Surgery – Specula – Retractor
Reexamination Certificate
1997-02-26
2001-02-27
Flanagan, Beverly M. (Department: 3732)
Surgery
Specula
Retractor
C600S210000, C600S213000, C600S226000
Reexamination Certificate
active
06193651
ABSTRACT:
BACKGROUND
1. Technical Field
This application relates to a surgical retractor, and more particularly, to a surgical retractor which facilitates the harvesting of veins.
2. Background of the Related Art
In certain surgical procedures, it is necessary to remove an artery or vein from the patient. For example, in coronary artery bypass surgery (CABG), to re-route the blood flow to or from the heart to bypass a blockage in the coronary artery, an artery or vein is harvested from the patient and connected to the coronary artery to enable the unobstructed flow of blood.
In certain instances, e.g. when only a short graft is required, the mammary artery can be harvested and used for CABG. However, the mammary artery is oftentimes of insufficient length. Therefore, the patient's saphenous vein is most often utilized. The saphenous vein runs the length of the leg and is about ¼ to 1 inch below the skin. The most common method of removing the saphenous vein currently performed by surgeons involves making an incision in the patient's leg extending the length of the section of the vein to be removed. Frequently, this requires an incision running the entire length of the leg, from the ankle to the groin, which can be over 40 inches in length. Once the leg is opened in this manner, the surgeon, utilizing a light source supported on headgear or a headband, dissects the vein from the surrounding tissue and ligates and severs the vein from its numerous branches along its length. The vein is then cut at both ends and removed from the patient for use as a graft attached to the coronary artery or aorta. After removal of the vein, the leg incision is sutured.
Such formation of a large leg incision has many disadvantages. It is time consuming, complicates the procedure, creates a large scar, and increases the risk of infection and skin necrosis. It also adds to the expense of the procedure by requiring additional surgeon time to close the leg incision. Moreover, it increases the patient's discomfort and prolongs the patient's recovery time. In fact, the recovery time from the leg incision can take even longer than the recovery time from the chest incision from the heart surgery.
The need for a less invasive method and instrumentation to remove the saphenous vein is recognized in the field. For example, in U.K. Patent No. 2,082,459, an apparatus is disclosed for harvesting the saphenous vein utilizing two small incisions. A center rod is inserted into the lumen of the vein, and the tubular body having a series cutting blades is introduced over the center rod and passed along the vein to cut the tributaries and fatty tissue around the vein. U.S. Pat. No. 4,793,346 to Mindlich discloses an apparatus which has a pair of knife blades extending from an elongate plastic tube. The tube has an inner diameter larger than the outer diameter of the vein. In use, the tube is inserted through an incision, and guided over the vein by a flexible guide which is inserted through the vein. The tube is rotated as it is advanced so that the knife blades can sever the vein branches. Electrically conductive wires are coupled to the knife blades to cauterize the severed end of the branches. U.S. Pat. No. 5,373,840 to Knighton discloses an endoscope and method for vein removal under visualization. A dissecting tool is inserted through one of the endoscope channels to separate the blood vessel from the connective tissue and a forceps is inserted through a second channel to hold the vessel during the procedure. The endoscope is inserted through a small incision and the dissecting tool is advanced along the vein. When a side branch is encountered, the dissection tool is removed and a ligating-cutting tool is inserted through the channel to sever the side branch.
Each of the instruments of the prior art described above are complex and expensive. Furthermore, they require the procedure to be performed in a tight working space as the vein is not separated from the surrounding tissue and the instruments are wedged between the vein and the tissue.
It would be advantageous to provide an apparatus which could minimally invasively separate the skin (and subcutaneous tissue) from the vein to enable dissecting and ligating instrumentation to be inserted through small incisions to facilitate removal of the saphenous vein. It would also be advantageous to equip such apparatus with illumination capabilities to enable the surgeon to better visualize the vein as it is dissected. This would not only eliminate the need for the surgeon to wear cumbersome head gear, but would avoid the expense involved with the use of an endoscope as well as avoid the additional time required for the constant withdrawal and reinsertion of the instruments through the endoscope's working channels.
SUMMARY
The present application discloses a retractor which advantageously increases the working space to facilitate minimally invasive harvesting of the vein from the patient. More specifically, the retractor lifts the skin and subcutaneous tissue away from the saphenous vein to improve visibility and enable dissecting and ligating instruments to more easily access the vein.
The retractor has a base adapted to lie on the patient's skin and a tissue retracting blade movably mountable to the base. Preferably the retracting blade extends from a handle which is slidably mounted with respect to the base. A locking member cooperating with the handle and movable to retain the tissue retracting blade in a selected position can be provided. The locking member preferably comprises a rotatable knob which engages threads on a shaft portion of the handle. The apparatus preferably includes means in the form of a light guide for enabling illumination of the surgical site. Optionally, a light shield is provided to shield a portion of the light emanating from the light guide. The apparatus may also include an adapter mounted to the base to increase the angle of the tissue retracting blade with respect to the tissue.
The base preferably has a pair of spaced apart legs adapted to lie on the patient's skin and an upper portion having a support to receive the tissue retracting member wherein the upper portion of the base is angled such that its front portion is raised with respect to its back portion.
A method for accessing the saphenous vein to facilitate harvesting the vein is also disclosed comprising the steps of making a small incision in the leg of the patient, positioning a retractor on the patient's leg such that a retractor blade extends into the incision and a base portion lies on the surface of the patient's leg, and pulling the retractor blade away from the patient to lift the tissue away from the underlying saphenous vein.
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pa
Flanagan Beverly M.
United States Surgical Corporation
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