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WO2014083217A1 - Magnetic endoscopic device - Google Patents

Magnetic endoscopic device Download PDF

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Publication number
WO2014083217A1
WO2014083217A1 PCT/ES2013/000262 ES2013000262W WO2014083217A1 WO 2014083217 A1 WO2014083217 A1 WO 2014083217A1 ES 2013000262 W ES2013000262 W ES 2013000262W WO 2014083217 A1 WO2014083217 A1 WO 2014083217A1
Authority
WO
WIPO (PCT)
Prior art keywords
patient
magnet
surgical instrument
endoscopic device
magnets
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/ES2013/000262
Other languages
Spanish (es)
French (fr)
Inventor
Jesús GÓMEZ DE GABRIEL
William Harwin
Victor Fernando MUÑOZ MARTÍNEZ
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.)
Universidad de Malaga
Original Assignee
Universidad de Malaga
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 Universidad de Malaga filed Critical Universidad de Malaga
Publication of WO2014083217A1 publication Critical patent/WO2014083217A1/en
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
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/73—Manipulators for magnetic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00158—Holding or positioning arrangements using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots

Definitions

  • the present invention is generally framed in the field of medicine, and more specifically in the field of surgery.
  • the main object of the invention is a new type of endoscopic device equipped with a surgical instrument that, once inserted into a patient's cavity, does not require an entry port for its operation, since it is governed from the outside by a support equipped with a set of magnets.
  • Guidance System composed of different surgical devices for SILS surgery.
  • One or two magnets are used per device to control the position and orientation of a camera or a separator.
  • the variation of the distance of the external magnets allows to change the inclination of the instrument, but the magnets are not used to actuate the end of the instrument (opening or closing of tweezers or scissors), nor is it foreseen, therefore, a system of handling from the outside that allows its control with one hand or by means of a robot.
  • the inventors of the present application have developed a magnetic endoscopic device that allows the surgeon to handle from the outside of the patient a surgical instrument disposed inside a patient's cavity.
  • the proposed device in comparison with the known magnetic instrument management systems, allows positioning, orientation and activation of the instrument.
  • different angles of access to the region of interest triangulation
  • different instruments can be operated by different people or robots.
  • Another main advantage of the invention is that the proposed device is completely passive, so it does not require an external supply of energy or batteries, nor is the transmission of movement through the hole made in the patient.
  • a first aspect of the invention is directed generally to the magnetic endoscopic device of the invention, which comprises two parts: an internal acting portion inside the patient and an external control portion magnetically connectable to said internal portion.
  • the inner portion is mechanically connectable to a surgical instrument, and comprises at least two actuating magnets of said surgical instrument that are magnetically connectable to corresponding at least two control handles of the outer portion.
  • the variation of the relative positions of the control magnets located outside the patient allows the operation of the surgical instrument located inside the patient.
  • the device of the invention may include a virtually unlimited number of pairs of magnets to move, guide and operate with different degrees of freedom and simultaneously one or more surgical instruments.
  • magnetically connectable refers to each pair formed by a driving magnet and a control magnet being configured for magnetic connection through the patient's abdominal wall, that is, the magnets of the couple are attracted and the force of attraction is sufficient to achieve the connection taking into account the thickness of said wall.
  • the expression “mechanically connectable” refers to the fact that the surgical instrument can be attached or fixed to the inner portion.
  • the surgical instrument could be interchangeable, engaging thread or similar, having a kit of compatible instruments (tweezers, scalpel, etc.) that could be used according to each particular application.
  • the surgeon only has to adequately modify the orientations and / or the relative positions of the control magnets to handle the surgical instrument located inside the patient's cavity, being able not only to operate the instrument , such as opening or closing tweezers or scissors, but also make it rotate or even shift it from position. All this is achieved without the need to maintain a mechanical connection between the inner and outer portions, and also without batteries or cables.
  • the surgical instruments can be in principle of any type, including scissors, tweezers, forceps, scalpels, etc., the positions of the magnets being configured in each case depending on the operation of each specific instrument.
  • a device designed for the handling of a surgical instrument of the clamp type or scissors, which is provided with two arms configured to open and close inside the patient will be specifically described.
  • a particularly preferred configuration of the invention comprises three pairs of magnets:
  • a first drive magnet mechanically connected to a first arm of the surgical instrument and magnetically connectable to a first control magnet.
  • a second drive magnet mechanically connected to a second arm of the surgical instrument and magnetically connectable to a second control magnet.
  • a central drive magnet mechanically connected to the first arm of the surgical instrument and magnetically connectable to a central control magnet.
  • the approach or withdrawal of the first actuating magnet and the second actuating magnet within the interior of the patient is caused patient, which in turn causes the closure or opening of the surgical instrument.
  • the central pair of magnets is primarily used to keep one of the arms of the surgical instrument under control through two points.
  • said arm of the instrument which we have called the first
  • the second the consequence is that the joint on which rotating both arms is also fixed, and therefore prevents unwanted turns during the movement or operation of the surgical instrument.
  • the variation of the relative position of the magnets allows the surgical instrument to be operated so that the arms of a clamp or scissors can be opened and closed remotely, while the variation of the position and orientation of the magnet assembly produces a variation in the position and orientation of the end of the surgical instrument.
  • the incorporation of more pairs of images makes it possible to increase the number of functions and degrees of freedom of the surgical instrument.
  • the two physically separated parts that comprise it are described in greater detail: the inner portion and the outer portion.
  • the inner portion is inserted inside the patient's cavity, and basically comprises two pieces:
  • the central magnet is connected to said proximal end of the inner shaft and the first drive magnet to a free end of the first drive arm.
  • a hollow external axis that houses the internal axis in a rotating manner, whose distal end protrudes the second arm of the surgical instrument and whose proximal end protrudes a second actuation arm.
  • the second drive magnet is fixed to its free end.
  • the drive arms can form any angle with the internal and external axes, and also have different shapes, always that the paths along the pairs of drive magnets and control magnets are compatible to maintain the magnetic connection.
  • the drive arms essentially form a right angle relative to the inner and outer axes of the inner portion.
  • the angles of rotation of the actuating arms are rounded to avoid causing damage to the patient during the operation and facilitate the introduction of the inner portion.
  • the arms of the surgical instrument form an obtuse angle with the inner and outer axes of the inner portion. This facilitates the introduction of the inner portion into the patient's cavity through an incision made for this purpose without causing damage to the patient.
  • the ends of the arms of the surgical instrument preferably also have a rounded shape to avoid damaging the patient by introducing the inner portion into the patient.
  • the first drive magnet has the same polarity as the second drive magnet.
  • the distance between the first and second drive magnets and the internal and external axes is greater than the distance between the ends of the arms of the surgical instrument and the internal and external axes.
  • the outer portion which allows the surgical instrument to move, rotate and operate the inner portion, takes the form of a handle comprising:
  • a first grip that has a distal end where it is Fixed the first control magnet.
  • a second gripping piece that has a distal end where the second control magnet is fixed.
  • Both grip pieces are pivotally connected by means of a shaft located at a proximal end thereof, the central magnet also being fixed to said proximal end.
  • the first grip piece has an elongated hole shaped to receive the index fingers to be annulled from a user
  • the second grip piece has a circular hole shaped to receive the user's thumb.
  • the magnets preferably have a rounded shape to avoid causing damage to the walls of the patient's cavity, and more preferably a cylindrical shape.
  • the number of magnets and their size may vary depending on the thickness of the abdominal wall, the desired forces and the number of surgical instruments of the inner portion.
  • an increase in said forces causes an increase in pressure on the patient's skin, which also increases friction between the magnet and the patient's skin, making it difficult to manipulate the surgical instruments.
  • a first semi-rigid sheet for example of plastic, placed on the outside of the patient between the skin and the support and handling magnets can be used.
  • a second additional semi-rigid sheet placed on the inner face of the patient's abdomen can also be used. This second sheet is inserted rolled by the incision, and is deployed inside before inserting the instrument.
  • a second aspect of the invention is directed to a surgical instrument that is mechanically attachable to the inner portion of an endoscopic device as described.
  • the surgical instrument might have one end. threaded proximal that allows it to be attached to the inner portion of the device of the invention, thus being able to exchange the instrument according to each particular application
  • Figure 1 shows a general side view of the device of the invention during its use in a patient.
  • Figure 2 shows perspective view of the device of the invention.
  • Figures 3a and 3b show perspective views of the device of the invention with the clamp respectively in the closed position and in the open position.
  • Figure 4 shows a general side view similar to that of Figure 1 of the device of the invention operated by means of a robot.
  • Figures 5a and 5b show a perspective view of the handle of the device of the invention respectively assembled and deployed.
  • Figure 6 shows an exploded perspective view of the clamp of the device of the invention.
  • Figure 7 shows a perspective view of the device of the invention operated by means of a robot where a friction reduction sheet is used.
  • FIGS 8a-8c schematically show how the clamp insertion is performed in the patient's cavity. Detailed description of the invention
  • FIG. 1 shows a profile view of the device (1) of the invention during its use. It can be seen how the device (1) is formed by an internal portion (2) which in this example is provided with a clamp (4), which is inside a patient's cavity (100), and an external portion ( 3) which is located outside said cavity.
  • the inner portion (2) is handled from the outside by means of the outer portion (3) thanks to a set of pairs of magnets that keep both portions (2, 3) magnetically connected.
  • the inner portion (2) is shown in greater detail in Fig. 3 (assembled) and in Fig. 6. (disassembled).
  • the inner portion (2) is formed essentially by two pieces or shafts (8, 9) that make up the clamp (4) and by the three actuating magnets (5a, 6a, 7a).
  • An internal shaft (8) has a proximal end from which a first actuating arm (10a) protrudes perpendicularly and a distal end from which a first arm (41) of the clamp (4) projects obliquely at an obtuse angle.
  • the angle between the internal axis (8) and the clamp arm (41) is between 90 ° and 180 ° in order to facilitate the introduction of the internal portion into the patient's cavity (100 ) through an incision made for this purpose.
  • the central drive magnet (7a) is located at the proximal end of the inner shaft (8), while the first drive magnet (5a) is located at the free end of the first drive arm (10a).
  • the external axis (9) is hollow to receive inside the internal axis (8) allowing the relative rotation between one and the other in order to achieve the opening and closing of the clamp (4).
  • the external axis (9) similarly has a proximal end from which a second actuating arm (10b) protrudes perpendicularly and a distal end from which a second arm (42) of the clamp (4) protrudes obliquely at an obtuse angle similar to that formed the first arm (41) in relation to the internal axis (8).
  • the second drive magnet (6a) is located at the free end of the second drive arm (10b).
  • the inner shaft (8) is housed inside the outer shaft (9), allowing relative rotation between them.
  • the arms (41, 42) that constitute the clamp (4) At the distal end of both axes (8, 9) are the arms (41, 42) that constitute the clamp (4), which are also rotatable relative to each other allowing the opening or closing of said clamp (4), while at the proximal end of both axes (8, 9) are the drive arms (10a, 10b) and the magnets (5a, 6a, 7a).
  • Figs. 5a and 5b show in detail the outer portion (3) of the device (1) of the invention respectively assembled and disassembled.
  • the outer portion (3) essentially takes the form of an ergonomic handle and easy to use by the surgeon from outside the patient. It is formed by a first grip piece (11) and a second grip piece (12) joined through a shaft essentially located at the proximal end of both pieces (11, 12).
  • the first grip piece (11) also has an elongated hole (13) and provided with an ergonomic wavy surface to receive the surgeon's pinky index fingers, while the second grip piece (12) has a round hole (14) thought to receive the surgeon's thumb.
  • the first control magnet (5b) is located at the distal end of the first grip piece (11), the second control magnet (6b) is located at the distal end of the second grip piece (12), and the Central magnet (7b) control is located on the shaft.
  • the axis allows the relative rotation of a piece relative to the other, which has the effect of bringing the first control magnet (5b) and the second control magnet (6b) closer or further apart.
  • Fig. 2 shows in detail the complete device (1).
  • the magnets described so far are located forming pairs of magnets of opposite polarity, and therefore attract each other: (5a, 5b), (6a, 6b) and (7a 7b).
  • 5a, 5b the outer portion (3) through the hole (13) of the first grip portion (11) and the hole (14) of the second grip portion (12)
  • This rotation causes the first (5b) and second (6b) control magnets to zoom in or out, keeping the central magnet (7b) in position.
  • the drive magnets (5a, 6a, 7a) "follow" the movements of the control magnets (5b, 6b, 7b), which causes the rotation of the drive arms (10a, 10b) relative to each other, rotation that is transmitted through the axes (8, 9) to cause the opening or closing of the arms (41, 42) of the clamp (4).
  • the device (1) of the invention could thus also be handled by a surgeon. (Fig. 1) to pick up, cut, etc. (according to the characteristics of the "clamp” or particular instrument) an internal organ (101) of the patient (100).
  • Another option represented in Fig. 4 would be for a robotic arm (102) to handle the device (1), whose operation and constitution would be similar perhaps except for the specific shape of the outer portion (3), which in that case no longer it would require ergonomic holes (13, 14) for the surgeon's hand.
  • the device (1) may include a first semi-rigid sheet (15) that interposes between the outer surface of the patient (100) and the magnets (5b, 6b, 7b) of the outer portion (3) of the device (1) ) and / or a second semi-rigid sheet (not shown in the figures) that would interpose between the inner surface of the patient (100) and the magnets (5th, 6th, 7th) of the inner portion (2).
  • This sheet (15) is shown in Fig. 7, where the device (1) is also operated by a robotic arm (102).
  • Figs. 8a-8c describes the way in which the inner portion (2) is introduced into the patient's cavity (100) through a small port made in the patient's abdomen.
  • the insertion is carried out in three phases: first the clamp arms (4) are inserted in closed position, as shown in Fig. 8a. Next, the shafts (8, 9) are inserted and the magnets (6a, 6a) are rotated to join them in the opposite position, as shown in Fig. 8b. Thirdly, the magnets are inserted, first the central (7a) and then the other two (5a, 6a), as shown in Fig. 8c. Finally, with the help of a conventional endoscopic instrument, the inner portion (2) is properly positioned to couple the drive magnets (5a, 6a, 7a) to the control magnets (5b, 6b, 7b) located outside .
  • the lengths L1 and L2 of the actuating arms (10a, 10b) can be made different, which would allow the actuating magnets (5a, 6a) to be aligned with the central magnet (7a) drive. Also, the distances D1 and the diameter of the magnets D2 must be reduced within the limits imposed by the manufacturing process and by the necessary forces.
  • the clamp (4) has been drawn in this example as an integral part of the inner portion (2), but as mentioned above it could be an interchangeable part.
  • the proximal ends of the arms (41, 42) of the clamp (4) could have a suitable thread to be fixed to the distal ends of the shafts (8, 9).
  • clamps (4) of different types could be attached for different applications, or scissors, scalpels, etc.

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

Abstract

Magnetic endoscopic device (1) formed by an inner portion (2) provided with a surgical instrument (4), which, once inside a cavity of the patient (100), allows said instrument (4) to be manipulated by a surgeon enabling the latter to take hold of, to cut, etc. an internal organ (101), and an outer portion (3) that is outside said cavity. The inner portion (2) is handled from the outside by means of the outer portion (3), by virtue of a set of pairs of magnets that keep the two portions (2, 3) connected magnetically, thereby requiring no entry opening in order to operate. The device (1) allows a person or robot to manipulate various types of surgical instrument (4) from outside the patient (100) and to obtain different angles of access to the region of interest (triangulation).

Description

DISPOSITIVO ENDOSCÓPICO MAGNÉTICO  MAGNETIC ENDOSCOPIC DEVICE

Campo de la invención La presente invención se enmarca de manera general en el campo de la medicina, y más concretamente en el campo de la cirugía. Field of the invention The present invention is generally framed in the field of medicine, and more specifically in the field of surgery.

El objeto principal de la invención es un nuevo tipo de dispositivo endoscópico dotado de un instrumento quirúrgico que, una vez introducido en una cavidad del paciente, no requiere de un puerto de entrada para su funcionamiento, ya que se gobierna desde el exterior mediante un soporte dotado de un conjunto de imanes. The main object of the invention is a new type of endoscopic device equipped with a surgical instrument that, once inserted into a patient's cavity, does not require an entry port for its operation, since it is governed from the outside by a support equipped with a set of magnets.

Antecedentes de la invención En el campo de la cirugía es de extrema importancia minimizar la cantidad y tamaño de las incisiones que se practican para una operación determinada, ya que ello redunda en un menor tiempo de hospitalización y en menores molestias para el paciente. La cirugía endoscópica permite realizar operaciones a través de orificios muy pequeños, a través de los cuales se introduce una pequeña cámara y todos el instrumental quirúrgico necesario para la operación. Por ejemplo, se pueden mencionar las técnicas conocidas SILS (Single Incisión Laparoscopic Surgery), donde se emplea un único orificio o puerto de acceso, y NOTES (Natural Orífice Translumenal Endoscopio Surgery), que emplean orificios naturales del cuerpo. Sin embargo, en ocasiones no es fácil llegar hasta todos los lugares que requiere una operación a través de una sola incisión, motivo por el cual es necesario practicar varias incisiones, o bien una incisión más amplia. Para resolver este problema, en la actualidad existen algunos dispositivos que utilizan las propiedades de los imanes con el objeto de permitir movimientos más amplios de los instrumentos en el interior de la cavidad del paciente donde se está realizando la operación. BACKGROUND OF THE INVENTION In the field of surgery it is extremely important to minimize the amount and size of the incisions that are made for a given operation, since this results in a shorter hospitalization time and less discomfort for the patient. Endoscopic surgery allows operations through very small holes, through which a small chamber and all the surgical instruments necessary for the operation are introduced. For example, we can mention the known SILS (Single Laparoscopic Surgery Incision) techniques, where a single orifice or access port is used, and NOTES (Natural Translumenal Orifice Endoscope Surgery), which use natural orifices of the body. However, sometimes it is not easy to reach all the places that require an operation through a single incision, which is why it is necessary to make several incisions, or a wider incision. To solve this problem, there are currently some devices that use the properties of the magnets in order to allow wider movements of the instruments inside the patient's cavity where the operation is being performed.

Un documento conocido es la solicitud de patente US2009/0043246, que está basada en unas pinzas de tipo cocodrilo unidas a un imán mediante un cable, y que se abren y posicionan con la ayuda de una pinza laparoscópica. Un imán en el exterior del paciente permite controlar la dirección y la tensión con la que se sujetan los tejidos. Sin embargo, este dispositivo no permite su apertura o cierre desde el exterior sin el uso de un puerto, ni ejerce esfuerzos en otras direcciones, por lo que posee una utilidad limitada en comparación con la invención propuesta. También es conocido un sistema denominado AGS (Magnetic Anchoring andA known document is patent application US2009 / 0043246, which is based on crocodile-type clamps attached to a magnet by means of a cable, and which are opened and positioned with the help of a laparoscopic clamp. A magnet outside the patient allows to control the direction and tension with which the tissues are fastened. Without However, this device does not allow opening or closing from the outside without the use of a port, nor exerts efforts in other directions, so it has limited utility compared to the proposed invention. Also known is a system called AGS (Magnetic Anchoring and

Guidance System), compuesto por diferentes dispositivos quirúrgicos para cirugía SILS. Se puede citar como ejemplo de esta técnica la solicitud de patente US2003/0114731 A1 , que está basada en el uso de imanes para el posicionamiento y orientación de dispositivos quirúrgicos. Se utilizan uno o dos imanes por dispositivo para controlar la posición y orientación de una cámara o un separador. En uno de ellos, la variación de la distancia de los imanes externos permite cambiar la inclinación del instrumento, pero no se utilizan los imanes para accionar el extremo del instrumento (apertura o cierre de pinzas o tijeras), ni se prevé, por tanto, un sistema de manejo desde el exterior que permita su control con una sola mano o mediante un robot. Guidance System), composed of different surgical devices for SILS surgery. One can cite as an example of this technique the patent application US2003 / 0114731 A1, which is based on the use of magnets for the positioning and orientation of surgical devices. One or two magnets are used per device to control the position and orientation of a camera or a separator. In one of them, the variation of the distance of the external magnets allows to change the inclination of the instrument, but the magnets are not used to actuate the end of the instrument (opening or closing of tweezers or scissors), nor is it foreseen, therefore, a system of handling from the outside that allows its control with one hand or by means of a robot.

El sistema descrito en la solicitud de patente US 2009/0005636A1 consiste en un sistema de sujeción y guiado de instrumentos quirúrgicos activos cámara y pinza que son posicionados mediante un imán y que se accionan por medio de una conexión eléctrica. Por último, el documento WO2010/083480A2 propone el uso de una plataforma insertable dentro del paciente que se sujeta magnéticamente, pero dotada de cámaras y pinzas activas alimentadas por baterías o bien por unas conexiones percutáneas. The system described in US patent application 2009 / 0005636A1 consists of a clamping and guiding system for active surgical instruments, chamber and clamp that are positioned by means of a magnet and that are actuated by means of an electrical connection. Finally, document WO2010 / 083480A2 proposes the use of an insertable platform within the patient that is magnetically held, but equipped with cameras and active clamps powered by batteries or by percutaneous connections.

Descripción de la invención Description of the invention

Los inventores de la presente solicitud han desarrollado un dispositivo endoscópico magnético que permite al cirujano manejar desde el exterior del paciente un instrumento quirúrgico dispuesto en el interior de una cavidad del paciente. El dispositivo propuesto, en comparación con los sistemas conocidos de manejo de instrumentos quirúrgicos de forma magnética, permite posicionar, orientar y activar el instrumento. Además, se pueden obtener diferentes ángulos de acceso a la región de interés (triangulación), y pueden manejarse diferentes instrumentos por diferentes personas o robots.  The inventors of the present application have developed a magnetic endoscopic device that allows the surgeon to handle from the outside of the patient a surgical instrument disposed inside a patient's cavity. The proposed device, in comparison with the known magnetic instrument management systems, allows positioning, orientation and activation of the instrument. In addition, different angles of access to the region of interest (triangulation) can be obtained, and different instruments can be operated by different people or robots.

Otra ventaja principal de la invención es que el dispositivo propuesto es totalmente pasivo, por lo que no requiere un suministro externo de energía o de baterías, ni tampoco la transmisión del movimiento a través del orificio practicado en el paciente. Another main advantage of the invention is that the proposed device is completely passive, so it does not require an external supply of energy or batteries, nor is the transmission of movement through the hole made in the patient.

También se evita la necesidad de realizar punciones percutáneas, que son un método invasivo, constituyendo un sistema más directo e intuitivo de uso sencillo, bajo coste, reutilizable y fácilmente esterilizable. It also avoids the need to perform percutaneous punctures, which are an invasive method, constituting a more direct and intuitive system of simple use, low cost, reusable and easily sterilizable.

Un primer aspecto de la invención está dirigido de forma general al dispositivo endoscópico magnético de la invención, que comprende dos partes: una porción interna de actuación en el interior del paciente y una porción externa de control conectable magnéticamente a dicha porción interna. La porción interna es conectable mecánicamente a un instrumento quirúrgico, y comprende al menos dos imanes de accionamiento de dicho instrumento quirúrgico que son conectables magnéticamente a unos correspondientes al menos dos ¡manes de control de la porción externa. De este modo, la variación de las posiciones relativas de los imanes de control situados en el exterior del paciente permiten el manejo del instrumento quirúrgico situado en el interior del paciente. Nótese que el dispositivo de la invención puede incluir un número virtualmente ilimitado de pares de imanes para desplazar, orientar y accionar con diferentes grados de libertad y de manera simultánea uno o varios instrumentos quirúrgicos. A first aspect of the invention is directed generally to the magnetic endoscopic device of the invention, which comprises two parts: an internal acting portion inside the patient and an external control portion magnetically connectable to said internal portion. The inner portion is mechanically connectable to a surgical instrument, and comprises at least two actuating magnets of said surgical instrument that are magnetically connectable to corresponding at least two control handles of the outer portion. Thus, the variation of the relative positions of the control magnets located outside the patient allows the operation of the surgical instrument located inside the patient. Note that the device of the invention may include a virtually unlimited number of pairs of magnets to move, guide and operate with different degrees of freedom and simultaneously one or more surgical instruments.

En este contexto, se entiende que la expresión "conectable magnéticamente" hace referencia a que cada pareja formada por imán de accionamiento e imán de control está configurada para su conexión magnética a través de la pared abdominal del paciente, es decir, los imanes de la pareja se atraen y la fuerza de atracción es suficiente para conseguir la conexión teniendo en cuenta el espesor de dicha pared. In this context, it is understood that the expression "magnetically connectable" refers to each pair formed by a driving magnet and a control magnet being configured for magnetic connection through the patient's abdominal wall, that is, the magnets of the couple are attracted and the force of attraction is sufficient to achieve the connection taking into account the thickness of said wall.

A su vez, la expresión "conectable mecánicamente" hace referencia a que el instrumento quirúrgico puede acoplarse o fijarse a la porción interna. Así, el instrumento quirúrgico podría ser intercambiable, acoplándose a rosca o similar, disponiéndose de un kit de instrumentos (pinzas, bisturí, etc.) compatibles que podrían utilizarse según cada aplicación particular.  In turn, the expression "mechanically connectable" refers to the fact that the surgical instrument can be attached or fixed to the inner portion. Thus, the surgical instrument could be interchangeable, engaging thread or similar, having a kit of compatible instruments (tweezers, scalpel, etc.) that could be used according to each particular application.

Así, una vez el dispositivo está operativo, el cirujano sólo tiene que modificar adecuadamente las orientaciones y/o las posiciones relativas de los imanes de control para manejar el instrumento quirúrgico situado en el interior de la cavidad del paciente, pudiendo no sólo accionar el instrumento, como por ejemplo abrir o cerrar unas pinzas o unas tijeras, sino también hacerlo girar o incluso desplazarlo de posición. Todo esto se consigue sin necesidad de mantener una conexión mecánica entre la porción interior y exterior, y también sin baterías o cables. Los instrumentos quirúrgicos pueden ser en principio de cualquier tipo, incluyendo tijeras, pinzas, fórceps, bisturís, etc., estando configuradas en cada caso las posiciones de los imanes en función del funcionamiento de cada instrumento concreto. En adelante, se describirá concretamente un dispositivo diseñado para el manejo de un instrumento quirúrgico de tipo pinza o tijeras, que está dotado de dos brazos configurados para abrirse y cerrarse en el interior del paciente. Thus, once the device is operative, the surgeon only has to adequately modify the orientations and / or the relative positions of the control magnets to handle the surgical instrument located inside the patient's cavity, being able not only to operate the instrument , such as opening or closing tweezers or scissors, but also make it rotate or even shift it from position. All this is achieved without the need to maintain a mechanical connection between the inner and outer portions, and also without batteries or cables. The surgical instruments can be in principle of any type, including scissors, tweezers, forceps, scalpels, etc., the positions of the magnets being configured in each case depending on the operation of each specific instrument. Hereinafter, a device designed for the handling of a surgical instrument of the clamp type or scissors, which is provided with two arms configured to open and close inside the patient, will be specifically described.

Para el manejo de un instrumento quirúrgico de tipo pinza o tijeras, el número mínimo de pares de imanes de accionamiento sería de dos, uno para cada uno de los brazos. Sin embargo, en caso de utilizar sólo dos pares de imanes quedaría sin control el punto central correspondiente al eje del instrumento alrededor del cual giran los brazos, pudiendo producirse giros indeseables o incontrolados del instrumento en el interior del paciente. Por ello, una configuración especialmente preferida de la invención comprende tres pares de imanes: For the operation of a clamp or scissors surgical instrument, the minimum number of pairs of actuating magnets would be two, one for each of the arms. However, if only two pairs of magnets are used, the central point corresponding to the axis of the instrument around which the arms rotate would remain uncontrolled, and undesirable or uncontrolled turns of the instrument may occur inside the patient. Therefore, a particularly preferred configuration of the invention comprises three pairs of magnets:

- un primer imán de accionamiento conectado mecánicamente a un primer brazo del instrumento quirúrgico y conectable magnéticamente a un primer imán de control.  - a first drive magnet mechanically connected to a first arm of the surgical instrument and magnetically connectable to a first control magnet.

- un segundo imán de accionamiento conectado mecánicamente a un segundo brazo del instrumento quirúrgico y conectable magnéticamente a un segundo imán de control.  - a second drive magnet mechanically connected to a second arm of the surgical instrument and magnetically connectable to a second control magnet.

- un imán central de accionamiento conectado mecánicamente al primer brazo del instrumento quirúrgico y conectable magnéticamente a un imán central de control.  - a central drive magnet mechanically connected to the first arm of the surgical instrument and magnetically connectable to a central control magnet.

De ese modo, al acercar o alejar entre sí el primer imán de control y el segundo imán de control en el exterior del paciente, se provoca el acercamiento o alejamiento entre sí del primer imán de accionamiento y el segundo imán de accionamiento en el interior del paciente, lo que a su vez provoca el cierre o apertura del instrumento quirúrgico. El par de imanes central sirve fundamentalmente para mantener bajo control a través de dos puntos uno de los brazos del instrumento quirúrgico. Como dicho brazo del instrumento, que hemos denominado el primero, está articulado al otro brazo, denominado el segundo, la consecuencia es que la articulación sobre la que giran ambos brazos se mantiene también fija, y por tanto se evita que se produzcan giros indeseados durante el desplazamiento o accionamiento del instrumento quirúrgico. Así, la variación de la posición relativa de los imanes permite accionar el instrumento quirúrgico de manera que se puedan abrir y cerrar remotamente los brazos de una pinza o unas tijeras, mientras que la variación de la posición y orientación del conjunto de imanes produce una variación en la posición y orientación del extremo del instrumento quirúrgico. Además, es fácil entender que la incorporación de más pares de ¡manes permite aumentar el número de funciones y de grados de libertad del instrumento quirúrgico. Thus, when the first control magnet and the second control magnet on the outside of the patient are zoomed in or out of each other, the approach or withdrawal of the first actuating magnet and the second actuating magnet within the interior of the patient is caused patient, which in turn causes the closure or opening of the surgical instrument. The central pair of magnets is primarily used to keep one of the arms of the surgical instrument under control through two points. As said arm of the instrument, which we have called the first, is articulated to the other arm, called the second, the consequence is that the joint on which rotating both arms is also fixed, and therefore prevents unwanted turns during the movement or operation of the surgical instrument. Thus, the variation of the relative position of the magnets allows the surgical instrument to be operated so that the arms of a clamp or scissors can be opened and closed remotely, while the variation of the position and orientation of the magnet assembly produces a variation in the position and orientation of the end of the surgical instrument. In addition, it is easy to understand that the incorporation of more pairs of images makes it possible to increase the number of functions and degrees of freedom of the surgical instrument.

A continuación, una vez descrito el funcionamiento general del dispositivo, se describen con mayor detalle las dos partes físicamente separadas que lo componen: la porción interna y la porción externa. Next, once the general operation of the device has been described, the two physically separated parts that comprise it are described in greater detail: the inner portion and the outer portion.

Porción interna Inner portion

La porción interna, como se ha mencionado anteriormente, se introduce en el interior de la cavidad del paciente, y comprende fundamentalmente dos piezas: The inner portion, as mentioned above, is inserted inside the patient's cavity, and basically comprises two pieces:

- Un eje interno de cuyo extremo distal sobresale el primer brazo del instrumento quirúrgico y de cuyo extremo proximal sobresale un primer brazo de accionamiento. El imán central está conectado a dicho extremo proximal del eje interno y el primer imán de accionamiento a un extremo libre del primer brazo de accionamiento. - An internal axis whose distal end protrudes the first arm of the surgical instrument and whose proximal end protrudes a first actuation arm. The central magnet is connected to said proximal end of the inner shaft and the first drive magnet to a free end of the first drive arm.

- Un eje externo hueco que aloja en su interior el eje interno de manera giratoria, de cuyo extremo distal sobresale el segundo brazo del instrumento quirúrgico y de cuyo extremo proximal sobresale un segundo brazo de accionamiento. El segundo imán de accionamiento está fijado a su extremo libre. - A hollow external axis that houses the internal axis in a rotating manner, whose distal end protrudes the second arm of the surgical instrument and whose proximal end protrudes a second actuation arm. The second drive magnet is fixed to its free end.

En principio, los brazos de accionamiento pueden formar cualquier ángulo con los ejes interno y externo, y también tener diversas formas, siempre que las trayectorias que recorren los pares de imanes de accionamiento y los imanes de control sean compatibles para mantener la conexión magnética. Sin embargo, en una realización preferida de la invención, los brazos de accionamiento forman esencialmente un ángulo recto con relación a los ejes interno y externo de la porción interior. Además, los ángulos de giro de los brazos de accionamiento son redondeados para evitar provocar daños al paciente durante la operación y facilitar la introducción de la porción interna. In principle, the drive arms can form any angle with the internal and external axes, and also have different shapes, always that the paths along the pairs of drive magnets and control magnets are compatible to maintain the magnetic connection. However, in a preferred embodiment of the invention, the drive arms essentially form a right angle relative to the inner and outer axes of the inner portion. In addition, the angles of rotation of the actuating arms are rounded to avoid causing damage to the patient during the operation and facilitate the introduction of the inner portion.

Según otra realización preferida de la invención, los brazos del instrumento quirúrgico forman un ángulo obtuso con los ejes interno y externo de la porción interior. Esto facilita la introducción de la porción interna en la cavidad del paciente a través de una incisión realizada al efecto sin provocar daños al paciente. Los extremos de los brazos del instrumento quirúrgico preferentemente tienen además una forma redondeada para evitar dañar al paciente al introducir la porción interior en el paciente. According to another preferred embodiment of the invention, the arms of the surgical instrument form an obtuse angle with the inner and outer axes of the inner portion. This facilitates the introduction of the inner portion into the patient's cavity through an incision made for this purpose without causing damage to the patient. The ends of the arms of the surgical instrument preferably also have a rounded shape to avoid damaging the patient by introducing the inner portion into the patient.

Adicionalmente, en otra realización preferida el primer imán de accionamiento tiene la misma polaridad que el segundo imán de accionamiento. De ese modo, aunque durante la introducción de la porción interior en la cavidad del paciente se fuerza a ambos imanes a permanecer uno junto a otro para ocupar el menor espacio posible, una vez dentro del paciente la propia fuerza magnética tiende a separarlos una vez liberados. Additionally, in another preferred embodiment the first drive magnet has the same polarity as the second drive magnet. Thus, although during the introduction of the inner portion into the patient's cavity, both magnets are forced to remain next to each other to occupy as little space as possible, once inside the patient the magnetic force itself tends to separate them once released. .

Además, preferentemente la distancia entre los primero y segundo imanes de accionamiento y los ejes interno y externo es mayor que la distancia entre los extremos de los brazos del instrumento quirúrgico y los ejes interno y externo. Se produce así un efecto de palanca que permite aplicar mayor fuerza en la pinza, aunque con desplazamientos (de apertura) menores. Porción externa Furthermore, preferably the distance between the first and second drive magnets and the internal and external axes is greater than the distance between the ends of the arms of the surgical instrument and the internal and external axes. This produces a lever effect that allows greater force to be applied to the clamp, although with smaller (opening) movements. External portion

La porción externa, que permite desplazar, girar y accionar el instrumento quirúrgico de la porción interna, toma la forma de un mango que comprende: The outer portion, which allows the surgical instrument to move, rotate and operate the inner portion, takes the form of a handle comprising:

- Una primera pieza de agarre que tiene un extremo distal donde está fijado el primer imán de control. - A first grip that has a distal end where it is Fixed the first control magnet.

- Una segunda pieza de agarre que tiene un extremo distal donde está fijado el segundo imán de control. - A second gripping piece that has a distal end where the second control magnet is fixed.

Ambas piezas de agarre están conectadas de manera pivotante por medio de un eje situado en un extremo proximal de las mismas, estando también el imán central fijado a dicho extremo proximal. En una realización preferida de la invención, la primera pieza de agarre tiene un orificio alargado conformado para recibir los dedos índice a anular de un usuario, y la segunda pieza de agarre tiene un orificio circular conformado para recibir el dedo pulgar del usuario. Además, preferentemente los imanes tienen una forma redondeada para evitar causar daños en las paredes de la cavidad del paciente, y más preferentemente una forma cilindrica. Both grip pieces are pivotally connected by means of a shaft located at a proximal end thereof, the central magnet also being fixed to said proximal end. In a preferred embodiment of the invention, the first grip piece has an elongated hole shaped to receive the index fingers to be annulled from a user, and the second grip piece has a circular hole shaped to receive the user's thumb. In addition, the magnets preferably have a rounded shape to avoid causing damage to the walls of the patient's cavity, and more preferably a cylindrical shape.

Por otro lado, el número de imanes y de su tamaño pueden variar en función del espesor de la pared abdominal, de las fuerzas deseadas y del número de instrumentos quirúrgicos de la porción interna. Sin embargo, un aumento de dichas fuerzas provoca un aumento de la presión sobre la piel del paciente, que también aumenta la fricción entre el imán y la piel del paciente, dificultando la manipulación de los instrumentos quirúrgicos. En ese caso, para reducir la presión entre los pares de imanes y disminuir la fricción se puede utilizar una primera lámina semirrígida, por ejemplo de plástico, colocada en el exterior del paciente entre la piel y los imanes de soporte y manipulación. Adicionalmente, también se puede utilizar una segunda lámina semirrígida adicional colocada en la cara interior del abdomen del paciente. Esta segunda lámina se introduce enrollada por la incisión, y se despliega en el interior previamente a la inserción del instrumento. Estos elementos facilitan la manipulación y permiten usar imanes de mayor tamaño, a la vez que reduce el riesgo de isquemia en el paciente. On the other hand, the number of magnets and their size may vary depending on the thickness of the abdominal wall, the desired forces and the number of surgical instruments of the inner portion. However, an increase in said forces causes an increase in pressure on the patient's skin, which also increases friction between the magnet and the patient's skin, making it difficult to manipulate the surgical instruments. In that case, to reduce the pressure between the pairs of magnets and reduce friction, a first semi-rigid sheet, for example of plastic, placed on the outside of the patient between the skin and the support and handling magnets can be used. Additionally, a second additional semi-rigid sheet placed on the inner face of the patient's abdomen can also be used. This second sheet is inserted rolled by the incision, and is deployed inside before inserting the instrument. These elements facilitate manipulation and allow the use of larger magnets, while reducing the risk of ischemia in the patient.

Un segundo aspecto de la invención está dirigido a un instrumento quirúrgico que es acoplable mecánicamente a la porción interna de un dispositivo endoscópico como el descrito. Por ejemplo, el instrumento quirúrgico podría tener un extremo proximal roscado que permita acoplarlo a la porción interna del dispositivo de la invención, pudiendo así intercambiar el instrumento según cada aplicación particular A second aspect of the invention is directed to a surgical instrument that is mechanically attachable to the inner portion of an endoscopic device as described. For example, the surgical instrument might have one end. threaded proximal that allows it to be attached to the inner portion of the device of the invention, thus being able to exchange the instrument according to each particular application

Breve descripción de las figuras Brief description of the figures

La Figura 1 muestra una vista lateral general del dispositivo de la invención durante su uso en un paciente. Figure 1 shows a general side view of the device of the invention during its use in a patient.

La Figura 2 muestra vista en perspectiva del dispositivo de la invención. Figure 2 shows perspective view of the device of the invention.

Las Figuras 3a y 3b muestran sendas vistas en perspectiva del dispositivo de la invención con la pinza respectivamente en posición cerrada y en posición abierta. Figures 3a and 3b show perspective views of the device of the invention with the clamp respectively in the closed position and in the open position.

La Figura 4 muestra una vista lateral general similar a la de la Figura 1 del dispositivo de la invención manejado por medio de un robot. Figure 4 shows a general side view similar to that of Figure 1 of the device of the invention operated by means of a robot.

Las Figuras 5a y 5b muestran una vista en perspectiva del mango del dispositivo de la invención respectivamente montado y despiezado. La Figura 6 muestra una vista despiezada en perspectiva de la pinza del dispositivo de la invención. Figures 5a and 5b show a perspective view of the handle of the device of the invention respectively assembled and deployed. Figure 6 shows an exploded perspective view of the clamp of the device of the invention.

La Figura 7 muestra una vista en perspectiva del dispositivo de la invención accionado por medio de un robot donde se utiliza una lámina para reducción de fricciones. Figure 7 shows a perspective view of the device of the invention operated by means of a robot where a friction reduction sheet is used.

Las Figuras 8a-8c muestran esquemáticamente cómo se realiza la inserción de la pinza en la cavidad del paciente. Descripción detallada de la invención Figures 8a-8c schematically show how the clamp insertion is performed in the patient's cavity. Detailed description of the invention

Se describe a continuación un ejemplo particular de la presente invención haciendo referencia a las figuras adjuntas, que muestran una realización particular donde el instrumento quirúrgico (4) es concretamente una pinza. La Fig. 1 muestra una vista de perfil del dispositivo (1) de la invención durante su uso. Se aprecia cómo el dispositivo (1) está formado por una porción interna (2) que en este ejemplo está dotada de una pinza (4), que se encuentra en el interior de una cavidad del paciente (100), y una porción externa (3) que se encuentra en el exterior de dicha cavidad. La porción interna (2) se maneja desde el exterior por medio de la porción externa (3) gracias a un conjunto de pares de imanes que mantienen ambas porciones (2, 3) magnéticamente conectadas. A particular example of the present invention is described below with reference to the attached figures, which show a particular embodiment where the surgical instrument (4) is specifically a clamp. Fig. 1 shows a profile view of the device (1) of the invention during its use. It can be seen how the device (1) is formed by an internal portion (2) which in this example is provided with a clamp (4), which is inside a patient's cavity (100), and an external portion ( 3) which is located outside said cavity. The inner portion (2) is handled from the outside by means of the outer portion (3) thanks to a set of pairs of magnets that keep both portions (2, 3) magnetically connected.

La porción interna (2) está representada con mayor detalle en la Fig. 3 (montada) y en la Fig. 6. (desmontada). La porción interna (2) está formada fundamentalmente por dos piezas o ejes (8, 9) que conforman la pinza (4) y por los tres imanes (5a, 6a, 7a) de accionamiento. Un eje interno (8) tiene un extremo proximal del que sobresale perpendicularmente un primer brazo de accionamiento (10a) y un extremo distal del que sobresale oblicuamente un primer brazo (41) de la pinza (4) según un ángulo obtuso. Es decir, el ángulo que forman eje interno (8) y brazo (41) de pinza (4) está comprendido entre los 90° y los 180° con el objeto de facilitar la introducción de la porción interna en la cavidad del paciente (100) a través de una incisión practicada al efecto. En el extremo proximal del eje interno (8) está ubicado el imán central (7a) de accionamiento, mientras que el primer imán de accionamiento (5a) está situado en el extremo libre del primer brazo (10a) de accionamiento. The inner portion (2) is shown in greater detail in Fig. 3 (assembled) and in Fig. 6. (disassembled). The inner portion (2) is formed essentially by two pieces or shafts (8, 9) that make up the clamp (4) and by the three actuating magnets (5a, 6a, 7a). An internal shaft (8) has a proximal end from which a first actuating arm (10a) protrudes perpendicularly and a distal end from which a first arm (41) of the clamp (4) projects obliquely at an obtuse angle. That is, the angle between the internal axis (8) and the clamp arm (41) is between 90 ° and 180 ° in order to facilitate the introduction of the internal portion into the patient's cavity (100 ) through an incision made for this purpose. The central drive magnet (7a) is located at the proximal end of the inner shaft (8), while the first drive magnet (5a) is located at the free end of the first drive arm (10a).

El eje externo (9) es hueco para recibir en su interior el eje interno (8) permitiendo el giro relativo entre uno y otro con el objeto de conseguir la apertura y cierre de la pinza (4). El eje externo (9) similarmente tiene un extremo proximal del que sobresale perpendicularmente un segundo brazo de accionamiento (10b) y un extremo distal del que sobresale oblicuamente un segundo brazo (42) de la pinza (4) según un ángulo obtuso similar al que formaba el primer brazo (41) con relación al eje interno (8). Además, en el extremo libre del segundo brazo de accionamiento (10b) se ubica el segundo imán de accionamiento (6a). The external axis (9) is hollow to receive inside the internal axis (8) allowing the relative rotation between one and the other in order to achieve the opening and closing of the clamp (4). The external axis (9) similarly has a proximal end from which a second actuating arm (10b) protrudes perpendicularly and a distal end from which a second arm (42) of the clamp (4) protrudes obliquely at an obtuse angle similar to that formed the first arm (41) in relation to the internal axis (8). In addition, the second drive magnet (6a) is located at the free end of the second drive arm (10b).

Cuando la porción interna (2) está montada (ver Fig. 3), el eje interno (8) se aloja en el interior del eje externo (9), permitiéndose el giro relativo entre ambos. En el extremo distal de ambos ejes (8, 9) se encuentran los brazos (41 , 42) que constituyen la pinza (4), que también son giratorios uno con relación al otro permitiendo la apertura o cierre de dicha pinza (4), mientras que en el extremo proximal de ambos ejes (8, 9) se encuentran los brazos de accionamiento (10a, 10b) y los imanes (5a, 6a, 7a). Es fácil comprobar cómo un movimiento de acercamiento o alejamiento del primer (5a) y segundo (6a) imanes de accionamiento entre sí provoca la apertura o cierre de los brazos de accionamiento (10a, 10b), lo cual a su vez causa la apertura o cierre de los brazos (41 , 42) de la pinza (4). When the inner portion (2) is mounted (see Fig. 3), the inner shaft (8) is housed inside the outer shaft (9), allowing relative rotation between them. At the distal end of both axes (8, 9) are the arms (41, 42) that constitute the clamp (4), which are also rotatable relative to each other allowing the opening or closing of said clamp (4), while at the proximal end of both axes (8, 9) are the drive arms (10a, 10b) and the magnets (5a, 6a, 7a). It is easy to verify how a movement of approaching or moving away from the first (5a) and second (6a) actuating magnets to one another causes the opening or closing of the actuating arms (10a, 10b), which in turn causes the opening or closing of the arms (41, 42) of the clamp (4).

Las Figs. 5a y 5b muestran con detalle la porción externa (3) del dispositivo (1) de la invención respectivamente montada y desmontada. La porción externa (3) adopta fundamentalmente la forma de un mango ergonómico y fácil de utilizar por el cirujano desde el exterior del paciente. Está formada por una primera pieza de agarre (11) y una segunda pieza de agarre (12) unidas a través de un eje situado esencialmente en el extremo proximal de ambas piezas (11 , 12). La primera pieza de agarre (11) tiene además un orificio (13) alargado y dotado de una superficie ondulada ergonómica para recibir los dedos índice a meñique del cirujano, mientras que la segunda pieza de agarre (12) tiene un orificio redondo (14) pensado para recibir el pulgar del cirujano. El primer imán de control (5b) está situado en el extremo distal de la primera pieza de agarre (11), el segundo imán de control (6b) está situado en el extremo distal de la segunda pieza de agarre (12), y el imán central (7b) de control está situado en el eje. Así, el eje permite el giro relativo de una pieza con relación a la otra, giro que tiene el efecto de acercar o alejar entre sí el primer imán de control (5b) y el segundo imán de control (6b). Figs. 5a and 5b show in detail the outer portion (3) of the device (1) of the invention respectively assembled and disassembled. The outer portion (3) essentially takes the form of an ergonomic handle and easy to use by the surgeon from outside the patient. It is formed by a first grip piece (11) and a second grip piece (12) joined through a shaft essentially located at the proximal end of both pieces (11, 12). The first grip piece (11) also has an elongated hole (13) and provided with an ergonomic wavy surface to receive the surgeon's pinky index fingers, while the second grip piece (12) has a round hole (14) thought to receive the surgeon's thumb. The first control magnet (5b) is located at the distal end of the first grip piece (11), the second control magnet (6b) is located at the distal end of the second grip piece (12), and the Central magnet (7b) control is located on the shaft. Thus, the axis allows the relative rotation of a piece relative to the other, which has the effect of bringing the first control magnet (5b) and the second control magnet (6b) closer or further apart.

La Fig. 2 muestra con detalle el dispositivo (1) completo. Los imanes descritos hasta ahora están situados formando pares de imanes de polaridad opuesta, y que por tanto se atraen entre sí: (5a, 5b), (6a, 6b) y (7a 7b). De ese modo, cuando el cirujano agarra la porción exterior (3) a través del orificio (13) de la primera porción de agarre (11) y del orificio (14) de la segunda porción de agarre (12), basta con abrir y cerrar su mano para provocar el giro de una pieza con relación a otra alrededor del eje. Este giro provoca el acercamiento o alejamiento del primer (5b) y segundo (6b) imanes de control entre sí, manteniéndose el imán central (7b) en su posición. Los imanes de accionamiento (5a, 6a, 7a) "siguen" los movimientos de los imanes de control (5b, 6b, 7b), lo que provoca el giro de los brazos de accionamiento (10a, 10b) uno con relación al otro, giro que se transmite a través de los ejes (8, 9) para causar la apertura o cierre de los brazos (41 , 42) de la pinza (4). El dispositivo (1) de la invención también podría así ser manejado por un cirujano (Fig. 1) para coger, cortar, etc. (según las características de la "pinza" o instrumento particular) un órgano interno (101) del paciente (100). Otra opción representada en la Fig. 4 sería que un brazo robotizado (102) manejase el dispositivo (1), cuyo funcionamiento y constitución sería similar quizás a excepción de la forma concreta de la porción externa (3), que en ese caso ya no requeriría orificios ergonómicos (13, 14) para la mano del cirujano. Fig. 2 shows in detail the complete device (1). The magnets described so far are located forming pairs of magnets of opposite polarity, and therefore attract each other: (5a, 5b), (6a, 6b) and (7a 7b). Thus, when the surgeon grabs the outer portion (3) through the hole (13) of the first grip portion (11) and the hole (14) of the second grip portion (12), it is sufficient to open and close your hand to cause the rotation of a piece in relation to another around the axis. This rotation causes the first (5b) and second (6b) control magnets to zoom in or out, keeping the central magnet (7b) in position. The drive magnets (5a, 6a, 7a) "follow" the movements of the control magnets (5b, 6b, 7b), which causes the rotation of the drive arms (10a, 10b) relative to each other, rotation that is transmitted through the axes (8, 9) to cause the opening or closing of the arms (41, 42) of the clamp (4). The device (1) of the invention could thus also be handled by a surgeon. (Fig. 1) to pick up, cut, etc. (according to the characteristics of the "clamp" or particular instrument) an internal organ (101) of the patient (100). Another option represented in Fig. 4 would be for a robotic arm (102) to handle the device (1), whose operation and constitution would be similar perhaps except for the specific shape of the outer portion (3), which in that case no longer it would require ergonomic holes (13, 14) for the surgeon's hand.

Como se ha mencionado anteriormente, si se utiliza un número mayor de imanes, por ejemplo para accionar unas pinzas y unas tijeras independientemente una de otra, o bien si los imanes son muy potentes, se pueden provocar daños en la pared del paciente (100). Para evitarlo, el dispositivo (1) puede incluir una primera lámina semirrígida (15) que se interpone entre la superficie exterior del paciente (100) y los imanes (5b, 6b, 7b) de la porción exterior (3) del dispositivo (1) y/o una segunda lámina semirrígida (no mostrada en las figuras) que se interpondría entre la superficie interior del paciente (100) y los imanes (5a, 6a, 7a) de la porción interior (2). Esta lámina (15) se muestra en la Fig. 7, donde el dispositivo (1) es manejado también por un brazo robotizado (102). As mentioned above, if a larger number of magnets are used, for example to operate tweezers and scissors independently of one another, or if the magnets are very powerful, damage to the patient's wall can be caused (100) . To avoid this, the device (1) may include a first semi-rigid sheet (15) that interposes between the outer surface of the patient (100) and the magnets (5b, 6b, 7b) of the outer portion (3) of the device (1) ) and / or a second semi-rigid sheet (not shown in the figures) that would interpose between the inner surface of the patient (100) and the magnets (5th, 6th, 7th) of the inner portion (2). This sheet (15) is shown in Fig. 7, where the device (1) is also operated by a robotic arm (102).

Por último, en las Figs. 8a-8c se describe el modo en que la porción interna (2) se introduce en el interior de la cavidad del paciente (100) a través de un puerto de reducidas dimensiones practicado en el abdomen del paciente. La inserción se realiza en tres fases: primero se insertan los brazos de la pinza (4) en posición cerrada, como se observa en la Fig. 8a. A continuación, se insertan los ejes (8, 9) y se giran los imanes (6a, 6a) para juntarlos en la posición opuesta, como se aprecia en la Fig. 8b. En tercer lugar, se insertan los imanes, primero el central (7a) y luego los otros dos (5a, 6a), como se representa en la Fig. 8c. Por último, con la ayuda de un instrumento endoscópico convencional se posiciona adecuadamente la porción interna (2) para acoplar los imanes de accionamiento (5a, 6a, 7a) a los ¡manes de control (5b, 6b, 7b) situados en el exterior. Finally, in Figs. 8a-8c describes the way in which the inner portion (2) is introduced into the patient's cavity (100) through a small port made in the patient's abdomen. The insertion is carried out in three phases: first the clamp arms (4) are inserted in closed position, as shown in Fig. 8a. Next, the shafts (8, 9) are inserted and the magnets (6a, 6a) are rotated to join them in the opposite position, as shown in Fig. 8b. Thirdly, the magnets are inserted, first the central (7a) and then the other two (5a, 6a), as shown in Fig. 8c. Finally, with the help of a conventional endoscopic instrument, the inner portion (2) is properly positioned to couple the drive magnets (5a, 6a, 7a) to the control magnets (5b, 6b, 7b) located outside .

Para reducir la dimensión mínima de la incisión en el abdomen del paciente, las longitudes L1 y L2 de los brazos de accionamiento (10a, 10b) pueden hacerse diferentes, lo que permitiría alinear los imanes (5a, 6a) de accionamiento con el imán central (7a) de accionamiento. Asimismo, las distancias D1 y el diámetro de los imanes D2 deben reducirse dentro de los límites impuestos por el proceso de fabricación y por las fuerzas necesarias. En este ejemplo, la pinza (4) se ha dibujado en este ejemplo como parte integral de la porción interna (2), pero como se ha mencionado anteriormente podría tratarse de una pieza intercambiable. Por ejemplo, los extremos proximales de los brazos (41 , 42) de la pinza (4) podrían tener una rosca adecuada para fijarse a los extremos distales de los ejes (8, 9). Así, se podrían acoplar pinzas (4) de tipos diferentes para diferentes aplicaciones, o bien tijeras, bisturís, etc. To reduce the minimum size of the incision in the patient's abdomen, the lengths L1 and L2 of the actuating arms (10a, 10b) can be made different, which would allow the actuating magnets (5a, 6a) to be aligned with the central magnet (7a) drive. Also, the distances D1 and the diameter of the magnets D2 must be reduced within the limits imposed by the manufacturing process and by the necessary forces. In this example, the clamp (4) has been drawn in this example as an integral part of the inner portion (2), but as mentioned above it could be an interchangeable part. For example, the proximal ends of the arms (41, 42) of the clamp (4) could have a suitable thread to be fixed to the distal ends of the shafts (8, 9). Thus, clamps (4) of different types could be attached for different applications, or scissors, scalpels, etc.

Claims

REIVINDICACIONES 1. Dispositivo (1) endoscópico magnético que comprende una porción interna (2) de actuación en el interior de un paciente (100) y una porción externa (3) de control conectable magnéticamente a dicha porción interna (2), caracterizado porque la porción interna (2) es conectable mecánicamente a un instrumento (4) quirúrgico y comprende al menos dos imanes de accionamiento (5a, 6a, 7a) de dicho instrumento (4) quirúrgico conectables magnéticamente a unos correspondientes al menos dos imanes de control (5b, 6b, 7b) de la porción externa (3), de tal modo que la variación en la orientación y/o las posiciones relativas de los imanes de control (5b, 6b, 7b) en el exterior del paciente permiten el manejo del instrumento (4) quirúrgico en el interior del paciente (100). 1. Magnetic endoscopic device (1) comprising an internal portion (2) acting inside a patient (100) and an external control portion (3) magnetically connectable to said internal portion (2), characterized in that the portion internal (2) is mechanically connectable to a surgical instrument (4) and comprises at least two actuating magnets (5a, 6a, 7a) of said surgical instrument (4) magnetically connectable to about corresponding at least two control magnets (5b, 6b, 7b) of the outer portion (3), such that the variation in the orientation and / or the relative positions of the control magnets (5b, 6b, 7b) outside the patient allow the instrument to be operated ( 4) surgical inside the patient (100). 2. Dispositivo (1) endoscópico magnético de acuerdo con la reivindicación 1 , que comprende: 2. Magnetic endoscopic device (1) according to claim 1, comprising: un primer imán (5a) de accionamiento conectado mecánicamente a un primer brazo (41) del instrumento (4) quirúrgico y conectable magnéticamente a un primer imán (5b) de control;  a first actuating magnet (5a) mechanically connected to a first arm (41) of the surgical instrument (4) and magnetically connectable to a first control magnet (5b); un segundo imán (6a) de accionamiento conectado mecánicamente a un segundo brazo (42) del instrumento (4) quirúrgico y conectable magnéticamente a un segundo imán (6b) de control; y  a second drive magnet (6a) mechanically connected to a second arm (42) of the surgical instrument (4) and magnetically connectable to a second control magnet (6b); Y un imán central (7a) de accionamiento conectado mecánicamente al primer brazo (41) del instrumento (4) quirúrgico y conectable magnéticamente a un imán central (7b) de control,  a central drive magnet (7a) mechanically connected to the first arm (41) of the surgical instrument (4) and magnetically connectable to a central control magnet (7b), de tal modo que al acercar o alejar entre sí el primer imán (5b) de control y el segundo imán (6b) de control en el exterior del paciente, se provoca el acercamiento o alejamiento entre sí del primer imán (5a) de accionamiento y el segundo imán (6a) de accionamiento en el interior del paciente, lo que a su vez provoca el cierre o apertura del instrumento (4) quirúrgico. such that when the first control magnet (5b) and the second control magnet (6b) on the outside of the patient approach or move away from each other, the approach or distance of the first actuating magnet (5a) is caused and the second actuating magnet (6a) inside the patient, which in turn causes the closure or opening of the surgical instrument (4). 3. Dispositivo (1 ) endoscópico magnético de acuerdo con la reivindicación 2, donde la porción interna (2) comprende: 3. Magnetic endoscopic device (1) according to claim 2, wherein the inner portion (2) comprises: un eje interno (8) de cuyo extremo distal sobresale el primer brazo (41) del instrumento (4) quirúrgico y de cuyo extremo proximal sobresale un primer brazo (10a) de accionamiento, estando fijado el imán central (7a) de accionamiento a dicho extremo proximal del eje interno (8) y el primer imán (5a) de accionamiento a un extremo libre del primer brazo (10a) de accionamiento; y an internal shaft (8) whose distal end protrudes the first arm (41) of the surgical instrument (4) and whose proximal end protrudes a first actuating arm (10a), the central actuating magnet (7a) being fixed to said proximal end of the inner shaft (8) and the first drive magnet (5a) to a free end of the first drive arm (10a); Y un eje externo (9) hueco que aloja en su interior el eje interno (8) de manera giratoria, de cuyo extremo distal sobresale el segundo brazo (42) del instrumento (4) quirúrgico y de cuyo extremo proximal sobresale un segundo brazo (10b) de accionamiento a cuyo extremo libre está fijado el segundo imán (6a) de accionamiento.  a hollow outer shaft (9) that internally houses the inner shaft (8) in a rotating manner, from whose distal end the second arm (42) of the surgical instrument (4) protrudes and from whose proximal end a second arm (10b protrudes) ) of drive to whose free end the second drive magnet (6a) is fixed. 4. Dispositivo (1 ) endoscópico magnético de acuerdo con la reivindicación 3, donde los brazos (10a, 10b) de accionamiento forman esencialmente un ángulo recto con relación a los ejes interno (8) y externo (9) de la porción interior (2). 4. Magnetic endoscopic device (1) according to claim 3, wherein the actuating arms (10a, 10b) essentially form a right angle relative to the internal (8) and external (9) axes of the inner portion (2) ). 5. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 3-4, donde los brazos de accionamiento (10a, 10b) tienen longitudes (L1 , L2) diferentes para permitir la alineación de los imanes de accionamiento (5a, 6a) con el imán central de accionamiento (7a) con el objeto de facilitar la introducción de la porción interior (2) en el interior de la cavidad del paciente. 5. Magnetic endoscopic device (1) according to any of claims 3-4, wherein the drive arms (10a, 10b) have different lengths (L1, L2) to allow alignment of the drive magnets (5a, 6a ) with the central drive magnet (7a) in order to facilitate the introduction of the inner portion (2) into the patient's cavity. 6. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 3-5, donde los brazos (41 , 42) del instrumento (4) quirúrgico forman un ángulo obtuso con los ejes interno (8) y externo (9) de la porción interior (2). 6. Magnetic endoscopic device (1) according to any of claims 3-5, wherein the arms (41, 42) of the surgical instrument (4) form an obtuse angle with the internal (8) and external (9) axes of the inner portion (2). 7. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 3-6, donde los extremos de los brazos (41 , 42) del instrumento (4) quirúrgico tienen una forma redondeada para evitar dañar al paciente al introducir la porción interior (2) en el interior del paciente. 7. Magnetic endoscopic device (1) according to any of claims 3-6, wherein the ends of the arms (41, 42) of the surgical instrument (4) have a rounded shape to avoid damaging the patient by introducing the inner portion (2) inside the patient. 8. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 3-7, donde la distancia entre los primero y segundo imanes de accionamiento (5a, 6a) y los ejes interno (8) y externo (9) es mayor que la distancia entre los extremos de los brazos (41 , 42) del instrumento quirúrgico (4) y los ejes interno (8) y externo (9). 8. Magnetic endoscopic device (1) according to any of claims 3-7, wherein the distance between the first and second drive magnets (5a, 6a) and the internal (8) and external (9) axes is greater than the distance between the ends of the arms (41, 42) of the surgical instrument (4) and the internal (8) and external (9) axes. 9. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 2-8, donde la porción externa (3) toma la forma de un mango que comprende: una primera pieza de agarre (11) que tiene un extremo distal donde está fijado el primer imán (5b) de control; y 9. Magnetic endoscopic device (1) according to any of claims 2-8, wherein the outer portion (3) takes the form of a handle comprising: a first grip piece (11) having a distal end where the first control magnet (5b) is fixed; Y una segunda pieza de agarre (12) que tiene un extremo distal donde está fijado el segundo imán (6b) de control,  a second grip piece (12) having a distal end where the second control magnet (6b) is fixed, estando ambas piezas de agarre (1 1 , 12) conectadas de manera pivotante por medio de un eje situado en un extremo proximal de las mismas, estando también el imán central (7b) de control fijado a dicho extremo proximal. both gripping pieces (1 1, 12) being pivotally connected by means of an axis located at a proximal end thereof, the central control magnet (7b) also being fixed to said proximal end. 10. Dispositivo (1) endoscópico magnético de acuerdo con la reivindicación 9, donde la primera pieza de agarre (11) tiene un orificio (13) alargado conformado para recibir los dedos índice a anular de un usuario, y la segunda pieza de agarre (12) tiene un orificio circular (14) conformado para recibir el dedo pulgar del usuario. 10. Magnetic endoscopic device (1) according to claim 9, wherein the first grip piece (11) has an elongated hole (13) shaped to receive the index fingers to be annulled from a user, and the second grip piece ( 12) has a circular hole (14) shaped to receive the user's thumb. 11. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones 2-10, donde el primer imán (5a) de accionamiento tiene la misma polaridad que el segundo imán (6a) de accionamiento. 11. Magnetic endoscopic device (1) according to any of claims 2-10, wherein the first drive magnet (5a) has the same polarity as the second drive magnet (6a). 12. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones anteriores, donde los imanes (5a, 5b, 6a, 6b, 7a, 7b) tienen una forma redondeada para evitar causar daños en las paredes de la cavidad del paciente. 12. Magnetic endoscopic device (1) according to any of the preceding claims, wherein the magnets (5a, 5b, 6a, 6b, 7a, 7b) have a rounded shape to avoid causing damage to the walls of the patient's cavity. 13. Dispositivo (1) endoscópico magnético de acuerdo con la reivindicación 12, donde los imanes (5a, 5b, 6a, 6b, 7a, 7b) tienen forma cilindrica. 13. Magnetic endoscopic device (1) according to claim 12, wherein the magnets (5a, 5b, 6a, 6b, 7a, 7b) are cylindrical in shape. 14. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones anteriores, que además comprende una primera lámina (15) semirrígida exterior de baja fricción adecuada para interponerse entre los imanes de control (5b, 6b, 7b) y el paciente. 14. Magnetic endoscopic device (1) according to any of the preceding claims, further comprising a first low-friction outer semi-rigid sheet (15) suitable for interposing between the control magnets (5b, 6b, 7b) and the patient. 15. Dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones anteriores, que además comprende una segunda lámina semirrígida interior de baja fricción adecuada para interponerse entre los imanes de accionamiento (5a, 6a, 7a) y el paciente, siendo dicha lámina semirrígida enrollable para permitir su introducción en el interior de la cavidad del paciente. 15. Magnetic endoscopic device (1) according to any of the preceding claims, further comprising a second low friction inner semi-rigid sheet suitable for interposing between the actuating magnets (5a, 6a, 7a) and the patient, said sheet being semi-rigid roller to allow its introduction into the patient's cavity. 16. Instrumento quirúrgico (4) caracterizado porque es acoplable mecánicamente a la porción interna (2) de un dispositivo (1) endoscópico magnético de acuerdo con cualquiera de las reivindicaciones anteriores. 16. Surgical instrument (4) characterized in that it is mechanically attachable to the inner portion (2) of a magnetic endoscopic device (1) according to any of the preceding claims. 17. Instrumento quirúrgico (4) de acuerdo con la reivindicación 16, que consiste en unas pinzas o unas tijeras. 17. Surgical instrument (4) according to claim 16, consisting of tweezers or scissors.
PCT/ES2013/000262 2012-11-30 2013-11-25 Magnetic endoscopic device Ceased WO2014083217A1 (en)

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WO2007149559A2 (en) * 2006-06-22 2007-12-27 Board Of Regents Of The University Of Nebraska Magnetically coupleable robotic devices and related methods
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WO2012164517A1 (en) * 2011-05-31 2012-12-06 Scuola Superiore Di Studi Universitari E Di Perfezionamento Sant'anna Robotic platform for mini-invasive surgery

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US20030114731A1 (en) * 2001-12-14 2003-06-19 Cadeddu Jeffrey A. Magnetic positioning system for trocarless laparoscopic instruments
WO2007149559A2 (en) * 2006-06-22 2007-12-27 Board Of Regents Of The University Of Nebraska Magnetically coupleable robotic devices and related methods
US20090082627A1 (en) * 2007-09-20 2009-03-26 Olympus Medical Systems Corp. Medical apparatus
US20100105984A1 (en) * 2008-10-21 2010-04-29 Reuben Brewer System and Method for Guiding a Medical Instrument with Magnetic Force Control
WO2012164517A1 (en) * 2011-05-31 2012-12-06 Scuola Superiore Di Studi Universitari E Di Perfezionamento Sant'anna Robotic platform for mini-invasive surgery

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