Patent Application
20140059773
The present invention is directed generally to improvements in surgical support devices for positioning and retaining a patient during a surgical procedure. More specifically, the invention relates to a surgical support device having design improvements related to securely and safely supporting an obese surgical patient in a position laying on one side justified on the operating table in close proximity to the operating surgeon during hip, pelvis or bariatric surgery.
A variety of patient support devices are generally known in the art for use in supporting a surgery patient under anesthesia on an operating table in a predetermined and substantially fixed position to facilitate certain surgical procedures. In this regard, such patient support devices are especially useful to support a surgery patient in a position lying on one side, commonly referred to as a lateral decubitus position, to facilitate surgical procedures such as hip, pelvis or bariatric surgery. The support devices are typically mounted by clamps or the like onto side edges of the operating table, and provide upstanding support plates for engaging the patient anteriorly and posteriorly in the pelvic region and the chest region. Secure patient retention can be extremely important in the course of some surgical procedures such as hip arthroplasty wherein it is desirable to retain the patient in a fixed reference position relative to the operating table to achieve optimum fit and function of a hip prosthesis. The supports should also be of such strength and stability that the operating table can be tilted from side to side to support the patient. Unfortunately, conventional patient support devices, such as the device shown and described with respect to U.S. Pat. No. 5,390,383 (hereinafter “the '383 patent”), the contents of which are herein incorporated by reference, use paddle-shaped, round peg-like or rectangular upstanding plates that tend to engage soft tissues in the anterior pelvic region, resulting in inadequate patient support and retention in supporting obese patients. The support device of the '383 patent does engage the boney prominences of the anterior pelvic region, but the upright support and fixation mechanism can undesirably engage the protuberant abdomen of the obese patient. Also, prior art devices prevent the patient from being positioned toward the front edge of the operating table so the surgeon can be closely positioned to the anterior of the patient during surgery. Supporting the patient by contacting soft tissue, especially in the anterior pelvic region, have sometimes resulted in circulatory restrictions and/or other complications attributable to the pressure applied to skin or to vital organs.
There exists, therefore, a significant need for improvements in patient support devices designed to securely and safely engage the anterior pelvic region of an obese surgery patient lying in a lateral decubitus position. In particular, such a support device should include a double-ended bracket-arm having a deep recess in a central portion thereof to accommodate the protuberant abdomen, said central portion of the bracket-arm being fixed to an angular bracket post mounted to an offset, angular, anteriorly justified bracket in the general shape of a question mark to minimize protuberant abdomen engagement and to position said patient in close proximity to a front edge of the operating table. The present invention fulfills this need and provides other related advantages.
In accordance with the embodiments described herein, an improved anterior pelvic support device is provided for positioning and retaining an obese surgery patient in a predetermined reference position lying on one side on an operating table, thereby facilitating surgical procedures such as hip surgery, pelvic surgery, bariatric surgery, etc. In particular, the anterior pelvic support device is used in combination with other conventional support devices applied to the posterior pelvic region and the chest region at the anterior and posterior sides of the patient. The anterior pelvic support device is adjustably mounted with respect to an operating table and includes a pair of spaced-apart padded enlarged end portions for engaging the patient at a pair of spaced-apart points, particularly such as the bony prominences defined by symphysis pubis and anterior superior iliac spine.
In accordance with one preferred embodiment, the improved anterior pelvic support device includes a double-ended bracket arm having a deep recess in a central portion thereof to accommodate a protuberant abdomen of a surgery patient. In particular, the deep offset central portion is offset away from the patient relative to the pair of padded elements to prevent compression of vital structures between the engaged boney prominences of the symphysis pubis and the down side anterior iliac spine of the pelvis. An upwardly and inwardly angularly extending bracket post adjustably connects to the an operating table and carries the double-ended bracket-arm at one end thereof and in a position for forward engagement with boney protuberances of the anterior pelvis of the surgery patient. Furthermore, a support bracket may selectively support the bracket post in an anteriorly offset position justified relative to one side of the operating table advantageously providing additional stabilization in the event the operating table needs to be moved or angled during surgery. In a preferred embodiment, the support bracket may be in the shape of a question mark and aligned flush or slightly offset from the operating table end.
Additionally, the improved pelvic support device may further include a mount that permits selective slide coupled clamping of the angularly extending bracket post relative to the question mark-shaped bracket. This enables the support device to be positioned offset from the operating table, yet in a position to stabilize the surgery patient in close proximity to the front edge of the operating table. In this respect, the angular bracket post may extend upwardly and inwardly at an angle between 25 and 35 degrees, and preferably at about 30 degrees, to provide the desired extension over the surface of the operating table. The bracket arm itself is preferably offset from its longitudinal axis relative to the longitudinal axis of the surgery patient by an angle between 45 and 55 degrees, and more preferably by approximately 50 degrees so the bracket arms adequately contact the aforementioned boney prominences.
In an alternative embodiment, the support bracket may include a first vertical extension configured for selective engagement with an operating table side rail, a lower horizontal extension coincident and parallel relative to an upper horizontal extension spaced apart therefrom by a second vertical extension. The upper horizontal extension is preferably configured for slide-in reception and locking of the bracket post. This permits the bracket post to be horizontally adjustable, i.e., the bracket post may be positioned relative to the operating table depending on the size of the surgery patient. In this respect, the lower horizontal extension preferably bends away from the surgery patient and the upper horizontal extension bends toward the surgery patient so that the bracket support double backs on itself to remain offset from the operating table, while allowing the bracket post to angularly extend over the operating table for patient engagement. In one embodiment, the bracket post may fixedly couple to the bracket arm to prevent relative rotational movement. Additionally, the deep recess in the double-ended bracket may include an arcuate cut-out in a central portion thereof to permit engagement of the double-ended bracket with a symphysis pubis and an anterior superior iliac spine of the surgery patient, while allowing for abdominal fat (panniculus) to fit therebetween and over the bracket arm. In this respect, the double-ended bracket may include a pair of support plates formed on opposite ends of the bracket arm to provide padded support. The deep recess may angularly extend inwardly and away from the support plates to provide further positional patient accommodation.
In another preferred embodiment, the improved anterior pelvic support device for securely and safely engaging an anterior pelvic region of a surgery patient lying in a lateral decubitus position includes a double-ended bracket arm that includes a deep recess in a central portion thereof to accommodate a protuberant abdomen of a surgery patient. The double-ended bracket arm may include a pair of support plates formed on opposite ends thereof, with an arcuate cut-out therein to permit engagement of the support plates with a symphysis pubis and an anterior superior iliac spine of the surgery patient while allowing for abdominal fat (panniculus) to fit therebetween and over the bracket arm. A bracket post extending upwardly and inwardly at an angle between 25 and 35 degrees may adjustably connect to an operating table and fixedly coupled to the double-ended bracket-arm at one end thereof to prevent relative rotational movement. The bracket post is positioned in this respect for forward engagement with boney protuberances of an anterior pelvis of the surgery patient from the operating table side edge, especially when used in association with the below-mentioned support bracket.
In this respect, the support bracket is preferably configured to selectively support the bracket post in an anteriorly offset position justified to and in a non-encroaching position relative to one side of the operating table. The bracket support may include a question mark-shaped bracket selectively engageable with the bracket arm and mountable to the operating table. The longitudinal axis of the bracket arm is preferably offset from the longitudinal axis of the surgery patient by an angle between 45 and 55 degrees, or more specifically by about 50 degrees. The support bracket may include a first extension configured for selective engagement with a side rail of the operating table, a second extension bending away from the surgery patient and coincident with a third extension bending toward the surgery patient. The second and third extensions may be vertically spaced apart from each other by a fourth vertical extension relatively smaller than the first vertical extension. The third extension is configured for slide-in reception of the bracket post anteriorly offset from one side of the operating table, and may include a mount for slide coupled clamping of the bracket post relative to the question mark-shaped bracket.
In another embodiment, the improved anterior pelvic support device includes a double-ended bracket arm having a deep recess with an arcuate cut-out therein. The central portion of the double-ended bracket arm angularly extends inwardly away from a pair of support plates designed to support an anterior pelvic region and accommodate a protuberant abdomen of a surgery patient. The bracket arm is preferably offset along its longitudinal axis relative to the longitudinal axis of the surgery patient by an angle between 45 and 55 degrees. An upwardly and inwardly angularly extending bracket post is adjustably connected to an operating table on one end and the double-ended bracket-arm at the other. To this end, the double-ended bracket arm extends into a forward position for engagement with boney protuberances of an anterior pelvis of the surgery patient.
Furthermore, a question mark-shaped bracket selectively engageable with the bracket arm and mountable to a side edge of the operating table may further facilitate edge mounting of the double ended bracket arm relative to the surgery patient. Here, the question mark-shaped bracket selectively supports the bracket post in an anteriorly offset position justified relative to one side of the operating table. For instance, the question mark-shaped bracket may include a first vertical extension configured for selective engagement with a side rail of the operating table and a lower horizontal extension coincident relative to an upper horizontal extension spaced apart therefrom by a second vertical extension. The upper horizontal extension being configured for slide-in reception of the bracket post, which may include a mount to selectively slide clamp the bracket post relative to the question mark-shaped bracket. To this end, the lower horizontal extension may bend away from the surgery patient and the upper horizontal extension may bend toward the surgery patient so that the bracket post mounts to the support bracket anteriorly offset from a side of the operating table and fixedly relative to the surgery patient.
Furthermore, in another preferred embodiment as discussed herein, the improved anterior pelvic support device for securely and safely engaging an anterior pelvic region of a surgery patient lying in a lateral decubitus position includes a double-ended bracket arm having a deep recess including an arcuate cut-out in the central portion thereof to permit engagement of a pair of support plates formed on opposite ends of the double-ended bracket with a symphysis pubis and an anterior superior iliac spine of the surgery patient while accommodating panniculus therebetween. An upwardly and inwardly angularly extending bracket post adjustably connects to an operating table at one end and the double-ended bracket-arm at another end, to position the double-ended bracket-arm in a position for forward engagement with boney protuberances of an anterior pelvis of the surgery patient. Furthermore, a support bracket having a first relatively elongated vertical extension configured for selective engagement with a side rail of the operating table and a second substantially horizontal extension bending away from the surgery patient and coincident and relatively parallel with a third substantially horizontal extension generally bending toward the surgery patient and spaced apart therefrom by a fourth relatively shortened vertical extension, may further facilitate side rail or operating table adjacent side mounting of the aforementioned double-ended bracket-arm. In this respect, the third extension may be configured for slide-in reception and locking of the bracket post anteriorly offset from a side of the operating table. A mount or other clamp may permit selective slide coupled clamping of the angularly extending bracket post relative to the support bracket to position the surgery patient in close proximity to a front edge of the operating table.
Moreover, the support device may also include a double-ended bracket-arm having a central portion joined to a pair of enlarged opposite ends disposed generally coplanar to each other and offset from the plane of the central portion. A pair of padded elements may be removably carried on opposite ends of the bracket-arm such that the bracket-arm defines a pair of spaced-apart padded support members. A central portion of the double-ended bracket-arm includes a deep recess to allow room for the protuberant abdomen. In particular, the deep offset central portion is offset away from the patient relative to the pair of padded elements to prevent compression of vital structures between the engaged boney prominences of the symphysis pubis and the down side anterior iliac spine of the pelvis.
The central portion of the bracket-arm is fixed to an angular bracket post to minimize engagement of the protuberant abdomen, which in turn allows the patient to be positioned closer to the side edge of the operating table. The angular bracket post further keeps the support device out of the way of the surgeon leaning over the operating table. The fixed connection between the angular bracket post and bracket arm prevents the bracket arm from rotating during surgery. Such rotation may reduce the support provided by the support device and lead to complications. The horizontal portion of the angular bracket post is mounted in turn as by clamping to a question mark-shaped bracket secured as by clamping to a side rail extending along the side edge of the operating table. The question mark-shaped bracket is configured to allow the angular bracket post to be moved closer to the edge of the operating table than other L-shaped angle brackets known in the art. The clamp-on mounting of the angular bracket post permits anterior-posterior adjustment of the bracket arm relative to the operating table.
Preferably, the improved anterior pelvic support device is used in combination with conventional patient support plates for securely and safely retaining the patient during surgery. In this respect, a posterior pelvic support plate engages the relatively bony posterior pelvic region and a pair of anterior and posterior chest support plates engage the patient in the region of the sternum and near the base of the scapula, respectively, to securely and safely support an obese surgical patient in a position laying on one side toward a front end of an operating table in close proximity to the operating surgeon during hip, pelvis or bariatric surgery.
Other features and advantages of the present invention will become apparent from the following more detailed description, when taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the invention.
The accompanying drawings illustrate the invention. In such drawings:
As shown in the exemplary drawings, an improved support device referred to generally by the reference numeral 10 is provided for engaging and supporting the anterior pelvic region of a surgery patient 12. The anterior pelvic support device 10 is designed for use in combination with other conventional upstanding support plates 14, 16 and 18 (
The improved support device 10 recognizes that complications sometimes arise as a result of improper and/or inadequate patient positioning and retention during a surgical procedure. Such complications are particularly likely when significant force or pressure is required to retain the patient in a predetermined orientation while under an anesthetic, such as an inherently unstable position lying on one side, often referred to as the lateral decubitus position. In the past, conventional support devices in the form of flat upstanding support plates, rectangular plates or round cylinders have been used to support the patient by engaging soft tissues in the anterior pelvic region, resulting in potential circulatory restriction and/or other complications arising as a result of pressure applied to skin and internal organs. Some surgeries require the patient to be adjusted on the operating table close to the operating surgeon. In this respect, obese patients have unique considerations due to protuberant abdomens. In addition, especially in hip arthroplasty wherein it is desired to retain the patient in a substantially fixed reference position relative to an operating table 20, anterior pelvic support by engagement of soft tissues has not provided adequate patient retention to ensure optimum fit and function of an implanted prosthesis.
Therefore, the improved support device 10 shown in generally in
The anterior pelvic support device 10 additionally uses a question mark-shaped bracket 40 adjustably secured to the table side rail 34 on the anterior side of the patient 12. More particularly, the question mark-shaped bracket 40 includes a vertical leg 42 that selectively slides into a side clamp 44 having a clamp screw 46 for adjustable mounting of the question mark-shaped bracket 40 relative to the operating table. The relative positioning of the vertical leg 42 determines the overall vertical height of the support device 10. More specifically, the vertical leg 42 forms a part of the question mark-shaped bracket 40 with a substantially horizontal lower extension 48 that bends outward relative to the operating table 20 and away from the vertical leg 42 at an approximate 90° angle. A relatively shorter vertical extension 50 is generally formed at a 90° angle relative to the horizontal lower extension 48 and at an opposite end thereof relative to the vertical leg 42, this vertical extension 50 then bending at a relative 90° angle back toward the operating table 20 to form a substantially horizontal upper extension 52 to form the question mark-shaped bracket 40. This upper extension 52 selectively slidably engages a side clamp 54 for selective releasable attachment to the support device 10 by a clamp screw 56.
In this respect, the question mark-shaped bracket 40 provides a mechanism for mounting the support device 10 without encroaching into the depth of the operating table 20 as best shown in
The support device 10 includes a bracket arm 62 preferably integrally formed from or fixed to the angular bracket post 58. The recessed bracket arm 62 is preferably structurally reinforced by direct fixation to the angular bracket post 58 at a central portion 64 thereof such that the support device 10 retains a low profile. Attachment at this location allows for a deep recess therein that does not otherwise compromise the structural integrity and strength of the bracket arm 62. In this respect, the bracket arm 62 attaches to the angular bracket post 58 in this manner to substantially reduce the overall dimensions of the support device 10 and to provide additional clearance and less encumberment for the protuberant abdomen. That is, the support device 10 provides more room for the overhanging panniculus of the obese patient. One advantage over the devices known in the prior art, including the embodiments disclosed in the '383 patent, is the elimination of the undesirable prominent thumbscrew nut and adjustable bracket post, which can cause interference with a particularly large protuberant abdomen in obese patients. Additionally, forming or fixing the bracket arm 62 to the angular bracket post 58 cures problems associated with the prior art devices that allow the support device 10 to rotate during surgery. Rotating devices are particularly problematic in the event the surgeon may need to tilt or reposition the operating table 20 to gain better access to the surgery patient 12. In this respect, an insufficiently tightened thumbscrew nut may loosen prior art devices such that the device no longer provides the requisite support during surgery.
The central portion 64 of the bracket arm 62 includes a generally arcuate cut-out or recess 66 that provides clearance for unencumbered placement of a protuberant abdomen when the support device 10 is placed at the correct position and angle such that a pair of end portions 72, 74, which are covered in end portion pads 68, 70, engage the symphysis pubis and a down side anterior superior iliac spine, respectively, of the boney pelvis. The preferred attachment angle is about 50° long axis of the patient 12 relative to the long axis of the bracket arm 62, but may be between 45° and 55°. The end portions 72, 74 are substantially co-planar and extend toward the patient 12 (best shown in
The deep offset of the central portion 64 of the bracket arm 62 in the outward or outboard direction from opposite ends defines the spaced-apart pair of substantially coplanar support members or end portions 72, 74 for the device 10. This prevents compression of the vital structures of the groin when the support device 10 is placed in close proximity to and supports the patient 12 at the symphysis pubis and anterior superior iliac spine. The specific positions of these end portions 72, 74 are adjustably selected by appropriate loosening of the thumbscrew nut 46 to accommodate vertical displacement of the vertical leg 42 of the question mark-shaped bracket 40, the angular bracket-post 58 and the bracket arm 62. The thumbscrew nut 46 is tightened to securely retain the vertical leg 42 and the question mark-shaped bracket 40, the angular bracket-post 58 and the bracket arm 62 in a fixed vertical position relative to the operating table 20.
In accordance with the preferred orientation of the support device 10, the end portions 72, 74 are oriented to contact bony prominences at the anterior pelvic region of the patient 12. Specifically, the bracket arm 62 is normally rotated relative to the angular bracket post 58, as shown in
A variety of modifications and improvements to the anterior pelvic support device shown and described herein will be apparent to those skilled in the art. Accordingly, no limitation on the invention is intended by way of the foregoing description and accompanying drawings, except as set forth in the appended claims.
| Number | Date | Country | |
|---|---|---|---|
| 61694687 | Aug 2012 | US |
