Improvements to surgical instruments, kits and methods of use and related improvements

Abstract

Surgical instruments, particularly retractors, configured to be operated manually by the user's thumb and other fingers. Specifically, a pair of handles, grasped by the thumb and other fingers and acted toward each other, exert force on a first output element and a second output element, which can, for example, provide retraction of the surgical site.

Description

Technical Field

[0001] The present disclosure generally relates to surgical instruments, such as manually operated surgical instruments, kits including such instruments, and methods of using such instruments. The surgical instruments have potential applicability in orthopedics, but are more generally applicable when the instrument applies force to a patient's site, another instrument, or another device such as an implant.

Background Art

[0002] Arthroplasty is a well-known surgical procedure in which a diseased and / or damaged living joint is replaced by an artificial joint. Examples include artificial knee joints and hip implants. During surgery, the procedure is made easier by using one or more retractors to increase access to the surgical site and the bone therein by deploying the incision portion in this patent section.

[0003] Such use of retractors exists in a wide variety of surgical procedures.

[0004] Furthermore, the manual application and conversion of force through a surgical instrument in which parts of the instrument are pushed together or separated is a feature of surgical instruments beyond retractors (e.g., scissors, forceps, clamps, staplers, laparoscopic instruments, etc.).

Summary of the Invention

Means for Solving the Problems

[0005] According to a first aspect of the present disclosure, there is provided a surgical instrument, the surgical instrument comprising: a first force input element and a second force input element, the first force input element and the second force input element being pivotably attached to each other by a pivot portion, the first force input element being provided on a first side of the instrument and provided opposite the second force input element provided on a second side of the instrument, the first force input element and the second force input element; The device includes a first force output element and a second force output element, the first force output element and the second force output element being pivotably mounted relative to each other by a pivot, the second force output element being provided on the first side of the device and opposite to the first force output element provided on the second side of the device.

[0006] The first force input element and the first force output element may be provided as a single integrated element. The first force input element and the first force output element may have a fixed position for the first force input element relative to the first force output element. The first force input element may be provided without pivoting or rotational motion relative to the first force output element.

[0007] The second force input element and the second force output element may be provided by separate elements. The second force input element and the second force output element may have an unfixed position of the second force input element relative to the second force output element. The second force input element may have at least a first position and a second position relative to the second force output element. The first position may be a different angular position and / or rotational position with respect to the second position and / or may have a different configuration. This difference may be with respect to the second force output element.

[0008] The pivots for the first force input element and the second force input element may be different from the pivots for the first force output element and the second force output element. The pivots for the first force input element and the second force input element may be the first pivot, and the pivots for the first force output element and the second force output element may be the second pivot.

[0009] The first pivot for the first force input element and the second force input element may be provided spaced apart, for example, along the length of the device.

[0010] The device may have a proximal end, for example, a force input element end. The device may also have a distal end, for example, a force output element end.

[0011] The first pivot for the first and second force input elements may be provided closer to the proximal end of the device than the second pivot for the first and second force output elements. The second pivot for the first and second force output elements may be provided closer to the distal end of the device than the first pivot for the first and second force input elements.

[0012] The device may provide a mechanism between at least one of the force input elements and at least one of the force output elements. The device may also provide a mechanism between only one of the force input elements and only one of the force output elements. The device may also provide a mechanism between a second force input element and a second force output element.

[0013] The mechanism may provide a link between the first pivot and the second pivot. The mechanism can transmit a force input around the first pivot to a force output around the second pivot.

[0014] The mechanism may provide a force multiplier for the device, for example, an increase in the lever action. The mechanism may multiply the input force into a higher output force.

[0015] This mechanism can provide a distance multiplier, for example, an increase in the distance traveled. The mechanism may also provide a distance traveled multiplier to a force output element compared to the distance traveled by a force input element.

[0016] Surgical instruments may include retractors. Surgical instruments may also include scissors, forceps, clamps, staplers, or laparoscopic instruments, which are used by applying force as a surgeon.

[0017] Surgical instruments can be operated manually, particularly in relation to the application of force.

[0018] The first and second force input elements may have an expanded configuration and a contracted configuration. The separation between the first and second force input elements is reduced in the contracted configuration compared to the expanded configuration. The separation between the first and second force input elements is increased in the expanded configuration compared to the contracted configuration.

[0019] The transition of the first force input element and the second force input element to or toward a contracted configuration may increase the separation of parts of the first force output element and the second force output element, particularly the distal portion.

[0020] The transition of the first and second force input elements to or toward an extended configuration may not change the separation of parts of the first and second force output elements, particularly the distal portions. The transition of the first and second force input elements to or toward an extended configuration may be facilitated by one or more springs, such as leaf springs.

[0021] By using iterative cycles of transitions of the first and second force input elements to or toward an extended configuration, and then to or toward a contracted configuration, the isolation of a portion of the first and second force output elements, particularly the distal portion, can be increased and potentially maximized.

[0022] The first force input element may be a part of the first arm of a surgical instrument, particularly the proximal section of the first arm. The first force input element may also be the first handle element.

[0023] The first handle element may include a user grip, such as a ring grip, particularly at its proximal end. The user grip may be adapted to accommodate the thumb and / or one and / or two and / or three fingers.

[0024] The second force input element may also be a second handle element.

[0025] The second handle element may include a user grip, such as a ring grip, particularly at the proximal end. The user grip may be adapted to receive the thumb and / or one and / or two and / or three fingers.

[0026] The first handle element can include a first abutting element. The second handle element may include a second abutting element. The first abutting element and the second abutting element may abut, particularly in the contracted configuration.

[0027] The first handle element may include a first arm section. The first arm section may extend between the user grip and the first pivot portion. The first handle element can include a mechanism mount, such as a plate extending laterally from the first handle element. A mechanism or a first part of a mechanism may be provided on the mechanism mount. The first handle element may be provided with a first mechanism housing portion, for example, to surround the first part of the mechanism.

[0028] The second handle element may include a second arm section. The second arm section may extend between the user grip and the first pivot portion. The second handle element can include a mechanism mount, such as a plate extending laterally from the second handle element. A mechanism or a second part of a mechanism may be provided on the mechanism mount. The second handle element may be provided with a second mechanism housing portion, for example, to surround the second part of the mechanism.

[0029] The first handle element may extend beyond the first pivot portion and / or beyond the first mechanism housing portion. The first handle element may extend to a first force output element.

[0030] The second handle element may terminate at the first pivot portion and / or the second mechanism housing portion.

[0031] The first pivot point may be a pivot point between the first handle element and the second handle element relative to each other. One or both of the first force output element or the second force output element do not need to pivot around the first pivot point.

[0032] The first side of the device may be the side having a first force input element and a first force output element. The first mechanism housing may extend between the first side and the second side.

[0033] The second side of the device may have a second force input element and a second force output element. The second mechanism housing may extend between the second side and the first side.

[0034] The first pivot may be provided midway between the first side and the second side.

[0035] The second pivot may be provided midway between the first and second sides.

[0036] The first and second force output elements may have both a closed and an open state. The separation between the first and second force output elements is reduced in the closed state compared to the open state. The separation between the first and second force output elements may be increased in the open state compared to the closed state. The first and second force output elements may have one or more intermediate states in which the separation is greater than in the closed state and / or less than in the closed state.

[0037] The transition of the first and second force output elements to or toward an open state may increase the separation of parts of the first and second force output elements, particularly the distal portions.

[0038] The transition of the first and second force output elements to or toward a closed state may reduce the separation of parts of the first and second force output elements, particularly the distal portions.

[0039] The first and second force output elements can transition from a closed state to an open state via one or more intermediate states.

[0040] The first force-generating element may be a part of the first arm of a surgical instrument, particularly the distal section of the first arm. The first force-generating element may also be the first retractor arm.

[0041] The first retractor arm may include one or more retractor elements, particularly at its distal end. The retractor elements may extend away from the arm.

[0042] The second force output element may be a second retractor arm.

[0043] The second retractor arm may include one or more retractor elements, particularly at its distal end.

[0044] The retractor elements of the first retractor arm and the retractor elements of the second retractor arm may be in contact with or close to each other, particularly in the closed state. The retractor elements of the first retractor arm and the retractor elements of the second retractor arm may be spaced apart from each other in the open state and / or one or more intermediate states.

[0045] A first arm, such as a first retractor arm, may include a first arm section and one or more retractor elements. The first arm section may extend between a second pivot and a distal end.

[0046] A second arm, such as a second retractor arm, may include a second arm section and one or more retractor elements. The second arm section may extend between the second pivot and the distal end. The second arm may include an interface with a mechanism, such as a second mechanism part.

[0047] The second arm may include a projection, for example, beyond the second pivot position. The projection may extend proximal.

[0048] In embodiments, the projection may extend proximal and lateral relative to the second pivot. The projection may provide an indirect interface with a mechanism, such as a second part of the mechanism, via a link element, for example. The link element may be pivotably connected to the projection, for example, near its proximal end. The link may be pivotably connected to a pin. The pin may be provided by a mechanism, particularly a second part of the mechanism.

[0049] In another embodiment, the projection may extend proximal to the other side of the second pivot compared to the second arm section having a distal end. The projection may directly provide an interface with a mechanism, such as a second part of the mechanism. The interface with the mechanism may include a slot for receiving a pin. The slot may be provided by the second arm. The pin may be provided by the mechanism, in particular by the second part of the mechanism.

[0050] The second pivot may be a pivot for the first and second output force elements. The second pivot may be a pivot for a first arm, such as a first retractor arm, and a second arm, such as a second retractor arm. One or both of the first and second force input elements do not have to be pivoted around the second pivot.

[0051] The first force input element and the first force output element may be formed from a single element. The separation and / or position and / or angle between the proximal end of the first force input element and the distal end of the first force output element may be the same in the open state and / or closed state and / or one or more intermediate states. The separation and / or position and / or angle between the distal end and proximal end of the first force input element and the distal end of the first force output element may be the same in the extended configuration and / or contracted configuration and / or one or more intermediate configurations.

[0052] The second force input element and the second force output element may be formed from different and / or physically separate elements. The separation and / or position and / or angle between the proximal end of the second force input element and the distal end of the second force output element may differ in the open state and / or closed state and / or one or more intermediate states. The separation and / or position and / or angle between the proximal end of the second force input element and the distal end of the second force output element may differ in the extended configuration and / or retracted configuration and / or one or more intermediate configurations.

[0053] The first pivot can be spaced from the second pivot by a distance greater than 2 cm, for example greater than 3 cm, potentially greater than 4 cm, or even greater than 5 cm. The first pivot may be spaced from the second pivot by a distance of less than 10 cm, for example less than 8 cm, potentially less than 6 cm, or even less than 5 cm. The spacing can be measured along the long axis of the surgical instrument.

[0054] The first and second pivots may be provided on axes that are parallel to each other but spaced apart, particularly along the long axis of the surgical instrument.

[0055] The mechanism may be provided as a first part of the mechanism and a second part of the mechanism.

[0056] The second part of the mechanism may be provided by a second force input element, in particular a second mechanism housing, and a second drive element such as a second pawl. The second drive element, such as a second pawl, can transmit a driving force to the first part of the mechanism.

[0057] The first part of the mechanism may be provided by a first force input element, in particular a first mechanism part housing, and a first drive element, such as a gear. The first drive element, such as a gear, can transmit a drive force from a second part of the mechanism to an interface, such as an interface with a second arm. The first drive element can transmit a drive force via a pin extending from the first drive element. The pin may extend through the first mechanism part housing.

[0058] The mechanism may interface with a second arm, such as a second retractor arm, via a projection, beyond a second pivot position, for example. The projection may extend proximal.

[0059] In embodiments, the projection may extend proximal and lateral relative to the second pivot. The projection may indirectly provide an interface with a mechanism, such as a first part of the mechanism, via a link element, for example. The link element may be pivotably connected to the projection, for example, near its proximal end. The link may be pivotably connected to a pin of the mechanism. The pin may be provided by the mechanism, particularly the first part of the mechanism.

[0060] In another embodiment, the projection may extend proximal to the other side of the second pivot compared to the second arm section having a distal end. The projection can directly provide an interface with a mechanism, such as the first part of the mechanism. The interface with the mechanism may include a slot for receiving a pin. The slot may be provided by the second arm. The pin may be provided by the mechanism, in particular by the first part of the mechanism.

[0061] The mechanism may include a second force input element, such as a pivot, such as a pin attached to the second mechanism housing. The mechanism may include a release mechanism, such as a release plate. The release plate may be attached to the pivot. The release plate may be attached between the second mechanism housing and the first drive element. The mechanism may include a first drive element. The first drive element may be attached to the pivot. The first drive element may be attached between the release plate and the first mechanism housing. The mechanism may include a pin on the first drive element. The mechanism may include a second drive element, such as a claw attached to the second housing mechanism. The attachment for the second drive element may allow rotation of the second drive element. The rotation may be facilitated by a spring, such as a leaf spring.

[0062] The mechanism may include a second drive element, such as a second pawl, which cooperates with the first drive element, such as a helical gear, to drive the first drive element. Cooperation may be provided during transitions from an extended configuration to a retracted configuration, or toward a retracted configuration. Cooperation may be released during transitions from a retracted configuration to an extended configuration, or toward an extended configuration.

[0063] Cooperation can be facilitated by the rotation of the second drive element toward the first drive element. Cooperation can be disengaged by rotating the second drive element toward the first drive element.

[0064] The mechanism may include a first locking element, for example, a first claw. The first locking element can maintain the device in a given closed state and / or intermediate state and / or open state. The first locking element can engage with a first drive element to prevent movement of the first drive element, such as rotation in a certain direction. The first locking element can allow movement of the first drive element, such as rotation in a second different direction. The first locking element may be pivotably mounted, for example, on a first mechanism housing. The first locking element can be facilitated to rotate in a given direction, for example, by contacting the first drive element.

[0065] The pin may extend through a channel, for example, a channel within the housing of the first mechanism part. The channel may be curved. The channel may be an arc. The pin may be at one end of the channel in the closed state. The pin may be at the other end of the channel in the open state. The pin may be in the middle in the intermediate state.

[0066] In this embodiment, the channel may be curved from the distal end to the proximal end.

[0067] In another embodiment, the channel may be curved from a first distal end through a proximal intermediate section to a second distal end.

[0068] A release mechanism may be provided. The release mechanism may include a rotatable arm, such as a lever arm. The release mechanism may extend from the mechanism housing. The end of the release mechanism may be accessible to the surgeon from the user grip. The release mechanism may include, for example, a release plate rotatable with the lever arm. The release plate may include one or more projections. A first projection may terminate with a first cam. The first cam may be adapted to move a first locking element away from cooperation with a first drive element, for example, by rotation of the cam. A second projection may terminate with a second cam. The second cam may be adapted to move a second drive element away from cooperation with a first drive element. The release mechanism may provide a released state. In the released state, the instrument may be able to move from the open state to the closed state, or to transition to the closed state.

[0069] The first embodiment, including other embodiments, may include any of the features, possibilities, or options described elsewhere in this specification.

[0070] According to a second aspect of the present disclosure, a surgical kit is provided, comprising a surgical instrument according to a first aspect of the present disclosure and one or more additional surgical components.

[0071] One or more surgical components may include one or more surgical instruments. A surgical instrument may be one or more of the following: different surgical retractors; different retractor blades; clamps for instruments or devices; rakes; hooks; incision forming instruments.

[0072] One or more surgical components may be an implant or part of an implant, such as a femoral implant or a hip implant.

[0073] Any feature or combination of features referred to as part of an intermediate component may, alternatively, be provided on the surgical component and / or further surgical components. Any feature or combination of features referred to as part of a surgical instrument may, alternatively, be provided on the intermediate component. Any combination of features described as being provided on the surgical instrument and intermediate component may be provided in the reverse configuration, where the surgical instrument feature(s) are transferred to the intermediate component and the intermediate component features are transferred to the surgical instrument.

[0074] The second embodiment may include any of the features and possibilities or options described elsewhere in this specification, including other embodiments.

[0075] According to a third aspect of this disclosure, a surgical method, the method is To provide a surgical instrument according to the first embodiment, Creating an incision site in the patient, A method is provided which includes engaging a surgical instrument with the outer periphery of the incision and moving the surgical instrument from a closed state to an open state, or toward an open state, to increase the access area through the incision.

[0076] The surgical method may be an orthopedic method. The surgical instrument may be a retractor.

[0077] The method may include a first force input element, and the second force input element may have an expansion configuration and a contraction configuration. The separation between the first force input element and the second force input element is reduced in the contraction configuration compared to the expansion configuration. The separation between the first force input element and the second force input element is increased in the expansion configuration compared to the contraction configuration.

[0078] This method may include transitioning from an expanded configuration to a contracted configuration.

[0079] The transition of the first force input element and the second force input element to or toward a contracted configuration may increase the separation of parts of the first force output element and the second force output element, particularly the distal portion.

[0080] The method may include transitioning from a contracted configuration to an expanded configuration.

[0081] A transition of the first force input element and the second force input element to or toward an extended configuration may not change the separation of parts of the first force output element and the second force output element, particularly the distal portion.

[0082] By using iterative cycles of transitions of the first and second force input elements to or toward an extended configuration, and then to or toward a contracted configuration, the isolation of a portion of the first and second force output elements, particularly the distal portion, can be increased and potentially maximized.

[0083] The first and second force output elements may have both a closed and an open state. The separation between the first and second force output elements is reduced in the closed state compared to the open state. The separation between the first and second force output elements may be increased in the open state compared to the closed state. The first and second force output elements may have one or more intermediate states in which the separation is greater than in the closed state and / or less than in the closed state.

[0084] The transition of the first and second force output elements to or toward an open state may increase the separation of parts of the first and second force output elements, particularly the distal portions.

[0085] The transition of the first and second force output elements to or toward a closed state may reduce the separation of parts of the first and second force output elements, particularly the distal portions.

[0086] The first and second force output elements can transition from a closed state to an open state via one or more intermediate states.

[0087] Any feature or combination of features referred to as part of an intermediate component may, alternatively, be provided on the surgical component and / or further surgical components. Any feature or combination of features referred to as part of a surgical instrument may, alternatively, be provided on the intermediate component. Any combination of features described as being provided on the surgical instrument and intermediate component may be provided in the reverse configuration, where the surgical instrument feature(s) are transferred to the intermediate component and the intermediate component features are transferred to the surgical instrument.

[0088] The third aspect may include any of the features and possibilities or options described elsewhere in this specification, including other aspects. [Brief explanation of the drawing]

[0089] Various embodiments of this disclosure will be described below, for illustrative purposes only, with reference to the attached drawings. [Figure 1] This is a diagram of a conventional retractor. [Figure 2] This is a diagram of an embodiment of the retractor of the present disclosure in a fully closed state and with a retractable handle configuration. [Figure 3] This is a view of the embodiment of Figure 2, with the extension handle configuration in a completely closed state, seen from the other side. [Figure 4] This is a diagram of the embodiment shown in Figure 2, in the first intermediate state and with the retractable handle configured. [Figure 5a] This is a diagram of the embodiment of Figure 2 in the first intermediate state and extended handle configuration. [Figure 5b] This is a view of the state and configuration of Figure 5a from the other side. [Figure 6] This is a diagram of the embodiment of Figure 2 in the second intermediate state and retractable handle configuration. [Figure 7a]This is a diagram of the embodiment of Figure 2 in the second intermediate state and extended handle configuration. [Figure 7b] This is a view of the state and configuration of Figure 7a from the other side. [Figure 8] This is a diagram of the embodiment of Figure 2 in the second intermediate state and retractable handle configuration. [Figure 9a] This is a diagram of the embodiment of Figure 2 in the second intermediate state and extended handle configuration. [Figure 9b] This is a view of the state and configuration of Figure 9a from the other side. [Figure 10] This is a diagram of the embodiment of the extended handle configuration in the fully open state shown in Figure 2. [Figure 11a] This is a diagram of a second embodiment of a retractor in a fully closed state and with an extended handle configuration. [Figure 11b] This is a diagram of the embodiment of Figure 11a in the first intermediate state and extended handle configuration. [Figure 11c] This is a diagram of the embodiment of Figure 11a in the second intermediate state and extended handle configuration. [Figure 11d] This is a diagram of the embodiment of Figure 11a in the third intermediate state and extended handle configuration. [Figure 11e] This is a diagram of the embodiment of Figure 11a in the fourth intermediate state and extended handle configuration. [Figure 11f] This is a diagram of the embodiment of Figure 11a in the fully open state and extended handle configuration. [Figure 12a] These are detailed diagrams of the mechanism of the embodiment shown in Figures 11a to 11f from the first side in the extended handle configuration. [Figure 12b] These are detailed diagrams of the mechanisms of the embodiments shown in Figures 11a to 11f from the same side in the retractable handle configuration. [Figure 13] This is a diagram showing the variation in hand size between individuals and their sexes. [Modes for carrying out the invention]

[0090] While various modifications and alternative forms are possible for the concepts of this disclosure, specific embodiments are shown in the drawings as examples and described in detail herein. However, it should be understood that it is not the intention of this disclosure to limit the concepts to the specific forms disclosed, but rather to encompass all modifications, equivalents, and alternatives included in this disclosure and the attached "Claims."

[0091] Terms such as anterior, posterior, medial, lateral, superior, and inferior, which indicate anatomical references, may be used throughout this specification in relation to orthopedic implants or prostheses and surgical instruments described herein, as well as in relation to the patient's natural anatomical structure. Such terms have well-understood meanings in both the study of anatomy and the field of orthopedic surgery. The use of such anatomical reference terms in the descriptions and claims described herein is intended to be consistent with their well-understood meanings unless otherwise specified.

[0092] Surgical instruments such as retractors are used to apply force to a patient's site or another device or implant for various purposes in a variety of surgical procedures, including orthopedic procedures. In the case of retractors, the force applied to the patient's site helps to increase the separation of those sites, and thus increases the surgical opening to assist in the surgical procedure.

[0093] With any surgical instrument that generates force manually by the surgeon's hand, there is a direct link between the size of the surgeon's hand and the range of positional movement the instrument's moving parts can achieve. There is also a direct link to the force applied to the moving parts and thus translated through the instrument. Generally, the smaller the hand, the smaller the range of positional movement and, potentially, the lower the level of force that can be applied. Smaller hands may also encounter increased fatigue levels when attempting to operate such manual surgical instruments.

[0094] Embodiments of this disclosure aim to provide an approach to manual surgical instruments that are better suited to users with smaller hands, including female surgeons. There is also a need for reduced input and / or grip strength requirements for good operation. Improved ergonomics and reduced fatigue during use for users with smaller hands are also potential benefits of this approach.

[0095] Figure 1 shows a prior art retractor 1, in which a first ring grip 3 is provided on a first arm 5. The first arm 5 is provided with the first ring grip 3 at its proximal end 7 and a retractor element 9 at its distal end 11. The first arm 5 is provided with a dogleg configuration as a result of the proximal portion 13 being angled relative to the distal portion 15 at the mounting position 17. The mounting position 17 is characterized by a projection 19 having a central opening 21 that engages with a pin 23. The pin 23 provides a pivot connection between the mounting position 17 of the first arm 5 and the mounting position 25 of the second arm 27.

[0096] The second arm 27 has a similar but mirror-image contour to the first arm 5. Thus, the second arm 27 is characterized by a second ring grip 29 at its proximal end 31 and a second retractor element 33 at its distal end 35. The first retractor element 9 and the second retractor element 33 face each other. The second arm 27 is also provided with a dogleg configuration as a result of the proximal section 35 being angled relative to the distal section 37 at the mounting position 39. The mounting position 25 is characterized by a projection 41 having a central opening 43 that engages with a common pin 23.

[0097] The retractor 1 is shown in an intermediate state between a fully open state and a fully closed state. The movement of the first ring grip 3 and the second ring grip 29 toward each other results in the first retractor element 9 and the second retractor element 33 moving toward each other. As the first ring grip 3 and the second ring grip 29 move toward each other, the first retractor element 9 and the second retractor element 33 close toward each other.

[0098] In the fully closed position, the separation between the first ring grip 3 and the second ring grip 29 is maximum. How this separation compares to the achievable separation of the surgeon's index finger [second] or the surgeon's index finger from the surgeon's thumb determines whether the fully closed position can be reached, and the force the surgeon can apply in immediate transitions from the fully closed position to the intermediate position and then to the open position. If the surgeon is stretching or applying force to reach that degree of separation, the force may be reduced and / or the comfort of the movement may be compromised.

[0099] In the conventional retractor 1 shown in Figure 1, the first arm 5 and the second arm 27 are integral elements from their proximal to distal ends, and therefore, movement of the ring grip is directly translated into movement of the retractor elements. The lever action is defined and set by the relative positions of the distal-proximal mounting positions. A single translation of the ring grip provides the entire movement of the retractor elements.

[0100] Figure 2 shows embodiments of the retractor 100 of the present disclosure in a fully closed state and a retractable handle configuration. The fully closed state is provided when the first retractor element 102 and the second retractor element 104 are in contact with each other. The retractable handle configuration is provided when the first ring grip 106 and the second ring grip 108 are in contact with each other. The first fastener 110 on the first grip ring 106 and the second fastener 112 on the second grip ring provide contact points.

[0101] A fully closed state may be provided by retractor elements and / or ring grips that are close to each other but are prevented from moving toward each other.

[0102] The first ring grip 106 and the second ring grip 108 are configured to receive either two fingers or the thumb of the surgeon and are configured to be usable by either hand in either orientation.

[0103] A first grip ring 106 is provided at the proximal end 114 of the first arm 116. The first arm 116 is a single, integrated element extending from the proximal end 114 to the distal end 118. The proximal section 120 of the first arm 116 is provided with a mechanism mount 122 extending away from the first arm 116. The first arm 116 also provides a first arm mount 124. The first arm mount 124 is distal to the mechanism mount 122. The first arm mount 124 provides a position for the first arm 116 to connect to the second retractor arm 136.

[0104] The mechanism mount 122 has a first portion of the mechanism 126 provided thereon. An example of the mechanism 126 will be described in more detail with respect to a second embodiment of the present disclosure. The mechanism mount 122 is in the form of a plate extending laterally from the first arm 116.

[0105] The first arm mount 124 is formed from a through-opening extending through the first arm 116, the through-opening being adapted to receive a pin 128 and thus provide a retractor pivot position RP.

[0106] A second grip ring 108 is provided at the proximal end 130 of the second handle arm 132. A second retractor element 104 is provided at the distal end 134 of the second retractor arm 136. Unlike the prior art and the first arm 116, the second handle arm 132 and the second retractor arm 136 are separate elements from each other.

[0107] The second handle arm 132 extends from its proximal end 130 to its intermediate end 138. The second handle arm 132 is pivotably mounted to the mechanism mount 122 at position HP. The intermediate end 138 of the second handle arm provides a second portion of the mechanism 126. A pin 140 pivotally mounts the second handle arm 132 to the mechanism mount 122 at position HP, thus allowing the proximal section 120 of the first arm 116 and the second handle arm 132 to pivot relative to each other. This pivot point HP is separated and spaced apart from the pivot point RP of the distal sections of the first arm 116 and the second retractor arm 136. The pivot point RP is located distal to the mechanism mount 122 and the pivot point HP.

[0108] The second retractor arm 136 is provided with a through-opening that extends through the second retractor arm 136, which receives the pin 128 and thus provides a pivot RP.

[0109] Figure 3 is a diagram of the embodiment of Figure 2 as seen from the other side, fully closed but transitioning to the extended handle configuration. The transition to the extended handle configuration is achieved by the surgeon increasing the separation of the thumb on one of the first ring grip 106 and the second ring grip 108 from the fingers on the other of the second ring grip 108 and the first ring grip 106. Mechanism 126 is in a free-rotation configuration during rotation in this direction. As a result, mechanism 126 does not transmit any movement to the first arm 116 and / or the second retractor arm 136 between the retracted handle configuration and the extended handle configuration. In the extended handle configuration, the instrument is ready to begin unfolding the first retractor element 102 and the second retractor element 104 so that they separate from each other.

[0110] Figure 3 also shows a link element 142 connecting mechanism 126 to the second retractor arm 136, in particular to the projection 144 on it. The projection 144 extends away from the pivot RP and applies leverage to the first arm 116 with the second retractor arm 136 during deployment.

[0111] From the closed state and extended handle configuration shown in Figure 3, the retractor 1 moves to the position shown in Figure 4 by the surgeon squeezing the first ring grip 106 and the second ring grip 108 together. Squeezing the first ring grip 106 and the second ring grip 108 together causes a relative rotation of the proximal section 120 of the first arm 116 with respect to the second handle arm 132. In Figure 4, the retractor 1 is in the first intermediate state, particularly with respect to deployment, and again in the retracted handle configuration. As can be seen from the figure, a first intermediate deployment gap 146 is provided.

[0112] Since the second handle arm 132 is not integrated with the second retractor arm 136, the range of movement from the maximum required extension to the minimum required extension of the first ring grip 106 and the second ring grip 108 relative to each other can be comfortably and easily achieved by all users. It is not necessary to push the maximum extension value to a high level to obtain a given degree of extension at the distal end, but as a result, surgeons with small hands may not be able to use the retractor comfortably and / or fully.

[0113] Furthermore, since the movement required to activate the deployment can be supplied via mechanism 126, mechanism 126 can be used to provide a mechanical advantage to the deployment. Thus, an increased deployment force can be obtained while the force required to be applied by the surgeon is easily achievable and maintained within a comfortable level for all users.

[0114] Dividing the pivot point HP of the proximal section 120 of the first arm 116 relative to the second handle arm 132 away from the pivot points RP of the distal sections of the first arm 116 and the second retractor arm 136 helps to deliver both of these benefits.

[0115] Mechanism 126 includes a retaining mechanism, described in more detail below, which maintains the retractor 1 with the achieved expanded gap 146 even when the surgeon is no longer applying compressive force to the first ring grip 106 and the second ring grip 108. This prevents fatigue of the hand and arm from continuously applying force to maintain the expansion gap 146. It is also possible for a leaf spring or the like attached to the retractor to expand the ring grips, putting the handle in an extended state, and when the compressive force is released, it becomes possible to achieve the next cycle that increases the expansion gap. Cycles of the grip rings, such as contraction to expansion, contraction to expansion, etc., allow each cycle to increase the expansion gap. Therefore, it is not necessary to achieve the entire range of the desired expansion gap of the retractor 1 in a single cycle. The expansion gap can be built up to the desired level using multiple small forces of the thumb and other fingers, and cycles of small travel distances. Within any single cycle, the expansion gap can be controlled to a partially increased level by squeezing the grip rings together only partially.

[0116] When release of the retractor 1 is desired to reduce or eliminate the deployment gap, the release lever 148 can be pulled proximal by the surgeon, which releases the restraint within the mechanism 126. Further details of the release lever 148 are provided below.

[0117] In general, Figures 5a, 5b, 6, 7a, 7b, 8, 9a, 9b, and 10 show a further transition to the fully opened and unfolded form of Figure 10. Thus, these figures briefly illustrate the changes that occur to the same components as those described in more detail above.

[0118] In Figure 5a, the retractor 1 is in the first intermediate state, similar to Figure 4, but here with an extended handle configuration ready for the next transition to increase the deployment. As previously mentioned, mechanism 126 allows rotation from the retracted handle configuration to the extended handle configuration without affecting the value of the deployment gap 146. Figure 5b is a diagram of the state and configuration of Figure 5a, viewed from the opposite side, showing the proximal end 150 of the link element 142 partially advanced away from the closed end 154 within the curved channel 152.

[0119] Figure 6 shows the increased deployment gap 156 resulting from the ring grip returning to the retractable handle configuration. Second intermediate state of the retractor 1.

[0120] Figure 7a shows the same increased deployment gap 156, but the expansion handle configuration is ready to activate the deployment of the next cycle. Figure 7b shows the state and configuration of Figure 7a viewed from the other side. The change in the position of the proximal end 150 of link 142 within channel 152 can be seen when compared with Figure 5b.

[0121] Figure 8 shows the further expanded gap 158 resulting from the ring grip returning to its retractable handle configuration. This is the third intermediate state of the retractor 1.

[0122] Figure 9a shows the same increased deployment gap 158, but the expansion handle configuration is ready to activate the deployment of the next cycle. Figure 9b shows the state and configuration of Figure 9a viewed from the other side. The change in the position of the proximal end 150 of link 142 within channel 152 can be seen when compared with Figure 7b.

[0123] Figure 10 shows the endpoint where the fully open state is achieved. In this case, the deployment gap 160 is larger than the preceding deployment gap 158. The proximal end 150 of link 142 has reached the end 161 of channel 152, and therefore further deployment is not possible. The retractor can be positioned in an expansion handle configuration as shown, but further squeezing the ring grip together does not increase the deployment.

[0124] Figure 11a shows an embodiment of a second retractor in a fully closed state and extended handle configuration. In this alternative embodiment, many of the same components as described above are present within the retractor 200. Again, the first arm 216 is a single, integrated element from the proximal end 214 to the distal end 218. The second handle arm 232 is pivotally attached to the proximal section 220 of the first arm 216 at a pivot point HP and is rotatable relative to it. This pivot point HP is spaced proximal to the pivot points RP of the distal sections of the first arm 216 and the second retractor arm 236.

[0125] In this embodiment, the projection 244, which extends from the first arm away from the pivot RP and applies leverage to the second retractor arm 236 against the first arm 216 during deployment, also functions as an equivalent of the link element 142 in the previous embodiment. The end of the projection 244 is provided with an elongated slot 270 that cooperates with a pin 272 connected to the mechanism 226. The pin 272 is confined within a curved channel 252 and moves within it.

[0126] Figure 11b is a diagram of the embodiment of Figure 11a in the first intermediate state and extended handle configuration, providing a first deployment gap.

[0127] Figure 11c is a diagram of the embodiment of Figure 11a in a second intermediate state and extended handle configuration, providing a second increased deployment gap.

[0128] Figure 11d is a diagram of the embodiment of Figure 11a in a third intermediate state and extended handle configuration. It provides a third, further increased deployment gap.

[0129] Figure 11e is a diagram of the embodiment of Figure 11a in a fourth intermediate state and extended handle configuration. It provides a fourth, further increased deployment gap.

[0130] Figure 11f is a diagram of the embodiment of Figure 11a in the fully open state and extended handle configuration, providing a fifth maximum deployment gap.

[0131] Again, as the expansion gap increases, pin 244 moves from one end to the other within channel 252.

[0132] Figure 12a is a detailed view of the mechanism 226 of the embodiments shown in Figures 11a to 11f from the first side in the extension handle configuration, and Figure 12b is a detailed view from the same side in the retraction handle configuration. Although this mechanism 226 is described in the context of the second embodiment, a similar mechanism with minor modifications can be used in the first embodiment.

[0133] Referring to Figure 12a, the mechanism 226 is provided within a mechanism housing 300, which is formed from a first mechanism housing 302 attached to the proximal section 220 of the first arm 216 and a second mechanism housing 304 attached to the second handle arm 232. The first mechanism housing 302 and the second mechanism housing 304 are combined to enclose the mechanism 226.

[0134] In Figure 12a, the second handle arm 232 is closest to the viewer and is attached to a pivot 306 that extends within the mechanism 226. Within the second mechanism housing 304, the pivot 306 also mounts a toothed matte gear 308.

[0135] Inside the second housing 304, the first claw 310 is mounted to the second housing 304 and moves with the second handle arm 232 as the second handle arm 232 rotates. The first claw 310 is pivotably mounted on the second mechanism housing 304 by a pivot 307 and is provided with a leaf spring to bias the first claw 310 and engage with a recess 312 between the teeth 314 on the gear 308. The first claw 310 is curved toward the gear 308.

[0136] The release lever 248 is fixed to a collar 316 extending within the mechanism 226, and the collar 316 is rotatably mounted on the pivot 306. The collar 316 is also fixedly mounted on a plate 318, which provides a pair of opposing projections 320, each terminating on cams 322a, 322b. The operation of the release lever 248 will be described in more detail below. The plate 318 is provided between the interior of the second mechanism housing 304 and the toothed matte gear 308.

[0137] Referring to Figure 12a, when the second handle arm 232 is first rotated toward the proximal end 220 of the first arm 216, the first pawl 310 is moved clockwise upward and over the top of the first tooth 324 on the toothed gear 308. The force applied by the leaf spring then causes the first pawl 310 to enter the next recess 326 between the first tooth 324 and the next tooth 328. Furthermore, due to the orientation of the first pawl 310 (curved toward the recess 326), as well as the shape of the recess 326 and the end 330 of the first pawl 310, the first pawl 310 engages with the toothed gear 308 such that further rotation of the second handle arm 232 also causes rotation of the toothed gear 308. Thus, the rotation of the second handle arm 232 directly results in a corresponding rotation of the toothed gear 308. This rotation continues until it reaches the retractable handle configuration.

[0138] On the opposite side of the mechanism 226 from the first claw 310, a second claw 332 is also pivotably mounted on the first mechanism housing 302 by a pivot 309 and is provided with a leaf spring that biases the second claw 332 to engage with a recess 334 between the teeth 336 on the gear 308. The second claw 332 is also curved toward the gear 308, but in the opposite direction to the first claw 310. As the gear 308 rotates and is pushed by the first claw 310, the relative shape of the second claw 332 and the teeth 336 on the gear 308 causes the second claw 332 to ride up over the teeth 336, and the leaf spring prompts the second claw 332 to return to the recess 334 as the teeth 336 rotate and pass over it. Therefore, the second pawl 332 allows the gear 308 to rotate clockwise in Figure 12a.

[0139] When the second handle arm 232 and the proximal end 220 of the first arm 216 reach the closed handle configuration, the second handle arm 232 may transition back to the extended handle configuration. As the second handle arm 232 rotates relative to the proximal portion 220 of the first arm 216, the curvature of the first claw 310, as well as the relative shapes of the teeth 324, 328, the recess 326, and the end of the first claw 310, all allow the second handle arm 232 and the first claw 310 to move freely counterclockwise relative to the gear 308. The second claw 332 resists the gear 308 rotating counterclockwise in Figure 12a. Therefore, the second claw 332 operates to maintain the position of the distal end 220 of the first arm 216 and the second retractor arm 232, and thus the value of the deployment gap for the retractor elements, while the second handle arm 232 and the proximal section 220 of the first arm 216 transition from a closed handle configuration to an extended handle configuration.

[0140] After the extended handle configuration is established, the gear 308 can be rotated clockwise in Figure 12a by using a further transition cycle to the retracted handle configuration.

[0141] As seen in Figure 11a, on the other side of the toothed gear 308, there is a pin 272 extending from the side 340 of the gear 308. The pin 272 extends through a channel 252 in the first mechanism housing 304. The side 340 of the gear 308 can be seen at the bottom of the channel 252. As the gear 308 rotates, the pin 272 rotates with it. The pin 272 engages with the side of an elongated slot 270 in the proximal end 244 of the second retractor arm 236. Thus, the pin 272 pushes the proximal end 244 of the second retractor arm 236 in the same direction, and by the pivot RP, this moves the second retractor arm 236 in the opposite direction, thus increasing the deployment gap 238.

[0142] The movement of pin 272 continues, causing the second handle arm 232 to rotate, and therefore the mating gear 308 to rotate. Counterclockwise movement of the second handle arm 232 in Figure 11a. During a single cycle of changing from the extended handle configuration to the retracted handle configuration, pin 272 advances along only a portion of the channel 252.

[0143] When the second handle arm 232c is rotated clockwise in Figure 11a to reach the extended handle configuration, the mating gear 308 and the pin 272 mounted thereon remain locked in the same position, and thus the force applied to the proximal end 244 of the second retractor arm 236 is maintained.

[0144] Further pumping of the handle causes further advancement of pin 272 and further increase of the deployment gap 238, as shown in the sequence in Figures 11a to 11f.

[0145] Referring to Figure 12b, when it is desired to release the retractor 200, the surgeon moves the end of the release lever 248 proximal, which rotates the release lever 248 as it is pivotally mounted. This rotation causes rotation of two opposing projections 320 attached to the release lever 248 inside the casing. The ends of the projections 320 each act as cams 322a, 322b, which rotate and contact the first claw 310 and the second claw 332 of the mechanism 226. Further rotation of the cams 322a, 322b causes them to push the first claw 310 and the second claw 332 out of engagement with the recess of the gear 308. The gear 308 then rotates freely, and the tension at the incision site closes the retractor elements. This allows for the repositioning of the retractor 200 and / or disengagement of the retractor 200 from the patient.

[0146] As shown in Figure 13, there are differences in material size among surgeons' hands. In this case, the hand dimensions of the 95th percentile for male surgeons and the hand dimensions of the 5th percentile for female surgeons are shown. By using multiple pump action types across multiple cycles rather than a single action, the retractor design achieves the desired level of retraction without requiring a range of grip and gippling force, which is within the range of comfortable achievement for more surgeons.

[0147] Other approaches, such as shortening the proximal section handle gap that needs to be closed, may bring their aspects to the range of more surgeons; however, this style of approach requires an increase in the length of the retractor arm at the other end to achieve the desired disengagement, and the force required will increase as the lever length decreases.

[0148] Within this disclosure, the length of the retractor arm (the range away from the pivot RP) is configured to give the required desired maximum deployment clearance value. This may be at least 120 mm, e.g., at least 130 mm, and potentially at least 135 mm. The maximum deployment clearance may be less than 150 mm, e.g., less than 140 mm.

[0149] Generally, the angular separation between the two retractor arms varies from zero, zero to 5° in the closed state, to 40° in the fully open state, which delivers the desired deployment gap.

[0150] The first and second ring grips may have a distance of at least 2 mm between their closest points in the retractable handle configuration. The maximum distance may be 60 mm or less, for example, 56 mm + / - 3%.

[0151] To achieve these objectives, the entire retractor can be fully operated without requiring significant force to be applied to the handle. Typically, the maximum gripping force is 15N, and the maximum force required for repeated use is 10N.

[0152] At the same time, these force limits can be achieved while maintaining an acceptable range of motion for the maximum handle extension used, for example, maintaining a grip span of 10 cm while avoiding spans exceeding 13 cm.

[0153] As described above, mechanism 226 is configured to give a linear response. A fixed rotation of the handle per pump is used. It is possible to replace this with a fixed force applied to the handle, resulting in a lower rotation of each progressive pump as greater resistance is encountered, resulting in a nonlinear response.

[0154] While the drawings and the above description have illustrated and illustrated the present disclosure in detail, such illustrations and descriptions are by their nature illustrative and should not be considered limiting, and merely illustrate illustrative embodiments. It is understood that all changes and modifications that fall within the spirit of the present disclosure should be protected.

[0155] There are several advantages of this disclosure arising from the various features of the apparatus, systems, and methods described herein. It should be noted that alternative embodiments of the apparatus, systems, and methods of this disclosure may not include all of the features described, but will benefit from at least some of the advantages of such features. Those skilled in the art will readily be able to devise their own implementations of apparatus, systems, and methods that fall within the spirit and scope of this disclosure, incorporating one or more of the features of the present invention.

[0156] [Implementation Method] (1) Surgical instruments, wherein the surgical instruments are A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and is provided opposite to the second force input element provided on the second side of the device, A surgical instrument comprising a first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the instrument and is provided opposite to the first force output element provided on the second side of the instrument. (2) The surgical instrument according to Embodiment 1, wherein the first force input element and the first force output element are provided by an integrated element, and the first force input element and the first force output element have a fixed position for the first force input element relative to the first force output element. (3) The surgical instrument according to Embodiment 1 or 2, wherein the second force input element and the second force output element are provided by separate elements, and the second force input element and the second force output element have an unfixed position of the second force input element relative to the second force output element. (4) The surgical instrument according to any one of embodiments 1 to 3, wherein the pivot for the first force input element and the second force input element is a different pivot from the pivot for the first force output element and the second force output element. (5) The surgical instrument according to any one of embodiments 1 to 4, wherein the pivot for the first force input element and the second force input element is a first pivot, the pivot for the first force output element and the second force output element is a second pivot, and the first pivot is spaced apart from the second pivot.

[0157] (6) The surgical instrument according to any one of embodiments 1 to 5, wherein the instrument has a proximal end at the end of the force input element, the instrument has a distal end at the end of the force output element, and the first pivot for the first force input element and the second force input element is provided closer to the proximal end of the instrument than the second pivot for the first force output element and the second force output element. (7) The surgical instrument according to any one of embodiments 1 to 6, wherein the first pivot portion is spaced from the second pivot portion by a distance greater than 2 cm but less than 10 cm. (8) The surgical instrument according to any one of embodiments 1 to 7, wherein the instrument provides a mechanism between at least one of the force input elements and at least one of the force output elements. (9) The surgical instrument according to any one of embodiments 1 to 8, wherein the instrument provides a mechanism between only one of the force input elements and only one of the force output elements. (10) A surgical instrument according to any one of embodiments 4 to 9, wherein the mechanism provides a link between the first pivot and the second pivot, and the link transmits a force input around the first pivot to a force output around the second pivot.

[0158] (11) A surgical instrument according to any one of embodiments 8 to 10, wherein the mechanism is provided as a first part of the mechanism and a second part of the mechanism, the second part of the mechanism being provided by a second force input element by a second mechanism part housing and a second drive element for transmitting a driving force to the first part of the mechanism. (12) The surgical instrument according to embodiment 11, wherein the first part of the mechanism is provided by a first force input element and a first drive element that transmits a driving force to an interface from the second part of the mechanism to the second arm. (13) The surgical instrument according to embodiment 12, wherein the first drive element transmits the driving force through a pin extending from the first drive element. (14) The surgical instrument according to embodiment 13, wherein the pin extends through a channel in the first mechanism housing. (15) The surgical instrument according to any one of embodiments 8 to 13, wherein the mechanism includes a first drive element and a second drive element that drives them in cooperation with a pin on the first drive element.

[0159] (16) The surgical instrument according to Embodiment 15, wherein the cooperation is provided in a transition from the expanded configuration to the contracted configuration, or toward the contracted configuration. (17) The surgical instrument according to any one of embodiments 8 to 15, wherein the mechanism includes a first locking element, the first locking element maintaining the instrument in a given closed state and / or intermediate state and / or open state. (18) The surgical instrument according to embodiment 17, wherein the first locking element engages with the first drive element to prevent movement of the first drive element, such as rotation in a certain direction. (19) A surgical instrument according to any one of embodiments 1 to 18, wherein a release mechanism is provided, the release mechanism comprising a rotatable arm and a release plate having one or more projections, the release mechanism being adapted to move the first locking element out of cooperation with the first drive element and / or move the second drive element out of cooperation with the first drive element. (20) A surgical kit comprising surgical instruments, wherein the surgical instruments are A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and is provided opposite to the second force input element provided on the second side of the device, A first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the device and is provided opposite to the first force output element provided on the second side of the device, The kit further comprises one or more additional surgical components.

[0160] (21) A surgical method, wherein the method is a) To provide a surgical instrument, wherein the surgical instrument is A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and opposite to the second force input element provided on the second side of the device, The invention includes a first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the device and opposite to the first force output element provided on the second side of the device. b) Creating an incision site in the patient, c) A surgical method comprising engaging the surgical instrument with the outer circumference of the incision and moving the surgical instrument from a closed state to an open state, or toward the open state, to increase the access area through the incision.

Claims

1. A surgical instrument, wherein the surgical instrument is A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and is provided opposite to the second force input element provided on the second side of the device, A surgical instrument comprising a first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the instrument and is provided opposite to the first force output element provided on the second side of the instrument.

2. The surgical instrument according to claim 1, wherein the first force input element and the first force output element are provided by an integrated element, and the first force input element and the first force output element have a fixed position for the first force input element relative to the first force output element.

3. The surgical instrument according to claim 1 or 2, wherein the second force input element and the second force output element are provided by separate elements, and the second force input element and the second force output element have an unfixed position of the second force input element relative to the second force output element.

4. The surgical instrument according to claim 1, wherein the pivot for the first force input element and the second force input element is a different pivot from the pivot for the first force output element and the second force output element.

5. The surgical instrument according to claim 1, wherein the pivot for the first force input element and the second force input element is a first pivot, the pivot for the first force output element and the second force output element is a second pivot, and the first pivot is spaced apart from the second pivot.

6. The surgical instrument according to claim 1, wherein the instrument has a proximal end at the end of the force input element, and the instrument has a distal end at the end of the force output element, and the first pivot for the first force input element and the second force input element is provided closer to the proximal end of the instrument than the second pivot for the first force output element and the second force output element.

7. The surgical instrument according to claim 1, wherein the first pivot portion is spaced from the second pivot portion by a distance greater than 2 cm but less than 10 cm.

8. The surgical instrument according to claim 1, wherein the instrument provides a mechanism between at least one of the force input elements and at least one of the force output elements.

9. The surgical instrument according to claim 1, wherein the instrument provides a mechanism between only one of the force input elements and only one of the force output elements.

10. A surgical instrument according to any one of claims 4 to 9, wherein the mechanism provides a link between the first pivot and the second pivot, and the link transmits a force input around the first pivot to a force output around the second pivot.

11. The surgical instrument according to claim 8, wherein the mechanism is provided as a first part of the mechanism and a second part of the mechanism, the second part of the mechanism being provided by a second force input element by a second mechanism part housing and a second drive element for transmitting a driving force to the first part of the mechanism.

12. The surgical instrument according to claim 11, wherein the first part of the mechanism is provided by a first force input element and a first drive element that transmits a driving force from the second part of the mechanism to the interface with the second arm.

13. The surgical instrument according to claim 12, wherein the first drive element transmits the driving force through a pin extending from the first drive element.

14. The surgical instrument according to claim 13, wherein the pin extends through a channel in the first mechanism housing.

15. The surgical instrument according to claim 8, wherein the mechanism includes a first drive element and a second drive element that drives them in cooperation with a pin on the first drive element.

16. The surgical instrument according to claim 15, wherein the cooperation is provided in a transition from the expanded configuration to the contracted configuration, or toward the contracted configuration.

17. The surgical instrument according to claim 8, wherein the mechanism includes a first locking element, the first locking element maintaining the instrument in a given closed state and / or intermediate state and / or open state.

18. The surgical instrument according to claim 17, wherein the first locking element engages with the first drive element to prevent movement of the first drive element, such as rotation in a certain direction.

19. A release mechanism is provided, the release mechanism comprising a rotatable arm and a release plate having one or more projections, the release mechanism being adapted to move the first locking element out of cooperation with the first drive element and / or move the second drive element out of cooperation with the first drive element, the surgical instrument according to claim 1.

20. A surgical kit comprising surgical instruments, wherein the surgical instruments are A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and is provided opposite to the second force input element provided on the second side of the device, A first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the device and is provided opposite to the first force output element provided on the second side of the device, The kit further comprises one or more additional surgical components.

21. A surgical method, wherein the said method is a) To provide surgical instruments, wherein the surgical instruments are A first force input element and a second force input element, wherein the first force input element and the second force input element are pivotably mounted relative to each other by a pivot, and the first force input element is provided on the first side of the device and is provided opposite to the second force input element provided on the second side of the device, The invention includes a first force output element and a second force output element, wherein the first force output element and the second force output element are pivotably mounted relative to each other by a pivot, and the second force output element is provided on the first side of the device and opposite to the first force output element provided on the second side of the device. b) Creating an incision site in the patient, c) A surgical method comprising engaging the surgical instrument with the outer circumference of the incision and moving the surgical instrument from a closed state to an open state, or toward the open state, to increase the access area through the incision.

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