DE202022001143U1 - cardiac retractor - Google Patents

Abstract

A heart retractor (1) for use in a surgical procedure on a human heart, comprising
- an elongate tubular shaft (2) having a first end (3) and a second end (4),
- a handle (5) arranged at the first end (3) of the shaft (2),
- an elongate transmission element (6) extending inside the shaft (2),
- a retractor head (7) comprising at least one retractor blade (8),
- A joint (9) formed at the second end (4) of the shaft (2) and forming a joint axis (11) oriented perpendicular to a longitudinal axis (10) of the transmission element (6), the handle (5) having a housing ( 12), a shaft (13) which extends within the housing (12) and is rotatably mounted relative to the housing (12) and a rotating element (14) coupled to the shaft (13) by means of which the shaft (13) can be rotated by applying a manual power is rotatable relative to the housing (12),
wherein the transmission element (6) interacts with the shaft (13) in such a way that the transmission element (6) can be moved along its longitudinal axis (10) relative to the shaft (2) as a result of a rotary movement of the shaft (13),
wherein the retractor head (7) is mounted at its proximal end (15) on the joint (9) in such a way that the joint axis (11) is oriented perpendicular to a retractor axis (17) of the retractor head (7), which extends from the proximal end (15) of the retractor head (7) towards its distal end (16),
wherein the joint (9) cooperates with the transmission element (6) in such a way that an angular position of the joint (9) relative to whose joint axis (11) can be changed as a result of an axial movement of the transmission element (6),
characterized in that
the shaft (13) and/or the rotating element (14) is sealed off from the housing (12) by means of at least one shaft sealing ring (18), so that unintentional entry of liquid into the housing (12) is avoided,
the shaft (13) being mounted relative to the housing (12) by means of at least one axial-radial bearing (19),
wherein the transmission element (6) has a penetration (20) oriented transversely to its longitudinal axis (10) in the form of an elongated hole, through which a bolt (21) extends, which is fixed at its opposite ends to a jacket (22) of the shaft (2) and serves as a stop for the transmission element (6), so that a distance along which the transmission element (6) can be moved relative to the shaft (2) is limited to a length (23) measured parallel to the longitudinal axis (10). the penetration (20) is limited.

Description

The present application relates to a heart retractor according to the preamble of claim 1.

The cardiac retractor includes an elongated shaft having a first end and a second end. The shank can be formed in particular in the form of a tube. The heart retractor also includes a handle which is arranged at the first end of the shaft. It is designed to be gripped manually at least during use of the heart retractor, so that the heart retractor can be operated manually by a user. The cardiac retractor also includes an elongate transmission element that extends within the shaft. The transmission element can in particular be a rod which extends in an interior space of the shaft, with a length of the transmission element generally corresponding at least essentially to a length of the shaft. Furthermore, the heart retractor includes a retractor head, which includes at least one retractor blade. The retractor head is arranged at the second end of the shaft and is therefore opposite the handle. Also formed at the second end of the shaft is a joint which forms a joint axis oriented perpendicular to a longitudinal axis of the transmission element.

The handle comprises a housing, a shaft which extends inside the housing and is mounted rotatably relative to the housing, and a rotary element which is coupled to the shaft. The rotating member and the shaft are connected to each other such that the shaft is rotatable relative to the housing upon application of manual force to the rotating member. The shaft is also connected to or interacts with the transmission element, so that the transmission element can be moved relative to the shaft as a result of a rotary movement of the shaft along its longitudinal axis. In use, it is therefore possible to rotate the shaft by manually operating the rotary element, which in turn causes an axial movement of the transmission element relative to the shaft as a result of the interaction of the shaft with the transmission element.

The retractor head is mounted with its proximal end on the joint, with the joint axis of the joint being oriented perpendicular to a retractor axis of the retractor head. The retractor axis is defined as extending from the proximal end of the retractor head to a distal end of the retractor head. When using the heart retractor, the retractor blade of the retractor head is used to mechanically displace or “push away” heart tissue so that a surgeon has space available for an intervention. In order to position the retractor blade in a meaningful way in or on the heart to be treated in each case, the adjustability of the retractor head using the joint is useful. Here, the joint interacts with the transmission element in such a way that an angular position of the joint relative to its joint axis can be changed as a result of an axial movement of the transmission element. In other words, it is possible by means of the heart retractor to move the transmission element in the manner described as a result of manual operation of the rotary element of the handle and thereby to bring about a change in the angular position of the joint, which is correspondingly accompanied by a movement of the retractor head, which is attached to the joint is stored. The heart retractor can be operated in this way.

State of the art

A heart retractor of the type mentioned above is already known in the prior art. For this, reference is made to the European patent specification EP 2 124 757 B1 pointed out.

The well-known heart retractor has proven to be disadvantageous insofar as a precise or sensitive adjustment of the retractor head or its at least one retractor blade can be difficult. This is due to the mechanics of the transmission of a rotary movement of the rotary element towards a spatial pivoting of the retractor head caused by the joint. It has thus been shown that internal frictional resistance in the known heart retractor can be so pronounced that the force that a user of the heart retractor must exert on the rotary element in order to change the position of the retractor head is of such an amount that at a Overcoming the static friction suddenly a large amount of movement of the retractor head is made in an unintentional manner. Depending on the complexity of the surgical procedure, this can be a hindrance. At least the convenience of using the heart retractor is restricted for the user of the heart retractor--particularly in the context of a nervously tense situation involving a surgical intervention on the heart.

task

The object of the present application is therefore to provide a cardiac retractor whose use is improved for the respective user.

solution

The underlying object is achieved according to the invention by means of a cardiac retractor with the features of claim 1. Advantageous refinements result from the associated subclaims.

The heart retractor according to the invention is characterized in that the shaft and/or the rotary element of the handle is/are sealed off from the housing by means of at least one shaft sealing ring. This prevents liquid from entering the housing unintentionally. Such entry can lead to contamination within the housing, which remains in the form of deposits and thereby increases internal friction in the area of the shaft or rotating element.

Furthermore, the shaft is mounted relative to the housing by means of at least one axial-radial bearing. This type of bearing is particularly stiff and highly resilient, resulting in high accuracy in operation. Frictional losses, which result from the bearing of the shaft within the housing, are reduced to a minimum as a result, which ensures the desired precision in the operation of the cardiac retractor.

Furthermore, the transmission element comprises a penetration which is oriented transversely to the longitudinal axis of the transmission element and has the shape of an elongated hole extending parallel to the longitudinal axis of the transmission element. In other words, a main axis of the penetration is oriented parallel to the longitudinal axis of the transmission element. A bolt extends through the penetration, which is fixedly mounted at its opposite ends on a casing of the shaft and serves as a stop for the transmission element. In this way, a distance along which the transfer member is movable relative to the shaft and is limited to a length of penetration measured parallel to the longitudinal axis of the transfer member. The mechanical limitation of the said distance along which the transmission element can move has the particular advantage that accidental "over-tightening" of the rotary element is prevented and will give the user of the heart retractor clear haptic feedback if the clearance within which the retractor head can be pivoted by means of the joint is exhausted. In the prior art, on the other hand, the respective heart retractor has occasionally been damaged because the user of the heart retractor tried to force the rotary element to rotate further and thereby achieve a further movement of the retractor head. The heart retractor according to the invention can therefore be operated more safely than in the prior art.

The heart retractor according to the invention has many advantages. In particular, its operation is simplified and generally improved compared to the prior art, which is due to the lower internal friction in the area of the housing. Furthermore, the operation of the heart retractor is simplified since, in the manner described, an adjustment range within which the retractor head can be adjusted is mechanically limited in such a way that damage to the heart retractor as a result of incorrect operation is avoided.

In an advantageous embodiment, the shank has a plurality of radial cleaning openings through which a liquid can be introduced into the shank and/or drained out of the shank. This configuration has the particular advantage that the inside of the shaft can be cleaned, in particular as a result of contamination from liquids entering or the like. This ensures that any increasing friction between the lateral surfaces of the transmission element and the shaft, which are in frictional contact with one another, is avoided. Accordingly, the operability of the heart retractor is improved.

If the cleaning openings are present, it can also be of particular advantage if the heart retractor comprises a sleeve which is open on the peripheral side and which can be placed or placed with an exact fit on an outer lateral surface of the shaft. The sleeve is designed to partially enclose the shank, with the sleeve preferably being able to be moved in a non-destructive manner both in the longitudinal direction and in the circumferential direction of the shank and to be removable from the shank in a non-destructive manner. The sleeve has the particular advantage that it mechanically reinforces the shank at least locally, in particular at those points at which the shank is mechanically weakened as a result of the cleaning openings made. Furthermore, the sleeve serves as an impact protection, whereby the shaft is protected from direct damage as a result of mechanical impact.

In an advantageous embodiment of the heart retractor according to the invention, it comprises at least a first position marker and a second position marker, the first position marker being arranged on the housing of the handle and the second position marker being arranged on the rotary element of the handle. The position markers are jointly set up to indicate a rotational position of the rotary element relative to the housing to display. In particular, it can be provided that the position markers are positioned in an overlap relative to one another when the cardiac retractor is present in a zero position. The position markers are preferably formed by elevations or depressions, so that they can be haptically detected by the user of the cardiac retractor. As a result, the user can capture information about the rotational position of the rotary element relative to the housing without having to optically capture the handle. Based on the position of the position marker, the user knows the position of the retractor head arranged on the joint or a relative angular position of a pivoting part of the joint.

Further developing the heart retractor according to the invention, the joint can be pivoted from a zero position in both directions about the joint axis by at least 35°, preferably at least 37.5°, more preferably at least 40°. Such pivotability is particularly well suited to adjusting the position of the retractor head depending on the respective situation of an operation, so that cardiac tissue can be mechanically displaced as intended. The adjustability of the retractor head in said range, which is due to the joint, gives the user of the heart retractor a large range of application without the user having to move the heart retractor as a whole.

In a particularly advantageous embodiment, the joint comprises a fixed part and a pivoting part, which can be pivoted relative to one another about the joint axis. The hinge axis is oriented perpendicularly to the longitudinal axis of the transmission element and is arranged at a distance from the longitudinal axis of the transmission element. In this way, there is a lever arm between the longitudinal axis of the transmission element and the joint axis, which allows the axial movement of the transmission element relative to the shaft, which is driven via the shaft as a result of the operation of the rotary element, to be converted into the desired pivoting movement of the joint about the to translate joint axis. Accordingly, the pivoting part is coupled to the transmission element in such a way that the axial movement of the transmission element can be forced into the pivoting movement of the pivoting part about the joint axis relative to the fixed part. The transmission element and pivoting part can be coupled in particular by means of a form-fitting means which is mounted in a receptacle.

In a particularly advantageous embodiment, the pivoting part and the fixed part are guided towards one another along complementary sliding surfaces, so that the pivoting part can be clearly positioned relative to the fixed part simply by moving the transmission element. Said guidance along the sliding surfaces has the advantage that, in addition to being connected to the fixed part via the joint axis, the pivoting part is also mounted on the sliding surfaces on the fixed part in such a way that at least compressive forces acting on the pivoting part are diverted to the fixed part be able. From the fixed part, the forces can in turn be transmitted to the shaft up to the handle. The configuration accordingly has the advantage that the pivoting part is securely mounted relative to the fixed part when assuming a desired pivoting position and does not unintentionally exhibit movement play that could lead to the retractor head “wobbling” when the cardiac retractor is used.

In a further advantageous embodiment of the heart retractor according to the invention, the retractor blade is flat and has at least one, preferably enclosed, recess. An “enclosed recess” means a recess that is completely enclosed along its edge by material of the retractor blade. The recess is designed in such a way that it makes up at least 20%, preferably at least 40%, more preferably at least 60% of a surface of the retractor blade. The result of this configuration is that the mass of the retractor blade is reduced at least substantially to the extent that the recess makes up the surface of the retractor blade compared to an otherwise identical retractor blade that does not have the recess. In other words, a recess that makes up 25% of the area of the retractor blade, for example, leads at least essentially to a mass saving of also approx. 25% compared to a retractor blade that has no such recess but is otherwise identical in design. This configuration has the particular advantage that the retractor blade and therefore the retractor head are lighter overall, as a result of which the cardiac retractor can be guided and operated more conveniently by the user. The reduced fatigue that occurs in the user when using the heart retractor in turn leads to increased precision in the use of the heart retractor.

If the said recess is present, it can be particularly advantageous if it is meander-shaped and preferably extends in the direction of the retractor axis. The meandering design of the recess has the advantage that the retractor blade, despite the presence of the recess, has an almost equivalent mechanical supporting effect on the respective heart bone compared to a retractor blade that has no recess weave can exercise. The reason for this is that the recess and the resulting omission of material of the retractor blade are distributed over a surface of the retractor blade, so that there are no flat areas in which the retractor blade loses its supporting effect. The heart retractor, which is equipped with a retractor head with such a retractor blade, is not restricted in the range of its usability compared to heart retractors that have retractor heads with full-surface retractor blades.

In a particularly preferred manner, the heart retractor comprises a plurality of retractor blades, preferably exactly two retractor blades. The retractor blades can be pivoted relative to one another about a pivot axis, with the first retractor blade preferably being mounted directly (via a base of the respective retractor head) or directly rigidly on the joint (in particular its pivoting part) and the second retractor blade being mounted on the first retractor blade, forming the pivot axis. In principle, it is also conceivable that both retractor blades are each pivotably mounted on a base of the retractor head, with the base being mounted on the joint.

The configuration with several retractor blades has the particular advantage that, as a result of pivoting the retractor blades relative to one another, an intermediate space can be opened up between the retractor blades, in which an intervention by a respective surgeon can take place. The retractor blades can therefore displace heart tissue on at least two sides and in this way open up the gap mentioned. The pivotability allows an individual setting depending on the application.

For this purpose, it is particularly advantageous if the retractor blades can be locked relative to one another after assuming a desired position, preferably by means of a clamping element. It is conceivable that the user of the heart retractor releases the lock for moving one of the retractor blades relative to the other, for example using a tool, positions the retractor blades relative to one another in the desired manner and then locks the retractor blades against one another again. This preserves the position of the retractor blades so that the respective intervention can then be carried out. The use of a clamping element is particularly preferable since a clamping force caused by such a clamping element can be released and applied particularly easily and at the same time can assume such high amounts that reliable locking is ensured. In a particularly preferred manner, the clamping element can be formed by a cylinder head screw, which provides a large friction surface on its underside for the purpose of generating the stated clamping force. Such a cylinder head screw can be provided with a hexagon socket, for example, so that it can be operated particularly easily in the course of a particular operation.

In a particularly preferred manner, the retractor blades are coupled to one another by means of a gear mechanism, via which the retractor blades can be moved relative to one another. It is particularly conceivable that the user of the cardiac retractor operates or drives an actuating element, with a movement of the actuating element being transmitted by means of the gear to a pivoting movement of at least one of the retractor blades, preferably both retractor blades, so that they are positioned in the desired manner relative to one another can become. In particular, it is conceivable that the actuating element is formed by a pivot bolt which is turned by the user of the heart retractor manually, for example using a tool, and this rotary movement is translated into the pivoting movement mentioned by means of the gearing. Depending on the setting of the translation of the gear, a particularly precise setting or positioning of the retractor blades relative to one another can take place as a result.

In a particularly preferred manner, the second or each additional retractor blade also has at least one recess, preferably a plurality of recesses. As a result, according to the above description, the mass of the respective retractor blade is reduced compared to an embodiment in which the retractor blade would not have any corresponding recesses. This is beneficial to the convenience of operating the cardiac retractor as discussed above.

exemplary embodiments

• 1: Eine perspektivische Ansicht eines erfindungsgemäßen Herzretraktors,
• 2: Ein Detail eines Handgriffs des Herzretraktors gemäß 1,
• 3: Ein Querschnitt durch den Handgriff gemäß 2,
• 4: Ein perspektivischer Querschnitt durch einen Schaft des Herzretraktors gemäß 1,
• 5: Ein Detail eines Gelenks des Herzretraktors gemäß 1 in einer ersten Schwenkstellung,
• 6: Das Detail gemäß 5, wobei sich das Gelenk in einer zweiten Schwenkstellung befindet,
• 7: Eine perspektivische Ansicht eines Retraktorkopfs mit zwei Retraktorblättern, die in einer ersten Arbeitsstellung relativ zueinander angeordnet sind,
• 8: Der Retraktorkopf gemäß 7, wobei die Retraktorblätter in einer zweiten Arbeitsstellung relativ zueinander angeordnet sind,
• 9: Eine perspektivische Ansicht eines weiteren Retraktorkopfs mit zwei Retraktorblättern,
• 10: Detail eines alternativ ausgebildeten Gelenks,
• 11: Detail eines alternativ ausgebildeten Gelenks.

The invention is explained in more detail below using an exemplary embodiment which is illustrated in the figures. It shows:

• 1 : A perspective view of a heart retractor according to the invention,
• 2 : A detail of a handle of the heart retractor according to 1 ,
• 3 : A cross section through the handle according to 2 ,
• 4 : A perspective cross-section through a shaft of the heart retractor according to FIG 1 ,
• 5 : A detail of a joint of the heart retractor according to 1 in a first pivoting position,
• 6 : The detail according to 5 , the joint being in a second pivoting position,
• 7 : A perspective view of a retractor head with two retractor blades arranged in a first working position relative to each other,
• 8th : The retractor head according to 7 , wherein the retractor blades are arranged relative to each other in a second working position,
• 9 : A perspective view of another retractor head with two retractor blades,
• 10 : Detail of an alternatively designed joint,
• 11 : Detail of an alternatively designed joint.

An embodiment in the 1 until 9 is shown comprises a heart retractor 1 according to the invention, which is particularly well based on 1 results. This includes a shaft 2, which is formed in the example shown by an elongated tube. A transmission element 6 extends inside the shank 2, which is formed here by a solid round rod whose diameter is slightly smaller than an inner diameter of the shank 2. The transmission element 6 extends along a longitudinal axis 10.

In the example shown, the shank 2 is provided with a multiplicity of cleaning openings 24 which extend radially through a jacket 22 of the shank 2 . This is particularly evident from 1 . The cleaning openings 24 have the advantage that the shaft 2 or its interior can be cleaned of dirt, in particular body fluids that have entered. However, the cleaning openings 24 also represent a mechanical weakening of the shank 2, which results in particular in a lower flexural rigidity of the shank 2. In order to counteract this, the heart retractor 1 comprises a sleeve 25 which is arranged on an outer lateral surface 26 of the shaft 2 . The sleeve 25 is open on the peripheral side and has a slotted circular arc shape when viewed in cross section. In this way, the sleeve 25 is suitable for being “clipped” onto the shaft 2 by applying a corresponding force. This is done without tools and non-destructively. The sleeve 25 offers a reinforcement of the shaft 2 as well as impact protection. It can be rotated without tools and non-destructively both in the circumferential direction of the shank 2 on the lateral surface 26 and in the axial direction of the shank 2 parallel to the longitudinal axis 10 of the transmission element 6 .

A handle 5 is arranged at a first end 3 of the shaft 2, by means of which the heart retractor 1 can be operated manually. A rinsing opening 38 through which a rinsing liquid can be introduced into the shank 2 is formed on an attachment piece 46 on which the handle 5 is attached at the first end 3 of the shank 2 . As a result, the shaft 2 can be cleaned particularly easily.

The handle 5 as such is particularly well based on 2 . It comprises a housing 12 and a rotary element 14 connected at the end to the housing 12. The housing 12 is non-rotatably connected to the shaft 2, while the rotary element 14 rotates relatively about an axis of rotation, which in the example shown coincides with the longitudinal axis 10 of the transmission element 6 to the housing 12 is rotatable. In the example shown, the handle 5 is provided with two position markers 27 , 28 , a first position marker 27 being assigned to the housing 12 and the second position marker 28 to the rotating element 14 . The position markers 27, 28 are each formed here by an elevation or depression that can be felt by a user of the cardiac retractor 1. When the heart retractor 1 is in a zero position, the position markers 27, 28 are arranged in overlap relative to one another, as shown in FIG 2 is recognizable.

The internal structure of the handle 5 is particularly well based on 3 . A shaft 13 which is arranged coaxially to the transmission element 6 extends within the housing 12 . The shaft 13 is connected to the rotary element 14 in a torque-transmitting manner, with the rotary element 14 having a sealing plug 39 at the end to produce this connection in the example shown, the rotary element 14 being screwed into a thread 48 of the shaft 13 by means of a connecting means. The result of the connection is that a manual rotation of the rotary element 14 causes a corresponding rotation of the shaft 13 . However, the shaft 13 interacts with the transmission element 6 in such a way that a rotation of the shaft 13 about the longitudinal axis 10 of the transmission element 6 results in an axial movement of the transmission element 6 along the longitudinal axis 10 . For this purpose, the shaft 13 and the transmission element 6 are connected to one another in the manner of a spindle drive, which enables a rotary movement to be translated into an axial movement.

An interior space of the housing 12, within which the shaft 13 extends, is shown in FIG th example by means of two sealing elements sealed against an environment, wherein the sealing elements are each formed by a shaft seal 18. These are particularly well suited to reliably sealing the interior against the unintentional ingress of liquids, which protects the interior from contamination. In this way, the effect is achieved in particular that the shaft 13 is mounted permanently within the housing 12 without impairment, so that a frictional resistance remains unchanged during the course of the rotation of the shaft 13 relative to the housing 12 .

The latter frictional resistance is particularly low in the cardiac retractor 1 since the shaft 13 is mounted against the housing 12 by means of two radial-axial bearings 19 in the example shown. As a result, in particular, static friction, which initially has to be overcome when the rotary element 14 is actuated, is particularly low, as a result of which the heart retractor 1 can be operated particularly precisely.

The transmission element 6 has a penetration 20 which is elongated in the manner of a slot. The penetration 20 penetrates the transmission element 6 in a direction perpendicular to the longitudinal axis 10 of the transmission element, the penetration 20 as such extending parallel to the longitudinal axis 10 . Consequently, the penetration 20 has a main axis and a secondary axis when viewed in a cross section, the main axis of the penetration 20 being oriented parallel to the longitudinal axis 10 of the transmission element 6 . As a result, the penetration 20 extends over a length 23 measured parallel to the longitudinal axis 10, as can be seen particularly well from FIG 4 results. In the penetration 20 , the transmission element 6 interacts with a bolt 21 which extends through the penetration 20 perpendicular to the longitudinal axis 10 . The bolt 21 is mounted at its opposite ends on a casing 22 of the shank 2 , a position of the bolt 21 being independent of an axial movement of the transmission element 6 . In this way, the bolt 21 serves as a stop for the transmission element 6 and limits a range of movement of the transmission element 6 to the length 23 of the penetration 20 since the transmission element 6 strikes the bolt 21 at its opposite ends of the penetration 20 . In this way, the heart retractor 1 is protected from unintentional incorrect operation, which could result from an “over-rotation” of the rotary element 14 in one direction or the other relative to the longitudinal axis 10 .

The axial movement of the transmission element 6 leads to an adjustment of a joint 9 which is arranged on the second end 4 of the shaft 2 . In the example shown, the joint 9 comprises a fixed part 29 and a pivoting part 30 which are mounted so as to be pivotable relative to one another about a joint axis 11 . The fixed part 29 is firmly connected to the second end 4 of the shaft 2 and offers an elongate recess for receiving an end piece 49 of the transmission element 6. The end piece 49 has a hook-shaped receptacle 50 in which a form-fitting means 51 of the pivoting part 30 of the joint 9 fits positively is stored. As a result of the axial movement of the transmission element 6 , the form-fitting means 51 can be moved in a direction parallel to the longitudinal axis 10 of the transmission element 6 , causing a pivoting movement of the pivot part 30 of the joint 9 about the joint axis 11 . This arises from the fact that the form-fitting means 51 is arranged at a distance 47 from the joint axis 11 . Furthermore, it is important that the joint axis 11 is arranged at a distance 31 from the longitudinal axis 10 . As a result, mechanically as a result of a force transmission from the transmission element 6 to the form-fitting means 51 , a torque is brought about about the joint axis 11 , which ultimately leads to the pivoting of the pivoting part 30 about the joint axis 11 . The receptacle 50 is designed with an oversize compared to the form-fitting means 51, so that the form-fitting means 51 can be moved on an arc of a circle about the joint axis 11, although the receptacle 50 only moves axially in relation to the longitudinal axis 10 of the transmission element 6.

For the purpose of dissipating forces from the pivoting part 30 to the fixed part 29, both parts are mounted on one another along complementary sliding surfaces 32. In this way, it is possible to derive forces acting on the pivoting part 30 by direct contact of the pivoting part 30 with the fixed part 29 along the sliding surfaces 32 into the fixed part 29 and thus into the shaft 2 of the cardiac retractor 1 . The sliding surfaces 32 are formed in the shape of a circular arc so that they do not block the pivoting of the pivoting part 30 about the pivot axis 11 . As is particularly well based on the 5 and 6 results, in the heart retractor 1 shown, the pivoting part 30 can be pivoted on both sides, starting from a zero position, by an angle 40 with respect to the joint axis 11 . A maximum deflection of the pivoting part 30 relative to the fixed part 29 is approximately 41° in the example shown.

At an end facing away from the fixed part 29, the pivoting part 30 comprises a threaded section 41 which is equipped with an external thread. This threaded section 41 is particularly well suited to interacting with a complementarily formed thread 42 and in this way receiving a retractor head 7 in a force-transmitting manner. Instead of the threaded section 41, other variants are also conceivable, by means of which the retractor head 7 can be mounted on the thread 9. For example, it is conceivable that the pivoting part 30 has a feather key 52 and a shortened threaded section 41 . The retractor head 7 is fastened to the joint 19 by means of a nut on the retractor head 7. Such a variant is shown particularly well using FIG 10 .

It is also conceivable that the pivoting part 30 does not have a threaded section 41 but rather a latching means 53 which is operated by means of a push button 54 on the pivoting part 30 , with the push button 54 preferably being able to be countersunk in the pivoting part 30 . There are various options for the latching means 53, for example a ball. Such a variant is exemplified in 11 illustrated. Conversely, it is conceivable that the push button 54 is located on the retractor head 7 and releases the connection with the latching means 53 , with the latching means 53 also being arranged in or on the retractor head 7 . In this case there is a correlating element (orifice) in the pivot part 30 .

Other connection mechanisms between the pivoting part 30 and the retractor head 7 are conceivable but are not listed here, e.g. quick couplings.

A retractor head 7 of the heart retractor 1 is mounted on the joint 9 in the manner described. Various configurations of retractor heads 7 result from the 7 until 9 . Irrespective of its design, the respective retractor head 7 has a thread 42 which is formed here by an internal thread. This is suitable and set up to interact with the threaded section 41 of the joint 9 so that the respective retractor head 7 can be mounted on the joint 9 in a force-transmitting manner. The respective thread 42 is located at a proximal end 15 of the retractor head, which is opposite a distal end 16 . A retractor axis 17 extends from the proximal end 15 to the distal end 16 of the retractor head 7. The retractor axis 17 is oriented perpendicularly to the joint axis 11.

A first exemplary retractor head 7, based on the 7 and 8th results, comprises two retractor blades 8, 34 which are mounted on one another to form a pivot axis 35. In this case, the first retractor blade 8 is arranged directly on a base 45 of the retractor head 7 which includes the thread 42 mentioned. In this way, the first retractor blade 8 is rigidly connected to the base 45 and therefore to the pivoting part 30 of the joint 9 . The second retractor blade 34 can be pivoted relative to the first retractor blade 8 by means of the pivot axis 35, so that the retractor head 7 as a whole can be transferred into different working positions. In order to lock the two retractor blades 8, 34 against each other in a respective working position of the retractor head 7, the retractor head 7 also includes a clamping element 37, which is formed here by a cylinder head screw. The clamping element 37 is suitable for interaction with a tool, the clamping element 37 having a hexagon socket in the example shown. The retractor blades 8, 34 are each provided with recesses 33, 36 in the example shown. The first retractor blade 8 has a continuous, enclosed recess 33 which extends in a meandering manner in the direction of the retractor axis 17 . In contrast, the second retractor blade 34 has three separate, ie separate, recesses 36 which extend parallel to one another within the retractor blade 34 and are also enclosed. The recesses 33, 36 have the effect that the retractor head 7 as a whole has a comparatively small mass compared to an embodiment in which the retractor blades 8, 34 do not have such recesses 33, 36. Due to the configuration, in particular the meandering configuration of the recesses 33 of the first retractor blade 8, the ability of the retractor head 7 to displace heart tissue as intended is not impaired.

A second exemplary retractor head 7 results from FIG 9 . This also includes two retractor blades 8 , 34 , but in contrast to the prescribed retractor head 7 , both retractor blades 8 , 34 are each mounted about a pivot axis relative to the base 45 of the retractor head 7 . In order to change the working position of the retractor head 7, the retractor head 7 includes an adjusting element 43, which is equipped here with a hexagon socket. The actuating element 43 interacts with a gear 44, by means of which the two retractor blades 8, 34 are kinematically coupled, so that when the actuating element 43 is actuated, both retractor blades 8, 34 are pivoted in the same way.

Reference List

1

cardiac retractor

2

shaft

3

first end

4

second end

5

handle

6

transmission element

7

retractor head

8th

retractor blade

9

joint

10

longitudinal axis

11

joint axis

12

Housing

13

Wave

14

rotary element

15

proximal end

16

distal end

17

retractor axis

18

shaft seal

19

Radial-axial bearings

20

penetration

21

bolt

22

a coat

23

length

24

cleaning opening

25

sleeve

26

lateral surface

27

position marker

28

position marker

29

fixed part

30

swivel part

31

Distance

32

sliding surface

33

recess

34

retractor blade

35

pivot axis

36

recess

37

clamping element

38

flushing port

39

sealing plug

40

angle

41

threaded section

42

thread

43

actuator

44

transmission

45

Base

46

attachment

47

Distance

48

thread

49

tail

50

recording

51

form-fitting means

52

Adjusting spring

53

locking means

54

push button

QUOTES INCLUDED IN DESCRIPTION

This list of documents cited by the applicant was generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Patent Literature Cited

• EP 2124757 B1 [0005]

Claims (15)

A heart retractor (1) for use in a surgical procedure on a human heart, comprising - an elongate tubular shaft (2) having a first end (3) and a second end (4), - a handle (5) which is arranged at the first end (3) of the shaft (2), - an elongate transmission element (6) which extends inside the shaft (2), - a retractor head (7) which comprises at least one retractor blade (8), - a joint (9) formed on the second end (4) of the shaft (2), which forms a joint axis (11) oriented perpendicularly to a longitudinal axis (10) of the transmission element (6), the handle (5) having a housing (12 ), a shaft (13) which extends within the housing (12) and is rotatably mounted relative to the housing (12), and a rotary element (14) coupled to the shaft (13) by means of which the shaft (13) can be rotated by applying a manual Force is rotatable relative to the housing (12), the transmission element (6) interacts with the shaft (13) in such a way that the transmission element (6) can be moved along its longitudinal axis (10) relative to the shaft (2) as a result of a rotary movement of the shaft (13), the retractor head (7) being movable in such a way is mounted on the joint (9) at its proximal end (15), that the joint axis (11) is oriented perpendicularly to a retractor axis (17) of the retractor head (7), which extends from the proximal end (15) of the retractor head (7 ) extends towards its distal end (16), the joint (9) interacting with the transmission element (6) in such a way that an angular position of the joint (9) relative to its joint axis (11) as a result of an axial movement of the transmission element (6) can be changed, characterized in that the shaft (13) and/or the rotating element (14) is sealed off from the housing (12) by means of at least one shaft sealing ring (18), so that an unintentional entry of liquid into the housing (12) is avoided , where the We Ile (13) is mounted by means of at least one axial-radial bearing (19) relative to the housing (12), the transmission element (6) having a penetration (20) oriented transversely to its longitudinal axis (10) in the form of an elongated hole through which a bolt (21) extends, which is fixedly mounted at its opposite ends on a jacket (22) of the shaft (2) and serves as a stop for the transmission element (6), so that a distance along which the transmission element (6) is movable relative to the shaft (2), is limited to a length (23) of the penetration (20) measured parallel to the longitudinal axis (10). Cardiac retractor (1) after claim 1 , characterized in that the shaft (2) has a plurality of radial cleaning openings (24) through which a liquid can be introduced into the shaft (2). heart retractor after claim 2 , characterized by a peripherally open sleeve (25) which can be placed or placed with an exact fit on an outer lateral surface (26) of the shaft (2) and partially encloses it, the sleeve (25) preferably being non-destructive both in the longitudinal direction and in the circumferential direction of the Shank (2) is movable and can be removed non-destructively from the shank (2). Heart retractor (1) according to one of the preceding claims, characterized by a first position marker (27) and a second position marker (28), the first position marker (27) on the housing (12) of the handle (5) and the second position marker ( 28) are arranged on the rotary element (14) of the handle (5), with the position markers (27, 28) being set up together, starting from a zero position, a rotary position of the rotary element (14) relative to the housing (12) and a relative angular position 40 of the joint (9) to display. Cardiac retractor (1) after claim 4 , characterized in that the position markers (27, 28) are each formed by an elevation or a depression for haptic perception. Heart retractor (1) according to one of the preceding claims, characterized in that the joint (9), starting from a zero position, rotates in both directions around the joint axis (11) by at least 35°, preferably at least 37.5°, more preferably at least 40° , is pivotable. Heart retractor (1) according to one of the preceding claims, characterized in that the articulation (9) comprises a fixed part (29) and a pivoting part (30), the pivoting part (30) relative to the fixed part (29) about the articulation axis (11 ) is pivotable, wherein the joint axis (11) is arranged perpendicularly to the longitudinal axis (10) of the transmission element (6) and at a distance (31) from the longitudinal axis (10), the pivoting part (30) being connected to the transmission element (6 ) is coupled in that an axial movement of the transmission element (6) causes a pivoting movement of the pivoting part (30) about the hinge axis (11) relative to the fixed part (29). Cardiac retractor (1) after claim 7 , characterized in that the fixed part (29) and the pivoting part (30) are guided towards one another along complementary sliding surfaces (32), so that the pivoting part (30) can be clearly positioned relative to the fixed part (29) simply by moving the transmission element (6). . Heart retractor (1) according to one of the preceding claims, characterized in that the retractor blade (8) is flat and has at least one enclosed recess (33) which covers at least 20%, preferably at least 40%, more preferably at least 60% of an area of the retractor blade (8). Cardiac retractor (1) after claim 9 , characterized in that the recess (33) is meander-shaped and preferably extends in the direction of the retractor axis (17). Cardiac retractor (1) according to one of the preceding claims, characterized in that the retractor head (7) has two retractor blades (8, 34) which can be pivoted relative to one another about at least one pivot axis (35). Cardiac retractor (1) after claim 11 , characterized in that the first retractor blade (8) is mounted on the joint (9) and the second retractor blade (34) is mounted on the first retractor blade (8), forming the pivot axis (35). Cardiac retractor (1) after claim 11 or 12 , characterized by a gear (44) by means of which a movement of an actuating element (43) can be translated into a rotary movement of at least one retractor blade (8, 34), the retractor blades (8, 34) preferably each forming a pivot axis on a base ( 45) of the retractor head (7), the base (45) being mounted directly on the joint (9). Cardiac retractor (1) after Claim 13 , characterized in that the second retractor blade (34) has at least one recess (36), preferably a plurality of recesses (36). Cardiac retractor (1) after Claim 13 or 14 , characterized in that the two retractor blades (8, 34) can be locked against one another by means of a clamping element (37), forming a clamping force, the clamping element (37) preferably being formed by a cylinder head screw.

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