US1944009A - Intra-abdominal retractor - Google Patents

Description

Jal). 16, R W HOMER INTRA-ABDOMI NAL RETRACTOR Filed June 14, 1952 iut Patented Jan. 16, 1934 rifNi*i2-El sr-A TES i-P-Aranr o Pfl-ica INTRA-ABDOMINAL RETRACTOR VRalph W.Hmer, ventura, Calif.

Application June. 14, 1932. 'Serial No; 617,147

9 lclaims. (o1. 12s- 20)V v This invention relates to surgical appliances "andfparticularlyto retractors for maintaining "the-walls of-cavities or various organs of the e "body "out" of the way during'an examination or operation.

-An'object ofthe invention is to provide means "insertable'within a 'body cavity for retracting organs or-'tissues away from a particular spot "to be'examined or operated upon.` *I0 A"In the drawing: K

AFigure `-l is a-sketch illustrating in a general 'way how an appliance yin accordance with the invention is insertedthroughy an abdominal ine "cision'andexpanded into a desired position;

Figures 2, 3,'Y and 4 are plan views illustrating various shapes in which a device in accordance 4withthev inventionimay be constructed; and

'Figure 5is 'a cross sectional View showing the Y construction ofthe device illustrated in Figures 2,"3, and 4. v

LIn'operating on various organs within the abdominal cavity itis common practice to enter the labdomenithrough an incision in the belly a V of the patient; this incision, which is in the form of a slit, is kept openby retractors of convenvtional form which hook over'the edges ofthe incision and spread them apart. However the abidominalcavity Yisilled with a mass of organs, 1 "many ofwhicharemore or less looselyattached T39 to "the walls 'ofthe cavity, and which tend to crowd together. It is therefore usually necessary for a surgeon to separate or press to one side the mass of viscera in order to obtain access n. to a desired organ. In many instances it is necessary to have an assistant at an operation whose sole duty is to hold the visceral mass out of the way with his hands. Obviously, such an assistant is in the way; furthermore, his duties are fatiguing and it may be difficult for him to maintain the viscera in a desired position for a long period of time. In some instances it is impossible to utilize an assistant, and the surgeon must himself maintain the bulging mass of tissues and viscera out of the way while he '"45 operates.

In accordance with the present invention there is provided a flexible plate which can be made in various shapes and sizes and can be shaped within the body cavity to form a dam for retaining the obstructing viscera out of the way of the surgeon, The essential characteristics of this plate are that it have a smooth non-porous surface of an insoluble, non-poisonous material capable of being sterilized, and that it be non- "255 elastic and sufciently rigid to retain any shape into which it may be bent, against the pressure of the tissues or organs it is to retract; at the same time being sufciently pliable kto be easily bent with the hands.

Avery satisfactory., plate satisfying the above '60 requirements comprises a core of thin sheetlea'd enclosed in an envelope of soft rubber. .'As shown in the cross sectional view of Figure 5, such a plate may be constructed by sandwiching a sheet of lead 2 between Vtwo sheets of rubber 65 of slightly larger dimensions, and vulcanizing the three sheets into a single integral unit rin which the lead core is completely enclosed by the. rubber. vThe soft rubber walls extendout a short distance beyond the edges of the lead .coreas shown at 8 to serve as cushions and preventinjuries to tissues with which vthey come in contact. VPlates as described may be constructed in a varietyfof shapes and sizes to serve different purposes. 'Three ,possible shapes .are shownin Figures2, 3, and 4 respectively andthe .dimensions' of each-of these plates may be variedA to satisfy Ydifferent requirements.

In many cases the vplate desirable for a particular purpose will be too long to be readily,l inserted 8 through an Y incision. In such instances, .as

lshown in Figure 1, theplate may beY coiled into a roll as' indicated at 3, for insertion through the incision; the retracted edges of the incision are indicated at 4. After insertion within 'the alb- 85 dominal cavity the plate may be uncoiled to form a dam ina desired position and of a desired shape as indicated by dotted lines at 5. Even though the initial coiling or rolling of the plate be unnecessary to enter it through the incision, such preliminary coiling is often desirable as the compact roll may be readily inserted between crowded organs; then as the roll is expanded by the surgeon, the organs are pushed away from the spot desired to be cleared and maintained in the position to which they are pushed.

A retractor having a lead core is very satisfactory for the reason that lead is extremely pliable and may be bent repeatedly into many shapes T00 without breaking; it is also substantially nonelastic and remains in any shape to which it may be bent. The hermetically sealed envelope of rubber prevents any contact of the lead with the body tissues.

A retractor shaped as shown in Figure 2 is particularly useful where it is desired to form a dam within the abdomen extending transversely across the body. The curved lower edge 6 of 110 the retractor then ts across the back bone of the patient and the lobes 7 ll the depressions on either side of the back bone.

A retractor of the shape shown in Figure 3 is useful where a high retracting wall is necessary on only one side, and a low wall suffices at other points. rlhe low wall may be advantageous in that it is less in the way of the surgeon.

Although many special uses of the retractor will be apparent to surgeons, it is particularly useful in prostate gland operations in which access to the gland is obtained by penetrating both the anterior and posterior walls of the bladder. In such operations it is found that as soon as the anterior wall of the bladder is opened the bladder collapses and becomesv a shapeless mass, rendering it diicult to open the posterior wall and remove the prostate gland. However, by inserting a coiled retractor, shaped as shown in Figure 4 and of suitable dimensions, into the bladder through the incision in the anterior wall and then expanding it, the collapsed walls of the bladder can be distended and a clear view had of the rear wall overlying the prostate gland. VIn this and in other operations, a small electric lamp can be clamped to the edge of the retractor after it has been expanded to facilitate the work of the surgeon.

Many other specific uses for the device will be apparent to surgeons and it may be desirable for some purposes to provide plates of shapes different Vfrom those illustrated. It is therefore to be understoodthat the invention isr limited only as set forth in the following claims.

I claim:

1. A retractor for insertion into an incision for the purpose of keeping the viscera from encroaching on the field of a surgical operation, comprising a pliable, non-elastic plate capable of being inserted as a whole withina body cavity and capable of being bent into any desired shape after insertion within a body cavity to form a re taining wall, said plate being suiciently pliable to be easily bent by the hands of a surgeon but stiff enough to resist bending under pressure exerted by the tissues or organs to be retracted.

2. A retractor for insertion into an incision for the purpose of keeping the viscera from encroaching on the eld of a surgical operation comprising a pliable, non-elastic plate capable of being and adapted to be bent into compact form for insertion through a small opening into a body cavity and thereafter expanded into desired shape by the hands of a surgeon to form a retaining Wall.

3. A retractor for insertion into an incision for the purpose of keeping the viscera from encroaching on the field of a surgical operation comprising a pliable, non-elastic plate having edge portions of soft yielding material, said plate being capable of being inserted as a whole within a body cavity and capable of being bent into a desired shape to form a retaining wall, and being suiiiciently pliable to be easily bent by the hands of a surgeon after insertion into a body cavity but stii enough to resist bending under pressure exerted by the tissues or organs to be retracted.

4. A rectractor for insertion into an incision for the purpose of keeping the viscera from encroaching on the field of a surgical operation and adapted to be inserted within a body cavity and shaped after insertion comprising a fiat plate of pliable, non-elastic material enclosed in an envelope of rubber, said envelope being hermetically sealed.

5. A retractor for insertion into an incision for the purpose of keeping the vscera from encroaching on the field of a surgical operation comprising a fiat plate of pliable, non-elastic material enclosed in a hermetically sealed envelope of rubber and adapted to be inserted into and shaped Within the body cavity, the outer edges of the envelope projecting beyond the edges of the plate and the plate being secured to the inner walls of the envelope to prevent relative moveinent therebetween.

6. A retractor for insertion into an incision for the purpose of keeping the viscera from encroaching on the eid of a surgical operation and adapted to be inserted into and shaped within .i115

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