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ES2951168T3 - Retractor de heridas con anillo exterior multisegmento - Google Patents

Retractor de heridas con anillo exterior multisegmento Download PDF

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ES2951168T3
ES2951168T3 ES16784680T ES16784680T ES2951168T3 ES 2951168 T3 ES2951168 T3 ES 2951168T3 ES 16784680 T ES16784680 T ES 16784680T ES 16784680 T ES16784680 T ES 16784680T ES 2951168 T3 ES2951168 T3 ES 2951168T3
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outer ring
rigid
segment
retractor
segments
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Jeremy Albrecht
Matthew Becerra
Eric Nguyen
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Applied Medical Resources Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0293—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors with ring member to support retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0218—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00876—Material properties magnetic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00889—Material properties antimicrobial, disinfectant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00902—Material properties transparent or translucent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0218—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for minimally invasive surgery
    • A61B2017/0225—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3435—Cannulas using everted sleeves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3443—Cannulas with means for adjusting the length of a cannula
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)
  • Gyroscopes (AREA)
  • Golf Clubs (AREA)

Abstract

Un retractor/protector adecuado para su uso en una incisión quirúrgica o un orificio natural comprende un eje longitudinal que define un canal de acceso al instrumento que se extiende desde un extremo proximal hasta un extremo distal; un anillo exterior flexible; un anillo interior; una funda flexible que se extiende entre el anillo exterior y el anillo interior; y al menos un segmento rígido adaptado para unirse al anillo exterior flexible para aumentar así la rigidez del anillo exterior. Se describen realizaciones del retractor/protector que tienen segmentos rígidos entrelazados y no entrelazados. También se describen realizaciones que tienen bases que se insertan dentro o debajo del anillo exterior flexible además de o en lugar de segmentos rígidos para aumentar la rigidez y/o proporcionar soporte para una tapa desmontable. (Traducción automática con Google Translate, sin valor legal)

Description

DESCRIPCIÓN
Retractor de heridas con anillo exterior multisegmento
Campo técnico
Esta invención se refiere a retractores o protectores de heridas.
Explicación de la Técnica Relevante
Se han descrito retractores/protectores de heridas en las patentes US Números. 7.650.887; 7.727.146; 7.883.461; 7.913.697; 8.235.054. y 8.267.858. Los componentes básicos de tales retractores de heridas incluyen un anillo o anillos exteriores, un anillo interior y una funda o manguito flexible unido a cada extremo del anillo exterior e interior. El anillo o anillos exteriores del retractor de heridas pueden ser flexibles o rígidos. En general, los anillos exteriores flexibles son más cómodos y fáciles de desplegar, mientras que los anillos exteriores rígidos proporcionan una mejor retracción y, opcionalmente, sirven como plataforma para la fijación de una tapa u otros dispositivos similares. Los documentos de patente EP 2609880 A1, US 2005/155611 A1, US 2005/203346 A1 y US 2010/249694 A1 revelan retractores similares en los que el anillo exterior está soportado en uso o tiene un elemento de refuerzo. Sin embar­ go, lo que se necesita es un retractor que tenga un anillo exterior que combine la comodidad y la facilidad de des­ pliegue de un anillo flexible con la retracción y la funcionalidad de un anillo rígido.
Sumario
De acuerdo con la presente invención, se proporciona un retractor/protector como se indica en lo que sigue.
Breve descripción de los dibujos
La figura 1 ilustra una vista isométrica de un retractor de heridas ajustable.
La figura 2 es una vista en sección transversal de un retractor de heridas desplegado en una incisión.
La figura 3A ilustra una vista frontal de un retractor de heridas de acuerdo con la presente invención, que tie­ ne un sistema de anillo exterior que comprende un anillo exterior flexible con segmentos rígidos intercambia­ bles.
La figura 3B ilustra una vista superior del retractor de heridas de la figura 3A.
La figura 3C ilustra una vista en perspectiva del retractor de heridas de la figura 3A.
La figura 4A ilustra una vista superior del sistema de anillo exterior de las figuras 3A-C.
La figura 4B ilustra una vista desde la derecha del sistema de anillo exterior de las figuras 3A-C.
La figura 5A ilustra una realización alternativa del retractor de heridas de las figuras 3A-C, que se muestra en una vista frontal.
La figura 5B ilustra una vista desde arriba del retractor de heridas de la figura 5A.
La figura 5C ilustra una vista en perspectiva del retractor de heridas de la figura 5A.
La figura 6A ilustra el sistema de anillo exterior de las figuras 5A-C, mostrado en vista superior.
La figura 6B ilustra el sistema de anillo exterior de las figuras 5A-C, mostrado en vista frontal.
Descripción detallada
La figura 1 ilustra un retractor de heridas ajustable 100 útil en una variedad de procedimientos quirúrgicos. El retrac­ tor de heridas 100 incluye un anillo exterior 102, un anillo interior 104, y una funda distensible 106 que acopla el anillo exterior y el anillo interior. El anillo exterior 102 se muestra como un único anillo, pero también puede ser un anillo doble o triple o múltiplos de los mismos. En la realización ilustrada, el anillo exterior 102 comprende un eje anular alrededor del cual el anillo exterior 102 es rotativo o invertible en un proceso por medio del cual el anillo exte­ rior 102 se enrolla a través de sí mismo.
Para facilitar la enrollamiento y proporcionar una mayor comodidad, el anillo exterior 102 preferiblemente comprende un material flexible. En algunas realizaciones, el material flexible comprende uno o más polímeros, por ejemplo, plásticos de ingeniería flexibles. En algunas realizaciones, el material flexible comprende un elastómero, por ejem­ plo, un elastómero termoplástico. En algunas realizaciones, el anillo exterior 102 comprende un material compuesto, por ejemplo, un polímero y un material de refuerzo. Los ejemplos de materiales de refuerzo adecuados incluyen fibras, telas y similares, que comprenden al menos uno de entre polímero, metal, vidrio, cerámica y similares. Reali­ zaciones del anillo exterior 102 se moldean y/o se extruyen como una única pieza o como una pluralidad de piezas que se montan en el anillo exterior 102.
En la realización ilustrada, una forma de sección transversal del anillo exterior 102 es generalmente una figura de 8, o un primer círculo y un segundo círculo unidos por una red que se extiende entre ellos. El anillo exterior puede ser macizo o puede tener uno o más lúmenes dispuestos en el anillo. Otras realizaciones del anillo exterior tienen dife­ rentes formas de sección transversal, por ejemplo, generalmente ovaladas o elípticas; en forma de rombo o romboi­ dal; en forma de reloj de arena o hueso para perro; en forma de muñeco de nieve; radialmente plano (anillo exterior en forma de arandela), longitudinalmente plano (anillo exterior cilíndrico) o plano en otro ángulo (anillo exterior troncocónico); circular (anillo exterior toroidal), en forma de X, triangular, cuadrado, hexagonal, poligonal y similares. Algunas realizaciones del anillo exterior comprenden una o más superficies de agarre que facilitan el enrollamiento manual del anillo exterior alrededor del eje anular del mismo. Los ejemplos de superficies de agarre adecuadas incluyen superficies generalmente aplanadas y superficies cóncavas. Algunas realizaciones del anillo exte­ rior 102 tienen una configuración de Mobius en la que el anillo exterior 102 se fabrica con una tensión de torsión circunferencial precargada, por ejemplo, retorciendo un miembro alargado seguido por la unión de los extremos.
En algunas realizaciones huecas del anillo exterior 102, se dispone un alambre o varilla en al menos un primer lu­ men. Algunas realizaciones del anillo exterior 102 no comprenden una varilla o alambre dispuesto en un lumen del mismo. Algunas realizaciones de un anillo exterior no conforme 102 facilitan el acoplamiento directo de otro disposi­ tivo al anillo exterior 102 por ejemplo, una tapa, capuchón y/o capuchón de gel. Algunas realizaciones de un anillo exterior conforme 102 se conforman a una superficie corporal.
Volviendo a la figura 1, la funda 106 se puede acoplar al anillo exterior 102 y al anillo interior 104 mediante termosellado, adhesivo u otros medios bien conocidos en la técnica. La funda 106 puede estar hecho de un material que sea flexible e impermeable a fluidos y bacterias.
Las realizaciones de la funda comprenden láminas, membranas, fibras y/o hebras de uno o más materiales que proporcionan a la funda la resistencia a la abrasión y a la perforación. Las láminas, membranas, fibras y/o hebras adecuadas comprenden al menos uno de entre polímeros naturales, polímeros semisintéticos, polímeros sintéticos, metal, cerámica, vidrio, fibra de carbono, nanotubos de carbono y similares. Los polímeros naturales adecuados incluyen celulosa, seda y similares. Las fibras semisintéticas incluyen nitrocelulosa, acetato de celulosa, rayón y similares. Las fibras sintéticas adecuadas incluyen poliéster, poliéster aromático, poliamida (NYLON®, DACRON®), aramida (KEVLAR®), poliimida, poliolefina, polietileno (SPECTRA®), poliuretano, poliurea, cloruro de polivinilo (PVC), cloruro de polivinilideno, poliéter amida (PEBAX®), poliéter uretano (PELLETHANE®), poliacrilato, poliacrilonitrilo, acrílico, sulfuro de polifenileno (PPS), ácido poliláctico (PLA), poli(diimidazopiridinileno-dihidroxifenileno) (M-5); poli(p-fenileno-2,6-benzobisoxazol) (ZYLON®), fibra de polímero de cristal líquido (VECTRAN®), y similares, y combina­ ciones, copolímeros, compuestos y mezclas de los mismos. Los metales adecuados incluyen acero inoxidable, acero para muelles, nitinol, materiales superelásticos, aleaciones de metales amorfos y similares.
Algunas realizaciones del material de la funda comprenden un compuesto que comprende un tejido o material textil, por ejemplo, al menos uno de un tejido revestido, un tejido laminado y un tejido incrustado en un polímero. Los re­ vestimientos y/o laminaciones se disponen sobre una o ambas caras del tejido. Los revestimientos y materiales de laminación adecuados incluyen polímeros, por ejemplo, al menos uno de entre poliuretano, poliéter, PVC, cloruro de polivinilideno, silicona, estireno-butadieno, polietileno, polipropileno, copolímero de etileno-propileno, poliisopreno, etileno acetato de vinilo (EVA), etileno- monómero de propileno-dieno (EPDM), poliamida (MYLAR®), bloque de poliéter amida (PEBAX®), poliéter uretano (PELLETHANE®), compuestos, mezclas, mezclas y similares. Un ejemplo de tejido compuesto adecuado es el tejido laminado de poliuretano (PUL). Algunas realizaciones del revestimiento o laminación modifican la permeabilidad al gas y/o a la humedad a través del material de la funda, por ejemplo, contro­ lando el tamaño de los poros a través de la misma. Por ejemplo, la disminución de la permeabilidad a la humedad reduce la deshidratación del tejido retraído y/o crea una barrera para los patógenos como las bacterias. El aumento de la permeabilidad a los gases y la humedad permite hidratar y/o oxigenar el tejido retraído. Algunos materiales son permeables selectivamente a ciertos fluidos. Por ejemplo, algunas realizaciones de PVC son permeables al oxígeno e impermeables a la humedad, lo que permite oxigenar simultáneamente el tejido mientras reduce la deshidratación. Algunas realizaciones del recubrimiento o laminación comprenden un agente antibacteriano o antimicrobiano. En algunas realizaciones, el agente antibacteriano o antimicrobiano es un agente de superficie o forma parte integral del material. Los ejemplos de agentes antibacterianos o antimicrobianos adecuados incluyen yodo, antibióticos, plata, triclosán, biocidas y similares. Algunas realizaciones del revestimiento o laminación proporcionan una superficie interior más suave y/o de menor fricción, lo que reduce la probabilidad de que el instrumento dañe la funda.
Algunas realizaciones de la funda comprenden un material compuesto que comprende una película o membrana de polímero reforzado con fibra. Las fibras o hebras adecuadas se han explicado más arriba. Los materiales de película de polímero adecuados incluyen al menos uno de los materiales explicados más arriba como materiales de revesti­ miento y laminación. En algunas realizaciones, las fibras se intercalan entre capas de película de polímero. En algu­ nas realizaciones, las capas de película de polímero se seleccionan de forma independiente. Por ejemplo, en algu­ nas realizaciones, la capa exterior proporciona las propiedades deseables de contacto con el tejido que se han des­ crito más arriba, mientras que la capa interior es resistente a las punciones.
Algunas realizaciones de la funda comprenden una pluralidad de capas, por ejemplo, una capa de tela y una capa de película de polímero, o una capa de tela intercalada entre las capas de película de polímero. En algunas realiza­ ciones, las capas están aseguradas unas a las otras. En otras realizaciones, las capas son independientes o no están unidas unas a las otras, por ejemplo, una capa de película de polímero y una capa que comprende una plura­ lidad de tiras o bandas como se ha explicado más arriba.
Algunas realizaciones de la funda comprenden una capa permeable a los fluidos dispuesta sobre una capa im­ permeable a los fluidos, estando dispuesta la capa impermeable a los fluidos en el interior de la funda. La capa permeable a los fluidos entra en contacto con los márgenes de la herida, lo que permite que un usuario suministre fluido a presión y/o aplique vacío a los márgenes de la herida. Por ejemplo, en algunas realizaciones, se suministran oxígeno, humedad, agente terapéutico y/u otros fluidos a los márgenes de la herida. En algunas realizaciones, la aplicación de vacío promueve el sangrado, reduciendo así la necrosis tisular. Las realizaciones de la capa permea­ ble a los fluidos comprenden al menos una de entre espuma de celdas abiertas, telas, telas no tejidas y telas de punto.
En algunas realizaciones, al menos una parte de la funda es transparente, proporcionando así una visión del tejido retraído. En algunas realizaciones que comprenden una membrana o película de polímero, la membrana o película de polímero es transparente.
El anillo interior 104 puede estar hecho de materiales de dureza suficiente para conservar su forma después de la inserción en una cavidad del cuerpo 904 (figura 2) pero suficientemente flexible para permitir que el anillo interior sea comprimido para su inserción a través de una incisión. Los materiales de los cuales se hace el anillo exte­ rior 102 deben permitir que el anillo exterior sea rotado alrededor de su eje anular como se describirá más adelante. La forma del anillo exterior. 102 afecta tanto a su capacidad de agarre como para proporcionar estabilidad durante y después del ajuste.
La figura 2 ilustra el retractor de heridas desplegado en una abertura de herida 900. Para desplegar el retractor de heridas, en primer lugar se hace una incisión en forma de hendidura en la pared del cuerpo. 902 de un paciente, tal como la pared abdominal 902. El anillo interior 104 se comprime y el anillo interior y la funda 106 se insertan ma­ nualmente en la cavidad del cuerpo 904 a través de la incisión estando el anillo exterior restante 102 fuera de la cavidad del cuerpo. Una vez que el anillo interior 104 está dentro de la cavidad del cuerpo 904, se expande alrede­ dor de la superficie interna de la incisión 900 para ser generalmente paralelo a la superficie exterior de la pared ab­ dominal 902. La funda 106 proporciona un canal de trabajo desde el exterior de la cavidad corporal 904 al interior de la cavidad corporal.
El anillo exterior 102 descansa inicialmente sobre la pared abdominal 902 alrededor de la abertura 900 de la heri­ da . Puesto que el extremo superior de la funda 106 está acoplado al anillo exterior 102, la funda 106 se puede esti­ rar hacia arriba y radialmente hacia afuera o hacia adentro, estirando de esta manera el anillo inte­ rior 104 firmemente contra la superficie interna de la pared abdominal 902. Además, la porción intermedia de la funda 106 se estira ajustadamente contra los lados y los bordes de la abertura de la herida 900, retrayendo de esta manera el tejido adyacente y produciendo una abertura herméticamente sellada en la cavidad del cuerpo 904. La funda 106 entra en contacto con toda la superficie de la herida 900 y la cubre y la sella protectoramente contra la contaminación y la infección. Dependiendo del tamaño y la profundidad de la incisión. 900, el usuario puede enrollar la funda 106 sujetando el anillo exterior 102 y haciéndolo rotar hasta que la funda 106 se apoye en el borde exterior de la abertura de la herida 900. El anillo interior 104 está adaptado para la yuxtaposición con la superficie interior de la pared abdominal 902 y el anillo exterior 102 está adaptado para la yuxtaposición con la superficie exterior de la pared abdominal. Tanto el anillo interior 104 como el anillo exterior 102 están adaptados para la disposición relativa a la incisión 900 en la pared abdominal 902. La funda 106 está adaptada para atravesar la incisión 900 en la pared abdominal 902.
Después de la cirugía, el retractor de heridas 100 se puede retirar agarrando el anillo interior 104 y la funda 106 y tirando de ellos a través de la abertura 900 de la herida . El uso de la funda 106 y la facilidad de retraer el anillo exterior 102 proporciona una mayor compresión entre los anillos interior y exterior. Como resultado, el retractor de heridas 100 proporciona capacidad de ajuste incremental para adaptarse a una amplia gama de tamaños de incisión y aísla y protege la herida de infecciones bacterianas a medida que partes del cuerpo enfermas e instrumentos con­ taminados pasan a través de la herida.
Las figuras 3 y 4 ilustran un nuevo retractor de heridas, en el que el sistema de anillo exterior está diseñado para proporcionar al usuario tanto flexibilidad para facilitar el despliegue como rigidez para una retracción completa una vez desplegado. El sistema de anillo exterior comprende un anillo exterior flexible 800 y uno o más segmentos rígi­ dos intercambiables 802 que se puede unir al anillo flexible para proporcionar rigidez al anillo exterior mientras está en estado de reposo. Los segmentos rígidos se pueden colocar estratégicamente a lo largo de la herida retraída en la que, por ejemplo, se requiere una visualización máxima constante.
En algunas realizaciones, los segmentos rígidos están diseñados para encajar por salto elástico en el anillo exterior flexible y pueden colocarse parcial o continuamente a lo largo de la circunferencia del anillo flexible de acuerdo con la preferencia del usuario y el grado de rigidez deseado.
La figura 3A muestra una vista frontal del nuevo retractor de heridas, en el que tres segmentos rígidos 802 se enca­ jan por salto elástico en el anillo exterior 800, como mejor se ve en la vista superior de la figura 3B o en la vista auxi­ liar de la figura 3C. El experto en la técnica apreciará que el número y las dimensiones de los segmentos rígidos variarán dependiendo del uso previsto. Así, por ejemplo, los segmentos rígidos pueden tener una longitud más corta, en la que se pueden unir muchos más segmentos de este tipo al anillo exterior, o una longitud más larga, en la que se unen relativamente pocos segmentos para proporcionar un anillo exterior más rígido. Variando el número y las dimensiones de los segmentos rígidos se modulará efectivamente la rigidez del anillo exterior. De manera similar, los segmentos se pueden colocar en cualquier parte del anillo exterior para proporcionar diferentes grados de rigidez. Mientras que los segmentos rígidos mostrados en la figura 3 están colocados de manera sustancialmente uniforme alrededor del anillo exterior, los segmentos pueden colocarse en regiones del anillo exterior en las que es deseable una mayor rigidez mientras se dejan otras partes del anillo exterior más flexibles, dependiendo de los requisitos particulares del usuario. Una vista en primer plano de los segmentos rígidos 802 unido al anillo exterior 800 se muestra en la figura 4A (vista desde arriba) y en la figura 4B (vista derecha).
En la realización mostrada en las figuras 3 y 4, los segmentos rígidos son unidades independientes, no unidas unas a las otras. En una realización alternativa, como se muestra en las figuras 5 y 6, los segmentos rígidos interbloqueables 804 comprenden un resalte 806 en un extremo y un rebaje 808 en el otro, estando adaptado el rebaje para recibir el resalte de un segmento rígido adyacente para unir de esta manera los segmentos unos a los otros En la realización ilustrada, los segmentos rígidos interconectados forman un anillo completo, que cubre sustancialmente el anillo exterior 800, como mejor se ve en las figuras 5B, 5C y en la figura 6B. Se debe apreciar que el resal­ te 806 puede ser rígido, para facilitar la inserción en el hueco 808, o relativamente flexible, de manera que la forma del anillo interconectado de segmentos rígidos 804 puede adaptarse a anillos exteriores flexibles de diferentes for­ mas, por ejemplo, circulares, ovaladas, elípticas y similares. En la presente divulgación también se contemplan otros dispositivos de interbloqueo además de un resalte y un rebaje, que incluyen abrazaderas, ganchos y otros medios de enclavamiento conocidos en la técnica.
Se debe apreciar que el sistema de anillo exterior puede configurarse para tener tantos (o tan pocos) segmentos rígidos como sea necesario. Los segmentos rígidos se pueden interconectar, por ejemplo, con una configuración de resalte y rebaje, o se pueden unir al anillo exterior de forma independiente. Se debe apreciar además que proporcio­ nar rigidez al anillo exterior con una serie de segmentos discretos se adapta a una gama de diseños de vainas, tales como formas circulares, elípticas u otras formas no circulares.
Aunque ciertas realizaciones se han mostrado y descrito en particular con referencia a realizaciones ejemplares de las mismas, los expertos en la técnica entenderán que se pueden realizar varios cambios en la forma y los detalles sin apartarse de la invención tal como se define en las siguientes reivindicaciones.

Claims (7)

REIVINDICACIONES
1. Un retractor/protector que comprende:
un anillo exterior flexible (800);
un anillo interior (104);
una funda flexible (106) que acopla el anillo exterior (800) y el anillo interior (104); y
un eje longitudinal que define un canal de acceso al instrumento que se extiende a través de la funda flexible desde el anillo exterior flexible (800) en un extremo proximal hasta el anillo interior en un extremo distal (104), en el que el retractor/protector comprende además dos o más segmentos rígidos (802), cada uno de los cua­ les tiene un primer extremo y un segundo extremo, en el que cada uno de los dos o más segmentos rígidos (802) está adaptado para encajar de forma desmontable en un segmento circunferencial respectivo de una superficie exterior del anillo exterior flexible (800) de modo que cada segmento rígido (802) se extienda en una dirección circunferencial entre sus extremos primero y segundo e incrementa la rigidez de ese segmento circunferencial respectivo del anillo exterior (800).
2. El retractor/protector (100) de la reivindicación 1, en el que un primer segmento rígido (802) y un segundo seg­ mento rígido (802) son interbloqueables.
3. El retractor/protector de la reivindicación 2, en el que el primer segmento rígido (802) comprende además un rebaje (808) en el primer extremo y un resalte (806) en el segundo extremo y el segundo segmento rígido (802) comprende además un rebaje (808) en el primer extremo y un resalte (806) en el segundo extremo, estando adapta­ do el rebaje (808) del primer segmento (802) para recibir el resalte (806) del segundo segmento (804) para interblo­ quear de esta manera el primer segmento rígido (802) con el segundo segmento rígido (802).
4. El retractor/protector de cualquier reivindicación anterior, en el que los dos o más segmentos rígidos (802) se extienden solo parcialmente alrededor del anillo exterior flexible (800) para aumentar de esta manera la rigidez de los dos o más segmentos circunferenciales respectivos del anillo exterior flexible (800) en contacto con los dos o más segmentos rígidos (802), dejando al menos un segmento circunferencial restante del anillo exterior flexible (800) que no está en contacto con los dos o más segmentos rígidos (802), en el que al menos un segmento circunferencial restante permanece flexible.
5. El retractor/protector de la reivindicación 4, en el que los dos o más segmentos rígidos (802) comprenden un primer segmento rígido y un segundo segmento rígido (802) que están dispuestos de manera que pueden colocarse selectivamente en diferentes segmentos circunferenciales de la superficie externa del anillo exterior flexible (800), para dejar al menos un segmento circunferencial del anillo exterior sin segmento rígido.
6. El retractor/protector de la reivindicación 1, en el que el anillo exterior flexible (800) comprende un eje anular alrededor del cual el anillo exterior flexible (800) es rotativo o invertible.
7. El retractor/protector de la reivindicación 1, en el que los dos o más segmentos rígidos (802) están configurados para encajar solo en las partes respectivas del anillo exterior flexible (800) de modo que cada uno de los dos o más segmentos rígidos (802) pueden ser colocado estratégicamente sobre el anillo exterior flexible (800).
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