Surgical retractor system

[0002] Not applicable.

[0003] Not applicable.

[0004] The present invention relates to medical devices, in particular to a surgical retractor blade and system.

[0005] Even with the advent of minimally invasive surgical techniques, many surgical procedures still require an exposed surgical field for the surgeon to successfully perform. Often, the greater the visibility and access a surgeon has to a surgical site, the greater the probability that a successful outcome will result. Once entry is made into a patient, soft tissue is dissected away further exposing the field. However, the exposed field must be maintained using instruments that do not obstruct either visual or physical access.

[0006] Surgical retractors are used to maintain exposure and access to a surgical field. There are a variety of retractors, and different surgical protocols require different styles of retractors. For example, in lumbar surgery the retractor needs to be strong enough to overcome the force exerted by the large muscle mass that has been dissected away from the field of exposure, while maintaining a visual field and access by the surgeon. Additionally, retractors are required to partition other soft-tissue components of the surgical field. This need has lead to retractor systems having solid blades connected to a firm blade-holding retractor frame. U.S. Pat. No. 5,520,608 discloses a curved, solid retractor blade useful for orthopaedic surgery.

[0007] During surgery, it is advantageous to have retractor blades that are removably attachable to a support frame. U.S. Pat. No. 4,421,108 is an example of a quick-release ratcheting holder for a surgical retractor. Other mechanisms for holding a retractor blade in position are disclosed in U.S. Pat. Nos. 4,424,724; 4,467,791; 5,375,481; 5,616,117; and 5,893,831.

[0008] Accordingly, there exists a need for greater flexibility in a surgical retractor system while improving both visual and physical access by the surgeon to the surgical field.

[0009] The present invention provides a surgical retractor blade and system useful for surgical procedures, including orthopaedic and spinal surgery. In one embodiment, the surgical retractor blade of the invention is used with a support frame that includes a horizontally oriented support member having a plurality of mounting holes. This surgical retractor system further includes at least one retractor blade which is mateable at a selected position on the support frame. The retractor blade includes an open access window that facilitates both visual and physical access to the surgical wound.

[0010] The retractor blade of the present invention has a substantially elongated, horizontally oriented mounting portion with a longitudinally extending slot formed therein. The retractor blade also comprises a tissue-retracting portion which is integral with and distal to the mounting portion. The tissue-retracting portion has a first section which is coplanar with the mounting portion, and a second section which is angularly oriented with respect to the first section. The open access window is substantially centrally formed, and it is present in both the first and second sections of the tissue-retracting portion of the retractor. The second section of the tissue-retracting position of the blade is preferably angularly oriented with respect to the first section. The angle of orientation is in the range of about 45° to 135°.

[0011] The retractor blade also comprises a fastening mechanism that effectively enables it to mate to the support frame in a desired position. In one embodiment, a mounting screw is used to mate the retractor blade to the support frame. Other fastening mechanisms, such as clamping devices, can also be used to fasten the retractor blade to the support frame.

[0012] The foregoing and other features and advantages of the present invention will be more fully understood from the following detailed description along with the accompanying drawings.

[0013] FIG. 1 is a perspective view of a surgical retractor system of the present invention in use during a surgical procedure;

[0014] FIG. 2A is a perspective view of the surgical retractor system of FIG. 1;

[0015] FIG. 2B is an exploded, disassembled view of the system shown in FIG. 2A;

[0016] FIG. 3A is a perspective view of a surgical retractor system according to another embodiment of the invention;

[0017] FIG. 3B is an exploded, disassembled view of the system shown in FIG. 3A;

[0018] FIG. 4 is a plan view of a portion of the retractor system according to one embodiment of the invention;

[0019] FIG. 5 is a plan view of a portion of the retractor system according to another embodiment of the invention;

[0020] FIG. 6A is a side elevational view of a retractor blade useful with the present invention;

[0021] FIG. 6B is a plan view of the retractor blade of FIG. 6A;

[0022] FIG. 6C is a sectional view of the retractor blade of FIG. 6B at lines 6C—6C; and

[0023] FIG. 7 is a perspective view of a retractor blade according to the present invention, together with a surgical tool.

[0024] Referring now to FIG. 1, there is shown a surgical retractor system 10 of the present invention. The retractor system 10 is attached to an operating table (not shown) in a manner well known to those having ordinary skill in the art. The retractor system 10 includes a frame 12, which is preferably suspended above the patient 14, common retractor blades 16, and retractor blades 18 having an access window 19. The system 10 may also include a supporting arm 20 which may be connected to a support post (not shown) or similar elements to affix and support the retractor system in a desired position.

[0025] With further reference to FIGS. 1 through 2B and 4, the retractor system 10 of the present invention further includes one or more fixation elements 22, such as thumb screws, that are effective to secure retractor blades 16, 18 to the frame 12 in a desired position so that tissue can be retracted. In one embodiment, the support frame 12 is a four-sided, substantially rectangular object having a central opening 21. Each side 12a, 12b, 12c, 12dof frame 12 includes one or more mounting holes 24, which preferably are internally threaded. The holes 24 are adapted to threadably mate with a threaded shaft 26 of fixation elements 22. Although shown as being substantially square or rectangular, it is understood that opposing sides 12a, 12b, 12c, 12dthat form frame 12 need not be parallel. Thus, the frame may be in the form of a circle or an oval, or it may be substantially O-shaped or D-shaped.

[0026] In one embodiment, the mounting holes 24 formed in sides 12band 12dare aligned so as to be parallel to the direction in which the sides 12band 12dextend, enabling retractor blades 16 to be positioned at various locations along the length of sides 12b, 12d(in the x direction, as shown in FIG. 2B). As shown best in FIG. 2B, sides 12aand 12ceach include flanges 28 that extend perpendicular to sides 12a, 12c, on either side of sides 12a, 12c. In this embodiment mounting holes 24 are disposed in flanges 28 such that the holes extend in a direction substantially parallel to the holes formed in sides 12b, 12d. The presence of the flange structure enables retractor blades 18 to be mounted securely on the frame 12 and to be positioned at various locations in the x direction (FIG. 2B). Optionally, additional mounting holes 24amay be present on sides 12a, 12c, extending in a direction parallel to that in which sides 12a, 12care oriented. The presence of mounting holes 24aallows the blades 16, 18 to be located in various positions in the y direction. One of ordinary skill in the art will readily appreciate that the common retractor blades 16 and retractor blades 18 each may be mounted on sides 12a, 12b, 12c, or 12d.

[0027] The dimensions of frame 12 may vary as required by different surgical applications. The number and size of mounting holes 24 may vary as well. In one embodiment, the sides 12a-12dhave a length and a range of about 100 to 500 mm. In one embodiment, the frame 12 may be square or rectangular, and the dimensions of central opening 21 are in the range of about 80 by 150 mm to about 300 by 450 mm. Flanges 28 preferably extend a distance L_fof about 20 to 60 mm. The number of mounting holes 24 present in the sides and in the flanges 28 may vary as well. Generally, about 5-10 holes 24 and 24aare present in each of the sides while about 3-6 holes 24 are formed in the flanges 28. In one embodiment mounting holes may be placed entirely around the frame.

[0028] FIGS. 3A, 3B, and 5 illustrate an alternative embodiment in which frame 12′ is a three-sided member, which can be characterized as being substantially C-shaped. As illustrated, frame 12′ has a long side 12a′ and opposed shorter sides 12b′ and 12c′. The long side 12a′ preferably includes a number of mounting holes 24′ that are oriented in a direction parallel to the side 12a′. The shorter sides 12b′, 12c′ each include flanges 28′ that extend in a direction parallel to side 12a′. The flanges 28′ preferably include a number of holes 24′ that are oriented in a direction parallel to the holes formed in side 12a′.

[0029] One of ordinary skill in the art will appreciate that the dimensions of frame 12′ may vary as well. The length of side 12a′ is in the range of about 150 to 500 mm while the length of sides 12b′, 12c′ is in the range of about 100 to 300 mm. The length L_fof flanges 28′ may be similar to that of flanges 28. In addition, one of ordinary skill in the art will appreciate that flanges 28′ may include the same as or a different number of holes as are present in flanges 28.

[0030] The common retractor blades 16 may be of a type that includes a mounting section 41 and a tissue-retracting section 43. The mounting section is substantially horizontally oriented and the tissue-retracting section 32 is angularly oriented with respect to the mounting section. The tissue-retracting section 32 may be oriented at an angle of about 45° to 135° with respect to the mounting section, and preferably at an angle of about 90°. The mounting section 30 further includes a slot 34 having screw nesting positions 36 as will be described below with respect to retractor blade 18. As described above, the orientation of the holes on sides 12band 12d(assuming one opts to mount blades 16 on sides 12band 12d) allows blades 16 to be mounted in various locations in the x direction. The position of blades 16 in the y direction can be controlled by the positioning of the screw nesting positions 36 of slot 34 with respect to fastening element 22.

[0031] The fixation elements 22 are used to secure the mounting portion 18 of a blade 16, 18 to the frame 12. For purposes of illustration, the fixation elements 22 are shown as thumb screws, having a head 27 and a shaft 26. Preferably, the shaft 26 has external threads 29, enabling the fixation element to mate with internal threads 31 formed in mounting holes 24, 24a. One of ordinary skill in the art will understand that the shaft 26 of the fixation element must be appropriately sized to fit within the mounting holes 24.

[0032] The retractor blades 18 of the present invention include features that allow tissue to be effectively retracted while increasing the surgeon's visual and physical access to the surgical site. With reference to FIGS. 6A-7, the blades 18 have a mounting portion 38 which, for reference purposes, is substantially horizontally oriented, and an adjacent tissue-retracting portion 40. The mounting portion 38 includes an elongate slot 34. In one embodiment, the elongate slot 34 has a scalloped perimeter that defines multiple screw seating positions 36. That is, as is best shown in FIGS. 6B and 6C, the slot 34 includes multiple adjacent screw seating positions 36a, 36b, 36c.

[0033] The tissue-retracting portion 40 of blade 18 includes a first section 42 that is coplanar with the mounting portion 38 and a second section 44 that is angularly oriented with respect to the first section. An open access window 19 is formed in both the first and second sections 42, 44 of the tissue-retracting portion 40. Preferably, the access window 19 is substantially centrally positioned within the first and second sections 42, 44. In one embodiment at least a portion of either or both of the mounting or tissue-retracting portions 38, 40 is malleable to enable a surgeon to optimize the shape of the blade for the best performance in tissue retraction. Selective malleability can be achieved by material choice and/or by utilizing a thinner material in a region or regions (“bend zone”) where malleability is desired.

[0034] As noted above, the second section 44 of the tissue-retracting portion 40 of plate 18 is angularly oriented with respect to the first section 42. The angle of orientation may be in the range of about 45° to 135°, and preferably this angle is about 90°. In an embodiment in which the blade is malleable, the angular orientation may be selectively altered by a surgeon.

[0035] The access window 19 spans both the first and second sections 42, 44 of the tissue-retracting portion 40 and thus is three dimensional, as shown in FIG. 7. The access window 19 can be characterized as being substantially rectangular in shape, having both a generally horizontal (formed in the first section 42) and a generally vertical portion (formed in the second section 44).

[0036] One of ordinary skill in the art will appreciate that the dimensions of the retractor blade 18 may vary upon the desired surgical applications. Referring to FIGS. 6A-6C, the length of a horizontally extending portion L_Hof the blade 18 is in the range of about 40 to 300 mm while the length of a vertically extending section L_vis in the range of about 15 to 100 mm. The length of the tissue retracting portion is in the range of about 20 to 200 mm. The width of the blade at a widest section (W₂) may be in the range of about 30 to 200 mm. As illustrated, one segment of the mounting portion 38 of the blade 18 may be slightly narrower than the width W₂. This width dimension (W₁) is in the range of about 10 to 100 mm and extends over a majority of the mounting portion 38 of the blade. The length of the narrower segment of the mounting portion, defined by L_H1in FIG. 6A, is in the range of about 20 to 250 mm.

[0037] As noted above, the slot 34 is elongate and generally has a length (L_s) in the range of about 20 to 200 mm. The width of the slot (W_s) is preferably in the range of about 3 to 10 mm.

[0038] The access window 19 preferably has a width (W_w) in the range of about 5 to 90 mm. The length of the access window in the first section 42 of the tissue retraction portion 40 (L_w1) is in the range of about 15 to 195 mm while the length (L_w2) of the access window in the second section 44 of the tissue retraction portion 40 is in the range of about 40 to 300 mm. The length (L_v) of the second section 44 of the tissue-retracting portion 40 is about 20 to 250 mm.

[0039] FIG. 7 schematically illustrates an advantage of the retractor blade 18 of the present invention. While the blade 18 is effective, in concert with other blades, to retract tissue, visual and physical access by the surgeon is enhanced as a result of the access window 19. That is, a surgical tool 46 is able to be passed through the access window to a desired location, or to further retract or otherwise manipulate tissue that is adjacent to the access window.

[0040] One of ordinary skill in the art will appreciate that the components of the retractor system of the present invention can be made from one or more biocompatible metals or metal alloys, or polymeric materials. An exemplary metal is titanium, while exemplary alloys include, but are not limited to, stainless steel (e.g., 316 LVM stainless steel), a titanium-vanadium-aluminum alloy (e.g., an alloy having about 90% by weight titanium, about 6% by weight aluminum, and about 4% by weight vanadium), a cobalt-chromium alloy, a cobalt-chromium-molybdenum alloy and a cobalt-nickel-chromium-molybdenum alloy. Biocompatible polymeric materials are also included within the instant invention. Examples of such polymers include nylons, polyetherether ketones (PEEK), polyetheraryl ketones (PEAK), and polysulfones.

[0041] One of ordinary skill in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not limited by what has been particularly shown and described, except as indicated by the appended claims. Although dimensions are provided, it is understood that these dimensions may vary and are provided for purposes of exemplification. All patents and publications cited herein are expressly incorporated by reference in their entirety.