Adjustable locking surgical retractor

Abstract

To provide a surgical retractor assembly for providing surgical exposure.SOLUTION: The surgical retractor assembly consists of two frame segments 100 connected by adjustable ratchet mechanisms 104 to form a retractor frame. The ratchet mechanisms can be attached to tissue retractor blades 108 that provide exposure of a wound when expanded, without the requirement of a direct connection / attachment to an operating table or bed frame. The tissue retractor blades are attached in a manner that is adjustable and facilitates raising or lowering the overall surgical retractor assembly with respect to a patient. The retractor frame also allows attachments of additional retractor blades or other surgical retractor accessories for additional surgical exposure.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] Priority paragraph This application claims priority to U.S. Provisional Patent Application No. 62 / 732,340, filed Sep. 17, 2018, which is incorporated by reference in its entirety. [Background technology]

[0002] background Abdominal surgery, in both emergency and elective settings, requires adequate exposure of abdominal contents to allow the surgeon to adequately visualize the site of injury or disease. This is typically accomplished through the use of stationary metal retractors. Two of the most common retractor mechanisms currently in use are the Balfour retractor and the Bookwalter retractor. Each of these retractors presents advantages and disadvantages in their design and use. The Balfour retractor consists of a frame with integrated metal blades on a ratchet system; when engaged, the frame retracts the abdominal wall laterally, thereby exposing the abdominal contents and allowing the surgeon to operate. The Bookwalter mechanism consists of a supporting frame that is attached to the operating table to which are attached rigid non-adjustable metal rings to which the retractor blades are then individually attached. Despite their ubiquitous use, the mechanisms of these surgical retractors have not been improved upon for some time.

[0003] The Balfour retractor is perhaps the most commonly utilized abdominal retractor due to its simplicity in design, ease of use, and rapid abdominal exposure, especially in trauma and emergency surgical settings where time is of the essence. Unlike the Bookwalter retractor, it does not require a metal frame to be attached to the operating room bed, so valuable time is not lost and it can be inserted quickly after the abdominal incision is made.

[0004] Although the Balfour retractor is popular in the operating room and easy to use, there are several limitations to its use. The Balfour retractor provides inadequate abdominal exposure in large or obese patients. In large or obese patients, the current design of the standard Balfour retractor often does not provide sufficient retraction to adequately expose the abdomen. The retractor blades run along a frame that is typically too short for large or obese patients, resulting in less than optimal exposure, often necessitating conversion to a different retractor system. The inherently limited design of the Balfour retractor only allows the surgical incision to be retracted along one axis (the transverse axis), limiting overall exposure of the wound. An optional additional retractor blade (bladder blade) can be attached, but it only adds inferior retraction, typically resulting in less than optimal exposure, often necessitating conversion to a different retractor system.

[0005] The 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 incision or abdominal contents compared to other retractor mechanisms, thereby limiting surgical exposure. In addition, the Balfour retractor system often presents significant problems during use due to accidental movement and migration of the retractor blades along the wound edges. The two retractor blades that provide lateral retraction to the wound edge (or abdominal wall in abdominal surgery) often accidentally migrate to either the top or bottom of the wound, which causes rotation of the entire retractor mechanism, loss of wound edge retraction, and requires either time-consuming repositioning of the retractor or conversion to another type of retractor system. This is especially prevalent in large or obese patients.

[0006] The Bookwalter retractor is a retractor system that is typically used when the Balfour retractor 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 a non-sterile individual 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.

[0007] The Bookwalter retractor, while popular, also has several limitations. The Bookwalter retractor mechanism involves fixation to the operating table, which requires installation by non-sterile personnel in the operating room. This sometimes raises concerns in maintaining a sterile field, as the surgeon may need to place his or her hands below the sterile barrier to assist and properly position the retractor arms. In addition, the multiple arms that require setup before surgical retraction can be achieved require significant time in instrument setup, making the system inadequate for emergency settings or procedures where time is of the essence. The circumferential rings used in the Bookwalter system are not expandable, and often limit the placement of additional retractors in both the vertical and horizontal axes. In addition, the ring size is fixed, so the retraction cannot be adjusted for each patient's individual physical characteristics and various types and sizes of wounds or incisions. The Bookwalter system also requires frequent repositioning by the surgical team during use. After the Bookwalter system is set up and attached to the bed frame, this secures the ring system in place, and additional retractors are attached. However, as the surgery progresses and the surgical exposure requirements change, the system requires repositioning to properly position the non-expandable, static ring. This requires interrupting the surgery, removing the retractor blades, repositioning the ring, and reinstalling the retractor blades, again requiring significant time. A need exists for additional retractor systems. Summary of the Invention

[0008] overview The present disclosure describes an adjustable retractor system that addresses many of the problems outlined above with current retractor systems while minimizing the number of components. Certain embodiments are directed to a surgical retractor with a frame having an adjustable circumference or width that includes two interconnecting frame segments. In certain aspects, the frame has a fixed length along one axis and an adjustable length along the other perpendicular axis. In certain aspects, the outer edge of the frame segment has a series of ridges that form teeth or grooves along at least a portion of its length, and in certain aspects along the entire length of the outer edge. The frame segment may have a stop mechanism positioned at one or both ends of the frame segment. In certain aspects, the stop may be anywhere along the length of the frame segment. The stop may be in the form of a screw, pin, hole, or raised material that can contact or engage with the connector to stop movement of the frame segment, which may result in disassembly or instability of the retractor. In certain aspects, the stop is a screw that can engage threads formed on the frame segments. In certain respects, the surgical retractor includes (a) a retractor frame having an adjustable circumference or width, the retractor frame including: (i) two frame segments, each frame segment including first and second substantially straight and substantially parallel arm portions connected by a middle portion substantially perpendicular to the arm portions. The frame segments form two curved portions connecting the arm portions to the middle portions. Each frame segment has an upper surface and a lower surface with inner and outer edges; the frame segments are configured to overlap, with the substantially straight first arm portion of one frame segment overlapping the substantially straight first arm portion of the other frame segment; and (ii) a connector configured to receive the arm portions of the first and / or second frame segments to form a retractor frame.The connectors can be in (i) a non-locking configuration that allows the arm portions of the frame segments to move relative to one another, thereby allowing adjustment of the frame circumference; or (ii) a locked configuration that fixes the substantially straight first arm portion of the first frame segment in a relative position to the substantially straight first arm portion of the second frame segment. In certain aspects, the connectors may be attached or removably attached to the frame segments. In further aspects, the first and second connectors may be attached or removably attached to the same or different frame segments. In certain aspects, the connectors are attached or removably attached to the ends of the straight arm portions of the frame segments. In certain aspects, the arm portions of one frame segment are not the same as the arm portions of the second frame segment. In other aspects, the arm portions are of equal or similar length. The adjustable retractor may include two, three, four, five, six, or more retractor blades coupled to the frame segments, where the faces of the retractor blades form an angle, e.g., substantially perpendicular, with the plane of the frame. In certain aspects, the connector is designed to provide a ratchet mechanism. The ratchet mechanism of the connector is configured to interact with teeth or grooves positioned along all or a portion of the inner or outer edge of the frame segment. The connector may include one, two, three, or more pawls configured to engage one or more frame segments. In certain aspects, the connector includes individual pawls configured to interact separately and / or independently with each frame segment. In further embodiments, the connector may be configured to provide a space between the faces of the frame segments. With the space between the frame segments, the space allows for the insertion of a portion of the attachment (e.g., a lip or protrusion on the attachment) to further stabilize additional attachments that may be attached to the retractor.The ratchet mechanism allows for expansion of the frame when the connector is in a locked position, but does not allow for contraction of the frame unless the release is engaged. In certain aspects, the ratchet mechanism associated with the connector is a directional ratchet that allows movement of the frame segments in one direction resulting in expansion of the frame, and resists or prevents movement of the frame segments in the opposite direction, i.e., contraction of the frame. In further aspects, the edges of the ratchet teeth or grooves are chamfered to allow clearance for the ratchet. The connector may further comprise one or more spring-loaded brake mechanisms. In certain aspects, the retractor may be configured to be stabilized, coupled, or secured to a subject's body, wound, incision, or cavity. The retractor may be stabilized, coupled, or secured by clamps, sutures, staples, or other mechanisms. In certain aspects, the retractor may have or be secured to an adapter, which may be secured to a support such as a bed or operating table.

[0009] In another aspect, the retractor blade is attached to the retractor blade connector. The retractor blade connector may be configured to allow the retractor blade to be adjusted up and down relative to the frame segment or moved and secured along the frame segment. The retractor blade connector may form a passageway through which the proximal portion of the retractor blade can pass. The passageway is configured with a retractor blade locking mechanism that reversibly locks the retractor blade at a particular position or depth. The locking mechanism may be a pin, screw, or other locking mechanism that can reversibly engage the proximal portion of the retractor blade to hold the retractor blade in place when engaged and allow movement of the retractor blade when disengaged. In certain aspects, the locking mechanism may include a spring to aid in engagement of the mechanism and resist disengagement of the mechanism. In certain aspects, the pin or screw may be able to pass through an opening in the retractor blade connector body or may be attached to the top or bottom of the retractor blade connector body. The proximal portion of the retractor blade may have an adjustment portion that passes through the retractor blade connector. The adjustment portion may have grooves, holes, or teeth for engaging the retractor blade locking mechanism. The connector may further include a removable stop that couples with a predefined slot or hole pattern formed in the frame segment and together configured to reversibly lock the connector in place. In certain aspects, the connector is configured to allow expansion of one or more frame segments and not allow contraction of one or more frame segments. The connector may be configured to be attached to at least one frame segment. The frame segments may not be of equal length. In certain aspects, the frame segments are of equal length.

[0010] In certain aspects, the retractor frame, when assembled, is a rounded polygon, such as a quadrilateral (square or rectangle). In further aspects, the frame is a rounded quadrilateral. In yet further aspects, the frame is a rounded rectangle. The frame may be constructed of two frame segments. The frame segment includes two substantially straight arm portions on each end and a middle portion connecting the substantially straight arm portions to form a U-shaped frame segment.

[0011] In certain aspects, the outer edge, inner edge, or outer edge and inner edge of the frame segment are toothed and / or grooved along at least a portion of the segment, hi further aspects, the upper surface, lower surface, or upper and lower surfaces also include a series of grooves or ridges.

[0012] In certain aspects, the upper surface, the lower surface, or the upper and lower surfaces are substantially planar. In further aspects, the upper surface, the lower surface, or the upper and lower surfaces are curved (concave or convex) along a single axis of the segment.

[0013] In certain aspects, each of the frame segments (substantially straight arms and intermediate portion) independently has a length measured along the uncurved or substantially straight portion that is about 2.5, 5, 10, 15, 20, 25, 30, 35, 40, 45, to 50 centimeters, including all values ​​and ranges therebetween. In further aspects, the substantially straight first arm portion of the segment has a length measured along the uncurved or substantially straight portion that is about 2.5-50, 5-40, 5-30, 5-20, 5-100, 10-40, or 10-30 centimeters, and the substantially straight second arm portion has a length measured along the uncurved or substantially straight portion that is about 2.5-50, 5-40, 5-30, 5-20, 5-100, 10-40, or 10-30 centimeters. The arms of the frame segments may or may not be the same length, with arms of different lengths being complemented by other frame segments in the frame. In further aspects, the intermediate portion of the frame segment has a length measured along a non-curved or substantially straight portion of about 2.5 to 50, 5 to 40, 5 to 30, 5 to 20, 5 to 100, 10 to 40, or 10 to 30 centimeters. In certain aspects, the first and second arm portions are equal in length. The length of the arm portion is measured from the end of the segment to the beginning of the curved portion of the segment (along the non-curved or substantially straight portion). In certain aspects, the rounded angle of the frame segments is about 90 degrees (+ / - 0.5, 1, 2, to 5 degrees). In further aspects, the arm portions of each frame segment are positioned such that an inner edge of the first arm portion is substantially parallel and aligned with an outer edge of the second frame segment. In another aspect, an upper surface of the first frame segment may face a lower surface of the second frame segment. The faces of the frame segments may contact one another when assembled, or may form a gap or space between the frame segments.In certain embodiments, the retractor has an adjustable internal distance of 2.5, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, to 90 centimeters in the expanded configuration, including all ranges and values ​​therebetween.

[0014] In certain aspects, two, three, four, five, six or more retractor blades are coupled to the retractor frame. The retractor blades may have a distal blade portion and a proximal connector or adjustment portion. In further aspects, at least two retractor blades are coupled to the frame. In other aspects, at least four retractor blades are coupled to the frame. In certain aspects, six retractor blades are coupled to the frame. In further aspects, at least one retractor blade is coupled to a retractor blade connector. In certain aspects, at least one retractor blade is coupled to a frame segment. In further aspects, at least one retractor blade is configured to be movable along the retractor frame. In still further aspects, the retractor blade is configured to be movable up and down relative to the retractor frame.

[0015] Certain embodiments are directed to a surgical retractor frame segment comprising first and second substantially straight arm portions connected by a substantially straight intermediate portion, with a curved portion between the arm portions and the intermediate portion, where the long axis of the intermediate portion is approximately perpendicular to the long axis of the arm portions and the arm portions project from the intermediate portion on the same side. In certain aspects, the arm portions are substantially parallel to one another. The frame segment has upper and lower surfaces with inner and outer edges. The frame segment may further comprise one or more extension stops that may be reversibly connected to the frame segment and may form protrusions on the upper or lower surface of the frame segment, which stops may be positioned at or near one or both ends of the frame segment and / or on both surfaces.

[0016] Other embodiments are directed to a surgical retractor connector comprising a body forming two or more lumens, each lumen configured to receive an arm portion of a separate frame segment. In certain embodiments, the surgical retractor connector may include a ratchet mechanism configured to interact with at least one edge (i.e., inner edge, outer edge, or inner edge and outer edge) of the frame segment when it is inserted into the lumen of the surgical retractor connector. The surgical retractor connector can be in (i) a non-locking configuration that allows the arm portions of the frame segments to move relative to one another, thereby allowing adjustment of the retractor frame; or (ii) a locked configuration that fixes the arm portion of a first frame segment in a relative position to the first arm portion of a second frame segment. The connector may further comprise or be configured to include a retractor blade that is positioned below the frame and may form a predetermined angle (e.g., perpendicular) with the plane of the frame. The retractor blades may be fixed to the connector body or may be removably connected to the connector body by a retractor blade connector.

[0017] Certain embodiments are directed to methods of using the surgical retractors described herein, comprising inserting retractor blades of a contracted retractor into a wound or incision; expanding the surgical retractor to expose a body cavity; and locking the retractor in position.

[0018] Other aspects of the invention are also discussed throughout this application. Any aspect discussed with respect to one aspect of the invention may also be applied to other aspects of the invention, and vice versa. Each embodiment described herein is understood to be an embodiment of the invention that is applicable to all aspects of the invention. Any embodiment discussed herein is contemplated to be implemented with respect to any method or composition of the invention, and vice versa. Furthermore, compositions and kits of the invention may be used to achieve methods of the invention.

[0019] The use of the words "a" or "an" when used in conjunction with the term "comprising" in the claims and / or this specification may mean "one," but is also not inconsistent with the meaning of "one or more," "at least one," and "one or more than one."

[0020] Throughout this application, the term "about" is used to indicate that a value includes the standard deviation of error for the device or method utilized to determine the value.

[0021] Use of the term "or" in the claims is used to mean "and / or" unless expressly indicated to refer to only one of the alternatives or the alternatives are mutually exclusive; however, this disclosure supports definitions that refer to only one of the alternatives and "and / or."

[0022] As used in the specification and claims, the words "comprising" (and any variation of comprising, such as "comprise" and "comprises"), "having" (and any variation of having, such as "have" and "has"), "including" (and any variation of including, such as "includes" and "include"), or "containing" (and any variation of containing, such as "contains" and "contain") are inclusive or open-ended and do not exclude additional, unrecited elements or method steps.

[0023] [The present invention 1001] below: 1. A retractor frame having an adjustable circumference, comprising first and second frame segments and two connectors, the first and second frame segments comprising: a first and second substantially straight arm portion and an intermediate portion connecting the first and second substantially straight arm portions, the first and second substantially straight arm portions and the intermediate portion lie substantially in the same plane; the major axes of the first and second substantially straight arm portions are parallel to one another and project to the same side of the intermediate portion; the intermediate portion forms first and second bends such that the major axis of the intermediate portion is perpendicular to the major axes of the first and second substantially straight arm portions; each frame segment has an upper surface and a lower surface along with inner and outer edges; the frame segments are configured such that the first arm portion of the first frame segment connects to the first arm portion of the second frame segment and the second arm portion of the first frame segment connects to the second arm portion of the second frame segment to form an adjustable retractor frame. said substantially straight first and second arm portions and an intermediate portion; a connector configured to receive the substantially straight first and second arm portions of the first and second frame segments to form the retractor frame, (i) a non-locking configuration that allows the substantially straight arm portions of the frame segments to move relative to one another, thereby allowing adjustment of the retractor frame; or (ii) a locking arrangement that fixes the substantially straight arm portion in a relative position to the substantially straight arm portion of the other frame segment; The connector can be the retractor frame comprising: two or more retractor blades connected to the frame, the faces of the retractor blades forming an angle with the plane of the frame; 1. An adjustable surgical retractor comprising: [The present invention 1002] Expansion stop configured to stop frame expansion before the frame segment completely passes through the connector The retractor of the present invention 1001, wherein the frame segment further comprises on one or both faces at one or both ends of the frame segment. [The present invention 1003] a removable stop that mates with a predefined slot or hole pattern formed in the frame segment and together is configured to reversibly lock the connector in place; The retractor of the present invention 1001 further comprises a connector. [The present invention 1004] A retractor of the present invention 1001, wherein the connector is configured to allow expansion of one or more frame segments and to prevent contraction of one or more frame segments. [The present invention 1005] The retractor of the present invention 1004, wherein the connector is attached or removably attached to at least one frame segment. [The present invention 1006] A retractor of the present invention 1005, in which the frame segments are not of equal length. [The present invention 1007] The retractor of the present invention 1005, wherein the frame segments are equal in length. [The present invention 1008] A retractor of the present invention 1001, in which the frame segments are equal in length. [The present invention 1009] The retractor of the present invention 1004, wherein the connector comprises a tab configured to engage one or more frame segments. [The present invention 1010] The retractor of the present invention 1009, wherein the connector comprises respective claws configured to interact with respective frame segments. [The present invention 1011] A retractor of the present invention 1001, wherein the connectors are configured to position the ends of the frame segments in a stacked configuration. [The present invention 1012] A retractor of the present invention 1001, wherein the connector is configured to position the ends of the frame segments in an offset configuration. [The present invention 1013] The retractor of the present invention 1001, wherein the connector is further constructed with a motorized, controlled, screw-driven, worm gear, or removable locking system that allows both adjacent frame segments to move toward or away from each other, thereby allowing the frame to be contracted or expanded when the system is in use. [The present invention 1014] The retractor of this invention 1001, wherein the connector further comprises one or more spring-loaded brake mechanisms. [The present invention 1015] A retractor of the present invention 1001, wherein the retractor blade is adjustable; the connector is configured to receive a proximal portion of the retractor blade and to reversibly fix the position of the retractor blade with a locking mechanism incorporated within the connector; and the proximal portion of the retractor blade is movable up and down until locked by the retractor blade locking mechanism. [The present invention 1016] A retractor of the present invention 1001, wherein the frame is a rounded polygon. [The present invention 1017] A retractor of the present invention 1001, wherein the frame is a rounded quadrilateral. [The present invention 1018] The retractor of the present invention 1001, wherein the outer edge of the frame segment defines one or more notches or teeth. [The present invention 1019] The retractor of the present invention 1018, wherein the teeth of the first frame segment are oriented in an opposite direction relative to the teeth of the second frame segment. [The present invention 1020] A retractor of the present invention 1001, wherein a substantially straight arm portion of an adjacent frame segment is positioned such that an inner edge of the substantially straight arm portion is aligned substantially parallel to an outer edge of an adjacent frame segment. [The present invention 1021] The retractor of the present invention 1001, wherein the substantially straight arm portion of the frame segment is approximately 2.5-50 centimeters in length and the intermediate portion of the frame segment is approximately 2.5-100 centimeters in length. [The present invention 1022] The retractor of the present invention 1001 has an adjustable internal distance of 2.5 to 90 centimeters in an extended configuration. [The present invention 1023] A retractor of the present invention 1001, wherein the rounded angle of the frame segments is approximately 90 degrees. [The present invention 1024] The retractor of the present invention 1001, wherein two, three, four, five, or six retractor blades are coupled to a retractor frame. [The present invention 1025] The retractor of the present invention 1001, wherein two, three, four, five, or six retractor blades are provided such that they can be decoupled from the retractor frame. [The present invention 1026] The retractor of the present invention 1001, wherein at least one retractor blade is coupled to a connector. [The present invention 1027] The retractor of the present invention 1001, wherein at least one retractor blade is connected to a frame segment. [The present invention 1028] The retractor of the present invention 1001, wherein at least one retractor blade is configured to be movable along the retractor frame. [The present invention 1029] The retractor of the present invention 1001 is connected to a bed frame. [The present invention 1030] The retractor of the present invention 1001 is attached to the patient after being expanded. [The present invention 1031] A retractor of the present invention 1001 configured for human surgical retraction. [The present invention 1032] The retractor of the present invention 1001 configured for veterinary surgical retraction. [The present invention 1033] First and second arm portions that are substantially straight and substantially parallel to one another, connected by a substantially straight intermediate portion. 1. A surgical retractor frame segment comprising: the intermediate portion being connected to each substantially straight arm portion by a curved portion; the frame segment having an upper surface and a lower surface along with an inner edge and an outer edge; Surgical retractor frame segment. [The present invention 1034] One or more expansion stops that may be reversibly connected to the top or bottom surface of the frame segment at or near one or both ends of the frame segment. The frame segment of the present invention 1033 further comprises: [The present invention 1035] 1. A surgical retractor connector comprising a body defining two or more lumens and a ratchet mechanism, each lumen configured to receive a substantially straight arm portion of two adjacent frame segments; the ratchet mechanism is configured to interact with at least one edge of a frame segment when inserted into the connector lumen; The connector, (i) a non-locking configuration that allows the substantially straight arm portions of adjacent frame segments to move relative to one another, thereby allowing adjustment of the frame circumference; or (ii) a locking arrangement that fixes one substantially straight arm portion in a relative position to one substantially straight arm portion of an adjacent frame segment; Can become, Surgical retractor connector. [The present invention 1036] A retractor blade positioned below the frame and forming an angle with the plane of the frame. The connector of the present invention 1035 further comprises: [The present invention 1037] The connector of the present invention 1036, wherein the retractor blade is attached to the connector body. [The present invention 1038] The connector of the present invention 1036, wherein the retractor blade is attached by a retractor blade arm configured to be removably connected to the connector body. [The present invention 1039] A method of using the surgical retractor of the present invention 1001, comprising the steps of: inserting the contracted retractor of the present invention 1001 into the wound or incision; expanding the surgical retractor in one or more directions superiorly, inferiorly, or laterally to expose the body cavity; and Locking the frame. Other objects, features, and advantages of the present invention will become apparent from the following detailed description, but it should be understood that the following detailed description and specific examples, while indicating specific embodiments of the present invention, are given by way of illustration only, since various changes and modifications within the spirit and scope of the invention will become apparent to those skilled in the art from this detailed description. [Brief description of the drawings]

[0024] The following drawings form part of the present specification and are included to further demonstrate certain aspects of the present invention. The invention may be better understood by reference to one or more of these drawings in combination with the detailed description of the embodiments presented herein.

[0025] [Figure 1] FIG. 1 is an exploded view of one embodiment of an adjustable retractor assembly. [Diagram 2] FIG. 1 is a perspective view of one embodiment of an adjustable retractor assembly. [Diagram 3] FIG. 13 is a top view of one embodiment of an adjustable retractor assembly. [Figure 4] FIG. 1 illustrates a bottom-up perspective view of one embodiment of an adjustable retractor assembly. [Diagram 5] FIG. 1 is a side view of one embodiment of an adjustable retractor assembly. [Figure 6] FIG. 2 is a perspective view of one embodiment of an adjustable retractor assembly in a fully expanded configuration. [Figure 7] FIG. 1 is an isolated perspective view of one embodiment of a retractor blade assembly. [Figure 8] FIG. 2 is an isolated perspective view of one embodiment of a frame segment. [Figure 9] FIG. 1 is a perspective view focusing on one embodiment of a surgical retractor connector in a surgical retractor assembly in a fully expanded configuration. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0026] explanation Attachment of the surgical retractors described herein to an operating table or other support is an option but not required, and thus use of the surgical retractors described herein does not necessarily require the involvement of non-sterile members of the surgical team. In addition, the absence of an intrusive fixed metal frame allows the surgeon greater mobility and positioning to the side of the patient during surgery. The system of the present invention remains sterile, and deployment is simple and rapid, making it applicable in emergency and time-sensitive situations.

[0027] The adjustable / expandable system of the present invention, which includes frame segments that are expanded on connectors or locking ratchet mechanisms, allows for full exposure of the surgical wound because the ratchet mechanisms attached to the frame segments allow for maximum wound retraction. This design allows for the incision to be retracted to its largest possible size because it is not limited by the use of pre-determined ring sizes (unlike the Bookwalter retractor).

[0028] The expandable, locking surgical retractor of the present invention can subsequently have multiple retractor blades attached to it (similar to the Bookwalter retractor) to provide additional surgical exposure. The frame of the present invention also allows for a lighting option that attaches directly to the frame, which improves surgical visibility and illumination of deep wounds and / or spaces.

[0029] The surgical retractors described herein may include two frame segments that are connected with a connector or retractor frame connector (see FIG. 9) to form a retractor frame. In certain aspects, the retractor includes two frame segments joined by two connectors. In certain embodiments, the segments have two substantially straight arm portions joined by a middle portion that has a curved portion connecting each of the substantially straight arm portions, thereby forming a U-shaped frame segment (see FIG. 8). The segments are configured to be assembled to form a rounded polygonal frame, e.g., a rounded rectangle. Each segment includes an upper surface / top and a lower surface / bottom, with an inner edge facing inward and an outer edge facing outward of the assembled frame.

[0030] FIG. 1 illustrates one embodiment of a surgical retractor frame in an exploded view. In a particular embodiment, the frame comprises two frame segments 100. Each frame segment 100 has two arm portions 120 and 122 connected by a middle portion 121. The frame segments are connected using a connector 103. The frame segments may have teeth or grooves 105 along one or more edges and / or ridges or grooves (105 or 106) along one or more faces. In particular aspects, the inner edge of the frame segment 100 is configured to interact with the connector 103, the connector 103 may have a ratchet mechanism 104, and portions of the frame segment 100 may have ratchet teeth 105 and / or 106 along the edges and / or faces of the frame segment. The inner edge faces the interior of an opening formed by assembly of the frame segments 100. In other aspects, the frame segments 100 may have notches, grooves, or teeth 105 and / or 106 that may be utilized to secure attachments and the like. In certain aspects, the notches, grooves, or teeth 106 may be positioned on the outer edge of the segment 100, on the upper surface of the segment 100, on the lower surface of the segment 100, or combinations thereof. The arm portions (also referred to herein as substantially straight arm portions) 120 and 122 of the separate frame segments may be connected by a connector 103. In certain embodiments, the connector 103 includes a ratchet mechanism 104 that interacts with ratchet teeth 105 to adjustably secure the arm portions 120 and 122, and allows for expansion and contraction of the assembled frame, as well as stabilizing the frame once a desired configuration is achieved. In certain aspects, the retractor blade connector 107 may have a fixed or removable retractor blade 108. In certain aspects, the frame segment 100 has an expansion stop 109 that projects from the face of the frame segment to stop the extension of the arm portion through the connector.The expansion stop may be a screw, clip, pin, or other mechanism configured to prevent the frame segment from passing through the connector 103 .

[0031] With further reference to FIG. 1 , the retractor blades 108 may be configured to move up and down relative to the frame. In this embodiment, the retractor blade connector 107 may be configured to allow movement of the retractor blades. The retractor blade connector 107 may be secured to the frame using a retractor blade connector locking mechanism 110. The mechanism may include a screw, pin, spring-loaded pin, or similar adjustable locking mechanism. The retractor blade connector 107 may be configured to receive a proximal portion (111) of the retractor blade. The proximal portion of the retractor blade may be reversibly locked using a retractor blade locking mechanism 112. The proximal portion of the retractor may form a retractor blade locking mechanism receiver. The locking mechanism receiver may be a notch, hole, cavity, or other structure for receiving a locking mechanism. When the locking mechanism is engaged, the retractor blade is reversibly fixed in its particular position. When it is desired to adjust the retractor blades, the locking mechanism is disengaged, the retractor blades are moved to a new position, and the position is secured by engaging the locking mechanism with the locking mechanism receiver.

[0032] FIG. 2 shows one embodiment of an assembled retractor frame. The connectors 203 are configured with a release / lock mechanism that allows one to release the frame segments 200, and provide a locking mechanism to allow the frame to expand or contract while also securely locking the segments in place when desired. In certain aspects, the connectors 203 include a locking ratchet mechanism 204. In another embodiment, the frame segments have a stop mechanism 209 that stops the frame expansion at a selected point. The expansion stop is a raised portion that cannot pass through the connector, thereby stopping the frame expansion at the point of the expansion stop. The expansion stop may be a screw or pin that can be engaged or disengaged as needed. Typically, the expansion stop is engaged during use to prevent over-expansion. In certain embodiments, not only does the frame have a mechanism for adjustment, but the retractor blade portion 208 of the device also has a mechanism for adjustment (212). The retractor blade 208 may have a portion near the frame (proximal portion 211) that passes through the retractor blade connector 207 and can engage the retractor blade locking mechanism 210 to be reversibly locked in a predetermined position. Reversibly locked means that it maintains its position until the locking mechanism is disengaged or the engagement is reversed to allow free movement upon disengagement. In certain aspects, the proximal portion may have one or more locking mechanism receivers that receive the locking mechanism. Also shown in FIG. 2 are notches, grooves, or teeth (ratchet teeth 205 and / or grooves 206) that may be utilized to secure an attachment or connector, etc., to the frame.

[0033] FIG. 3 is a top-down view of an assembled frame showing frame segment connectors 303 connecting frame segments 300 with an example of a frame locking mechanism 309 to securely lock the segments in place when desired. In certain aspects, connectors 303 include a locking ratchet mechanism 304. Frame segment stop mechanism 309 is also shown. Retractor blade portion 308 is shown with proximal portion 311 of the retractor blade across retractor blade connector 307. Retractor blade 308 may be reversibly positioned on the frame using retractor blade locking mechanism 312. Retractor connector locking mechanism 312 is shown interacting with locking pin 310 that fits within groove 306. Also shown in FIG. 3 are notches, grooves, or teeth (ratchet teeth 305 and / or grooves 306) that may be utilized to secure attachments, connectors, or the like to the frame.

[0034] FIG. 4 is a bottom-up perspective view of an assembled frame, showing frame segment connectors 403 connecting frame segments 400 with an example of a frame locking mechanism 409 to securely lock the segments in place when desired. In certain aspects, connectors 403 include a locking ratchet mechanism 404. Frame segment stop mechanism 409 is also shown. Retractor blade portion 408 is shown with a proximal portion 411 of the retractor blade across retractor blade connector 407. Retractor blade 408 may be reversibly positioned on the frame using retractor blade locking mechanism 412. Retractor connector locking mechanism 412 is shown interacting with locking pin 410 that fits within groove 406. Also shown in FIG. 4 are notches, grooves, or teeth (ratchet teeth 405 and / or groove 406) that may be utilized to secure an attachment or connector, etc., to the frame.

[0035] FIG. 5 is a side view of an assembled frame, showing a frame segment connector 503 connecting frame segments 500 with an example of a frame locking mechanism 504 to securely lock the segments in place when desired. In certain aspects, the connector 503 includes a locking ratchet mechanism 504. A frame segment stop mechanism 509 is also shown. A retractor blade portion 508 is shown with a proximal portion 511 of the retractor blade across the retractor blade connector 507. The retractor blade 508 may be reversibly positioned on the frame using a retractor blade locking mechanism 512. The retractor connector locking mechanism 512 is shown interacting with a locking pin 510 that fits within a groove 506. Also shown in FIG. 5 is a notch, groove, or tooth (groove 506) that may be utilized to secure an attachment or connector, etc., to the frame.

[0036] FIG. 6 is a top perspective view of the assembled and fully extended frame, showing frame segment connectors 603 connecting frame segments 600 with an example of a frame locking mechanism 604 to securely lock the segments in place when desired. In certain aspects, connectors 603 include a locking ratchet mechanism 604. Frame segment stop mechanism 609 is also shown. Retractor blade portion 608 is shown with proximal portion 611 of the retractor blade across retractor blade connector 607. Retractor blade 608 may be reversibly positioned on the frame using retractor blade locking mechanism 612. Retractor connector locking mechanism 612 is shown interacting with locking pin 610 that fits within groove 606. Also shown in FIG. 6 are notches, grooves, or teeth (ratchet notches 605 and grooves 606) that may be utilized to secure attachments or connectors, etc., to the frame.

[0037] The retractor blade assembly is shown in isolation in Figure 7. The retractor blade 708 is shown with the proximal portion 711 of the retractor blade across the retractor blade connector 707. The retractor blade 708 may be reversibly positioned on the frame using a retractor blade locking mechanism. The retractor connector locking pin 710 fits into a groove or other frame element.

[0038] FIG. 8 shows the frame segments in isolation. The frame segments have a first arm (substantially straight arm) portion 820 and a second arm (substantially straight arm) portion 822 connected by a middle portion 821. Each arm portion 820 / 822 of the frame segments is configured to interact with a connector in a manner that allows for assembly and adjustment of the assembled retractor frame. The inner edge of the arm portion may be configured to allow for release / locking of the connector (e.g., ratchet 805). In certain aspects, the outer edge may be configured to interact with the connector, alone or in combination with the inner edge, such as, for example, groove 806. The middle portion 821 is the portion of the frame segment between the arm (substantially straight arm) portions 820. The middle portion 821 has a curved portion 823 that connects the arm (substantially straight arm) portions 820 / 822 to the middle portion 821. In certain aspects, when there are two opposing U-shaped frame segments that are positioned to be moved away from each other, for example to open the abdomen; the retractor is configured to lock in place to prevent collapse when expanded; and the connector is configured with one pawl to release both frame segments, in this configuration, the teeth on the frame segments for interacting with the pawl may be cut or configured in opposite directions to provide locking during expansion with a single pawl. In other aspects, individual pawls may be provided in an appropriate configuration so that there is no need to cut or position the teeth in opposite directions. The teeth on the individual frame segments may be cut or configured in the same or opposite directions, so that when the retractor is assembled, the teeth all face in opposite directions or face in the same direction, respectively.

[0039] FIG. 9 illustrates one embodiment of an assembly of frame segment connectors (or connectors) 903 and frame segments 900 in isolation. Each connector 903 may have one or two receiving openings for receiving arm portions of two frame segments (900a and 900b). In certain aspects, the openings may be offset, stacked, or side-by-side. In certain aspects, the openings are offset. In other aspects, the openings are stacked. In certain aspects, the connector 903 has one opening (e.g., when the connector is a fixed, integral part of one end of a frame segment); or the connector 903 may have two or more openings. In certain aspects, one frame segment may be attached to two connectors, e.g., the connectors may be fixed to one or both ends of the frame segments. In other aspects, one connector may be adjustably connected to two frame segments, e.g., the connector has one or two openings for receiving an arm portion of a first frame segment and an arm portion of a second frame segment. The frame segments may be attached, coupled, or connected through a shared connector. The connector 903 may include a ratchet or pawl 904 configured to ratchet in opposite directions. The ratchet or pawl 904 may be configured to interact with toothed surfaces (e.g., 905a and 905b) of two adjacent segments. The ratchet or pawl may be configured to allow the frame to expand without disengaging the ratchet by applying a force in a direction away from the center point of the retractor. In other aspects, the ratchet is configured to not allow contraction of the frame unless the ratchet is disengaged. Other release / locking mechanisms may be integrated into the current design, and thus the ratchet mechanism is just one example. The connector may include one, two, three, or more ratchets or pawls configured to engage one or more frame segments.In certain aspects, the connectors include individual ratchets or pawls configured to interact separately and / or independently with each frame segment.

[0040] The position of the connector along the segment may be fixed by engaging a locking mechanism that can engage a tooth or groove in the frame segment for locking purposes. In other embodiments, the connector may be integrated into one end of the frame segment, in which case the connector may only have one opening and one ratchet mechanism since the connector is fixed to one end of that segment.

[0041] The retractor blades do not have to be associated with a connector. The retractor blades or other instruments may be secured to one or more retractor blade connectors or may be an accessory instrument attached to the frame at a position other than the connector point. Multiple retractor blades or other instruments may be attached to the frame, and in certain aspects, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more retractor blades and / or other instruments may be attached to the frame. The only limiting factors for attachment are the available space along the frame and physical interference between attachments.

[0042] The frame segment comprises various regions or portions. The frame segment has a first arm (substantially straight arm) portion and a second arm (substantially straight arm) portion connected by a middle portion. Each arm portion of the frame segment is configured to interact with a connector in a manner that allows for assembly and adjustment of the assembled retractor frame. An inner edge of the arm portion may be configured to allow for release / locking of the connector. In certain aspects, the outer edge may be configured to interact with the connector alone or in combination with the inner edge. The middle portion is a portion of the frame segment between the arm portions. The middle portion has a curved portion that connects the arm portion to the middle portion. The curved portion forms an angle between the arm portion and the middle portion. The curved portion may be characterized by an angle formed between the long axes of the arm portion and the middle portion. In certain aspects, the angle is between 85 and 95 degrees. In certain aspects, the segment angle is at or about 90 degrees.

[0043] The frame segments, connectors, and retractor blades may be metal, metal alloy, plastic, or combinations thereof. In certain aspects, the retractor is made of a material that can be autoclaved or otherwise sterilized (e.g., irradiated, etc.). The frame segments may be formed rods (with bends or angles) with circular, oval, square, or rectangular cross sections. The connectors are configured to receive and reversibly engage the frame segments of the frame. The segments are connected by the connectors to form the retractor frame. Each connector connects two segments.

Claims

1. below: A retractor frame having a first frame segment and a second frame segment and two connectors, each of the first frame segment and the second frame segment comprising: a first and second substantially straight arm portion and an intermediate portion connecting the first and second substantially straight arm portions, the first and second substantially straight arm portions and the intermediate portion lie substantially in the same plane; and each segment has a continuous, fixed length; the major axes of the first and second substantially straight arm portions are parallel to one another and project to the same side of the intermediate portion; the intermediate portion forms first and second bends with the first and second substantially straight arm portions, respectively, such that the major axis of the intermediate portion is perpendicular to the major axes of the first and second substantially straight arm portions; each frame segment has an upper surface and a lower surface with inner and outer edges; the first frame segment and the second frame segment are configured to connect to form an adjustable retractor frame when the substantially straight first arm portion of the first frame segment connects with the substantially straight first arm portion of the second frame segment and the substantially straight second arm portion of the first frame segment connects with the substantially straight second arm portion of the second frame segment. the substantially straight first and second arm portions and an intermediate portion; a connector configured to receive the substantially straight first and second arm portions of the first and second frame segments to form the adjustable retractor frame, (i) a non-locking configuration that allows the substantially straight arm portions of the frame segments to move relative to one another, thereby allowing adjustment of the retractor frame; or (ii) a locking arrangement that fixes the substantially straight arm portion in a relative position to the substantially straight arm portion of the other frame segment; The connector can be the retractor frame comprising: two or more retractor blades connected to the retractor frame, the faces of the retractor blades forming an angle with the plane of the retractor frame; 1. An adjustable surgical retractor comprising:

2. 10. The adjustable surgical retractor of claim 1, wherein the connector is configured to allow one or more frame segments to move in one direction.

3. 3. The adjustable surgical retractor of claim 2, wherein the connector is attached or removably attached to the at least one frame segment.

4. 3. The adjustable surgical retractor of claim 2, wherein each connector comprises a tab configured to engage one or more frame segments.

5. 5. The adjustable surgical retractor of claim 4, wherein the connector comprises respective prongs configured to interact with respective frame segments.

6. 10. The adjustable surgical retractor of claim 1, wherein each connector is configured to position ends of the frame segments in a stacked configuration.

7. 10. The adjustable surgical retractor of claim 1, wherein each connector is configured to position an end of a frame segment in an offset configuration.

8. the adjustable surgical retractor further comprising two or more retractor blade connectors for connecting two or more retractor blades to a retractor frame; 2. The adjustable surgical retractor of claim 1, wherein each of the two or more retractor blades is adjustable; each of the two or more retractor blade connectors is configured to receive a proximal portion of the two or more retractor blades and to reversibly fix the position of the retractor blades with a retractor blade locking mechanism incorporated therein; and the proximal portions of the retractor blades are movable up and down until locked by the retractor blade locking mechanism.

9. 2. The adjustable surgical retractor of claim 1, wherein the substantially straight arm portions of the first and second frame segments are positioned such that an inner edge of the substantially straight first arm portion of the first frame segment is in substantially parallel alignment with an outer edge of the substantially straight first arm portion of the second frame segment.

10. 2. The adjustable surgical retractor of claim 1, wherein the substantially straight arm portion of each of the first and second frame segments is about 2.5 to 50 centimeters in length and the intermediate portion of each of the first and second frame segments is about 2.5 to 100 centimeters in length.

11. 10. The adjustable surgical retractor of claim 1, having an adjustable internal distance of 2.5 to 90 centimeters in the retractor frame in the expanded configuration.

12. 10. The adjustable surgical retractor of claim 1, wherein two, three, four, five, or six retractor blades are coupled to the retractor frame.

13. 1. A surgical retractor comprising: an adjustable retractor frame having a first frame segment and a second frame segment and two connectors; and two or more retractor blades connected to the retractor frame, the faces of the retractor blades forming an angle with the plane of the retractor frame; each of the first frame segment and the second frame segment comprises first and second substantially straight arm portions and an intermediate portion connecting the first and second substantially straight arm portions, the first and second substantially straight arm portions and the intermediate portion being substantially in the same plane and each segment having a continuous fixed length, the major axes of the first and second substantially straight arm portions projecting on the same side of the intermediate portion, the intermediate portion forming first and second bends with the first and second substantially straight arm portions, each frame segment having an upper surface and a lower surface with inner and outer edges; the first frame segment and the second frame segment are configured to be connected with the two connectors to form an adjustable retractor frame when a substantially straight first arm portion of the first frame segment is connected with a substantially straight first arm portion of the second frame segment and a substantially straight second arm portion of the first frame segment is connected with a substantially straight second arm portion of the second frame segment; and the connector is configured to connect with the first and second substantially straight arm portions of the first and second frame segments to form an adjustable retractor frame, the connector being capable of being in (i) a first configuration that allows expansion or contraction of the adjustable retractor frame, or (ii) a second configuration that resists contraction of the adjustable retractor frame. Surgical retractors.

14. The surgical retractor of claim 13, wherein the connector is attached to at least one frame segment.

15. The surgical retractor of claim 13, wherein the connector is removably attached to the at least one frame segment.

16. 14. The surgical retractor of claim 13, wherein the adjustable retractor frame has a fixed length along a first axis and an adjustable length along a second axis, the second axis perpendicular to the first axis.

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