Surgery – Specula – Retractor
Reexamination Certificate
1999-07-06
2001-10-30
Smith, Jeffrey A. (Department: 3732)
Surgery
Specula
Retractor
C600S219000, C600S210000, C600S215000, C600S235000
Reexamination Certificate
active
06309349
ABSTRACT:
INTRODUCTION
1. Technical Field
This invention relates to an adjustable surgical retractor and its use for improving a surgeon's ability to perform closed-chest, video-assisted exploratory, diagnostic or surgical procedures on a patient. The invention also relates to unique blades useful in combination with the retractor.
2. Background
Surgery on the heart is one of the most commonly performed types of surgery that is done in hospitals across the U.S. Cardiac surgery can involve the correction of defects in the valves of the heart, defects to the veins or the arteries of the heart and defects such as aneurysms and thromboses that relate to the circulation of blood from the heart to the body. In the past, most cardiac surgery was performed as open-chest surgery, in which a primary median sternotomy was performed. That procedure involves vertical midline skin incision from just below the super sternal notch to a point one to three centimeters below the tip of the xiphoid. This is followed by scoring the sternum with a cautery, then dividing the sternum down the midline and spreading the sternal edges to expose the area of the heart in the thoracic cavity. This technique causes significant physical trauma to the patient and can require one week of hospital recovery time and up to eight weeks of convalescence. This can be very expensive in terms of hospital costs and disability, to say nothing of the pain to the patient.
Recently, attempts have been made to change such invasive surgery to minimize the trauma to the patient, to allow the patient to recover more rapidly and to minimize the cost involved in the process. New surgical techniques have been developed which are less invasive and traumatic than the standard open-chest surgery. This is generally referred to as minimally-invasive surgery. One of the key aspects of the minimally invasive techniques is the use of a trocar as an entry port for the surgical instruments. In general, minimally invasive surgery entails several steps: (1) at least one, and preferably at least two, intercostal incisions are made to provide an entry position for a trocar; (2) a trocar is inserted through the incision to provide an access channel to the region in which the surgery is to take place, e.g., the thoracic cavity; (3) a videoscope is provided through another access port to image the internal region (e.g., the heart) to be operated on; (4) an instrument is inserted through the trocar channel, and (5) the surgeon performs the indicated surgery using the instruments inserted through the access channel. Prior to steps (1)-(5), the patient may be prepared for surgery by placing him or her on a cardiopulmonary bypass (CPB) system and the appropriate anesthesia, then maintaining the CPB and anesthesia throughout the operation. See U.S. Pat. No. 5,452,733 to Sterman et al. issued Sep. 26, 1995 for a discussion of this technique.
While this procedure has the advantage of being less invasive or traumatic than performing a media, sternotomy, there are numerous disadvantages to using trocars to establish the entry ports for the instruments and viewscope. For example, the trocars are basically “screwed” into position through the intercostal incision. This traumatizes the local tissues and nerve cells surrounding the trocar.
Once in place, the trocar provides a narrow cylindrical channel having a relatively small circular cross-section. This minimizes the movement of the instrument relative to the longitudinal axis and requires specially-designed instruments for the surgeon to perform the desired operation (See, e.g., the Sterman patent U.S. Pat. No. 5,452,733). In addition, because of the limited movement, the surgeon often has to force the instrument into an angle that moves the trocar and further damages the surrounding tissue and nerves. The need to force the instrument causes the surgeon to lose sensitivity and tactile feedback, thus making the surgery more difficult. The surgical retractor of this invention is designed to reduce the initial trauma to the patient in providing access to the internal region, to reduce the trauma to the patient during surgery, to provide the surgeon with greater sensitivity and tactile feedback during surgery, and to allow the surgeon to use instruments of a more standard design in performing the non-invasive surgery.
Other less invasive surgical techniques include access to the region of the heart to be corrected by anterior mediastinotomy or a thoracotomy. In a mediastinotomy, an incision is made that is two to three inches in length of a parasternal nature on the left or the right of the patient's sternum according to the cardiac structure that needs the attention in the surgery. Either the third or the fourth costal cartilage is excised depending on the size of the heart. This provides a smaller area of surgical access to the heart that is generally less traumatic to the patient. A thoracotomy is generally begun with an incision in the fourth or fifth intercostal space, i.e. the space between ribs
4
and
5
or ribs
5
and
6
. Once an incision is made, it is completed to lay open underlying area by spreading the ribs. A retractor is used to enlarge the space between the ribs.
At the present time, when either of these techniques are used, a retractor is used to keep the ribs and soft tissues apart and expose the area to be operated on to the surgeon who is then able to work in the surgical field to perform the operation. The types of retractors that are used may be seen, for example, in volume 1 of
Cardiac Surgery
by John W. Kirkland and Brian G. Barratt-Boyes, Second Edition, Chapter 2, at page 101. Commercial-type retractors for minimally-invasive surgery that are useful for a mediastinotomy or a thoracotomy are manufactured by Snowden Pencer (the ENDOCABG rib spreader and retractor), U.S. Surgical (the mini CABG system), and Cardiothoracic Systems (the CTS MIDCAB™ System). The ENDOCABG refractor is two opposing retractor arms that are interconnected by a ratchet arm having a thumbscrew which can adjust the distance between the retractor arms. While this provides a useful retractor, it has certain shortcomings in its ease of use. The mini CABG System is an oval-based platform to which a number of retractors are then fitted around the extremity of the universal ring base and adjusted by a gear tooth connection. Each of the retractors have to be separately adjusted and there are other devices that can be connected to the universal base which can aid the surgeon in damping the heart movement to better work on the artery or vessel to which the surgeon is directing his attention. The CTS MIDCAB™ System serves a similar function to the ENDOCABG retractor, but is more complex. The designation CABG refers to “coronary artery bypass graft.”
Major disadvantages of these systems include their limited positioning, complexity, and lack of reusability. It has now been discovered that the shortcomings of the retractors that are known in the prior art can be overcome with a new design as set forth in the following description.
OBJECTS OF THE INVENTION
An object of this invention is to provide a surgical retractor that is useful in exploratory or diagnostic work on a patient or preparing for and/or performing cardiac and other types of surgeries.
Another object of this invention is to provide a surgical retractor that is easier to use than the surgical retractors presently available.
Another object of this invention is to provide a surgical retractor that defines a larger opening than a surgical trocar through which a surgeon can insert surgical, exploratory or diagnostic instruments.
Another object of this invention is to provide a surgical retractor that can be used for both anterior or lateral access to the thoracic cavity, access to the abdominal cavity or exposure of an subcutaneous body structure.
Another object this invention is to provide a surgical retractor having removable blades, thus providing the surgeon with the flexibility to choose a size and shape blade to fit a patient's anatomy.
A further ob
Bertolero Arthur A.
Bertolero Raymond S.
Riebman Jerome B.
Cooley & Godward LLP
Endoscopic Technologies, Inc.
Smith Jeffrey A.
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