Abstract:
An apparatus for holding a surgical retractor comprises a support handle and a surgical retractor holding element pivotally attached to the support handle. A rod engages the retractor holder element at a position spaced from the pivotal attachment to the support handle with the rod being movable thereby pivoting the holding element to move the position of the retractor blade of the surgical retractor.

Description:
CROSS REFERENCE TO RELATED APPLICATION(S)  
       [0001]     This application claims priority of U.S. Provisional Application Ser. No. 60/512,320 filed on Oct. 17, 2003 entitled ARTICULATED RETRACTOR BLADE HOLDER.  
         [0002]     This application claims priority of U.S. Provisional Application Ser. No.  60 / 535 , 915  filed on Jan. 12, 2004 entitled ARTICULATED RETRACTOR BLADE HOLDER. 
     
    
     BACKGROUND OF THE INVENTION  
       [0003]     The present invention relates to a surgical retractor. More particularly, the present invention relates to an articulated holder for a surgical blade.  
         [0004]     Surgical retractors are used to retract flesh from an incision at a surgical site. Surgical retractors typically have a blade that is fixedly attached to a handle where the blade is inserted into surgical incision. Manual force is typically applied to the retractor handle to retract flesh to expose the surgical site. With the surgical site exposed, the retractor is retained in a retracting position by clamping the handle to a retractor support apparatus positioned about the surgical site with a clamp.  
         [0005]     However, to reposition the surgical retractor laterally, transversely and, in some instances, vertically within the surgical site, the surgical clamp must first be positioned into a non-clamping position. With the clamp in the non-clamping position, the lateral, transverse and vertical position of the surgical retractor is repositioned into a new selected position.  
         [0006]     The surgical retractor is then secured in the new selected position by positioning the clamp in the clamping position. However, having to position the surgical clamp into the non-clamping position to make even minor adjustments to the position of the surgical retractor may add unnecessary time to the surgical procedure and inconvenience to the surgical personnel.  
       SUMMARY OF THE INVENTION  
       [0007]     The present invention includes an apparatus for holding a surgical retractor, the surgical retractor having a retractor blade. The apparatus comprises a support handle having a longitudinal axis and a surgical retractor-holding element pivotally attached to the support handle. A rod engages the retractor-holding element at a position spaced from the pivotal attachment to the support handle, the rod being movable thereby pivoting the holding element to move position of the tractor blade.  
         [0008]     In another aspect of the present invention, the apparatus for holding a surgical retractor permits pivotal movement of the retractor blade and rotational movement of the retractor blade. The retractor blade may also be moved longitudinally along an axis of its handle.  
         [0009]     Yet in a further aspect of the present invention, the apparatus for holding the surgical retractor includes a clamp that permits movement of a retractor blade in three-dimensions, that is, in a horizontal x and y direction, and a vertical direction. The clamp is constructed such that a retractor blade of a surgical retractor may be repositioned exactly in the same position that it was previously. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0010]      FIG. 1  is a perspective view of an articulated retractor blade holder of the present invention proximate a surgical site.  
         [0011]      FIG. 2  is a perspective view of the articulated retractor blade holder of the present invention.  
         [0012]      FIG. 3  is an exploded view of the articulated retractor blade holder of the present invention.  
         [0013]      FIG. 4  is a sectional view of the articulated retractor blade holder of the present invention.  
         [0014]      FIG. 5  is a perspective view of an alternative embodiment of an articulated retractor blade holder of the present invention retained within a clamp.  
         [0015]      FIG. 6  is a perspective view of the alternative embodiment of an articulated retractor blade holder of the present invention.  
         [0016]      FIG. 7  is a sectional view of an articulated retractor blade holder of the present invention. 
     
    
     DETAILED DESCRIPTION  
       [0017]     An articulated retractor blade holder of the present invention is generally illustrated at  10  in  FIG. 1 . The articulated retractor blade holder  10  is rotatably attached to a clamp  16  that is positioned in a selected position on a retractor support apparatus  14  that is positioned about a surgical site  12 .  
         [0018]     Referring to  FIGS. 1 and 4 , a retractor blade  18  is removably attached to a blade engaging member  20  of the articulated blade holder  10 . The retractor blade  18  is attached to the blade engaging member  20  by positioning a cylindrical shaft  26  attached to the retractor blade  18  within a through bore  22  proximate a distal end  24  of the blade engaging member  20 . The retractor blade  18  is rotatably retained to the blade engaging member with a spring-loaded spherical member  30  extending into the through bore  22  that engages an annular groove  28  within the cylindrical shaft  26 .  
         [0019]     The retractor blade  18  is removed from the blade engaging member  20  by applying manual force to the retractor blade  18  that overcomes the bias on the spring-loaded spherical member  30  and forces the spherical member  30  from the through bore  22 . With the spring-loaded spherical member  30  forced from the through bore  22 , the shaft  26  is removed from the blade engaging member  20  with manual force.  
         [0020]     With the selected retractor blade  18  rotatably secured to the blade engaging member  20 , the retractor blade  18  is positioned proximate the surgical site  12  by positioning the clamp  16  in the selected position on the retractor support apparatus  14  as illustrated in  FIG. 1  the blade holder  10  be slid in the general direction of arrow  15  until clamped into position. With the clamp  16  positioned on the retractor support apparatus  14  and in the non-clamping position, the retractor blade  18  is positionable laterally, transversely and vertically within an incision  13  without having to reposition the clamp  16  on the retractor support apparatus  14 .  
         [0021]     What is meant by lateral is a direction generally along a length of the incision. What is meant by transverse is a direction generally towards or away from the incision. What is meant by vertical is a direction in which the depth of the retractor blade is adjusted within the incision.  
         [0022]     Referring to  FIGS. 2-4 , the retractor blade  18  is vertically positioned within the surgical site  12  by pivotally moving the blade engaging member  20  as indicated by arrow  27  about a pivot pin  32  that pivotally attaches the blade engaging member  20  to a handle  34 . A push rod  36  is positioned through a cavity  35  within the handle  34 , and a slot  25  extending from an outer surface and intersecting a channel  21  in the blade engaging member  20 , where the slot  25  is generally aligned with the cavity  35 . The push rod  36  has a proximal engaging end  38  that is positioned within the channel  21  that is also generally aligned with the cavity  35 .  
         [0023]     As the push rod  36  moves transversely with respect to the incision  13 , the engaging end  38  exerts a force upon a surface  23  defining the channel  21  and causes the blade engaging member  20  to pivot about the pivot pin  32  as indicated by arrow  27 . The pivotal attachment of the blade engaging member  20  to the handle  34  and the movement of the engaging end  38  within the channel  21  creates an articulated joint  33  that moves the retractor blade  18  into a selected vertical position.  
         [0024]     The channel  21  is preferably located in a substantially orthogonal relationship to the pivotal attachment of the blade engaging member  20  to the handle  34 . Other positional relationships of the channel  21  and the pivotal attachment are also within the scope of the present invention.  
         [0025]     A distal portion  37  of the push rod  36  is non-rotatably attached to a knob  42  that threadably engages a threaded distal end  40  of the handle  34 . The push rod  36  is non-rotatably secured to the knob  42  with a frictional engagement of a shoulder  49  engaging an inner surface  43  of a plate  41  that constricts a through bore in the knob  42 . The push rod  36  is frictionally secured to the knob  42  by compressing a compression spring  62  positioned about the push rod  36  into an outer surface  45  of the plate  41  which forces the shoulder  49  into the inner surface  43  of the plate  41 . A threaded nut  66  threadably engages a threaded end  47  of the push rod  36  to force the compression spring  62  to compress and create the frictional engagement that non-rotatably secures to the push rod  36  to the knob  42 .  
         [0026]     As the knob  42  is rotated as indicated by arrow  56 , the threaded engagement of the knob  42  with the handle  34  causes the knob  42  to transversely move. As the knob  42  rotates and transversely moves, the push rod  36  also rotates and transversely moves such that the engaging end  38  applies a force to the blade engaging member  20 . The force causes the engaging end  38  to move and rotate within the channel  21  and the blade engaging member  20  to pivot about the pivot pin  32 .  
         [0027]     The engaging end  38  preferably has a generally spherical configuration that engages the arcuate cylindrical surface  23  defining the channel  21 . The spherical engaging member  38  is captivated within the channel  21  because a width of the slot  25  is less than a diameter of the spherical engaging end  38 . However, other configurations of the engaging end  38  and the channel  21  are within the scope of the present invention provided the engaging end  38  moves within the channel  21  and is aligned with the cavity  35 .  
         [0028]     To raise the retractor blade  18 , the knob  42  is rotated to threadably move the knob  42  transversely away from the blade engaging member  20 . As the knob  42  moves away from the blade engaging member  20 , the engaging end  38  contacts the surface  23  defining the channel  21  proximate the slot  25  and exerts a force upon the blade engaging member  20 . The force urges the blade engaging member  20  to pivot upward about the pivot pin  32  and thereby raise the retractor blade  18 .  
         [0029]     To lower the retractor blade  18 , the knob  42  is rotated to threadably move the knob  42  transversely towards the blade engaging member  20 . As the knob  42  moves toward the blade engaging member  20 , the engaging end  38  contacts the surface  23  defining the channel  21  generally opposite the slot  25  and exerts a force upon the blade engaging member  20 . The force urges the blade engaging member  20  to pivot downward about the pivot pin  32 , and thereby lower the retractor blade  18 .  
         [0030]     The engagement of the rotating generally spherical engaging end  38  with the generally cylindrical surface  23  allows the push rod  36  to be rapidly moved without the risk of binding the engaging end  38  within the channel  21 . The engagement of the spherical surface of the engaging end  38  with the generally arcuate cylindrical surfaces  23  defining the channel  21  is non-binding whether the retractor blade  18  is in a raised or lowered position. Therefore, the articulated joint  35  of the present invention provides for a faster, non-binding vertical adjustment of the retractor blade within the surgical site than other articulated joints.  
         [0031]     The retractor blade  18  is transversely moved as indicated by arrow  55  within the surgical site  12  with a rack and pinion mechanism  57 . Other mechanisms for transversely moving the retractor blade  18  are also within the scope of the present invention.  
         [0032]     The rack and pinion mechanism  57  includes a rack  46  on the handle  34  that is positioned within a through bore  54  of a gearbox  52 . A gear  48  is positioned within a gearbox  52  such that pinions  50  of the gear  48  engage the rack  46  on the handle  34 .  
         [0033]     As the gear  48  rotates, the pinions  50  engage the rack  46  causing the handle  34  to transversely move with respect to the gear box  52 . As the handle  34  moves transversely, the retractor blade  18  is also transversely moved within the surgical site  12  and into a selected transverse position.  
         [0034]     The retractor blade  18  is retained in the selected transverse position with a pawl  58  having an engaging end  60  that is biased into engagement with the rack  46  with a compression spring  62 . The pawl  58  is pivotally attached to the gearbox  52  with a pin  61 . With the engaging end  60  of the pawl  58  engaging the rack  46 , the handle  34  is retained in the selected transverse position and is prevented from accidentally sliding toward the surgical site  12  due a force applied to the retractor blade  18  by the retracted flesh.  
         [0035]     The retractor blade  18  is laterally positioned as indicated by arrow  51  within the surgical site  12  by rotating the retractor blade holder  10  about a base  64  of the gearbox  52  that is rotatably captivated to an upper leg  80  of the clamp  16 . As the retractor blade holder  10  in the general direction of arrow  53  is rotated about the base  64 , the retractor blade  18  moves in an arcuate path thereby adjusting both the lateral and transverse position of the retractor blade  18  within the surgical site  12 .  
         [0036]     The base  64  is captivated to the upper leg  80  of the clamp  16  by positioning a cylindrical peg  68  through a through bore  82  of the upper leg  80  and positioning the cylindrical peg  66  within a recess  65  in the base  64 . With the cylindrical peg  66  positioned within the recess  65  in the base  64 , a pin  76  is inserted through aligned bores  78 ,  79  in the peg  66  and the base  64 , respectively, to fixedly attach the peg  66  to the base  64  and captivate the base  64  to the upper leg  80 .  
         [0037]     In operation, the clamp  16  is placed in a non-clamping position by rotating an actuating mechanism  90  into a first non-clamping position. With the actuating mechanism  90  in the general direction of arrow  91  in the first non-clamping position, the clamp  16  can accept the retractor support arm  14  and the retractor blade holder  10  is rotatable with respect to the clamp  16 .  
         [0038]     The clamp  16  is positioned in a selected position on the retractor support arm  14  by positioning a clamping socket  94  about the retractor support arm  14 . A restricted entrance  96  to the clamping socket  94  retains the clamp  16  on the retractor support arm  14  while the clamp  16  is slidably positionable on the retractor support arm  14 .  
         [0039]     With the clamp  16  positioned in a selected position on the retractor support arm  14 , the retractor blade holder  10  is rotatably positioned within the surgical site  12  with manual force. Rotating the retractor blade holder  10  adjusts both the lateral position and also the transverse position of the retractor blade  18  within the surgical site  12 . With the retractor blade  18  in the selected lateral position within the surgical site, the actuating mechanism  90  is rotated about a shaft  94  and into a second clamping position.  
         [0040]     Referring to  FIGS. 2 and 3 , with the actuating mechanism  90  in the second position, the actuating mechanism  90  transfers a force to the lower leg  81  and also forces a shoulder  95  of the shaft  94  into the peg  66  which frictionally secures the peg  66  to the upper leg  80  of the clamp  16 . The frictional engagement secures the peg  66  and the articulated retractor blade holder  10  in a selected lateral position with respect to the clamp  16 .  
         [0041]     Further, with the actuating mechanism  90  in the second position, the upper and lower legs  80 ,  81  are forced apart which causes a fulcrum portion  98  to flex. As the fulcrum portion  98  flexes, the clamping socket  94  constricts such that the clamp  16  frictionally engages the retractor support arm  14  and is retained in the selected position.  
         [0042]     With the clamp  16  secured in the selected position on the retractor support arm  14  and the lateral position of the retractor blade  18  fixed within the surgical site  12 , the transverse position of the retractor blade is adjusted by manipulating the gear  48  which engages the pinions  50  with the rack  46  on the handle  34 . The rack and pinion mechanism  57  allows the retractor blade  18  to be moved in a transverse direction away from the surgical site  12  while the engaging end  60  of the pawl  58  engages the rack  46  to prevent movement in the opposite direction. To move the retractor blade  18  transversely towards the surgical site  12 , manual force is applied to the pawl  58  to overcome the bias of the compression spring  62  to displace the engaging end  60  from the rack  46 . With the engaging end  60  displaced from the rack  46 , the gear  48  is rotated in an opposite direction such that the pinions  50  engage the rack  46  to move the retractor blade  18  toward the surgical site  12 .  
         [0043]     The vertical position of the retractor blade  18  is adjusted within the surgical site  12  by rotating the knob  42  attached to the push rod  36 . The knob  42  threadably engages the threaded end  44  of the handle  34  and transversely moves the push rod  36 , non-rotatably attached to the knob  42 , with respect to the handle  34 . As the push rod  36  is moved, the engaging end  38  of the push rod  36 , which is positioned within the channel  21  of the blade engaging member  20 , applies a force to the blade engaging member  20 . As the force is applied to the blade engaging member  20 , the blade engaging member  20  pivots about the pivot pin  32  and adjusts the vertical position of the retractor blade  18  within the surgical site  12 .  
         [0044]     The articulated retractor blade holder  10  in cooperation with the clamp  16  also provides a low profile device for conducting the surgical procedure. What is meant by low profile is that the articulated retractor blade holder  10  is positioned proximate the retractor support apparatus  14 . By positioning the articulated retractor blade holder  10  proximate the retractor support apparatus  14 , access to the surgical site  12  remains relatively open and free from obstruction.  
         [0045]     Another advantage of the clamp  16  cooperating with the articulated retractor blade holder  10  is that the articulated retractor blade holder  10  is positionable away from a surgical site  12  while the retractor blade  18  is in a selected position within the surgical site  12 . With the retractor blade  18  in the selected lateral position, the articulated retractor blade holder  10  pivots about the retractor blade  18  by moving the clamp  16  along the retractor support apparatus  14 . As the clamp  16  moves along the retractor support apparatus  14 , the peg  66  and the base  64  rotate with respect to the clamp  16 . As the peg  66  and the base  64  rotate and the articulated retractor blade holder  10  rotates about the shaft  26 , the articulated retractor blade holder  10  is moved away from the surgical site  12 . With the holder  10  in a selected position, the actuating mechanism  90  is positioned into the clamping position which frictionally secures the peg  66  and the base  64  to the clamp  16  and also frictionally secures the clamp  16  to the retractor support apparatus  14 .  
         [0046]     An alternative embodiment of an articulated retractor blade holder of the present invention is generally illustrated at  200  in  FIGS. 5-7 . The articulated retractor blade holder  200  includes an articulated joint  212  that is similar to the articulated joint  35  of the retractor blade holder  10 . Unlike the retractor blade holder  10 , the articulated retractor blade holder  200  is not fixedly attached to a clamp  206  and does not include a mechanical mechanism for adjusting a transverse position of the retractor blade within the surgical site.  
         [0047]     A handle  210  of the retractor blade holder  200  is positioned within an upper clamping socket  204  of an upper clamping member  207  of the clamp  206 . With the clamp  206  in the non-clamping position, the upper clamping member  207  rotates as indicated by arrow  205  within a through bore in an upper leg  257  of a lower clamping member  250  to laterally position as indicated by arrow  211  a retractor blade  214  within the surgical site (not shown). Although a rotatable upper clamping member  207  is preferred, a non-rotatable upper clamping member  207  is also within the scope of the present invention.  
         [0048]     The handle  210  preferably has a circular cross-section and is slidably positionable within the clamping socket  204  as indicate by arrow  213 . Handles having other cross-sections are also within the scope of the present invention provided the handle  210  is slidably positionable within the upper clamping socket  204  and is securable in a selected position when the clamp  206  is positioned into the clamping position. Manual force is placed upon the handle  210  to adjust a transverse position as indicated by arrow  215  of the retractor blade  214  within the surgical site.  
         [0049]     The lower clamping member  250  is similar to the clamp  16  and has a lower clamping socket  252  similar to the clamping socket  94  for engaging the retractor support apparatus  208 . When the clamp  206  is in the non-clamping position, the clamping socket  252  can accept the retractor support apparatus  208  and the lower clamping member  250  is slidably positionable on the retractor support apparatus  208  as indicated by arrow  253 .  
         [0050]     With the lower clamping member  250  in a selected position on the retractor support apparatus  208  and the retractor blade  214  in the selected lateral and transverse positions within the surgical site (note shown), an actuating mechanism  254  is rotated as indicated by arrow  255  into a clamping position where the socket  252  is constricted to frictionally secure the lower clamping member  250  to the retractor support apparatus  208 . A shaft  256  threadably engaged with the actuating mechanism  254  is forced into the upper clamping socket  204  to frictionally secure the handle  210  within the upper socket  204 . Otherwise the clamp socket may be rotatable in the general direction of arrow  259  thereby pivoting the blade engaging member in the general direction of arrow  219 . The upper clamping member  207  is frictionally secured to the upper leg  257  of the lower clamping member  250  to prevent rotational movement of the upper clamping member  207  with respect to the lower clamping member  250 .  
         [0051]     After securing the retractor blade  214  in a selected lateral and transverse positions in the surgical site, a vertical position as indicated by arrow  217  of a retractor blade is adjusted by pivotally moving the blade engaging member  216  as generally indicated by arrow  221  about a pivot pin  232  that pivotally attaches the blade engaging member  216  to the handle  210 . A push rod  236  is positioned within a cavity  242  within the handle  210 , and a slot  237  within the blade engaging member  216  that is aligned with the cavity  242 . The slot  237  intersects a channel  234  that accepts a proximal engaging end  238  of the push rod  236 . As the push rod  236  moves within the handle  210 , the engaging end  238  exerts a force upon a surface  233  defining the channel  234  and causing the blade engaging member  216  to pivot about the pivot pin  32 .  
         [0052]     As the blade engaging member  216  pivots about the pivot pin  232 , the retractor blade  214  is manipulated into a selected vertical position. The channel  234  is preferably located in a substantially orthogonal relationship to the pivotal attachment of the blade engaging member  216  to the handle  210 , although other positional relationships of the channel  234  and the pivotal attachment are within the scope of the present invention.  
         [0053]     A distal portion  237  of the push rod  236  is non-rotatably attached to a knob  24  as previously described in the embodiment  10 . The knob  244  threadably engages a threaded distal end  246  of the handle  210 . As the knob  244  is rotated, the threaded engagement of the knob  244  with the handle  210  causes the knob  244  to transversely move. As the knob  244  rotates and transversely moves, the push rod  236  also rotates and transversely moves such that the engaging end  238  applies a force to the blade engaging member  216 . The force causes the engaging end  238  to move within the channel  234  and the blade engaging member  216  to pivot about the pivot pin  232 . The movement of the engaging end  238  within the channel  234  along with the pivotal attachment of the blade engaging member  216  to the handle  210  creates the articulated joint  212  that moves the retractor blade  18 .  
         [0054]     The engaging end  238  preferably has a generally spherical configuration that engages the surface  233  generally arcuate cylinder defining the channel  234  in the blade engaging member  216 . The engaging end  238  is captivated within the channel  234  because a width of the slot  237  is less than a diameter of the spherical engaging end  238 .  
         [0055]     To raise the retractor blade  214 , the knob is rotated to threadably move the knob  242  transversely away from the blade engaging member  216 . As the knob  242  moves away from the blade engaging member  216 , the engaging end  238  contact the surface  233  defining the channel  234  proximate the slot  237  and exerts a force upon the blade engaging member  216 . The force urges the blade engaging member  216  to pivot upward about the pivot pin  232  and thereby raise the retractor blade  214 .  
         [0056]     To lower the retractor blade  214 , the knob  244  is rotated to threadably move the knob  244  transversely towards the blade engaging member  216 . As the knob  244  moves toward the blade engaging member  216 , the engaging end  238  contacts the surface  233  defining the channel  234  generally opposite the slot  237  and exerts a force upon the blade engaging member  216 . The force urges the blade engaging member  216  to pivot downward about the pivot pin  232 , and thereby lower the retractor blade  216 .  
         [0057]     The retractor blade  214  is removably attached to the blade engaging member  216  by positioning a cylindrical shaft  222  attached to the retractor blade  214  within a through bore  218  proximate a distal end of the blade engaging member  216 . The retractor blade  214  is rotatably retained to the blade engaging member  216  with a spring-loaded spherical member  226  extending into the through bore  218  that engages an annular groove  224  within the cylindrical shaft  222 .  
         [0058]     Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.