Surgical retractor frame and surgical retractor assembly

Abstract

To provide a surgical retractor frame and a surgical retractor assembly that can substantially eliminate the risk of racking or snagging during the assembly of the retractor, including when expanding or contracting the frame. [Solution] The surgical retractor assembly comprises a first frame segment, a second frame segment, and a pair of connectors configured to connect the first frame segment to the second frame segment. The first and second ends of the first frame segment extend from the same side of the central portion of the first frame segment and are angled outward so as to be away from each other at an angle suitable for reducing the risk of racking when expanding the retractor frame.

Description

Technical Field

[0001] The present application relates to a surgical trocar frame and a surgical trocar assembly.

Background Art

[0002] This section is intended to explain the background or circumstances of the invention recited in the claims. The description in this specification may include concepts that, although pursued, are not necessarily those that have been 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 the present application and is not admitted to be prior art by virtue of being included in this section.

[0003] Abdominal surgery, in both emergency and elective procedures, requires adequate exposure of the abdominal contents so that the surgeon can properly visualize the area of injury or disease. This is typically accomplished by use of a static metal trocar. Two of the most commonly used trocar mechanisms currently in use are the Balfour trocar and the Bookwalter trocar. Each of these trocars exhibits advantages and disadvantages in its design and use. The Balfour trocar consists of a frame with metal blades incorporated onto a ratchet system, which, when engaged, pulls the abdominal wall in a lateral direction, thereby exposing the abdominal contents and allowing the surgeon to operate. The Bookwalter mechanism consists of a support frame that attaches to the operating table, onto which a rigid non-adjustable metal ring is attached, and then trocar blades are individually attached to this metal ring.

[0004] The Balfour retractor, with its simple design, ease of use, and rapid abdominal exposure, is perhaps the most commonly used abdominal retractor, especially in trauma and emergency surgical situations where time is critical. Unlike the Bookwalter retractor, the Balfour retractor does not require a metal frame to be attached to the operating room bed, thus saving valuable time and allowing for immediate insertion of the retractor after the abdominal incision has been made.

[0005] Despite the widespread use and ease of use of the Valfour retractor in the operating room, its application has several limitations. For example, the Valfour retractor results in insufficient abdominal exposure in larger or obese patients. In larger or obese patients, the current design of the standard Valfour retractor often does not provide sufficient traction to adequately expose the abdomen. The frame over which the retractor blade extends is typically too short for larger or obese patients, resulting in suboptimal exposure and often requiring a change to a different retractor system. Due to the inherently limited design of the Valfour retractor, the surgical incision is pulled along only one axis (lateral), limiting overall wound exposure. An optional additional retractor blade (bladder blade) can be attached, but this only adds downward traction and typically results in suboptimal exposure requiring a change to a different retractor system.

[0006] Standard Valfour retractors, apart from a single bladder blade, do not offer an additional frame for attaching additional retractor blades. This significantly limits their ability to pull additional incisions or abdominal contents compared to other retractor mechanisms, thereby limiting surgical exposure. In addition, the Valfour retractor system generally presents significant problems during its use due to unintended movement and displacement of the retractor blades along the edges of the surgical wound. The two retractor blades, which provide lateral traction at the wound edge (or abdominal wall during abdominal surgery), often unintentionally move either above or below the wound, resulting in rotation of the entire retractor mechanism and loss of wound edge traction, requiring either a time-consuming retractor repositioning or a change to a different type of retractor system. This is particularly common in large or obese patients or in situations where the Valfour retractor system is significantly expanded for use in larger wounds or surgical openings. Simply put, the more the system is adapted to larger wounds, the greater the shortcomings of the Valfour retractor system.

[0007] The Bookwalter retractor is typically used when the Balfour retractor system is considered inadequate or ineffective. The Bookwalter retractor consists of a support metal rod, which is attached to the side rails on the operating table by a non-sterile person in the operating room after the patient has been 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 support rod, and a rigid circular or elliptical metal ring is then attached to the second metal arm. Once this is in place, individual retractor blades can then be attached using the rigid rings for support.

[0008] Despite its popularity, the Bookwalter retractor also exhibits several limitations. The Bookwalter retractor mechanism involves attachment to the operating table, requiring installation by non-sterile personnel in the operating room. Occasionally, this can raise concerns regarding the maintenance of a sterile field, as the surgeon may need to place their hands under the sterile barrier to assist and properly position the retractor arms. Additionally, the multiple arms, requiring setup before surgical traction is achieved, demand considerable time for instrument setup, making the system unsuitable for urgent situations or surgeries where time is critical. The circumferential ring used in the Bookwalter system is not expandable and often restricts the placement of additional retractors along both the longitudinal and transverse axes. Furthermore, the fixed dimensions of the ring prevent adjustment of traction according to each patient's individual physical characteristics 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, the ring system is secured in place, and 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 interrupting the surgery, removing the retractor blade, repositioning the ring, and reattaching the retractor blade, which again takes considerable time. There is an existing demand for an additional retractor system. [Overview of the Initiative]

[0009] In some embodiments, a surgical retractor assembly may comprise a first frame segment having a central portion positioned between a first end and a second end. The surgical retractor assembly may further comprise a second frame segment having an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, the pair of end portions maintaining an orientation substantially parallel to each other, and each of the pair of end portions having an upper and a lower surface. The surgical retractor assembly may further comprise a pair of connectors configured to couple the first frame segment to the second frame segment. Each of the pair of connectors may comprise a ratchet housing for connecting one of the connectors to one of the ends of the first frame segment. A channel is formed within the ratchet housing, and the channel is shaped to receive the upper or 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. Therefore, for example, a surgical retractor assembly may comprise frame segments that can be superimposed perpendicularly on each other and joined together. When joined together, the frame segments may define an adjustable frame that can expand or contract to help visualize a patient's wound or incision. For example, in one preferred embodiment, the channels of a pair of connectors may be configured to receive the upper surface of the end portion of the second frame segment when the pair of connectors are superimposed perpendicularly on the top of the second frame segment and lowered so that the end portion of the second frame segment is received within the channels. In particular, this makes it possible to join the frame segments together without the surgeon having to back off or lean back from the operating table in certain situations where the first frame segment has already been used in a medical procedure.

[0010] In some embodiments, a surgical retractor assembly may comprise a first frame segment having a central portion positioned between a first end and a second end, and a second frame segment having an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, wherein the pair of end portions maintain an orientation substantially parallel to each other, and each of the pair of end portions has an upper and a lower surface. The surgical retractor assembly may further comprise a pair of connectors, each configured to connect the first frame segment to the second frame segment in order to form a retractor frame, and at least one blade assembly. The at least one blade assembly may comprise a blade including a front blade surface, the front blade surface configured to be positioned adjacent to the tissue wall of the wound or incision. The surgical retractor assembly may further comprise at least one blade block configured to attach at least one blade assembly to the retractor frame, the blade block configured to selectively orient the front blade surface toward the tissue wall. Therefore, the surgical retractor assembly avoids inadvertent damage to the patient's tissue if the blade is accidentally positioned away from the tissue wall, and can be more easily formed into a frame in emergencies.

[0011] In some embodiments, a surgical retractor assembly may comprise a first frame segment having a central portion positioned between a first end and a second end. The surgical retractor assembly may further comprise a second frame segment having an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, the pair of end portions maintaining an orientation substantially parallel to each other, and each of the pair of end portions having an upper and a lower surface. The surgical retractor assembly may further comprise a pair of connectors configured to connect the first frame segment to the second frame segment in order to form a retractor frame. The first end of the first frame segment may be a substantially linearly extending portion of the first end portion, and the second end of the first frame segment may be a substantially linearly extending portion of the second end portion. The first end portion 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 outward so as to be apart from each other at an angle suitable for reducing the risk of racking when extending the retractor frame.

[0012] In some embodiments, a surgical retractor assembly may comprise 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, wherein the first frame segment comprises an intermediate portion, a first end portion, and a second end portion, the intermediate portion being positioned between the first end portion and the second end portion, and the first end portion and the second end portion protruding from the same side of the first intermediate portion, and the second frame segment comprises The second frame segment comprises an intermediate portion, a first end portion, and a second end portion, the intermediate portion being positioned between the first end portion and the second end portion, and the first end portion and the second end portion protruding from the same side of the first intermediate portion; and the pair of connectors comprising a first connector configured to be coupled to the first end portion of the first frame segment and a second connector configured to be coupled to the second end portion of the first frame segment, each of the pair of connectors comprising a channel, the channel being configured to receive the end portion of the second frame segment when the end portion and the channel are aligned substantially parallel to each other and superimposed in a vertical direction. [Brief explanation of the drawing]

[0013] [Figure 1] A perspective view of an embodiment of a surgical retractor assembled in an extended configuration. [Figure 2] A plan view of the surgical retractor shown in Figure 1, assembled in its extended configuration. [Figure 3] A bottom view of the surgical retractor shown in its expanded configuration in Figure 1. [Figure 4] A perspective view of the surgical retractor shown in Figure 1, assembled in a reduced form. [Figure 5] A plan view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 6]A bottom view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 7] A perspective view of an embodiment of a surgical retractor segment and a pair of connectors attached thereto. [Figure 8A] A diagram showing an embodiment of a frame segment of a surgical retractor, illustrating the connection between the segment and a connector or ratcheting subassembly. [Figure 8B] Figure 8A shows the end of a frame segment, illustrating the robust connection between the segment and the connector or ratcheting subassembly. [Figure 9] Plan view of an embodiment of the frame segment of a surgical retractor. [Figure 10] Figure 9 shows a bottom view of the frame segment. [Figure 11] A perspective view of the frame segment shown in Figure 9. [Figure 12] A diagram showing an embodiment of a surgical retractor kit. [Figure 13A] A diagram showing embodiments of the left and right ratchet subassemblies. [Figure 13B] Component diagram of the left ratchet subassembly shown in Figure 13A. [Figure 13C] A perspective view of the left ratchet subassembly shown in Figure 13A, including a first field of view suitable for viewing the upper side of the ratchet subassembly and a second field of view suitable for viewing the lower side of the ratchet subassembly. [Figure 14] An illustration of an embodiment in which two frame segments are connected together. [Figure 15] A close-up view of the ends of the two frame segments shown in Figure 14, before the two frame segments are joined together. [Figure 16] A close-up view of the ends of the two frame segments shown in Figure 14, after both frame segments have been joined together. [Figure 17] A diagram showing embodiments of the components used to construct a blade block. [Figure 18]Perspective view of the blade block oriented to show the upper surface of the blade block. [Figure 19] Perspective view of the blade block oriented to show the lower surface of the blade block. [Figure 20] Plan view of the blade segment shown in FIGS. 18 and 19. [Figure 21] Diagram showing an embodiment of the components used to construct the blade assembly. [Figure 22] Diagram showing the blade assembly in a first orientation. [Figure 23] Diagram showing the blade assembly in a second orientation. [Figure 24A] Diagram showing the blade block and blade assembly before connecting the components. [Figure 24B] Diagram showing the blade assembly attached to the blade block. [Figure 25] View from above of the blade assembly attached to the blade block, showing an embodiment that selectively restricts the rotation of the blade assembly within the blade block, and an enlarged view of the blade assembly attached to the blade block with annotations in the relevant part. [Figure 26A] Diagram showing the blade assembly attached to the blade block and rotated in a first orientation. [Figure 26B] Diagram showing the blade assembly attached to the blade block and rotated in a second orientation. [Figure 27A] Diagram showing the blade block arranged for attachment to a frame or frame segment. [Figure 27B] Diagram showing the blade block during an intermediate stage when attaching the blade block to a frame or frame segment. [Figure 27C] Diagram showing the blade block attached to a frame or frame segment. [Figure 28A] Diagram showing the blade block attached to the frame segment in a first position. [Figure 28B] Figure 28A shows a blade block that operates to move along the frame segment shown in Figure 28A. [Figure 28C] Figure 28A shows the blade block of Figure 28A locked in a second position along the frame segment shown in Figure 28A. [Figure 29A] Plan view and perspective view of the frame assembled in its fully scaled-down form. [Figure 29B] Plan view and perspective view of the frame assembled in an intermediate extension configuration. [Figure 29C] Plan view and perspective view of the frame assembled in its fully extended configuration. [Figure 30A] Plan view and perspective view of a frame assembled in an intermediate extension configuration, and a ratchet button positioned to facilitate the reduction of the frame. [Figure 30B] Plan and perspective views of the frame assembled in its fully scaled-down form, and the ratchet button in the locked position. [Figure 31] A diagram showing an alternative embodiment of the frame segment of a surgical retractor. [Figure 32] A diagram showing another alternative embodiment of the frame segment of a surgical retractor. [Figure 33] A diagram illustrating an embodiment of a method for assembling a surgical retractor. [Figure 34A] A diagram showing an embodiment of a frame segment in which the end portion of the frame segment is inclined or sloped, or the connector has a channel that is angled relative to the connector housing. [Figure 34B] A diagram showing an embodiment of a frame segment in which the end portion of the frame segment is inclined or sloped, or the connector has a channel that is angled relative to the connector housing. [Figure 34C] A diagram showing an embodiment of a frame segment in which the end portion of the frame segment is inclined or sloped, or the connector has a channel that is angled relative to the connector housing. [Modes for carrying out the invention]

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

[0015] "Comprises" means to include, but not to be limited to, those things. "Comprising" means including, but not being limited to, those things.

[0016] "Having" means including, but not being limited to, those things. The references to "right" and "left" are from the patient's perspective, with the patient lying supine and their abdominal cavity exposed.

[0017] This disclosure relates to a medical retractor, associated segments or arms of a retractor frame, attachments used with a medical retractor, and associated methods for fabricating and using a medical retractor. While attachment of the retractor described herein to an operating table or other support is not mandatory, it can be an option for several embodiments. Therefore, the use of the retractor does not require the involvement of any non-sterile members of the surgical team, nor does the retractor come into contact with any support structure extending outside the sterile field surrounding the surgical opening or wound. Thus, the retractor is less susceptible to contamination during setup and use, and easier to maintain sterility. The absence of a mandatory, cumbersome fixed metal frame supporting the retractor increases the surgeon's mobility during surgery and allows for positioning on both sides of the patient. Furthermore, in contrast to several other retractors that can be used without an cumbersome metal frame, the retractor described herein minimizes the risk of unintended movement and displacement of the retractor blade along the edge of the surgical wound, thus solving important problems related to other retractors in the prior art.

[0018] The retractors described herein are further configured to be easily and quickly deployed so that they can be applied in emergency or time-constrained situations. For example, in some situations, a retractor may be introduced during a busy medical procedure by using one of a pair of frame segments (e.g., to pull the tissue to expose a surgical opening) and connecting the other frame segment to the frame segment in use without interrupting the ongoing surgical procedure. Specific features of a retractor, including but not limited to the type of connector used, the relative dimensions and shape of the frame segments, and the form of the associated blade block, may thus help facilitate the use of the retractor.

[0019] For example, a retractor may be assembled using a pair of frame segments, with the ends of one frame segment positioned above the ends of the other frame segment, so that the ends of the two frame segments are aligned approximately parallel to each other but offset in different vertical planes, and then by lowering one frame segment onto the other frame segment to engage the segments together using one or more connectors, such as snap-fit ​​connectors. This simplifies the assembly of the frame without interfering with the ongoing surgical procedure, even in situations where one of the frame segments may need to be positioned under one or both of the surgeon's arms. For example, one frame segment may be fitted with one or more blades positioned to be used to grasp the free end of a wound or incision from a side away from the surgeon (e.g., on the opposite side of the operating table where the surgeon is standing). The one or more blades may be used, for example, to retract tissue to help the surgeon access the wound or incision, or to enable the surgeon to perform medical procedures such as clamping an artery to help prevent bleeding. Next, the other frame segment of the pair can be positioned 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] In this design, as will be further explained in relation to Figures 14-16, it should be understood that the frame segments positioned under one or both of the surgeon's arms do not need to be positioned adjacent to the other frame segment in an end-to-end manner for engagement (i.e., with the ends of each frame segment aligned on substantially the same vertical plane so that the ends of each frame segment can pass through one or more holes or lumens of the connector), as in some other prior art retractors. In particular, assembling such a retractor requires less space under the surgeon's outstretched arm than performing this alternative end-to-end mounting. In some embodiments, the width of at least one of the frame segments may be further selected to further assist in the assembly of the retractor. For example, in some embodiments, the frame segment extending under the surgeon's arm may feature a smaller width than the other frame segment. Once these frame segments are connected to form a frame, the frame may be adjustable. For example, frame adjustment may be performed using a ratcheting mechanism or other mechanism so that the end portions of the two frames move relative to each other, with these end portions aligned in a substantially parallel relationship to each other.

[0021] The retractor blades described herein may be pre-installed in one 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 so that the frame segments can accommodate one or more retractor blades. Advantageously, the retractor blades may be held in one or more blade blocks in such a way that the retractor blades can be rotatably adjusted to grip the incision or wound wall at an appropriate angle, such as an angle desired to provide appropriate tension to hold the wall of the wound or incision site and assist in visualization. However, the blades may be selectively restricted in rotation so that the blades are automatically orienting at least generally in an appropriate orientation during the assembly of the retractor, thereby facilitating the rapid use of the device. For example, as further described in more detail with reference to Figure 25, the blade block may be provided with ribs or other features (e.g., mechanical stoppers) to selectively restrict the rotation of the retractor blade post within the blade block hole. The stopper can automatically orient the blade so that it does not rotate in a way that prevents the front side of the blade from properly facing the tissue wall in which it is intended to engage. Thus, the surgeon or surgical staff does not need to spend time manually adjusting the position or orientation of the blade during the assembly of the retractor. Inadvertent damage to adjacent tissue near the wound or incision site, which may occur if the blade is accidentally rotated during insertion, can also be avoided. Furthermore, in some embodiments, the mechanical stopper or rib can help prevent changes in the angle of the blade, which may result in inadvertent movement of the retractor around the wound. Thus, the rib or stopper may be shaped to minimize the risk of tissue damage during the initial setup or assembly of the retractor, or to help prevent inadvertent movement of the retractor around the edge of the wound during surgical procedures, or both.

[0022] The retractors described herein further include certain modifications to substantially eliminate the risk of racking or jamming during the assembly of the retractor, including when expanding or contracting the frame. For example, in some embodiments, a connector may be firmly attached to one of a pair of frame segments used to form the frame. The connector may be fixed to one of the frame segments, for example, by welding or by other means, to substantially eliminate any movement between the connector and the 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 have one or more complementary feature portions to help guide the placement of the frame segment into the channel and to guide sliding motion between them 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 be positioned 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 in the channel. Furthermore, in some embodiments, the frame segment may be shaped with an outward slope or incline to further help to substantially eliminate the risk of racking.

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

[0024] For example, various embodiments of the retractor 10 are described in relation to Figures 1 to 4, which show the surgical retractor 10 assembled as it is used to visualize an incision or wound in a patient, in an expanded state (Figures 1 to 3) and a retracted state (Figure 4). 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, the two end portions 16, 18 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 connected via a central or intermediate portion 26 and curved portions 23, 25. When the retractor 10 is in an assembled form, 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 to 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 to the end portion 24 of the second frame segment 14.

[0025] For example, in some embodiments, connectors 28, 30 may each include a channel 82 (as shown in Figure 13C), where the channel 82 is aligned with the longitudinal axis (A) of the end portion. L It is formed to a size that accommodates one of the end portions 22, 24 when aligned approximately parallel to the longitudinal axis (A) of the end portion 24. For example, as best shown in Figures 2 and 3, L) is shown aligned with channel 82 (the channel is hidden from view in Figure 3 but is generally positioned as indicated by the relevant arrows). Channel 82 may be formed, for example, at least partially within the housing of connectors 28,30 (best illustrated, for example, in Figure 13C) and shaped to receive the upper surface 21a of the end portion 24 of frame segment 14. The user may activate one or more buttons or locks on connectors 28,30 to provide access to the channel so that, for example, the end portions 22,24 can be inserted into the channel and nested. When receiving the end portions 22,24 into the channel, the connector may snap into place or otherwise provide an audible or tactile indication of the connection. Thus, the connectors herein may allow segments 12,14 to snap into place together. An audible or tactile indication of the connection may be particularly useful, for example, in a situation where 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] In particular, this can be done when connectors 28, 30 (e.g., connectors that can already be coupled to the first frame segment 12) are superimposed vertically on the end portions 22, 24 of the second segment 14 so as to receive the upper surfaces 21a, 21b, and the segments 12, 14 are snap-fitted together. This procedure may be in contrast to other procedures, such as those that may require the end portion of an arm to be passed through a separate hole or lumen of the connector (e.g., an end-to-end contact configuration for engagement of the frame segments). Such an end-to-end contact configuration for engagement may require more space than may be available when the surgeon is already engaged in the medical procedure. For example, this configuration of engagement may require the surgeon to move away from or lean back on the operating table during the assembly of the frame so that space is available to position the frame segments so that the end portions of the frame segments can be aligned with the openings of the connectors. In some embodiments, the width of at least one of the frame segments may be further selected to further assist in the assembly of the frame. When coupled together, the connectors 28,30 can slide slidably across the end portions 22,24 during frame adjustment and can be held in a selected configuration using a ratcheting mechanism. Typically, the connectors 28,30 can engage with the end portions 22,24 at any point along their nearly entire length, thus making segment engagement even easier and quicker. Thus, the connectors 28,30 can be particularly adapted for quickly connecting frame segments 12,14 together, and the widths of the segments 12,14 (for example, the lengths of the end portions 22,24 of frame segment 14 may be relatively extended, and the end portions 16,18 of frame segment 12 may be shortened) are configured to further assist the user during frame assembly.

[0027] The retractor 10 may be characterized by defining a frame comprising two frame segments 12, 14 when segments 12, 14 are joined together. The frame may define a surrounding area configured to provide access to a wound or incision site. The frame may be described as having a perimeter that can be adjusted to adjust the dimensions of the frame to be suitable for a given surgery. For example, the frames shown in Figures 1 to 4 may define a substantially rectangular shape comprising an adjustable axis and a fixed axis. When the frame comprises an adjustable axis and a fixed axis, the length and width of the frame may be referred to. 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 range greater than or less than the length of the frame, for example, depending on whether the frame is in a reduced or expanded state. As used herein, a substantially rectangular frame does not preclude curved edges at the corners of the frame.

[0028] Each of the first frame segment 12 and the second frame segment 14 may have teeth along one or more edges and / or ridges or grooves along one or more faces. For example, referring to Figures 2 and 3, the first frame segment 12 may have teeth 32 on its outer edge. Similarly, teeth 34 may be provided on the outer edge of the second frame segment 14. In some embodiments, the teeth 32, 34 may be provided on the inner edges of the frame segments 12, 14, or the 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, a 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 so that the blade block 32 can slide along the frame. In other embodiments, the blade block may move across grooves, ridges, or other suitable structures to allow for adjustable positioning, in contrast to moving along teeth 32, 34.

[0029] Frame segments 12, 14 can be connected to each other using connectors 28, 30. For example, connectors 28, 30 may have a ratchet mechanism that interacts with ratchet teeth 38 to adjustably fix the frame segments 12, 14 in selected positions, allowing for expansion and contraction of the frame. In some embodiments, a directional ratchet may 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 may 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, connector 28 may have a wing 40, which is appropriately shaped to accept a standard Bookwalter-type attachment or other attachment. For example, as shown in Figures 34A to 34B (illustrating the left connector 30 and associated wing 42), the Bookwalter attachment 35 may be positioned on the wing 42. The wing 42 may be shaped such that, due to its vertical height relative to the top of the frame connector 30, the user can access one or more Bookwalter adjustment levers 31 on the attachment 35, even when the attachment 35 is positioned adjacent to the connector 30 "facing" it. Thus, the Bookwalter blade 33 or other attachments can be flexibly positioned around the frame, for example, including the midpoint of any side of the frame, including the adjustable side of the frame. In particular, the ability to position the attachment at the midpoint of a side of the frame may be especially useful because this position can help provide sufficient visibility of internal tissue in larger incisions, which may be particularly useful in surgeries performed on large or obese patients.

[0030] Of note, for some frames in some extended states, the connectors 28,30 can be positioned near or at the midpoint of the frame. Some embodiments of this specification with wings 40,42 can still allow the user to position the blade or other attachment approximately at the midpoint of the frame by providing the flexibility to connect the attachment along the wings 40,42 or at several other positions on the frame, such as positions A,B shown in Figure 34A. In other words, depending on the required level of frame extension, the user can move the blade to either position A or position B so that the blade can always be positioned approximately at the midpoint of the frame.

[0031] In some embodiments, the wing 40 may be shaped so that an attachment can be mounted on the wing 40, and a separate blade block 36 or other attachment can be mounted near or below the wing 40 on the lower portion 22 of the frame segment 14. In some embodiments, the wing 40 may be offset vertically from the end portion 22 to accommodate the placement of one attachment near or even directly below the wing attachment. For example, at least a portion of the wing 40 may be angled so that the wing 40 is positioned above the lower portion 22, or the wing 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 required to properly visualize tissue, illuminate tissue, or perform some other function. Similarly, the connector 30 may have a similar wing 42 configured to engage with an attachment. 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 approximately around the entire length of the frame, and the frame may be configured to accommodate one or more attachments over approximately the entire length of the frame. Embodiments in which multiple blade blocks 36 or other attachments can be positioned on a given side of the frame may be particularly useful when adjusting the dimensions of the retractor 10 for use on large or obese individuals.

[0032] In some embodiments, either or both of the frame segments 12, 14 may have one or more expansion or contraction stops. The stops may be, for example, in the form of a ridge, groove, screw, pin, hole, or raised material that can contact or engage with the connectors 28, 30 to stop the movement of the frame segment through the connectors 28, 30. Thus, inadvertent disassembly of the retractor can be prevented. For example, the second frame segment 14 may include expansion stops 46, 50. The second frame segment may further include contraction stops 44, 48.

[0033] Various embodiments of the first segment 12 are further described in relation to Figures 5–7, which show the first segment 12 and a pair of connectors 28, 30 attached to the first segment 12 and equipped with wings 40, 42. As shown in Figure 5, the first segment 12 may be generally "C" shaped, with an intermediate portion 20 positioned between two end portions 16, 18. The two end portions 16, 18 project from the same side of the intermediate portion 20 and extend so that the two end portions 16, 18 are substantially parallel to each other. In some embodiments, the two end portions 16, 18 may be slightly inclined away from each other at an angle of less than about 1.5 degrees, for example. The term "substantially parallel" as used herein does not preclude the intentional inclination of the end portions away from each other at such small angles, 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 respective end portions of frame segments 12 and 14 are still designed to move relative to each other while maintaining a nearly parallel relationship when the frame is expanded or contracted.

[0034] The first segment 12 may be provided with one or more marks or visual indicators 52 for the recommended placement of the blade block 36. For example, the visual indicators 52 may be spaced apart by a recommended distance so that the blade block 36 coupled to the visual indicator 52 can cooperate with the corresponding blade block 36 on the second frame segment 14, thereby stabilizing the surgical wound in such a way that unintended movement and displacement of the retractor blade along the edge of the surgical wound is prevented. However, the retractor 10 may allow the user to position the blade block 36 at other positions 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, and the groove 54 assists in the placement and movement of the blade block 36. Visual indicators (indictors) 52 and / or grooves 54 may further assist in identifying the correct orientation of the frame segment 12. This can 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, the two end portions 16,18 connected via a central or intermediate portion 20 and curved portions 15,17. The curved portions 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 segment and to accommodate the mounting of attachments at the curved portions. For example, in some embodiments, the curved portions 15,17 may have a curve that allows a blade block 36 to be connected to the curved portions 15,17. For example, in some embodiments, the user can slide the blade block 36 from the intermediate portion 20 to the curved portions 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 relatively straight portion of a certain length 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 the curvature becomes negligible and extends to the endpoint of the first frame segment 12.

[0036] In some embodiments, the length of the end portions 16, 18 can be minimized to reduce the overall width of the first frame segment 12. This may be advantageous because the first frame segment 12 may be positioned above the second segment 14 when the frame is assembled. Also, in some cases, this operation may be performed under the arm of a surgeon in a space-constrained situation. For example, in some embodiments, the end portions 16, 18 may have mounting end faces, areas, or tabs to which connectors 28, 30 can be coupled. Thus, the connectors 28, 30 can be coupled to the frame segment 12 directly adjacent to the curved portions 15, 17. For example, the end portions 16, 18 may simply have end tabs to which connectors 28, 30 can be coupled.

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

[0038] In some embodiments, the first frame segments 12,220,320 may have lengths of approximately 20, 25, 30, 35, 40, 45, 50, 60, 65, 70, 75, or 80 centimeters, and all values ​​and ranges in between. In some embodiments, the length of the first frame segments 12,220,320 may be such that at least two blade blocks 36 can be coupled to the first frame segments 12,220,320. The blade blocks 36 may be further spaced apart by a certain distance. For example, as shown in Figure 1, a pair of blade blocks 36 are coupled to the first frame segment 12 and spaced apart along the length of the intermediate portion 20. The blade blocks 36 can be positioned on the frame segments 12,220,320, for example, near the location of the visual indicator 52, and as a result, the blade blocks 36 are spaced apart by a recommended distance. Referring further to Figure 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 to a recommended distance. Thus, the frame may comprise two pairs of blade blocks 36 positioned near the corners of the frame. The blade blocks 36 on each of the frame segments 12, 14 may work together to help prevent unintended movement and displacement of the retractor blade along the edge of the surgical wound.

[0039] In some embodiments, frame segments 12, 220, 320 may have widths of approximately 5, 7, 10, 15, 20, or 25 cm, and all values ​​and ranges in between. For example, in frame segment 320, the minimum width of the segment may be limited simply 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 segments 12, 220, 320 with the second frame segment 14 when the surgeon is already using the second frame segment 14 to retract wound tissue during a surgical procedure.

[0040] In some embodiments, the frame segment 12 includes a pair of connectors 28,30 that can be fixedly connected to each end portion 16,18. For example, as shown in Figure 8A, the connectors 28,30 (which in some embodiments are ratcheting connectors and may be referred to as ratchet subassemblies) can be mounted on the frame segment 12 (which may also be referred to as upper arm segments). The connectors 28,30 can be welded along one or more joints to ensure that the connectors 28,30 are securely attached to each end portion 16,18 (as shown in Figure 8B). In such embodiments, the connectors 28,30 can be considered as part of the frame segment 12. Alternatively, the connectors 28,30 may be fixedly attached to the frame segment 12 by other means, such as using epoxy resin, adhesive, or some other suitable method, to provide a firm and secure connection between them. Thus, in some embodiments, the connectors 28,30 can be fixedly or firmly connected to the ends of the frame segment 12, and the connectors 28,30 can be configured to be manually and reversibly connected to a second frame segment 14. Fixing connectors 28,30 to one of the segments proved particularly advantageous in helping to prevent misalignment of the frame segments when expanding or contracting the frame. This situation, which may be a common problem with other ratchet systems, is sometimes referred to as "racking" and can cause the ratcheting assembly to stop or get stuck, making it difficult to adjust the frame. In other embodiments, connectors 28,30 may be configured to be reversibly attached to both frame segments 12,14, i.e., the connectors can be manually attached to and detached from both frame segments 12,14. Some of these embodiments may have 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 reference to Figures 9 to 11. For example, as similarly described with respect to the first frame segment 12, the second frame segment 14 may be provided with one or more visual indicators 52 indicating a position for the recommended placement of the blade block 36. Similar to segment 12, segment 14 may also allow for adjustable placement and movement of the blade block 36 on segment 14. For example, segment 14 may be provided with a central groove 53 and side grooves 56, 58. The grooves 53, 56, 58 may facilitate the sliding adjustment of the blade block 36 or other attachments connected to segment 14. Instead of multiple grooves 53, 56, 58, segment 14 may be provided with a single groove (not shown) that may extend over each of, for example, end portions 22, 24, intermediate portions 26, and curved portions 23, 25. Thus, in some embodiments, the retractor blade 36 may be slidably moved within its single groove along substantially the entire length of the second frame segment 14. As most clearly shown in Figure 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 surfaces. For example, the teeth 38 may be formed on the inner surfaces of each of the end portions 22, 24. The retractor 10 can adjust the dimensions by moving the frame segments 12, 14 relative to each other by moving the connectors 28, 30 along the teeth 38. In other embodiments, in contrast to moving along the teeth 38, the connectors 28, 30 may move across grooves, ridges, or other suitable structures to allow for adjustable dimensional adjustment of the frame.

[0042] In some embodiments, frame segment 14 may have lengths of approximately 20, 25, 30, 35, 40, 45, 50, 60, 65, 70, 75, or 80 centimeters, and all values ​​and ranges in between. In some embodiments, frame segment may have widths of approximately 15, 20, 25, 30, 35, 40, 45, or 50 cm, and all values ​​and ranges in between. In particular, in this design, frame segment 12 may have a width significantly different from the width of the second frame segment. For example, if the assembled frame is extended to a considerable full width such as approximately 60 cm, approximately 50 cm, approximately 40 cm, approximately 30 cm, approximately 25 cm, or other suitable widths, at least a large portion of this width may be provided by the second frame segment 14. Because the narrow frame segment 12 can be easily passed under the surgeon's arm during the assembly of the retractor, this geometric shape may be particularly advantageous in some embodiments in which the second frame segment 14 is attached to the wound or incision site in front of the first frame segment 12. For example, in some embodiments, the width of the frame segment 12 may 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. Figure 12 shows an embodiment of a component that may be part of a surgical retractor assembly. The component may be provided to the 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. Connectors 28, 30 may be provided integrally connected to the first segment 12, or as separate components configured to reversibly couple to the first segment 12. Any number of attachments, such as 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, but a different number of blade blocks 36 may also be provided.

[0044] Various embodiments of connectors 28,30 are further described in reference to Figures 13A–13C. In some embodiments, connectors 28,30 may be configured to operate using a ratcheting mechanism. Thus, connectors 28,30 may also be referred to as the left ratcheting subassembly and the right ratcheting subassembly. The two subassemblies may include left and right ones, which may be substantially identical except that the two subassemblies may have symmetrical ratchet housings. In this regard, the names “left” and “right” refer to a reference coordinate system with respect to a patient who is supine and oriented to expose the abdominal cavity, and each of the first segment 12 and the second segment 14 is oriented to be positioned across the patient laterally. In this exemplary situation, the first segment 12 may be positioned in an upward direction “closer to the patient’s head” relative to the second segment 14. Thus, connector 28 may be positioned on the right side of the patient’s body, and connector 30 may be positioned on the left side of the patient’s body. Similarly, when used in this exemplary manner, 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 on, for example, the orientation of the incision or wound in the abdominal cavity and the surgeon's choice. For example, in contrast to being positioned laterally from right to left on the patient's body, the first segment may be positioned along a longitudinal axis along the direction from the patient's head to their toes. Thus, the frame segments 12,14 may be referred to as the upper arm or lower arm segment. However, this terminology should not be interpreted as limiting the segments to being suitable for use in only one particular orientation.

[0045] Using this reference coordinate system, the components of the "left" side connector 30 are shown in Figure 13B. As shown in Figure 13B, the connector 30 may comprise a ratchet actuator 62, a spring 64, a ratchet or connector housing 66, a mating pin 68, a first compression spring 70, a slide lock 72, a second compression spring 74, a ratchet fastener 76, and a mating pin 78. The spring 64 may be, for example, a torsion spring or a leaf spring, or some other suitable spring or element may be used. The ratchet fastener 76 may include, for example, a clamp, brace, or clasp. The "right" side ratchet may comprise similar components. Figure 13C shows a perspective view of the "left" side connector 30 oriented to show both the top and bottom of the connector 30. As can be seen from the top perspective view, the connector 30 may comprise a wing 42 to which standard attachments such as a Bookwalter attachment can be mounted. As shown in the lower perspective view, the connector 30 may include a channel 82 with a feature portion 80 such as a raised portion, which is suitable for coupling with a groove 58 (illustrated on the end portion 24 of the frame segment 14) so ​​that the connector 30 can slide along the frame segment 14 when the frame is assembled and when the ratchet is disengaged. Of course, the "right" side connector 28 may have similar components, except that the ratchet housing 66 may be shaped as a mirror image. In some embodiments, the feature portion 80 and the groove 58 may allow the connector to properly coupling only with the appropriate end portion or surface of the frame segment. To further help ensure that the appropriate end portion and the connector are paired and / or coupled in the correct orientation, one or more surface marks may be provided on one or more of the connectors 28, 30 and the frame segments 12, 14. For example, in some embodiments, each of the connectors 28, 30 and end portions 22, 24 is marked or color-coded to help guide the user in properly assembling the retractor frame. While the above features are described by the feature portion 80 as a raised portion and the complementary groove 58, it should be understood that other complementary structures may be used.For example, the feature portion 80 may be a groove, and the raised portion may replace the groove 58 on the end portions 22, 24. Mechanisms using connectors 28, 30 to connect the first frame segment 12 to the second frame segment 14 will be further described, for example, in relation to Figures 14 to 16.

[0046] Referring to Figures 14-16, connectors 28 and 30 may be used to join segments 12 and 14 together during frame assembly. Connectors 28 and 30 may also be used to disengage segments 12 and 14, for example, to remove the retractor from a wound or incision site. This can be done, in particular, even in situations where shrinking the frame before removal of the frame is not a viable option. During the assembly of the retractor, if necessary (for example, if the connectors have not yet been fixedly or otherwise attached to the first frame segment 12), the user can attach connectors 28 and 30 to the first frame segment 12. The user can then connect segments 12 to segment 14 by aligning each connector 28 and 30 so that the channel 82 of each connector overlaps with the appropriate end portion 22 and 24 of the frame segment 14. For example, the right-side connector 28 may be aligned so 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 overlap. For example, by lowering the connector 28 above the end portion 22, these structures can be superimposed. Of course, the user may instead superimpose the connector 28 and frame segment 14 by raising the frame segment 14 so that the end portion 22 is positioned within the channel 82, or so that both structures can be moved together. Similarly, the left connector 30 can 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 these structures to be superimposed. Importantly, engagement of the two frame segments 12,14 can be achieved by changing the relative vertical position of the frame segments 12,14, and does not require the two frame segments to be connected end-to-end for engagement (i.e., with the ends of each frame segment aligned in the same vertical plane) so that the ends of each frame segment can pass through one or more holes or lumens in the connector.

[0047] With connectors 28 and 30 aligned with end portions 22 and 24, the user can slidably unlock the slide lock 72 to unlock the ratchet fastener 76. For example, the ratchet fastener 76 may rotate as shown in Figure 14 (e.g., by the sliding action of the slide lock 72 and the actuation of a spring) to open the channel 82 so that the end portion 22 can be placed in the channel 82 and the end portion 22 can be connected to the connector 28. In other words, the ratchet fastener 76 may rotate so that the lower arm "frame segment 14" can be nested inside the connector 28. Similarly, the connector 30 may be connected to the end portion 24 that is placed in the channel 82 of the left connector 30 (shown in Figure 16). Once the end portions 22 and 24 of the lower arm, i.e., the frame segment 14, are placed in the respective channels 82 of the connectors 28 and 30, the user can release the slide lock, and as a result the ratchet fastener 76 rotates to lock segments 12 and 14 together. In some embodiments, the ratchet fastener 76 may be provided with a lip 90 or other suitable feature to help lock the end portions 22, 24 into the channel 82 and to help hold the frame segments 12, 14 together.

[0048] The connector 28 can 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 to 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 to the contraction stop 44. Thus, advantageously, the segments 12 and 14 can be coupled together in any of the fully expanded, fully contracted, or intermediate states. This can simplify the assembly of the retractor, particularly 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, members of the surgical team can quickly adjust the position where the frame segments 12 and 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 and 14 can be coupled together in the required manner.

[0049] Figures 17 to 20 show embodiments of the blade block 36 and its associated components in various orientations. As shown in Figure 17, the blade block 36 may comprise several components, including, but not limited to, a pivot button 92, a torsion spring 94, a blade block housing 96, one or more compression springs 98, a push button 100, and alignment pins 102, 104. A leaf spring or other suitable element may be used instead of the torsion spring 94. Figures 18 and 19 show perspective views of the blade block 36 in orientations such as that showing the upper side of the blade block in Figure 18 and the lower side of the blade block 36. During the assembly or use of the retractor, the user can press the pivot button 92 to release the blade block 36 from the locked position in order to allow adjustment of the blade block 36 along the perimeter of the frame. For example, when the pivot button 92 is pressed, the biasing force that biases either the teeth 32 or teeth 34 of either the frame segment 12 or the frame segment 14 against the corresponding groove 93 (which may be formed in the blade block housing 96 as best shown in Figure 19) is removed, allowing the blade block 36 to move along the frame. In some embodiments, the blade block may have a raised portion or other feature portion 120 that is appropriately shaped so that the blade block 36 can be mounted to the frame only in a precise orientation, i.e., the raised portion 120 is positioned 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 Figure 20, the blade block 36 may have a visual indicator 122 to assist in the proper positioning of the blade along either the frame segment 12 or 14. One or more feature portions 124, such as bumps or raised portions, may be configured to prevent free rotation of the blade post within the housing 96, as described in more detail in Figure 25.

[0050] As further shown in Figures 17 to 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 Figures 21 to 23). For example, a push button 100 may allow the user to raise and lower the retractor blade. Referring further to Figures 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 can be activated to allow the blade post 110 to slide through the opening 106. Once the blade 114 is in the desired height, the user can release the push button 100 to lock the blade 114 in place. In some embodiments, the blade post 110 may have one or more grooves 130. For installation within the blade block housing 96, the blade post 110 may be vertically adjusted so that at least one of the grooves 130 engages properly with the opening 106. For example, in some embodiments, when a 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 has been positioned. Alternatively, the groove 130 may provide a visual indication of the vertical position of the blade 114. Thus, in some embodiments, a specific vertical height of the blade 114 may be selected based on which of one or more protrusions 130 is selected. Because a specific vertical height of the blade 114 can be selected, blades at different positions on the frame can be set to the same vertical height or at different heights. Thus, tension on the wall of the wound or incision can be controlled more precisely than in other retractors. For example, blades on opposing sides of the frame may be set to a constant vertical height so that those blades are at the same height. In some embodiments, grooves or other marks may be established so that the user can easily set blades on opposing sides of the frame to the same height, even if the frame segments to which the blades are mounted are at different heights.For example, grooves can be defined using gradation units that correspond to the height difference between opposing edges of the frame.

[0051] Various embodiments of the retractor blade assembly 60 are further described in reference to Figures 21-23. As shown in Figure 21, the retractor blade assembly 60 may comprise a blade 114, a blade post 110, and a aligning pin 112. In some embodiments, the aligning pin 112 may act as a directional 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 post 110 may be joined in several other ways. In some embodiments, the retractor blade assembly 60 may be configured to rotate over a controlled angle when the assembly 60 is mounted on the blade block 36. For example, as shown in Figure 23, the blade post 110 may have a flat portion 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 Figure 25), or the rotation of the blade may be limited to several other suitable angles. The blade 114 may be restricted in rotation so that it can be automatically oriented to at least a generally appropriate orientation during the assembly of the retractor, thereby facilitating the rapid assembly of the retractor 10. For example, as shown in Figures 26A and 26B, the retractor blade 114 may be restricted in rotation to an angle of about 90 degrees or some other suitable angle. In some embodiments, the retractor blade 114 may be restricted in rotation to a range of about 120 degrees to about 60 degrees.

[0052] Figures 27A to 27C illustrate embodiments of a mechanism to which a blade block 36 can be attached to a frame segment. For example, as shown in Figure 27A, the blade block 36 may be positioned on the frame near a recommended mounting point, which may be indicated by one or more visual indicators 52 provided on a given frame segment 12, 14. The visual indicators 52, 122 (not visible in the side view shown in Figure 27A) may provide indication of how to orient the blade block 36 for mounting. For example, if the blade block 36 is oriented so that the "T" on the visual indicator 122 aligns with the corresponding "T" on the visual indicator 52 on the frame, the user may recognize that the blade block is properly oriented for mounting. As shown in Figure 27B, the blade block 36 can be angled relative to the frame segment 12, 14 to which the blade block is attached, so that the frame segment 12, 14 is inserted into the inner shelf portion of the blade block 36. The blade block 36 can then be rotated into place. Without activating the pivot button 92 (for example, by releasing the pivot button 92), the blade block 36 will snap into place on the frame. As shown in Figure 27C, when properly assembled, the protrusion 120 on the blade block 36 can be nested into a groove or slot on the frame segment to which the blade block 36 is attached. For example, a groove 54 is shown in Figures 27A to 27C. When properly assembled, the lip 122 can help hold the blade block 36 on the frame. In particular, if the blade block 36 is incorrectly assembled in the wrong position, upside down, or otherwise, the lip 122 will not engage properly with the frame, and the blade block 36 will not be able to lock into place.

[0053] In some embodiments, the blade block 36 may be positioned around the frame. Figures 28A–28C illustrate embodiments of how the blade block 36 may be adjustablely positioned on the frame or frame segments 12,14. Figure 28A shows the blade block 36 in one possible initial position, mounted on the retractor frame or individual frame segments. For example, as shown in Figure 28A, the blade block 36 is shown mounted on a frame segment 14. As shown in Figure 28B, the pivot button 92 can be actuated, causing the blade block 36 to move in a direction such that the teeth 34 disengage from the corresponding grooves 93 (more clearly illustrated in Figure 19). This may provide clearance for the blade block 36 to slide along the frame to a desired position. In particular, in this act, the blade block 36 does not need to be removed from the frame. As shown in Figure 28C, once the blade block 36 is moved to the desired position, the pivot button 92 can be released to reengage the teeth 34 with the grooves 93 to lock the blade block 36 in place.

[0054] Advantageously, the surgical retractor 10 can initially be positioned over the incision in one of the following states: fully retracted, intermediately extended, or fully extended. The frame can then be extended and retracted as needed during the surgical procedure. For example, as shown in Figures 29A-29C, the retractor 10 can be assembled in the nearly fully retracted position as shown in Figure 29A. To adjust the frame, the user can, for example, hold the upper and lower arms (i.e., the first segment 12 and the second frame segment 14) and extend the frame outward. In this approach, connectors 28,30 can be positioned along the end portions 16,18 of the first frame segment 12 and further coupled to each end portion 22,24 of the second frame segment 14. When extending the frame, the connectors 28,30 can slide along the length of the end portions 22,24 which are located along substantially parallel first and second axes. In this design, the connectors 28, 30 move together along the end portions 22, 24, maintaining their relative alignment with one another. The retractor 10 may have any number of design features that help prevent any kind of misalignment that could cause frame racking (for example, the frame could lock in an unexpected place).

[0055] In some embodiments, the risk of racking is minimized by the method of coupling between the connectors 28,30 and the end portions 22,24. For example, connector 28 may have a raised portion or other feature portion 80 that moves along a groove 56. Similarly, connector 30 may have a raised portion or other feature portion 80 that moves along a groove 58. More generally, connectors 28,30 have a channel 82 containing one or more feature portions, one or more of which are shaped complementary to the corresponding feature portion on the end portions 22,24 in order to constrain the end portions 22,24 within the channel 82 and help prevent the end portions 22,24 from twisting in response to any jarring motion on the frame that could otherwise inadvertently misalign the frame segments 12,14. In other words, the end portions 22,24 are held firmly in the channel to which they are constrained, and may be held in grooves or raised portions of complementary shape 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 in length to provide a significant contact area between the connector and the end portions 22, 24. By widening the contact surface within the channel, it is possible to help maintain the end portions 22, 24 and the connectors 28, 30 in the alignment necessary to minimize the risk of racking.

[0056] In some embodiments, the risk of racking can be minimized by fixing the connectors 28,30 to the frame segment 12. Thus, the relative motion between the connectors 28,30 and the ends 16,18 to which they are attached can be greatly reduced and almost eliminated. In some of these embodiments, the frame segment 12 itself is rigid, and each connector 28,30 can be welded to the frame segment 12 or otherwise firmly fixed, so that the connectors 28,30 themselves can be fixedly connected. This rigid design can help minimize the effects of frame warping and / or any curvature, helping to facilitate smooth sliding of the frame during adjustment and helping to prevent misalignment of the frame that could cause racking.

[0057] In some embodiments, one or more end portions of either or both of the frame segments 12, 14 may be inclined or tilted so that the end portions (16, 18 and / or 22, 24) are not perfectly parallel to each other. For example, in some embodiments, the end portions 16, 18 may be configured to tilt slightly outward in order to angle the connectors 28, 30 (attached to the end portions 16, 18) away from each other. This angle is not large enough to significantly hinder the expansion or contraction of the frame. However, the outward tilt of the end portions 16, 8 generates 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) to substantially reduce the risk of misalignment and racking of the frame. For example, when end portions 22, 24 are installed within connectors 28, 30, a biasing force may be applied between the end portions 22, 24 and channel 82 to counteract jarring forces in the frame of a type that could otherwise inadvertently misalign the frame segments 12, 14. Alternatively, as described below, a biasing force may be applied that tends to mitigate the stress caused by frame misalignment, depending on the angle between channel 82 and the end portions 22, 24 received by channel 82, thus helping to minimize the severity of racking. For example, this biasing force may tend to realign the frame segments when the user expands or contracts the frame.

[0058] For example, as shown in Figure 34A, the outward inclination relative to the end portions 16,18 may be characterized by angles A1,A2. Angle A1 represents the angle between the axis parallel to the middle portion 20 of the frame segment 12 and the connector 30. Angle A2 represents the angle between the axis parallel to the middle portion 20 of the frame segment 12 and the connector 28. In general, even small positive angles A1,A2 can act to significantly reduce the risk of racking. For example, in some embodiments, angles A1,A2 may be nearly identical, ranging 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 Figure 34A, angles A1 and A2 are shown relative to the entire connector, so that the channel 82 (generally parallel to the connector housing) is positioned at the same angle to the intermediate portion as the entire connector housing is positioned. However, in some embodiments, the connector may be configured such that the channel 82 formed in the connector is angled to the connector housing. In this case, simply angling the channel 82 so that it has an outward inclination (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 Figure 34A. That is, another end portion would be received within the channel 82 which is inclined outward at a certain angle, and as a result, a similar force would be generated between the channel 82 and the end portion received within the channel 82, which would help to reduce the stress caused by racking.

[0059] Similarly, as shown in Figure 34B, angle B can be used to indicate the relative angle between the connectors 28, 30 and the channel 28 formed therein. In some embodiments, angle B ranges from about 0.01° to about 1.30°. In some embodiments, angle B can range from about 0.10° to about 0.76°. In some embodiments, angle B can 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 can have a range of angles including maximum angles of about 1.30°, 1.00°, or about 0.76°. Again, angle B is shown relative to the entire connector in Figure 34B, but a similar effect can be achieved by fabricating a connector with a channel angled relative to the connector housing. For example, as shown in Figure 34C, the channel 82 of connector 28 may be inclined at a certain angle (indicated by a dashed line) such that the channel is biased at angle C1 within the connector housing. Similarly, in some embodiments, the connector 30 may be similarly inclined at a certain angle with respect to the connector housing. In some embodiments, the channel 82 may be inclined or angled with respect to the end portion that is received in the channel 82 based on angling the channel 82 with respect to the connector housing, inclining the end portion to which the connector is attached, angling the end portion that is received in the channel, or any combination of 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 almost completely eliminate racking. Furthermore, it has been found that even in the rare case where the two frame segments 12,14 become slightly misaligned (for example, 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 embodiments in which the first frame segment 12 has end portions 16,18 configured to be slightly inclined outward, the increase in force required to expand the frame will be mitigated by applying an opposing force (e.g., one that releases the ratchet and contracts the frame).

[0061] In the embodiments shown in Figures 29A to 29C, the connectors 28 and 30 do not need to be pressed during expansion. In other words, the frame can expand freely until it reaches the desired distance (or tension). For example, as the frame expands, the wall of the patient's incision may begin to press against each of the two frame segments 12 and 14. The user can release the frame, and the system can remain in place due to the tension of the blade against the incision. The ratchet assemblies of the connectors 28 and 30 can maintain the desired tension until carefully released by the user.

[0062] As shown in Figures 30A and 30B, the surgical retractor 10 can be retracted. For example, from the fully extended position (shown in Figure 29C), the user can release the ratchet lock by simultaneously pressing both ratchet actuators. Once the ratchet lock is released, the user can guide the system from the intermediate extended state (shown in Figure 30A) to the retracted state shown in Figure 30B.

[0063] The surgical retractor 10 can be used in various ways for different surgical procedures. For example, Figure 33 shows an embodiment of a method 150 for assembling and using the surgical retractor. In step 152, one frame segment of the surgical retractor may be positioned adjacent to one side of the 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 where the surgeon or operator is standing. In some embodiments, step 152 may also simultaneously use the frame segment to retract the wall of the incision or wound at least to some extent to help visualize 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 to the frame segment 14. The blade assembly 60 may be held within a blade block 36 such that the front surface 115 of the blade 114 is positioned at least generally toward the wall of the wound or incision. The front surface 115 of the blade 114 can be angled or shaped, for example, to facilitate proper contact with the wall of a wound or incision, so that the blade 114 can properly retract the wall as intended, or otherwise hold it. In some embodiments, the blade 114 may be allowed to rotate within a limited range of rotation within the blade assembly 60 to prevent the surface 115 from rotating so that the surface 115 is not properly oriented toward the wall of the wound or incision with which the surface 115 is intended to engage.

[0064] In step 154, the frame segment 12 may then be positioned relative to the frame segment 14 so that it can be joined to the frame segment 14 to form a frame. For example, the frame segment 12 may be positioned such that its end portions 16, 18 are aligned approximately parallel to the end portions 22, 24 of the frame segment 14. In some situations, this may involve passing the frame segment 12 under one or both outstretched arms of a surgeon who is already performing a medical procedure, as illustrated in Figure 33B, for example.

[0065] In step 156, frame segments 12 and 14 can be joined together. For example, as also shown in relation to Figure 14, the user may slide the slide lock 72 to rotate the ratchet fastener 76, guiding the frame segment 14 into the channel 82 in the ratchet housing 66. Once the frame segment 14 is in place in the channel 82, the user can release the slide lock 72 so that the fastener 76 engages with the frame segment 14. Segment 12 is designed so that the user can operate both connectors 28 and 30 almost simultaneously to quickly join the two segments 12 and 14 together. In particular, frame segment 12 can be aligned with frame segment 14 and joined to frame segment 14 at any point along the length of the end portions 22 and 24. For example, in some situations it may be desirable to join segments 12 and 14 so that the frame is assembled in a reduced state. This makes it easier to grasp one or more walls of an incision that may not be completely separated, for example. However, instead, segments 12 and 14 may be connected to form a frame in several intermediate extended or even fully extended states. This may be necessary, for example, when a surgeon has already begun to engage with a patient in a medical procedure and the first segment 12 and the second segment 14 must be connected in a way that avoids them bumping into the surgeon's arm.

[0066] As shown in step 158, the frame can be adjusted as needed to effectively visualize the patient's internal tissues. For example, as also shown in relation to Figure 29, to adjust the frame, the user can hold the upper and lower arms (i.e., the first segment 12 and the second frame segment 14) and extend the frame outward. If desired, other attachments can be attached in the same way to complete the assembly of the retractor.

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

Claims

1. A surgical retractor assembly, A first frame segment having a central portion positioned between a first end extending in a nearly straight line and a second end extending in a nearly straight line, A second frame segment comprising an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, wherein the pair of end portions maintain an orientation substantially parallel to each other, and each of the pair of end portions comprises a top surface and a bottom surface. A pair of connectors configured to connect the first frame segment to the second frame segment in order to form a retractor frame, The first end of the first frame segment, which extends substantially in a straight line, and the second end of the first frame segment, which extends substantially in a straight line, extend from the same side of the central portion and are inclined outward at an angle suitable for reducing the risk of racking when expanding the retractor frame. A surgical retractor assembly equipped with [a specific feature].

2. The surgical retractor assembly according to claim 1, wherein the angle is approximately 0.01° to approximately 1.30°.

3. The surgical retractor assembly according to claim 1, wherein the angle is approximately 0.10° to approximately 1.00°.

4. The surgical retractor assembly according to claim 1, wherein the angle is approximately 0.20° to approximately 0.76°.

5. The surgical retractor frame according to claim 1, wherein the pair of connectors comprises a first connector fixedly connected to the substantially linearly extending first end and a second connector fixedly connected to the substantially linearly extending second end.

6. A surgical retractor frame according to claim 1, The pair of connectors comprises a first connector and a second connector, The first connector comprises a first ratchet housing, and the second connector comprises a second ratchet housing. A surgical retractor frame, wherein the first ratchet housing is welded to the substantially linearly extending first end, and the second ratchet housing is welded to the substantially linearly extending second end.

7. A surgical retractor frame according to claim 1, The aforementioned central portion is almost straight, A surgical retractor frame, wherein the central portion is connected to the substantially straight first end and the substantially straight second end via a pair of curved portions.

8. A surgical retractor frame according to claim 1, Each of the pair of connectors is equipped with a ratchet housing. A surgical retractor frame, wherein the ratchet housing includes channels for receiving each of the pair of end portions when connecting the first frame segment to the second frame segment to form a surgical retractor frame.

9. A surgical retractor frame according to claim 8, The ratchet housing comprises one or more grooves or protrusions formed inside it, and the one or more grooves or protrusions are arranged within the channel. A surgical retractor frame, wherein each of the pair of end portions has a feature complementary to the one or more grooves or protrusions.

10. A surgical retractor frame according to claim 9, The complementary feature is a groove provided on the upper surface of the second frame segment. The second frame segment is a surgical retractor frame having ratchet teeth positioned on its inner edge.

11. A surgical retractor assembly, A first frame segment having a central portion positioned between a first end and a second end, A second frame segment comprising an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, wherein the pair of end portions maintain an orientation substantially parallel to each other, and each of the pair of end portions comprises a top surface and a bottom surface. A pair of connectors comprising a first connector and a second connector, each of the first and second connectors being fixedly attached to the first frame segment, the pair of connectors being configured to connect the first frame segment to the second frame segment to form a retractor frame, the first connector comprising a first channel, the second connector comprising a second channel, the first channel and the second channel forming an angle between them, the angle being inclined at an angle suitable for reducing the risk of racking when the retractor frame is expanded, and A surgical retractor assembly equipped with [a specific feature].

12. A surgical retractor frame according to claim 11, The angle is between approximately 0.03° and approximately 1.03°, in the surgical retractor frame.

13. A surgical retractor frame according to claim 12, A surgical retractor frame, wherein each of the first and second ends is directly connected to the central portion.

14. A surgical retractor frame according to claim 12, A surgical retractor frame, wherein each of the first and second ends is part of an end portion that extends in a substantially straight line.

15. A surgical retractor frame according to claim 11, A surgical retractor frame with a channel length ranging from approximately 2 cm to 10 cm.

16. A surgical retractor assembly, A first frame segment having a central portion positioned between a first end and a second end, A second frame segment comprising an intermediate portion and a pair of end portions projecting from the same side of the intermediate portion, wherein the pair of end portions maintain an orientation substantially parallel to each other, and each of the pair of end portions comprises a top surface and a bottom surface. A pair of connectors configured to connect the first frame segment to the second frame segment in order to form a retractor frame, Each of the pair of connectors is A ratchet housing configured to connect to the first frame segment, A channel formed within the ratchet housing, shaped to receive the upper or lower surface of one of the end portions of the second frame segment, and positioned at a certain angle to the one of the end portions received by the channel in order to reduce the risk of racking when the retractor frame is expanded, A ratchet fastener configured to hold one of the pair of end portions of the second frame segment within the channel, A surgical retractor assembly, including the retractor assembly.

17. The first end of the first frame segment is a part of the first end that extends in a substantially straight line, and the second end of the first frame segment is a part of the second end that extends in a substantially straight line. The surgical retractor assembly according to claim 16, wherein the first end and the second end of the first frame segment extend from the same side of the central portion, and the first end and the second end are inclined outward so as to be away from each other to position the channel at the angle.

18. The surgical retractor assembly according to claim 17, wherein the angle is approximately 0.20° to approximately 0.76°.

19. A surgical retractor frame according to claim 16, The channel is angled with respect to the ratchet housing, and the frame is a surgical retractor.

20. A surgical retractor frame according to claim 16, The angle is between approximately 0.03° and approximately 1.03°, in the surgical retractor frame.

Images