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WO1992019146A1 - Instrument chirurgical - Google Patents

Instrument chirurgical Download PDF

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Publication number
WO1992019146A1
WO1992019146A1 PCT/EP1992/000892 EP9200892W WO9219146A1 WO 1992019146 A1 WO1992019146 A1 WO 1992019146A1 EP 9200892 W EP9200892 W EP 9200892W WO 9219146 A1 WO9219146 A1 WO 9219146A1
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WO
WIPO (PCT)
Prior art keywords
instrument
handle
shaft
jaws
operative
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/EP1992/000892
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English (en)
Inventor
Andrew Michael Wild
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Publication of WO1992019146A1 publication Critical patent/WO1992019146A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A61B17/1606—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other
    • A61B17/1608—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other the two jaw elements being linked to two elongated shaft elements moving longitudinally relative to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments

Definitions

  • the present invention relates to surgical instruments.
  • Surgical instruments for use with rigid or flexible endoscopes are well known in biopsy procedures and certain types of endosurgery.
  • the telescope portion of the endoscope is generally housed within a cannula which also houses the shaft of a single surgical instrument.
  • the operative end of the instrument protrudes from the distal cannula end into the field of view of the endoscope, and is controllable from the proximal end by the surgeon.
  • SUBSTITUTE SHEET not required.
  • Systems permitting manipulation of one flexible instrument end portion in one lateral to and fro direction within the field of view are also known, for example in laser-induced Shockwave lithotripsy (LISL) or intra-vesicle electronic lithotripsy, but such systems are not suited to use in delicate or complex procedures such as endoscopic neurosurger .
  • LISL laser-induced Shockwave lithotripsy
  • intra-vesicle electronic lithotripsy but such systems are not suited to use in delicate or complex procedures such as endoscopic neurosurger .
  • a surgical instrument and endoscope support apparatus for use in endoscopic surgery, the support apparatus comprising means for retaining a telescope portion of an endoscope to permit it to extend down into an operating zone, sheath means defining two channels each extending down into the operating zone and each capable of receiving a flexible surgical instrument and guiding it to the operating zone on advancement down the channel, and instrument deflection means associated with the sheath means at the end of each channel in the operating zone, the deflection means being controllable externally of the patient for moving an operative end of the respective instrument laterally to and fro within the operating zone.
  • the sheath means may suitably be separate or conjoined rigid tubes to define the two channels.
  • the flexible instruments may be selected from laser fibres, suction tubes, flexible rongeurs and flexible scissors.
  • the apparatus may if desired define further channels and may include further deflection means.
  • the apparatus may be adapted to retain one (or, less preferably, more) additional rigid surgical instrument so as to extend down into the operating zone.
  • the deflection means suitably comprise a pair of longitudinally-extending flaps or collars each hingedly connected to the sheath means at the distal end of a respective channel and arranged to be moveable independently of each other and without interfering with each other.
  • the flaps or collars are each moved by push-pull members passing up to manual control means (e.g. conventional wheel controls) suitably provided on a fixed bridge or platform structure at the proximal sheath end. On release of the tension, the deflection means will conveniently remain in the deflected position.
  • the bridge structure mentioned above is securely fixed to the proximal end of the sheath means.
  • the bridge structure serves as a base for the push-pull control means such as mentioned above, and is provided with ports or apertures to permit the entry of the instruments and endoscope telescope into the channels or otherwise down to the operating zone.
  • the bridge structure may also include irrigation ports etc.
  • a surgical instrument for use in endoscopic surgery, the instrument having instrument control means and operative means spaced mutually apart by a shaft which is retainable in a suitable support means to extend the operative means down into an operating zone and to present the control means externally of the patient, the operative means being moveable in response to push-pull control of cable connection means extending between the operative means and the instrument control means, wherein the instrument control means comprises elongate handle means pivotally mounted to the shaft so as to be pivotable between a first and second position to effect said control.
  • the elongate handle is preferably rather wider than the instrument shaft. This is useful in enabling the pivot to be sufficiently offset from the axis of the shaft to provide the necessary leverage when operating push-pull control of the cable connection means passing down the shaft.
  • the handle is preferably ergonomically configured to permit comfortable gripping and operating by the surgeon's hand.
  • Means may be provided for releasably locking the handle at the desired degree of pivoting.
  • Actuation of the operative end of the instrument will suitably be by manipulation of additional actuation control means, associated with the elongate handle means but able to function irrespective of the pivotal orientation of the handle.
  • SUBSTITUTESHEET convenient such actuation control means is a finger-controlled rocker mechanism mounted to the handle (and preferably arranged and configured in an ergonomically efficient manner), the rocker mechanism being mechanically linked to the operative end of the instrument to actuate and deactuate that end on rocking the mechanism respectively to and fro.
  • the mechanical linkage may, for example, include any or all of tensioning cable connector means, push/pull rods, leve * ⁇ s, pivots and rocker bars.
  • a combination form of the instrument according to the second aspect of the present invention may also be desirable in some surgical procedures.
  • Such an instrument comprises a first part and a second part, the two parts being brought together into cooperation for use and the second part consisting of a conventional flexible-shafted endosurgical instrument such as a flexible rongeur or scissor instrument.
  • the first part of the instrument has the instrument control means and operative means spaced mutually apart by a shaft and has the control and operative means of the general types described above, but in addition the shaft is substantially rigid, the operative means comprises a deflector means hinged to the distal shaft end, a longitudinal bore runs the length of the shaft and elongate handle to accomodate the flexible shaft of the second part of the instrument on insertion down the bore from the proximal end, and the bore of the shaft of the first part of the instrument and deflector means are so arranged that on completion of said insertion of the second into the first parts the operative end of the second instrument part lies beside the deflector means and may be moved in response to operation of the elongate handle means.
  • the elongate handle may if desired be hollow, e.g. to receive a laser optical fibre passing up the instrument shaft, through the interior of the handle and out through the handle end to the laser apparatus. Similarly, a suction tube may pass through the handle.
  • a surgical instrument comprising handle means and a shaft extending therefrom such that in use the distal end of the shaft lies in an operating zone, the shaft serving to support a first portion of an elongate member (e.g.
  • a flexible fibre or tube having an operative function and to direct the distal end of the member to the operating zone while permitting the member to move relative to the shaft
  • the handle means is adapted to support a flexible second portion of the member in spaced apart relationship to a portion of the handle means in a resting condition of the instrument, the arrangement being such that on bringing the second portion of the member and the handle portion mutually together the distal end of the member retracts from the operating zone and on returning the second portion of the member and the handle portion to the resting condition the distal end of the member returns to the operating zone.
  • ITUTE SHEET The aspect of the invention described above can conveniently be incorporated into instruments having elongate pivotable handles and deflectable operative ends according to the second aspect of this invention to provide a novel and advantageous deflectable and accurately controllable surgical fibre/tube carrying instrument.
  • pincer instruments typically for gripping (e.g. forceps) or for bipolar diathermy and the like. It is a further aim of the present invention to provide an improved or at least alternative pincer instrument suitable for use in endoscopic surgery.
  • a surgical instrument for use in endoscopic surgery, the instrument having instrument control means and operative means spaced mutually apart by a shaft, wherein the operative means comprise pincer jaws extending from the shaft and jaw closing and opening means which include a yoke overlying a part of the jaws and cooperating portions of the yoke and jaws arranged so that, on moving yoke longitudinally along the jaws, the cooperating portions engage (e.g. slidingly) with each other to cause the jaws to open or close.
  • the shaft may be rigid or flexible and, where rigid, may suitably be hinged so that the operative end can be deflected in both the rigid-shafted and flexible-shafted forms for endoscopic procedures.
  • the control means may suitably be provided according to the second aspect of the invention described above, and in particular the operative means may be deflectable in response to a change in tension of cable connection means extending between the operative means and the instrument control means caused by operation of the instrument control means, the instrument control means comprising elongate handle means pivotally mounted to the shaft so as to be pivotable between a first and second position to effect said change in cable tension and may be actuable by manipulation of actuation control means associated with the elongate handle means to move the yoke longitudinally along the jaws to cause the jaws to open or close.
  • the yoke is preferably retractable over the base portion of the jaws to close the jaws, the yoke inner surface and the jaws outer surface having projections and recesses which cooperate with each other in a cam-type action when the tube is retracted over the jaws causing the jaws to move together.
  • the tube retraction conveniently takes place against a restoring force so that the yoke returns automatically to its resting position when it is desired to open the jaws.
  • kits of surgical instruments for use in an endoscopic surgical procedure wherein the instruments each have a deflectability function (e.g. integral deflectability) to enable the operative end of the instrument to be brought into the endoscopic field of view after insertion into the sheath, is novel and constitutes a further feature of the present invention.
  • a deflectability function e.g. integral deflectability
  • a bridge structure for mounting an endoscope and surgical instrument assembly, the bridge structure having at least one instrument port provided on its internal surface with adjustable gripping means capable upon actuation of releasably gripping the instrument in the port.
  • the adjustable instrument gripping means preferably comprise expansion means provided within the port aperture capable upon actuation of expanding elastically to releasably grip the portion of the instrument within the port aperture.
  • the expansion means may comprise an elastic washer sandwiched between a fixed part and an internally threaded cap which can be screwed down onto the fixed part to squeeze the elastic washer between the two, the arrangement being such that the instrument passes through the cap, washer and fixed part and that on said squeezing the washer is forced against the instrument, the grip being releasable on unscrewing on the cap.
  • the instruments and the apparatus are all further housed in a rigid cannula, suitably of diameter about 7 to 8 mm, previously inserted into the patient's body to provide a passage between the operating field within the body and the outside world.
  • the cannula is preferably secured to some external system of fixation, and provides further support for the bridge structure and instrumentation, and ancillary equipment.
  • Fig. IA shows a side view of part of a surgical instrument and endoscope support apparatus prior to insertion of the instruments
  • Fig. IB shows another view of the top part of the apparatus of Fig. IA looking in the direction of arrow X;
  • Fig. 2 shows a section on the line 2-2 of Fig. 1 looking in the direction of the arrows;
  • TUTE HEET Fig. 3 shows a side view of part of an alternative surgical instrument and endoscope support apparatus prior to insertion of the instruments
  • Fig. 4 shows a section on the line 4-4 of Fig. 3 looking in the direction of the arrows;
  • Fig. 5 shows an enlarged partial vertical cross-section view of the bridge structure illustrated in Fig. 3;
  • Fig. 6 shows a cannula for receiving the assembly of Fig. 1 or Fig. 3 prior to use in neurosurgery;
  • Fig. 7 shows a trocar for use in the initial location of the cannula of Fig. 4;
  • Fig. 8 shows a graph of intracranial pressure vs. irrigation fluid volume
  • Fig. 9 shows a schematic view of a neurosurgical system
  • Fig. 10 shows a side view of a laser instrument for use in endoscopic surgery
  • Fig. 11 shows a view of the handle portion of the instrument of Fig. 10 looking in the direction of arrow A;
  • Fig. 12 shows a side view of a bipolar instrument for use in endoscopic surgery
  • Fig. 13 shows an enlarged partial section view of the distal end of the instrument of Fig. 12;
  • Fig. 14 shows a side view of a rongeur instrument for use in endoscopic surgery
  • Fig. 15A shows a side view of a dissector instrument for use in endoscopic surgery
  • Fig. 15B shows an enlarged partial side view of the distal end of the instrument of Fig. 15A;
  • Fig. 16 shows a side view of a hook instrument for use in endoscopic surgery
  • Fig. 17 shows a side view of a forceps instrument for use in endoscopic surgery
  • Fig. 18 shows an enlarged partial section view of the distal end of the instrument of Fig. 17;
  • Fig. 19 shows a side view of a deflection instrument for use with other operative instruments in endoscopic surgery.
  • Fig. 20 shows an enlarged view of the distal end of the instrument of Fig. 19 looking in the direction of arrow B.
  • Figs. 1 and 3 show alternative forms of a basic endoscope and double instrument support apparatus (omitting the two operative instruments) including two instrument sheaths 10,11, a bridge structure 12 attached to the proximal sheath end and a conventional endoscope 13 releasably mounted to the bridge structure so that the telescope portion 14 of the endoscope passes through the bridge structure and down alongside the instrument sheaths 10,11. Part 11 is not visible in Fig. 3 and part 14 is not visible in Fig. 1.
  • the distal sheath ends are each provided with a deflector 15,16 mounted on arms hinged to the distal sheath end and moveable independently of each other under the surgeon's control from the bridge structure via conventional push-pull control members a,b and wheels 17,18.
  • the deflectors are shaped to move towards and away from the field of view of the endoscope so as to deflect any appropriately flexible instrument, protruding from a distal sheath 10,11 end, into the endoscope field of view and laterally to and fro across the field of view.
  • the bridge structure 12 shown in Fig. 1 includes two conventional curved ports 20,21 for receiving flexible instrumentation and one conventional linear port 22 for receiving rigid instrumentation.
  • the bridge structure is provided with apertures 24,25,26,27 for receiving respectively the endoscope telescope, the first flexible instrument inserted through port 20, the second flexible instrument inserted through port 21, and a third rigid instrument (not shown) which is inserted through port 22.
  • Apertures 25 and 26 are, of course, aligned with sheaths 10,11.
  • control wires a,b for controlling the deflectors 15,16 pass up in pairs from the deflectors (to which they are attached in known manner) alongside the respective sheath and through the bridge structure via respective small apertures 28,29 to the respective wheels 17,18.
  • Figs. 3 to 5 where generally like parts are designated as above, two sheaths 10,11 are present of which one is shown, but these do not have their own deflector mechanisms as the instrumentation to be used (which will be described in more detail below) each has integral deflection functionality where necessary.
  • the bridge structure 12 of Figs. 3, 4 and 5 is simpler than that shown in Figs. 1 and 2, and generally provides for the four apertures 24,25,26,27 but without the control wire apertures.
  • the bridge structure 12 in Fig. 3 has two specialised entry ports 31,32 (positioned above bridge apertures 26,27 respectively) for instrumentation (although any number of such
  • SUBSTITUTE SHEET ports may be used as desired). For neurosurgical use two or three such ports 31,32 are preferred.
  • the entry ports 31,32 are adapted to releasably grip the instrumentation, as is shown in more detail in Fig. 5.
  • the bridge structure 12 is provided with an externally threaded, centrally perforated, protrusion 34 onto which screws a threaded centrally perforated cap 36, and an elasticly deformable washer 38 is sandwiched between the protrusion and the cap.
  • the cap 36 is first loosened and then retightened if necessary after the instrument has been moved.
  • the novel ports of the assembly of Fig. 3 are extremely compact and easy to operate, thereby considerably simplifying the bridge structure. They permit instrumentation to be advanced, rotated and retracted, and retained in location with great accuracy.
  • an instrument assembly including the novel bridge mechanism shown in Fig. 3 should also include novel integrally deflectable instrumentation as will be described below with reference to Figs. 10 to 20.
  • novel integrally deflectable instrumentation as will be described below with reference to Figs. 10 to 20.
  • a cannula 40 of generally conventional construction (and having in particular ports 42 (only one, fluid exit, port being illustrated) for irrigation fluid to relieve crowding of ports on the bridge structure), is first inserted in conventional manner into the patient's brain through surface tissue by means of a trocar 44, which has a rounded tip to avoid cutting vessels but is elongated sufficiently to part the brain tissue.
  • the cannula should have the smallest possible outside diameter necessary to accommodate all desired instrumentation. Normally a maximum cannula diameter of about 7 to 8 mm will be satisfactory for neurosurgical procedures.
  • the length of the cannula will be selected in known manner according to the desired depth of operation and the system of fixation employed.
  • a generally conventional system of fixation may be used with the apparatus, to provide a solid support, particularly to the cannula and bridge
  • SUBSTITUTE SHEET structure while retaining maneuverability and ergonomic praticality where required by the surgeon.
  • the system of fixation should also provide adequate support for extra systems such as video cameras or teaching attachments.
  • the endoscope used will suitably be a conventional monocular endoscope of relatively small diameter telescope (e.g. down to about 1.95 mm). It is important that the illumination of the endoscope field of view is adequate, and this may suitably be achieved using a fairly large diameter fibre-optic cable or using fluid cables. Teaching and recording aids such as compatible video or stills cameras and compatible flash facilities may also be provided in conventional manner.
  • control and fail-safe mechanisms are important, to ensure that when irrigation fluid such as artificial cerebrospinal fluid (artificial CSF) is used (e.g. for work within the ventricles or with mechanical aspirators) the intracranial pressure does not rise unduly.
  • irrigation fluid such as artificial cerebrospinal fluid (artificial CSF) is used (e.g. for work within the ventricles or with mechanical aspirators) the intracranial pressure does not rise unduly.
  • Fig. 8 illustrates the relationship between the volume of irrigation fluid supplied to the cranial cavity and the resultant intracranial pressure, and shows how the intracranial pressure can rise sharply at higher fluid volumes.
  • Figure 9 illustrates schematically a preferred control system in which the pressure of both the voluntary suction and the passive fluid escape systems are monitored and regulated continuously, and are used to apply signals to a fluid input control gate controlling the supply of irrigation fluid from a reservoir.
  • Figs. 10 to 19 there is shown a range of novel specialised instrumentation suitable particularly for use in neurosurgical procedures with the housing and support assembly of Fig. 3.
  • the instruments all possess a novel projecting elongate ergonomic handle 51 which allows for extremely simple and fine control from above the bridge structure 12, and permits more than one instrument to be positioned in the bridge structure in relatively close proximity to each other, while permitting any one such instrument to be rotated, advanced, retracted and operated manually without the handle fouling the handles of the other instruments).
  • the ergonomic handle 51 in each case is pivotably jointed at 52 to the proximal end of the instrument shaft 53 so as to be pivotable between a first (resting) condition in which the handle axis lies generally parallel to the axis of the instrument shaft and a second (operative) condition in which the handle axis lies at an angle to the axis of the instrument.
  • a laser instrument is illustrated having an ergonomic handle 51 to provide specific instrument control highly suited to the surgeon's requirements.
  • the laser instrument has a thin rigid shaft 53 (maximum diameter suitably about 3 mm), with a straight top edge to reduce interference with neighbouring instruments, receivable in the appropriate sheath 10 or 11, the shaft 53 housing a thin (core diameter about o.4 or 0.6 mm for unsheathed fibre and 1.8 mm for cooled fibre) optical fibre 56 for carrying the pulsed laser energy (typically from a Neodymium YAG laser, wavelength 1064 nm, output power adjustable up to 100 mJ, pulse duration c. 8 ns and frequency adjustable up to 50 Hz) which emerges at the operative distal end 54.
  • the optical fibre 56 protrudes at its distal end through a terminal hole in a cable-operated deflection cage 58 and which serves to point the distal end of the optical fibre (which may optionally have a sapphire tip) in the desired direction.
  • the deflection cage 58 is hinged to the shaft 53 at 60 and is deflected in the to and fro direction (arrow X) by corresponding pivotal movement of the handle 51 about pivot 52 (arrow Y).
  • Coarse control of advancement/retraction of the instrument within the sheath 10 is by means of the constricting port mechanism 32 described above.
  • Fine control of advancement/retraction of the optical laser fibre 56 is by simple index finger pressure by the surgeon on an exposed portion 56a of that section of the fibre that passes through the interior of the handle 51.
  • the fibre is to be moveable longitudinally within the instrument.
  • the shaft 53 diameter is suitably about 2.5 mm and the shaft length suitably about 152 mm; the handle 51 diameter is suitably about 10 mm and the handle length suitably about 75 mm.
  • the operative end 54 of the instrument is not hinged to the shaft 53, but the shaft 53 is hollow and receives a flexible inner member made in a conventional spiral wire 55 and core arrangement.
  • the deflection control wires 57 pass from the handle 51 to an anchor point 59 at the distal end of the flexible member and offset from the central axis of the system.
  • the bipolar instrument has a pair of jaws 69,70 to which electric current is supplied via a standard foot control by means of insulated wires (not shown), for diathermy procedures.
  • the jaws are moveable to close and open by means of a retractable yoke 72 overlying a part of the operative end and provided with internal ribs 73,74 which cooperate with depressions in the jaws surfaces when the yoke is moved up the instrument to create a mutually inward movement of the jaws.
  • SUBSTITUTE SHEET The yoke is pulled against a restoring force by a cable connector (not shown) linking the yoke to a rocker mechanism 75 pivoted on the handle 51, the surgeon can depress one side or the other of the rocker mechanism to either tension or detension the cable connector to retract or release the yoke as desired.
  • the shaft 53 diameter is suitably about 2.5 mm and the shaft length suitably about 152 mm; the handle 51 diameter is suitably about 10 mm and the handle length suitably about 75 mm.
  • a specialised rongeur instrument is illustrated.
  • Biopsy rongeurs require a larger mechanical advantage on the cutting edge to provide a clean cutting action, and this is achieved in the illustrated embodiment by using a rocker actuation control mechanism 75 as previously described, so widening the handle 51.
  • the rongeur blades 78,79 are opened using the index finger and closed with the middle finger and thumb grip.
  • the shaft 53 is formed in malleable stainless steel and is provided with a hinge at 60, which allows the operative head 54 to be deflected at the field of operation, using the pivoted handle 51 (deflection control wires omitted from the drawings for clarity).
  • the mechanical actuation linkage between the rocker mechanism and the rongeur blades 78,79 is suitably via a push-pull rod system about a pivot point 80 and via a flexible corner linkage at 81.
  • FIGs. 15 and 16 in which like parts are designated as above and function in analogous manner, a specialised endoscopic dissector and hook are illustrated.
  • Forceps are used as general grasp instruments and require the same smooth advance and deflection mechanism.
  • the forceps jaws 84,85 are closed by retracting an outer sheath 86 over a camming arrangement in a manner analogous to closure of the bipolar instrument illustrated in Figs. 12 and 13.
  • the instrument of Figs. 17 and 18 is hinged at 60 (in contrast to the arrangement in Figs. 12 and 13), and the operative end 54 is deflected as desired using the pivoted handle 51 as already described.
  • a suitable deflector instrument is shown, to permit the use of bendable instruments, including generally scissors, rongeurs, suction instruments, flexible bipolars etc.
  • Deflection control wires (not shown) pull on a hinged H-shaped frame 90, as shown more clearly from side B in Fig. 20, using the pivoted handle 51 as already described, and move tie H-frame in the direction shown by the curved arrow in the enlarged detail of Fig. 19.
  • the instrument is shown with an adaptable handle, including the elongate "pencil-grip” type handle 51 as previously described, but also a conventional pistol-grip flexible rongeur handle 91 for actuating the flexible rongeur 92 the shaft of which passes right down a bore in the handle 51 and shaft 53 to emerge beside the H-frame at the operative end 54.
  • FIG. 1 Other possible instrumentation which may be used with the assembly described above include an endoscopic suction system (not illustrated).
  • the suction system is linked to the irrigation system to maintain adequate fluid flow and prevent intracranial pressure rises. This is important with intraventricular surgery.
  • Deflection functions analogously to those previously described should preferably be incorporated in the suction instrument, to avoid the constant need to reposition the cannula.
  • a conventional plastic sucker pipe can be inserted alongside the deflection instrument illustrated in Figs. 19 and 20, to rest against the cross-bar of the H-frame, so that movement of the H-frame will direct the suction pipe to the required position. All the instruments described above may be used with the novel bridge structure illustrated in Fig. 3, with the smooth advance and retraction functions of each instrument being provided by the specialised entry ports 31,32.
  • the present invention enables a complete kit of surgical instruments having all the necessary functions for complex and delicate endosurgical procedures.
  • the above examples are given for illustration purposes only, and are not to be taken as limiting on the scope of the invention.

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  • Endoscopes (AREA)

Abstract

Instrument chirurgical et dispositif de maintien d'endoscope destiné à maintenir la partie télescope (14) d'un endoscope (13) en se prolongeant jusqu'à la zone d'opération. Il se compose d'une gaine (10, 11) définissant deux chenaux permettant de guider les instruments chirurgicaux souples jusqu'à la zone d'opération. Les instruments chirurgicaux destinés à être utilisés avec ce dispositif sont commandés de l'extérieur de l'organisme du patient de telle sorte que leur extrémité fonctionnelle puisse être déplacée latéralement dans la zone d'opération.
PCT/EP1992/000892 1991-04-26 1992-04-23 Instrument chirurgical Ceased WO1992019146A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB919109109A GB9109109D0 (en) 1991-04-26 1991-04-26 Surgical instruments
GB9109109.0 1991-04-26

Publications (1)

Publication Number Publication Date
WO1992019146A1 true WO1992019146A1 (fr) 1992-11-12

Family

ID=10694071

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1992/000892 Ceased WO1992019146A1 (fr) 1991-04-26 1992-04-23 Instrument chirurgical

Country Status (2)

Country Link
GB (1) GB9109109D0 (fr)
WO (1) WO1992019146A1 (fr)

Cited By (20)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5474057A (en) * 1993-02-22 1995-12-12 Valleylab Inc. Laparoscopic dissection tension retractor device and method
WO1997034536A3 (fr) * 1996-03-22 1997-11-13 Dispositifs et procedes de chirurgie percutanee
US5792044A (en) * 1996-03-22 1998-08-11 Danek Medical, Inc. Devices and methods for percutaneous surgery
WO1997042884A3 (fr) * 1996-05-10 1999-11-25 Andrew Michael Wild Ensemble instrument chirurgical destine a etre utilise en chirurgie endoscopique
US6152871A (en) * 1996-03-22 2000-11-28 Sdgi Holdings, Inc. Apparatus for percutaneous surgery
DE19935725A1 (de) * 1999-07-29 2001-02-15 Wolf Gmbh Richard Medizinisches Instrument, insbesondere Rektoskop
EP1340463A1 (fr) * 1997-09-25 2003-09-03 Allegiance Corporation Instrument chirurgical avec bras malleable
US6679833B2 (en) 1996-03-22 2004-01-20 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US7056321B2 (en) 2000-08-01 2006-06-06 Endius, Incorporated Method of securing vertebrae
US7198598B2 (en) 1996-03-22 2007-04-03 Warsaw Orthopedic, Inc. Devices and methods for percutaneous surgery
US7427264B2 (en) 2005-04-22 2008-09-23 Warsaw Orthopedic, Inc. Instruments and methods for selective tissue retraction through a retractor sleeve
US7569054B2 (en) 1988-06-13 2009-08-04 Warsaw Orthopedic, Inc. Tubular member having a passage and opposed bone contacting extensions
EP2174602A1 (fr) * 2008-10-07 2010-04-14 Neurendo B.V. Ensemble neurochirurgical minimalement invasif
US7985247B2 (en) 2000-08-01 2011-07-26 Zimmer Spine, Inc. Methods and apparatuses for treating the spine through an access device
US8540746B2 (en) 1998-08-20 2013-09-24 Zimmer Spine, Inc. Cannula for receiving surgical instruments
US8915940B2 (en) 2010-12-02 2014-12-23 Agile Endosurgery, Inc. Surgical tool
WO2017078645A1 (fr) * 2015-11-04 2017-05-11 Dokuzlar Ugur Dispositif d'endoscope combiné avec une aspiration de déclenchement
WO2017092976A1 (fr) * 2015-11-30 2017-06-08 Karl-Heinz Bachmann Manchon de travail pour trocart
CN115054330A (zh) * 2022-06-13 2022-09-16 上海微创医疗机器人（集团）股份有限公司 穿刺器、被动手术器械和手术器械模组
US20220354359A1 (en) * 2021-05-07 2022-11-10 Arthrex, Inc. System providing improved visibility for minimally invasive surgery systems

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US2038394A (en) * 1933-10-28 1936-04-21 Wappler Frederick Charles Catheterizing instrument
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US4586923A (en) * 1984-06-25 1986-05-06 Cordis Corporation Curving tip catheter
US4750475A (en) * 1985-08-14 1988-06-14 Kabushiki Kaisha Machida Seisakusho Operating instrument guide mechanism for endoscope apparatus
EP0422887A2 (fr) * 1989-10-13 1991-04-17 Kabushiki Kaisha Machida Seisakusho Dispositif de pliage

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Publication number Priority date Publication date Assignee Title
US1679950A (en) * 1925-12-18 1928-08-07 Stern Maximilian Method and apparatus for surgical resection
US2038394A (en) * 1933-10-28 1936-04-21 Wappler Frederick Charles Catheterizing instrument
US4112932A (en) * 1977-02-24 1978-09-12 Chiulli Robert D Laparoscopic cannula
GB2004749A (en) * 1977-10-03 1979-04-11 American Hospital Supply Corp Urological indsturment
US4586923A (en) * 1984-06-25 1986-05-06 Cordis Corporation Curving tip catheter
US4750475A (en) * 1985-08-14 1988-06-14 Kabushiki Kaisha Machida Seisakusho Operating instrument guide mechanism for endoscope apparatus
EP0422887A2 (fr) * 1989-10-13 1991-04-17 Kabushiki Kaisha Machida Seisakusho Dispositif de pliage

Cited By (46)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7569054B2 (en) 1988-06-13 2009-08-04 Warsaw Orthopedic, Inc. Tubular member having a passage and opposed bone contacting extensions
US5474057A (en) * 1993-02-22 1995-12-12 Valleylab Inc. Laparoscopic dissection tension retractor device and method
US5683349A (en) * 1993-02-22 1997-11-04 Valleylab Inc Laparoscopic dissection tension retractor device and method
US6176823B1 (en) 1996-03-22 2001-01-23 Sdgi Holdings, Inc. Fixture for supporting a viewing element within a cannula
US6206822B1 (en) 1996-03-22 2001-03-27 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US5954635A (en) * 1996-03-22 1999-09-21 Sdgi Holdings Inc. Devices and methods for percutaneous surgery
EP1466564A1 (fr) * 1996-03-22 2004-10-13 SDGI Holdings, Inc. Dispositifs pour la chirurgie percutanée
US6007487A (en) * 1996-03-22 1999-12-28 Sdgi Holdings, Inc. Tissue retractor for use through a cannula
US6152871A (en) * 1996-03-22 2000-11-28 Sdgi Holdings, Inc. Apparatus for percutaneous surgery
US6162170A (en) * 1996-03-22 2000-12-19 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US7198598B2 (en) 1996-03-22 2007-04-03 Warsaw Orthopedic, Inc. Devices and methods for percutaneous surgery
US5792044A (en) * 1996-03-22 1998-08-11 Danek Medical, Inc. Devices and methods for percutaneous surgery
US5902231A (en) * 1996-03-22 1999-05-11 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US6217509B1 (en) 1996-03-22 2001-04-17 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US6425859B1 (en) 1996-03-22 2002-07-30 Sdgi Holdings, Inc. Cannula and a retractor for percutaneous surgery
US6679833B2 (en) 1996-03-22 2004-01-20 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
WO1997034536A3 (fr) * 1996-03-22 1997-11-13 Dispositifs et procedes de chirurgie percutanee
US6605036B1 (en) 1996-05-10 2003-08-12 Andrew Michael Wild Surgical instrument assembly for use in endoscopic surgery
WO1997042884A3 (fr) * 1996-05-10 1999-11-25 Andrew Michael Wild Ensemble instrument chirurgical destine a etre utilise en chirurgie endoscopique
EP1340463A1 (fr) * 1997-09-25 2003-09-03 Allegiance Corporation Instrument chirurgical avec bras malleable
US8540746B2 (en) 1998-08-20 2013-09-24 Zimmer Spine, Inc. Cannula for receiving surgical instruments
DE19935725A1 (de) * 1999-07-29 2001-02-15 Wolf Gmbh Richard Medizinisches Instrument, insbesondere Rektoskop
DE19935725C2 (de) * 1999-07-29 2003-11-13 Wolf Gmbh Richard Medizinisches Instrument, insbesondere Rektoskop
US6458077B1 (en) 1999-07-29 2002-10-01 Richard Wolf Gmbh Medical instrument, in particular a rectoscope
US8864785B2 (en) 2000-08-01 2014-10-21 Zimmer Spine, Inc. Method for securing vertebrae
US9622735B2 (en) 2000-08-01 2017-04-18 Zimmer Spine, Inc. Method for securing vertebrae
US7699877B2 (en) 2000-08-01 2010-04-20 Zimmer Spine, Inc. Method of securing vertebrae
US7985247B2 (en) 2000-08-01 2011-07-26 Zimmer Spine, Inc. Methods and apparatuses for treating the spine through an access device
US8277486B2 (en) 2000-08-01 2012-10-02 Zimmer Spine, Inc. System for performing a procedure at a spinal location
US9101353B2 (en) 2000-08-01 2015-08-11 Zimmer Spine, Inc. Method of securing vertebrae
US7056321B2 (en) 2000-08-01 2006-06-06 Endius, Incorporated Method of securing vertebrae
US8777997B2 (en) 2000-08-01 2014-07-15 Zimmer Spine, Inc. Method for securing vertebrae
US7427264B2 (en) 2005-04-22 2008-09-23 Warsaw Orthopedic, Inc. Instruments and methods for selective tissue retraction through a retractor sleeve
US20100145142A1 (en) * 2008-10-07 2010-06-10 Neurendo B.V. Minimal invasive neurosurgery assembly as well as a method for neurosurgery using such a neurosurgery assembly
EP2537478A1 (fr) * 2008-10-07 2012-12-26 Neurendo B.V. Ensemble neurochirurgical minimalement invasif
US8690761B2 (en) * 2008-10-07 2014-04-08 Neurendo B.V. Minimal invasive neurosurgery assembly as well as a method for neurosurgery using such a neurosurgery assembly
EP2174602A1 (fr) * 2008-10-07 2010-04-14 Neurendo B.V. Ensemble neurochirurgical minimalement invasif
US8915940B2 (en) 2010-12-02 2014-12-23 Agile Endosurgery, Inc. Surgical tool
WO2017078645A1 (fr) * 2015-11-04 2017-05-11 Dokuzlar Ugur Dispositif d'endoscope combiné avec une aspiration de déclenchement
WO2017092976A1 (fr) * 2015-11-30 2017-06-08 Karl-Heinz Bachmann Manchon de travail pour trocart
US10806488B2 (en) 2015-11-30 2020-10-20 Karl-Heinz Bachmann Working sleeve for a trocar
US20220354359A1 (en) * 2021-05-07 2022-11-10 Arthrex, Inc. System providing improved visibility for minimally invasive surgery systems
US12042133B2 (en) * 2021-05-07 2024-07-23 Arthrex, Inc. System providing improved visibility for minimally invasive surgery systems
US20240293020A1 (en) * 2021-05-07 2024-09-05 Arthrex, Inc. System providing improved visibility for minimally invasive surgery systems
US12426777B2 (en) * 2021-05-07 2025-09-30 Arthrex, Inc. System providing improved visibility for minimally invasive surgery systems
CN115054330A (zh) * 2022-06-13 2022-09-16 上海微创医疗机器人（集团）股份有限公司 穿刺器、被动手术器械和手术器械模组

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