Surgical retractor and stabilizing device and method for use

Abstract

An adjustable surgical retractor and its use for improving a surgeon's ability to perform closed-chest video-assisted exploratory, diagnostic or surgical procedures on a patient. The surgical retractor has opposable blades which can be inserted into a surgical incision in a patient undergoing a surgical procedure then spread apart to form an elongated access opening through which a instrument may be inserted to perform exploratory, diagnostic or surgical procedures. The blades used in the surgical retractor may be flexible or rigid and are attachable to the retractor. The blades are of a width, depth and thickness to provide an access to an internal cavity or subcutaneous region to allow greater degrees of freedom to the surgeon in inserting instruments into the access opening. The use of the surgical retractor forms a substantially ovoid channel, through which a medical instrument can be inserted to perform surgical or other operations.

1 . An adjustable surgical retractor that comprises 
 (a) two handles suitable for grasping positioned opposite each other and connected so that the handles move reciprocatingly relative to each other,    (b) a head connected to each handle so that each head moves reciprocatingly relative to the other,    (c) a means for locking the heads at a preset distance from each other, and    (d) a blade connected to each head, each blade having a width, depth and thickness so that the width extends substantially parallel to the length of the handle and the depth extends downward from the top of the head wherein the blades taken together at the position of closest proximity to each other are of a size suitable to be inserted into a surgical incision in a patient undergoing a surgical procedure then spread apart to form an elongated access opening through which a medical instrument may be inserted to perform exploratory or surgical procedures.    
     
     
         2 . The surgical retractor of  claim 1  wherein each blade has an inside face and an outside face, said inside face of each blade facing the inside face of the other blade and the outside face of each blade designed to (i) minimize the trauma to the patient's body at the incision when the head and blades are spread apart and (ii) stabilize the blades in the incision.  
     
     
         3 . The surgical retractor of  claim 1  wherein the upper edge of each blade when spread apart has a concavely smooth surface corresponding to a concave surface of the inner face and is designed to stabilize a surgical instrument when such instrument contacts it.  
     
     
         4 . The surgical retractor of  claim 3  wherein each blade comprises a flexible material with the outer face having a textured surface to stabilize the blade in the incision.  
     
     
         5 . The surgical retractor of  claim 4  wherein when the inner faces of the blades are in closest proximity, the width of each blade is parallel to the other.  
     
     
         6 . The surgical retractor of  claim 3  wherein each blade is a flexible material and the outer surface comprises a resilient material.  
     
     
         7 . The surgical retractor of  claim 1  wherein each blade is rigid and each inner face is concave relative to the other with an outwardly protruding lip on the upper and lower edge of each blade to assist in maintaining the blades in the incision when the head and blades are spread apart after insertion into the patient's surgical incision.  
     
     
         8 . The surgical retractor of  claim 1  wherein the blades are disposable.  
     
     
         9 . The surgical retractor of  claim 1  wherein the width of each blade is about one inch to about four inches, the depth is about one inch to about three inches and the thickness is about one-eighth inch to about three-quarters of an inch.  
     
     
         10 . The surgical retractor of  claim 1  wherein when the head and blades are spread apart a surgical opening is formed having a length of about one inch to about four inches and a width of about one-quarter inch to about two inches.  
     
     
         11 . The surgical retractor of  claim 1  wherein each blade is connected to each head by a post and a corresponding receptacle.  
     
     
         12 . The surgical retractor of  claim 11 , wherein each blade can swivel on each post.  
     
     
         13 . The surgical retractor of  claim 11 , wherein each post is formed of a locking pin, thereby preventing the blade from swiveling on the post.  
     
     
         14 . The surgical retractor of  claim 11  wherein said post is frictionally held in said receptacle.  
     
     
         15 . The surgical retractor of  claim 11  wherein the blade is removably connected to the head.  
     
     
         16 . A method of providing surgical access to the internal thoracic region of a patient, which method comprises making an intercostal, surgical incision through the skin and soft tissue of the patient, wherein the incision is sufficiently sized to allow for the insertion of a surgical retractor in the incision; 
 providing a surgical retractor including: 
 (a) two handles suitable for grasping positioned opposite each other and connected so that the handles move reciprocatingly relative to each other;  
 (b) a head connected to each handle so that each head moves reciprocatingly relative to the other;  
 (c) a means for locking each head at a preset distance from the other; and  
 (d) a blade connected to each head, each blade having a width, depth and thickness so that the width extends substantially parallel to the length of the handle and the depth extends downward from the top of the head;  
   inserting two blades of said surgical retractor perpendicularly through the incision; and    spreading the blades of said retractor to provide a relatively symmetrical, elongated channel for accessing the internal thoracic region of the patient, said channel being defined by said blades wherein the internal faces of the blades have a concave surface to define a substantially ovoid channel, each blade having a smooth, continuous upper surface.    
     
     
         17 . The method of  claim 16 , wherein at least two surgical incisions are made intercostally and sufficiently spaced apart to allow for the insertion and spreading of the blades of two of said surgical retractors, each pair of spread blades providing a relatively symmetrical, elongated channel for accessing the internal thoracic region of the patient.  
     
     
         18 . The method of  claim 16 , wherein said two surgical incisions are made laterally on said patient.  
     
     
         19 . The method of  claim 16 , wherein said two surgical incisions are made anteriorly on said patient.  
     
     
         20 . The method of  claim 16 , wherein said two surgical retractors are interconnected by a stabilizing bar to fix their positions relative to the other.  
     
     
         21 . The method of  claim 16 , wherein a third incision is made to provide access to the patient's thoracic cavity sufficient to insert an image transmission means to transmit an image of the patient's internal thoracic region.  
     
     
         22 . A method of performing minimally-invasive cardiac surgery on a patient, which method comprises 
 providing a surgical retractor including: 
 (a) two handles suitable for grasping positioned opposite each other and connected so that the handles move reciprocatingly relative to each other,  
 (b) a head connected to each handle so that each head means moves reciprocatingly relative to the other,  
 (c) a means for locking each head at a preset distance from the other, and  
 (d) a blade connected to each head, each blade having a width, depth and thickness so that the width extends substantially parallel to the length of the handle and the depth extends downward from the top of the head;  
   making an intercostal surgical incision through the skin and soft tissue of the patient, wherein the incision is sufficiently sized to allow for the inserting and spreading of the blades of said surgical retractor,    inserting two blades of a surgical retractor, perpendicularly through the incision,    spreading the blades of said retractor to provide a relatively symmetrical, elongated channel for accessing the internal thoracic region of said patient, said channel being defined by said blades wherein the internal faces of the blades have a concave surface to define a substantially ovoid channel, each blade having a smooth continuous upper surface,    inserting a surgical instrument through said substantially ovoid channel, and    performing a surgical procedure using the surgical instrument so inserted.    
     
     
         23 . The method of  claim 22 , wherein said surgery is cardiac surgery and said patient is maintained on a cardiopulmonary by-pass machine.  
     
     
         24 . The method of  claim 23 , wherein at least two surgical incisions are made intercostally and sufficiently spaced apart to allow for the inserting and spreading of the blades of two of said surgical retractors, each pair of spread blades providing a relatively symmetrical, elongated channel for accessing the internal thoracic region of the patient.  
     
     
         25 . The method of  claim 22 , wherein said two surgical incisions are made laterally on said patient.  
     
     
         26 . The method of  claim 22 , wherein said two surgical incisions are made anteriorly on said patient.  
     
     
         27 . The method of  claim 22 , wherein said two surgical retractors are interconnected by a stabilizing bar to fix their positions relative to the other.  
     
     
         28 . The method of  claim 22 , wherein a third incision is made to provide access to the patient's thoracic cavity sufficient to insert an image transmission means to transmit an image of the patient's internal thoracic region.  
     
     
         29 . The method of  claim 28 , wherein the surgery is performed by the surgeon by manipulating the instruments viewing the image surgery so transmitted by the transmission means.