US2586488A - Table supported surgical retractor - Google Patents

Description

D. P. SMITH TABLE SUPPORTED SURGICAL RETRACTOR Feb. 19, 1952 3 Sheets-Sheet 1 Filed May 11, 1949 INVENTOR. Dnvm R SM/TH d l r9.

HTTORNEY Feb. 19, 1952 D. P. SMITH 2, 8 8

TABLE SUPPORTED SURGICAL RETRACTOR Filed May 11, 1949 3 Sheets-Sheet 2 INVENTOR. DH V/D R SM/ TH BY i 9 W Fl TTORNE Y Feb. 19, 1952 D. P. SMITH 2,586,488

TABLE SUPPORTED SURGICAL. RETRACTOR Filed May 11, 1949 3 Sheets-Sheet 3 INVENTOR. DHV/D P 'SM/ TH TTORNEY Patented Feb. 19, 1952 ITE'D STATE S PATE N T O F F 1 :CE

TABLE SUPPORTED SURGICAL RETRACTOR David P. Smith, Meriden, "Conn.

Application Mayll, 1949, Serial No. 92,602

6 Claims. 1

This invention relates to surgical ,retractors. and more p rticularly to an abdominal retractor which has a plurality of independently adjustable retracting elements for holding the edges of a wound and the viscera or other organs away from the field of an operation.

One object of this invention is to provide a device of the above nature in which the retracting elements are adapted to be secured in fixed positions with relation to the .operating table or other surface upon which the patient rests, thus avoiding movement of the retracting elements which would shock the patient or which would be a source of annoyance to the surgeon.

Another object .is to provide a device of the above nature which may be employed to retract any part ,of the wound or the organs therein in one direction without requiring a retraction of another part in an opposite direction.

Another object is to provide a device of the above nature in which the positions of one or more of the retracting elements may be changed whenever desired during the course of an operation without disturbing the adjustment of the other retracting elements.

Another object is to provide a device of the above nature which may be readily applied, adjusted, and removed, and which will not be likely to accidentally change its adjustment, whereby the retractor will require a minimum of attention from the operating surgeon, and a minimum number of assistants will be required.

A further object is to provide a device of the above nature whichwill be simple in construction, inexpensive to manufacture, easy to install and manipulate, veryeflicient and durable in use, and

which will greatly facilitate the 'work of the surgeon.

With these and other objects in view, there have been illustrated on the accompanying drawing several forms in which the invention may conveniently be embodied in practice.

In the drawings,

Fig. 1 is an end view of one form of the improved retractor as it would appear when applied to an operating table, the patients body being indicated in broken lines.

Fig. 2 :is a plan view of the same.

Fig. 3 is a perspective view, on an enlarged scale, partly in section, taken on the line 3-3 of Fig .2, showing one of the retracting elements secured in the supporting ring.

Fig. 4 is a fragmentary sectional .view, taken approximately upon the line 4-.4 of Fig. v2, showing how one side of the supporting ring .is attached to one of the side bars.

4 the line 1 1 of 'Fig. 6, an angularly adjusted position of the retracting element being shown in broken lines.

Fig. 8 is an end view, partly in-section of a.

modification of the invention, showing a con-' cave-convex supporting ring which is adapted to conform approximately to the shape of the patients abdomen.

Figs. 9 and 10 are plan views of 'another'modified form of the invention in which two independently mounted half rings are provided for securing the retracting elements.

Fig. 11 is a partial plan view of another modification of the invention in which a slotted ring is adapted to support retracting elements by means of chains.

Fig. 12 is a cross sectional view of a portion of the same on an enlarged scale, taken on the line -12l2 of Fig. 11.

Fig. 1'3 is an end view similar to Fig. l, 'but showing how the first form of retractor may be mounted upon an auxiliary trough upon which the patient rests.

Referring now to the drawings in which like reference numerals denote corresponding parts throughout the several views, the improved .retractor comprises a, supporting ring l0 which is of flat circular shape, and which is provided with a symmetrical series of diametrically opposed horizontal radial apertures ll of rectangular cross-section.

The supporting ring 10 is also provided with a. series of vertical circular apertures 12 which intersect the radial apertures H, and which are adapted to receive a plurality of angular locking pins I3.

In order to support the ring l0, provision is made of a pair of horizontally extending side arms M, 15, which are adapted to enter a diametrically opposed .pair of the horizontal apertures H, and which arms are apertured adjacent their inner ends for the reception of a pair of the locking pins 13, whereby the ring l0 may be securely and detachably fastened to said side arms.

The side arms M, l5 are bent downwardly at their outer ends'so as to form vertical lower por- .tions .20, .2! which are adapted to be secured to an operating table I6 of the type which has side tracting elements 36.

adjustment vertically and longitudinally of the operating table IS. The clamps 22, 23 are provided with thumb screws 25, whereby the side arms [4, l may be firmly clamped to the side rails IT, IS.

In order to hold the wound open and retain the internal organs of the body away from the field of operation of the surgeon, provision is made of a plurality of bendable retracting elements 25 which are adapted to be shaped manually as desired, and which are provided with elongated rigid upper horizontal base portions 26 adapted to selectively enter any of the radial apertures H of the ring 10.

Each of the base portions 26 is provided with a longitudinal row of apertures 21, whereby the locking pins 13 may be employed to lock the retracting elements 25 in any of a plurality of longitudinally adjusted positions within the radial apertures l i.

A modified type of retracting element 27a which may be supported by the ring I8 is shown in Fig. 5,

and comprises an upper horizontal base portion 28 having a downwardly-extending T-shaped arm 29 which i adapted to engage and hold the wound or the organs therein. The base portion 28 is adapted to be inserted in any of the radial apertures ll of the ring 10 and is provided with a longitudinal row of apertures 38, whereby said base portion may be locked in different adjusted positions by means of one of the locking pins l3.

If desired, provision may be made of a modified concavo-convex form of supporting ring 3| (Fig. 8) which is provided with horizontal edge portions 32 having radial apertures ll adapted to receive the side arms [4, i5. 3! may be shaped to conform closely to the curvature of the patients abdomen when it is supported with its concave side downwardly as shown, while in other cases it may be applied in an inverted position, in accordance with the various conditions which may arise.

In Figs. 6 and '7 another modified supporting ring 33 is shown which is similar to the ring (8, but which is also provided with a plurality of radially-extending cylindrical apertures or bores 34 adapted to slidably and rotatably receive elongated cylindrical base portions 35 of bendable re- In order to adjustably secure the retracting elements 36 in the ring 33, provision is made of knurled set screws 31 which are adapted to be engaged in a plurality of vertical tapped aperture 38, intersecting the radial apertures 34.

Under some circumstances it may be desirable to support the retracting elements at different levels, as for example in performing operations closely adjacent the chest, in which some of the retracting elements may necessarily be held above the chest while others, in order to be effective, must be held at a lower level, adjacent a sagging abdomen. In such circumstances the surgeon may make use or" a pair of half rings 39, 40 (Figs. 9 and 10) which are supported respectively by the side arms [4, I5 and by a corresponding pair of side arms M, 42. It will be understood that The supporting ring 1.

additional clamps 22, 23 will be provided for holding the side arms 4|, 42 upon the side rails l1, [8.

Each of the half rings 39, 40 extends slightly more than degrees so that a pair of the radial apertures II will be diametrically opposed and will thus permit said half rings 39, All to be secured to the side arms l4, l5, and M, 42, respectively. In other respects, the half rings 39, 40 may be identical to the supporting ring Ill, and will, in efiect, provide a single supporting ring, the different halves of which may be supported at different levels.

Fig. 11 shows a modified supporting ring 43 which is similar to the supporting ring H! with the further provision of a narrow, outwardlyextending upper flange M which has a series of radial slots i5 disposed around the periphery of said ring. A modified rake retractor 46, is adapted to be adjustably secured to the supporting ring 43 by means of a chain M which is of the ball and link type and which may be passed over the top surface of the ring 43, and then engaged in one of the slots 45 where it will be held by tension exerted by the retracting element 53.

In the event that it is desired to employ the improved surgical retractor in connection with an o erating table 48 which lacks side rails (Fig. 13), provision may be made of a trough 49 upon which the patient P will lie and which is provided with a pair of side rails 55, 5| to which the clamps 22, 23 will be applied for supporting the side arms l4, l5.

Manner of use In use, the retractor herein disclosed will be applied to the operating table 16 after the patient P has first been prepared for the operation and is resting on said table in the position indicated in Fig. l. The first step in applying the retractor will be to insert the side arms l4, 15 in the clamps 22, 23, which embrace the rails [7, l8, after which the upper ends of said side arms will be sprung apart so as to permit them to be inserted in an opposed pair of the radial apertures ll of the supporting ring 18, where they will be secured by means of a pair of the locking pins 13. The insertion of the side arms [4, 15 will be facilitated by having a certain degree of looseness in the clamps 22, 23, inasmuch as the thumbscrews 24 preferably will not be tightened until the supporting ring I 0 has been placed in the position which it will occupy during the operation. The supporting ring ID will not rest upon the patient but will be supported entirely by the side arms l4, 15. It will be understood that, if desired, the

side arms M, iii may be supplied in various horizontal lengths, whereby the supporting ring H1 may be mounted in eccentric positions with respect to the table l6.

After an incision has been made in the patients body, the retracting elements 25 will be inserted in the ring ID as desired, and secured by locking pins I l. Inasmuch as the retracting elements 25 are provided with a plurality of apertures 27, said retracting elements may be secured in vari ous positions in order to afford the desired support to the organs or to the edges of the open wound.

It will be understood that the retracting elements 25 may be inserted, removed, or adjusted at any time during the course of the operation, and if desired, may be bent or replaced with retracting elements which are longer or shorter, or of a different type, so as to suit the needs of the moment.

porting ring; 10 (Figs. 1 nds), with theexceptign that said half-rings -wi=llbe independently supported by -the-pa-irs ofside arms l4, l5, "and 4|, 42, respectively, and thus may be independently adjusted with respect to the operating table IS.

The modified supporting rings 3!, 33 and 43 (Figs. 6, '7, 8, and 11) may be mounted upon the operating table l6 by means of the side arms l4, 15 in the same manner as described above in connection with the supporting ring 10. The ring 3|, however, will be employed for holding: the desired retracting elements more closely adjacent concave or convex portions of the patients body, whereas the supporting ring 33 will permit the retracting elements 36 to be adjusted not onlylongitudinally, but also in an angular direction, as indicated in broken lines in Fig. 7.

The supporting ring 43 (Fig. 11) may be employed for holding the retracting elements 25 and 28, and is also adapted to support retracting elements such as the rake retractor 46 which will be adjustably secured by drawing the chain 41 over the upper surface of the ring 43, and then downwardly so that said chain will enter and be held at the desired point in one of the slots 45.

If the surgeon should be called upon to perform an operation when the only available operating table 48 lacks side rails, he will place upon said table a trough 49 having side rails 50, 5!, to which he will attach the side arms [4, l5 by means of the clamps 22, 23.

It will be noted that the invention herein disclosed provides a means whereby each of the retracting elements may be independently adjusted and held in a definite fixed position with-relation to the operating table l6, or to the trough 49 upon which the patient lies.

Thus, the retracting elements cannot accidentally change their position, and the force exerted by one retracting element will be independent of the force exerted by any of the other retracting elements. Consequently, the patient will be spared the shocks which are caused by accidental movements of retractors in contact with the peritoneum.

One advantage of the invention herein disclosed is that in most cases it will enable the surgeon to perform an operation with the aid of only one assistant, inasmuch as manually held retractors will be unnecessary.

While there have been disclosed in thisspecification several forms in which the invention may be embodied, it is to be understood that these forms are shown for the purpose of illustration only, and that the invention is not to be limited to the specific disclosures, but may be modified and embodied in various other forms without departing from its spirit. In short, the invention includes all the modifications and embodiments coming within the scope of the following claims.

Having thus fully described the invention, what is claimed as new, and for which it is desired to secure Letters Patent, is:

1. In a surgical retractor, a supporting ring,

means on said ring for mounting said ring" upon an operating table, a plurality of retracting elements, and means adjustably attaching said retracting elements to said ring in positions extending inwardly jrom said ring, said ringmounting means comprising side arms secured in opposite rad-ial'a-pertures providing in said inasaids de arms aving vert al po i s pr vided with clamps for adiu ifibl securing said arms to a support, said .ver ticalportions being vertically slidable in apertures in said clamps and rele'asably held by screws said clamps.

'f;2. In a surgical retractor, a supporting ring, means on said ring for mounting said ring upon an operating table, a plurality of retracting elements, and means adjustably attaching said retracting elements to said ring in positions ex tending inwardly from said ring, said attaching means for said retracting elements comprising a plurality of radial apertures in said ring, said retracting elements having base portions adapted to be secured in said radial apertures by locking pins entered through vertical apertures in said supporting ring and said base portions said ring mounting means comprising a pair of angular members having horizontal arms adjustably secured in opposite radial apertures of said ring and vertical side arms provided with clamps for attaching to the sides of said table.

3. In a surgical retractor, a supporting ring, means on said ring for mounting said ring upon an operating table, a plurality of retracting elements, and means adjustably attachin said retracting elements to said ring in positions extending inwardly from said ring, said attaching means for said retracting elements comprising a plurality of radial apertures in said ring, said retracting elements having base portions adapted to be secured in said radial apertures by set screws engaged in tapped vertical apertures in said supporting ring and engaging said base portions said ring mounting means comprising a pair of angular members having horizontal arms adjustably secured in opposite radial apertures of said ring and vertical side arms provided with clamps for attaching to the sides of said table.

4. In a surgical retractor, a supporting ring, means on said ring for mounting said ring upon an operating table, a plurality of retracting elements, and means adjustably attaching said retracting elements to said ring in positions extending inwardly from said ring, said attaching means for said retracting elements comprising an outwardly-extending slotted peripheral flange on said ring, said retracting elements having chains adapted to be engaged in slots in said flange.

5. The invention as defined in claim 1, including a trough adapted to support the patient, and provided with opposite side rails, said clamps being attached to said side rails.

6. In a surgical retractor, a supporting ring having a plurality of radial apertures, a plurality of retracting elements engaged in some of said apertures, a pair of side arms engaged in a diametrically opposed pair of said apertures, means securing said retracting elements and said side arms in said apertures, said side arms comprising vertical end portions adapted to overlap a pair of opposite side rails upon an operating table, a pair of clamps having intersecting horizontal and vertical channels loosely embracing said vertical side arm portions and adapted to embrace said rails, and set screws in said clamps for clamping said rails and said vertical end portions together.

DAVID P. SMITH.

(References on following page) REFERENCES CITED Number Name Date Van Meter May 9, 1893 Crossley June 26, 1917 Number 8 Name Date Morris May 17, 1921 McCrory et a1 Dec. 20, 1921 Langworthy May 18. 1926 Stein Jan. 4, 1927 Straus Feb. 18, 1930 Kraus Jan. 11, 1949 Rozek Jan. 3, 1950

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