Surgery – Specula – Retractor
Reexamination Certificate
2002-04-05
2003-09-09
O'Connor, Cary (Department: 3732)
Surgery
Specula
Retractor
C600S233000
Reexamination Certificate
active
06616604
ABSTRACT:
TECHNICAL FIELD
The invention relates to the field of surgical instruments, particularly, a device for anchoring surgical retractors during operative procedures.
BACKGROUND OF THE INVENTION
Medical professionals have long-recognized the need for surgical instruments that can be reliably placed and retained in position during surgery. What has been needed but was heretofore unavailable are surgical retractor anchoring devices that reliably retain retractors and are easily engaged and disengaged during surgery. Such long-felt needs have been particularly prevalent in the field of intracranial neurosurgery.
Surgical retractors designed to retract tissues during surgery may be generally classified into two types; those which are designed to be held free and manipulated by an assistant during surgery, and those that are attached to the patient, the operating table or other external support. This later class is styled in the art as self-retaining retractors. A common style of self-retaining retractor is exemplified by that disclosed by the Alvarez-Jacinto U.S. Pat. No. 5,052,374, where an annular ring supports substantially opposing retractors around an abdominal incision. The substantially opposing retractors are locked into place on the annular ring, commonly by ratchet devices as in Alvarez-Jacinto '374, or with a slide and thumbscrew assembly as taught by Sherts, et al., U.S. patent application Ser. No. US 2001/0009971 A1. These retractors are commonly designed to produce considerable and continuous pressure to retract strong tissues, such as the abdominal tissues described by Alvarez-Jacinto '374. Alternatively, a retractor may be fixed to the skin of the patient, such as that disclosed by Sharpe, U.S. Pat. No. 4,621,619. Alternatively, a retractor may be attached to the surgical drapes which cover the patient and operative field during surgery, such as that disclosed by Chiuli, U.S. Pat. No. 4,051,844.
Intracranial neurosurgery makes particular demands for the retraction of human tissue to allow the surgeon maximum access and stability of the surgical field. Due to the extremely delicate nature of the surgery, the surgical field, that is, the patient's head, must be held entirely immobile throughout the often lengthy procedure. Secondly, various tissues of differing tensile strengths, ranging from relatively strong scalp tissue to exceedingly delicate brain structures, must be retracted to allow surgical access during the procedure. The immobilization of the patient's head is commonly achieved by a halo style fixation device, such as that described by Dinkler et al., U.S. Pat. No. 5,529,358. Fixation devices, such as the screws disclosed in Dinkler et al., '358, attached the halo device to the bone of the patient's cranium, achieving positive fixation. The halo portion of the device surrounds the cranium, and may be adapted to hold various appliances during surgery, such as retractors, as further disclosed by Dinkler '358.
A particular demand of intracranial neurosurgery is the need to retract a flap of the patient's scalp away from the opening to be made through the bone of the patient's cranium. An incision is made about the sides and posterior border through the scalp, comprising the planned flap, and the flap is reflected away from the underlying bone anteriorly, maintaining a hinge-like attachment to the scalp, such that blood supply is preserved to the flap. The scalp flap, remaining attached at its anterior border, therefore has the tendency to fall back across the planned bone incision site, unless it is dependably retracted. The traditional means for accomplishing this intraoperative retraction is through the use of scalp hook retractors, which are devices well known in the art. These scalp hook retractors comprise a proximal sharp hooked portion made of a rigid material, such as surgical steel, attached to a distal elasticized band. The traditional application of these scalp hook retractors has been to evert the scalp flap away from the planned bone incision site, placing the proximal sharp hooked portion of the scalp hook into the underside edge of the scalp flap, and stretching the elasticized band of the scalp hook retractor away from the planned bone incision site. This action imparts a tensile stretch and pulls the edge of the scalp flap away from the planned bone incision site. The stretch of the elasticized band is maintained by looping or tying the elasticized band of the scalp hook retractor to the halo portion of the cranial fixation device. This allows the elasticized band of the scalp hook retractor to exert a continuous, but gentle, force on the edge of the scalp flap, retaining it away from the surgical site.
While effectively maintaining the scalp flap away from the surgical site, this means of attaching the elasticized band of the scalp hook retractor to the halo device creates several recurring problems. First, the attachment of the elasticized band of the scalp hook retractor to the halo device by tying or looping creates a potentially insecure attachment to the halo device, such that the elasticized portion of the scalp hook retractor may slip during surgery. Due to the extremely delicate nature of the surgery, such sudden motion in the surgical field can have disastrous consequences for the patient. Second, the nature of a halo style fixation device is that it provides a plurality of potential positions about the patient's skull such that the point of fixation of the scalp hook retractor, and thereby its vector of force, may be radially varied. However, to achieve such radial adjustment, repositioning the scalp hook retractor requires untying or unlooping the elasticized band and then re-tying or re-looping the elasticized band, a cumbersome and time consuming procedure, particularly if a plurality of scalp hooks need to be readjusted. Third, fixation by tying or looping makes it difficult for the surgeon to effectively select the amount of tension desired, as the length, and therefore tension, of the elasticized material will often change while manually tying or looping the elasticized material.
Accordingly, the art has needed a means for locking scalp hooks retractors in position, satisfying the need for a secure attachment, yet one that is easily releasable and adjustable by the surgeon.
What continues to be needed, but is missing from the field of surgical retractor anchoring devices, is a surgical retractor securing apparatus, which is designed for ease of use, manufacture, sterilization, and improved reliability that improves the capability for secure connections. While some of the prior art devices attempted to improve the state of the art of surgical retractor retaining devices, none has achieved a cost optimized capability that has an easy to fabricate and convenient to use arrangement. With these capabilities taken into consideration, the instant invention addresses many of the shortcomings of the prior art and offers significant benefits heretofore unavailable.
SUMMARY OF INVENTION
In its most general sense, the present invention overcomes the shortcomings and limitations of the prior art in any of a number of generally effective configurations. An aspect of this invention is to provide a scalp hook locking device that is capable of quickly and dependably locking the elasticized band of a scalp hook to an external fixation device.
A further aspect of this invention is to provide a surgical retractor securing apparatus such that the degree of tensile stretch upon the elasticized band of the scalp hook retractor may be easily selected and adjusted by the surgeon, and once selected, will be positively maintained. A yet further aspect of this invention is to provide an easily adjustable scalp hook locking device that may be varied in radial orientation around a patient's skull. Additionally, the present invention is designed to have flexibility of assembly, ease of cleaning and sterilization, ease of manufacturing, and low cost.
The surgical retractor securing apparatus includes an adj
Bass Daniel
Wiedenmaier Udo
Allegiance Corporation
Gallagher & Dawsey Co. LPA
Nickey Donald O.
O'Connor Cary
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