Patent Description:
Surgical retractors may be employed during a surgical treatment to provide access and visualization of a surgical site. Such retractors space apart and support tissue and/or other anatomical structures to expose anatomical structures at the surgical site and/or provide a surgical pathway for the surgeon to the surgical site. Conventional retractors may expand access to a tissue site using a limited number of blades that are typically fixed in number. A problem occurs when the limited number of blades are expanded, that tissue can creep into the surgical site between the blades. Although conventional retractors may articulate the limited number of blades, they often require multiple mechanical means for articulating each individual blade or at most a sub-group of blades. Conventional retractors typically are not generally capable of simultaneously expanding and/or simultaneously articulating a plurality of modular blades.

Document <CIT>discloses a retractor comprising an outer tube, in the form of a torus segment, with a concave surface that faces towards the center of a surrounded space, said concave surface comprising at least one motion channel formed on said concave surface, an inner tube in the form of a torus-segment movably and telescopically placed in an inner part of the outer tube, such that said inner tube and said outer tube define said surrounded space, a plurality of tissue pushers hung to the motion channel and which are constituted in a manner that they can move along the outer tube, said retractor being adapted to be used at open heart surgeries to make the mitral and tricuspid valves apparent during the surgical operation, said retractor further comprising a plurality of adjustment holes formed on said surface of the inner tube that faces toward the center of the surrounded space, and holders fixed to each end of the outer tube by connection rings, wherein said holders are attached to the adjustment holes of said inner tube by pins.

The techniques of this disclosure generally relate to a modular retractor configured for use with a plurality of modular blades of varying types and sizes that is capable of expanding and/or articulating the plurality of modular blades simultaneously. The presently claimed invention relates to a modular retractor according to claim <NUM>. Further developments of the herein claimed invention are described in the dependent claims.

Referring generally to FIGS. 1A-15B a modular retractor system <NUM> is disclosed. <FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of installed primary blades <NUM> and a non-installed supplemental blade <NUM>. As used in this specification and the appended claims, the term "modular" shall have its ordinary technical meaning, referring to components that can be independently created, modified, replaced or exchanged with disclosed systems and components thereof. For example, both of the primary blades <NUM> and secondary blades <NUM> may each be independently replaced, exchanged, and/or added for use with the disclosed modular retractor system.

The modular retractor system <NUM> may include a handle <NUM> that is operably coupled to a first annular retaining ring <NUM> and a second annular retaining ring <NUM>, for example. In some embodiments, each primary blade <NUM> is disposed around a circumference of the first annular retaining ring <NUM>. The first annular retaining ring <NUM> may be disposed above the second annular retaining ring <NUM>. The supplemental blade <NUM> is illustrated in a non-installed position. However, supplemental blade <NUM> may be installed for use with modular retractor system <NUM>, as will be explained in further detail below.

<FIG> is an example perspective view of a modular retractor system <NUM> including a first annular retaining ring <NUM> and a second annular retaining ring <NUM>. The first annular retaining ring <NUM> may be oriented into a substantially circular arrangement defining a first center point C1. Similarly, the second annular retaining ring <NUM> may be oriented into a substantially circular arrangement defining a second center point C2. Annular retaining rings, <NUM>, <NUM> may be formed of a deformable material, such as, for example, a flexible wire, such as nitinol or the like, a flexible plastic, a relatively thin metallic wire or the like, and/or a combination of the above disclosed materials. In some embodiments, annular retaining ring <NUM> may have a substantially circular cross-section and in other embodiments, annular retaining ring <NUM> may resemble a ribbon or flat chord. In some embodiments, annular retaining ring <NUM> may be formed of a different material than annular retaining ring <NUM>. In the illustrated embodiment, the first center point C1 and second center point C2 may define an axis C-C, for example. Axis C-C may be oriented substantially vertical with respect to handle <NUM> of modular retractor system <NUM>.

<FIG> is an example perspective view of an inside surface 10a of a primary blade <NUM>. <FIG> is an example perspective view of an outside surface 10b of a blade. Primary blade <NUM> may include channel 10c extending down side surfaces thereof. Although primary blade <NUM> is illustrated as including a planar outside surface 10a and a planar inside surface 10b it shall be understood that the illustrations are an example and the inventive concepts disclosed herein are not limited to blades having flat or planar surfaces. For example, in other embodiments, primary blade <NUM> may include curved surfaces defined by a radius of a circle or curved surfaces that are defined by a segment of an ellipsis. For example still, in at least one embodiment, surfaces 10a, 10b may be shaped like a segment of an oval cylinder. In at least one embodiment, surfaces 10a, 10b may be shaped in such a way as to correspond to the shape of a set of nested dilators such as, for example, the dilators referred to in <CIT>. For example, the surfaces 10a, 10b may correspond to the shape of and fit around a last dilator of one or more sequential dilators. In use, an end user may place the primary blades <NUM> around the last dilator in a closed position for insertion into an opening of a surgical site. Thereafter, an end user may enlarge the opening of the surgical site in a manner as will be explained in further detail below.

Primary blade <NUM> may include a primary blade retaining clip <NUM> disposed at a top portion thereof, for example. In some embodiments, primary blade retaining clip <NUM> may include a first groove <NUM>-<NUM> at an upper portion thereof and a second groove <NUM>-<NUM> disposed directly beneath and proximate to the first groove <NUM>-<NUM>. First groove <NUM>-<NUM> may be configured to snap to first annular retaining ring <NUM>. For example, first groove <NUM>-<NUM> and annular retaining ring <NUM> may be deformable, at least partly, and be sized to snap together. The first groove <NUM>-<NUM> may be curved and include a cross sectional depth corresponding to a radius of curvature of the first annular retaining ring <NUM>. At least one advantage of using a snapping ring as the annular retaining ring <NUM> is that modular retractor system <NUM> can accommodate various amounts of primary blades <NUM>, e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, etc. Additionally, first annular retaining ring <NUM> and first groove <NUM>-<NUM> may comprise low friction surfaces that may facilitate the sliding of annular retaining ring <NUM> within first groove <NUM>-<NUM>, as will be explained in more detail below.

Second groove <NUM>-<NUM> may be configured to snap to second annular retaining ring <NUM>. For example, second groove <NUM>-<NUM> and annular retaining ring <NUM> may be deformable, at least partly, and be sized to snap together. The first groove <NUM>-<NUM> may be curved and include a cross sectional depth corresponding to a radius of curvature of the first annular retaining ring <NUM>. In other embodiments, second annular retaining ring <NUM> may not snap to second groove <NUM>-<NUM> and be passively retaining within second groove <NUM>-<NUM>. For example, in some embodiments, second annular retaining ring <NUM> may comprise an elastic ribbon that when seated within second groove <NUM>-<NUM> is retaining within the groove due to a biasing force.

In disclosed embodiments, the first grooves <NUM>-<NUM> of each primary blade retaining clip <NUM> may define, together, a first pathway, and the second grooves <NUM>-<NUM> of each primary blade retaining clip <NUM> may define together, a second pathway. Additionally, the first annular retainer <NUM> may be operably coupled to each primary blade <NUM> via the first pathway, and the second annular retainer <NUM> may be operably coupled to each primary blade <NUM> via the second pathway, for example.

Primary blade <NUM> may further include a ball and socket mechanism <NUM> including a ball portion 11a and a corresponding socket portion 11b. For example, each primary blade <NUM> may include a ball portion 11a on a first side surface and a corresponding socket portion 11b on a second side surface opposite the first side surface. Disclosed ball and socket mechanism <NUM> may be configured to allow second annular retaining ring <NUM> to pass through an internal channel 11c. In practice, a first primary blade <NUM> and a second primary blade <NUM> may be operably coupled at a junction including a ball portion 11a from the first primary blade <NUM> and a corresponding socket portion 11b of the second blade.

<FIG> is an example perspective view of an inside surface 20a of a supplemental blade <NUM>. <FIG> is an example perspective view of an outside surface 20b of a supplemental blade <NUM>. Although supplemental blade <NUM> is illustrated as including a planar outside surface 20a and a planar inside surface 20b it shall be understood that the illustrations are an example and the inventive concepts disclosed herein are not limited to blades having flat or planar surfaces. For example, in other embodiments, supplemental blade <NUM> may include curved surfaces defined by a radius of a circle or curved surfaces that are defined by a segment of an ellipsis. For example still, in at least one embodiment, surfaces 20a, 20b may be shaped like a segment of an oval cylinder.

In some embodiments, supplemental blade <NUM> may include a groove <NUM> on side surfaces thereof. Groove <NUM> may resemble a semi-circle in cross section, for example. Groove <NUM> may extend down along a portion of side surfaces of supplemental blade <NUM>. Groove <NUM> may be configured to operably slide in and nest with channel 10c, as will be explained in further detail below. Supplemental blade <NUM> may further include a protrusion 20pr extending laterally and away from side surfaces of supplemental blade <NUM>, for example. Protrusion 20pr may be disposed proximate to and above groove <NUM>. Protrusion 20pr may have a generally conical shape with a flat surface at an outermost portion thereof. Supplemental blade <NUM> may include a supplemental blade retaining clip <NUM>. In disclosed embodiments, supplemental blade retaining clip <NUM> may be the same as, similar, or substantially the same as primary blade retaining clip <NUM>. In the illustrated embodiment, supplemental blade retaining clip <NUM> may include a groove <NUM>-<NUM>. The flat surface of protrusion 20pr may be a planar surface that extends laterally and farther out from supplemental blade <NUM> than groove <NUM>-<NUM>. Protrusion 20pr may be configured to nest inside of recess 10r of primary blade <NUM>, as will be explained in further detail below.

Groove <NUM>-<NUM> may be configured to snap to and/or couple with first annular retaining ring <NUM>. For example, groove <NUM>-<NUM> and annular retaining ring <NUM> may be deformable, at least partly, and be sized to snap together. The groove <NUM>-<NUM> may be curved and include a cross sectional depth corresponding to a radius of curvature of the first annular retaining ring <NUM>. At least one advantage of using a snapping ring as the annular retaining ring <NUM> is that modular retractor system <NUM> can accommodate various amounts of primary blades <NUM> and/or supplemental blades <NUM>, e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, etc. of each type of blade, for example. Additionally, first annular retaining ring <NUM> and groove <NUM>-<NUM> may comprise low friction surfaces that may facilitate the sliding of annular retaining ring <NUM> within groove <NUM>-<NUM>, as will be explained in more detail below.

<FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of installed primary blades <NUM>. <FIG> is an example top view of a modular retractor system <NUM> of <FIG>. In the example embodiment, primary blades <NUM> are operably and pivotally coupled by ball and socket mechanism <NUM>. Additionally, primary blades <NUM> may be urged inward toward axis C-C due to a biasing force applied to primary blades <NUM> by second annular retaining ring <NUM>. According to the claimed invention, second annular retaining ring <NUM> is an elastic material or a semi-elastic material exerting a natural biasing force against primary blades <NUM> urging them towards axis C-C. In the illustrated embodiment, modular retractor system <NUM> is in a contracted position.

<FIG> is an example perspective view of a modular retractor system <NUM> being moved into an open position. <FIG> is an example top view of a modular retractor system <NUM> including an expansion mechanism comprising an actuator 1a moving the primary blades <NUM> into the open position. Actuator 1a may be a slidable actuator that is coupled to a first end portion 3y and a second end portion 3z of first annular retaining ring <NUM> that extend into a cavity within handle <NUM>. In practice, an end user may slide actuator 1a towards a distal side 1d of handle <NUM> (illustrated schematically by arrows). In this way, actuator 1a may apply a tension force to first and second end portions 3y, 3z of first annular retaining ring <NUM> such that first annular retaining ring <NUM> contracts inward radially towards axis C-C. For example, actuator 1a may be configured to cause first annular retaining ring <NUM> to contract radially inward, or at least urge primary blades <NUM> to contract inward towards axis C-C via direct contact at first groove <NUM>-<NUM>. Stated another way, first annular retaining ring <NUM> may apply a force to primary blades <NUM> at a top portion thereof in a direction extending towards axis C-C. In turn, the applied force from first annular retaining ring <NUM> at first groove <NUM>-<NUM> of primary blade retaining clip <NUM> may cause primary blades <NUM> to pivot outwardly at a distal end 10d (shown by arrows). In the disclosed embodiment, each of primary blades <NUM> may articulate outwardly at a distal end 10d with respect to axis C-C. The articulation may increase the size of an opening of a surgical site.

In some embodiments, first annular ring <NUM> may be operable via a contraction mechanism comprising a turnbuckle and/or a set screw and a sliding ring (not illustrated) and a suitable actuator. For example, a turnbuckle may be disposed medially within handle <NUM> and operably coupled to end portions 3y, 3z near the distal side of handle <NUM> and a turning knob disposed near the proximate side of handle <NUM>, for example. An end user may turn the turning knob and cause a rotation of the turnbuckle that applies a tensile force to end portions 3y, and 3z, for example. Similarly, a set screw may be disposed medially within handle <NUM> and operably coupled to end portions 3y, 3z by a sliding ring near the distal side of handle <NUM>, for example. The sliding ring may slide longitudinally along the length of the set screw forward and backward upon turning the set screw, for example. In at least one embodiment, the set screw is rotatable via a turning knob or driving portion disposed at the distal side of handle <NUM>, for example. The driving portion may be rotatable via an external tool such as a screwdriver or the like, for example.

<FIG> is an example perspective view of a modular retractor system <NUM> being moved into a closed position. <FIG> is an example top view of a modular retractor system <NUM> including an actuator 1a being moved into the closed position. When actuator 1a is moved towards the proximal side 1p of handle, the tension force applied to first and second end portions 3y, 3z of first annular retaining ring <NUM> is released such that first annular retaining ring <NUM> expands outward and away from axis C-C. For example, actuator 1a may be configured to cause first annular retaining ring <NUM> to expand, at least partly, such that an internal radial force towards axis C-C is no longer applied to primary blades <NUM> by first annular retaining ring <NUM>. In some embodiments, expanding first annular retaining ring <NUM> radially away from axis C-C urges the distal portion 10d of primary blades <NUM> to articulate inwards towards axis C-C Additionally and/or alternatively, second annular retaining ring <NUM> may apply a biasing force against supplemental primary blades <NUM> such that supplemental primary blades <NUM> pivot at ball and socket mechanism <NUM>. The biasing force applied by second annular ring <NUM> may urge the distal portion 10d of primary blades <NUM> to articulate inwards towards axis C-C.

<FIG> is an example perspective view of a modular retractor system <NUM> including a supplemental blade <NUM> being moved into an installed position. <FIG> is an example top down view of a modular retractor system <NUM> including a supplemental blade being moved into an installed position. In the illustrated embodiment, a first supplemental blade <NUM> may be positioned between an adjacent pair primary blades <NUM>, for example. As previously explained, supplemental blade <NUM> may include a groove <NUM> extending along side surfaces thereof. Groove <NUM> may be configured to mate with a corresponding channel 10c extending along side surfaces of primary blade <NUM>, for example. In the illustrated embodiment, supplemental blade <NUM> includes a groove <NUM> that extends from a proximal portion 20p of supplemental blade <NUM> to the distal portion 20d of supplemental blade <NUM>. For example, in the illustrated embodiment, groove <NUM> extends along a first side surface of supplemental blade <NUM> all the way down to the distal portion 20d and groove <NUM> extends along a second side surface of supplemental blade <NUM> all the way down to the distal portion 20p. As shown in <FIG>, the distal portion 20d is placed between adjacent primary blades <NUM> and the groove <NUM> is mated with the corresponding channels 10c.

<FIG> is an example perspective view of a modular retractor system <NUM> including a supplemental blade <NUM> being moved into an installed position. <FIG> is an example top down view of a modular retractor system including a supplemental blade being moved into an installed position. In practice, an end user may insert the distal portion 20d of supplemental blade <NUM> between two adjacent primary blades <NUM> such that the groove <NUM> at the narrowed tip of the distal portion 20d mates with corresponding channels 10c of supplemental primary blade <NUM>, for example, an end user may apply a downward force to supplemental blade <NUM> while supplemental blade <NUM> is guided into position between adjacent primary blades <NUM>. In pushing supplemental blade <NUM> downward, the adjacent primary blades <NUM> may separate at the ball and socket mechanism <NUM>. Additionally, the first annular retaining ring <NUM> may expand, at least partly, to accommodate supplemental blade <NUM>. For example, the first annular retaining ring <NUM> may expand radially away from axis C-C.

<FIG> is an example perspective view of a modular retractor system <NUM> including a supplemental blade <NUM> fully inserted in the installed position. <FIG> is an example top down view of a modular retractor system <NUM> including a supplemental blade <NUM> fully inserted in the installed position. In the illustrated embodiment, supplemental blade <NUM> has been fully inserted into an installed position where protrusions 20pr are mated inside of corresponding recesses 10r of primary blades <NUM>. In practice, an end user may slide supplemental blade <NUM> downward with the guiding assistance of grooves <NUM> and channels 10c until protrusions 20pr come into alignment with corresponding recesses 10r. In seating supplemental blade <NUM> between a pair of adjacent primary blades <NUM>, the protrusions 20pr and corresponding recesses 10r may function as a pivoting point. Additionally, supplemental blade <NUM> may be operably coupled with first annular retaining ring <NUM> at groove <NUM>-<NUM>. For example, first retaining ring <NUM> may extend through groove <NUM>-<NUM> consistent with previous disclosure.

In practice, by inserting and pushing supplemental blade <NUM> into the installed position an opening of a surgical access site may be enlarged without requiring an articulation of the primary and supplemental blades <NUM>, <NUM>. Thereafter, the primary and supplemental blades <NUM>, <NUM> may be selectively articulated in varying degree to enlarge the opening of the surgical access site as may be desired, for example. In some embodiments, supplemental blades <NUM> may be added to modular retractor system <NUM> in advance of being placed in an opening of a surgical site. For example, both primary blades <NUM> and supplemental blades <NUM> may be selectively added to modular retractor system <NUM> and then be placed around a set of nested dilators, or at least an outermost dilator, such as, for example, the dilators referred to in <CIT>. Thereafter, the nested dilators may be removed and an end user may articulate both the primary blades <NUM> and supplemental blades <NUM> to enlarge an opening of the surgical access site as may be desired, for example.

<FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of primary blades <NUM> and a supplemental blade <NUM> being articulated into an open position. <FIG> is an example top down view of a modular retractor system <NUM> including a plurality of blades <NUM> and a supplemental blade <NUM> being articulated into an open position. Consistent with previous disclosure, an end user may cause first annular retaining ring <NUM> to contract inward radially and exert a circumferential force at grooves <NUM>-<NUM> and <NUM>-<NUM>. The applied radial force may cause primary blades <NUM> and supplemental blades <NUM> to pivot with respect to one another and axis C-C because of the corresponding ball and socket mechanisms <NUM> and the pivoting junction between protrusions 20pr of supplemental blades <NUM> and corresponding recesses 10r of primary blades <NUM>. As illustrated, the distal ends of primary blades <NUM> and supplemental blades <NUM> articulate outwardly. In doing so, a surgeon may expand a surgical access site.

<FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, a first supplemental blade <NUM> in the installed position, and a second supplemental blade <NUM> being inserted into an installed position. <FIG> is an example top down view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, a first supplemental blade <NUM> in the installed position, and a second supplemental blade <NUM> being inserted into an installed position. Consistent with the above disclosure, a second supplemental blade <NUM> may be inserted and installed via groove <NUM> and channels 10c in substantially the same manner as explained above.

<FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, a first supplemental blade <NUM> in the installed position, and a second supplemental blade <NUM> in the installed position. <FIG> is an example top down view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, a first supplemental blade <NUM> in the installed position, and a second supplemental blade <NUM> in the installed position. Consistent with the previous disclosure, by inserting the second supplemental blade <NUM> into the installed position, the first annular retaining ring <NUM> may expand radially outwardly to accommodate the second supplemental blade <NUM>. Additionally, the second supplemental blade <NUM> may be pivotally coupled with a pair of adjacent primary blades <NUM> in substantially the same manner as explained above. The process may be repeated to accommodate any number of blades as may be desired or necessary for each unique surgery being performed.

<FIG> is an example perspective view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, and a plurality of supplemental blades <NUM> in the installed position. <FIG> is an example top down view of a modular retractor system <NUM> including a plurality of primary blades <NUM>, and a plurality of supplemental blades <NUM> in the installed position. In the example embodiment, four primary blades <NUM> and four supplemental blades <NUM> are operably and pivotally coupled together at each respective pivoting junction where each protrusion 20pr is mated with a corresponding recess 10r. Additionally the four primary blades <NUM> and four supplemental blades <NUM> are operably coupled to first annular retaining ring <NUM>. In the disclosed embodiment, due to the number of primary blades <NUM> and supplemental blades <NUM>, a distance from an edge portion of annular retaining ring <NUM> to axis C-C is relatively greater than in embodiments having less primary blades <NUM> and/or supplemental blades <NUM>.

Claim 1:
A modular retractor (<NUM>), comprising:
a first annular retainer (<NUM>) and a second annular retainer (<NUM>), the first annular retainer (<NUM>) defining a first center point (C1) and the second annular retainer (<NUM>) defining a second center point (C2);
a central axis (C-C) projecting through the first center point (C1) and the second center point (C2);
a plurality of primary blades (<NUM>), the plurality of primary blades (<NUM>) being coupled to the first annular retainer (<NUM>), each primary blade (<NUM>) of the plurality of primary blades (<NUM>) being configured to pivotally couple to an adjacent primary blade (<NUM>) of the plurality of primary blades (<NUM>);
a handle (<NUM>); and
a contraction mechanism (1a) operably coupled to the first annular retainer (<NUM>), the contraction mechanism (1a) being configured to cause radial contraction of the first annular retainer (<NUM>) by pulling at least one end portion of the first annular retainer (<NUM>) within a cavity of the handle (<NUM>),
wherein the first annular retainer (<NUM>) and the second annular retainer (<NUM>) are arranged at a proximal portion (10p) of the primary blades (<NUM>);
wherein the first annular retainer (<NUM>) is configured to radially contract towards the first center point (C1) when sliding the contraction mechanism (1a) towards a distal side (1d) of handle (<NUM>) such that each primary blade (<NUM>) of the plurality of primary blades (<NUM>) articulates outwardly at a distal end (10d) of the primary blades (<NUM>) with respect to the central axis (C-C), thereby moving the modular retractor (<NUM>) from the closed position to an open position;
wherein, in the closed position, the second annular retainer (<NUM>) circumscribes the outside of the plurality of primary blades (<NUM>); and
wherein the second annular retainer (<NUM>) is of an elastic or semi-elastic-material to be thereby configured to apply a biasing force against each primary blade (<NUM>) of the plurality of primary blades (<NUM>) towards the central axis (C-C).