US3858578A - Surgical retaining device - Google Patents

Abstract

A device for holding surgical instruments firmly in place. A surgical instrument is attached to a retaining arm, the rigidity of which is controlled by a fluid actuated operating apparatus. By activating the operating apparatus, the arm can be made flexible as the instrument is being positioned and rigid once the instrument is in place.

Description

United States Patent 1191 Milo Jan. 7, 1975 SURGICAL RETAINING DEVICE 1.279.803 9/1918 Watson .1 2411/1611 1,460,697 7 1923 B dl' ['75] lnventor: SImcha MllO, Haifa, Israel 2,334841 11943 t z u [73] Assignee: Pravel, Wilson & Matthews, g'ggg'gf g i p O C l Houston a part Interest 3,643,655 2/1972 Peronti 1. 1212/20 [22] Filed: Jan. 21, 1974 [21] Appl No: 435,235 Primary Examiner-Lucie H. Laudenslager [52] US. Cl. 128/20 [57] ABSTRACT: I [51 m 17 02 A devlce for holdmg surg1cal Instruments firmly 1n 158 Field 61 Search 128/20, 3; 248/160, 276; P A Surgical instrymem is attached to a retaining 2 5 4 arm, the rigidrty of whlch is controlled by a flurcl actuated operating apparatus. By activating the operating [5 References Cited apparatus, the arn can be macle flexible as the instru- UNITED STATES PATENTS ment 1s bemg posmoned and rlglcl once the mstrument 205,069 6/1878 Farnsworth 285/166 m piace' 1,276,117 8/1918 Riebe 64/4 9 Claims, 2 Drawing Figures Patented Jan. 7, 1915 3,858,578

SURGICAL RETAINING DEVICE BACKGROUND OF THE INVENTION The field of this invention is surgical devices.

It is frequently necessary for a surgeon to employ retractors during an operation in order to hold the sides of an incision open or to gain access to a particular part of the patients body. The retractors must be properly positioned and held very securely to avoid possible injury to the patient.

In the past, a few mechanical holding devices, such as those described in U.S. Pat. Nos. 3,278,207 and 3,638,973, have been available, but they were not used extensively because they did not allow proper positioning of the surgical instrument and did not hold the instrument firmly in place once it was positioned. Neither did the support and conduit devices, such as described in U.S. Pat. Nos. 1,276,117; 1,279,803; and 1,460,697 overcome the placement and holding problems. As a result, the job of holding retractors in place has been accomplished by surgical assistants who manually hold the retractors. The job is a tiresome one, and the assistants congest the area around the operating table.

SUMMARY OF THE INVENTION It is an object of this invention to provide a new and improved surgical retaining device. The device in cludes a retaining arm comprised of a plurality of arm members having a central bore therethrough, a cable attached to one end of the retaining arm and extending through the bores of the arm members, a fluid actuated operating apparatus for adjusting tension on the cable to control the rigidity of the retaining arm, and a means for connecting a surgical instrument to the retaining arm. During the positioning of the surgical instrument, the operating apparatus exerts no force on the cable and the retaining arm is highly flexible. However, once the surgical instrument is in place, the operating apparatus exerts a force on the cable sufficient to make the retaining arm rigid and thereby prevent the surgical instrument from moving.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a top view showing a mode of employing the surgical retaining device; and

FIG. 2 is a sectional view of the invention which also includes a schematic representation of a valve in the operating apparatus.

DESCRIPTION OF THE PREFERRED EMBODIMENT In the drawings, the letter A designates generally the surgical retaining device wherein a surgical retractor T is joined to retaining arm B by a surgical instrument connector C. A cable D is affixed at one end to connector C and extends through a central bore in arm B to operating apparatus E. As will be described in more detail below, arm B is flexible until a tension is placed on cable D by operating apparatus E; however, when tension is placed on cable D, the retaining arm B becomes rigid and holds the surgical retractor T firmly in place.

Considering the invention in more detail, a surgical instrument, such as surgical retractor T, is attached to connector C in a conventional manner. FIG. 2 illustrates one such method where the surgical retractor T has a threaded bottom shaft which is screwed into a first threadedcavity 12 of connector C. In a similar manner, connector C may be joined to cable D by screwing a threadedshaft 14, which is attached to cable D, into a second threadedcavity 16 of connector C.

Retaining arm B is positioned between connector C and abase member 18. The arm B includes a plurality ofarm members 20 which are identical in structure. However, for descriptive purposes only, two of the arm members are designated as anoutermost arm member 20a and an innermost arm member 20b.

Each of thearm members 20 has anarcuate head portion 22, and aconical tail portion 24 with an arcuateannular surface 26 formed to receive thearcuate head portion 22 of another arm member in retaining arm B. Each of the arm members also has a centralconical bore 28 which forms anaperture 30 having alip 31 at thearcuate head 22. Theconical bore 28 extends completely through theconical tail 24 of arm member As shown in FIG. 2, the arm members are positioned head to tail between the connector C andbase 18. The lower portion of connector C has an arcuateannular surface 32 formed to receive thearcuate head 22 of theoutermost arm member 20a. Thebase 18 has an arcuatetop portion 34 which is received in the arcuateannular surface 26 of the innermost arm member 20h.

Cable D, which is attached to connector C atshaft 14, extends through aconnector cavity 36, the centralconical bore 28 of each arm member, and acylindrical bore 38 inbase 18.

The shape ofarm members 20 makes them capable of substantially universal movement with respect to each other when cable D has no tension on it. Thearcuate head portion 22 and thearcuate surface 26 of thearm members 20 have the same curvature. Thus, when cable D is slack and exerts no force on the arm members,arcuate head 22 of one arm member is received atarcuate surface 26 of another arm member, thereby placing the two arm members in relatively frictionless sliding contact with each other. In a somewhat similar manner, the shape ofbase 18 permits innermost arm member 20b to move with respect tobase 18, and the shape of the lower portion of connector C permits movement of theoutermost member 20a with respect to connector cap C. Thearcuate top 34 ofbase 18 and the arcuateannular surface 26 of innermost arm member 20b have the same curvature, and whenarcuate top 34 is received in thearcuate surface 26 the two members are placed in frictionless sliding contact. Similarly, thearcuate surface 32 in the lower portion of connector cap C has the same curvature asarcuate head 22 ofoutermost arm member 20a. When thearcuate head 22 ofoutermost member 20a is received in thearcuate surface 32 of connector C, the outermost arm member 200 and the connector C are placed in frictionless sliding contact.

The shape ofbore 28 is also an important factor in achieving freedom of movement betweenarm members 20. As thearm members 20 move with respect to each other, thelip 31 ofaperture 30 will deflect tension free cable D. Thecentral bore 28 is conical to prevent cable D from becoming wedged betweenlip 31 andtail 24 and thereby assures unrestricted sliding contact betweenadjacent arm members 20. In a somewhat similar manner, connector C hascavity 36 which is substantially larger in diameter than cable D to permit deflection of tension free cable D asoutermost member 20a moves with respect to connector C.

From the above description, it can be seen that retaining arm B is very flexible when cable D is slack.

Each of the arm members is in relatively frictionless contact with its adjacent arm members, and the structure of thearm members 20 permit substantially universal movement of themembers 20 with respect to each other. Moreover, since cable D is made of metal or any other suitable flexible material which can withstand repeated use without wear, cable D will not lessen the flexibility of retaining arm B. However, if cable D is under tension, a force is applied to connector C and to each of thearm members 20. This force causesarcuate surface 32 to be moved into firm contact witharcuate head 22 ofoutermost arm member 20a. It also causes thearcuate head portion 22 of each of the other arm-members 20 to be placed in firm contact with thearcuate surface 26 of an adjacent arm member. Thearcuate surface 26 of innermost arm member 20b placed in firm contact with thearcuate top 34 ofbase 18 by the same force. In this manner, each of thearm members 20 is frictionally engaged and thereby rendered immobile with respect to each other, the connector C, and thebase 18. Retaining arm B thus becomes rigid to hold surgical retractor T in place.

The tension on cable D is controlled by operating apparatus E. Cable D extends throughcentral bore 38 ofbase 18 and intocylinder 40 through afirst cylinder aperture 42. Thecylinder 40 is mounted beneathbase 18 in such a way thataperture 42 is aligned withbore 38. In actual practice, of course, thebase 18 and thecylinder 40 may be constructed as a single element of this invention to avoid any alignment problems.

Apiston 44 withincylinder 40 is attached to anend 46 of cable D. Thepiston 44 has a diameter very slightly less than the inside diameter ofcylinder 40 and dividescylinder 40 into a first fluid-tight chamber 48 and a second fluid-tight chamber 50.

Asecond cylinder aperture 52 receives a communicating means, such asflexible hose 54, to connectchamber 50 to valve means 56. In FIG. 2, anadditional hose 55 is shown connected toline 54 for a purpose to be hereinafter explained. The valve means 56 is a conventional three-way valve which alternately connectschamber 50 to the outside atmopshere and to a supply of pressurized fluid. A communicating means, such asflexible hose 58, is provided to connect valve means 56 with the supply of pressurized fluid such as a compressed air tank 88 (FIG. 1), as will be more fully explained. Normally, the fluid used will be air, but any suitable fluid may be employed.

When valve means 56 is in the position schematically represented in FIG. 2, pressurized fluid will pass intochamber 50 ofcylinder 40. The fluid is prevented from escaping throughaperture 42 bysealing means 60. The pressure of the fluid in chamber'50 will causepiston 44 to move downward until the pressures inchambers 50 and 48 have been equalized. Aspiston 44 moves downward, it places cable D under tension and thereby causes retaining arm B to become rigid.

As previously mentioned, valve means 56 can also connectchamber 50 to the outside atmosphere. In the schematic representation of valve means 56 in FIG. 2, this is accomplished by rotating thevalve 56 to move thepassage 62 of valve means 56 ninety degrees clockwise. In this position, the valve permits the pressurized fluid inchamber 50 to exhaust throughhose 54 and anexhaust line 64 into the atmosphere. As the fluid leaveschamber 50, thepiston 44 is moved upwardly until the pressure in thechamber 50 is essentially atmospheric pressure. Whenpiston 44 has moved up, cable D will no longer be under tension and retaining arm B will be flexible.

The operating apparatus E is also provided with. adjustable mounting means 66 to permit the placement of the surgical retaining device at any point along the edge of a table 68 or other working surface. An upper mountingmember 70 and a lower mountingmember 72 extend fromcylinder 40. The lower mountingmember 72 has a threadedaperture 74 which receives threadedbolt 76. An operator may position the surgical retaining device by placing upper mountingmember 70 over atop surface 78 of table 68 and sliding the surgical retaining device to a desired position along table 68. Thebolt 76 is then tightened until it comes into contact with alower surface 80 of table 68. In this manner, the surgical retaining device is held at the desired position.

FIG. 1 illustrates the preferred use of the surgical retaining device. However, other arrangements of the apparatus are within the scope of this invention as are other uses of the disclosed device.

In FIG. 1, two retaining arms B holding surgical retractors T are mounted on table 68 by the adjustable mounting means 66.Hoses 54 and 55 connect eachchamber 50 of eachcylinder 40 to the valve means 56 (FIG. 2) which is enclosed in a valve housing 82 (FIG. 1). Thehose 58 connects valve means 56 in thehousing 82 to the supply ofpressurized air 88 or a similar source of fluid under pressure.Foot pedals 84 and 86 which protrude throughvalve 82 are exemplary of means to actuate valve means 56. Whenfoot pedal 86 is depressed, valve means 56 is rotated or otherwise moved to connectchambers 50 to the supply ofpressurized air 88 causing thepistons 44 to move downward or in a direction to tighten the cable D, thereby causing each of the arm members B to become rigid. Whenfoot pedal 84 is depressed, the valve means 56 connectschambers 50 andexhaust line 64. When that occurs, since the air or other fluid inchambers 48 is then greater than atmospheric pressure, thepistons 44 are moved upwardly or in a direction to loosen or slacken the cable D. The slackening of the cable D causes retaining arms B to become flexible and movable to various selected positions.

Before a surgeon makes anincision 90 in the body of apatient 92,foot pedal 84 is momentarily depressed to make arms B flexible. The arms B are then placed along the edges of table 68. However, once theincision 90 has been made and the retractors T are to be employed, the surgeon positions the retractors T so that they will hold the sides ofincision 90 apart.Foot pedal 86 is then momentarily depressed to make retaining arms B rigid and hold retractors T firmly in place. Once the retaining arms B are rigid, the surgeon may take his foot off thepedal 86, and the arms B will remain rigid untilpedal 84 is actuated. The surgeon can thus move around without concern for holding the retractors, and he is free to work on the patient without anyone in his way.

As an alternative, it should be recognized that the valve means 56 may be of a spring-loaded type which would always return to the rigid or holding position shown in FIG. 2. In such case, onlypedal 84 would be needed to rotate or movevalve 56 when it was desired to make the arms B flexible and movable for changing the positions of the retractors T. Also, it is to be noted that each arm B may be separately controlled with aseparate valve 56 for each arm B, if so desired. Any number of arms B and retractors T therewith may be employed at a time, and they may be separately or jointly operated. Also, various types of retractor members T may be used, depending upon the area of the incision or other factors. For this reason, the retractors T are preferably replaceable and are also illustrated.

The foregoing disclosure and description of the invention are illustrative and explanatory thereof, and various changes in the size, shape, and materials as well as in the details of the illustrated construction may be made without departing from the spirit of the invention.

I claim: 1. A surgical retaining device for holding a surgical instrument in place, comprising:

a base having a bore therethrough; a surgical instrument connector adapted to be attached at its top portion to a surgical instrument; a plurality of arm members, each having a bore therethrough, an arcuate head portion, and a conical tail portion with an arcuate annular surface to receive the head portion of another arm member, said arm members being positioned head to tail between the connector and the base and with adjacent members pivotable with respect to each other; and a flexible cable affixed at its first end to the bottom portion of the connector and extending through the bores of the arm members and base whereby exerting a force on a second end of said cable holds the arm members rigidly together and the surgical instrument in place. 2. The structure set forth inclaim 1, wherein: said base has an arcuate top portion; and said surgical instrument connector has an arcuate annular surface in its bottom portion. 3. The structure set forth inclaim 1, wherein: said arcuate head portions and said arcuate annular surfaces of said arm members have the same curvature to provide sliding contact between adjacent arm members. 4. The structure set forth inclaim 1, wherein: said bores through said arm members are conical. 5. A fluid actuated apparatus for controlling the rigidity of a hollow, jointed surgical arm comprising:

a flexible cable attached at its first end to an end of a surgical arm and extending through the hollow portion of said arm; a piston attached to a second end of the cable; a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure;

valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and

means for communicating fluid between the valve means and the second cylinder aperture whereby supplying pressurized fluid to the second cylinder aperture depresses the piston, exerts a force on a second end of the flexible cable, and holds the surgical arm rigid.

6. A surgical apparatus for holding a surgical instrument in place, comprising:

a plurality of arm members each having a central bore therethrough and each being pivotable relative to other arm members;

a surgical instrument having a connector attached thereto and positioned at one end of the plurality of arm members;

a flexible cable having a first end and a second end,

with the first end affixed to said connector and extending through the bores of said arm members; and

fluid actuated means operably connected to the second end of said cable for alternately pulling and slackening said cable to hold said arm members frictionally in contact with each other so that they cannot move relative to each other when the cable is tightened, but permitting said arm members to move relative to each other when the cable is slackened for thereby controlling the mobility of said arm members and the surgical instrument therewith.

7. The structure set forth in claim 3, wherein said fluid actuated means comprises:

a piston attached to the second end of said cable;

a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure;

valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and

means for communicating fluid between the valve means and the second cylinder aperture.

8. The structure set forth in claim 6, wherein:

said valve means is actuated by a foot pedal.

9. The structure set forth in claim 6, further comprismeans for adjustably mounting one extremity of said arm members on a surgical table.

Claims (9)

1. A surgical retaining device for holding a surgical instrument in place, comprising: a base having a bore therethrough; a surgical instrument connector adapted to be attached at its top portion to a surgical instrument; a plurality of arm members, each having a bore therethrough, an arcuate head portion, and a conical tail portion with an arcuate annular surface to receive the head portion of another arm member, said arm members being positioned hEad to tail between the connector and the base and with adjacent members pivotable with respect to each other; and a flexible cable affixed at its first end to the bottom portion of the connector and extending through the bores of the arm members and base whereby exerting a force on a second end of said cable holds the arm members rigidly together and the surgical instrument in place.

2. The structure set forth in claim 1, wherein: said base has an arcuate top portion; and said surgical instrument connector has an arcuate annular surface in its bottom portion.

3. The structure set forth in claim 1, wherein: said arcuate head portions and said arcuate annular surfaces of said arm members have the same curvature to provide sliding contact between adjacent arm members.

4. The structure set forth in claim 1, wherein: said bores through said arm members are conical.

5. A fluid actuated apparatus for controlling the rigidity of a hollow, jointed surgical arm comprising: a flexible cable attached at its first end to an end of a surgical arm and extending through the hollow portion of said arm; a piston attached to a second end of the cable; a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure; valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and means for communicating fluid between the valve means and the second cylinder aperture whereby supplying pressurized fluid to the second cylinder aperture depresses the piston, exerts a force on a second end of the flexible cable, and holds the surgical arm rigid.

6. A surgical apparatus for holding a surgical instrument in place, comprising: a plurality of arm members each having a central bore therethrough and each being pivotable relative to other arm members; a surgical instrument having a connector attached thereto and positioned at one end of the plurality of arm members; a flexible cable having a first end and a second end, with the first end affixed to said connector and extending through the bores of said arm members; and fluid actuated means operably connected to the second end of said cable for alternately pulling and slackening said cable to hold said arm members frictionally in contact with each other so that they cannot move relative to each other when the cable is tightened, but permitting said arm members to move relative to each other when the cable is slackened for thereby controlling the mobility of said arm members and the surgical instrument therewith.

7. The structure set forth in claim 3, wherein said fluid actuated means comprises: a piston attached to the second end of said cable; a fluid-tight cylinder surrounding the piston and having a first aperture through which the cable extends and a second aperture at the top of the cylinder cavity for receiving fluid under pressure; valve means for controlling the supply of pressurized fluid to the cylinder and the exhaust of fluid from said cylinder; and means for communicating fluid between the valve means and the second cylinder aperture.

8. The structure set forth in claim 6, wherein: said valve means is actuated by a foot pedal.

9. The structure set forth in claim 6, further comprising: means for adjustably mounting one extremity of said arm members on a surgical table.

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