HK1240803B - Organizer for surgical instruments and items used during surgery - Google Patents

Description

Organizer for surgical instruments and items used during surgery

Technical Field

An organizer for holding surgical instruments in an operating room.

Background Art

1. Field: Organizer used to hold surgical instruments in operating room.

2. Related Applications: This patent claims priority to the following utility patent applications: Application No. 14/509,986, filed on October 8, 2014, entitled "Organizer for Surgical Tools and Items Used During Surgery." Application No. 14/685,465, filed on April 13, 2015, entitled "Organizer for Surgical Instruments and Items Used During Surgery." Application No. 14/798,327, filed on July 13, 2015, entitled "Organizer for Surgical Instruments and Items Used During Surgery." Applicant claims priority based on these applications. These applications are incorporated by reference.

3. General Background and State of the Art: Surgeons and their staff require that instruments and other items used during surgery be readily accessible and well-organized. Time spent searching for lost instruments adds significant time to surgery. This is undesirable for patients because delays increase the length of surgery and the time spent under anesthesia.

Increasing the time required for each surgery is also detrimental to the surgeon (along with the physicians and staff) and the hospital or surgery center. Surgeons and other physicians and staff are in high demand and often perform many procedures each day. Adding time to each surgery can result in the cancellation of one or more surgeries each day or force surgeries scheduled for one day to be postponed to the next or later day.

For hospitals and surgery centers, delays are compounded for each surgical team. Many hospitals' operating rooms are underutilized. This fact alone causes delays in patient surgery scheduling. Furthermore, if some or all operating rooms handle fewer than one surgery per day, hospital efficiency decreases, thus increasing costs. Because fully equipped operating rooms are very expensive, adding more is costly. On the other hand, if any operating rooms are added but unused, less revenue is generated to cover operating room and other hospital expenses.

Increased costs and decreased efficiency aren't the only concerns. At the end of each procedure, the surgical team must inventory all instruments. For example, if a surgeon starts with 15 forceps and leaves five unused at the end of the procedure, the remaining ten must be accounted for. Otherwise, the missing forceps could be inside the patient. More likely, it could be hidden on the operating table or dropped on the floor. While finding the forceps might not be difficult and might not take an inordinate amount of time, the time spent typically adds up across every operating room, hospital, or even multiple hospitals.

Summary of the Invention

An organizer for holding surgical instruments includes a tray with a recess extending downward from the tray's top surface. The recess forms an instrument port. The shape of each instrument port corresponds to the shape of a specific surgical instrument. For example, the instrument port for scissors has two circular areas that accommodate the finger openings of the scissors, a rectangular area extending from the circular areas, and a narrow area corresponding to the tip of the scissors. Similarly, the instrument port for a scalpel has a tapered length corresponding to the handle and a narrower area for the blade.

The depth of each instrument port corresponds to the height of the stack of surgical instruments the surgeon plans to use. For example, if a particular procedure typically uses three scalpels, the depth of the scalpel port will accommodate three scalpels. If another type of procedure uses more than three scalpels, the port will be deeper. Alternatively, more than one instrument port can be used, with the scalpels divided between the ports.

The top of the stack can be aligned with the top surface of the tray, or multiple stacks should be placed at the same short distance below that surface. After surgery, used instruments are returned to their respective instrument ports. This allows for a quick check to determine whether the instrument ports are full. If any instrument port is not full, an instrument is missing, alerting operating room staff to the need to locate the missing instrument.

Alternatively, a set of complementary instrument ports can be provided. Each instrument port in the complementary set has the same or nearly the same shape and depth as one of the first-mentioned instrument ports. After a surgical instrument is used, it is placed in the appropriate instrument port in the complementary set rather than being returned to the first-mentioned instrument port.

The tray can have a locking rod at the top or upper surface of the tray that extends above each instrument port. In the locked position, instruments cannot be added to or removed from the instrument ports. The rod can be pivoted or otherwise moved to a position that does not cover the instrument ports so that instruments can be removed from or added to the instrument ports. When the rod extends above the instrument ports, if the ports are full, the rod will rest on the top instrument in the instrument ports. Seeing the contact between the rod and the top instrument allows you to quickly see if the instrument ports are full. If a surgical instrument is lost, the distal end of the locking rod may be offset to protrude upward to alert the operator that the instrument is missing.

If instruments are returned to their instrument ports or initially empty ports after surgery, each instrument port containing a used instrument should contain the same number of instruments as the port that was filled at the start of the surgery. If one or more instruments are missing from an instrument port, the locking bar intersects with the structure of the tray adjacent to the instrument port, causing the end of the locking bar to protrude relative to the surface of the tray. This allows for quick verification of whether all instrument ports are filled because all surgical instruments have been returned to their respective recesses.

Plastic (a potential material for the tray) is not a good conductor of heat. If the surgical instruments in the instrument port are to be sterilized by high-temperature, pressurized steam in an autoclave, the plastic of the instrument port may prevent adequate sterilization of the surgical instruments. If the instrument port is not solid, the high-temperature steam can reach the surgical instruments, allowing them to be sterilized. To make the port walls non-solid, they can be formed from spaced-apart plastic strips or arms. Perforating the port walls with sufficiently open spaces will also allow steam to reach the instruments.

To further assist operating room staff, a portion or the entire top of the locking lever can be colored green or another color so that when the locking lever is in the closed position over an instrument, the surgeon or staff can see that the lever is closed. Similarly, a portion or the entire opposite side of the locking lever can be colored red or another color different from the first side of the locking lever. Thus, when the instrument is in use and the locking lever is in the open position, the red color will be visible. At the end of the procedure, when all the locking levers are completely flush with the tray and green is shown above each instrument port, the operating room staff can be sure that all instruments have been accounted for. Instead of color, the top and bottom of the locking lever can have contrasting symbols.

Alternatively, the organizer can include a locking plate that pivots about an axis perpendicular to the top surface of the tray. In the unlocked orientation, the locking plate clears the surgical instruments in the instrument ports. Pivoting the locking plate about its axis moves a portion of the locking plate over the topmost surgical instrument to lock the instruments in the instrument ports. The locking plate can be pivoted into a small cavity at the top surface of the tray. Pivoting the locking plate into the cavity unlocks the instruments in the instrument ports and covers the top surface of the cavity. The top surface of the cavity is colored to indicate whether the locking plate is locked. That is, if the color of the cavity is visible, the locking plate is locked. If the user cannot see the color, the locking plate is unlocked. Thus, after all instruments have been returned to their appropriate instrument ports and all locking plates are locked, the color of each lock should be visible.

A spring may be mounted below the bottommost instrument to push the instrument upward toward or above the top surface of the tray. A plunger may be mounted adjacent to the instrument port. A base extending from an upright portion of the plunger extends below the bottommost instrument in the instrument port, and a spring is mounted below the base of the plunger. When at least one instrument is removed from the port, the spring pushes the plunger upward so that the top of the upright portion of the plunger extends above the top of the tray. After surgery, and after all instruments have been returned to their respective instrument ports, it can be determined whether any instruments are missing because the top of at least one plunger extends above the top surface of the tray.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of one aspect of a tray showing an instrument in an instrument port.

2 is a plan view of one version of the tray showing the instruments in the instrument ports.

3 is a side cross-sectional view of one aspect of the tray, taken along plane 3 - 3 of FIG. 2 .

4 and 5 are cross-sectional views of one instrument port at the top surface of the tray.

6, 7, 8 and 9 are perspective views of one instrument port at the top surface of the tray showing the locking lever in different orientations.

10 is a perspective view of a second version of the tray showing an instrument in the instrument port.

11 is a perspective view of a second aspect of the tray showing one portion of the tray folded relative to another portion of the tray.

12 is a perspective view of a second aspect of the tray showing one portion of the tray fully folded relative to another portion of the tray.

Figure 13 is a plan view of a second version of the tray in its "open" configuration.The figures show the instrument in the instrument port.

14 is a side cross-sectional view of the second version of the tray, taken along plane 14 - 14 of FIG. 13 .

15 , 16 and 17 are cross-sectional views of a portion of the instrument port showing detail 15 of FIG. 14 .

18 is a cross-sectional view of a portion of the instrument port taken along plane 18-18 of FIG. 13. FIG.

19 and 20 are perspective views of one instrument port at the top surface of the tray showing the locking lever in different orientations.

10 is a perspective view of a second version of the tray showing an instrument in the instrument port.

11 is a perspective view of a second aspect of the tray showing one portion of the tray folded relative to another portion of the tray.

12 is a perspective view of a second aspect of the tray showing one portion of the tray fully folded relative to another portion of the tray.

Figure 13 is a plan view of a second version of the tray in its "open" configuration.The figures show the instrument in the instrument port.

FIG14 is a side sectional view of the second embodiment of the tray taken along the plane 14-14 of FIG13

15 , 16 and 17 are cross-sectional views of a portion of the instrument port showing detail 15 of FIG. 14 .

18 is a cross-sectional view of a portion of the instrument port taken along plane 18-18 of FIG. 13. FIG.

19 and 20 are perspective views of one instrument port at the top surface of the tray showing the locking lever in different orientations.

21 is a perspective view of the improved organizer in its closed position.

22 and 23 are perspective views of the improved tray.

FIG. 24 is a perspective view of another improved tray.

FIG. 25 is a perspective view, partially cut away, showing details of the improved instrument port.

26 and 27 are cross-sectional views taken along planes 26 - 26 and 27 - 27 of FIG. 25 .

FIG. 28 is a perspective view, partially cut away, showing a modified instrument port.

FIG29 is a cross-sectional view taken along the plane 29-29 in FIG28.

DETAILED DESCRIPTION

Tray 100 (FIGS. 1, 2, and 3) for holding surgical instruments can be made of any suitable material, such as plastic or corrosion-resistant metal, such as stainless steel, but cardboard, formed paper, and composite materials are some options. Non-metallic materials may be easier to form and less expensive than metal. The material used for the tray shown in the figures is rigid, but the material can be flexible.

The tray 100 may be disposable. However, non-disposable materials should be able to retain their shape when subjected to autoclave temperatures (100° C. at 20 psi) or any conventional temperature and pressure for a particular facility.

The tray 100 shown in the drawings has a top surface 102 and depending side walls, only three of the four being visible in the drawings, 104, 106 and 108. The tray is rectangular, but other shapes such as polygonal, circular, oval and other arbitrary shapes are acceptable.

The base of the tray 100 is open, but it can be closed. With the base open, the underside 110 of the tray ( FIG. 3 ) is accessible. See also FIG. 24 , discussed below, where the sides of the tray are open for high pressure and high temperature steam in an autoclave to reach surgical instruments.

The top surface 102 of the tray 100 has a plurality of recesses that form instrument ports for receiving surgical instruments. Eight instrument ports 120, 122, 124, 126, 128, 130, 132, and 134 are shown in the figures, but the tray can have more or fewer instrument ports. Rather than adding many instrument ports to create a potentially oversized tray, two or more trays of a desired size can be used instead of a single large tray.

Each instrument port is shaped to receive a specific instrument. For example, port 120 conforms to the shape of a scalpel 140 (FIGS. 1 and 2). Instrument port 122 receives forceps 142. Scissors 144 fit into instrument port 144, and forceps 146 fit into instrument port 126. Port 128 holds an additional forceps 148. Ports 130, 134, and 132 receive small, medium, and large needle holders 150, 154, and 152, respectively. The instrument ports may have notches 138 at appropriate locations to allow for easier gripping of the instruments.

FIG3 illustrates that the instrument port can have different depths to accommodate surgical instruments of varying sizes and quantities. For example, consider the instrument port 124 of FIG3 that accommodates scissors 144. The recess forming the instrument port includes a base 160 that depends from side walls 162 and 164. The tops of the side walls intersect shoulders 166 and 168, and the outside of each shoulder intersects a short extension 170 and 172. The extensions intersect the top surface 102 of the tray 100. The function of the space above the shoulders is discussed below.

Experienced surgeons expect to use a specific number of surgical instruments for a specific operation. Therefore, for a specific operation, the number and shape of the instrument ports for a specific instrument may vary.

Consider that the surgeon anticipates that a particular procedure will require three pairs of scissors of the size of scissors 144 in FIG. 1 . Thus, for that procedure, the depth of the instrument port is sufficient to hold three pairs of scissors—no more, no less. Similarly, if the surgeon anticipates that four pairs of forceps will be needed, the depth of the instrument port 126 is sufficient to hold four pairs of forceps 146. Because forceps are thicker than scissors 144, the instrument port 126 holding four pairs of forceps is much thicker than the instrument port 124 holding three pairs of scissors. The deepest instrument port 122 holds ten pairs of surgical forceps 142.

Leaf springs or other springs (not shown) may be used at the bottom of some or all of the instrument ports to push the instruments upwards. This arrangement may aid in gripping the topmost instruments.

A locking rod extends above the topmost instrument in each instrument port. The locking rods are similar; only locking rods 190 and 192 will be discussed. Instrument port 128 holds five forceps or surgical forceps 148 ( FIG. 4 ). Locking rod 192 is mounted on pin 198 in the space above shoulders 194 and 196. The top surface 220 of the locking rod is coplanar with the top surface 102 of tray 100. As seen in FIG. 4 , the locking rod rests on the topmost forceps.

In order to remove the instrument from the instrument port, the locking bar is pivoted to vertical or pivoted past vertical. Thus, as shown in Figures 6 and 7, the locking bar 190 is pivoted from a horizontal position (Figure 6) above the instrument port 120 and the scalpel 140 to a vertical orientation (Figure 7) about its pin (not shown). The locking bar can continue to rotate to the position of Figure 8, wherein the locking bar rests in the groove 202. In this position (and its position in Figure 6), a person moving his or her hand over the top 102 of the tray 100 will not encounter obstructions from the locking bar. The groove can also have a notch 204 that allows the insertion of a finger or instrument to pull the locking bar out of the groove. The locking bar can have a spring-loaded pin 210 that engages a detent (not shown) in the groove. This arrangement tends to keep the locking bar above the instrument until the locking bar is rotated away from the instrument.

The locking levers can have different colors on their top and bottom. For example, all or a portion of the top surface 220 ( FIG. 4 ) can be green, which will show that all the locking levers are in their locked or nearly locked ( FIG. 5 ) positions. For example, all or a portion of the bottom surface can be red, so that the red side is shown when the locking levers are open, allowing access to the instrument port 148. Symbols can replace colors.

In the accompanying drawings, the locking lever is pivoted above and away from the instrument ports. Other arrangements are possible, although they may not provide all the advantages of a pivoting locking lever. For example, the locking lever can slide in an elongated groove from a position above the instrument ports to a position spaced apart from the instrument ports. Similarly, a U-shaped fastener can be inserted into the opening adjacent to the side of each instrument port. The trays shown in Figures 10 and 25 utilize a pivoting locking plate that, in one position, obstructs the insertion and removal of instruments, but in its other position, does not obstruct the instrument ports. Other arrangements are also possible.

When the surgery begins, the surgeon or an assistant unlocks all the locking levers of the fully loaded tray 100, such as levers 190 and 200. Of course, not all locking levers need to be unlocked at the beginning, but it may be more convenient to do so. As the surgery progresses, the surgeon and his or her staff use the instruments as needed until the surgery is complete. The instruments are then returned to their original instrument ports.

When all five forceps or surgical forceps 148 are returned to the instrument port 128 and the locking bar 200 is pivoted to its locked position, the locking bar is aligned with the top surface 102 of the tray 100. See Figure 4. However, if only four forceps are returned to their instrument ports, then when the locking bar is pivoted to the locked position, the end of the locking bar is pivoted further until it contacts the shoulder 194. See Figure 5. As a result, the right side of the locking bar (Figure 5) protrudes above the top surface of the tray. This is because the pin 198 serving as a fulcrum is closer to the short side 224 of the locking bar. Thus, a person can tell at a glance or by moving their hand over the tray that at least one forceps is missing from its instrument port.

Likewise, if fewer than two scalpels 140 are returned to the instrument port 120, the locking bar 200 will not be flat. See Figure 9. One can easily tell that at least one scalpel is missing.

Thus, one advantage of having a pivoting locking lever such as lever 190 or 200 is that when the instrument ports are not filled, they are oriented to protrude above the surface 102 of the tray 100. Once an instrument is discovered missing from the tray, personnel in the operating room can search for the instrument. Since searching is a fraction of the time it takes to return the instrument to the tray, locating all used instruments is handled simultaneously and becomes more efficient.

The second version of the organizer includes a tray 300 (Figures 10, 11 and 12). The material used for the tray is similar to that of the tray 100 (Figure 1). The material of the tray shown in the figures is rigid, but the material can be flexible.

Tray 300 can be divided into at least two sections 301 and 303. The two sections shown in Figures 11 to 13 can be hinged together at 305 to allow one section to be folded over the other. Comparing Figure 11 with Figures 12 and 13, Figure 13 is open, Figure 12 is closed, and Figure 11 is between open and closed. The tray can have structure for securing the two sections in the closed position. For example, hook 311 (Figure 10) on section 303 can engage a pin, eye, or other structure (not shown) on section 301.

If the tray is plastic, the hinge 305 can be a plastic living hinge formed during injection molding. Fabric, metal or plastic or other types of hinges can be used instead of living hinges.

The tray 300 may be disposable. However, any non-disposable materials should be able to retain their shape when subjected to autoclave temperatures.

The tray 300 shown in the accompanying drawings includes a top surface 302 that is divided into surface areas 302a and 302b. The tray is rectangular, but other shapes are acceptable. The tray also has downwardly projecting side walls, only three of which 304, 306a, and 306b are visible in FIG10 . See also side wall 306c ( FIG12 ). When the tray is in its open configuration ( FIG10 ), the two portions 301 and 303 can be spaced apart along a gap 308.

The base of tray 300 can be open, but in this embodiment the base is closed. That is, panels 307a and 307b cover the base (Figures 10, 11, 12, and 14). The panels can be removable. Thus, the panels are secured to the base of the tray by screws 309 or other fasteners. Removing the panels allows access to the interior 310 of the tray (Figure 14).

Recesses in the top surface 302 of the tray 300 form instrument ports for receiving surgical instruments. Eight instrument ports 320, 322, 324, 326, 328, 330, 332, and 334 are shown in the figures, but the tray may have more or fewer instrument ports.

Positioning surgical instruments on one side or the other of surface 302 facilitates opening and closing the tray. See Figures 10 and 13, which show no instruments extending beyond hinge 305. Note that the axis of each instrument port is perpendicular to the hinge, but angling one or more of the ports can accommodate longer instruments. Similarly, orienting the ports differently can allow the tray to hold more instruments.

The shape of each instrument port conforms to the shape of a specific instrument. For example, the shape of port 320 conforms to the shape of scalpel 340 (Figures 10 and 13). Instrument port 322 receives surgical forceps 342. Scissors 344 fit into instrument port 344, and forceps 346 fit into instrument port 326. Port 328 holds additional forceps 348. Instrument ports 330, 334, and 332 respectively accept small, medium, and large needle holders 350, 354, and 352. The instrument port can have a notch at an appropriate location, such as notch 338, to allow the instrument to be more easily grasped by fingers or other instruments. See Figures 10, 13, 18, 19, and 20.

The instrument port can have different depths to accommodate different numbers of surgical instruments and instruments of different sizes. For example, consider the instrument port 324 for scissors 344 in the cross-sectional view in FIG14. The recess forming the instrument port includes a bottom 360 located at the bottom of side walls 362 and 364. The top of side wall 362 intersects with a shoulder 366, which extends into a short extension 367 that intersects with top surface 302a. Side wall 364 extends to top surface 302a.

Bases 307a and 307b have struts extending upward from the base to support the corresponding instrument ports. Only the struts for base 307a are shown in the accompanying drawings. See Figure 14, which shows struts 430, 432, 434, 436, 438, and 440. Each strut 430, 434, 438, and 440 has a base portion with a cavity at the top. See cavity 439 on base 442 in Figures 14, 15, 16, and 17. Because instrument port 322 is deeper than the other ports and extends almost to base 307a, strut 432 does not require a base portion to elevate its cavity 433 high enough to allow surgical instruments to reach near surface 302a. Thus, its cavity extends to base 307a. Because the struts, base, and cavity perform similar functions, only the structures of struts 432 and 438 will be discussed in further detail.

Each cavity contains a coil spring. See spring 448 in Figures 14, 15, 16, and 17, and spring 446 in Figure 14. Leaf springs or other types of resilient structures can replace the coil springs. In the figures, the cavities may be cylindrical to accommodate round coil springs. If other types of springs are used, the cavities can be sized to accommodate the springs. If so, the struts can be sized to accommodate cavities of different sizes and shapes.

Springs such as springs 446 and 448 extend through the base of their respective instrument ports, such as bottom 360 of port 324. The springs push upward on arm 450 of plunger 380. Similarly, spring 448 extends through an opening in base 449, where it pushes upward on arm 456 of plunger 452. The upward force from each spring pushes the surgical instrument within the respective instrument port upward toward top surface 302a or 302b.

A plunger 380 is mounted in opening 381. See Figures 10, 13, and 14. Figure 25 also shows a plunger, but will be discussed in conjunction with the discussion of that figure. A corresponding plunger is mounted adjacent each of the other instrument ports. Plunger 380 (Figure 14) includes an upright portion 382 and a base 384 at the bottom of the upright portion. The base of the plunger extends below the surgical instrument into the instrument port, with scissors 344 being the instrument in instrument port 324.

15, 16, and 17 illustrate the plunger 452 for the instrument port 328 in greater detail. The plunger includes an upright portion 454 and a base 456. The base of the plunger extends beneath the forceps 348 in the instrument port 324. When the instrument port 328 is full, i.e., contains five forceps, the locking plate 390 holds the forceps in place against the upward force from the spring 448. The locking plate is described below.

Assume that during a surgical procedure, the surgeon plans to use fifteen surgical forceps of the size of forceps 342 and 348 (Figures 14, 15, 16, and 17). Ten forceps are in port 322. Thus, for this operation, another instrument port 328 should be deep enough to hold five forceps - no more, no less. Although the scheme shown in Figure 14 divides ten forceps into one port 322 and five forceps into another port 328, the depth of each port can have a total depth of fifteen forceps, which are divided into nine and six, eight and seven, or other distributions. Similarly, if the surgeon expects to need four forceps, the depth of instrument port 326 is enough to hold four forceps 346. Because the height of the forceps is greater than the height of the forceps, the instrument port 326 that holds four forceps is deeper than the depth of the instrument port 328 that holds three scissors. The deepest instrument port 322 holds ten surgical forceps 348.

The instrument ports can be made deeper to accommodate additional surgical instruments, but when a normal number of instruments are used with the deeper ports, spacers can be installed under the instruments so that the position of the topmost instrument is similar to the position of the topmost instrument in Figure 14.

A locking rod or plate extends above the topmost instrument in each instrument port. The locking plates for all ports are similar; only locking plate 390 (Figures 15-18) will be discussed. Instrument port 328 holds five surgical forceps 348 (Figure 14). Locking plate 390 is mounted on shaft 392, which extends into shoulder 366. The top surface 400 of the locking plate is in or near the same plane as the tray's top surface 302a. In Figure 15, the locking plate is in the locked position on the topmost forceps of the five forceps. The locking plates can be semicircular. By positioning the curved or semicircular surfaces of all locking plates in their locked orientation, the tray can be inspected to determine whether all locking plates are in their locked positions. See Figure 15, where the curved side of each locking rod faces right. For larger instruments, such as the medium needle holder 354 and the large needle holder 352 (Figure 13), having more than one locking rod may be desirable. Thus, the two locking plates 391 lock the instruments. The rounded surfaces also face each other. In addition to the viewing advantages provided by the semi-circular locking plates, the rounded outer surfaces of the locking plates make it easier to slide over the topmost surgical instrument when the plates are pivoted to their locked position.

The locking plates can have one or more stops (not shown) so that when each locking plate reaches a locked or unlocked position, the locking plate stops in that position. The stops can also provide tactile feedback whether the locking plate is locked or unlocked. The locking plates can also have markings such as arrows or other distinctive graphics. Similarly, the opposite sides of the locking plates can have contrasting colors. The markings or contrasting colors make it easier to determine whether all the locking plates are locked.

When a person wishes to remove an instrument from the instrument port, he or she rotates locking plate 390 from the position of Figure 15 to the position of Figure 16. See also Figures 19 and 20, which illustrate locking plate 394 interacting with a scalpel 340 in instrument port 320a. When the locking plate is in the position of Figure 19, it is above a portion of the uppermost scalpel 340 and blocks removal of the instrument from instrument port 320. In the position of Figure 20, the locking plate is pivoted out of contact with the scalpel, allowing removal of the scalpel.

Locking plates, such as plate 394, prevent surgical instruments from falling out of the instrument port as the tray halves 301 and 303 are moved between their open and closed positions.

Before the procedure begins, the instrument ports are loaded with the correct number of appropriate instruments, and all locking plates are rotated to a locked orientation. Thus, each instrument is secured in its corresponding instrument port. The surgeon or assistant opens all locking plates, such as plate 390, of the fully loaded tray 300. Of course, not all locking plates need to be opened at the outset, but doing so may be more convenient.

When the locking plate is pivoted to its unlocked orientation, spring 448 raises instrument 348 and plunger 452. Compare Figures 15, 16, and 17. As the plunger rises, the top of upright portion 454 protrudes to a position flush with or nearly flush with surface 302a (Figure 16), and then to a position above the surface (Figure 17). Side walls 363 and 365 form instrument port 328, and side wall 365 has a slot 369 that receives arm 456 of plunger 452. The top of the slot limits the distance the plunger can move upward. Thus, as shown in Figure 17, the top of the plunger extends above surface 302a.

As the operation progresses, the surgeon and his or her staff use the instruments as needed until the operation is completed. The instruments are then returned to their original, corresponding instrument ports. If surgical instruments of the same type and size fit into two or more instrument ports, the instruments can be returned to any appropriate port. When the correct number of instruments are returned to the appropriate instrument ports, the top of each plunger is retracted from above the top surface 302a. Thus, when all five surgical forceps 348 are returned to the instrument port 328 and the locking plate returns to its locked position, the top of the plunger 452 is pushed below the top surface 302a.

If fewer than five forceps 348 have been returned to the instrument ports 328, the tops of the plungers 452 remain above the top surface 302a. If a person refilling the tray 300 after surgery sees any plungers extending above the top surfaces 302a or 302b, they will know that at least one instrument has not been returned to the tray. However, if all the plungers are retracted, the user will know that all the instrument ports have been refilled. Thus, all instruments in the tray before surgery have been returned to the tray 300 and none have been lost.

The top of each plunger can be colored to contrast with the color of the top surfaces 302a and 302b to make visual inspection easier. In addition, the surgeon or staff can slide their hand over the top surface to find the position of the plunger extending above the top surface. If it is not felt, the instrument port is filled again and all instruments are returned to the tray. If a protruding plunger is felt after all instruments are reloaded, it will be known in time that the instrument has not been returned. When this happens, those in the operating room can search for the instrument. Because the search can occur simultaneously with the return of the instrument to the tray, the location of all used instruments can be found at the same time and become more efficient.

21, 22 and 23 show an organizer comprising a tray 1000. The material of the tray may be similar to that of trays 100 and 300 (FIGS. 1 and 10). The material used for the trays shown in the figures is rigid, but the material may be flexible.

The tray 1000 can be divided into at least two parts 1001 and 1003. The two parts can be hinged together at 1005 to allow one part to be folded over the other into a closed position. See Figure 21. The tray can include a lock or other structure for securing the two parts in the closed position.

If the tray is plastic, the hinge 1005 can be a plastic living hinge, a type of hinge formed during injection molding. Fabric, metal or plastic or other types of hinges can be used instead of living hinges.

The tray 1000 may be disposable. However, any non-disposable materials should be able to retain their shape when subjected to autoclave temperatures.

Portion 1001 of tray 1000 includes top surface 1002A. Portion 1003 also includes top surface 1002B. The tray and its portions are rectangular, but other shapes are acceptable. The tray also has downwardly projecting sidewalls, only three of which, 1004, 1006A, and 1006B, are visible in Figures 22 and 23. When the tray is open (Figures 22 and 23), the two portions 1001 and 1003 can be separated by a gap 1008.

Recesses in the top surfaces 1002A and 1002B of the tray 1000 form instrument ports for receiving surgical instruments. Portion 1001 in Figures 22 and 23 has eight first instrument ports 1020, 1022, 1024, 1026, 1028, 1030, 1032, and 1034, and portion 1003 has eight additional second, complementary instrument ports 1021, 1023, 1025, 1027, 1029, 1035, 1031, and 1033. The tray may have more or fewer instrument ports depending on the specific surgical requirements.

In the preceding paragraphs, "complementary" means that each second instrument port in portion 1003 has substantially the same shape and depth as the corresponding first instrument port in portion 1001. See Figures 22 and 23. Thus, instrument ports 1021 and 1023 have substantially the same shape and depth as corresponding ports 1020 and 1022 for holding a scalpel and forceps, respectively.

The instrument port may have notches, such as notches 1038 and 1039, at appropriate locations to facilitate grasping of the instrument by fingers or an instrument.

The instrument port can have different depths to accommodate different numbers of surgical instruments and instruments of different sizes. The discussion of this application with respect to Figures 3 and 14 has described the depth of the instrument port relative to the thickness of the surgical instruments and the height of a predetermined number of those instruments. Because these descriptions are complete, Figures 22 and 23 do not illustrate the varying depths of their instrument ports. In addition, Figure 14 shows an arrangement that includes a spring that pushes the surgical instruments toward the top of the tray. The apparatus shown in Figures 22 and 23 can utilize this arrangement.

A locking rod extends above the topmost instrument in each instrument port. In the embodiment of FIG. 1 , a locking rod, such as rod 190, is mounted to pivot onto or away from the top of each instrument port. In the embodiment of FIG. 10 , a locking rod, such as plate 390, slides or pivots over at least a portion of each instrument port. FIG. 22 and 23 use the locking rod 190 shown in FIG. 1 . However, it is possible to use the locking rods of the embodiment of FIG. 10 or an equivalent.

When a surgical procedure begins, a tray 1000 containing sterile surgical instruments is in the operating room. Eight instrument ports 1020, 1022, 1024, 1026, 1028, 1030, 1032, and 1034 in section 1001 are loaded with a predetermined number of surgical instruments for each instrument port. The other eight instrument ports 1021, 1023, 1025, 1027, 1029, 1031, 1033, and 1035 in section 1003 are initially empty. The top surfaces of sections 1001 and 1003 can be different colors or have markings that distinguish sections with instrument ports containing unused surgical instruments from sections with empty instrument ports.

When the procedure begins, the locking lever is pivoted or moved to a position that allows the corresponding instrument port in the first part 1001 to be taken out of the surgical instrument. The instrument that the surgeon needs is taken out from its instrument port and is provided to the surgeon. For example, Figure 23 shows surgical forceps 1042 taken out from instrument port 1022, and then after use, the forceps are returned to instrument port 1021. After the surgeon has finished using each specific instrument, the instrument is returned to its appropriate complementary instrument port 1021, 1023, 1025, 1027, 1029, 1031, 1033 or 1035 in part 1003. Returning the surgical instrument to the appropriate instrument port can be done immediately after the surgeon has finished using it. Otherwise, the instrument is put aside and put into its appropriate instrument port later.

When the procedure begins, the instrument ports in section 1003 are empty (Figures 22 and 23). However, the instrument ports can be in different locations. For example, loading port 1020 can be adjacent to empty port 1021, and loading port 1022 can be adjacent to empty port 1023. The empty ports can be rotated relative to the loading ports. Alternatively, some of the empty instrument ports can be on one side of section 1001, and the remaining empty instrument ports can be on the other side of the section. Other arrangements of instrument ports and sections are possible.

The various locking rod structures for the instrument ports on section 1003 should be flat only when the instrument ports have all the appropriate surgical instruments. Additionally, the locking rods can have different colors or markings on their faces. The appropriate color or marking indicates a filled instrument port. The device can also utilize a plunger arrangement such as that shown in Figures 15, 16, and 17.

The sides and bottom of an instrument port, such as instrument port 120 (FIGS. 1 and 2), surround the surgical instruments, leaving only the top of the port open. In particular, if the organizer is plastic, which is not a good conductor of heat, the high-pressure steam in the autoclave may not adequately sterilize the instrument port and the surgical instruments therein. FIGURES 25 through 29 illustrate variations of the instrument port, and FIGURE 24 illustrates a variation of the organizer that increases steam access to the instruments and port.

In Figures 25, 26, and 27, the top surface 1102 of the tray 1100 has recessed portions forming instrument ports for receiving surgical instruments. Figure 25 shows only one such port 1120, which is shaped to receive a scalpel. Compare this to the ports 120 in Figures 1 and 2. The instrument ports 1120 may have notches 1138 at appropriate locations to allow fingers or tools to enter the ports for removal of surgical instruments.

Instead of a continuous bottom and side, the instrument port 1120 is open to allow steam from the autoclave to reach the surgical instruments in the port. See Figures 25 and 27. The instrument port 1120 is opened by using a grid of support members 1118. The support members include horizontal supports 1122, each of which is flanked by vertical supports 1124 and 1126 that extend from the ends of the horizontal supports to the top surface 1102.

Figures 25 and 26 show four support members 1118, but the device can have more or fewer support members. Connector 1132 extends between the support members by attachment to horizontal support member 1122. Vertical legs 1128 and 1130 extend upward from connector 1132 at the front and rear of the instrument port. Note that the lengths of the horizontal supports vary from the front to the rear of the instrument port (Figure 25) to accommodate surgical instruments of different widths. Horizontal support member 1122, vertical support members 1124 and 1126, connector 1132, and vertical legs 1128 and 1130 can be a single, integral component. However, in Figure 25, a housing 1140 for the spring and plunger (described below) divides the integral component into two parts.

Alternatively, a solid bottom surface attached to the vertical legs can replace the horizontal supports. The solid surface can also have openings to allow steam to enter. This arrangement can provide acceptable sterilization. Similarly, the horizontal supports can extend between the bottoms of the solid side walls (with or without openings for steam), allowing steam to enter the instrument port through the top and bottom of the instrument port (as well as any openings in the solid side walls).

The use of a support member such as support member 1118 ( FIG. 25 ) leaves plenty of room for high-pressure steam to reach the surgical instruments. However, other arrangements may be desirable. For example, the wall forming the instrument port can be nominally solid, with perforations or other openings through the wall. A screen-like material can accomplish the same function. Similarly, spaced-apart plastic strips can be formed to form the same shape as the solid walls in FIG. 1 and 2 , as well as in other figures. The spacing between the strips allows the high-pressure steam to reach the surgical instruments. For strength, short fasteners can connect adjacent strips.

The instrument port in Figure 25 uses a spring-plunger arrangement similar to the spring and plunger in Figures 14 to 20. The spring elevates the surgical instrument within the corresponding instrument port, making it easier to reach. The plunger is used to signal that the corresponding instrument port contains all of its instruments or that some instruments are missing from the port.

A spring, such as spring 1146, is mounted in housing 1140 below instrument port 1120. See Figure 26. A small plate 1148 is attached to the top of the spring and contacts the bottom-most surgical tool 1142. The spring pushes plate 1148 upward, which in turn pushes the surgical instrument upward.

Plate 1148 also extends to plunger 1180 ( FIG. 25 ). The plate and plunger can be a single component. The plunger fits into opening 1181 , which conforms to the shape of the plunger (which is circular in FIG. 25 ). By pushing plate 1148 upward, spring 1146 also pushes plunger 1180 upward.

FIG25 also shows a locking plate 1190 adjacent to the instrument port 1120. In the position of FIG25 , the locking plate resists the upward force from the spring 1148 to hold the surgical instrument in place. Thus, the locking plate hinders the insertion or removal of surgical instruments from the instrument port. The locking plate has a semicircular shape. Pin 1192 mounts the locking plate to the spring-plunger housing 1140. The top of the tray 1102 has a cutout 1194 that can accommodate most of the locking rod when the locking rod is rotated 180° from its position in FIG25 . In this rotated position, surgical instruments can be added to or removed from the instrument port. The curved or semicircular sides of the locking plate allow viewing of all the locking plates to determine whether all the locking plates are in their locked positions.

The top surface 1202 of the tray 1200 in Figures 28 and 29 has recesses forming instrument ports for receiving surgical instruments. Figure 25 shows only one such port 1220, which is shaped to receive a scalpel. The instrument port 1220 may have notches 1238 at appropriate locations to allow fingers or tools to enter the port for removal of surgical instruments from the port.

Like the port in FIG25 , instrument port 1220 is also open to allow steam to reach the surgical instruments in the port and the material forming the port. See FIG28 . Instrument port 1220 has a grid of support members 1218. The support members include horizontal supports 1222, each of which is flanked by vertical supports 1224 and 1226 extending from the ends of the horizontal supports to the top surface 1202.

Instead of using the pivoting locking plate 119 used in the apparatus of FIG. 25 , a locking lever 1290 can be used. The construction and installation of the locking lever are similar to those of the locking lever 190 of FIG. 1 . Specifically, the locking lever is mounted on a pin 1294 in a recess 1292. See FIG. 28 and 29 . The locking lever can pivot between a position above the recess 1220 that prevents surgical tools from being added to or removed from the recess, and a position that allows surgical tools to be added or removed.

In addition to the improvements to the instrument ports and associated structure of Figures 24 to 29, tray 1100 (Figure 24) has open sides 1103, 1104, 1105, 1106, and other sides not visible in Figure 24. The open sides improve sterilization by allowing high pressure steam to more easily reach the instrument ports and surgical tools.

Although only Figures 24 to 29 show the side portion that opens and the instrument port that opens, the organizer shown in other figures also can use these features.Even if the organizer uses the same instrument port that is used to distribute instruments and returns instruments after surgery, those organizers also can use the side portion that opens and the instrument port that opens.

This description is illustrative, not restrictive, and is provided by way of example only. Although examples are shown and described herein, it will be apparent to those skilled in the art that changes, modifications, or variations may be made. Many of the examples relate to specific combinations of methods, actions, or system elements, but these actions and elements may be combined in other ways to achieve the same goals. Actions, elements, and features discussed in connection with only one embodiment are not intended to be excluded from similar functions in other embodiments.

"Multiple" means two or more. A "group" of articles may include one or more such articles. The terms "comprise", "include", "carry", "have", "contain", "involve", etc. in a written specification or claim are open-ended, i.e., each means "including but not limited to". Only the transitional phrases "consisting of..." and "consisting essentially of..." regarding the claims are closed or semi-closed. The ordinal numbers of the elements modified for protection in the claims, such as "first", "second", "third", etc., do not themselves imply any priority, precedence or order of the time sequence in which one element for protection is performed relative to another or the method action. Instead, they are merely used as labels to distinguish a claimed element with a certain name from another element with the same name (but for ordinal terms). Alternatively, terms such as "or" include any combination of the listed items.

Claims (14)

1. A tissue holder for holding surgical instruments, comprising: A tray with a top surface; The tray contains a plurality of recesses that form instrument openings whose shape corresponds to the external shape of the instrument; Each instrument port is configured to have a depth corresponding to the height of a predetermined number of such instruments, with at least one instrument port being deeper than at least one other instrument port. At least a first locking lever is located on the upper surface of the tray adjacent to the first instrument port and is configured to move between a first position covering a portion of the first instrument port and a second position away from the first instrument port, such that in the first position the first locking lever prevents the removal of a tool from the first instrument port and the addition of a tool to the first instrument port, and such that in the second position the first locking lever allows the removal of a tool from the first instrument port and the addition of a tool to the first instrument port. The first locking lever is pivotally mounted on a pin and has a short portion extending from the pin and a long portion opposite the short portion. When the first locking lever returns to a first position and its corresponding instrument port contains a specific number of tools less than the predetermined number, the pin acts as a fulcrum and causes the short portion of the first locking lever to protrude above the pin. 2. The tissue applicator of claim 1, further comprising at least a second locking lever located on the upper surface of the tray adjacent to a second instrument port, the second instrument port being spaced apart from the first instrument port, the second locking lever being configured to move between a first position covering a portion of the second instrument port and a second position away from the second instrument port, such that in the first position the second locking lever prevents removal of a tool from the second instrument port or addition of a tool to the second instrument port, and such that in the second position the second locking lever allows removal of a tool from the second instrument port and addition of a tool to the second instrument port. 3. The tissue of claim 1, further comprising at least one first locking plate on the upper surface of the tray, the first locking plate being pivotally mounted about an axis substantially perpendicular to the upper surface of the tray between a first position covering a portion of the first instrument port and a second position not covering the first instrument port. 4. The tissue applicator of claim 3, wherein the first instrument port has at least one shoulder extending from the first instrument port, the shoulder being positioned within a distance below the lower surface of the tray, and the first locking plate is mounted on the at least one shoulder. 5. The tissue applicator of claim 1, further comprising a plunger mounted in the tray adjacent to an instrument port, the plunger having an upright portion and a base, the upright portion having a longitudinal axis substantially perpendicular to the top surface of the tray, the base being substantially perpendicular to the upright portion, the upright portion of the plunger being below the top surface of the tray when the first instrument port contains a predetermined number of surgical instruments pushed together thereon, the base of the plunger extending into the first instrument port below all surgical instruments thereon, a spring mounted in the tray being operatively connected to the plunger, the spring pushing the plunger toward the top surface of the tray such that when the tray contains fewer than the predetermined number of surgical instruments, the upright portion extends above the top surface of the tray. 6. The tissue applicator of claim 1, wherein each instrument port has a sidewall and a bottom, the tissue applicator further comprising a tray base spaced from the top surface of the tray, a strut mounted on the tray base and extending to the bottom of the instrument port, the strut having a cavity and a spring within the cavity. 7. The tissue applicator of claim 1, wherein each instrument port has a sidewall and a bottom, the tissue applicator further comprising a tray base spaced from the top surface of the tray, a strut mounted on the tray base and extending to the bottom of the instrument port, the strut having a cavity, the tissue applicator further comprising a plunger mounted in the tray adjacent to the instrument port, the plunger having an upright portion and a base, the upright portion having a longitudinal axis generally perpendicular to the top surface of the tray, the base being generally perpendicular to the upright portion, the upright portion of the plunger being below the top surface of the tray when the first instrument port contains a predetermined number of surgical instruments pushed together, the base of the plunger extending into the first instrument port below all surgical instruments in the first instrument port, a spring mounted in the cavity and operatively connected to the plunger, the spring pushing the plunger toward the top surface of the tray such that when the tray contains fewer than the predetermined number of surgical instruments, the upright portion extends above the top surface of the tray. 8. The tissue applicator of claim 1, wherein at least a first instrument port is formed by spaced-out supports, each spaced-out support including a bottom arm spaced from the top of the instrument port, each spaced-out support further including a side arm extending from the bottom arm toward the top of the instrument port. 9. The organizer of claim 8, further comprising a connector that attaches at least two of the spaced supports together. 10. A tissue device for holding a surgical instrument having a specific shape and height, comprising: Multiple recesses are formed to form instrument ports, each instrument port having a top, the instrument ports extending downward from their respective tops, and the shape of each instrument port corresponding to the external shape of a specific surgical instrument. Each instrument opening is configured such that its depth corresponds to the height of a specific stack of instruments, and the depth of at least one instrument opening differs from the depth of at least one other instrument opening, and the depth of each instrument opening maintains a predetermined number of specific instruments. At least a first locking lever is provided, adjacent to the top of a first instrument opening and mounted for movement between a first position covering a portion of the first instrument opening and a second position not covering the first instrument opening. The recess forms the first instrument opening, which has at least one shoulder extending from it, the shoulder positioned within a distance below the top of the first instrument opening such that the first locking lever is aligned with the top of the first instrument opening when the first instrument opening contains the predetermined number of specific instruments, and is not aligned with the top of the first instrument opening when the first instrument opening contains fewer or more specific instruments than the predetermined number. 11. The tissue of claim 10, wherein the first locking lever is mounted for pivoting on a pin, the pin dividing the first locking lever into two unequal short and long portions, wherein when the first locking lever returns to a first position and its corresponding instrument port contains a specific number of instruments less than a predetermined number, the pin acts as a fulcrum and causes the short portion of the first locking lever to protrude over the pin. 12. The tissue of claim 10, further comprising at least a first locking lever at the top of the first instrument port and configured to move between a first position covering a portion of the first instrument port and a second position away from the first instrument port, such that in the first position the first locking lever prevents removal of an instrument from the first instrument port and addition of an instrument to the first instrument port, and such that in the second position the first locking lever allows removal of an instrument from the first instrument port and addition of an instrument to the first instrument port. 13. The tissue applicator of claim 10, further comprising at least a second locking lever located on the upper surface of the tray adjacent to a second instrument port, the second instrument port being spaced apart from the first instrument port, the second locking lever being configured to move between a first position covering a portion of the second instrument port and a second position away from the second instrument port, such that in the first position the second locking lever prevents removal of a tool from the second instrument port or addition of a tool to the second instrument port, and such that in the second position the second locking lever allows removal of a tool from the second instrument port and addition of a tool to the second instrument port. 14. An organ for holding surgical instruments having a specific shape and height, comprising: Multiple recesses are formed at the instrument opening; Multiple first instrument ports, each having a top, the first instrument ports extending downward from their respective tops, the shape of each first instrument port corresponding to the external shape of a particular first surgical instrument; Each first instrument port is configured such that its depth corresponds to the height of a specific stack of first instruments, and the depth of at least one first instrument port is different from the depth of at least one other first instrument port. Multiple second instrument ports, each having a top, the second instrument port extending downward from its respective top, the shape of each second instrument port corresponding to the external shape of a specific second surgical instrument; Each second instrument port is configured such that its depth corresponds to the height of a specific stack of second instruments, and the depth of at least one second instrument port is different from the depth of at least one other second instrument port. Each second instrument port is configured to have a depth corresponding to the depth of a specific first instrument port, wherein the depth of each instrument port maintains a predetermined number of specific instruments; At least a first locking lever is provided, adjacent to the top of a first instrument opening and mounted for movement between a first position covering a portion of the first instrument opening and a second position not covering the first instrument opening. A recess forms the first instrument opening, which has at least one shoulder extending from it, the shoulder being positioned within a distance below the top of the first instrument opening such that the first locking lever is aligned with the top of the first instrument opening when the first instrument opening contains the predetermined number of specific instruments, and is not aligned with the top of the first instrument opening when the first instrument opening contains fewer or more specific instruments than the predetermined number.