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WO1995033407A1 - Extenseur chirurgical et methode associee - Google Patents

Extenseur chirurgical et methode associee Download PDF

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Publication number
WO1995033407A1
WO1995033407A1 PCT/US1994/006301 US9406301W WO9533407A1 WO 1995033407 A1 WO1995033407 A1 WO 1995033407A1 US 9406301 W US9406301 W US 9406301W WO 9533407 A1 WO9533407 A1 WO 9533407A1
Authority
WO
WIPO (PCT)
Prior art keywords
organic tissues
engaging
stretching
clamping
tissues
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/US1994/006301
Other languages
English (en)
Inventor
Peter J. Wilk
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.)
Valleylab Inc
Original Assignee
Valleylab Inc
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Valleylab Inc filed Critical Valleylab Inc
Priority to PCT/US1994/006301 priority Critical patent/WO1995033407A1/fr
Publication of WO1995033407A1 publication Critical patent/WO1995033407A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0218—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible

Definitions

  • This invention relates to a surgical instrument assembly. More particularly, this invention relates to a spreading device for use in surgery. This invention also relates to an associated surgical method or procedure.
  • one of the most impor ⁇ tant operations is the spreading of convoluted and folded organic tissues to enable visual inspection and physical access to a potential surgical site.
  • access is achieved by initially attaching a first clamp to tissues on one side of the desired site and a second clamp to tissues on the opposite side of the site. The clamps are then pulled apart, by surgical assistants, to spread the tissues between the two clamps.
  • Laparoscopy involves the piercing of a patient's abdominal wall and the insertion of a cannula through the per ⁇ foration.
  • the cannula is a trocar sleeve which surrounds a trocar during an abdomen piercing operation.
  • the trocar is withdrawn while the sleeve remains traversing the abdominal wall.
  • a laparoscopic instrument such as a laparoscope or a forceps, is inserted through the cannula so that a distal end of the instrument projects into the abdominal cavity.
  • each per ⁇ foration is formed by a trocar which is surrounded by a sleeve, the sleeves or cannulas all remaining in the abdominal wall during the surgical procedure.
  • a hollow needle Prior to insertion of the first trocar and its sleeve, a hollow needle is inserted through the abdominal wall to enable pressurization of the abdominal cavity with carbon dioxide. This insufflation procedure distends the abdominal wall, thereby producing a safety space above the patient's abdominal organs.
  • Laparoscopic surgery provides several advantages over conventional incision-based surgery.
  • the laparoscopic perforations in being substantially smaller than the inci ⁇ sions made during conventional operations, are less traumatic to the patient and provide for an accelerated recovery and convalescence. Hospital stays are minimized.
  • laparoscopic surgery is less time consuming and less expensive than conventional surgery for correcting the same problems.
  • the tissue spreading procedure described above requires the formation of at least four abdominal perforations and the insertion of four trocar sleeves.
  • Two sleeves are required for the clamps, another sleeve for the laparoscope and a fourth sleeve for an instru ⁇ ment (e.g., scalpel, forceps, cautery probe, etc.) to perform a surgical operation at the sugical site which has been made visible by the tissue spreading procedure.
  • an instru ⁇ ment e.g., scalpel, forceps, cautery probe, etc.
  • a laparoscopic surgical device comprises, in accord ⁇ ance with the present invention, an elongate frame member having a distal end and a proximal end and tissue stretching componentry mounted to the frame member at the distal end thereof for engaging and stretching selected internal organic tissues of a patient during a laparoscopic procedure.
  • An actuator is mounted to the frame member at the proximal end and is operatively connected to the stretching componentry for operating the stretching componentry to spread the selected internal organic tissues of the patient to faciltate a surgi ⁇ cal operation on the selected internal organic tissues.
  • the stretching componentry includes a first engagement element movably mounted to the frame member at the distal end thereof for engaging first organic tissues of the patient, and a second engagement element also movably mounted to the frame member at the distal end thereof for engaging second organic tissues of the patient spaced from the first organic tissues.
  • the first organic tissues and the second organic tissues are portions of the selected internal organic tissues.
  • the surgi- cal device further comprises a spreading control mounted to the frame member and operatively connected to the first engagement element and the second engagement element for increasing a distance between the engagement elements upon engagement of the first and the second organic tissues by the respective engagement elements.
  • the first engagement element includes a first clamp for exerting a clamping force on the first organic tissues
  • the second engagement element includes a second clamp for exerting a clamping force on the second organic tissues.
  • the actuator includes a first control element and a second control element operatively connected to the first clamp and the sec ⁇ ond clamp, respectively, for controlling operation thereof. At least one of the clamps may include a pair of jaws.
  • the engagement elements are secured to the frame member via respective shafts
  • the spreading control includes an articulated linkage pivotably connected to the shafts.
  • the spreading control further includes means for alternately shifting the linkage in a distal direction and a proximal direction.
  • a surgical method in accordance with the present invention utilizes a surgical instrument with an elongate frame having stretching componentry at a distal end for engag ⁇ ing and stretching organic tissues and having an actuator at a proximal end for operating the stretching componentry.
  • the method comprises the steps of (a) inserting a distal end por ⁇ tion of the instrument through a laparoscopic trocar sleeve into a patient, (b) engaging selected organic tissues about an operative site with the stretching componentry upon insertion of the distal end portion of the instrument through the trocar sleeve, (c) operating the actuator to stretch the organic tis ⁇ sues upon engagement of the selected organic tissues with the stretching componentry, and (d) performing an operation at the surgical site upon stretching of the selected organic tissues.
  • the step of engaging the selected organic tissues includes the step of holding the selected organic tissues with the first and second engagement elements and exerting a force via the surgical instrument to increase a distance between the first and second engagement elements.
  • the step of holding may include the step of clamp ⁇ ing the selected organic tissues with the first and second engagement elements.
  • the stretching componentry includes a plurality of clamping mechanisms disposed at distal ends of respective flexible shafts connected to the frame
  • the step of engaging selected organic tissues includes the step of operat ⁇ ing the clamping mechanisms to clamp organic tissues of the patient at spaced points with the clamping mechanisms
  • the step of operating the actuator includes the step of pressing the shafts apart from one another.
  • a surgical instrument assembly and associated method in accordance with the present invention for use in spreading organic tissues of a patient during an operation are particularly useful in laparoscopic surgery. Only one trocar sleeve is required. However, the method and instrument assembly may be used in open surgery as well.
  • Fig. 1 is a schematic side elevational view of a laparoscopic surgical clamping assembly in accordance with the present invention, showing a pair of grasping forceps disposed in a mutually parallel insertion configuration and with closed grasping jaws.
  • Fig. 2 is a schematic side elevational view of the laparoscopic surgical clamping assembly of Fig. 1, showing the grasping forceps disposed in a spread-apart use configuration and with opened grasping jaws.
  • Figs. 3A-3C are partial schematic cross-sectional views of a patient's abdomen with the surgical clamping assembly of Figs. 1 and 2 inserted therein, the clamping assembly being illustrated in successive steps of a clamping and spreading operation in accordance with the present inven ⁇ tion.
  • Fig. 4 is a partial schematic side elevational view of another laparoscopic surgical clamping assembly in accord ⁇ ance with the present invention, showing a pair of grasping forceps disposed in a mutually parallel insertion configura ⁇ tion and with closed grasping jaws.
  • Fig. 5 is a partial schematic side elevational view of yet another laparoscopic surgical clamping assembly in accordance with the present invention, showing two grasping forceps parallel to one another insertion configuration and with closed grasping jaws.
  • a surgical clamping device 12 for spreading or stretching clamped organic tissues comprises a frame member 14 having a distal end 16 and a proximal end 18.
  • Two clamping mechanisms in the form of respective grasping forceps 20 and 22 are movably mounted to frame member 14 at distal end 16 thereof for exerting clamping forces on spaced organic tissues of a patient.
  • a first actuator 24 is mounted to frame member 14 at proximal end 18 thereof and is operatively connected to grasping forceps 20 for controlling the opening and closing of jaws 26 of that forceps
  • a second actuator 28 is mounted to frame member 14 at proximal end 18 and is operatively connected to grasping forceps 22 for alternately opening and closing jaws 30 of that grasping forceps.
  • a third actuator 32 including a reciprocatable plunger element or push rod 34 is slidably mounted to frame member 14 and operatively connected to grasp ⁇ ing forceps 20 and 22 for increasing the distance between jaws 26 and jaws 30, thereby stretching the clamped organic tissues and facilitating access to the stretched tissues.
  • actuator 32 also includes an articulated linkage 36 comprising a pair of arms 36a and 36b pivotably connected to push rod 34 at the distal end thereof and pivotably connected to shafts 38 and 40 of respective grasping forceps 20 and 22.
  • Shafts 38 and 40 are flexible in a region immediately distal of a distal end of frame member 14, thereby enabling a relative spreading of grasping forceps 20 and 22 from a straightened or mutually parallel insertion configuration of Fig. 1 to a spread use configuration if Fig. 2 upon a distally directed stroke of push rod 34.
  • Push rod 34 is provided at a proximal end with a flange 42 for facilitat ⁇ ing manual reciprocation of push rod 34.
  • Figs. 3A-3C show a distal end portion of clamping device 12 inserted into an abdominal cavity AC of a patient through a laparoscopic trocar sleeve 44 itself traversing an abdominal wall AW of the patient.
  • Fig. 3A illustrates an ini ⁇ tial insertion configuration of clamping device 10 wherein push rod 34 is retracted in a proximal direction and grasping jaws 26 and 30 are closed. (This configuration is also used when the clamping device 12 is being withdrawn from abdominal cavity AC upon termination of the laparoscopic tissue spread ⁇ ing operation.)
  • push rod 34 may be shifted slightly in the distal direction, if desired, to partially separate jaws 26 and 30 of grasping forceps 20 and 22 (Fig. 3B). Actuators 24 and 28 are then operated to open jaws 26 and 30, whereupon device or instrument 12 is manipu ⁇ lated from outside the patient to engage and hold respective portions of organic tissue, for example, of the colon CN, on opposite sides of a traumatic injury or perforation TP. After a subsequent closure of jaws 36 and 30, push rod 34 is pushed further in the distal direction, as depicted in Fig. 3C, to spread or stretch the tissues of colon CN in the region about traumatic injury or perforation TP.
  • the stretching of the tissues of colon CN about per ⁇ foration TP facilitates surgery by providing direct access to the injury.
  • a suturing operation or other surgical treatment may be performed easily on traumatic perforation TP.
  • the steps illustrated in Figs. 3A- 3C are performed in reverse order.
  • another surgical clamping device 52 for spreading or stretching clamped organic tissues comprises a frame member 54 having a distal end 56 and a proximal end (not shown).
  • Two clamping or grasping forceps 60 and 62 are movably mounted to frame member 54 at distal end 56 thereof for engaging and holding spaced organic tissues of a patient.
  • Actuators (not shown) are mounted to frame member 54 at the proximal end thereof for controUably opening and closing jaws 66 of forceps 60 and closing jaws 68 of forceps 62.
  • a third actuator includes a rotatable shaft 70 carrying a tapered screw 72 at a distal end.
  • Screw 72 Upon a rotation of shaft 70, screw 72 is pulled into an internally threaded split bush ⁇ ing or nut 74.
  • Nut 74 has a first half 74a attached to a par ⁇ tially flexible shaft 76 of forceps 60, while a second half 74b of nut 74 is fixed to a partially flexible shaft 78 of forceps 62.
  • the entry of screw 72 into nut 74 causes the separation of halves 74a and 74b and consequently of forceps shafts 76 and 78 in opposition to an inherent spring force or a helical tension spring 80 extending between forceps shafts 76 and 78.
  • yet another surgical clamping device 82 for spreading or stretching clamped organic tissues comprises a frame member 84 having a distal end 86 and a proximal end (not illustrated).
  • Two clamping or grasping forceps 90 and 92 are movably mounted to frame member 84 at distal end 86 thereof for engaging and holding spaced organic tissues of a patient.
  • Actuators (not shown) are mounted to frame member 84 at the proximal end thereof for controUably opening and closing jaws 94 of forceps 90 and closing jaws 96 of forceps 92.
  • a third actuator includes a slidable shaft 98 carrying a wedge 100 at a distal end.
  • wedge 100 slidingly engages cam ⁇ ming elements 102 and 104 which are attached to shafts 106 and 108 of forceps 92 and 94 and forces the shafts apart in oppo ⁇ sition to an inherent spring force or a helical tension spring 110 extending between forceps shafts 106 and 108.
  • the clamping action of grasping for ⁇ ceps 20 and 22 may be accomplished by other equivalent engage ⁇ ment and holding devices.
  • a hook or paw may perform a clamping or catching operation sufficient for spreading organic tissues as described herein.
  • the capture and entrainment of internal organic tissues may be implemented by suction nozzles.

Landscapes

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

Abstract

Instrument chirurgical comprenant un corps (14) présentant une extrémité distale et une extrémité proximale et une paire de mécanismes d'ancrage (20, 22) montés mobiles à l'extrémité distale et destinés à exercer une force d'ancrage dans des tissus espacés les uns des autres du patient. Des leviers (24, 28) montés à l'extrémité proximale du corps sont reliés aux éléments d'ancrage pour en commander le fonctionnement. Un autre levier (32) également placé sur le corps et relié aux mécanismes d'ancrage permet d'en accroître l'écartement de façon à étirer les tissus situés entre les points d'ancrage. Cet instrument s'avère particulièrement utile pour la chirurgie laparoscopique.
PCT/US1994/006301 1994-06-06 1994-06-06 Extenseur chirurgical et methode associee Ceased WO1995033407A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US1994/006301 WO1995033407A1 (fr) 1994-06-06 1994-06-06 Extenseur chirurgical et methode associee

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1994/006301 WO1995033407A1 (fr) 1994-06-06 1994-06-06 Extenseur chirurgical et methode associee

Publications (1)

Publication Number Publication Date
WO1995033407A1 true WO1995033407A1 (fr) 1995-12-14

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Family Applications (1)

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PCT/US1994/006301 Ceased WO1995033407A1 (fr) 1994-06-06 1994-06-06 Extenseur chirurgical et methode associee

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WO (1) WO1995033407A1 (fr)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7214234B2 (en) 1998-02-13 2007-05-08 Medtronic, Inc. Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication
WO2008149173A1 (fr) * 2007-06-05 2008-12-11 Cardenas Marcela Dispositif médical d'exploration et d'intervention dans la cavité abdominale et dans la cavité pelvienne
US7578828B2 (en) 1999-01-15 2009-08-25 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4655219A (en) * 1983-07-22 1987-04-07 American Hospital Supply Corporation Multicomponent flexible grasping device
US4700694A (en) * 1984-02-20 1987-10-20 Olympus Optical Co., Ltd. Endoscope means and ovum picker employed by inserting through endoscope means
US5099827A (en) * 1989-12-13 1992-03-31 Richard Wolf Gmbh Instrument set for closing opened body organs, wounds or the like

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4655219A (en) * 1983-07-22 1987-04-07 American Hospital Supply Corporation Multicomponent flexible grasping device
US4700694A (en) * 1984-02-20 1987-10-20 Olympus Optical Co., Ltd. Endoscope means and ovum picker employed by inserting through endoscope means
US5099827A (en) * 1989-12-13 1992-03-31 Richard Wolf Gmbh Instrument set for closing opened body organs, wounds or the like

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7214234B2 (en) 1998-02-13 2007-05-08 Medtronic, Inc. Delivering a conduit into a heart wall to place a coronary vessel in communication with a heart chamber and removing tissue from the vessel or heart wall to facilitate such communication
US7578828B2 (en) 1999-01-15 2009-08-25 Medtronic, Inc. Methods and devices for placing a conduit in fluid communication with a target vessel
WO2008149173A1 (fr) * 2007-06-05 2008-12-11 Cardenas Marcela Dispositif médical d'exploration et d'intervention dans la cavité abdominale et dans la cavité pelvienne

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