WO2007104331A1

WO2007104331A1 - Retractor device

Info

Publication number: WO2007104331A1
Application number: PCT/EP2006/002372
Authority: WO
Inventors: Ingeborg Rolle; Axel Rolle
Original assignee: Rolle + Rolle Gmbh & Co Kg
Priority date: 2006-03-15
Filing date: 2006-03-15
Publication date: 2007-09-20
Also published as: DE212006000093U1

Abstract

The invention relates to a retractor device (1) for keeping body cavities (24) open, in particular the cavities of the thorax, with at least two retractor jaws (2, 3), which are arranged lying approximately opposite one another, and each of which is able to force a margin (26) of the body opening aside, and with a jaw holder (6), with which the retractor jaws can be held at a distance from one another. To improve this retractor device in the sense of providing the operating surgeon with a better view of the treatment area despite the size of the opening remaining unchanged, while ensuring that the device is easy to handle, it is proposed that at least one of the retractor jaws has a light emitter (13).

Description

spreading

The invention relates to a spreading device with the features of the preamble of claim 1.

Known spreading devices of this genus are z. B. used as so-called rib obstruction in the thoracic surgery. Here they serve to spread surgically created body openings in order to give the surgeon good access to the treated tissue or organ such. As the heart, the lung, the esophagus or the spine. A disadvantage of the use of such spreading devices from the prior art are the limited visibility. Often, the expansions of the body orifices are less than the dimensions of the exposed body cavity, so that the tissue or organ to be treated is restrictedly accessible and visible through the body orifice. The body cavities are usually illuminated with ceiling mounted surgical lights. For better visibility operators use so-called head lights, which illuminate the area located in front of the field of view and see through turns of the head and lateral areas of the body cavity. These efforts are relatively expensive for the surgeon in practice and still limit his view.

The invention has the object to improve a spreading device of the type mentioned in that despite about the same size body opening and good handling by the attending physician, z. As a surgeon, zuehendes treatment area is more visible.

This object is achieved according to the invention with a spreading device having the features of claim 1.

The arrangement of a light emitter on at least one of the spreading jaws allows a good illumination, including the edge regions of the treatment area. Areas that were difficult to recognize in conventional lighting can be illuminated in this way become. By arranging the light emitter on the spreading jaws protruding into the body opening, the shadow cast in the treatment area can be reduced. Since the light emitter is located very close to or in the patient, a good illumination of the entire treatment area is ensured and the shadow is reduced, compared to a further away from the patient light source.

Advantageously, the light emitter can emit light into a body cavity accessible through the body opening. Thus, the entire body cavity and thus the treatment area is well lit.

Furthermore, cladding rays of a light cone emitted by the light emitter may be below or at most in an ebene defined by the opening edge of the body opening. As a result, the light emission is largely limited to the treatment area.

In a variant of the invention, the light emitted by the light emitter may have a color temperature in the range of about 1,000 to 10,000 K, preferably in the range of about 3,000 to 8,000 K and in particular in the range of about 4,000 to 7,000 K. Light with such a color temperature allows a largely realistic color perception and is thus well suited for operations.

In a favorable embodiment of the invention, the color temperature of the light emitted by the light emitter light can be changed. Thus, the lighting can be adapted to the needs of the treating physician and / or the respective treatment area. Even unfavorable lighting conditions of the environment can be compensated if necessary.

Advantageously, the brightness of the light emitted by the light emitter can be changeable. The light can be as ambient conditions such. B. the attending physician, the treatment area, etc. adapt.

In a variant of the invention, the light emitter may have a diffuse light emission. This helps to reduce shadows. Conveniently, the light emitted by the light emitter may be colourfast. This gives the doctor a largely realistic color impression of the tissue in the treatment area. This helps the doctor to correctly interpret the treatment situation and thus increases the safety.

In a variant of the invention, the light emitter may consist of biocompatible material. This allows a gentle treatment of the patient. Treatment risks such. As a contact allergy or possible late effects can be reduced.

Furthermore, the light emitter can be sterilized. This allows reuse and thus economical use of the spreading device.

Advantageously, the light emitter can lie approximately flush with the jaw material. The flush system allows a largely gap-free transition from the material of the expanding jaws to the light emitter. This facilitates sterilization.

In a favorable embodiment of the invention, the light emitter can be connected via at least one conductor element to a power source. This allows a good and lasting energy supply and thus a good light output of the light emitter over the treatment period.

Conveniently, the energy source may be a light source, which is connected via an optical conductor to the light emitter. Thus, the light emitter can be connected to an existing light source z. For example, connect an external light source in the OR.

In a variant of the invention, the light source may be a cold light source. The cold light reduces dehydration and heating of the illuminated fabric.

Advantageously, the light source may be a laser light source. This allows the use of a light with a specific wavelength. In a favorable embodiment of the invention, the energy source can be connected via an electrical conductor to the light emitter. This allows the light emitter to be connected to an existing power source.

Furthermore, the conductor element can be provided extending in and / or on the spreading device. By the leadership of the conductor within and / or along individual components of the spreading of the conductor is largely protected from external influences such. B. mechanical influences or contamination. The treatment area is kept clear and the patient can be protected from any unwanted contact with the conductor.

In a variant of the invention, the spreading device may have a guide for the conductor element. Thus, the conductor is securely guided when moving the expanding jaws.

Conveniently, the cross section of the expanding jaws may have a curved shape. Thus, the spreading jaws can safely hold the opening edge and optionally, depending on the embodiment, also encompass.

Furthermore, the light emitter may extend approximately along the spreader jaw. The longitudinal extension of the light emitter allows a large emission area.

In a favorable embodiment of the invention, the light emitter may be provided on the side of the spreading jaw projecting into the body opening. This ensures a good illumination of the body cavity or the treatment area.

In a variant of the invention, the light emitter may extend approximately to half the height of the spreader jaw. As a result, the emission surface of the light emitter is further increased. A radiation of light beyond the body opening is still largely reduced.

An embodiment of the invention will now be described with reference to the following drawings. Showing: Figure 1 is a perspective view of a spreading device according to the invention and

FIG. 2 shows the spreading device according to the invention from FIG. 1 in a state inserted into a body opening and FIG

FIG. 3 shows a section through the spreading jaws of the spreading device according to the invention from FIG. 2.

Figure 1 shows a perspective view of a spreading device 1 according to the invention with two expanding jaws 2, 3. The spreading jaws are here integrally formed with mounting rails 4, 5, via which the expanding jaws 2, 3 are connected to a jaw holder 6.

The jaw holder 6 allows the spacing of the two expanding jaws 2, 3 and has a rack and pinion mechanism in this embodiment. The rack 7 is firmly connected to the first support rail 4. The foot 8 of the support rail 5 of the second expanding jaw 3 surrounds the rack 7 and houses in its interior a gear (not shown here), which meshes with the teeth 9 of the rack 7. Via a lever 10 which is pivotally connected to the axis 11 of the gear, the gear and thus the clamping jaw 3 can be moved manually. The rack and pinion mechanism shown here is self-locking and thus at the same time allows a fixation of the clamping jaw 3. However, other embodiments of the invention may alternatively but other adjustment and jaw holding mechanisms such. B. lever and / or screw mechanisms have.

All previously mentioned components of the spreading device 1, namely the expanding jaws 2, 3, the support rails 4, 5 and the jaw holder 6 with the lever 10 in this embodiment of biocompatible, sterilizable material such. B. medical grade stainless steel.

The expanding jaws 2, 3 are here flat and curved in itself. Each expanding jaw carries at its end facing away from the mounting rail 12 a light emitter 13. The light emitter 13 are connected via a conductor element 14 with a connecting element 15 z. B. a plug, a socket or the like. The connecting element 15 is in this embodiment on the mounting rail

5 and consists of a sterilizable plastic such. B. PEEK. It is flush and largely free of gaps with the material of the support rail 5 from. Alternatively, however, it could be provided at any other location of the spreading device. In other embodiments of the invention, the connection element 15 z. B. on the second mounting rail

6 be provided. Furthermore, depending on the application, a plurality of connection elements may be provided, for. B. on each support rail 4, 5 for supplying the corresponding Lichtemitters 13. Also, the connection element 15 is not necessarily, as here, be arranged in the lower region of the support rail. Depending on the application, it may be located at any point of the conductor element 14. The connection element can be designed, for example, as a sterilizable, integrated socket into which jack plugs or screw plugs are inserted.

The conductor element 14 consists in this embodiment of two internal 16 and an external conductor 17. The internal conductors 16 extend inside the expanding jaws 2, 3 and the support rails 4, 5 and are indicated here by dashed lines. The external conductor 17 connects the two internal conductors 16 with each other. Provides an insulating layer of plastic and is sterilizable. At the same time it allows by its mechanical properties and / or by its shape an elongation of the conductor. In this embodiment, the external conductor 17 has a spiral-wound shape. This allows an elongation of the conductor when the spreader jaws are moved away from each other. At the same time, it allows the conductor to return to its original shape when the spreading jaws are moved towards each other again.

The conductors 16, 17 are designed with a sterilizable cable insulation, which is impregnated for example with polyurethane PUR or acrylic paint.

The external conductor 17 is held in this embodiment by a guide 18 which extends approximately parallel to the rack 7. It is firmly connected to the mounting rail 4 of the first expanding jaw 2 and extends, as the rack 7, also through an opening in the foot 8 of the support rail 5 of the second expanding jaw third The number of internal and external conductors 16, 17 and the course of the conductor element 14 may vary depending on the embodiment of the invention. If only one light emitter 13 is provided on one of the expanding jaws 2 or 3, z. B. an internal conductor which runs within the corresponding support rail 4 or 5, be sufficient. If both expanding jaws 2, 3 are equipped with light emitters 13, as here, the conductor element 14 can alternatively also run only externally. It can, for. B. be moved along the individual components 2 to 5 of the spreading along. For this purpose, the spreader jaws and / or the mounting rails z. B. no holder may be provided which has a partial attachment of the conductor z. B. allow by gluing. Alternatively, grooves may be provided on the surface of the corresponding components, in which the conductor element 14 can be laid. In principle, depending on the application, any combination of the above possibilities are conceivable.

The conductor element 14 in this embodiment is an electrical conductor and allows connection to a 12 volt power supply. In this case, the light emitter has one or more light sources such. As an incandescent lamp, a diode, an LED or the like. The light emitters shown here are with a cold light source such. As a Flureszen- tube or a gas discharge lamp provided. The power supply can vary depending on the application. That is, in other embodiments of the invention, the conductor and, in particular, the connection element can also be used for another power supply, for. B. with 24 volts, 220 volts, etc. be designed.

Alternatively, the conductor element and an optical conductor, so z. Example, a fiber optic cable or the like, and the connection element may be an optical connection element. In this case, the actual light source can also be outside the light emitter and / or outside the spreader. So z. B. a present in the OP cold light connection, a laser light or the like can be used.

FIG. 2 shows the spreading device 1 according to the invention in a state inserted into an artificial body opening 24. The reference symbols used in FIG. 3 designate the same parts as in FIG. 1, so that reference is made to the description of FIG. 1 in this regard. The spreading jaws 2, 3 extend into the body opening 24 and surround the opening edge 26. The spread-open opening edge 26 provides a view of the underlying body cavity 25 free. The region of the spreading jaws 2, 3 facing away from the carrier rail, which accommodates the light emitter 13, is located almost entirely in the body cavity 25 in this exemplary embodiment.

3 shows a section through the spreader jaws 2, 3 of the spreading device 1 according to the invention from FIG. 2. The reference symbols used in FIG. 3 designate the same parts as in FIGS. 1 and 2, so that reference is made in this regard to the description of FIGS. 1 and 2.

The spreading jaws 2, 3 have in cross section an arcuate, curved shape. Alternatively, however, other cross-sectional shapes z. B. L- or U-like angled cross-sectional shapes conceivable.

In this exemplary embodiment, the light emitter 13 extends approximately along the respective spreading jaws 2, 3 (cf., FIG. 1) and makes up approximately half of the total height H of the spreading jaws 2, 3. Alternatively, however, the light emitter 13 could also extend over a lower level. He could z. B. only linearly in the region facing away from the support rail area 12 of the expanding jaw 2, 3 extend or be introduced only selectively in this area.

The light emitter 13 consists of a sterilizable, translucent, unbreakable, scratch-resistant material and is approximately flush and largely free of gaps in the material of the respective expanding jaw 2, 3 at. This can be z. B. by gluing, direct casting of the light emitter 13 or by other common manufacturing methods can be achieved. As materials come z. As special glasses, ceramics or plastics such. B. PEEK in question. High sodium glasses may be used which have been solidified by ion exchange.

The light emission takes place in each of the light emitter 13 shown here over the entire outer radius. The mantle rays of a resulting light cone are provided with the reference numerals 19 and 20. The sheath rays 19, 20 run approximately in or under half a defined by the opening edge 26 level. Preferably, as shown here, they are inclined downwards, that is to say in the direction of the body cavity 25. The exact position of the jacket jets 19, 20 may vary in further embodiments of the invention depending on the application. The maximum angle of deflection α of the jacket jet 19 is limited by the outer contour or the outermost edge 27 of the opposing expansion jaw. This limiting jacket jet 28 is shown in FIG. 2 by a dashed line. In further embodiments of the invention, in addition z. B. also the inner radius of the light emitter be used as a radiating surface. The emitted light cone would then expand accordingly.

The light emitted by the light emitter 13 is diffuse, that is, scattered, and has a color temperature in the range of about 1,000 to 10,000 K, and preferably in the range of about 3,000 to 8,000 K. In particular, a color temperature in the range of about 4,000 to 7,000 K is preferred most likely corresponds to the daylight. In addition, the emitted light is colorfast. This achieves a realistic color effect and good contrasts.

The brightness and the color temperature are variable in this embodiment by two separate controller 21, 22 (Figure 1). However, in other embodiments of the invention, these regulators may also be omitted altogether, depending on the application. The color temperature can then be set to a fixed value such as. B. 5,500 K or 6,000 K. Alternatively, the two controls shown here can also be replaced by a combined controller that allows varying of both variables.

The mode of operation of the exemplary embodiment illustrated in FIGS. 1 to 3 will be explained below.

To keep the body opening 24 open, the spreading jaws 2, 3 of the spreading device 1 are introduced into a natural or artificially created body opening 24. Due to the curved shape of the spreading jaws 2, 3, they engage in the body opening 24. In this embodiment, the expanding jaws 2, 3 surround the opening edge 26, as shown in Figure 3. By turning the lever 9 in the direction of arrow 23 about the axis 11, the spreading jaws 2, 3 are moved away from each other via the jaw holder 6 until the body is moved away. opening 24 is completely spread and thus allows the attending physician good access to the body.

During the spacing of the spreading jaws 2, 3, the shape of the external conductor 17 changes. The spirally wound shape of the conductor 17 continues to expand, thus allowing the total length of the external conductor 17 to be adapted to the distance of the spreading jaws 2, 3 external conductor 17 is guided by the guide 18.

Now, the spreading device 1 is connected via the connecting element 15 with a power source. Alternatively, this can be done even before the introduction of the spreading jaws 2, 3 in the body opening 24. About the conductor element 14, the energy z. B. in the form of electrical current or light to the light emitters 13 in the expanding jaws 2, 3 passed. In the embodiment considered here, the current causes the light sources in the interior of the light emitter 13 to light up and the light emitters 13 emit light into the body opening

24 or in the resulting body cavity 25 from.

As a result of the special shape or arrangement of the light emitter 13 in the area 12 of the spreading jaws 2, 3 which is remote from the mounting rail and thus protruding into the body opening 24, the light mainly becomes vertical or obliquely downward into the body cavity

25 given in, as shown in Figure 2. The sheath rays 19, 20 of a light cone emitted by the light emitter 13 are thus below or in a plane defined by the opening edge 26. The area above this level and thus outside of the body opening 24 remains largely lichtstrahlen- and thus glare-free. Thus, a good and large-scale illumination of the treatment area is achieved in the body cavity. Since the light emitted by the light emitter in this embodiment is diffuse, the treatment area is illuminated as uniformly as possible. In addition, the shadowing and light reflections are reduced.

The color temperature and the brightness of the light emitted by the light emitters 13 light can be varied in this embodiment, depending on the application via two separate controller 21, 22. The attending physician varies the brightness via the controller 21 and the color temperature via the controller 22 until the light emitted by the light emitter 13 satisfies its requirements. Thus, the light can be the respective application z. For example according to the treatment area and lighting situation of the environment and the respective doctor.

In this exemplary embodiment, the light emitted by the light emitters 13 is cold light with the lowest possible infrared component. This reduces the heating and dehydration of the irradiated tissue. The right color temperature, in this case a color temperature in the range of approximately 4,000 to 7,000 K, and the color fastness of the radiated light ensure good contrasts and that the attending physician perceives the colors as realistically as possible. All these factors contribute to a successful treatment and thus to a good treatment outcome.

After treatment, the spreading jaws 2, 3 are released. That is, they are with the aid of the jaw holder 6 with the rack mechanism by turning the lever 10 against the direction of arrow 23 toward each other. The spiral-like winding of the external conductor 17 thereby changes its shape and thus shortens the total length of the external conductor 17. Subsequently, the expansion jaws are removed from the body opening 24. The conductor element 14 and the connection element 15 are disconnected from the energy source.

Subsequently, the spreader is sterilized in preparation for its next use. Thanks to the materials used, such. As stainless steel, high quality plastics, etc., and the connection method, the spreading device 1 according to the invention is completely autoclavable. In principle, however, other sterilization methods such. As Gastro- sterilization, gamma rays or other common methods conceivable. The largely gap-free transition from the light emitter 13 to the jaw material of the respective spreading jaws 2, 3 allows a good sterilization result and a good sterility in the transition region.

Claims

claims

1. spreading device (1) for keeping open body openings (24), in particular of the thorax, with at least two approximately oppositely arranged spreading jaws (2, 3), with which ever an opening edge (26) of the body opening (24) is urged to the side, and a jaw holder (6), with which the expanding jaws (2, 3) at a distance from each other are durable, characterized in that at least one of the spreading jaws (2, 3) has a light emitter (13).

2. Spreading device (1) according to claim 1, characterized in that the light emitter (13) radiates light into a through the body opening (24) accessible to the body cavity (25).

3. spreading device (1) according to claim 2, characterized in that mantle jets (19, 20) of one of the light emitter (13) radiated light cone below or maximally in a through the opening edge (26) of the body opening (24) defined plane.

4. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitted by the light emitter (13) light a color temperature in the range of about 1,000-10,000 K, preferably in the range of about 3,000-8,000 K and in particular in the range of about 4,000-7,000K.

5. spreading device (1) according to claim 4, characterized in that the color temperature of the light emitter (13) radiated light is variable.

6. spreading device (1) according to at least one of the preceding claims, characterized in that the brightness of the light emitted by the light emitter (13) light is controllable.

7. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) has a diffuse light emission.

8. spreading device (1) according to at least one of the preceding claims, characterized in that the of the light emitter (13) radiated light is colorfast.

9. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) consists of biocompatible material.

10. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) is sterilizable.

11. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) is approximately flush with the material of the expanding jaw (2, 3).

12. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) via at least one conductor element (14) is connected to a power source.

13. spreading device (1) according to claim 12, characterized in that the energy source is a light source, which is connected via an optical conductor (14) with the light emitter (13).

14. spreading device (1) according to claim 13, characterized in that the light source is a cold light source.

15. spreading device (1) according to at least one of claims 13 and 14, characterized in that the light source is a laser light source.

16. spreading device (1) according to claim 12, characterized in that the energy source via an electrical conductor (14) to the light emitter (13) is connected.

17. spreading device (1) according to at least one of claims 12 to 16, characterized in that the conductor element (14) in and / or on the spreading device (1) is provided extending.

18. spreading device (1) according to at least one of claims 12 to 17, characterized in that the spreading device (1) has a guide for the conductor element (14).

19. spreading device (1) according to at least one of the preceding claims, characterized in that the cross section of the expanding jaws (2, 3) have a curved shape.

20. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) extends approximately along the spreader jaw (2, 3).

21. Spreading device (1) according to at least one of the preceding claims, characterized in that in that the light emitter (13) is provided on the side (12) of the spreading jaw (2, 3) projecting into the body opening (24).

22. spreading device (1) according to at least one of the preceding claims, characterized in that the light emitter (13) extends approximately to half the height of the expanding jaw (2, 3).