WO2010125598A1

WO2010125598A1 - An autostatic retractor with screw closure mechanism for neck surgery

Info

Publication number: WO2010125598A1
Application number: PCT/IT2010/000176
Authority: WO
Inventors: Lrnerio Angelo Muttillo
Original assignee: Lrnerio Angelo Muttillo
Priority date: 2009-04-29
Filing date: 2010-04-23
Publication date: 2010-11-04
Also published as: EP2432398A1; IT1393859B1; ITRM20090205A1

Abstract

An autostatic retractor with screw closure mechanism for neck surgery comprising a base plate (100) constituted by two symmetrical arms (110), capable of opening wide and coplanar with respect to each other and interconnected by means of a central pin (150), whose constituent profile presents a semicircular conformation terminating with a proximal rectilinear segment, constituting a jaw of closure pliers of "Bernard" type (140) made in such position, comprising a screw mechanism (180) capable of achieving the aforesaid opening movement, comprising a central retractor (200) in medial position, connectable to the base plate (100), equipped with the valve (210), comprising two further lateral retractors (300) in lateral position, connectable to the base plate (100), each equipped with a rotatable valve (310) and finally comprising, on at least one symmetrical arm (110) of the base plate (100), a connection device (410) capable of engaging a vertical rod (400) for supporting mini- telecameras.

Description

An autostatic retractor with screw closure mechanism for neck surgery

Field of the art

The present invention generally refers to the field of devices used in surgery. The invention is applicable to any field where one such device can be advantageously used, but preferably this regards the field of front neck surgery and specifically thyroid and parathyroid surgery.

State of the art

The diffusion of ecotomography studies and doctors' increased attention towards endocrine pathology has led today to the confirmation of a high number of thyroid and parathyroid diseases. Currently, surgery of the front portion of the neck, specifically regarding the thyroid gland, essentially comprises two types of operations: total thyroidectomy, in which the entire gland is removed, and hemithyroidectomy or thyroid lobectomy or thyroid isthmus-lobectomy in which only one lobe is removed. Classic operation is carried out in general anesthesia and consists of reaching the thyroid through a transverse incision on the neck, about 3 cm above the jugular notch, comprising the skin, the subcutaneous tissue and the underlying platysma muscle. Then, there is the separation of the two flaps at their upper part, up to the thyroid cartilage and below to the jugular, the longitudinal opening of the median line according to the size of the member to be removed, the separation of the ribbon-shaped muscles from the front face of the thyroid, the preparation of the operating field until the common carotid artery is found and finally the exposure of the poles and sectioning of the vascular stalks. Nevertheless, it must be considered that at the rear of the lower half of the two thyroid lobes, on the side of the trachea, there are the lower laryngeal nerves, which after having crossed the lower thyroid artery enter into the larynx and innervate the vocal cords. It also must not be ignored that at least four parathyroid glands are situated at the rear of the thyroid.

Various techniques and advanced technologies are already known which allow reducing the incision to the minimum where possible, i.e. reducing to a minimum the scar on the neck and limiting the risks connected with the operation itself. This is the case of the min- invasive technique called MIVAT (Minimally-Invasive Video-Assisted Thyroidectomy) which initially provides for a transverse skin incision of only 1.5-2 cm, the separation of the aforesaid muscles and the subsequent introduction in the formed cavity of a 5 mm optical system capable of assisting the operation itself. Notwithstanding such embodiments, up to now the operations regarding the thyroid and parathyroid are still characterized among those considered "delicate", i.e. among those operations which during the separation maneuvers of the thyroid from the tracheal plane must respect both the aforesaid lower (or recurrent) laryngeal nerve and the parathyroid glands. The damage of the recurrent nerve, in fact, can cause a temporary or permanent paresis of the homolateral vocal cord. The other possible complication consists of postoperative hypocalcaemia due to the suffering and hence to the lack of functioning of the parathyroid, which in its most serious form can be responsible for involuntary contractions, in particular of the fingers (tetanic crisis). In specialized centers, the effect of these complications is not at all negligible: this turns out on the order of 1-2% for the recurrent lesion and 4-6% for the parathyroid lesion.

Further complications of thyroidectomy operations regard the treatment of those thyroid pathologies with an abnormal development of the upper pole and/or the presence of plurinodular goiters, which render modern surgical technologies characterized by minimal incisions unusable. In these cases, with the currently available instrumentation, the operation can only be carried out by means of wide skin incisions and wide muscle sections with relative functional, symptomatic and esthetic consequences.

Currently, surgical operations, with the instrumentation available in the state of the art, must be carried out by least three operators at the operating table and in the case of the aforesaid mini-invasive or video-assisted surgery by as many as four surgeons. As is known to those skilled in the art, an essential condition to be respected during a surgical operation is the good exposure of the operating site, resulting from several factors including a suitable incision, good lighting, a careful and effective hemostasis, but mainly from a suitable use of the retractors. The current techniques for exposing the operating site, during the thyroidectomy operations of the prior art, consist of the use of ribbon-shaped, rigid, non-adjustable manual retractors (Farabeux or Mathy) or those which are not very adjustable, i.e. retractors which during the operation are held in situ on the operating site exclusively by the hands of the operators and thus necessarily require personnel assigned for the use thereof. Such situation, entrusted to the strength and use of the personnel set to ensure a correct orientation and enduring seal of the retractors themselves, is inevitably accompanied by a frequent worsening of the operating site exposure, which becomes increasingly evident the longer the surgical operation. Thus, the object of the present invention is to solve or at least minimize the abovementioned problems, at the same time respecting the improved use characteristics already present in the preceding techniques.

Description of the invention

The innovative concept underlying the present invention generally consists of making an autostatic retractor with screw closure mechanism that is capable of brilliantly solving the abovementioned problems.

Said inventive autostatic retractor is characterized in that it is constituted by anatomic- shaped valves, which are adjustable, slidable and capable of being ideally adapted to the anatomic spaces of the neck, allowing an excellent, atraumatic, stable and wide exposure simultaneously at several points of the operating site.

In particular, said surgical device, capable of optimizing the anatomic exposure and hence magnifying the exposure of the zone to be operated, on one hand facilitates the various above-listed operating steps, in particular the display and preparation of the recurrent nerves and the parathyroids, and on the other hand drastically reduces surgery times and consequent tissue traumatism. Also, said characteristic is advantageously implemented in that said inventive retractor allows supporting at least one mini-telecamera capable of advantageously assisting the various operation steps. A further object is to provide said inventive surgical device, capable of autonomously and constantly maintaining its own function and position in complete safety, so as to solve the abovementioned problems by means of the management of the same directly by the operator, thus requiring a lower number of health personal at the operating table. A further characteristic of the inventive autostatic retractor is that, due to the numerous intrinsic adjustments, this allows an extreme anatomic adaptability and hence a smaller skin incision. But it also above all allows a reduced traumatism of the tissues affected by the surgical operation, i.e. of the muscular and nervous bundles which must be moved in order to allow a correct surgical exposure and hence a much faster post-operative recovery phase and a considerable reduction of the post-operative pain with respect to that encountered with current instruments.

Another important characteristic of the inventive autostatic retractor is that, due to the magnification of the zone to be operated, one can operate with greater ease in all those thyroid pathology cases with an abnormal development of the upper pole and/or presence of plurinodular goiters. Another, not less important characteristic of the inventive autostatic retractor is that which consists of the reduction of the instrumentation necessary for carrying out the surgical operation, and hence in the drastic reduction of the complications associated with the use, the wear and the sterilization of the same. It must also be noted that even if the main testing of said autostatic retractor predominantly regarded front neck surgery, such characteristic must be considered as non-limiting of the invention, since by virtue of the simplicity of application and possible multi-adjustments of the inventive retractor, the latter can be effectively employed in multiple surgery applications. With regard to the materials composing the aforesaid inventive autostatic retractor, these can be selected by the man skilled in the art so as to meet the technical characteristics in this particular field and mainly deriving from the multiuse, including solidity, strength, anti- corrosiveness, lightness and easy sterilizability - nevertheless, said materials can comprise polymers of plastic type and those of metal type. A preferred embodiment of the present invention provides that said autostatic retractor is made of stainless steel. Other advantages of the invention will be clearer from the detailed description of an exemplifying and non-limiting embodiment thereof, illustrated below.

Brief description of the drawings

The preceding advantages, as well as other advantages and characteristics of the present invention, will be illustrated by making reference to the attached Figures, which are to be considered merely illustrative and non-limiting or non-binding for the purposes of the present patent application, in which:

FIGURE 1 is a plan view of the autostatic retractor according to the present invention, completely assembled;

FIGURE 2 is a plan view of the autostatic retractor of Fig. 1 lacking relative retractors;

FIGURE 3 is a side view of the retractors, relative valves and vertical rod.

Description of some preferred embodiments of the invention

The present invention will now be described in detail with reference to the Figures and to a preferred embodiment thereof shown therein, where identical numeric references were used for the same components.

With reference to the different Figures, these show an innovative autostatic retractor with screw closure mechanism for the front surgery of the neck characterized by the presence of a base plate 100 constituted by two symmetric arms 110 capable of opening wide with respect to each other and wherein each of the distal portions thereof is connected to the contralateral portion by means of a central pin 150, received in suitable seats of the same symmetrical arms 110, capable of ensuring their turnability. The particular profile of said symmetric arms 110, shown in Figures 1 and 2, i.e. a semicircular conformation terminating with a proximal rectilinear segment, constituting a jaw of closure pliers of "Bernard" type 140 made in such position, allows such symmetric arms 110 a wide, coplanar opening. Specifically, said closure pliers of "Bernard" type 140, once the transverse skin incision has been executed, allow coupling the two skin flaps and then opening wide the incision itself by means of the divarication of the aforesaid symmetrical arms 110.

As shown in Figs. 1 and 2, the divarication movement is actuated by means of a screw mechanism 180, i.e. by means of two opposite screws 181 screwable in an internally- threaded cylindrical hollow element 185, respectively connected to the base plate 100 by means of the lateral pins 160, received in suitable seats placed on opposite positions of the two symmetric arms 110. Said screw mechanism 180 is capable of finely adjusting the divarication or approaching movements of the two symmetric arms 110 of the inventive autostatic retractor, by simply rotating (with the fingers) a knurled element 186 made on the aforesaid internally-threaded cylindrical hollow element 185. The structure described up to now, nevertheless, only represents a small part of the inventive retractor, since said base plate 100 constitutes the anchorage point of further retractors capable of implementing and at the same time improving the achievement of the invention. In particular, as can be observed in Figs. 1-3, the present invention comprises a central retractor 200, whose valve 210 is right-angle shaped with rounded edges and whose stem 211 is characterized by the longitudinal groove 213 made along nearly the entire height of the same. Such central retractor 200 is connected to the base plate 100 by means of the interaction of said longitudinal groove 213 with the aforesaid central pin 150, which respectively allows, by means of a screw/nut system, the sliding or the in situ locking as needed. Specifically, the possible movements of said central retractor 200 are coplanar to those of the aforesaid symmetric arms 110, and consist of sliding and/or rotation movements with respect to the aforesaid central pin 150. The task reserved to said central retractor 200 is that of allowing, by means of the valve 210, a wide initial exposure of the carotid jugular region, on the side of the thyroid lobes. As can be observed in Figs. 1-3, the present invention further comprises two lateral retractors 300 constituted by two separate portions, i.e. the stem 311 characterized by the longitudinal groove 313 made along nearly the entire height of the same and the rotatable valve 310 connected to the aforesaid stem 311 by means of the apical pin 350 engageable in the aforesaid longitudinal groove 313. Each lateral retractor 300 is connected to the base plate 100 by means of the interaction of said longitudinal groove 313 with the respective lateral pin 160, which respectively allows, by means of a screw/nut system, the sliding or in situ locking as needed. Specifically, also the movements of said lateral retractors 300 are coplanar with those of the aforesaid symmetric arms 110, and exclusively consist of sliding and/or rotation movements with respect to the aforesaid lateral pins 160. Nevertheless, the versatility of the invention is particularly implemented by the aforesaid apical pins 350 (Fig. 3) engaged in the longitudinal groove 313, which allow a wide adjustment possibility of the aforesaid rotatable valves 310, i.e. respectively allowing their sliding and/or in situ locking, by means of a nut/screw system, as needed. In particular, said apical pins 350 allow a rotation coplanar to that of the aforesaid symmetrical arms 110, equal to a round angle and hence a high adaptability to the tissues on which the traction is made. In particular, the above is also achieved by the particular oblique anatomic shape of the rotatable valves 310, which allows the latter to be ideally inserted in the corner behind the trachea, the upper lobe of the thyroid and the ribbon-like muscles and thus obtain optimal exposure of the upper pole of the thyroid, avoiding traumatisms, above all at the outer branch of the upper laryngeal nerve and the cricothyroid muscle.

The autostatic retractor, complete with the central retractor 200 and lateral retractors 300 and the closure pliers of "Bernard" type 140, allows obtaining an optimal exposure of the entire thyroid area, facilitating all of the aforesaid surgical operation steps. A further aspect, in addition to all of the technical solutions described up to now but of particular importance in the achievement of the invention, is that which can also be applied to the execution of the aforesaid mini-invasive/video-assisted surgery called MIVAT. The inventor of the present patent has in fact provided for a connection device 410 placed on at least one symmetric arm 110 of the base plate 100, capable of engaging a vertical rod 400, preferably with biconcave cross section, equipped with a rotating support head 440 for small-size optical systems or mini-telecameras.

With regard to the sizes of said inventive autostatic retractor, it should be noted that the following are merely indicative and not limiting of the invention: nevertheless they may be expressed and on the whole summarized regarding the height of the stems of the retractors, comprised between 240 mm and 120 mm and more preferably 180 mm and with regard to the dimensions of the valves comprised between 20 mm x 20 mm and 60 mm x 60 mm and more preferably 40 mm x 40 mm. In conclusion, returning the surgical device complete with all of its constituent pieces, it must be emphasized for the purposes of the accomplished inventive function that this has undeniable and revolutionary advantages. This is especially true due to the fact that the valves possess an anatomic, oblique shape and are adjustable over three anatomical planes, thus allowing an excellent exposure of the operating site, specifically of the thyroid area and still more specifically of the upper pole of the thyroid with its vascular-nervous connections. Even if such invention was described with reference to the specific and concrete embodiment shown in the present document, it must not be considered as limited to the indicated details; moreover, the patent must be considered comprehensive of the modifications and changes that can be derived from the following claims.

Claims

1. An autostatic retractor with screw closure mechanism for neck surgery characterized in that it comprises a base plate (100) constituted by two symmetrical arms (110) capable of opening wide and coplanar with respect to each other, and wherein each of the distal portions thereof are connected to the contralateral portion by means of a central pin (150) received in suitable seats of the same symmetrical arms (110) and capable of ensuring their turnability, in that the profile of said symmetrical arms (110) has a semicircular conformation terminating with a proximal rectilinear segment, constituting a jaw of closure pliers of "Bernard" type (140) made in such position, in that the aforesaid opening movement is carried out by means of a screw mechanism (180), in that in medial position a central retractor (200) is present that is connectable to the base plate (100), whose valve (210) is right-angle shaped with rounded edges and whose stem (211), which has a longitudinal groove (213) made along nearly the entire height of the same, is capable of interacting with the aforesaid central pin (150) and finally in that, in the lateral position, two further lateral retractors are present (300) connectable to the base plate (100) and constituted by two separate portions, i.e. the stem (311) characterized by the longitudinal groove (313) made along nearly the entire height of the same and capable interacting with the aforesaid lateral pins (160), and the rotatable valve (310) connected to the aforesaid stem (311) by means of the apical pin (350) engageable in the aforesaid longitudinal groove (313).

2. An autostatic retractor according to claim 1, characterized in that the longitudinal groove (213) of the central retractor (200) is engageable with the central pin (150) and allows, by means of a screw/nut system, sliding and/or rotation movements with respect to the aforesaid central pin (150), such movements coplanar with the aforesaid symmetrical arms (110), or in situ locking.

3. An autostatic retractor according to claim 1 or 2, characterized in that the longitudinal groove (313) of each lateral retractor (300) is engageable with each lateral pin (160) and allows, by means of a screw/nut system, sliding and/or rotation movements with respect to the aforesaid lateral pin (160), such movements coplanar with the aforesaid symmetrical arms (110), or in situ locking.

4. An autostatic retractor according to any one of the preceding claims, characterized in that each rotatable valve (310) is engageable by means of each apical pin (350) to the longitudinal groove (313) of each lateral retractor (300) and in that each apical pin (350) allows, by means of a screw/nut system, sliding and/or rotation movements with respect to the aforesaid apical pin (350), equal to a round angle and coplanar with the movements of the aforesaid symmetric arms (110), or in situ locking.

5. Au autostatic retractor according to any one of the preceding claims, characterized in that the screw mechanism (180) comprises two opposite screws (181), screwable in the internally-threaded cylindrical hollow element (185) and respectively connected to the base plate (100) by means of the lateral pins (160), received in suitable seats placed on opposite positions of the two symmetric arms (110) and in that at least one knurled element (186) is made on the internally-threaded cylindrical hollow element (185).

6. An autostatic retractor according to any one of the preceding claims, characterized in that at least on one symmetrical arm (110) of the base plate (100), a connection device (410) is made, capable of engaging a vertical rod (400), preferably with biconcave cross section, equipped with a rotating support head (440) for small-size optical systems or mini- telecameras.

7. An autostatic retractor according to any one of the preceding claims, characterized in that the constituent materials can comprise polymers of plastic type and polymers of metal type.

8. An autostatic retractor according to any one of the preceding claims, characterized in that the constituent material is stainless steel.

9. An autostatic retractor according to any one of the preceding claims, characterized in that the height of the retractor stems is comprised between 240 mm and 120 mm and more preferably is 180 mm and that the dimensions of the valves are comprised between 20 mm x 20 mm and 60 mm x 60 mm and more preferably are 40 mm x 40 mm.

10. An autostatic retractor according to any one of the preceding claims, characterized in that the valve (210) and the rotatable valves (310) have an anatomic, oblique shape and are adjustable over three anatomical planes.