WO1999015081A1

WO1999015081A1 - Rib retractor and lifter

Info

Publication number: WO1999015081A1
Application number: PCT/US1998/020108
Authority: WO
Inventors: Leo James Lichte; Paul E. Morris
Original assignee: Alliance Medical Technologies, Inc.
Priority date: 1997-09-26
Filing date: 1998-09-24
Publication date: 1999-04-01
Also published as: AU9666898A

Abstract

The present invention is a tool (10) for retracting, and lifting the ribs of a patient. The tool includes a retractor rack (14) with a stationary arm (22) attached to one end. Pivotally connected to the retractor rack, and proximate the stationary arm is a lifting rack (16). A movable arm (23), similar in configuration to the stationary arm, is attached to the lifting rack. The movable arm is movable relative to the stationary arm to retract, and lift the patient's ribs.

Description

RIB RETRACTOR AND LIFTER

Background of the Invention The present invention relates generally to the field of surgical instruments and, in particular, to a rib retractor and lifter used during heart surgery. A variety of surgical instruments are used to provide access to the heart during cardiac surgery. For example, during conventional open heart surgery, access to the heart is provided by using a scalpel to make an incision beginning at the throat area and cutting medially the entire length of the sternum and using a saw to cut through the sternum. A retractor (also referred to as sternum spreader) is inserted into the gap created by the cut in the sternum and the retractor is used to force the sternum and rib cage apart to provide access to the heart. A conventional retractor is disclosed in U.S. Patent No. 5,052,373 issued to Michelson. The Michelson patent discloses a first retractor arm fixed at one end of a toothed rack and a second retractor arm which is moved along the rack by rotating a gear that engages the teeth extending along one edge of the rack. The second retractor arm is locked into a desired position along the rack by a pivotally mounted pawl which engages the rack teeth. The surgeon can pivot the pawl to disengage it from the rack teeth and rotate the gear to move the second retractor arm to a new position along the rack. Because the pawl must be pivoted and the gear rotated to change the distance between the retractor arms, these steps increase the time and add to the complexity of the surgery.

During heart surgery, it is known to lift one side of the chest area or rib cage to provide increased access to the heart and, in particular, to the internal mammary artery. The internal mammary artery extends longitudinally along the interior surface of the sternum. A known method for accessing the internal mammary artery is to use a conventional retractor to separate the rib cage and another device to lift one side of the rib cage. Specifically, a conventional retractor spreads the rib cage and then the retractor is removed. A second device is then inserted into the opening and it is used to lift one side of the rib cage. The heart surgery is then performed and the lifting device is removed after the surgery is completed. This method requires the use of two different components, which frequently have to be assembled by the surgeon, and this method is time consuming, traumatic to the patient and unnecessarily complicates the surgical procedure.

Another device used during heart surgery is disclosed in U.S. Patent No. 5,025,779 issued to Bugge, which discloses a device used to open the chest during heart surgery. The device includes a pair of plates with opposed hooks intended to grip opposite edges of an incision in the chest. The plates are interconnected by a frame, and one plate is connected to the frame by a hinge. An adjusting screw tilts the plate about the hinge to lift one edge of the incision away from the underlying body tissues. This device is unsatisfactory because of the limited range of movement of the hinged plate and the end of the hinged plate opposite the hook portion produces unnecessary pressure on the patient's rib cage. Additionally, the hooks do not securely engage the ribs and the hooks may damage or irritate the ribs or surrounding tissues because the hooks apply pressure to only a small portion of the patient's rib cage. There is a need for a surgical tool which retracts the ribs and lifts one side of the rib cage without the above-described disadvantages. Summary of the Invention One aspect of the invention is a retractor which can be used during minimally invasive heart surgery in which several small incisions and various cannuiae are typically placed in the chest wall, which obviates the need for a gross thoracotomy wherein a large opening is created in the thoracic cavity. This technique avoids the trauma and complications which often result from the large incision required during conventional open heart surgery.

Another aspect of the retractor is it can be utilized during open heart surgery. During open heart surgery, using conventional techniques, the sternum is cut longitudinally (a median sternotomγ) to provide access between opposing halves of the anterior portion of the rib cage. Alternatively, open heart surgery may be performed by a lateral thoracotomy wherein a large incision is made between two ribs and the ribs are retracted apart. A portion of one or more ribs may be permanently removed to optimize access. The retractor of the present invention can be used in conjunction with either a median or lateral sternotomy to provide increased access to the heart.

Still another aspect of the invention is a retractor which retracts or separates a portion of the rib cage, and lifts one side of the rib cage to provide increased access into the thoracic cavity. Advantageously, the retractor provides the surgeon with increased visibility, additional operating area and better access to the surgical site. Yet another aspect of the retractor is it simplifies a complex operation by eliminating steps required during conventional surgery, which saves time and effort of the surgeon. Additionally, the retractor is constructed from a few simple components which provide quick and easy assembly and disassembly. This allows all or a portion of the retractor to be readily sterilized or disposed.

Still another aspect of the retractor is it provides increased flexibility for the surgeon because it is widely adjustable which allows it to be used during a variety of surgical procedures and with patients having a wide range of physical characteristics. Significantly, the retractor is also adjustable during surgery. in one embodiment of the invention, a tool retracts the ribs or sternum of a patient to provide the surgeon with increased access to the heart or other organs of the body located within the rib cage. The tool includes a retractor rack, a stationary arm fixed to one end of the retractor rack, and a jaw attached to the stationary arm. The tool also includes a lifting rack, a movable arm which moves along the length of the lifting rack and a jaw which is attached to the movable arm.

In another embodiment of the invention, the tool includes a retractor rack which is pivotally connected to a lifting rack. A stationary arm is connected to the retractor rack and a movable arm is connected to the lifting rack. The movable arm can be moved laterally away from the stationary arm to retract the ribs of a patient. The movable arm may also be raised relative to the stationary arm to lift the ribs of the patient.

In still another embodiment of the invention, a method of retracting and lifting a portion of the rib cage includes making an incision in the patient and inserting a pair of jaws into the incision. The rib retractor and lifter is connected to the jaws and the rib retractor and lifter is adjusted to separate and lift one side of the rib cage.

Advantageously, the rib retractor and lifter can be used with different types of jaws depending upon the surgical procedure to be performed. In yet another embodiment of the invention, the tool includes a retracting mechanism having a stationary arm and a movable arm. The tool also includes a lifting mechanism having two racks pivotally connected for lifting one side of the rib cage. Preferably, various types of jaws may be attached to the stationary and movable arms according to the desired use of the tool. Advantageously, the present invention allows the surgeon to use a single device to retract and lift one side of the rib cage. This creates an asymmetric opening in the chest which provides the surgeon with increased access and visibility of the thoracic cavity. Significantly, the invention also provides increased access to the internal mammary artery.

Brief Description of the Drawings These and other features of the present invention will now be described with reference to the drawings of preferred embodiments, which are intended to illustrate and not to limit the invention, in which:

Figure 1 is a perspective view of a rib retractor and lifter in accordance with an embodiment the present invention, illustrating a retracted position;

Figure 2 is another perspective view of the rib retractor and lifter shown in Figure 1, illustrating a raised position;

Figure 3 is another perspective view of the rib retractor and lifter shown in Figure 1, illustrating a raised position and tissue supporting fingers connected to the jaws;

Figure 4 is a side view of the rib retractor and lifter shown in Figure 1, illustrating a raised position and without jaws connected to the movable and stationary arms; and Figure 5 is a top view of the rib retractor and lifter shown in Figure 4, illustrating the movable arm positioned near the stationary arm.

Detailed Description of the Preferred Embodiments

The rib retractor and lifter 10, as shown in Figure 1, is used to spread and lift one side of the rib cage of the patient. In particular, when the rib retractor and lifter is used during conventional open heart surgery, the front chest area of the patient is cut medially along the sternum with a scalpel and the sternum is opened with a saw to provide access to the thoracic or chest cavity area of the patient. The rib retractor and lifter 10 is inserted into the incision to spread apart the sternum and to mechanically keep the sternum spread apart to allow access into the thoracic cavity by the surgeon. The rib retractor and lifter 10 also lifts one side of the rib cage to provide increased access to the heart and the internal mammary artery. The rib retractor and lifter 10 can also be used during minimally invasive surgery and other surgical procedures.

Additionally, the rib retractor and lifter 10 can be used to retract adjacent ribs and to lift one side of the rib cage. Further, the rib retractor and lifter 10 can be used to provide access to other areas of the body. Thus, while the rib retractor and lifter 10 is described in detail below as providing access to the heart during cardiac surgery, it will be appreciated that the rib retractor and lifter can also be used during a variety of surgical procedures and it can provide access to various portions of the body. The rib retractor and lifter 10 includes a frame 12 with a retractor rack 14 and a lifting rack 16 which are pivotably connected by a pivot block 18. The retractor rack 14 is securely fastened to the pivot block 18 by any known means, such as bolts, screws, gluing or welding; or these parts may be integrally formed. The lifting rack 16 is pivotably connected to the pivot block 18 by a pivot or roll pin 20. A stationary arm 22 is also securely fastened to or integrally formed with the pivot block 18, but the stationary arm 22 may also be releasably connected to the pivot block. Desirably, the stationary arm 22 and the retractor rack 14 form a generally L-shaped member because the arm is generally perpendicular to the longitudinal axis 24 of the retractor rack.

As used in the description of the rib retractor and lifter 10 shown in the accompanying figures, the longitudinal direction refers to the direction generally parallel to the longitudinal axis 24 of the retractor rack 14, and the vertical direction refers to the direction generally perpendicular to the longitudinal direction. Thus, when the rib retractor and lifter 10 is used with a patient in a conventional position lying down with his or her back on the operating table, the longitudinal direction is generally parallel to the upper surface of the operating table and the vertical direction is perpendicular to the upper surface of the operating table. Thus, as described below, when the rib cage is lifted in the vertical direction, the ribs are moved in a generally upward direction. Of course, the rib retractor and lifter 10 can be used with the patient in other positions, such as on his or her stomach or side.

The length of the retractor rack 14 is preferably between about 4 inches (10.2 cm) and 16 inches (40.6 cm) and, more preferably, about 11 inches (27.9 cm). The length of the retractor rack 14 may also be longer or shorter, depending upon the size and physical characteristics of the patient. The retractor rack 14 is about .75 inches (1.9 cm) in width and includes a series of teeth 26 which extend along one edge of the rack, but the teeth may also be positioned on the other side or both sides of the rack. The teeth 26 desirably extend almost the entire length of the rack 14, but the teeth may also extend a shorter distance. The teeth 26 have a width of about .125 inches (.3 cm) and are spaced apart by about .125 inches (.3 cm). Of course, the teeth 26 may have any desired size and configuration.

A sliding block 30 is slidablγ mounted to the retractor rack 14 and the sliding block moves in either direction along the longitudinal axis 24 of the rack. The sliding block 30 is generally rectangular in configuration with a height of about 1 inch (2.5 cm) and a width of about .5 inches (1.3 cm). The sliding block 30 includes an opening 32 through which the retractor rack 14 extends. Additionally, a lifter truck 34 is movably mounted to the retractor rack 14. The lifter truck 34 includes an opening 36 to receive the retractor rack 14 and the truck moves in either direction along the longitudinal axis 24 of the rack. The truck is about 1 inch (2.5 cm) in height and about 75 inches (1.9 cm) in width. The upper surface 36 of the lifter truck 34 includes an opening 38 located towards one end, proximate the teeth 26 of the rack 14. The opening 38 is preferably circular, vertically aligned with the teeth 26, and configured to receive a key 40. The key 40 includes a pinion (not shown) with a plurality of teeth that are configured to engage the teeth 26 extending along the rack 14. A shaft 42 connects the pinion to a handle 44 with two outwardly extending portions 46 and 48 which are configured to be grasped by the surgeon. It will be appreciated that the key 40 may have any desired configuration, and many different shapes and sizes. Additionally, the key 40 may be securely connected to the lifter truck 34, or removably connected. In operation of the key 40, the handle 44 is rotated in one direction which causes the pinion to rotate. The rotating teeth of the pinion engage the teeth 26 of the rack 14 and this causes the lifter truck 34 to move relative to the rack 14. Additionally, the handle 44 can be rotated in the other direction to move the lifter truck 34 in the opposite direction along the longitudinal axis 24 of the rack 14. The lifter truck 34 can be detached from the rack 14 by simply rotating the handle 44 until it reaches the end of the rack. This allows the rib retractor and lifter 10 to be readily disassembled, cleaned and sterilized. Alternatively, a stop or other type of member (not shown) may prevent the truck 34 from being removed from the rack 14.

The key 40 and retractor rack 14 are collectively termed a rack and pinion system. It will be appreciated that other methods, such as detent mechanisms or serrated edges which allow the lifter truck 34 to move relative to the rack 14 may also be employed. Desirably, the rack and pinion system is configured such that, when the handle 44 is not rotated, the lifter truck 34 remains in a stationary position. Thus, when the surgeon places the lifter truck 34 in the desired location, the truck will not move from that location. Alternatively, the lifter truck 34 may be secured in the desired location by using a threaded member (not shown) which extends through an opening in the truck and engages the retractor rack 14. This threaded member prevents unintended movement of the truck 34. Further, it will also be understood that, instead of using the key 40 to move the truck 34, a motor or other device may be used. The motor, for example, may be powered by air pressure, electricity, batteries and other known means.

The lifter truck 34 has an exterior surface 46 which is configured to contact an exterior surface 48 of the sliding block 30 and, when the lifter truck is moved in one direction along the length of the retractor rack 14, it may engage the sliding block and cause it to slide along the rack. For example, when the truck is moved along the rack 14 towards the stationary arm 22 and the exterior surface 46 of the truck 34 contacts the exterior surface 48 of the block, the truck forces the block to slide towards the stationary arm. Because the sliding block 30 and truck 34 are separate components, however, the block and truck can move independently. This provides the surgeon with increased flexibility during various operating procedures. For example, lifter truck 34 may be moved away from the sliding block 30 and, if there are no other forces on the block, the block may remain in a stationary position. Additionally, the sliding block 30 may be secured in a desired location by using a threaded member (not shown) which extends through an opening in the block to engage the rack 14. Thus, the surgeon can move the truck 34 in one direction to place the sliding block 30 in the desired location, secure the block in that location, and then move the truck in the opposite direction to another location. This provides improves the access and visibility for the surgeon. As discussed above, the frame 12 of the rib retractor and lifter 10 also includes the lifting rack 16 which is pivotally connected to the retractor rack 14 by the pivot block 18. The lifting rack 16 is generally similar in configuration to the retractor rack 14, but the lifting rack is preferably shorter in length than the retractor rack. For example, the lifting rack 16 may be between 2 inches (5.1 cm) and about 8 inches (20.3 cm) in length and, more preferably, about 5 inches (12.7 cm) in length, but it may also be longer or shorter. A retractor truck 50 is movably attached to the lifting rack 16. In particular, the retractor truck 50 includes an opening 52 configured to receive the lifting rack 16 and an opening 54 configured to receive a crank mechanism 56. The crank mechanism 56 includes a pinion (not shown) with a plurality of teeth which are configured to engage the teeth 58 of the lifting rack 16 to create a rack and pinion system. The pinion is connected to one end of a shaft 60 and the other end of the shaft is pivotably connected by a pivot pin 64 to an elongated member 62. A handle 66 is rotatably or non-rotatably connected to the end of the elongated member. The crank mechanism 56 is preferably permanently attached to the retractor truck 50, but it may also be removably attached.

The crank mechanism 56 controls the movement of the retractor truck 50 along the length of the lifting rack 16. Desirably, the retractor truck 50 is configured such that, when the crank mechanism 56 is not rotated, the truck remains in a stationary position. Alternatively, the retractor truck 50 may be secured in a desired location by a thread member (not shown) which extends through an opening in the truck to engage the rack 16. Additionally, the truck 50 may be detached from the rack 16 by removing it from the open end of the rack, or a stop or other member (not shown) may prevent the truck from being removed from the rack. As explained in detail below, the retractor truck 50 is used to control the movement of the movable arm 23 relative to the stationary arm 22.

The racks 14 and 16 are connected by a pair of lifting arms 70 which are pivotally connected at one end to the lifter truck 34 by shoulder bolt 72 or other type of fastener. The other end of the lifting arms 70 are pivotally connected to the retractor truck 50 by shoulder bolt 74 or other type of fastener. A single shoulder bolt which extends through one end of each lifting arm and through the truck may be used to connect the lifting arms to the trucks, or a pair of shoulder bolts may be used to connect the lifting arm to each of the trucks. The lifting arms 70 are about 4.5 inches (11.4 cm) in length, but may be larger or smaller depending, for example, upon the size of the patient or the amount that one side of the rib cage is to be lifted. As explained in greater detail below, the lifting arms 70, retractor rack 14 and lifting rack 16 may be positioned generally parallel to each other as shown in Figure 1 , or the arms and racks may be at an angle as shown in Figures 2 and 3. When the lifting arms 70 are generally perpendicular to the retractor rack 14, the lifting rack 16 is also generally perpendicular to the retractor rack. The lifting arms 70 include a slot 76 which is generally centrally located along the length of the arms. The slot 76 has a length of about .9 inches (2.3 cm) and a width of about .2 inches (.5 cm), but the slot 76 may have any desired dimensions.

A rotating arm 80 is also connected to the retractor truck 50. The rotating arm 80 has a length of about 2.6 inches (6.6 cm) and a width of about .5 inches (1.3 cm). In particular, one end of the arm 80 is attached to the movable arm 23 and the other end is slidably connected to the slot 76 in the lifting arms 70 by a pin 82. The pin 82 is preferably circular and has a diameter slightly smaller than the width of the slot 76. The rotating arm 80, as discussed below, causes the movable arm 23 to rotate into the desired position as the lifting rack 14 is moved relative to the retractor rack 14.

The components described above generally comprise the frame 12 of the rib retractor and lifter 10. The frame 12 is preferably constructed from stainless steel or other metal alloys, but other materials which can withstand the stress and loads of the present invention, such as plastics or composites, may also be utilized. It will be understood the dimensions of the various components of the frame 12 may depend upon the material used to construct the frame. Further, it will be appreciated that the components described above may be configured into different arrangements.

As shown in Figure 1, attached to the stationary arm 22 and the movable arm 23 are jaws 100 and 102, respectively, which engage and separate the ribs or sternum of the patient. In particular, a portion of each the jaws 100 and 102 extends into the incision in the patient and the jaws engage the ribs or sternum to facilitate retracting and lifting of the ribs.

The jaws 100 and 102, shown in Figure 1, are generally mirror images of each other and include a base 104 with a passage 106 which receives the stationary arm 22 or movable arm 23. In particular, the stationary arm 22 and movable arm 23 are inserted or slid into the passage 106 of the jaws 100 and 102, which allows the jaws to be readily connected or removed from the arms. The jaws may also be connected to the arms with a slight friction or interference fit to prevent the unintended removal of the jaws. Additionally, a detent mechanism or similar structure which "snaps" the jaws 100 and 102 onto the arms 22 and 23 may be located in the passage 106. The "snap" connection makes a sound to indicate to the surgeon that the jaws 100 and 102 are securely connected to the arms 22 and 23. The snap connection also allows the jaws 100 and 102 to be removed from the arms 22 and 23. Other types of releasable or permanent attachment of the jaws 100 and 102 to the arms 22 and 23 may also be used.

The jaws 100 and 102 include a generally downwardly extending extension 108 which is about 1 inch (2.5 cm) in length. Attached to the end of the extension 108 is a curved portion 110. The curved portion 110 is generally U-shaped and includes an upper surface 112 and lower surface 114 which are approximately equal in length, but one surface may be longer than the other surface. The upper and lower surfaces 112 and 114 form an opening 116, which is generally about 1 inch (2.5 cm) wide, configured to engage the patient's ribs or sternum along one side of the incision. The base 104, extension 108 and curved portion 110 are preferably integrally constructed to form a single component.

The jaws 100 and 102 may be rotatablγ connected to the stationary arm 22 and movable arm 23, but the jaws 100 and 102 are more preferably not rotatably connected to the stationary arm 22 and movable arm 23. Instead, as best shown in Figure 5, the rotating arm 80 includes a tube 110 which is securely fastened to one end of the arm by means such as welding. The tube has a length of about 2.3 inches (5.8 cm) and an outside diameter of about .3 inches (.8 cm). The tube 110 is configured to fit over the movable arm 23 and pivot about the arm. Extending along the outer surface of the tube 110 is a guide 112. The guide 112 is configured to fit within a channel in the passage 106 of the jaw 102, such that the jaw does not freely pivot about the tube 110. Instead, movement of the rotating arm 80 causes the tube 110 to rotate, which causes the jaw 102 to rotate. Thus, when one side of the ribs or sternum is being lifted, the movement of the rotating arm 80 causes the jaw 102 to pivot such that the jaw is placed in the desired location.

In one embodiment, as seen in Figure 1, the jaws 100 and 102 includes upper and lower surfaces 112 and 114 which are about equal in length. In this embodiment, the jaws 100 and 102 are preferably used to retract the ribs. Alternatively, as seen in Figures 2 and 3, jaw 120 includes an extended lower surface 122 which is generally planar and provides a broad support for the rib cage of the patient. The extended lower surface 122 preferably has a length sufficient to extend beneath at least three ribs of the patient for better support of the rib cage and so that the jaw 120 will not slip off the ribs, but the surface 122 may also be longer or shorter. In this configuration, the jaw 120 is preferably used to retract and lift the ribs. It will be understood that the size and configuration of the jaws 100, 102 and 120 may depend upon the type of procedure to be performed.

Advantageously, the extended surface 122 distributes the stress from lifting the ribs over a broad surface area and this minimizes trauma to the patient because excessive force is not applied to a specific portion of the rib cage. Additionally, the controlled rotation of the jaw 120 by the rotating arm 80 further distributes the stress evenly over the rib cage because a large portion of extended surface 12 remains in contact with the rib cage while the ribs are being lifted. Further, this decreases the risk that a particular rib will be damaged or broken because the stress from lifting the rib cage is distributed over a plurality of ribs.

The jaws 100, 102 and 120 are preferably available in various sizes and configurations for different surgical procedures and differently sized patients. This is an important feature because it allows the rib retractor and lifter 10 to be used with many different types and sizes of patients, and it increases flexibility for the surgeon. Of course, the size of the jaws 100, 102 and 120 are limited by the size of the incision in the patient.

The jaws 100, 102 and 120 are constructed from generally rigid materials such as steel or other metal alloys, but the jaws may also be constructed from other materials such as plastics or composites. The jaws 100, 102 and 120 may also be constructed from resilient or slightly flexible materials to permit a certain amount of adjustment or flexibility. Additionally, the jaws may be constructed from shape memory alloys which are materials, either plastic or metal, that are flexible at one temperature and generally rigid at another temperature. Desirably, the alloy is flexible at a temperature greater than body temperature (e.g., over 50°C) and generally rigid at about body temperature (37°C) or lower. Thus, the jaws constructed from shape memory alloys are generally rigid to facilitate retracting and lifting of the ribs, but flexible when heated above body temperature. This allows the surgeon to heat and shape the jaws into a configuration most suitable for use during surgery, and then cooled so that the jaws maintain the desired shape during surgery. Advantageously, this allows the jaws to be configured according to the particular needs of the surgeon, and the jaws can be used for different procedures.

The jaws 100, 102 and 120 are preferably constructed from materials which can be sterilized or readily disposed. In addition, the jaws 100, 102 and 120 may be constructed from the same material as the frame 12, or different materials. Further, all or portions of the frame 12 and jaws 100, 102 and 120 may be constructed from materials which can be sterilized or disposed.

It will be appreciated that the shape, size and configuration of the jaws 100, 102 and 120 herein described and shown in the accompanying figures is an example of a preferred embodiment, but other jaws in accordance with the disclosed rib retractor and lifter 10 may also be utilized.

As best seen in Figure 2, the jaws 100, 102 and 120 preferably include fittings 130 located proximate the upper surface 112 of the curved portions 110 to receive attachments 132. The fittings 130 have a generally flat lower surface with two upwardly extending side walls 134 and 136. The side walls 134 and 136 are curved towards each other and an opening 138 extends between the upper portion of the side walls 134 and 136. The end of the fitting 130 opposite the connector 116 and 124, respectively, includes an aperture 140 configured to receive the attachment 132.

The attachment 132, as seen in Figures 1 and 3, includes a base 142 configured to fit inside the fitting 130, and a plurality of fingers 144 configured to extend through the opening 138. Although three fingers 144 are illustrated in Figures 1 and 3, the attachment 132 may include any number of fingers. The fingers 144, of course, may have any desired shape, size and configuration. The attachments 132 assist in keeping the skin and fatty tissues of the patient away from the surgical site. The fingers 144 are preferably malleable and vary in length according to the physical characteristics of the patient. Advantageously, the attachments 132 provide increased visibility and access for the surgeon, but the attachments can be removed if not needed.

Thus, a rib retractor and lifter 10 has been described which is conveniently and easily handled and adjusted by the surgeon. It will be understood that various parts of the invention may be substituted by other parts of varying size and shape depending upon, for example, the type of surgery and the physical condition and characteristics of the patient. OPERATION

In use, the surgeon creates an incision in the sternum, or between the ribs or other portion of the thoracic cavity for surgery on the heart. Using the embodiment shown in Figure 1, for example, the curved portions 110 of the jaws 100 and 102 are inserted next to each other on opposing sides of the incision. Advantageously, because the jaws 100 and 102 are not yet connected to the rib retractor and lifter 10, the jaws 100 and 102 are readily insertable into the incision. The rib retractor and lifter 10 is then connected to the jaws 100 and 102. Specifically, the jaw 100 is connected to the stationary arm 22 and the jaw 102 is connected to the tube 110 connected to the rotating arm 80. These connections provide a simple and convenient attachment of the jaws 100 and 102 to the frame 12. In this first position, where the ribs have not been retracted or separated, the retractor rack 14, lifter rack 16 and lifting arms 70 are generally parallel to each other and the stationary arm 22 is located near the movable arm 23, as best shown in Figure 5.

In order to spread the ribs or sternum of the patient, the surgeon first positions the lifting truck 34 near the end of the retractor rack 14 opposite the stationary arm 22. The surgeon then turns the handle 66 of the crank mechanism 56 connected to the retractor truck 50 in a first direction to rotate the pinion and move the movable arm 23 in the longitudinal direction 24 away from the stationary arm 22. The movement of the movable arm 23 away from the stationary arm 22 causes the ribs or sternum to separate, and when the ribs or sternum are separated by the desired distance, the surgeon stops rotating the crank mechanism 56.

In order to spread the ribs or sternum and lift one side of the rib cage, the movable arm 23 is initially positioned near the stationary arm 22 and the lifting truck 34 is placed next to the sliding block 30 by rotating the handle 44. The surgeon then turns the handle 66 of the crank mechanism 56 to move the retractor truck 50 and the movable arm 23 away from the stationary arm 22. While the retractor truck 50 is moving away from the stationary arm 22, the lifting arms 70 cause the lifting rack 16 to pivot upwardly and away from the retractor rack 14. The movable arm 23, which is connected to the retractor truck 50, is also forced upwardly and this causes the jaw 120 to lift that side of the rib cage. Advantageously, the jaw 120 is maintained at the correct angle to securely engage the rib cage because of the rotating arm 80.

Another method of using the rib retractor and lifter 10 to spread the ribs or sternum of the patient includes turning the handle 66 of the crank mechanism 56 in a first direction to move the retractor truck 50 and movable arm 23 away from the stationary arm 22. While the retractor truck 50 is moving away from the stationary arm 22, the lifting arms 70 are also pushing the sliding block 30 away from the stationary arm. The lifting truck 34 is desirably positioned near the end of the retractor rack 14 opposite the stationary arm 22 so that the lifting truck does not impede or hinder the movement of the sliding block 30. The movement of the movable arm 23 away from the stationary arm 22 causes the ribs or sternum to separate, and when the ribs or sternum are separated by the desired distance, the surgeon stops rotating the crank mechanism 56. The retractor truck 50 desirably stays in that location, but the surgeon may tighten a threaded member extending through an opening in the retractor truck to keep the retractor truck in a stationary position. The surgeon then turns the handle 44 such that the lifter truck 34 moves toward the stationary arm 22. The lifter truck 34 engages the sliding block 30 and moves the sliding block towards the stationary arm 22. This causes the lifting arms 70 and the lifting rack 16 to pivot upwardly, away from the retractor rack 14. The movable arm 23, which is connected to the retractor truck 50, is aiso forced upwardly and this causes the jaw 102 to lift that side of the rib cage.

Additionally, in another preferred method, the surgeon can retract the ribs or sternum in a manner described above. When the ribs or sternum are retracted the desired distance, however, the surgeon rotates the crank mechanism 56 in the opposite direction to allow the jaw 102 to be removed from the movable arm 23 and replaced with the jaw 120 shown in Figure 2. The surgeon can then spread and lift one side of the rib cage using the methods described above. Advantageously, this procedure allows the jaw 120 with the extended surface 122 to be easily inserted between the ribs. It will be understood that jaws 100, 102 or 120 may be used during the entire lifting and retracting procedure. Although this invention has been described in terms of certain preferred embodiments, other embodiments apparent to those of ordinary skill in the art are also within the scope of this invention. Accordingly, the scope of the invention is intended to be defined only by the claims which follow.

Claims

WHAT IS CLAIMED IS:

1. A tool for retracting and lifting the ribs of a patient, comprising: a first cross bar; a first arm fixed to said first cross bar; a first tissue supporting element connected to said first arm, said first tissue supporting element having a curved surface configured to engage the ribs; a first member selectively movable along the length of said first cross bar; a second cross bar pivotally connected to said first cross bar; a second member selectively movable along the length of said second cross bar; a second arm fixed to said second movable member; a second tissue supporting element connected to said second arm, said tissue supporting element having a curved surface configured to engage the ribs; and a lift arm pivotally connecting said first member and said second member; wherein movement of said first member and said second member moves said second arm relative to said first arm.

2. The tool of Claim 1 further comprising a foot support connected to said first cross member, said foot support configured to engage the sternum of the patient.

3. The tool of Claim 1 further comprising an attachment connected to said first and second tissue supporting elements, said attachment including at least one outward extending finger for keeping skin and tissue away from the ribs.

4. A tool for retracting and separating the ribs of a patient, comprising: a frame, said frame including a first cross bar pivotally connected to a second cross bar, said first cross bar including a first member movable along the length of said first cross bar; a first arm connected to said first cross bar; said second cross bar including a second member movable along the length of said second cross bar; a second arm connected to said second member; and a lift arm pivotally connected said first member and said second member; wherein movement of said first and second members causes said second arm to move relative to said first arm.

5. The tool of Claim 4 further comprising a first tissue gripping element connected to said first arm and a second tissue gripping element connected to said second arm.

6. The tool of Claim 5 wherein said second tissue gripping element includes an elongated surface.

7. The tool of Claim 4 further comprising a foot support connected to said first cross bar.

8. The tool of Claim 4 further comprising an attachment connected to said first and second tissue supporting elements, said attachment including at least one outward extending finger for keeping skin and tissue away from the surgical site.

9. A tool for retracting and lifting the ribs of a patient, comprising: a first cross bar; a first arm connected to said first cross bar; a first tissue supporting element connected to said first arm, said first tissue supporting element configured to engage the ribs; a second cross bar; a second arm connected to said second cross bar; and a second tissue supporting element connected to said second arm, said second tissue supporting element configured to engage the ribs; wherein said second arm is selectively movable relative to said first arm to retract and lift the ribs.

10. The tool of Claim 9 wherein said first cross bar is pivotally connected to said second cross bar.

11. The tool of Claim 9 further comprising a support connected to said first cross bar, said support configured to engage the sternum of the patient.

12. The tool of Claim 9 wherein said first arm is fixed in a stationary position at one end of said first cross bar and said second arm is selectively movable along said second cross bar.

13. The tool of Claim 9 further comprising a first member movably mounted to said first cross bar; a second member movably mounted to said second cross bar; and a lift arm pivotally connecting said first member and said second member.

14. The tool of Claim 13 wherein said second arm is connected to said second member.

15. The tool of Claim 14 wherein movement of said first member and said second member moves said second arm relative to said first arm.

16. The tool of Claim 13 further comprising a first crank mechanism which controls the movement of said first member, and a second crank mechanism which controls the movement of said second member.

17. The tool of Claim 9 wherein said first tissue supporting element is releasably connected to said first arm and said second tissue supporting element is pivotally connected to said second arm.

18. The tool of Claim 9 wherein said first and second tissue supporting elements include a curved surface configured to engage the ribs of the patient.

19. The tool of Claim 9 further comprising a fitting connected to said first and second tissue supporting elements, said fitting configured to hold an attachment with at least one outward extending finger for keeping skin and fatty tissue away from the surgical site.

20. The tool of Claim 9 wherein said second tissue supporting element has an extended surface configured to support at least two ribs.

21. A rib retractor and lifter, comprising: a first cross bar; a second cross bar, said first cross bar pivotally connected to said second cross bar; a stationary arm connected to said first cross bar; and a movable arm connected to said second cross bar; wherein said second arm is selectively movable relative to said first arm to retract and lift the ribs of a patient.

22. The rib retractor and lifter of Claim 21 further comprising a first tissue supporting element connected to said stationary arm, said tissue supporting element having a curved surface configured to engage the ribs of the patient; and a second tissue supporting element connected to said movable arm, said tissue supporting element having a curved surface configured to engage the ribs of the patient and an extended surface configured to support at least two ribs.

23. The rib retractor and lifter of Claim 21 further comprising a first movable member connected to said first cross bar; and a second movable member connected to said second cross bar, said movable arm connected to said second movable member.

24. The rib retractor and lifter of Claim 23 further comprising a lift arm pivotally connected to said first movable member and said second movable member; wherein movement of said first movable member and said second movable member moves said movable arm relative to said stationary arm.

25. A method of opening the thoracic cavity of a patient, comprising: creating an opening in the thoracic cavity of the patient; inserting a portion of a tissue supporting element along each side of said opening; providing a rib retractor and lifter, comprising: a first cross bar; a second cross bar; a stationary arm connected to said first cross bar; and a movable arm connected to said second cross bar; wherein said second arm is selectively movable relative to said first arm to retract and lift the ribs of a patient; connecting said stationary arm and said movable arm to said tissue supporting elements; separating said tissue supporting elements a desired distance to retract and lift the ribs of the patient.

26. The method of Claim 23 further comprising attaching an attachment with one or more fingers to each of said tissue supporting elements.