DE102010049759B4 - Device for manual muscle retraction - Google Patents

Abstract

Device (10) for manual retraction of a muscle or for lifting another organ, comprising:
a spatula device (20) for passing behind the muscle or organ;
one hand movement (60);
a joint (80) between the proximal end (21) of the spatula device (20) and the handle (60);
a light guiding device (30) which couples a coupling (31) for a light guiding cable (70) with a light emission surface (32) at the distal end (22) of the spatula device (20), wherein the coupling (31) is rigidly connected to the spatula device (20);
characterized by
a working channel device (90) with a working channel (92) at least either for guiding or holding an endoscope or other instrument, wherein the working channel device (90) is detachably connected to the spatula device (20).

Description

The present invention relates to a device for the manual retraction of a muscle, in particular the large back muscle, or for lifting another organ.

One approach to breast reconstruction after mastectomy involves using a flap of the latissimus dorsi muscle as an autologous implant. This procedure requires elevating the latissimus dorsi muscle. To do this, the muscle is retracted using a spatula device. A handle is provided at the proximal end of the spatula device for its operation. During the surgery, the surgeon may need to transfer the retractor in situ to medical personnel standing on the opposite side of the operating table. In many cases, it turns out that the receiving medical personnel cannot easily hold the retractor in a relaxed posture.

The US patent US 6 817 978 B2 This text describes a retractor designed for harvesting blood vessels for transplantation. It comprises a handle and an elongated (working) section connected to it by a joint. A light guide is provided to illuminate the working area, including a fiber optic connector attached to the handle. A flexible fiber optic cable extends from this connector through the handle, the joint, and to the end of the working section.

The US patent US 5 891 018 B2 It also reveals a retractor with a joint between the handle and the working section. For observing the working area, the working section has a working channel for inserting an endoscope.

One object of the present invention is to provide an improved device for the manual retraction of a muscle or for lifting another organ.

This problem is solved by the subject matter of the independent claim.

Further training opportunities are listed in the dependent requirements.

A device for manually retracting a muscle or lifting another organ comprises a spatula device for passing behind the muscle or organ, a handle, and a joint between the proximal end of the spatula device and the handle.

The handle is a key component of a handling device, with the handling device and the spatula device being articulated together by a joint. This joint allows for adjustment of the handle's orientation relative to the spatula device, enabling medical personnel to hold the device comfortably and with minimal fatigue. Specifically, medical personnel on either side of an operating table can individually adjust the handle relative to the spatula device for optimal comfort, or a setting can be found that is convenient for both sides. Thus, the device with the joint between the handle and the spatula device facilitates fatigue-free and, consequently, precise and error-free work.

A device such as described herein further comprises a light guiding device which couples a coupling for a light guide cable to a light emission surface at the distal end of the spatula device.

The light guide device enables illumination of the space at the distal end, in particular the space distal to the distal end of the spatula device. For this purpose, illumination light generated by a light source can be coupled into the light guide device via a fiber optic cable and the coupling.

Illuminating the area distal to the distal end of the spatula makes it easier for medical personnel, especially the surgeon, to visually guide the spatula behind the muscle or organ. One or more light outlets at the distal end of the spatula allow illumination to be directed precisely where it is needed. This distribution of light is therefore significantly more favorable than, for example, illumination from an external operating lamp.

The coupling is rigidly connected to the spatula device.

A rigid coupling arrangement on the spatula assembly allows for a design of the light guide in which the light guide remains unchanged even when the orientation of the handle relative to the spatula assembly is altered. This significantly reduces the likelihood of a defect in the light guide, such as a fiber breakage.

Furthermore, the hermetic sealing of the light guide against gases or liquids is significantly easier to achieve if the coupling is rigidly connected to the spatula assembly without a flexible section or joint. In this case, the light guide can be arranged in a closed, preferably metallic, casing that completely encloses the light guide from the coupling to the light output and shields it from environmental influences. This casing is particularly spatula-shaped and forms an integral part of the spatula assembly.

In a device with a light guide, as described here, the handle may include a channel for receiving a light guide cable.

The fiber optic cable connects the aforementioned external light source to the device's light guide via a coupling. Positioning the fiber optic cable within a channel in the handle simultaneously guides the cable and directs it away from the surgical field. The fiber optic cable, located within the handle channel, automatically follows every movement of the device. In this case, its path within or near the surgical field generally does not require further attention. This simplifies handling the device, reduces strain on medical personnel, and promotes fatigue-free, precise, and error-free work.

The device is specifically designed so that when the handle is pivoted around the joint, a light guide cable connected to the coupling and guided through the channel remains in the channel and is elastically deformed distal to the coupling.

Elastic deformation of the optical fiber can lead to a defect, particularly a fiber breakage, just as elastic deformation of the optical fiber assembly of the device can also lead to a defect. However, if the device is designed to elastically deform the optical fiber connected to the coupling when the handle is pivoted, while the optical fiber assembly and the coupling are rigidly arranged, the risk of a defect is largely concentrated in the optical fiber. The optical fiber can then be easily and relatively inexpensively replaced. In contrast, a defect in the optical fiber assembly of the device requires a complete replacement or repair of the device, which is significantly more costly.

A device such as described here may further include a screw connection between the handle and the joint.

A screw connection between the handle and the joint allows for easy replacement of the handle, for example, to adapt the device to the hand or gripping habits of medical personnel. Furthermore, the ability to detach the handle from the joint can simplify sterilization of the device. In particular, if the handle, as described above, includes a channel for a fiber optic cable, the easily detachable screw connection between the handle and the joint can simplify the assembly and disassembly of a fiber optic cable at the coupling.

The screw connection can include a thread on a threaded sleeve, wherein the threaded sleeve is permanently connected to the joint, and wherein the threaded sleeve has a slot through which an optical fiber can be inserted into the lumen of the threaded sleeve in a radial movement with respect to the axis of the screw connection.

The aforementioned advantage of the screw connection, namely simplifying the assembly and disassembly of a fiber optic cable, is particularly relevant to the described design of the threaded sleeve with a slot. The fiber optic cable can be inserted into the threaded sleeve in any order and connected to the device's coupling, provided the handle is only subsequently screwed onto the threaded sleeve. For this purpose, the threaded sleeve has an external thread and the handle an internal thread.

In a device such as the one described here, the handle can be part of a handling device that is tapered between the handle and the joint.

In particular, the handling device has a tapered bar or several bars between the handle and the joint, the common outer contour of which is tapered. The tapering is provided, in particular, near the point where a fiber optic cable coupling is to be gripped for mounting to or dismounting from the device's coupling. The tapering can thus simplify the mounting or dismounting of a fiber optic cable from the device's coupling by facilitating manual access to the fiber optic cable coupling and/or the coupling on the device.

A device such as the one described here may include a locking mechanism for securing the joint.

The locking mechanism is specifically designed to lock the handling device and the spatula device in one or more predetermined relative orientations. For example, the locking mechanism is designed to lock the joint in several angular positions with equal or different angular intervals. Alternatively, the locking mechanism can be designed to fix the handling device and the spatula device in any desired relative orientation. The locking mechanism can be released by pressing one or multiple release buttons simultaneously.

In particular, an alternative setting of the joint in several predetermined relative orientations of the handling device and spatula device can significantly simplify the handling of the device and the switching between the predetermined relative orientations.

A device such as described herein comprises a working channel device with a working channel at least either for guiding or holding an endoscope or other instrument.

Such a working channel device can, for example, allow observation of the approach to a muscle or organ using an endoscope. The endoscope does not need to be guided separately but can be operated with a single hand simultaneously with the device. Furthermore, the working channel device allows for a one-time alignment of the endoscope, which can then be easily maintained throughout the entire use of the device. In this way, the working channel device can simplify relaxed, precise, and error-free work.

The working channel device is detachably connected to the spatula device.

The working channel assembly can be rigidly locked to the spatula assembly. The ability to remove the working channel assembly simplifies cleaning and sterilization of the device. Furthermore, the working channel assembly can be replaced if damaged or to adapt it to an endoscope or other instrument. It can also be advantageous to be able to remove the working channel assembly to reduce the risk of injury when not in use.

A device such as the one described here is specifically designed for retracting the large back muscle.

Retraction of the latissimus dorsi muscle can be necessary or advantageous, particularly during breast reconstruction following mastectomy. Due to its cross-section, mass, and robust structure, retracting and lifting the latissimus dorsi muscle with a spatula device requires a tool that can be operated with ease and minimal fatigue by medical personnel, thus ensuring precise and error-free execution. The features of the device described here make this possible to a significant degree.

Brief description of the characters

• 1 eine schematische Darstellung einer Vorrichtung zur manuellen Retraktion eines Muskels;
• 2 eine weitere schematische Darstellung der Vorrichtung aus 1;
• 3 eine weitere, axonometrische Darstellung der Vorrichtung aus den 1 und 2;
• 4 eine schematische Darstellung eines Teils der Vorrichtung aus den 1, 2 bis 3;
• 5 eine weitere schematische Darstellung des in 4 dargestellten Teils;
• 6 eine schematische Darstellung eines weiteren Teils der Vorrichtung aus den 1, 2 bis 3;
• 7 eine schematische Darstellung eines weiteren Teils der Vorrichtung aus den 1, 2 bis 3;
• 8 eine weitere schematische Darstellung des in 7 dargestellten Teils.

The following descriptions of the embodiments are explained in more detail with reference to the accompanying figures. They show:

• 1 a schematic representation of a device for the manual retraction of a muscle;
• 2 a further schematic representation of the device 1 ;
• 3 another, axonometric representation of the device from the 1 and 2 ;
• 4 a schematic representation of part of the device from the 1 , 2 until 3 ;
• 5 another schematic representation of the in 4 depicted part;
• 6 a schematic representation of another part of the device from the 1 , 2 until 3 ;
• 7 a schematic representation of another part of the device from the 1 , 2 until 3 ;
• 8 another schematic representation of the in 7 depicted part.

Description of the embodiments

1 Figure 1 shows a schematic representation of a device 10 for the manual retraction of a muscle or the elevation of another organ. The device 10 comprises a spatula assembly 20 with a proximal end 21 and a distal end 22. The spatula assembly 20 is spatula-shaped with a flat cross-section, in which the width-to-height ratio is, in particular, 5:1 or more. The cross-section, length, and an optional longitudinal curvature, as described in Figure 10, are shown in Figure 10. 1 As shown, the intended application of the Device 10 adapted. If the device 10 is intended for retraction of the latissimus dorsi muscle, for example, the length of the spatula device is between 20 cm and 30 cm, its width between 3 cm and 6 cm, and its thickness is approximately 3 mm to 6 mm.

Within the cross-section of the spatula device 20, one or more flushing channels 24 are arranged. 1 A tubular section of the irrigation channel 24 is particularly noticeable, projecting beyond the proximal end 21 of the spatula assembly 20. A coupling device 26 for the direct or indirect connection of a hose to the irrigation channel 24 is provided at the proximal end of the tubular section of the irrigation channel 24. The irrigation channel(s) 24 extend to the distal end 22 of the spatula assembly 20 and terminate there, in particular, in one or more end-face openings, which are 1 are not recognizable due to the orientation of the device 10.

The irrigation channel(s) 24 are designed and configured to direct an irrigation fluid, for example, a saline solution, into the space adjacent to the distal end 22 of the spatula device 20. An irrigation fluid can be used to displace and/or remove, for example, blood or other fluids or solids. Alternatively or additionally, the irrigation channel(s) 24 can be configured to aspirate a fluid from a space adjacent to the distal end 22 of the spatula device 20. Both irrigation and aspiration can improve visibility in the space adjacent to the distal end 22 of the spatula device 20.

Furthermore, one or more light guide devices 30 are arranged within the cross-section of the spatula device 20, extending from a coupling 31 at the proximal end 21 of the spatula device 20 to one or more light emission surfaces 32 at the distal end 22 of the spatula device 20. Each light guide device 30 comprises one or more optical waveguides, for example, a bundle of glass fibers or plastic fibers.

Illumination light generated by an external light source can be guided by means of a fiber optic cable 70 to the device 10 and via the coupling 31 and the fiber optic assembly 30 to the light emission surface 32, where it is coupled out to illuminate a spatial area distal to the distal end 22 of the spatula assembly 20. The fiber optic cable 70 is in 1 It is shown only in broken lines because it is not part of the device 10.

The device 10 further comprises a working channel device 90, which, with reference to the 7 and 8 will be described in more detail.

At the proximal end 21 of the spatula device 20, a handling device 40 is arranged, having a proximal end 41 and a distal end 42. The handling device 40 comprises a handle 60 with a proximal end 61 and a distal end 62. The proximal end 61 of the handle 60 is simultaneously the proximal end 41 of the handling device 40. The handle 60 is approximately half the length of the entire handling device 40.

The handling device 40 further comprises one or more stiles 44 that rigidly connect the handle 60 to a joint 80. The handling device 40 is pivotally connected to the spatula device 20 via the joint 80. The joint 80 allows the handling device 40 to pivot relative to the spatula device 20 about an axis 81 within a predetermined angular range. In contrast to the example shown here, the joint 80 can be designed to allow pivoting about more than one axis.

2 shows a schematic representation of the device made of 1 , in which the handling device 40 assumes an alternative position relative to the spatula device 20. At 1 The handling device 40 is oriented essentially perpendicular to the spatula device 20. In the illustration in 2 The handling device 40 and the spatula device 20 enclose an angle of 40 degrees to 50 degrees. To transfer the handling device 40 from the in 1 the position shown in 2 The handling device 40 is positioned relative to the spatula device 20 or vice versa, as shown, around the drawing planes of the 1 and 2 The pivot axis 81 of the joint 80 is pivoted essentially vertically.

A locking device 82 is provided at joint 80 for securing the joint 80. The locking device 82 can be used for alternatively securing the joint 80 in the two positions shown in the 1 and 2 The relative positions of the handling device 40 and the spatula device 20 are as shown. The locking mechanism 82 can also be used to fix the joint 80 in further discrete positions, as shown in the illustration. 1 and 2 The relative positions of the handling device 40 and the spatula device 20, not shown, are configured. For example, the locking mechanism 82 for fixing the joint 80 is configured for a finite discrete set of predetermined relative orientations of the handling device 40 and the spatula device 20, wherein adjacent predetermined orientations The angles can differ by 10 degrees, 15 degrees, or another predetermined angle. Alternatively, the locking device 82 can be configured to fix the joint 80 in any relative orientation of the handling device 40 and the spatula device 20.

A release button 84 is provided for unlocking the locking device 82. In particular, a release button 84 is provided on each of two opposite sides of the joint 80, as shown in the illustrations in the 1 and 2 A release button is arranged facing the viewer and another release button is arranged on a side of the device 10 facing away from the viewer. The locking mechanism 82 and the release buttons 84 are designed such that only simultaneous actuation of both release buttons releases the locking mechanism of the joint 80.

The light guide cable 70 runs in a channel of the handle 60, which is described below based on the 4 , 5 until 6 is described. In comparison of the 1 and 2 It can be seen that the optical fiber 70 remains in the channel in the handle 60 in both of the illustrated relative positions of the handling device 40 and the spatula device 20. When the handling device 40 is pivoted relative to the spatula device 20, the optical fiber 70 is elastically deformed immediately distal to the coupling 72. The optical fiber 30 remains stationary even when the handling device 40 is pivoted relative to the spatula device 20 and can therefore be rigidly designed and/or completely rigidly encapsulated.

Repeated elastic deformation of the optical fiber 70 can result in a defect in the optical fiber 70, in particular possibly a break in the optical fibers. However, this defect can be easily remedied by replacing the optical fiber 70. The costs incurred in this case can be significantly lower than the costs for repairing or replacing the entire device 10.

3 shows a schematic axonometric representation of the above based on the 1 and 2 device shown. In 3 Several features are recognizable, which are also evident in the more schematic representations of the 1 and 2 not shown. For example, the cross-sections of the spatula device 20, the handle 60, and the coupling 31 are recognizable from the axonometric representation. The cross-section of the spatula device 20 is constant over a large part of its length from the distal end 22 to near the joint 80 and has an oval rim with two arcuate and two straight sections. The handle 60 and the coupling 31 each have a substantially rotationally symmetrical shape.

Furthermore, in 3 It can be seen that the handling device 40 has two slightly curved stiles 44. In a central area between the handle 60 and the joint 80, the two stiles 44 are at their smallest distance from each other. Due to the essentially constant cross-sections of the stiles 44, a waist 45 is formed in the central area.

Furthermore, in 3 Arrows 84 indicate the directions of forces with which the release buttons 84 can be actuated. The release buttons 84 are arranged, in particular, such that they can be pressed together, for example, with the thumb and index finger or thumb and middle finger of one hand in the directions 86 to release the locking mechanism 82 of the joint 80. When the release buttons 84 are pressed together with sufficient force, the orientation of the handling device 40 relative to the spatula device 20 can be changed, as described above.

The 4 and 5 schematic cross-sectional views of a part of the above are shown based on the 1 , 2 until 3 illustrated device 10. 4 shows a section along a plane AA parallel to the drawing planes of the 1 and 2 The position of the cutting plane AA is also in 5 hinted at. 5 shows a schematic representation of a section along a plane BB perpendicular to the plane AA and to the drawing planes of the 1 and 2 The location of plane BB is in 4 hinted at.

In the 4 and 5 It can be seen that a threaded sleeve 50 with an axis 52 is arranged at the proximal ends of the spars 44, which is inserted into the 1 , 2 until 3 The axis 52 of the threaded sleeve 50 is simultaneously the axis of an external thread 56 on the threaded sleeve 50. The axis 52 is essentially parallel to the stiles 44.

The threaded sleeve 50 has a lumen 57 and a slot 58 parallel to the axis 52 of the threaded sleeve 50. Due to the slot 58, a fiber optic cable 70 can be inserted not only by movement parallel to the axis 52 of the threaded sleeve 50, but alternatively by movement perpendicular to the axis 52 of the threaded sleeve 50 and parallel to the drawing planes or sectioning planes AA and BB of the 4 and 5 into the lumen 57 of the threaded sleeve 50. In particular in 5 It can be seen that the cross-sectional area of the threaded sleeve 50 is not annular due to the slot 58. or multiple interconnected, but U-shaped or simply interconnected.

6 shows a schematic representation of a section through the handle 60 along a plane that corresponds to the cutting plane AA or the drawing plane of the 4 corresponds and thus also parallels the drawing planes of the 1 and 2 The handle 60 has an essentially tubular or circular cylindrical shape with a lumen or channel 67. To improve ergonomics, the outer contour of the cross-section of the handle 60 deviates slightly from perfect circular cylindrical symmetry. In particular, slight tapering is provided near the proximal end 61 and near the distal end 62.

At its distal end 62, the handle 60 has an internal thread 65 which corresponds to the external thread 56 of the above based on the 4 and 5 The illustrated threaded sleeve 50 corresponds to, or can be screwed into, it with minimal friction and play. When the handle 60 is screwed into the threaded sleeve 50 in the intended manner, the [missing information] is created. 1 , 2 until 3 recognizable shape of the handling device 40.

To mount a fiber optic cable 70 to the coupling 31, the coupling 72 of the fiber optic cable 70 can first be connected to the coupling 31 of the device 10, and then the fiber optic cable 70 can be inserted through the slot 58 into the lumen 57 of the threaded sleeve 50. Afterwards, the handle 60, in whose channel 67 the fiber optic cable 70 may already have been inserted before connecting the couplings 72 and 31, can be screwed onto the threaded sleeve 50.

Another advantage of the slot 58 in the threaded sleeve 50 is, in the context of the 1 , 2 , 3 , 4 until 5 The optical fiber 70 must, due to the tubular shape of the handle 60, run completely within the channel 67 in the handle 60. However, the slot 58 in the threaded sleeve 50, immediately distal to the distal edge of the handle 60, allows for lateral deflection of the optical fiber 70. This is evident in 2 recognizable. This allows the slot 58 in the threaded sleeve 50 to be angled, as in the 2 and 3 As shown, there is less elastic deformation than would be possible without the slot 58 in the threaded sleeve 50. This can reduce the stress on the optical fiber 70 and increase its service life.

The 7 and 8 show schematic sectional views, which are in the 1 , 2 until 3 recognizable working channel device 90 at the proximal end 21 of the spatula device 20. 7 shows a section along a plane CC parallel to the cutting plane AA and to the drawing planes of the 1 , 2 , 4 and 6 The position of the cutting plane CC is also in 8 hinted at. 8 shows a schematic representation of a section along a cutting plane DD perpendicular to the cutting plane CC of the 7 The position of the cutting plane DD is in 7 hinted at.

The working channel device 90 has a working channel 92 that is essentially circular and cylindrical. The cross-section of the working channel 92 is, for example, adapted to the outer cross-section of an endoscope intended for use with the device 10.

The working channel assembly 90 is positively engaged with the proximal end 21 of the spatula assembly 20 via a dovetail guide 94. The working channel assembly 90 can be released from the proximal end 21 of the spatula assembly 20 by moving it in a direction parallel to the cutting plane C-C and perpendicular to the cutting plane D-D. To prevent unintentional release of the working channel assembly 90 from the spatula assembly 20, a locking mechanism 95 in the form of a non-circular disc is provided. The working channel assembly 90 can be locked or unlocked from the spatula assembly 20 by rotating the locking mechanism 95 about an axis perpendicular to the cutting plane D-D.

A union nut 96 is provided at one end of the working channel assembly 90, which is connected to the working channel assembly 90 via a thread. An elastic clamping element 97 is provided between the working channel assembly 90 and the union nut 96. By rotating the union nut 96, the elastic clamping element 97 can be elastically deformed so that an endoscope inserted into the working channel 92 is held there by force-fit or friction-fit.

Reference sign

10

Device for manual retraction

20

spatula attachment

21

proximal end of the spatula device 20

22

distal end of the spatula device 20

24

Flushing channel

26

Coupling device on the flushing channel 24

30

Light guide device in the spatula device 20

31

Coupling at the proximal end of the light guide 30

32

Light emission surfaces at the distal end of the light guiding device 30

40

Handling device

41

proximal end of the handling device 50

42

distal end of the handling device 50

44

Holm

45

Waisting of the spars 44

50

Threaded sleeve

52

Axis of threaded sleeve 50

56

External thread on the threaded sleeve 50

57

Lumen of the threaded sleeve 50

58

Slot in the threaded sleeve 50

60

Handle on the handling device 50

61

proximal end of the handle 60

62

distal end of the handle 60

65

Internal thread in the handle 60

67

Channel in handle 60

70

Fiber optic cable

72

Coupling on the fiber optic cable 70

80

Joint between spatula device 20 and handling device 50

81

pivot axis of the joint 80

82

Locking mechanism for joint 80

84

Release button for locking mechanism 82

86

Direction of force for actuating the release button 84

90

Working channel setup

92

Working channel

94

Dovetail guide between working channel device 90 and spatula device 20

95

Locking of the working channel device 90 on the spatula device 20

96

union nut

97

elastic clamping element

Claims (7)

Device (10) for manually retracting a muscle or lifting another organ, comprising: a spatula device (20) for passing behind the muscle or organ; a handle (60); a joint (80) between the proximal end (21) of the spatula device (20) and the handle (60); a light guide device (30) which couples a coupling (31) for a light guide cable (70) with a light emission surface (32) at the distal end (22) of the spatula device (20), wherein the coupling (31) is rigidly connected to the spatula device (20); characterized by a working channel device (90) with a working channel (92) at least either for guiding or holding an endoscope or another instrument, wherein the working channel device (90) is detachably connected to the spatula device (20). Device (10) according Claim 1 , characterized in that the handle (60) includes a channel (67) for receiving a fiber optic cable (70). Device (10) according Claim 2 , characterized in that when the handle (60) pivots about the joint (80) a light guide cable (70) connected to the coupling (31) and guided through the channel (67) remains in the channel (67) and is elastically deformed distal to the coupling (31). Device (10) according to one of the preceding claims, characterized by a screw connection (56, 65) between the handle (60) and the joint (80). Device (10) according to the preceding claim, characterized in that the screw connection comprises a thread (56) on a threaded sleeve (50), wherein the threaded sleeve (50) is permanently connected to the joint (80), and wherein the threaded sleeve (50) has a slot (58) through which a fiber optic cable (70) can be inserted into the lumen (57) of the threaded sleeve (50) in a radial movement with respect to the axis (52) of the screw connection (56, 65). Device (10) according to one of the preceding claims, characterized in that the handle (60) is part of a handling device (40) which is tapered (45) between the handle (60) and the joint (80). Device (10) according to one of the preceding claims, characterized by a locking mechanism (82) for fixing the joint (80).