US2897029A - Operating table apparatus for gravity exposure of the heart - Google Patents

Description

uly 28, 1959 B. MAISEL 2,897,029

OPERATING TABLE APPARATUS FOR GRAVITY EXPOSURE OF THE HEART Filed April 9, 1958 2 Sheets-Sheet 1 IIIIIIIIIIII=I1 II 1 l IIIIIII IIIIIIIII-IIII'II II I INVENTOR. BERNARD MAISEL.

BY uxkmmum m So\\onk ATTORNEYS B. MAISEL July 28, 1959' OPERATING TABLE APPARATUS FOR GRAVITY EXPOSURE OF THE HEART Filed April 9, 1958 2 Sheets-Sheet 2 BY (mam ,om'm k 6 Qe mxk.

ATTORNEYS United States Patent OPERATING TABLE APPARATUS FOR GRAVITY EXPOSURE OF THE HEART Bernard Maisel, Englewo'od, N.J., assignor of one-half to Cornell Research Foundation, Inc., Ithaca, N.Y., and one-half to New York Heart Association, Inc, New York, NY.

Application April 9, 1958, Serial No. 727,472 6 Claims. (Cl. 311-7) This invention relates to operating table apparatus particularly suited for use in surgery involving gravity exposure of the heart. The illustrative embodiment of the invention described herein as an example is operating table apparatus which is particularly suited for supporting a patient in prone position so as to enable the surgeon to utilize the force of gravity for exposing the patients heart in a position especially'convenient for surgery upon the rear portions or vessels of the heart or for exposing the entire surface of the heart for treatment.

In certain types .of heart operations involving exposure of large areas of the heart or involving regions or vessels of the heart at or toward the back, one of the major problems faced by the surgeon is the difiiculty of obtaining adequate and efiicient access to the posterior portions and vessels of the heart. In operating techniques suggested heretofore wherein the patient lies face up upon the operating table, it would be necessary for the surgeon to lift up or support the heart manually while reaching in through a large incision in the chest in order to obtain access to the posterior portions of the heart for the necessary treatment. This lifting and supporting of the heart so as to reach down in and underneath it would involve extensive manual handling of the heart during the course of an operation and would be an extremely delicate and exacting procedure and one which would be very diflicult to carry out. In any procedure which wouldcall upon the surgeon to lift and support the heart while reaching in under it and while the heart continues to beat, the surgeon would find that it is impossible to apply and maintain a uniform supporting force upon all areas of the heart over a length of time as required for surgery. Experiments upon animals have shown that this type of supporting and reaching underneath the heart causes irregular and undue stimulation of the heart. As a result the heart is likely to stop beating during the operation, or it may lapse into an erratic beating pattern which causes death within an hour or two after completion of the operation. Moreover, the necessity of supporting the heart requires the use of one hand and interferes with the vision and access required for surgery upon the underneath portion of the heart. Thus, it will be appreciated that an attempt to perform surgery upon the parts or vessels of the heart at or toward the back when the patient is lying face up involves three serious difficulties: (1) the heart itself is likely to be irregularly and unduly stimulated, (2) the surgeon has only a very limited field of vision and limited access with only one hand, and (3) a very large incision is required so as to provide even a minimum, although not satisfactory, field for simultaneously supporting and operating upon or near the rear of the heart.

The present inventor has also conceived and evolved an entirely new technique and approach to the problem of surgery upon posterior parts or vessels of the heart. In this new technique the extent of the incision and the dislocation of adjacent muscles, bones and organs is reduced to a Further, and of extreme impor- 7 2,897,029 Patented July 28, 1959 tance, it is no longer necessary for the surgeon to handle the patients heart in order to remove that organ from its natural position within the body of the patient when the entire heart must be exposed for treatment. In this new technique the patient is placed in a face down and prone position. The fifth rib on the left side is removed, and the fourth and sixth ribs are severed near the spinal column in such a way that they will readily heal back. Then the fourth and sixth ribs are spread apart to provide an opening in the front and side of the patients chest. The patient is then tipped or rotated by inclining the operating table apparatus of the present invention so as to lower the left side of the patient by an angle of approximately 12 up to 18. As the heart beats, the force of gravity urges the heart so as to shift it and move it down out of the cavity. The beating motion of the heart aids in gently changing its position so that it soon hangs exposed from the patients body suspended and supported by its great vessels which are attached to the top of the heart. Thus, there is no necessity for the surgeon to handle the heart and the possibility of injury to the heart during such handling is eliminated.

Accordingly, it is an object of the present invention to provide operating table apparatus which facilitates the practice of an operating technique wherein the patients heart is exposed by gravity after a minimum of surgery. It is another object to provide such operating table apparatus which may be inclined -and,-thus, manipulate the body of the patient so as to accomplish the gravity exposure of patients heart and which yields convenient access to the patients heart when suspended. It is a further object to provide operating table apparatus for gravity exposure of the heart which may, if desired, be 'used as an attachment in conjunction with an operating table of the general type which is found in most hospitals. It is a still further object to provide operating table apparatus which may be made collapsible and which may be easily stored when not in use. 1

In this specification and the accompanying drawings a preferred embodiment of the present invention in operating tables is shown and described which is particularly suited for gravity exposure of the heart. It is to .be un derstood that this is not intended to be exhaustive nor a limiting of the invention, but, on the contrary, it is depicted for the purpose of illustration in order that others I skilled in the art may fully understand the invention, its principles and the manner of carrying it out.

A more complete understanding of the invention and of further objects and features thereof, can be obtained from the following detailed description of the illustrative embodiment thereof, which is to be read in connection with the accompanying drawings, wherein:

Figure l is a perspective view of gravity exposure heart operating table apparatus in accordance with the present invention and shown being used in conjunction with a standard operating table,

Figure 2 is a diagrammatical sectional view showing the heart operating table apparatus in a substantially horizontal position;

Figure 3 is a diagrammatical sectional view showing the heart operating table apparatus in a position wherein it is inclined to the right;

Figure 4 is a diagrammatical sectional view showing the heart operating table apparatus in a position wherein it is inclined to the left;

Figure 5 is a plan view of the heart operating table apparatus;

Figure 6 is a longitudinal side elevational view of the apparatus;

Figure 7 is an end elevational view of the apparatus;

Figure 8 is a sectional view, on enlarged scale, showing the clamp device for seeming the legs of the. heart operating table apparatus to a side rail on a standard operating table; this view is taken along the direction of the arrows 8--8 of Figure 6; and

Figure 9 is a top view of the clamp device on the same scale as Figure 8.

Referring to the drawings and to Figure 1 in particular, operating table apparatus for gravity exposure of the heart is generally indicated at 10 in accordance with the present invention, and this illustrated embodiment of the invention is adapted to be used in conjunction with an operating table 11 of the type generally found in most hospitals. The heart operating table apparatus 10 (hereafter called the heart table) has a head platform portion 12 and a foot platform portion 14 which are connected together by a bridge member 16. The head and foot portions are supported andspaced above the top 18 of the standard table 11 by means of a series of side legs 20 and a pair of center supporting posts 22 which apply additional supporting force to the respective platforms at points near the ends of the bridge member 16.

The top 18 of a standard operating table is customarily about 24 inches in width, but for the heart table it is advantageous to use a width in the range from to inches, and 18 inches has been found to be the optimum value for this type of heart table. It has also been found that a head portion 24 inches long and a foot portion 36 inches long are quite suitable.

The construction of the heart table 10 is explained inmore detail in connection with Figures 5, 6 and 7. As shown therein, the head and foot portions 12 and 14 are connected together by the bridge 16, which is detachable from the head portion and telescopes within the foot portion. The head end of bridge 16 is attached to a cross member 24 and the foot end of the bridge is attached to a similar cross member 25. These cross members 24 and 25 have L-shaped bent end portions 26, each with a set of holes 28 therein. Each set of holes 28 is spaced apart the same distance as similar holes 30 which are located in a skirt flange 32 which is turned down all around the perimeter of the head portion 12 and in a similar skirt flange 34 of the foot portion 14.

To enable adjustment of the overall length of the heart table 10, the bridge member slides in telescoping relation through a slot 35 in the skirt flange 34, and the holes 28 in the L-shaped ends of the cross member 25 are matched with a selected pair of the series of holes 30 in the skirt flange 34 of the foot portion 14. This adjustability of the length of the heart table 10 permits the spacing between the head and foot portions 12 and 14 to be enlarged or reduced as desired in order to accommodate patients of various heights.

In order to disconnect the head end of the bridge 16 from the head platform, a pair of 'wing bolts 37 are unfastened so as to release the end of thebridge from the cross member 24. Then the end of the bridge is withdrawn through a slot 39 in the skirt flange. This head end of the bridge is bent over to accommodate a hole for the wing bolts 37, but can be withdrawn through the slot by suitably moving the head platform.

The head and foot portions 12 and 14 are spaced above the top 18 of the table 11 by the legs 20- and the posts 22. In actual practice it has been found that a height of 18 inches between the top 18 of table 11 and the top of the heart table 10 is most satisfactory. Since the table 11 itself is supported on a base 19 and may be raised or lowered and the top 18 inclined to the right or left by hydraulic control means 21, the elevation and angle of the heart table 10 may be changed by suitably adjusting the standard operating table 11.

The posts 22 are detachably mounted on each of the cross members 24 and 25 by screwing into sockets 41 and foot plates 36 are attached to the bottom of the posts 22 to spread the load carried by the posts in supporting the central region of the heart table 10.

In the illustrated embodiment, each set of supporting legs 20 is made from a single length of flat bar stock which is bent to provide an inverted U-shaped support frame 33 comprising the legs 20 and a center section 38. This center section 38, in addition to connecting the legs 20 also supports the top flat area of the head and foot portions 12 and 14.

The ends 40 of the legs 20 are bent inwardly to form flat shoes and these rest on the top 18 of table 11 near the edge. These shoes 40 are each associated with an outwardly and downwardly projecting arm 42 attached to the lower part of each leg 20 so as to secure and to stabilize the heart table 10. The arms 42 diverge from the legs 20 and extend below the top 18 of the table 11 where they are received in clamping sockets as will be explained.

As shown in Figure 1 in particular, a rail 44 runs along each side of the table 11 and a series of mounting clamps 46 are slidably attached to this rail. The end of each arm 42 is inserted down into a recess in a respective one of the clamps 46 and fastened therein as shown in Figures 8 and 9 by a clamp screw 47. Because the clamps 46 are held locked in place on the rails 44 by the clamp screws 47, they also serve to fasten the arms 42 and the support frames 33 securely to the table 10'.

A gusset plate 50 is provided at the top of each leg 211*. This gusset plate 50 has a pair of holes 52 therein which match with similar holes 54 in the skirt flanges 32 and 34. Suitable fastening means are fitted into the holes 52 and 54 to secure the frames 37 to the head and foot portions 12 and 14. Thus, the head and foot portions are securely, but detachably, connected to the frames 33 which, in turn, are securely fastened to the table 10 by the slide clamps 46, 47.

It will be appreciated that it is advantageous to have the various supporting components of the illustrated heart table apparatus detachable so that the apparatus may be readily disassembled and conveniently stored when not in use.

As stated previously, this invention in operating table apparatus provides means for carrying out the new heart operating technique originated by the present inventor. In order to appreciate the advantages of the present invention it may be helpful to have a more detailed explanation of the utilization of the apparatus in conjunc tion with this new surgery method carried out by using the present invention. In this new technique the patient is placed in a prone and face down position on the heart table 10, which advantageously has a width within the range specified, so that normally a few inches of the patients torso hangs over each side of the heart table 10. The head, shoulders and the very upper part of the chest is supported by the head platform portion 12. The chest and mid-section of the patient is supported on the bridge 16.

To insure that pressure on the patient is uniform a soft cushion such as a rolled wash blanket is placed beneath the patient along the bridge 16. The legs and the lower portion of the patients torso are supported on the foot portion 14. To assure that the pressure on the body parts is uniform, in addition to the wash blanket on the bridge 16, cushions are also placed beneath the patients head, knees and ankles. The patient is held in position on the heart table 10 by means of straps 56 which are run across the patients shoulders, pelvis and knees.

By having the heart table 10 divided into two major platform portions 12 and 14 and connected by a narrow bridge 16, a large and freely accessible work space is provided about the patients chest. This large work space permits the surgeon to have easy access to the heart as it hangs suspended from the chest cavity.

With the patient in position the surgeon is ready to perform the necessary surgery to obtain access to the a) heart as explained above so that the heart is exposed, but it remains in the chest cavity. In order to remove it from this cavity in order to treat it, the heart table is rolled over from the horizontal position of Figure 2 so as to incline downwardly toward the left. The necessary angle of incline will vary with different cases, but will be of the order of 12 to 18 or 20.

With the patient in an inclined position the force of gravity and the natural pumping action of the heart causes that organ to drop from its natural cavity within the patients body. The heart then hangs, supported by the great vessels at the top of the heart which have sufficient strength to support the heart adequately. The selfsupported heart is now available to the surgeon who has obtained full access to it without the necessity of handling it.

Following the operation, the heart table is gently rolled over the other way so that gravity and the pumping action of the heart will urge it back again into the chest cavity.

In the above description it was assumed that the surgeon particularly wished to have access from the left of the patient. It will be noted that the bridge 16 acts as a support for the patients sternum, and that the right side of the body is also readily accessible. When the surgeon particularly wishes to obtain access from the right, then the incision is made in the right side. The neart 1s then exposed through this opening on the right by gravity action by racking the patient so as to be inclined downwardly on the right by a similar angle in the range from 12 up to 18 or 20. The heart is returned to its normal position following the operation by racking the heart table gently over the opposite way.

During the operation, while the heart hangs suspended beneath the heart table, the surgeon may conveniently rest his elbows on the surface of the standard operating table 11.

I claim:

1. Operating table apparatus for use in gravity exposure operations comprising first and second spaced platforms in a common plane, said platforms having a width of from to inches, a narrow bridge member extending longitudinally between said platforms, said bridge member being detachable from one of said platforms and telescoping within the other platform, first and second pairs of legs depending from opposite sides of said first and second platforms, respectively, each of said legs including a foot portion adapted to rest upon the top surface of an operating table for supporting said platforms, and an arm portion extending outwardly and downwardly from each leg below the level of the foot portion thereof,

each arm portion being adapted to be clamped to theside of the operating table for stabilizing the position of the leg, and a supporting element extending down from at least one of said platforms adapted to rest upon the top surface of an operating table for applying supporting force to said platform at a point near to the juncture with said bridge member.

2. An operating table for use in the performance of gravity exposure operations on the heart and comprising an upper table, a lower supporting table, a rotating device and a support base, said upper'table having head and foot portions joined by a narrow connecting member, said upper table being mounted on and above said supporting table and said head and foot portions being narrower than said supporting table, said supporting table being rockably attached to said support base whereby said support table and upper table may be rotated about a longitudinal horizontal axis with respect to said base so that the plane of the top of said upper table is inclined with respect to the horizontal plane of said support base.

3. An operating table for use in the performance of gravity exposure operations onthe heart comprising a pair of operating support platforms at each end having a narrow bridgemember spanned therebetween and control means for rotating said pair of operating support plat forms and bridge member about their longitudinal axis.

4. An operating table for use in the performance of gravity exposure operations in the chest for supporting the patient face down comprising first and second spaced platforms in a common plane, a narrow bridge member extending between said platforms and adjustably secured to and telescoping within one of said platforms for adjusting the spacing between said platforms, and control means for rotating said first and second platforms and said narrow bridge member about a longitudinal axis for lowering one side of the table with respect to the other side, thereby to facilitate the gravity exposure.

5. An operating table for use in the performance of gravity exposure operations of the heart comprising an upper operating platform having a substantial reduced central portion therein, side supporting legs being attachable to clamps positioned along a second table set be neath said upper table, support means for said second table, and a control mechanism for rotating said second table attached thereto, said upper operating table being spaced from said second table by said side legs.

6. An operating table for use in the performance of gravity exposure operations as defined in claim 5 and including additional support members for said upper table adjacent said central portion and in load-bearing contact with said second table.

References Cited in the file of this patent UNITED STATES PATENTS 1,042,252 Myers Oct. 22, 1912 1,882,121 Collins Oct. 11, 1932 2,556,362 Crumpler June 12, 1951 2,660,495 Schwalbe Nov. 24, 1953 OTHER REFERENCES Tower Co., 'Inc., P.0. Box 3181, Seattle 14, Wash, Feb. 21, 1951.

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