US 5,514,075 A · Properitoneal mechanical retraction apparatus and methods of using

Abstract

A fan retractor has a pair of angle-shaped elements moveable relative to one another. The angle-shaped elements include first legs disposed in a generally parallel relationship, and second legs that extend laterally from the first legs, and are adapted for engaging with the abdominal wall. The second legs fan out upon rotation of the first legs relative to one another and have an effective thickness, measured in the direction defined by the first legs, that decreases distally from the first legs. The retractor also includes a lifting device that applies a lifting force to the angle-shaped elements. In variations, the second legs have a stiffness that decreases distally from the first legs; the first legs are linked so as to contrarotate relative to one another; the retractor includes a lifting force indicator; and the lifting device unidirectionally applies the lifting force to the angle-shaped elements. The fan retractor is preferably used properitoneally, that is, the second legs of the retractor are inserted between the properitoneal fat layer and the peritoneum. With this placement of the retractor, the peritoneum provides a drape over the bowel and omentum and prevents the second legs of the retractor from snagging the bowel or the omentum. The fan retractor may additionally be used conventionally with its second legs placed posteriorly relative to the peritoneum.

Claims54

Dependent claims

Apparatus for atraumatically and properitoneally lifting the abdominal wall by applying a lifting force of greater than ten kilograms thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction, and
(2) elongate second legs extending from the first legs towards distal ends in a second leg direction, substantially perpendicular to the first leg direction, the second legs:
(i) fanning out upon rotation of the first legs relative to one another,
(ii) being shaped to include a broad lifting surface substantially perpendicular to the first leg direction,
(iii) being adapted for separating the peritoneum from the properitoneal fat layer by insertion therebetween to engage the lifting surface with the properitoneal fat layer,
(iv) having an effective thickness in the first leg direction that decreases in the second leg direction from a maximum adjacent the first legs, and
(v) having an effective width perpendicular to the first leg direction and to the second leg direction that increases in the second leg direction to a maximum adjacent the distal ends, the effective width being plural times the effective thickness adjacent the distal ends;
and
(b) lifting force applying means for applying the lifting force to the first legs in a direction substantially parallel to the first leg direction.

7 more elements

Apparatus for properitoneally lifting the abdominal wall by applying a lifting force thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction, and
(2) elongate second legs extending from the first legs in a second leg direction, substantially perpendicular to the first leg direction, the second legs:
(i) fanning out upon rotation of the first legs relative to one another;
and
(ii) each having a length and a cross-section, wherein:
the cross-section is substantially semi-circular in a first part of the length of the second legs, proximal to the first legs, the semi-circular cross-section having a diameter that is substantially parallel to the first legs,
the cross-section gradually changes to substantially oblong in a second part of the length of the second legs, adjacent to the first part, the oblong cross-section having a long axis that is substantially parallel to the first legs, and
the cross-section remains substantially oblong in a third part, adjacent to the second part, and in a fourth part, adjacent to the third part, of the length of the second legs, the oblong cross-section having a long axis that progressively changes from substantially parallel to the first legs to substantially perpendicular to the first legs over the third part, and remains substantially perpendicular to the first legs in the fourth part to provide an effective thickness in the first leg direction that decreases in the second leg direction from a maximum adjacent the first legs;
and
(b) lifting force applying means for applying the lifting force to the first legs in a direction substantially parallel to the first leg direction.

8 more elements

Apparatus for properitoneally lifting the abdominal wall by applying a lifting force thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction, and
(2) elongate second legs extending from the first legs in a second leg direction, substantially perpendicular to the first leg direction, the second legs:
(i) fanning out upon rotation of the first legs relative to one another;
and
(ii) each having a length and a cross-section, wherein:
the cross-section is substantially semi-circular in a first part of the length of the second legs, proximal to the first legs, the semi-circular cross-section having a diameter that is substantially parallel to the first legs,
the cross-section gradually changes to substantially oval in a second part of the length of the second legs, adjacent to the first part, the oval cross-section having a major axis that is substantially parallel to the first legs, and
the cross-section remains substantially oval in a third part, adjacent to the second part, and in a fourth part, adjacent to the third part, of the length of the second legs, the oval cross-section having a major axis that progressively changes from substantially parallel to the first legs to substantially perpendicular to the first legs over the third part, and remains substantially perpendicular to the first legs in the fourth part to provide an effective thickness in the first leg direction that decreases in the second leg direction from a maximum adjacent the first legs;
and
(b) lifting force applying means for applying the lifting force to the first legs in a direction substantially parallel to the first leg direction.

8 more elements

Apparatus for lifting an abdominal wall by applying a lifting force thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction,
(2) elongate second legs extending from the first legs in a second leg direction, substantially perpendicular to the first leg direction, the second legs:
(i) fanning out upon rotation of the first legs relative to one another;
(ii) each having a length and a cross-section, wherein:
the cross-section is substantially semicircular in a first part of the length of the second legs, proximal to the first legs, the semi-circular cross-section having a diameter that is substantially parallel to the first legs,
the cross-section gradually changes to substantially oblong in a second part of the length of the second legs, adjacent to the first part, the oblong cross-section having a long axis that is substantially parallel to the first legs, and
the cross-section remains substantially oblong in a third part, adjacent to the second part, and in a fourth part, adjacent to the third part, of the length of the second legs, the oblong cross-section having a long axis that progressively changes from substantially parallel to the first legs to substantially perpendicular to the first legs over the third part, and remains substantially perpendicular to the first legs in the fourth part to provide stiffness in the first leg direction that decreases in the second leg direction from a maximum adjacent the first legs;
and
(b) lifting force applying means for applying the lifting force to the first legs in a direction substantially parallel to the first leg direction.

7 more elements

Apparatus for lifting an abdominal wall by applying a lifting force thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction,
(2) elongate second legs extending from the first legs in a second leg direction, substantially perpendicular to the first leg direction, the second legs:
(i) fanning out upon rotation of the first legs relative to one another;
(ii) each having a length and a cross-section, wherein:
the cross-section is substantially semi-circular in a first part of the length of the second legs, proximal to the first legs, the semi-circular cross-section having a diameter that is substantially parallel to the first legs,
the cross-section gradually changes to substantially oval in a second part of the length of the second legs, adjacent to the first part, the oval cross-section having a major axis that is substantially parallel to the first legs, and
the cross-section remains substantially oval in a third part, adjacent to the second part, and in a fourth part, adjacent to the third part, of the length of the second legs, the oval cross-section having a major axis that progressively changes from substantially parallel to the first legs to substantially perpendicular to the first legs over the third part, and remains substantially perpendicular to the first legs in the fourth part to provide stiffness in the first leg direction that decreases in the second leg direction from a maximum adjacent the first legs;
and
(b) lifting force applying means for applying the lifting force to the firs legs in a direction substantially parallel to the first leg direction.

7 more elements

Apparatus for lifting the abdominal wall by applying a lifting force thereto, the apparatus comprising:

(a) a pair of angle-shaped elements moveable relative to one another, the angle-shaped elements including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction, and
(2) elongate second legs extending from the first legs in a second leg direction, substantially perpendicular to the first leg direction, the second legs fanning out upon rotation of the first legs relative to one another, being shaped to include a broad lifting surface substantially perpendicular to the first leg direction, and being adapted for insertion through the abdominal wall to engage the broad lifting surface with the abdominal wall;
(b) lifting force applying means for compliantly applying the lifting force to the first legs in a direction substantially parallel to the first leg direction, the lifting force applying means comprising:
(1) a cylindrical sleeve having a bore with a lip part-way along, the bore receiving the first legs of the angle-shaped members, and
(2) means for attaching the cylindrical sleeve to a lifting arm;
and
(c) force measuring means, coupled between the lifting force applying means and the first legs, for measuring the lifting force applied to the abdominal wall, the force measuring means comprising:
(1) a mounting block, slidably mounted in the bore of the cylindrical sleeve, the mounting block being cylindrical, and including a contact face, and a force indicating means for indicating the lifting force, the first legs of the angle-shaped elements being rotatably mounted in the mounting block with the second legs facing the contact face, and
(2) a coil spring, disposed within the bore of the cylindrical sleeve between the lip and the contact face of the mounting block, and surrounding the first legs of the angle-shaped elements.

7 more elements

A method of properitoneally lifting an abdominal wall by applying a lifting force thereto, the abdominal wall including a properitoneal fat layer and a peritoneum, the method comprising steps of:

(a) providing a retractor including a pair of angle-shaped elements moveable relative to one another and including:
(1) first legs disposed in a generally parallel relationship, the first legs having a first leg direction, and
(2) elongate second legs extending from the first legs towards distal ends, the second legs extending in a second leg direction, substantially perpendicular to the first leg direction, the second legs fanning out from a closed state upon rotation of the first legs relative to one another, and being shaped to include a broad lifting surface substantially perpendicular to the first leg direction;
(b) making an incision through the abdominal wall except for the peritoneum;
(c) inserting the distal ends of the second legs in the closed state into the incision to abut the peritoneum;
(d) advancing the second legs in the closed state between the properitoneal fat layer and the peritoneum to engage the broad lifting surface with the properitoneal fat layer;
(e) rotating the first legs relative to one another to fan out the second legs;
and
(f) applying the lifting force to the first legs in a direction substantially parallel to the first leg direction.

6 more elements

Dependencies are inferred from the claim text.

Properitoneal mechanical retraction apparatus and methods of using

Life of this patent

Properitoneal mechanical retraction apparatus and methods of using

Life of this patent

Abstract

Claims54