Surgical incision device

Abstract

A surgical retractor assembly and associated attachments are provided for assisting in a surgical procedure. The surgical retractor provides increased flexibility and ease of assembly. The surgical retractor includes, for example, two frame segments configured to be coupled together with a connector that allows one frame segment to be positioned vertically above the second frame segment and lowered onto the second frame segment such that the top surface of the second frame segment is received within the connector channel. Thus, the frame segments can be coupled together to form an adjustable frame.

Description

[Technical field]

[0001] FIELD OF THE DISCLOSURE This application relates generally to surgical retractors and associated attachments and connectors. [Background technology]

[0002] This section is intended to describe the background or context of the invention recited in the claims. The description herein may include concepts that could be pursued, but not necessarily previously conceived or pursued. Thus, unless otherwise indicated herein, what is described in this section is not prior art to the description and claims of this application, and is not admitted to be prior art by inclusion in this section.

[0003] Abdominal surgery in both emergency and elective settings requires adequate exposure of the abdominal contents in order for the surgeon to adequately visualize the area of ​​injury or disease. This is typically accomplished through the use of static metal retractors. Two of the most common retractor mechanisms currently in use are the Balfour retractor and the Bookwalter retractor. Each of these retractors exhibits advantages and disadvantages in their design and use. The Balfour retractor consists of a frame with metal blades mounted on a ratchet system that, when engaged, retracts the abdominal wall laterally, thereby exposing the abdominal contents and allowing the surgeon to operate. The Bookwalter mechanism consists of a support frame that is attached to the operating table, on which a rigid, non-adjustable metal ring is mounted, to which the retractor blades are then individually attached.

[0004] The Balfour retractor is perhaps the most commonly utilized abdominal retractor due to its simple design, ease of use, and rapid exposure of the abdomen, especially in trauma and emergency surgery situations where time is of the essence. Because the Balfour retractor does not require a metal frame to be attached to the operating room bed, as the Bookwalter retractor does, valuable time is not wasted and the retractor can be inserted immediately after the abdominal incision is made.

[0005] Despite the prevalence and availability of Balfour retractors in the operating room, there are several limitations to their use. For example, Balfour retractors provide inadequate abdominal exposure in large or obese patients. In larger or obese patients, the current design of the standard Balfour retractor often does not provide enough traction to adequately expose the abdomen. The frame from which the retractor blades extend is typically too short for larger or obese patients, resulting in suboptimal exposure, often necessitating a change to a different retractor system. Due to the inherently limited design of the Balfour retractor, the surgical incision is retracted along only one axis (lateral), limiting overall exposure of the wound. An optional additional retractor blade (bladder blade) can be attached, but this only applies downward traction, typically resulting in suboptimal exposure necessitating a change to a different retractor system.

[0006] A standard Balfour retractor does not provide an additional frame for mounting additional retractor blades, except for the single bladder blade. This significantly limits the ability to retract additional incisions or abdominal contents compared to other retractor mechanisms, thereby limiting surgical exposure. In addition, the Balfour retractor system generally presents significant problems during its use due to unintended movement and movement of the retractor blades along the edges of the surgical wound. The two retractor blades that provide lateral traction at the wound edge (or abdominal wall during abdominal surgery) often unintentionally move to either the top or bottom of the wound, causing rotation of the entire retractor mechanism and loss of traction at the wound edge, necessitating either time-consuming repositioning of the retractor or changing to a different type of retractor system. This is particularly common in large or obese patients and in situations where the Balfour retractor system is significantly expanded for use with larger wounds or surgical openings. Simply put, the inadequacies of the Balfour retractor system are magnified as the system is adjusted for larger wounds.

[0007] The Bookwalter retractor is a retractor system that is typically used when the Balfour retractor system is deemed insufficient or ineffective. The Bookwalter retractor consists of a supporting metal rod that is attached to a side rail on the operating table by non-sterile personnel in the operating room after the patient is anesthetized (the rails on the operating table are not considered part of the sterile surgical field). A second metal arm is then attached to this supporting rod, and then a rigid circular or oval metal ring is attached to the second metal arm. Once this is in place, the individual retractor blades can then be attached, using the rigid ring for support.

[0008] Despite the popularity of the Bookwalter retractor, it also presents some limitations. The Bookwalter retractor mechanism involves fixation to the operating table requiring installation by non-sterile personnel in the operating room. At times, this can pose concerns in maintaining a sterile field, as the surgeon may need to place his or her hands under a sterile barrier to assist and properly position the retractor arms. In addition, the multiple arms that require setup before surgical traction can be obtained require significant time for instrument setup, making the system inadequate for emergency situations or procedures where time is critical. The circumferential rings used in the Bookwalter system are not expandable, often limiting the placement of additional retractors in both the longitudinal and lateral axes. In addition, the fixed dimensions of the rings do not allow for adjustment of traction according to the individual physical characteristics of each patient and the various types and dimensions of wounds or incisions. The Bookwalter system also requires frequent repositioning by the surgical team during its use. After the Bookwalter system is set up and attached to the bed frame, thereby fixing the ring system in place, additional retractors are attached. However, as the surgery progresses and surgical exposure requirements change, the system needs to be repositioned to place the static non-expandable ring in the correct location. This requires interruption of the surgery, removal of the retractor blades, repositioning the ring, and reattachment of the retractor blades, again requiring significant time. There is an existing need for additional retractor systems. Summary of the Invention

[0009] In some embodiments, the surgical retractor assembly may include a first frame segment including a central portion disposed between a first end and a second end. The surgical retractor assembly may further include a second frame segment including a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface. The surgical retractor assembly may further include a pair of connectors, the pair of connectors configured to couple the first frame segment to the second frame segment. Each of the pair of connectors may include a ratchet housing for connecting one of the pair of connectors to one of the ends of the first frame segment. A channel is formed in the ratchet housing, the channel shaped to receive an upper surface or a lower surface of one of the end portions of the second frame segment. The ratchet fastener is configured to hold one of the end portions of the second frame segment within the channel. Thus, for example, a surgical retractor assembly may include frame segments that may be vertically stacked on one another and coupled together. When coupled together, the frame segments may define an adjustable frame that may be expanded or contracted to aid in visualization of a patient's wound or incision. For example, in one preferred embodiment, the channel of a pair of connectors may be configured to receive a top surface of an end portion of a second frame segment when the pair of connectors is vertically stacked on top of the second frame segment and lowered so that the end portion of the second frame segment is received within the channel. This, among other things, allows the frame segments to be coupled together without the surgeon having to step back or lean back from the operating table in certain situations where a first frame segment has already been used in a medical procedure.

[0010] In some embodiments, the surgical retractor assembly may include a first frame segment including a central portion disposed between a first end and a second end, and a second frame segment including a middle portion and a pair of end portions protruding from the same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface. The surgical retractor assembly may further include a pair of connectors configured to couple the first frame segment to the second frame segment to form a retractor frame, and at least one blade assembly. The at least one blade assembly may include a blade including a forward blade surface, the forward blade surface configured to be positioned adjacent a tissue wall of the wound or incision. The surgical retractor assembly may further include at least one blade block configured to attach the at least one blade assembly to the retractor frame, the blade block configured to selectively direct the forward blade surface toward the tissue wall. Thus, the surgical retractor assembly can be more easily formed into a frame in an emergency while avoiding inadvertent damage to the patient's tissue if the blade is accidentally placed away from the tissue wall.

[0011] In some embodiments, the surgical retractor assembly may include a first frame segment including a central portion disposed between a first end and a second end. The surgical retractor assembly may further include a second frame segment including a middle portion and a pair of end portions protruding from the same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface. The surgical retractor assembly may further include a pair of connectors, the pair of connectors configured to couple the first frame segment to the second frame segment to form a retractor frame. The first end of the first frame segment may be a portion of a substantially linearly extending first end portion, and the second end of the first frame segment is a portion of a substantially linearly extending second end portion. The first end portion of the first frame segment and the second end portion of the first frame segment extend from the same side of the central portion, and the first end portion and the second end portion are angled outwardly away from one another at an angle suitable to reduce the risk of racking when expanding the retractor frame.

[0012] In some embodiments, a surgical retractor assembly can include a first frame segment, a second frame segment, and a pair of connectors for connecting the first frame segment to the second frame segment during assembly of the retractor frame, the surgical retractor assembly including the first frame segment having a middle portion, a first end portion, and a second end portion, the middle portion being disposed between the first end portion and the second end portion, the first end portion and the second end portion protruding from the same side of the first middle portion, and the second frame segment, , a second frame segment having a middle portion, a first end portion, and a second end portion, the middle portion being disposed between the first end portion and the second end portion, the first end portion and the second end portion protruding from the same side of the first middle portion, and the pair of connectors including a first connector configured to couple to the first end portion of the first frame segment and a second connector configured to couple to the second end portion of the first frame segment, each of the pair of connectors having a channel configured to receive an end portion of the second frame segment when the end portions and the channel are aligned substantially parallel to one another and vertically overlapped. [Brief description of the drawings]

[0013] [Figure 1] 1 is a perspective view of an embodiment of a surgical retractor shown assembled in an expanded configuration. [Diagram 2] 2 is a top view of the surgical retractor of FIG. 1 shown assembled in an expanded configuration. [Diagram 3] 2 is an underside view of the surgical retractor of FIG. 1 shown assembled in an expanded configuration. [Figure 4] FIG. 2 is a perspective view of the surgical retractor of FIG. 1 assembled in a collapsed configuration. [Diagram 5] 1 is a top view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 6]1 is a bottom view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 7] 1 is a perspective view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 8A] 13A-13C illustrate an embodiment of a frame segment of a surgical retractor, showing the connection between the segment and a connector or ratcheting subassembly. [Figure 8B] FIG. 8B illustrates the end of the frame segment shown in FIG. 8A, showing a rigid connection between the segment and a connector or ratcheting subassembly. [Figure 9] 1 is a top view of an embodiment of a frame segment of a surgical retractor. [Figure 10] 10 is a bottom view of the frame segment shown in FIG. 9 . [Figure 11] FIG. 10 is a perspective view of the frame segment shown in FIG. 9 . [Figure 12] 1 illustrates an embodiment of a surgical retractor kit. [Figure 13A] 13A-13D illustrate an embodiment of left and right ratchet subassemblies. [Figure 13B] Component diagram of the left ratchet subassembly shown in FIG. 13A. [Figure 13C] 13B is a perspective view of the left ratchet subassembly shown in FIG. 13A including a first view suitable for viewing the top side of the ratchet subassembly and a second view suitable for viewing the bottom side of the ratchet subassembly. [Figure 14] 1 illustrates an embodiment of connecting two frame segments together. [Figure 15] 15 is a close-up view of the ends of the two frame segments shown in FIG. 14 before the two frame segments are joined together. [Figure 16] 15 is a close-up view of the ends of the two frame segments shown in FIG. 14 after the two frame segments have been connected together. [Figure 17] FIG. 2 illustrates an embodiment of components used to construct a blade block. [Figure 18]FIG. 2 is a perspective view of the blade block oriented to show the upper side of the blade block. [Figure 19] FIG. 2 is a perspective view of the blade block oriented to show the underside of the blade block. [Figure 20] FIG. 20 is a plan view of the blade segment shown in FIGS. 18 and 19 . [Figure 21] 1A-1C illustrate embodiments of components used to construct a blade assembly. [Figure 22] FIG. 2 illustrates the blade assembly in a first orientation. [Diagram 23] FIG. 13 shows the blade assembly in a second orientation. [Figure 24A] FIG. 2 shows the blade block and blade assembly prior to connection of the components. [Figure 24B] FIG. 2 shows the blade assembly attached to the blade block. [Diagram 25] FIG. 1 is a top view of a blade assembly mounted in a blade block illustrating an embodiment for selectively limiting rotation of the blade assembly within the blade block, with a close-up view of the blade assembly mounted in the blade block annotated in relevant portions. [Figure 26A] FIG. 2 illustrates a blade assembly mounted in a blade block and rotated in a first orientation. [Figure 26B] FIG. 13 illustrates the blade assembly attached to the blade block and rotated to a second orientation. [Figure 27A] FIG. 2 shows a blade block positioned for attachment to a frame or frame segment. [Figure 27B] 13A-13C show a blade block during an intermediate stage in mounting the blade block to a frame or frame segment. [Figure 27C] FIG. 2 illustrates a blade block attached to a frame or frame segment. [Figure 28A] FIG. 2 illustrates a blade block attached to a frame segment in a first position. [Figure 28B] 28B illustrates the blade block of FIG. 28A actuated to move along the frame segment shown in FIG. 28A. [Figure 28C] 28B shows the blade block of FIG. 28A locked in a second position along with the frame segment shown in FIG. 28A. [Figure 29A] 1A and 1B are plan and perspective views of the frame assembled in a fully reduced configuration; [Figure 29B] 1A and 1B are plan and perspective views of an assembled frame in an intermediate expanded configuration. [Figure 29C] 1A and 1B are plan and perspective views of the assembled frame in a fully expanded configuration. [Figure 30A] 13A and 13B are plan and perspective views of the assembled frame in an intermediate expanded configuration and a ratchet button in the proper position to collapse the frame. [Figure 30B] 13A and 13B are plan and perspective views of the frame assembled in a fully collapsed configuration and the ratchet button in a locked position. [Diagram 31] 13A-13C illustrate alternative embodiments of frame segments of a surgical retractor. [Diagram 32] 13A-13C illustrate another alternative embodiment of a frame segment of a surgical retractor. [Diagram 33] 13A-13D illustrate an embodiment of a method for assembling a surgical retractor. [Figure 34A] 13A-13D illustrate embodiments of frame segments in which the end portions of the frame segments are slanted or angled, or the connectors include channels that are angled relative to the connector housing. [Figure 34B] 13A-13D illustrate embodiments of frame segments in which the end portions of the frame segments are slanted or angled, or the connectors include channels that are angled relative to the connector housing. [Figure 34C] 13A-13D illustrate embodiments of frame segments in which the end portions of the frame segments are slanted or angled, or the connectors include channels that are angled relative to the connector housing. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0014] As used herein, the following terms shall be understood to have the meanings indicated, unless the context otherwise requires. When an item is preceded by "a" or "an," it is understood to mean one or more of that item.

[0015] "Comprises" means including but not limited to. "Comprising" means including but not limited to.

[0016] "Having" means including, but not limited to. References to "right" and "left" are from the perspective of the patient lying supine and oriented to expose the patient's abdominal cavity.

[0017] The present disclosure relates to medical retractors, associated segments or arms of a retractor frame, attachments for use with medical retractors, and associated methods of making and using medical retractors. Attachment of the retractors described herein to an operating table or other support is not required, but may be an option for some embodiments, such that use of the retractors does not require the involvement of any non-sterile members of the surgical team or the retractors come into contact with any support structures that extend outside the sterile field surrounding the surgical opening or wound. Thus, the retractors are less likely to become contaminated and easier to maintain sterility during set-up and use of the retractor. The lack of a required, intrusive, fixed metal frame supporting the retractor increases the surgeon's mobility during surgery and allows for placement on both sides of the patient. Furthermore, in contrast to some other retractors that may be used without an intrusive metal frame, the retractors described herein minimize the risk of unintended movement and movement of the retractor blades along the edges of the surgical wound, thus solving a significant problem associated with other retractors in the prior art.

[0018] The retractors described herein are further configured to be easily and quickly deployed, making them applicable in emergency or time-sensitive situations. For example, in some situations, the retractor may be introduced during a busy medical procedure, such as by using one frame segment of a pair of frame segments (e.g., retracting tissue to expose a surgical opening) and coupling the other frame segment to the frame segment in use without interrupting the ongoing surgical procedure. Certain features of the retractor, including but not limited to the type of connector used, the relative size and shape of the frame segments, and the configuration of the associated blade block, may help facilitate use of the retractor in this manner.

[0019] For example, a retractor may be assembled with a pair of frame segments by placing the ends of one frame segment over the ends of another frame segment such that the ends of the two frame segments are aligned generally parallel to one another but offset in different vertical planes, and then lowering one frame segment onto the other to engage the segments together using one or more connectors, such as, for example, snap-fit ​​connectors. This simplifies assembly of the frames without interfering with ongoing surgical procedures, even in situations where one of the frame segments may need to be positioned under one or both arms of the surgeon. For example, one frame segment may be fitted with one or more blades positioned so that they can be used to grasp the free end of a wound or incision from a side located away from the surgeon (e.g., on the opposite side of the operating table from which the surgeon stands). The one or more blades may be used, for example, to retract tissue to assist the surgeon in reaching the wound or incision so that the surgeon can perform a medical procedure, such as clamping an artery to help prevent bleeding. The other of the pair of frame segments can then be placed under one or both of the surgeon's arms without interfering with the surgeon, and the two frame segments are engaged to form a working frame.

[0020] It should be appreciated that in this design, as also described in connection with FIGS. 14-16, the frame segment that is placed under the surgeon's arm or arms need not be placed adjacent to the other frame segment in an end-to-end manner for engagement (i.e., with the ends of each frame segment aligned in approximately the same vertical plane so that the ends of each frame segment can be threaded through one or more holes or lumens in the connector) as is the case with some other prior art retractors. Notably, assembly of such a retractor requires less space under the surgeon's outstretched arm than does this alternative end-to-end attachment. In some embodiments, the width of at least one of the frame segments may be further selected to further aid in retractor assembly. For example, in some embodiments, the frame segment that extends under the surgeon's arm may feature a smaller width than the other frame segment. Once the frame segments are connected to form a frame, the frame may be adjusted. For example, the frame may be adjusted using a ratcheting or other mechanism to move the end portions of the two frames relative to one another while the end portions are aligned in a generally parallel relationship relative to one another.

[0021] The retractor blades described herein may be preloaded into either or both of the frame segments. That is, the retractor blades may be attached to the frame segments before the frame segments are joined together. For example, one or more blade blocks or other attachments may be coupled to the frame segments such that the frame segments may receive one or more retractor blades. Advantageously, the retractor blades may be held within one or more blade blocks in such a manner that the retractor blades may be rotatably adjusted to grip the incision or wound wall at an appropriate angle, such as an angle desired to provide the appropriate tension to hold the wound or incision site wall and aid in visualization. However, the blades may be selectively limited in rotation such that the blades are automatically oriented at least generally in the appropriate orientation during assembly of the retractor, thereby facilitating rapid use of the device. For example, as further described in more detail in connection with FIG. 25, the blade blocks may include ribs or other features (e.g., mechanical stops) to selectively limit the rotation of the retractor blade posts within the blade block holes. The stop can automatically orient the blade to prevent the blade from rotating so that the leading edge of the blade does not properly face the tissue wall that it is intended to engage. Thus, the surgeon or surgical staff does not have to spend time manually adjusting the position or orientation of the blade during assembly of the retractor. Inadvertent damage to adjacent tissue near the wound or incision site, as may occur if the blade is incorrectly rotated during insertion, can also be avoided. Furthermore, in some embodiments, the mechanical stop or rib can help prevent changes in the angle of the blade that may accompany inadvertent movement of the retractor around the wound. Thus, the rib or stop can be shaped to minimize the risk of damage to tissue during initial setup or assembly of the retractor, or to help prevent inadvertent movement of the retractor around the edges of the wound during the surgical procedure, or both.

[0022] The retractors described herein further include certain modifications to substantially eliminate the risk of racking or jamming during assembly of the retractor, including when expanding or contracting the frame. For example, in some embodiments, a connector may be rigidly attached to one member of a pair of frame segments used to form the frame. The connector may be, for example, welded or otherwise secured to one of the frame segments to substantially eliminate any movement between the connector and its frame segment. This stabilization may help reduce misalignment between the frame segments when expanding or contracting the frame. In some embodiments, the frame segment may be received within a channel of the connector. The channel and the frame segment may include one or more features that are complementary in shape to help guide the installation of the frame segment within the channel and to guide the sliding motion therebetween to substantially eliminate the risk of racking. For example, the channel may include a groove formed in the channel and the frame segment may include a ridge shaped to sit within the groove, or vice versa. In some embodiments, the channel may be widened to increase the contact surface area between the channel and the frame segment received therein. Additionally, in some embodiments, the frame segments may be shaped with an outward slope or angle to further help substantially eliminate the risk of racking.

[0023] In some embodiments, the retractor may be made of a lightweight yet sturdy material to facilitate handling by personnel operating within the sterile field, such as surgeons and operating room technicians. Notably, the lighter the material, the less tension that must be applied to the incision to counteract the weight of the retractor to help prevent the retractor from inadvertently sinking downward into the patient's wound or surgical opening. In some embodiments, the retractors herein may contain or be made of titanium, carbon fiber, carbon fiber reinforced thermoplastic, or thermoplastic. For example, suitable thermoplastic materials for some embodiments of the retractors described herein include polycarbonate, polypropylene, polyethylene. In some embodiments, one or more openings, holes, or recesses may be configured in the frame segments. The openings or holes may give the segments a unique shape. The openings, holes, or recesses may further reduce the amount of material used to make the frame segments, reducing the weight of the frame segments. These and other advantageous features that may be included in some of the various embodiments herein are further described below.

[0024] For example, various embodiments of the retractor 10 are described in connection with Figures 1-4, which show the assembled surgical retractor 10 in an expanded (Figures 1-3) and contracted (Figure 4) state as it would be used to visualize an incision or wound on a patient. The retractor 10 may comprise a frame including at least two frame segments 12, 14. For example, the first frame segment 12 may comprise a first end portion 16 and a second end portion 18, respectively, which are connected via a central or intermediate portion 20 and curved portions 15, 17. The second frame segment 14 may comprise a first end portion 22 and a second end portion 24, respectively, which are connected via a central or intermediate portion 26 and curved portions 23, 25. When the retractor 10 is in the assembled configuration, the first frame segment 12 may be coupled to the second frame segment 14 to define an adjustable frame. When assembling the frame, the first connector 28 may be used to connect the end portion 16 of the first segment 12 with the end portion 22 of the second segment 14. Similarly, the second connector 30 may be used to connect the end portion 18 of the first segment 12 with the end portion 24 of the second frame segment 14.

[0025] For example, in some embodiments, connectors 28, 30 can each include a channel 82 (shown in FIG. 13C ) that is aligned along the longitudinal axis (A L 2 and 3, the longitudinal axis (A) of the end portion 24 is aligned substantially parallel to the longitudinal axis (A). L) is shown aligned with channel 82 (the channel is hidden from view in FIG. 3 but is generally positioned as indicated by the associated arrow). Channel 82 may, for example, be at least partially formed within the housing of connectors 28, 30 (best shown, for example, in FIG. 13C ) and shaped to receive top surface 21 a of end portion 24 of frame segment 14. A user may, for example, activate one or more buttons or locks on connectors 28, 30 to provide access to the channel so that end portion 22, 24 may be inserted and nested within the channel. Upon receiving end portion 22, 24 within the channel, the connector may snap into place or otherwise provide an audible or tactile indication of connection. Thus, connectors herein may snap-fit ​​segments 12, 14 together. An audible or tactile indication of connection may be particularly useful in situations where, for example, a surgeon is already engaged in a surgical procedure and a member of the surgical team is tasked with engaging one frame segment with another.

[0026] Notably, this may occur when the connectors 28, 30 (e.g., connectors that may already be coupled to the first frame segment 12) are vertically superimposed onto the end portions 22, 24 of the second segment 14 to receive the upper surfaces 21 a, 21 b, and the segments 12, 14 are snapped together. This procedure may be contrasted with other procedures, such as those that may require the ends of the arms to be threaded through separate holes or lumens in the connector (e.g., end-to-end manner for engagement of the frame segments). Such end-to-end manner of engagement may require more space than may be available when the surgeon is already engaged in the medical procedure. For example, this manner of engagement may require the attending surgeon to step off or lean back from the operating table during assembly of the frame so that space is available to position the frame segment so that the ends of the frame segment can be aligned with the openings of the connector. In some embodiments, the width of at least one of the frame segments may be further selected to further aid in assembly of the frame. When coupled together, the connectors 28, 30 can be slidably moved across the end portions 22, 24 during adjustment of the frame and can be held in a selected configuration using a ratcheting mechanism. Typically, the connectors 28, 30 can engage the end portions 22, 24 anywhere along substantially the entire length of the end portions 22, 24, making engagement of the segments easier and faster. Thus, the connectors 28, 30 can be particularly adapted to quickly connect the frame segments 12, 14 together, and the width of the segments 12, 14 (e.g., the end portions 22, 24 of the frame segment 14 may be embodied with a relatively extended length and the end portions 16, 18 of the frame segment 12 may be shorter) configured to further assist a user in assembling the frame.

[0027] The retractor 10 may be characterized as defining a frame that comprises two frame segments 12, 14 when the segments 12, 14 are joined together. The frame may define an enclosed area configured to provide access to a wound or incision site. The frame may be described as having a perimeter that may be adjusted to tailor the dimensions of the frame as may be appropriate for a given procedure. For example, the frame shown in Figures 1-4 may define a generally rectangular shape with an adjustable axis and a fixed axis. When a frame comprises an adjustable axis and a fixed axis, reference may be made to a length and a width of the frame. The length of the frame may be characterized as the distance along the fixed axis. The width of the frame may be characterized as the distance along the adjustable axis. Thus, in this characterization, the width of the frame may be greater in extent or less in extent than the length of the frame depending, for example, on whether the frame is in a contracted or expanded state. As used herein, a generally rectangular shaped frame does not exclude curved edges at the corners of the frame.

[0028] Each of the first and second frame segments 12, 14 may have teeth along one or more edges and / or ridges or grooves along one or more faces. For example, with reference to FIGS. 2 and 3, the first frame segment 12 may have teeth 32 on its outer edge. Similarly, the second frame segment 14 may have teeth 34 on its outer edge. In some embodiments, the teeth 32, 34 may be provided on the inner edges of the frame segments 12, 14, or ridges or grooves may be provided on one or more faces of the frame segments 12, 14. One or more blade blocks 36 or other attachments may be adjustably positioned along the frame segments 12, 14. For example, the blade block 36 may be configured to move along the teeth 32, 34 of a ratcheting mechanism, or the blade block 36 may be disengaged from the teeth 32, 34 to allow the blade block 32 to slide along the frame. In other embodiments, rather than moving on the teeth 32, 34, the blade block may move over a groove, ridge, or another suitable structure to allow for adjustable positioning.

[0029] The frame segments 12, 14 can be connected to one another using connectors 28, 30. For example, the connectors 28, 30 can include a ratchet mechanism that interacts with ratchet teeth 38 to adjustably secure the frame segments 12, 14 in a selected position and allow for expansion and contraction of the frame. In some embodiments, a directional ratchet can allow a portion of the frame to move in one direction resulting in expansion of the frame, and resist or not allow movement in the opposite direction, i.e., contraction or shrinkage of the frame. In some embodiments, one or more of the connectors 28, 30 can be configured to allow a retractor blade or other attachment to be positioned on the connector 28, 30 or on an adjacent wing portion. For example, the connector 28 can include wings 40 that are appropriately shaped to receive a standard Bookwalter attachment or other attachment. For example, as shown in FIGS. 34A-B (showing a left connector 30 and associated wing 42), a Bookwalter attachment 35 may be positioned on a wing 42. The wing 42 may be shaped such that the vertical height of the wing 42 relative to the top of the frame connector 30 allows a user to access one or more Bookwalter adjustment levers 31 on the attachment 35 even when the attachment 35 is positioned adjacent "across" from the connector 30. Thus, a Bookwalter blade 33 or other attachment may be flexibly positioned about the frame, including, for example, at the midpoint of any side of the frame, including an adjustable side of the frame. Notably, being able to position an attachment at the midpoint of a side of the frame may be particularly useful, as this position may be used to help provide adequate visualization of internal tissues in larger incisions, which may be particularly useful for procedures performed on large or obese patients.

[0030] Of note, for some frames in some states of expansion, the connectors 28, 30 may be located near or at the midpoint of the frame. Some embodiments herein with wings 40, 42 may still allow a user to place a blade or other attachment at approximately the midpoint of the frame by providing the flexibility to connect an attachment either along the wings 40, 42 or at some other location on the frame, such as alternative locations A, B shown in FIG. 34A. That is, depending on the level of frame expansion required, the user can move the blade to either location A or location B such that the blade can always be located approximately at the midpoint of the frame.

[0031] In some embodiments, the wings 40 may be shaped such that an attachment may be placed on the wings 40 and a separate blade block 36 or other attachment may be mounted near or below the wings 40 on the lower portion 22 of the frame segment 14. In some embodiments, the wings 40 may be vertically offset from the end portion 22 to accommodate placement of an attachment near or even directly below the wing attachment. For example, at least a portion of the wings 40 may be angled to place the wings 40 above the lower portion 22, or the wings 40 may extend from the connector 28 at a height offset from the lower portion 22. This configuration may be particularly advantageous for complex surgical procedures where multiple attachments may be necessary to properly visualize tissue, illuminate tissue, or perform some other function. Similarly, the connector 30 may include similar wings 42 configured to engage the attachments. In some embodiments, the connectors 28, 30 may be connected to the frame segment 12 using a frame that does not include wings. In some embodiments, the teeth 32, 34 may extend around approximately the entire length of the frame, and the fame may be configured to accommodate one or more attachments along approximately the entire length of the frame. Embodiments in which multiple blade blocks 36 or other attachments may be placed on a given side of the frame may be particularly useful in sizing the retractor 10 for use with larger or obese individuals.

[0032] In some embodiments, either or both of the frame segments 12, 14 may have one or more expansion or retraction stops. The stops may be in the form of, for example, ridges, grooves, threads, pins, holes, or raised material that may contact or engage the connectors 28, 30 to stop movement of the frame segments through the connectors 28, 30. Thus, inadvertent disassembly of the retractor may be prevented. For example, the second frame segment 14 may include an expansion stop 46, 50. The second frame segment may further include a retraction stop 44, 48.

[0033] Various embodiments of the first segment 12 are further described in connection with FIGS. 5-7, which show the first segment 12 and a pair of connectors 28, 30 attached to the first segment 12 and having wings 40, 42. As shown in FIG. 5, the first segment 12 may be generally "C" shaped with a middle portion 20 disposed between two end portions 16, 18. The two end portions 16, 18 project from the same side of the middle portion 20 and extend such that the two end portions 16, 18 are substantially parallel to one another. In some embodiments, the two end portions 16, 18 may be slightly angled away from one another, such as at an angle of less than about 1.5 degrees. The term "substantially parallel" as used herein does not exclude the end portions being intentionally angled away from one another at such a small angle, which may be used to reduce the risk of racking when expanding or contracting the retractor frame as further described herein. For example, even with this small angle, the end portions of each of the frame segments 12, 14 are still designed to move relative to one another and maintain a generally parallel relationship relative to one another when the frame is expanded or contracted.

[0034] The first segment 12 may include one or more marks or visual indicators 52 for recommended placement of the blade block 36. For example, the visual indicators 52 may be spaced apart a recommended distance to allow the blade block 36 coupled to the visual indicator 52 to cooperate with a corresponding blade block 36 on the second frame segment 14 such that the surgical wound is stabilized in a manner that prevents unintended movement and movement of the retractor blade along the edges of the surgical wound. However, the retractor 10 may allow the user to place the blade block 36 at other locations along the frame segment 12. For example, in some embodiments, a central groove 54 may be provided on the upper side of the first segment 12, which aids in the placement and movement of the blade block 36. The visual indicators 52 and / or groove 54 may further aid in identifying the proper orientation of the frame segment 12. This may prevent the user from inadvertently attempting to assemble the frame in an incorrect orientation. The first frame segment 12 may comprise a first end portion 16 and a second end portion 18, respectively, with the two end portions 16, 18 being connected via a central or intermediate portion 20 and a curved portion 15, 17. The curved portion 15, 17 may be defined by a degree or level of curvature suitable for transitioning from the intermediate portion 20 to the end portions 16, 18. The degree of curvature may be selected to minimize the presence of sharp corners on the segments and to accommodate attachments at the curved portion. For example, in some embodiments, the curved portion 15, 17 may have a curvature such that a blade block 36 may be connected to the curved portion 15, 17. For example, in some embodiments, a user may slide the blade block 36 from the intermediate portion 20 to the curved portion 15, 17 without disengaging the blade block 36 from the frame segment 12.

[0035] In some embodiments, the end portions 16, 18 may be defined by a length of relatively straight section at the end of the first frame segment 12. In other words, the end portions 16, 18 may include a portion of the frame that begins where there is negligible curvature and extends to the end of the first frame segment 12.

[0036] In some embodiments, the length of the end portions 16, 18 may be minimized to reduce the overall width of the first frame segment 12 as a whole. This may be advantageous because the first frame segment 12 may be placed on top of the second frame segment 14 when the frame is assembled. Also, in some cases, this may be performed under the surgeon's arm in space-limited situations, etc. For example, in some embodiments, the end portions 16, 18 may include a mounting end surface, area, or tab to which the connectors 28, 30 may be coupled. Thus, the connectors 28, 30 may be coupled to the frame segment 12 directly adjacent the curved portions 15, 17. For example, the end portions 16, 18 may simply include a terminal tab to which the connectors 28, 30 may be coupled.

[0037] For example, Figure 31 illustrates an alternative embodiment of a first segment 220. As shown in Figure 31, the connectors 28, 30 may be coupled (e.g., fixedly or manually reversibly attached) to the first segment 220 using end tabs such that the connectors 28, 30 may be attached directly adjacent to the curved portion of the segment 220. In some embodiments, the connectors 28, 30 may be modified to be attached directly to the middle portion 20 without having a curved portion in between. For example, Figure 32 illustrates an alternative embodiment of a segment 320 in which the connectors 28, 30 are attached directly to both ends of the middle portion 20.

[0038] In some embodiments, the first frame segment 12, 220, 320 may have a length of approximately 20, 25, 30, 35, 40, 45, 50, 60, 65, 70, 75, or 80 centimeters in length, including all values ​​and ranges therebetween. In some embodiments, the length of the first frame segment 12, 220, 320 may be such that at least two blade blocks 36 may be coupled to the first frame segment 12, 220, 320. The blade blocks 36 may further be spaced apart a certain distance. For example, as shown in FIG. 1, a pair of blade blocks 36 are shown coupled to the first frame segment 12 and spaced apart along the length of the intermediate portion 20. The blade blocks 36 may be positioned on the frame segment 12, 220, 320, such as near the location of the visual indicator 52, such that the blade blocks 36 are spaced apart a recommended distance. Still referring to FIG. 1, another pair of blade blocks 36 may be coupled to the second frame segment 14. This additional pair of blade blocks 36 may also be spaced apart at the recommended distance. Thus, the frame may include two pairs of blade blocks with the blade blocks 36 located near the corners of the frame. The blade blocks 36 on each of the frame segments 12, 14 may cooperate to help prevent unintended movement and migration of the retractor blades along the edges of the surgical wound.

[0039] In some embodiments, the frame segments 12, 220, 320 may have widths of approximately 5, 7, 10, 15, 20, or 25 cm, including all values ​​and ranges therebetween. For example, in the frame segment 320, the minimum width of the segment may be limited solely by the width of the connectors 28, 30. For example, this width may be minimized to solve the problem of how to engage the first frame segment 12, 220, 320 with the second frame segment 14 when the surgeon is already engaged in a surgical procedure using the second frame segment 14 to retract tissue at the wound.

[0040] In some embodiments, the frame segment 12 includes a pair of connectors 28, 30 that may be fixedly connected to each end portion 16, 18. For example, as shown in FIG. 8A, the connectors 28, 30 (which in some embodiments are ratcheting connectors and may be referred to as a ratchet subassembly) may be assembled onto the frame segment 12 (which may also be referred to as an upper arm segment). The connectors 28, 30 may be welded along one or more joints (as shown in FIG. 8B) so that the connectors 28, 30 are securely attached to each end portion 16, 18. In such an embodiment, the connectors 28, 30 may be considered part of the frame segment 12. Alternatively, the connectors 28, 30 may be fixedly attached to the frame segment 12 in other ways, such as with an epoxy, adhesive, or some other suitable method, to provide a solid and reliable connection therebetween. Thus, in some embodiments, the connectors 28, 30 may be fixedly or rigidly connected to the ends of the frame segment 12, and the connectors 28, 30 may be configured to be manually reversibly connected to the second frame segment 14. Securing the connectors 28, 30 to one segment has been found to be particularly advantageous in helping to prevent misalignment of the frame segments when expanding or contracting the frame. This condition, which may be a common problem with other ratcheting systems, may be referred to as "racking" and may cause the ratcheting assembly to stall or jam, making it difficult to adjust the frame. In other embodiments, the connectors 28, 30 may be configured to be reversibly attached from both frame segments 12, 14, i.e., the connectors may be manually attached and detached from both frame segments 12, 14. Some of these embodiments may include one or more other features that help reduce the risk of racking.

[0041] Various embodiments of the second frame segment 14 are further described in relation to Figures 9-11. For example, as similarly described for the first frame segment 12, the second frame segment 14 may include one or more visual indicators 52 that indicate a position for a recommended placement of the blade block 36. Like the segment 12, the segment 14 may also allow for adjustable placement and movement of the blade block 36 on the segment 14. For example, the segment 14 may include a central groove 53 and side grooves 56, 58. The grooves 53, 56, 58 may facilitate sliding adjustment of the blade block 36 or other attachments connected to the segment 14. As an alternative to multiple grooves 53, 56, 58, the segment 14 may include a single groove (not shown), which may extend, for example, across each of the end portions 22, 24, the middle portion 26, and the curved portions 23, 25. Thus, in some embodiments, the retractor blade 36 may slidably move within the single groove along substantially the entire length of the second frame segment 14. As shown most clearly in FIG. 11, each of the end portions 22, 24 may have teeth 38 along one or more edges and / or ridges or grooves along one or more faces. For example, the teeth 38 may be formed on an inner surface of each of the end portions 22, 24. The retractor 10 may be adjusted in size by moving the connectors 28, 30 along the teeth 38 to move the frame segments 12, 14 relative to one another. In other embodiments, as opposed to moving on the teeth 38, the connectors 28, 30 may move over grooves, ridges, or another suitable structure to allow for adjustable dimensional adjustment of the frame.

[0042] In some embodiments, the frame segment 14 may have a length of about 20, 25, 30, 35, 40, 45, 50, 60, 65, 70, 75, or 80 centimeters, including all values ​​and ranges therebetween. In some embodiments, the frame segment may have a width of about 15, 20, 25, 30, 35, 40, 45, or 50 cm, including all values ​​and ranges therebetween. Notably, in this design, the frame segment 12 may have a width significantly different from the width of the second frame segment. For example, if the assembled frame is expanded to a substantial full width, such as about 60 cm, about 50 cm, about 40 cm, about 30 cm, about 25 cm, or other suitable width, at least a majority of this width may be provided by the second frame segment 14. This geometry can be particularly advantageous in some embodiments where the second frame segment 14 is attached to the wound or incision site before the first frame segment 12, because the narrower frame segment 12 can be easily passed under the surgeon's arm during assembly of the retractor. For example, in some embodiments, the width of the frame segment 12 can be about 75% or less, about 60% or less, about 50% or less, about 40% or less, or about 30% or less of the width of the second frame segment 14.

[0043] In some embodiments, various components of a surgical retractor, including, for example, associated blades and attachments, may be provided in the form of a surgical retractor kit. FIG. 12 illustrates an embodiment of components that may be part of a surgical retractor assembly. The components may be provided to a consumer as a kit including, for example, a first segment 12, a second segment 14, a blade block 36, and a retractor blade assembly 60. The connectors 28, 30 may be provided integrally connected to the first segment 12 or may be provided as separate components configured to reversibly couple to the first segment 12. Any number of attachments, such as the connectors 28, 30 and the blade block 36, may be provided. For example, the kit may include a group of four separate blade blocks 36, although other numbers of blade blocks 36 may be provided.

[0044] Various embodiments of the connectors 28, 30 are further described in relation to Figures 13A-13C. In some embodiments, the connectors 28, 30 may be configured to operate using a ratcheting mechanism. Thus, the connectors 28, 30 may alternatively be referred to as a left ratcheting subassembly and a right ratcheting subassembly. The two subassemblies may include a left and a right that may be substantially identical except that the two subassemblies may include diametrically opposed ratcheting housings. In this context, the designations "left" and "right" refer to a reference coordinate system with respect to a patient oriented supine to expose the abdominal cavity, with the first segment 12 and the second segment 14 each oriented to lie laterally across the patient. In this exemplary situation, the first segment 12 may be located in a superior direction "closer to the patient's head" relative to the second segment 14. Thus, the connector 28 may be located on the right side of the patient's body and the connector 30 may be located on the left side of the patient's body. Similarly, when used in this exemplary method, the first frame segment 12 may be referred to as the upper segment or upper arm, and the second frame segment 14 may be referred to as the lower segment or lower arm. However, the retractor 10 may be positioned differently, depending, for example, on the orientation of the incision or wound in the abdominal cavity and the surgeon's preference. For example, the first segment may be positioned along a longitudinal axis along a direction from head to toe of the patient, as opposed to being positioned laterally from right to left on the patient's body. Thus, the frame segments 12, 14 may be referred to as upper or lower arm segments. However, this terminology should not be construed to limit the segments as being suitable for use only in one particular orientation.

[0045] Using this reference coordinate system, the components of the "left" side connector 30 are shown in FIG. 13B. As shown in FIG. 13B, the connector 30 may include a ratchet actuator 62, a spring 64, a ratchet or connector housing 66, a dowel pin 68, a first compression spring 70, a slide lock 72, a second compression spring 74, a ratchet fastener 76, and a dowel pin 78. The spring 64 may be, for example, a torsion spring, a leaf spring, or some other suitable spring or element may be used. The ratchet fastener 76 may include, for example, a clamp, a brace, or a clasp. The "right" side ratchet may include similar components. FIG. 13C shows a perspective view of the "left" side connector 30 oriented to show both the top and bottom sides of the connector 30. As can be seen from the top perspective view, the connector 30 may include wings 42 to which a standard attachment, such as a Bookwalter attachment, may be attached. As shown in a bottom perspective view, the connector 30 can include a channel 82 including a feature 80, such as a ridge, adapted to mate with a groove 58 (shown on the end portion 24 of the frame segment 14) to allow the connector 30 to slide along the frame segment 14 when the frame is assembled and the ratchet is disengaged. Of course, the "right" side connector 28 can have similar components, except that the ratchet housing 66 can be shaped as a mirror image. In some embodiments, the feature 80 and groove 58 can allow the connector to only properly mate with the appropriate end portion or surface of the frame segment. To further help ensure that the appropriate end portion and connector are properly oriented to mate and / or mate, one or more surface markings can be provided on the connectors 28, 30 and one or more of the frame segments 12, 14. For example, in some embodiments, each of the connectors 28, 30 and end portions 22, 24 are marked or color coded to help guide the user to properly assemble the retractor frame. Although the above features have been described with the features 80 as ridges and complementary grooves 58, it should be understood that other complementary structures may be used.For example, feature 80 could be a groove and ridges could take the place of grooves 58 on end portions 22, 24. Mechanisms using connectors 28, 30 to couple first frame segment 12 to second frame segment 14 are further described, for example, in connection with Figures 14-16.

[0046] 14-16, the connectors 28, 30 may be used to couple the segments 12, 14 together during assembly of the frame. The connectors 28, 30 may also be used to disengage the segments 12, 14, for example, to remove the retractor from the wound or incision site. Notably, this may be done even in situations where reducing the frame prior to removal of the frame is not a viable option. During assembly of the retractor, if necessary (e.g., if the connectors are not already fixedly or otherwise attached to the first frame segment 12), the user may attach the connectors 28, 30 to the first frame segment 12. The user may then connect the segment 12 to the segment 14 by aligning each connector 28, 30 such that the channel 82 of each connector is overlapped with the appropriate end portion 22, 24 of the frame segment 14. For example, the right connector 28 may be aligned such that the end portion 22 of the frame segment 14 is approximately parallel to the long axis of the channel 82, allowing these structures to be overlapped. For example, the connector 28 may be lowered onto the top of the end portion 22, causing the structures to overlap. Of course, the user may instead overlap the connector 28 and frame segment 14 by raising the frame segment 14 so that the end portion 22 becomes seated within the channel 82, or both structures may be moved together. Similarly, the left connector 30 may be aligned so that the end portion 24 of the frame segment 14 is approximately parallel to the long axis of the channel 82 on the connector 30, allowing the structures to overlap. Importantly, engagement of the two frame segments 12, 14 may be accomplished by changing the relative vertical positions of the frame segments 12, 14, and does not require the two frame segments to be joined in an end-to-end manner (i.e., with the ends of each frame segment aligned in the same vertical plane) for engagement such that the ends of each frame segment may pass through one or more holes or lumens in the connector.

[0047] With the connectors 28, 30 aligned with respect to the end portions 22, 24, a user can slidably unlock the slide lock 72 to unlock the ratchet fastener 76. For example, the ratchet fastener 76 can be rotated (e.g., by the sliding action of the slide lock 72 and the actuation of a spring) as shown in FIG. 14 to open the channel 82 so that the end portion 22 can be placed in the channel 82 to couple the end portion 22 and the connector 28. That is, the ratchet fastener 76 can be rotated to allow the lower arm "frame segment 14" to nest within the connector 28. Similarly, the connector 30 can be coupled with the end portion 24 that is placed in the channel 82 of the left connector 30 (shown in FIG. 16). Once the end portions 22, 24 of the lower arm or frame segment 14 are placed in their respective channels 82 of the connectors 28, 30, a user can release the slide lock, which causes the ratchet fastener 76 to rotate to lock the segments 12, 14 together. In some embodiments, the ratchet fastener 76 may include a lip 90 or other suitable feature to help lock the end portions 22,24 within the channel 82 and to help hold the frame segments 12,14 together.

[0048] The connector 28 may be coupled to the end portion 22. For example, the connector 28 may be coupled to the end portion 22 near the distal end of the end portion 22 adjacent the expansion stop 46. However, the connector 28 may also be coupled to the end portion 22 at the proximal end of the portion 22 adjacent the retraction stop 44. Thus, advantageously, the segments 12, 14 may be coupled together in either a fully extended configuration, a fully contracted configuration, or some intermediate state. This may make assembly of the retractor easier, especially in situations where the surgeon may already be engaged with the patient and where the frame segment 12 must be inserted under the surgeon's arm before being coupled to the frame segment 14. For example, a member of the surgical team may be able to quickly adjust the position at which the frame segments 12, 14 are coupled together based on the position of the surgeon's arm, as opposed to moving the surgeon, so that the frame segments 12, 14 may be coupled together in the manner required.

[0049] 17-20 show an embodiment of the blade block 36 and associated components in various orientations. As shown in FIG. 17, the blade block 36 may include several components including, by way of non-limiting example, a pivot button 92, a torsion spring 94, a blade block housing 96, one or more compression springs 98, a push button 100, and dowel pins 102, 104. A leaf spring or other suitable element may be used in place of the torsion spring 94. FIGS. 18 and 19 show perspective views of the blade block 36 oriented to show the top side of the blade block of FIG. 18 and the bottom side of the blade block 36. During assembly or use of the retractor, a user may depress the pivot button 92 to release the blade block 36 from a locked position to allow adjustment of the blade block 36 around the circumference of the frame. For example, when the pivot button 92 is pressed, the biasing force biasing the teeth 32 or teeth 34 of either the frame segment 12 or the frame segment 14 against the corresponding grooves 93 (which may be formed in the blade block housing 96 as best shown in FIG. 19) may be removed, allowing the blade block 36 to move along the frame. In some embodiments, the blade block may include a ridge or other feature 120 appropriately shaped so that the blade block 36 may be attached to the frame only in the correct orientation, i.e., with the ridge 120 seated in one or more of the grooves 54 of the frame segment 12 or the grooves 53, 56, 58 of the frame segment 14. As shown in FIG. 20, the blade block 36 may include a visual indicator 122 to aid in proper placement of the blade along either the frame segment 12, 14. One or more features 124, such as a bump or ridge, may be configured to prevent free rotation of the blade post within the housing 96, as described in more detail in FIG. 25.

[0050] As further shown in FIGS. 17-20, the blade block 36 may include an opening 106 suitable for receiving a blade post 110 (e.g., the blade post 110 shown in FIGS. 21-23). ​​For example, a push button 100 may allow a user to raise and lower the retractor blade. With further reference to FIGS. 24A and 24B, the blade assembly 60 may be attached to the blade block 36 by inserting the blade post 110 into the opening 106. The push button 100 may be actuated to allow the blade post 110 to slide through the opening 106. Once the blade 114 is at a desired height, the user may release the push button 100 to lock the blade 114 in place. In some embodiments, the blade post 110 may include one or more grooves 130. For installation within the blade block housing 96, the blade post 110 may be vertically adjusted such that at least one of the grooves 130 is properly engaged within the opening 106. For example, in some embodiments, once the selected groove 130 is positioned within the opening 106, the user may be given an audible click or receive a tactile indication that the selected groove 130 is set. Alternatively, the groove 130 may provide a visual indication of the vertical position of the blade 114. Thus, in some embodiments, a particular vertical height of the blade 114 may be selected based on which of the one or more ridges 130 is selected. Because a particular vertical height of the blade 114 can be selected, blades at different locations on the frame may be set to the same vertical height or different heights. Thus, tension on the wound or incision walls may be more precisely controlled than in other retractors. For example, blades on opposing sides of the frame may be set to a constant vertical height such that the blades are at the same height. In some embodiments, grooves or other markings may be established to allow the user to easily make the blades on opposing sides of the frame at the same height, even if the frame segments to which the blades are attached are at different heights.For example, the grooves may be set in gradation units that match the height difference between opposing sides of the frame.

[0051] Various embodiments of the retractor blade assembly 60 are further described in connection with FIGS. 21-23. As shown in FIG. 21, the retractor blade assembly 60 may include a blade 114, a blade post 110, and a dowel pin 112. In some embodiments, the dowel pin 112 may act as an orientation feature to prevent incorrect insertion of the blade assembly 60 into the blade block 36. In some embodiments, the blade 114 may be welded to the blade post 110 or the blade 114, or the blade post 110 may be attached in some other manner. In some embodiments, the retractor blade assembly 60 may be configured to rotate through a controlled angle when the assembly 60 is attached to the blade block 36. For example, as shown in FIG. 23, the blade post 110 may include a flat potion shaped to form a surface that limits the rotation of the blade to an angle of about 90 degrees (45 degrees in each direction from the centerline as shown in FIG. 25), or the rotation of the blade may be limited to some other suitable angle. Blade 114 may be rotationally limited, for example, so that blade 114 may be automatically oriented at least generally in the proper direction during assembly of the retractor, thereby facilitating rapid assembly of retractor 10. For example, as shown in Figures 26A and 26B, retractor blade 114 may be rotationally limited to an angle of about 90 degrees or some other suitable angle. In some embodiments, retractor blade 114 may be rotationally limited in a range of about 120 degrees to about 60 degrees.

[0052] 27A-27C illustrate embodiments of mechanisms by which the blade block 36 may be attached to a frame segment. For example, as shown in FIG. 27A, the blade block 36 may be positioned on the frame, such as near a recommended attachment point that may be indicated by one or more of the visual indicators 52 provided on a given frame segment 12,14. The visual indicators 52,122 (not visible from the side view shown in FIG. 27A) may provide an indication as to how to orient the blade block 36 for attachment. For example, if the blade block 36 is oriented such that the "T" on the visual indicator 122 is aligned to overlap with the corresponding "T" on the visual indicator 52 of the frame, a user may recognize that the blade block is properly oriented for attachment. As shown in FIG. 27B, the blade block 36 may be angled relative to the frame segment 12,14 to which it is attached, such that the frame segment 12,14 is inserted within the inner shelf of the blade block 36. The blade block 36 may then be rotated into place. Without actuating the pivot button 92 (e.g., releasing the pivot button 92), the blade block 36 will snap into place on the frame. As shown in FIG. 27C, when properly assembled, the ridge 120 on the blade block 36 may nest into a groove or slot on the frame segment to which the blade block 36 is attached. For example, groove 54 is shown in FIGS. 27A-C. When properly assembled, the lip 122 may help hold the blade block 36 on the frame. Specifically, if the blade block 36 is incorrectly assembled, such as backwards, upside down, or in an incorrect position, the lip 122 will not properly engage the frame and the blade block 36 will not lock into place.

[0053] In some embodiments, the blade block 36 may be positioned around the frame. Figures 28A-C show an embodiment of how the blade block 36 may be adjustably positioned on the frame or frame segment 12, 14. Figure 28A shows the blade block 36 in one possible initial position attached to the retractor frame or individual frame segment. For example, as shown in Figure 28A, the blade block 36 is shown attached to the frame segment 14. As shown in Figure 28B, the pivot button 92 may be actuated and the blade block 36 may be moved in a direction to disengage the teeth 34 from the corresponding grooves 93 (more clearly shown in Figure 19). This may provide clearance for the blade block 36 to be slid along the frame to a desired position. Notably, in this action, the blade block 36 does not need to be removed from the frame. As shown in Figure 28C, once the blade block 36 has been moved to the desired position, the pivot button 92 may be released to re-engage the teeth 34 with the grooves 93 to lock the blade block 36 in place.

[0054] Advantageously, the surgical retractor 10 may be initially placed on the incision in either a fully contracted state, an intermediate expanded state, or a fully expanded state. The frame may then be expanded and contracted as needed during the surgical procedure. For example, as shown in FIGS. 29A-C, the retractor 10 may be assembled in a nearly fully contracted position as shown in FIG. 29A. To adjust the frame, the user may, for example, hold the upper and lower arms (i.e., the first frame segment 12 and the second frame segment 14) and expand the frame outward. In this approach, the connectors 28, 30 may be disposed along the end portions 16, 18 of the first frame segment 12 and further coupled to the respective end portions 22, 24 of the second frame segment 14. When expanding the frame, the connectors 28, 30 may slide along the lengths of the end portions 22, 24 that lie along substantially parallel first and second axes. In this design, the connectors 28, 30 move together along the end portions 22, 24 to maintain relative alignment between one another. The retractor 10 can include any number of design features that help prevent any type of misalignment that may cause the frame to rack (e.g., where the frame may unexpectedly lock into place).

[0055] In some embodiments, the risk of racking is minimized by the method of coupling between the connectors 28, 30 and the end pieces 22, 24. For example, the connector 28 may include a ridge or other feature 80 that rides along the groove 56. Similarly, the connector 30 may include a ridge or other feature 80 that rides along the groove 58. More generally, the connectors 28, 30 include a channel 82 that includes one or more features that are complementary in shape to corresponding features on the end pieces 22, 24 to constrain the end pieces 22, 24 within the channel 82 and help prevent the end pieces 22, 24 from twisting in response to any jarring motion on the frame that may otherwise inadvertently misalign the frame segments 12, 14. That is, the end pieces 22, 24 may be held rigidly in the channel where they are constrained, and held in a complementary shaped groove or ridge within the channel. The channel 82 itself may be sized to help prevent racking. For example, in some embodiments, the channel 82 may be at least about 2 cm, 4 cm, 6 cm, 8 cm, or about 10 cm long to provide a significant contact area between the connectors and the end pieces 22, 24. The increased contact area within the channel helps to maintain the end pieces 22, 24 and connectors 28, 30 in the necessary alignment to minimize the risk of racking.

[0056] In some embodiments, the risk of racking may be minimized by rigidly connecting the connectors 28, 30 to the frame segments 12. Thus, relative movement between the connectors 28, 30 and the ends 16, 18 to which they are attached may be greatly reduced or nearly eliminated. In some of these embodiments, the connectors 28, 30 themselves may be rigidly connected, since the frame segments 12 themselves are rigid, and each connector 28, 30 may be welded or otherwise rigidly secured to the frame segments 12. This rigid design may help to minimize the effects of warping and / or any curvature of the frame, to help promote smooth sliding of the frame during adjustment and to help prevent misalignment of the frame that may cause racking.

[0057] In some embodiments, one or more of the end portions of either or both of the frame segments 12, 14 may be tilted or angled so that the end portions (16, 18 and / or 22, 24) are not perfectly parallel to one another. For example, in some embodiments, the end portions 16, 18 may be configured with a slight outward angle to angle the connectors 28, 30 (attached to the end portions 16, 18) away from one another. This angle is not so great as to significantly impede the expansion or contraction of the frame. However, the outward angle of the end portions 16, 8 creates a force between the connectors 28, 30 and the end portions 22, 24 of the second frame segment 14 (when these end portions 22, 24 are received within the channels 82 of the connectors 28, 30) that substantially reduces the risk of misalignment and racking of the frame. For example, when the end portions 22, 24 are installed within the connectors 28, 30, a biasing force may be provided between the end portions 22, 24 and the channel 82 to counteract jarring forces in the frame that may otherwise inadvertently misalign the frame segments 12, 14. Alternatively, as described below, the angle between the channel 82 and the end portions 22, 24 received therein may provide a biasing force that tends to reduce stresses caused by frame misalignment to help minimize the severity of racking. For example, this biasing force may tend to realign the frame segments when a user expands or contracts the frame.

[0058] For example, as shown in FIG. 34A, the outward tilt for the end portions 16, 18 may be characterized by angles A1, A2. Angle A1 denotes the angle between an axis parallel to the mid-portion 20 of the frame segment 12 and the connector 30. Angle A2 denotes the angle between an axis parallel to the mid-portion 20 of the frame segment 12 and the connector 28. In general, even small positive angles A1, A2 may act to significantly reduce the risk of racking. For example, in some embodiments, angles A1, A2 may be approximately the same and range from about 90.05° to about 90.65°, respectively. In other embodiments, angles A1, A2 may range from about 90.10° to about 90.60°, or from about 90.15° to about 90.55°, or from about 90.18° to about 90.38°, respectively. In the embodiment shown in FIG. 34A, angles A1 and A2 are shown relative to the entire connector, so that channel 82 (which is generally parallel to the connector housing) is disposed at the same angle relative to the mid-portion as the entire connector housing is disposed. However, in some embodiments, the connector may be configured such that channel 82 formed in the connector is angled relative to the connector housing. In this case, simply angling channel 82 so that it has an outward slope (without angling the end portion to which it is attached) would produce a similar effect to that which would be obtained in the embodiment shown in FIG. 34A. That is, another end portion would be received in channel 82 that is outwardly sloped at an angle, so that a similar force would be generated between channel 82 and the end portion received in channel 82, helping to reduce stresses caused by racking.

[0059] Similarly, as shown in FIG. 34B, angle B may be used to indicate the relative angle between connectors 28, 30. In some embodiments, angle B may range from about 0.01° to about 1.30°. In some embodiments, angle B may range from about 0.10° to about 0.76°. In some embodiments, angle B may have a range of angles including minimum angles of about 0.0°, 0.1°, 0.2°, 0.3°, and 0.4°. In some embodiments, angle B may have a range of angles including maximum angles of about 1.30°, 1.00°, or about 0.76°. Again, angle B is shown for the entire connector in FIG. 34B, but a similar effect can be achieved by fabricating a connector with channels angled relative to the connector housing. For example, as shown in FIG. 34C, channel 82 of connector 28 may be tilted at an angle (illustrated by dashed lines) such that the channel is biased at angle C1 within the connector housing. Similarly, in some embodiments, the connector 30 may be similarly tilted at an angle relative to the connector housing. In some embodiments, the channel 82 may be tilted or angled relative to the end portion received in the channel 82 based on any combination of angling the channel 82 relative to the connector housing, angling the end portion to which the connector is attached, angling the end portion received in the channel, or any combination thereof.

[0060] In general, any number of the above strategies for eliminating racking can be combined. For example, in some embodiments, all of the above strategies may be combined to nearly eliminate racking. Furthermore, it has been found that even in the rare case where the two frame segments 12, 14 become slightly misaligned (such as when the frame is intentionally twisted and vibrated), the increase in force required to expand or contract the frame due to racking can be easily mitigated. For example, in an embodiment in which the first frame segment 12 includes end portions 16, 18 configured with a slight outward tilt, applying an opposing force (e.g., one that releases the ratchet and contracts the frame) will mitigate the increase in force required to expand the frame.

[0061] In the embodiment shown in Figures 29A-29C, the connectors 28, 30 do not need to be compressed during expansion. In other words, the frame may freely expand until it is at the desired distance (or tension). For example, as the frame is expanded, the walls of the patient's incision may begin to compress each of the two frame segments 12, 14. The user may release the frame and the system may remain in place due to the tension of the blade against the incision. The ratchet assembly of the connectors 28, 30 may hold the desired tension until carefully released by the user.

[0062] As shown in Figures 30A-30B, the surgical retractor 10 can be contracted. For example, from a fully extended position (shown in Figure 29C), a user can simultaneously depress both ratchet actuators to release the ratchet lock. Once the ratchet lock is released, a user can navigate the system from an intermediate extended state (shown in Figure 30A) to a contracted state as shown in Figure 30B.

[0063] The surgical retractor 10 may be used in a variety of ways for different surgical procedures. For example, FIG. 33 illustrates an embodiment of a method 150 of assembling and using a surgical retractor. At step 152, one frame segment of the surgical retractor may be positioned adjacent to one side of a patient's incision or wound. For example, the frame segment 14 may be positioned on the opposite side of the operating table from the side on which the surgeon or surgeon stands. In some embodiments, at the same time, at step 152, the frame segment may be used to at least partially retract the wall of the incision or wound to aid in visualization of the patient's internal tissue. For example, the frame segment 14 may have at least one blade assembly 60 (e.g., a pair of blade assemblies) attached thereto. The blade assembly 60 may be held within the blade block 36 such that the front side 115 of the blade 114 is positioned at least generally toward the wall of the wound or incision. The leading surface 115 of the blade 114 can be angled or shaped, for example, to facilitate proper contact with the wound or incision wall so that the blade 114 can properly retract or otherwise hold said wall as intended. In some embodiments, the blade 114 can be permitted to rotate within the blade assembly 60 within a limited range of rotation to prevent the surface 115 from rotating such that it is not properly oriented toward the wound or incision wall that it is intended to engage.

[0064] At step 154, frame segment 12 may then be positioned relative to frame segment 14 so that frame segment 12 may be joined to frame segment 14 to form a frame. For example, frame segment 12 may be positioned so that end portions 16, 18 of frame segment 12 are aligned generally parallel to end portions 22, 24 of frame segment 14. In some circumstances, this may involve passing frame segment 12 under the outstretched arm or arms of a surgeon who is already performing a medical procedure, for example as illustrated in FIG.

[0065] In step 156, the frame segments 12, 14 may be coupled together. For example, as also described in connection with FIG. 14, a user may slide the slide lock 72 to rotate the ratchet fastener 76 to guide the frame segment 14 into the channel 82 in the ratchet housing 66. Once the frame segment 14 is placed in the channel 82, a user may release the slide lock 72 so that the fastener 76 engages the frame segment 14. The segment 12 is designed such that a user may operate both connectors 28, 30 at substantially the same time to quickly couple the two segments 12, 14 together. Notably, the frame segment 12 may be aligned with the frame segment 14 and coupled to the frame segment 14 using any location along the length of the end portions 22, 24. For example, in some circumstances, it may be desirable to couple the segments 12, 14 such that the frames are assembled in a contracted state. This may, for example, make it easier to grasp one or more walls of an incision that may not be completely separated. However, the segments 12, 14 may alternatively be connected to form a frame in some intermediate expanded state or even a fully expanded state, which may be necessary, for example, when the surgeon has already begun to engage the patient in a medical procedure and the first segment 12 and the second segment 14 must be connected in a way that avoids bumping into the surgeon's arm.

[0066] As shown in step 158, the frame may be adjusted as needed to effectively visualize the patient's internal anatomy. For example, as also described in connection with FIG. 29, to adjust the frame, a user can hold the upper and lower arms (i.e., first segment 12 and second frame segment 14) and expand the frame outward. If desired, other attachments can be similarly attached to complete assembly of the retractor.

[0067] As described in detail above, the present application relates to surgical retractors and associated components, such as frame segments, blade blocks, and ratcheting connectors, that may be used in surgical procedures, such as abdominal surgery. Those skilled in the art will understand that the surgical retractors and associated components described herein may be utilized in other suitable surgical procedures. Similarly, those skilled in the art will understand that the components herein, such as the blade blocks and ratcheting connectors, may be shown and described for use with a particular surgical retractor. However, the blade blocks and ratcheting connectors may be used with other suitable surgical retractors, including those that may be shaped differently or include a different number of frame segments than those described herein.

Claims

1. An adjustable surgical retractor frame, comprising: a first frame segment having a central portion disposed between a first end and a second end; a second frame segment including a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface; a pair of connectors configured to couple the first frame segment to the second frame segment to form an adjustable surgical retractor frame, each of the pair of connectors comprising: a ratchet housing configured to connect to the first frame segment; a channel formed in a ratchet housing configured to receive one of the pair of end portions of a second frame segment when a relative vertical position of the channel and one of the pair of end portions is changed such that the one of the pair of end portions is received in the channel after the channel is aligned substantially parallel to and vertically offset from the one of the pair of end portions; a ratchet fastener configured to releasably retain one of the pair of end portions of the second frame segment within the channel; 1. An adjustable surgical retractor frame comprising:

2. 2. The adjustable surgical retractor frame of claim 1, wherein each of the pair of connectors further comprises a lock operable by a user to actuate the ratchet fastener to provide access to the channel and such that one of a pair of end portions of the second frame segment can be received within the channel.

3. The adjustable surgical retractor frame of claim 1 , wherein one of the pair of end portions of the second frame segment includes a feature complementary to one or more grooves or ridges.

4. 4. The adjustable surgical retractor frame of claim 3, wherein interaction between the one or more grooves or ridges and the complementary features allows a user to properly place one of the pair of end portions of the second frame segment within the channel when an intended one of the upper surface or the lower surface is received within the channel, but prevents the user from placing one of the pair of end portions of the second frame segment within the channel when an unintended one of the upper surface or the lower surface is received within the channel.

5. When forming an adjustable surgical retractor frame, the channel of each of the pair of connectors is shaped to receive an upper surface of one of the pair of end portions of the second frame segment; The surgical retractor assembly of claim 4 , wherein the first frame segment has a width that is less than or equal to about 75% of a width of the second frame segment.

6. at least one blade assembly comprising a blade including a forward blade surface, the forward blade surface configured to be positioned adjacent a tissue wall of a wound or incision; at least one blade block configured to mount the at least one blade assembly to the adjustable surgical retractor frame, the blade block configured to automatically orient the forward blade surface toward the tissue wall; The adjustable surgical retractor frame of claim 1 , comprising:

7. 7. The adjustable surgical retractor frame of claim 6, wherein the at least one blade block comprises a blade block housing including an opening sized to receive a blade post, the opening shaped to allow the blade post to be inserted into the opening in an orientation that will direct the forward blade surface into engagement with the tissue wall, and the opening shaped to prevent the blade assembly from being inserted in an orientation that will direct the forward blade surface away from the tissue wall.

8. 8. The adjustable surgical retractor frame of claim 7, wherein the blade block housing includes a slot shaped to allow passage of the blade post when the blade post is oriented to direct the forward blade surface toward the tissue wall.

9. 7. The adjustable surgical retractor frame of claim 6, wherein the at least one blade block comprises a blade block housing including an opening dimensioned to receive a blade post, the opening shaped to allow limited rotation of the blade post.

10. 10. The adjustable surgical retractor frame of claim 9, wherein the blade post is shaped as a cylinder with a flattened side, the flat side of the blade post configured to contact a rib inside an opening in the blade block to limit rotation of the blade post.

11. the first end of the first frame segment is part of a substantially linear first end portion and the second end of the first frame segment is part of a substantially linear second end portion; 2. The adjustable surgical retractor frame of claim 1, wherein the first end portion and the second end portion are angled outwardly away from one another at an angle suitable to reduce a risk of racking when expanding the adjustable surgical retractor frame formed by joining the first frame segment and the second frame segment together.

12. The adjustable surgical retractor frame of claim 11, wherein the angle is from about 0.01 degrees to about 1.30 degrees.

13. The adjustable surgical retractor frame of claim 1 , wherein the ratchet housing is welded to one of the first and second ends of the first frame segment.

14. 1. A surgical retractor assembly comprising: a first frame segment having a central portion disposed between a first end and a second end; a second frame segment including a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface; a pair of connectors configured to couple a first frame segment to a second frame segment to form a retractor frame; at least one blade assembly comprising a blade including a forward blade surface, the forward blade surface configured to be positioned adjacent a tissue wall of a wound or incision; at least one blade block configured to mount the at least one blade assembly to the retractor frame, the blade block configured to selectively direct a forward blade surface toward the tissue wall; A surgical retractor assembly comprising:

15. 15. The surgical retractor assembly of claim 14, wherein the at least one blade block comprises a blade block housing including an opening sized to receive a blade post, the opening shaped to allow the blade post to be inserted into the opening in an orientation that will direct the forward blade surface into engagement with the tissue wall, and the opening shaped to prevent the blade assembly from being inserted in an orientation that will direct the forward blade surface away from the tissue wall.

16. An adjustable surgical retractor frame comprising: a first frame segment having a central portion disposed between a first end and a second end; a second frame segment including a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions including an upper surface and a lower surface; a pair of connectors configured to couple a first frame segment to a second frame segment to form an adjustable surgical retractor frame; the first end of the first frame segment is part of a first end portion that extends substantially linearly and the second end of the first frame segment is part of a second end portion that extends substantially linearly; a first end portion of the first frame segment and a second end portion of the first frame segment extending from the same side of the central portion, the first end portion and the second end portion being angled outwardly away from one another at an angle suitable to reduce racking when expanding the adjustable surgical retractor frame; A surgical retractor assembly comprising:

17. The adjustable surgical retractor frame of claim 16, wherein the angle is from about 0.01 degrees to about 1.30 degrees.

18. An adjustable surgical retractor frame comprising: a first frame segment having a central portion disposed between a first end and a second end; a second frame segment comprising a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions comprising an upper surface and a lower surface; a pair of connectors configured to couple the first frame segment to the second frame segment to form an adjustable surgical retractor frame; Each of the pair of connectors comprises: a ratchet housing configured to connect to the first frame segment; a channel formed in the ratchet housing configured to receive one of the pair of end portions of the second frame segment when a ratchet fastener is actuated to expose the channel for receiving the pair of end portions and the pair of connectors are vertically stacked on the pair of end portions; and a ratchet fastener configured to retain one of a pair of end portions of the second frame segment within the channel; A surgical retractor assembly comprising:

19. An adjustable surgical retractor frame comprising: a first frame segment having a central portion disposed between a first end and a second end; a second frame segment comprising a middle portion and a pair of end portions protruding from a same side of the middle portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions comprising an upper surface and a lower surface; a pair of connectors configured to couple the first frame segment to the second frame segment to form an adjustable surgical retractor frame; Each of the pair of connectors comprises: a ratchet housing configured to connect the ratchet housing to the first frame segment; a channel formed in the ratchet housing, the channel configured to receive an upper or lower surface of one of the end portions of the second frame segment; the channel being disposed at an angle relative to one of the end portions received in the channel to reduce racking when the adjustable surgical retractor frame is expanded; a ratchet fastener configured to retain one of the pair of end portions of the second frame segment within the channel; A surgical retractor assembly comprising:

20. The surgical retractor assembly of claim 19, wherein the channel is angled within the ratchet housing.

21. A connector for an adjustable surgical retractor comprising a frame formed by joining a first frame segment to a second frame segment, the first frame segment including a central portion disposed between a first end and a second end, the second frame segment including an intermediate portion and a pair of end portions protruding from a same side of the intermediate portion, the pair of end portions maintaining a substantially parallel orientation relative to one another, each of the pair of end portions having an upper surface and a lower surface, the connector comprising: A ratchet housing; a channel formed in the ratchet housing, the channel being shaped to receive an upper or lower surface of one of the pair of end portions of the second frame segment; a ratchet fastener configured to retain one of the pair of end portions of the second frame segment within the channel; A connector comprising:

22. 22. The connector of claim 21, further comprising a lock operable by a user to actuate the ratchet fastener to provide access to the channel and so that one of the end portions of the second frame segment may be received within the channel, the ratchet fastener being configured to automatically retain the end portion within the channel when the lock is not engaged by the user.

23. A first frame segment according to any one of the preceding claims.

24. A second frame segment according to any one of the preceding claims.

25. The surgical retractor blade assembly of any one of claims 6 to 10, 14 and 15.

26. The surgical retractor blade block of any one of claims 6 to 10, 14 and 15.

Images