Abstract:
A surgical instrument for spreading apart openings of natural orifices or surgically made openings to perform procedures on internal structures and/or organs of a patient. The instrument includes a pair of upper and lower blades that open to spread apart the area being examined so that a surgical tool can be inserted therein. A second pair of lateral blades are fixedly mounted between the spaced pair of upper and lower blades. The instruments can be eliminated from the area of view by allowing the surgical tool to pass up into a gate while maintaining the spread-apart condition of the area being examined. The blades can then be restored to their closed position after the tool is withdrawn. The gate may have a plurality of notches for accommodating differing surgical tools.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The invention relates to surgical instruments; and, more particularly, to diagnostic and surgical instruments for use in abdominal, thoracic or vaginal and anal surgical procedures that may also include endoscopies. 
     2. Related Art 
     Certain surgical and diagnostic devices are known for examining vaginal and other cavities. For example, women of a certain age should have a diagnostic pap smear annually. Certain prior art devices, known as speculums, are used which consist of a pair of wide or broad blades, but such are uncomfortable to the patient, causing much discomfort. 
     Also, when such instruments are used in examining a body cavity, such as the vagina, a second instrument is inserted into the vagina through the speculum. Such an instrument is called a lateral vaginal retractor and is used to retract the vaginal side walls which normally obstruct the doctor&#39;s view into the patient&#39;s cervix. During a surgical procedure, the surgeon needs to insert a clamp, a source of lighting, a suctioning catheter, and irrigation tube through the speculum, thus further obstructing the surgeon&#39;s view of the cervix which might interfere with the surgical procedure being performed. 
     In my U.S. Pat. No. 5,868,668, the teachings of which are incorporated herein by reference, I disclose a surgical and diagnostic instrument which eliminates the need for a lateral vaginal retractor during vaginal surgery. The instrument should be anatomically designed with a narrow oval shape in its closed position to allow it to be inserted comfortably into the patient&#39;s vagina without the discomfort generally associated with a conventional speculum. It allows the introduction of other instruments such as a light, an irrigation tube, etc. without obstruction the surgeon&#39;s view. 
     I have found that, although this instrument in my U.S. Pat. No. 5,868,668 works quite well, it is not necessary that the blades 21, 22 disclosed therein are part of the pivoting mechanism. By making these blades integral the upper flange assembly, I reduce the number of parts and need for careful machining of these blades. 
     SUMMARY OF THE INVENTION 
     It is an object of this invention to provide an improved surgical and diagnostic instrument for examining a patient&#39;s body cavity, such as a vagina, eliminating the need for a lateral vagina retractor during surgery. 
     It is another object of this invention to carry out the foregoing object that is anatomically designed (four quadrant retraction allows the blades to be of less width producing a narrower instrumentation) to cause little if any discomfort to the patient. 
     It is still another object of this invention to provide a multi-bladed vaginal diagnostic and surgical instrument which is quickly and easily activated to expand the blades with slight rotation movement and little discomfort to the patient. 
     It is further an object of this invention to carry out the foregoing objects allowing easy insertion into the body cavity being examined without allowing the instrument to slip out of the body cavity during examination. 
     Such an instrument should allow a tenaculum and other diagnostic tools to be moved out of the area of view of the surgeon while carrying out diagnostic procedures. 
     These and other objects are preferably accomplished by providing a surgical instrument for spreading apart openings of natural orifices or surgically made openings to perform procedures on internal structures and/or organs of a patient. The instrument includes a plurality of spaced upper and lower blades that open to spread apart the area being examined so that a surgical tool can be inserted therein. A second pair of lateral blades are fixedly mounted between the spaced pair of upper and lower blades. The instrument can be eliminated from the area of view by allowing the surgical tool to pass up into a gate while maintaining the spread-apart condition of the area being examined. The blades can then be restored to their closed position after the tool is withdrawn. The gate may have a plurality of notches for accommodating differing surgical tools. 
    
    
     BRIEF DESCRIPTION OF THE DRAWING 
     FIG. 1 is an exploded view of a surgical instrument in accordance with the teachings of the invention; 
     FIG. 2 is a side view of the assembled surgical instrument of FIG. 1, the blades being in closed position; 
     FIG. 3 is a view taken along lines  3 — 3  of FIG. 1, parts thereof being omitted for convenience of illustration; 
     FIG. 4 is a perspective view of the upper blade assembly alone of the instrument of FIG. 1; 
     FIG. 5 is a view taken along lines  5 — 5  of FIG. 6; 
     FIG. 6 is a rear view of the instrument of FIG. 2, the blades being in closed position; 
     FIG. 7 is a view similar to FIG. 2 showing the blades in open position; and 
     FIG. 8 is a view similar to FIG. 6 showing the blades in open position. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
     Referring now to FIG. 1, a surgical instrument  10  is shown having a handle  11  and an integral flanged portion  12  comprised of a pair of spaced flange  13 ,  14  and a planar midsection  13 ′. A pair of knob and washer combinations  15 ,  16  are provided, each having an integral washer portion  17  and an integral knob portion  18 . These combinations  15 ,  16  are adapted to be inserted between flanges  13 ,  14  aligned with apertures  19 ,  20 , respectively (aligned apertures similar to  19 ,  20  are disposed in flange  13  and are not visible in FIG.  1 ). 
     A boss  26  having a stepped 3-part pin  27  integral with each boss  26  extends toward apertures  19 ,  20 . 
     In my U.S. Pat. No. 5,868,668, the teachings of which are incorporated herein by reference, blades 21, 22 each included an outwardly extending blade portion 24. These blade portions have been eliminated in this application and are now part of the upper apparatus of my invention as shown in FIG. 1, and will be discussed. However, the pivoted connection and operation of boss  26 , pin  27 , and combinations  15 ,  16 , is identical to that of the blades 21, 22 in my U.S. Pat. No. 5,868,668. 
     Thus, referring again to FIG. 1, a blade  28 , slightly curved in cross-section, is integral with flange  13  and extends outwardly therefrom in a plane generally normal to the plane of handle  11  below the upper edge  29  of flange  13 . Blade  28 , at its forward end  30 , is curved and depressed areas  31 ,  32  are provided in the middle of the upper edges of flanges  13 ,  14 . The handle  11  may have a hollowed out interior  33  to save weight and costs of manufacture. 
     A blade assembly  34  is provided having a main body portion  35  and an integral fourth blade  36  extending therefrom lying in a plane generally normal to the plane of the main body portion  35 . Blade  36  terminates at its forward end  37  in a curved end and is also slightly curved in cross-section. 
     Main body portion  35  is adapted to fit over flanged portion  12  (FIG. 2) and is generally rectangular with a pair of spaced inner curved walls  38 ,  39  flanged at top (see flange  41 ′ in FIG. 1) forming a space  40  therebetween formed between upper rail  42  of main body portion  35  and the lower rail  43  thereof. An oval opening or slot  39 ′ is formed integral with each curved wall  38 ,  39 . Rail  43  has a raised flange portion  44  at generally the middle thereof and walls  38 ,  39  are interconnected by an inner partition wall  45 . Walls  38 ,  39  are curved at their upper ends. A portion  46  of wall  45  is thus accessible below flange portion  44  to provide a thumb rest for instrument  10  as will be discussed. 
     Rail  42  includes a downwardly depending elongated flange  47  having a plurality of spaced notches  48  to  50  for reasons to be discussed. Although shown as grooves, tracks, or notches, notches  48  to  50  can have a variety of configurations. 
     As heretofore discussed, in my U.S. Pat. No. 5,868,668, blades  21 ,  22  were part of the handle  11 . However, in this improved invention, blades  21 ′,  22 ′ (see also FIG. 3) are integrally mounted to a flange  100  having a pair of spaced pins  101 ,  102  adapted to be received in aligned apertures  103 ,  104 , respectively, in blade assembly  34 . Each blade  21 ′,  22 ′ is arcuate in cross-section, as can be seen in FIG. 3, is shorter than blades  28 ,  36  (see FIG. 2) and disposed therebetween. Each blade  21 ′,  22 ′ is tapered on its upper surface as seen at taper  105  in FIG.  1 . The final assembly of blades  21 ′,  22 ′ to blade assembly  34  is shown in FIG.  4 . The forward ends of blades  21 ″,  22 ′ may curve inwardly toward each other from the plane of blades  21 ,′,  22 ′. As seen in FIG. 5, flange  100  has a pair of throughbores  106  (only one visible in FIG. 5) aligned with holes  103 ,  104 , respectively. A hollow cylindrical element  107  is mounted in each throughbore  106  with a reduced diameter opening  108  in flange  100  leading into throughbore  106 . Each pin  101  includes a piston  109  reciprocal in each throughbore  106 , and generally conforming to the inner diameter of element  107 , with a reduced diameter piston shaft  110  integral with enlarged head  111 . A coiled spring  112  is disposed between the forward end  113  of piston  109  and the forward end wall  114  of element  107 . A ball element  115  is adapted to extend out of opening  116  in element  107  and peened thereabout to trap ball element  115  so it can&#39;t extend out of opening  116 . A first reduced diameter section  117  is provided in piston  109  leading to a second reduced diameter section  118 , greater in diameter, in piston  109 . In this manner, pushing in on head  111  against the bias of spring  112  allows ball element  115  to fall into reduced diameter section  118  allowing flange  100  and interconnected blades  21 ′,  22 ′ to be withdrawn from blade assembly  34 . Flange  100  can be quickly and easily assembled to blade assembly  34  by inserting cylindrical elements  107  into aligned holes  103 ,  104  to snap ball elements  115 , now in reduced diameter section  117 , out of holes  116  when ball elements  115  move past flange  111  and snap out of holes  116  as seen in FIG.  5 . 
     The final assembly of flange  100 , and blades  21 ′,  22 ′, is shown in FIG.  4 . 
     It can be seen by comparing FIGS. 1 and 2 that the main housing portion  35  of blade assembly  34  is mounted over flanged portion  12  as described in my U.S. Pat. No. 5,868,668. 
     The washer portions  17  of combinations  15 ,  16  are inserted between spaced flanges  13 ,  14 . Stepped pins  27  are now inserted into the respective aligned apertures  19 ,  20  with levers  23  extending out of slot  39 ′ (see FIG. 6) and thus accessible outside of blade assembly  34 . 
     As seen in FIG. 2, the flanged portion  12  is at an angle with respect to handle  11  so that knobs  18  are retained within slots  39 ′. The lower portions  54  of main housing portion  35  is also angled as seen in FIG.  2 . 
     In operation, as seen in FIG. 7, pushing it at thumb rest  46  (not visible in FIG.  5 —see FIG. 1) on lower portion  54  in the direction of arrow  55  raises blade  36 . Continuing to push up on thumb rest  46  in the direction of arrow  55  raises blades  36 ,  21 ′, and  22 ′ further with knob  18  moving down slot  39 ′. 
     Pins  27  are stepped or not perfectly round such as having a non-round or spiraled midsection, as midsection  100  in my U.S. Pat. No. 5,868,668, so that, when the arms  23  are rotated downwardly, knobs  18  are pulled inwardly tightening the assembly  23 . 
     The operation of instrument  10  is discussed in detail in my U.S. Pat. No. 5,868,668. Instrument  10  has a narrow oval configuration as instrument  10  in U.S. Pat. No. 5,868,668. A conventional tenaculum can be inserted between the pin blades, when in the FIG. 7 position, as discussed in my patent. Notches  48  to  50  are used in the same manner as disclosed in my patent. 
     My instrument is of a simple construction requiring no moving parts. It is a separate and distinct tool that can be made, adapted, and attached for speculums or other surgical instruments. It can be made of metal, plastic, and coated (plastic or laser coating) for regular, electrocautery, or laser usage. It is a separate and distinct tool that can be attached to speculums or other surgical instruments in order to prevent other tissues (retraction) from cascading into the site of surgery or other procedures. 
     My instrument is a separate and distinct tool that can be attached to speculums or other surgical instruments in order to present laterally, without extending beyond the parameters of the original instrumentation (vertical blades), which would become unduly uncomfortable for the patient or hamper the operator. It is a separate and distinct tool that can be attached to speculums or other surgical instruments in order to provide assistant usage or be easily removed if not needed (portability). It is a separate and distinct tool that can be attached to speculums or other surgical instruments providing a lever for the finger or fingers to shift the yoke into an elevated or lower position as desired. My instrument is a separate and distinct tool that can be attached to speculums or other surgical instruments that acts harmoniously with the part or parts of the speculum until it can be fixed in an optimal position. It is a separate and distinct tool that can be attached to speculums or other surgical instruments that can be used in conjunction with many diagnostic and/or therapeutic uses. It is a separate and distinct tool that can be attached to speculums or other surgical instruments that remains locked in place to prevent slippage during surgical and diagnostic procedures by numerous interlocking tabs. 
     My instrument is a separate and distinct tool that can be attached to speculums or other surgical instruments that have the lateral blades conform to the contours of the vertical blades to avoid obstructing vertical blades from assuming the closed position or projecting away from the vertical blades that penetration of the vaginal vault or other similar applications would be jeopardized. It is a separate and distinct tool that can be attached to speculums or other surgical instruments that have such simplicity in design that it allows for low cost in manufacturing and marketing in a budgetary conscious public. It is a separate and distinct tool that can be attached to speculums or other surgical instruments that wrap around the yoke or poles of the instruments so as to be reinforced from bending inwards yet persist in its retraction of tissues. 
     I have disclosed a separate and distinct tool that can be attached to speculums or other surgical instruments that have inwardly bent and rounded edges of their tips to avoid snagging tissues. 
     There is thus disclosed a surgical instrument which is a four-way spreader useful in examining the body of a patient. The spreader holds open the area one desires to examine, such as the vaginal pouch leading to the uterus, and can be moved quickly and easily off to the side upon insertion of a conventional diagnostic tool, such as a tenaculum, to provide better visibility and maneuverability. The instrument can be made of any suitable materials, such as plastic.