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WO2014083217A1 - Dispositif endoscopique magnétique - Google Patents

Dispositif endoscopique magnétique 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
English (en)
Spanish (es)
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/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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.

Landscapes

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

Abstract

Dispositif endoscopique magnétique (1) constitué, d'une part, d'une partie interne (2) pourvue d'un instrument chirurgical (4), qui, une fois à l'intérieur d'une cavité d'un patient (100), permet à un chirurgien de manipuler ledit instrument (4) et de saisir, couper etc. un organe interne (101) ; et, d'autre part, d'une partie externe (3) se trouvant à l'extérieur de la cavité. La partie interne (2) peut être manipulée depuis l'extérieur au moyen de la partie externe (3) grâce à un jeu de paires d'aimants qui maintiennent les deux parties (2, 3) reliées magnétiquement, une porte d'entrée destinée à son fonctionnement n'étant donc pas nécessaire. Le dispositif (1) permet à une personne ou à un robot de manipuler différents types d'instrument chirurgical (4) depuis l'extérieur du patient (100) et d'obtenir différents angles d'accès à de la région d'intérêt (triangulation).
PCT/ES2013/000262 2012-11-30 2013-11-25 Dispositif endoscopique magnétique Ceased WO2014083217A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ES201201209A ES2400283B2 (es) 2012-11-30 2012-11-30 Dispositivo endoscópico magnético
ESP201201209 2012-11-30

Publications (1)

Publication Number Publication Date
WO2014083217A1 true WO2014083217A1 (fr) 2014-06-05

Family

ID=47892108

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/ES2013/000262 Ceased WO2014083217A1 (fr) 2012-11-30 2013-11-25 Dispositif endoscopique magnétique

Country Status (2)

Country Link
ES (1) ES2400283B2 (fr)
WO (1) WO2014083217A1 (fr)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030114731A1 (en) * 2001-12-14 2003-06-19 Cadeddu Jeffrey A. Magnetic positioning system for trocarless laparoscopic instruments
WO2007149559A2 (fr) * 2006-06-22 2007-12-27 Board Of Regents Of The University Of Nebraska dispositifs robotiques pouvant être couplés magnétiquement et procédés associés
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 (fr) * 2011-05-31 2012-12-06 Scuola Superiore Di Studi Universitari E Di Perfezionamento Sant'anna Plateforme robotique pour une chirurgie à effraction minimale

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030114731A1 (en) * 2001-12-14 2003-06-19 Cadeddu Jeffrey A. Magnetic positioning system for trocarless laparoscopic instruments
WO2007149559A2 (fr) * 2006-06-22 2007-12-27 Board Of Regents Of The University Of Nebraska dispositifs robotiques pouvant être couplés magnétiquement et procédés associés
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 (fr) * 2011-05-31 2012-12-06 Scuola Superiore Di Studi Universitari E Di Perfezionamento Sant'anna Plateforme robotique pour une chirurgie à effraction minimale

Also Published As

Publication number Publication date
ES2400283A1 (es) 2013-04-08
ES2400283B2 (es) 2013-12-09

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