjustable surgical support system in accordance with the present disclosure. 
           [0026]      FIG. 11  depicts an axial view of the retractor handle shown in  FIG. 10 . 
           [0027]      FIG. 12  depicts a retractor handle connected to a retractor in a cross-section view. 
           [0028]      FIG. 13  depicts an example retractor having an angled side. 
       
    
    
     DETAILED DESCRIPTION  
       [0029]    While multiple embodiments are disclosed, still other embodiments of the present disclosure will become apparent to those skilled in the art from the following detailed description, which shows and described illustrative embodiments. As will be realized, the invention is capable of modification in various aspects, all without departing from the spirit and scope of the present disclosure. Accordingly, the drawings and detailed descriptions are to be regarded as illustrated in nature, and not restrictive. 
         [0030]    The present disclosure relates generally to an adjustable surgical support system and retractors that can be used therewith or independently. Referring to the one embodiment depicted in  FIG. 1 , an adjustable surgical retractor system  90  is shown mounted on an operating room table  100  having a rail  101 . A mounting member, such as a rail clamp or swinger clamp  102 , is adjustable attached to the operating table rail  101 . Suitable rail clamps  102  are described in U.S. Application Publication No. 2006/0290076, and U.S. Pat. Nos. 4,796,846 and 6,315,260, the contents of which are herein incorporated by reference in their entirety. 
         [0031]    A surgical tool support  110  is depicted adjustably positioned within the clamp  102 . The surgical tool support  110 , depicted in the embodiment of  FIG. 1 , is preferably of an L-shape, with a bend  111  transitioning fixedly at approximately 90° at the upper end of the support. Other suitable surgical tool supports, including adjustable surgical tool supports, are described in U.S. Application Publication 2006/0293568, the contents of which are herein incorporated by reference in their entirety. In a preferred embodiment, the length of the surgical tool support  110  may be 665 mm. In other embodiments, the length may be between 600 and 700 mm, or between 500 and 800 mm. Alternative supports can have other shapes, and can be straight or can include an attachment to a rail or another surgical support member. 
         [0032]    At the top end of the surgical tool support  110  is depicted a first telescoping support component, which can be a horizontal support component  130  placed so as to extend over and across the patient on table  100 . The preferred embodiment of the horizontal support component  130  includes a horizontal bar guide and a horizontal bar  120  to extend over the patient. The horizontal bar  120  includes a plurality of teeth  121 , such as on the upper surface thereof. The horizontal bar  120  is inserted through the horizontal bar guide  131 . The horizontal bar guide  131  includes an opening shaft  137  through which the horizontal bar  120  is received. Opening  137  can be a cylindrical bore or can have another shape, depending on the cross-sectional shape of bar  120 . 
         [0033]    As shown in  FIG. 4 , the interior of the opening  137  of the horizontal support component  130  can have bearings to facilitate sliding of the bar  120 . Ball bearings are shown in elliptical races  136 , although other types of bearings, including bushings can be used, and in one embodiment, a simple metal bore is provided. 
         [0034]    The teeth  121  of the horizontal bar  120  cooperates with an adjustment component  132  of the horizontal bar guide. The adjustment component  132 , in one embodiment, can include a pinion to engage the teeth  121  of the horizontal bar  121  to provide a rack and pinon to move, such as to telescope, the bar  120  for adjusting the position of the horizontal bar  120  horizontally. A manipuable portion  132  of the horizontal support component  130  is disposed and configured to be exterior of the horizontal bar guide  131 , connected with the pinion which extends into the interior of the bar guide  131  to operate the rack and pinion. Alternative embodiments can have other mechanisms to move, position, and/or lock the bar  120  with respect to the support  110 , such as with a pure ratchet or other arrangements. 
         [0035]      FIG. 3  depicts a close-up view of the horizontal support component  130  of the embodiment of  FIG. 1 . The teeth  121  of the horizontal bar  120  are showing greater detail, as is the cylindrical shape of the horizontal bar guide  131 . The ratchet  133  is also visible with the teeth contact and being within the support component  130 , and the finger pad  139   a  being exterior. The adjustment component  132 , the interior portion of which in this embodiment is a pinion for cooperation with the rack (teeth  121 ) of the horizontal bar  120 , is also shown on the horizontal support component  130 . 
         [0036]    Further included on the horizontal support component  130  is a ratchet  139  mechanism. The preferred ratchet includes a pivoting jaw  133  that is spring-loaded or otherwise biased into racheting engagement with the teeth  121  of the horizontal bar  120 . The contact point between the jaw  133  and the teeth  121  may be in the form of a pawl. The teeth  121  and the ratchet jaw  133  cooperate in such a manner that when the ratchet is in contact with the teeth, the horizontal bar  120  can only be moved in one direction, preferably distally with respect to the incision, towards the upright support  110 . Movement in the other direction, proximally with respect to the incision, is prevented by the ratchet when it is engaged. In this manner, tension provided by tissue that is being held by a retractor on the far end of the bar  120  is resisted, but adjustment of the bar in the other direction is quick and easy without disengaging the ratchet. To move the horizontal bar  120  in the distal direction (proximally, away from the rail clamp), the ratchet is lifted by a user out of engagement with the teeth  121 , such as by depressing on a finger pad  139   a  on an opposite side of the ratchet pivot  133   a  from the jaw  133 , thereby allowing the horizontal bar  120  to be moved in either direction. The rack and pinion, or other incremental adjustment mechanism to move the bar  120 , is preferably configured to allow the bar  120  to be moved by directly pulling on the bar distally, towards the rail clamp. In a preferred embodiment the length of the horizontal bar  120  may be 440 mm. In other embodiments, the length of the horizontal bar  120  may be between 400 mm and 480 mm, or between 350 mm and 550 mm. 
         [0037]    At one end of the horizontal bar  120  is a secondary adjustment member  140 . In some embodiments, the secondary adjustment member  140  may include mechanisms similar to the horizontal support component  130 . The secondary adjustment member  140  may include an opening therethrough for accepting an mounting portion  157  of a surgical retractor  150 . The mounting portion  157  of the surgical retractor  150  may have teeth  156  on an outward surface thereof similar to teeth  121 . An adjustment component  141  of the secondary adjustment member  140  may be configured similar to the adjustment component  132  of the horizontal support component  130 . Some embodiments can include, for example, a rack and pinion and/or a ratchet relationship between the adjustment component  141  and the teeth  156 , or any other known adjustable relationship or configuration. The preferred embodiment is shown with a ratchet  142  of the secondary adjustment member  140  may cooperate with the teeth  156  of the mounting portion  157  of the retractor  150  a similar manner as with the ratchet  133  and the horizontal bar  120 . The secondary adjustment member may also be rotatably adjustable in the plane of the horizontal bar about its connection point to the horizontal bar  120 . The degree of rotatable adjustability may be between +/−20°, +/−40°, or +/−70° from vertical. The length of the mounting portion  157  of the retractor  150  may preferably be 150, 170, or 200 mm. In some embodiments, the length may be between 130 and 220 mm, or it may be between 100 and 250 mm. 
         [0038]    In preferred embodiments, an insertion end  143  of the secondary adjustment member is flared so as to easily receive the mounting portion  157  of the retractor  150 . While the axial cross-section of the opening of the secondary adjustment member is preferably shaped to prevent or limit axial rotation of the retractor, the flared end can flare from that shape to another to easily receive the tip of the mounting portion  157 . For instance, in the embodiment shown, the mounting portion  157  cross-section is generally square, as is the cross-section of the mounting portion  157 , and the flared guide end becomes generally rounded or circular with a substantially larger cross section, e.g. about 2 to 10 times as large as the cross section holding the adjustment member from rotations. During surgery, a surgical team will position the retractor within the patient, and then may easily position and adjust the surgical retractor system so that the insertion end  143  of the vertical support component is placed over the mounting portion  157  to receive and secure the retractor  150 . 
         [0039]      FIG. 5  depicts a close-up view of the secondary adjustment member  140  and the mounting portion  157  of the retractor  150 . The flared insertion end  143  of the secondary adjustment member  140  is more clearly visible, the retractor, and the teeth  156  thereof, inserted therethrough. The teeth contacting end of the ratchet  142  (e.g., a pawl) is shown contacting the teeth  156 , thereby allowing the retractor to be adjusted upwardly, but not downwardly. To adjust the retractor  150  downwardly, the depression end of the ratchet  142  would be pressed so as to remove contact between the ratchet and the retractor. 
         [0040]    The surgical retractor  150  may include an mounting portion  157 , as discussed above, which can be welded (at  153 ) or other wise affixed or secured to a retraction portion, such as a retractor blase  151 , which preferably has a flat and straight base. In one embodiment, the angle between the mounting portion  157  and the blade  151 , about bend  152 , is approximately 110°. Other angles are possible, as will be discussed in greater detail below, including 90°, or between about 70° or 80° and 130° or 140°, or a range between 70° and 130°. A lip  155  is positioned on the end of the retraction portion  151  opposite the bend  152 . A lip  155  is preferably provided at the distal tip of the blade  151  that is inserted within the patient and serves to help retract and retain retracted the desired anatomy for surgery. In some embodiments, the lip  155  may be generally heart-shaped, and bent inwardly at an angle (at  154 ) to the retraction portion  151 , or can have other shape. The preferred lip is preferably bent as an angle upwards from the blade base, towards the side of the mounting portion  157 , thereby allowing the horizontal bar  120  to be moved in either direction. Further,  FIG. 7  depicts a close-up of a retractor  150  in accordance with the embodiment of  FIG. 1 . Additionally,  FIG. 8  depicts a close-up view, at a different angle, of a retractor  150  in accordance with the embodiment of  FIG. 1 . 
         [0041]      FIG. 9  depicts a schematic illustration of a retractor  150  in accordance with adjustable retractor system of some embodiments of the present disclosure. In particular, lip  155  may be heart-shaped and width  191  preferably of about 30 mm, or about 25 mm-35 mm, or about 20 mm-40 mm. In other embodiments, it may be between 20 and 50 mm in width or other desired sizes. The distance  192  between weld  153  and bend  152  is preferably about 30 mm in one embodiment. In other embodiments, it may be between 2 and 100 mm, for example, although other distances can be used. Several retractors can be provided in a kit, having lengths of the retraction portion  151  such as 150, 170, or 200 mm. In some embodiments, the length may be between 100 and 250 mm, for example. The angle  198  of bend  154  may preferably be 110°, or it may be between 100° and 120°, or 80° and 140°. Other angles can be selected. The bend  152  may be formed of a very small, sharp radius, e.g. 3, 4, 5, 6, or 7 mm, and the angle  199  thereof may be between about 80° and about 140°, or preferably between about 100° and 120°. The portions of the retractor which connect to and terminate at the bend  152 , the blade  151  and the mounting portion  157 , are substantially straight. The height  193  of the lip  155  may be about 20 mm in a preferred embodiment although other heights, such as between 10 and 30 mm can be used in other embodiments. The thickness of blade  151  and lip  155  (thickness  194 ,  195 , respectively) may be 3 or 4 mm in preferred embodiments, and is typically between about 1 mm and 5 mm in other embodiments. The thickness  194  of the blade  151  can be the same or different than the thickness  195  of the lip  155  or other parts of the retractor. The width  196  of the retraction portion  151  maybe 20 mm in a preferred embodiment. In alternative embodiments it can be between about 10 mm and 30 mm, for example, although other widths can be selected. The width  197  of the lip may be slightly larger than that of the retraction portion at its widest part, for example, preferably 25 mm, or more generally between about 10 mm and 50 mm. 
         [0042]    Depicted in  FIG. 2  is another example embodiment of an adjustable surgical retractor. In this embodiment, the horizontal bar  120  is configured with notches  122  as opposed to the teeth  121  depicted in  FIG. 1 . These notches  122  cooperative with an adjustment handle  135  of the horizontal support component  130 , so as rotation of the handle causes horizontal movements of the horizontal bar  120  in either direction, depending on which direction the handle  135  is rotated. An internal component of the handle  135  contacts the notches  122  and causes them to be pushed horizontally in either direction when the exterior portion of the handle  135  is rotated. This embodiment provides an alternative rack and pinion arrangement, in which the pinion has over-center positions within the rack so that not ratchet is needed to resist or prevent movement of the rack in either direction without rotating the handle. Further, it is noted that in this depicted embodiment, the bend  152  of the retractor  150  is approximately 90°, as opposed to the approximately 110° of  FIG. 1 . 
         [0043]      FIG. 6  depicts a close-up view of a retractor  150  in accordance with the embodiment of  FIG. 2 . On the upper surface of the retraction portion  151  of the retractor  150  are three wires, tubes, or other connections  161  associated with three surgical instruments or sensors, such as suction, a light or other fiber optics, and a sensor such as to interact with a cell of the thyroid or another cell to detect cancer or another condition. The instruments and/or sensors and/or their connections  161  may be inserted through holes  160  of the lip  155  of the retractor  150  or another part of the blade. The cables are connected to instrument bases  170 , at another location within the surgical environment. 
         [0044]    Referring now generally to  FIGS. 10-13 , a retractor handle  200  suitable for use with the presently disclosed surgical retractor system is depicted. The handle  200  may generally include an axial portion  201  being formed of a generally cylindrically-shaped piece of stainless steel, having irregular diameter across its length so as to conform to the grip of a human hand. On both the proximal and distal ends of the axial portion are located material extensions  202 ,  203 . Lateral extensions  202 ,  203  extend laterally from the axial portion. Extensions  202 ,  2003  are spaced apart from one another between about 3 inches-6 inches, or preferably 4 inches-5 inches, to conform to the width of a human hand while the hand is gripping the axial portion  201 . Extensions  202 ,  203  may generally extend between about 0.5 inches-3 inches, or more preferably between about 1 inch-2 inches. A distal extension  204  extends distally from the distal end of the axial portion  201  and generally forms a hollow square of proportions to meet with the mounting portion  157  of a surgical retractor  150 . The distal extension  204  generally extends from the axial portion  201  between about 1 inch-4 inches, or preferably between about 1.5 inches-3 inches. 
         [0045]    Mounted on an outward surface  205  of the distal extension is a ratchet  206 . The ratchet  206  is configured and operates in a manner similar to ratchet  142  of the secondary adjustment member, as described above, having a biasing spring  206   c  and a pivot point  206   d . The ratchet  206 , via a teeth contacting end  206   a  thereof (which may be in the form of a pawl, as discussed above), cooperates with the teeth  156  of the mounting portion  157  of a retractor  150  through an opening  209  on the outward surface  205  of the distal extension  204  (see  FIGS. 12 and 13 ), such that, when the mounting portion is inserted into an open end  207  of the distal extension  204 , the retractor  150  by its mounting portion  157  is locked in cooperative association with the handle  200 . To release the retractor  150  from the handle  200 , a finger pad  206   b  of the retractor  206  is depressed, thereby releasing contact between the contacting end  206  and the teeth  156 , allow the mounting portion  157  to slide-out from within the distal extension  204 . 
         [0046]    In use, a surgeon or other operator may generally insert the mounting portion  157  of the retractor  150  within the distal extension  204  of the handle  200  to cooperatively lock the two components together. (See  FIGS. 12 and 13 ). The surgeon then grips the axial portion  201  of the handle  200  and manipulates the retractor  150  into position within the patient, i.e. retracting a particular anatomy. Once in the desire position, the handle  200  is released from the retractor by depressing the finger pad  206   b , releasing the cooperative association between the mounting portion  157  (and the teeth  156  thereof) and the contacting end  206   a  of the ratchet  206 , allowing the mounting end  157  to slide-out of the distal extension  204  of the handle  200 . 
         [0047]      FIG. 11  depicts an axial view of the handle  200 , looking into the open end  207  of the distal extension  204 . The spring  206   c  is positioned on the underside of the ratchet  206  and is configured to bias the ratchet about its pivot point  206   d  in a position to contact teeth  156  when the mounting portion  157  is present. 
         [0048]      FIG. 12  depicts a cross-section view of a handle  200 . As shown, the inside channel  209  through which the mounting portion of a retractor  150  may be inserted extends substantially the entire length of the axial portion  201 . In this embodiment, the handle  200  further includes a flare  143  at distal extension  204 . The flare  143  allows easier insertion of the mounting portion of the retractor  150  into the handle  200 . As also shown in  FIG. 12 , the pawl of the ratchet  206  is contacting teeth of the mounting portion, thereby securely holding it in place at the desired length. 
         [0049]      FIG. 14  shows an additional embodiment of a retractor  250  connected to a handle  200 . The retractor  250  had a configuration especially suited for use with robotically-performed surgery, wherein the retractor  250  is configured to avoid contact with robotic arms during such surgery. The retractor  250  includes a connection portion  251 , which may be, for example, welded to, and extending from a mounting portion (as described above, e.g., mounting portion  157 ). A first bend  252  is angled below the connection portion at a generally obtuse angle, for example, about 170, 160, 150, 140, 130, 120, 110, or 100 degrees from the mounting portion. The first bend  252  is positioned between the connection portion  251  and a side  253 , which extend from the bend  252  is positioned between the connection portion  251  and a side  253 , which extend from the bend  252  at the desired angle. Side  253  is connected to blade  151  with a second bend  254 . The second bend  254  may generally form an acute angle, for example, about 20, 30, 40, 50, 60, 70, or 80 degrees. As described above, in a preferred embodiment, blade  151  may have a heart-shaped lip  155 . Alternatively, lip  155  may be a generally rounded shape. The first and second bends  252 ,  254  allow the side  253  to remain clear of a robotic arm during surgery, while still allowing the blade  151  to be properly positioned. The retractors described in the present disclosure are sufficiently strong to retract a shoulder for providing space for surgical entry through the axilla. 
         [0050]    The surgical support, retractors, and handle of the present disclosure may be used in performing various surgeries, including thyroid surgery wherein the thyroid is accessed through the axilla, as well as vaginal and rectal surgeries, and as examples other surgical procedures in which a surgical tool is supported or for example a deep incision or body opening is to be retracted. In one embodiment, a surgeon or surgical technician may position the retractor  150  in the desired location and orientation, sometimes cutting against the bottom side of the retractor blade  151  as the blade  151  is inserted into the incision. The height and angle at which the upright surgical tool support  110  is connected to the rail  101  of the operating table  100  is then adjusted, including by positioning and manipulating the swinger clamp  102  and tightening it onto the rail  101  and upright support  110 . Then, the horizontal bar  120  is adjusted horizontally within the horizontal support component  130  and over the patient, in the manner described above rotating the manipuable adjustment component  132 , or by simply pulling on the bar  120 , which may or may not require depressing the ratchet  133  (depending on which direction the bar is moved, as discussed above). The flared insertion end  143  of the vertical support component may then be guided over the adjustment portion  157  of the retractor  150 , an secured in position at the appropriate point along the adjustment portion  157 . If the retractor needs to be repositioned once guided within the vertical support component  140 , the adjustment portion  141  and/or the ratchet  142  may be manipulated as necessary, in the same manner as the like components of the horizontal support component  130 . 
         [0051]    In a preferred embodiment of a surgical procedure using the inventive system, thyroid surgery is conducted, in which access to the thyroid is gained through the axilla. This procedure can be performed robotically or manually by a surgeon. The retractor used and the support can be configured to keep the surgical tool support as free from the tissue about the incision, such as an axillic incision, as possible to allow for other surgical equipment, which in some cases may be robotically operated, to more easily access the incision and thyroid or other tissue that needs to be accessed. As shown in  FIG. 1 , th horizontal bar  120  and surgical retractor is cantilevered from the surgical tool support  110  so that the surgical retractor is entirely supported from the opposite side of the surgical table  100  from the surgical retractor  150 . Preferably, the surgical support system is easily adjustable to adapt it&#39;s position to a retractor that has already been positioned in an incision in a patient. 
         [0052]    The term “substantially,” as used herein to refer to a shape, e.g., substantially semi-cylindrical or semi-circular cross-section, is intended to include variations from the true shape that do not affect the overall function of the device. 
         [0053]    The term “about,” as used herein, should generally be understood to refer to both numbers in a range of numerals. Moreover, all numerical ranges herein should be understood to include each whole integer within the range. 
         [0054]    While illustrative embodiments of the invention are disclosed herein, it will be appreciated that numerous modifications and other embodiments can be devised by those of ordinary skill in th art. Features of the embodiments described herein can be combined, separated, interchanged, and/or rearranged to generate other embodiments. Therefore, it will be understood that the appended claims are intended to cover all such modifications and embodiments that come within the spirit and scope of the present invention.