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WO2020121354A1 - Porte-aiguille laparoscopique magnétique rotatif - Google Patents

Porte-aiguille laparoscopique magnétique rotatif Download PDF

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Publication number
WO2020121354A1
WO2020121354A1 PCT/IT2019/050263 IT2019050263W WO2020121354A1 WO 2020121354 A1 WO2020121354 A1 WO 2020121354A1 IT 2019050263 W IT2019050263 W IT 2019050263W WO 2020121354 A1 WO2020121354 A1 WO 2020121354A1
Authority
WO
WIPO (PCT)
Prior art keywords
shaft
laparoscopic
coupling means
needle
intracorporeal
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/IT2019/050263
Other languages
English (en)
Inventor
Francesco NOVELLO
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of WO2020121354A1 publication Critical patent/WO2020121354A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0483—Hand-held instruments for holding sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0485—Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00876—Material properties magnetic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft

Definitions

  • the present invention relates to a laparoscopic device, in particular an improved laparoscopic needle holder for the formation of intracorporeal knots.
  • the invention relates to a laparoscopic device of the mentioned type, studied and realized in particular to form intracorporeal knots for suturing human or animal tissues, but which can be used for the formation of any knot, where it is necessary to operate at a given distance and with limited maneuver room.
  • laparoscopy is a minimally invasive surgical technique, through which the surgeon can, for example, operate inside the abdominal or pelvic cavity of a patient, without resorting to large incisions required by the traditional“open air” surgery.
  • the laparoscopic surgical technique involves making small incisions, necessary for the introduction of the laparoscope.
  • Extracorporeal knotting consists in the execution of knots outside the body.
  • Said extracorporeal knots are subsequently introduced, through the trocars, into the intracorporeal operative field to be firmly tightened.
  • the intracorporeal knots are performed directly inside the intracorporeal cavity through the combined use of a laparoscopic needle holder and a laparoscopic graspers, which have to be coordinated each other at the same time to rotate with respect to each other, so that they couple and decouple each other with the suture needle.
  • intracorporeal suturing techniques consists in the formation of an intracorporeal knot comprising the following phases:
  • the length of the suture thread can affect the execution speed of said intracorporeal knot.
  • sutures with a length between 20 cm and 25 cm, as both a length less than 20 cm and a length greater than 25 cm could make the realization of the intracorporeal knot difficult.
  • a further drawback of such known solutions is due to the fact that the learning curve for a laparoscopic surgeon is extremely steeper in the case of intracorporeal knots than the extracorporeal ones, and consequently the intracorporeal knots are easily formed only by more expert surgeons.
  • extracorporeal knots can be made only using one hand, while intracorporeal knots need two hands, each to operate with a respective laparoscopic instrument.
  • the maneuverability angle of the laparoscopic needle holder and the laparoscopic grasper is limited by the presence of the entry holes through the trocars, which act as a central fulcrum limiting the surgeon's movements.
  • Still another drawback of these solutions according to the prior art is due to the fact that it is necessary to operate with a reduced view, since visibility is defined only by the visibility area of the laparoscopic probe.
  • suture thread type influences the ease of making the intracorporeal knot.
  • monofilaments require a greater number of knots than woven threads and make the technique of making intracorporeal knots even more complex and difficult for the surgeon to perform.
  • sutures with detached stitches guarantee greater reliability and management to the surgeon, compared with the continuous sutures, allowing, for example, to repair a blood vessel or not to ischemise the operated tissues.
  • Another object of the invention is to provide a laparoscopic device that is easy to use and that allows the surgeon to use only one hand for realizing the semiknots necessary for the formation of the intracorporeal knot, using, instead, both hands only in the final phase, to tighten the previously created semiknots.
  • a further object of the present invention is providing a laparoscopic device for making both continuous and with detached points intracorporeal knots.
  • Another object of the present invention is to provide a laparoscopic kit of laparoscopic devices for making intracorporeal knots in a simple, intuitive and fast way.
  • a further object of the present invention is to provide a laparoscopic device which is highly reliable and simple to manufacture, at competitive costs if compared to the prior art.
  • a laparoscopic device intended to the formation of intracorporeal knots by an operator by means of a suture thread connected to a needle, comprising: a first shaft comprising a proximal portion and a distal portion; a grasping clamp for grasping and releasing said needle and/or said suture thread, arranged in correspondence of said distal portion of said first shaft; and an handle, arranged in correspondence of said proximal portion of said first shaft, and operatively connected to said grasping clamp for opening and closing it; said device being characterized in that it comprises coupling means to be coupled with said needle, wherein said coupling means are arranged between said grasping clamp and said proximal portion, and wherein said coupling means are rotatable around the symmetry axis of said first shaft in both rotation directions; and in that it comprises an actuation handle, operatively connected to said coupling means, and configured for rotating said coupling means when activated by an operator.
  • said device may comprise a second shaft that is hollow and concentric to said first shaft between said proximal portion and said grasping clamp, said second shaft being able to rotate around said symmetry axis in both rotation directions, and said coupling means may be arranged on said second shaft.
  • said actuation handle may be operable by said operator and may be connected to said second shaft.
  • said first shaft may be adapted to rotate around said symmetry axis in both rotation directions, and said coupling means may be arranged on said first shaft.
  • said coupling means may be magnetic elements magnetically couplable with a respective needle.
  • said grasping clamp may comprise a first jaw and a second jaw and may have a closed configuration for blocking said needle and/or said suture thread and an open configuration for releasing said needle and/or said suture thread.
  • said coupling means may be arranged proximately to said grasping clamp.
  • a laparoscopic kit comprising a laparoscopic device as mentioned and at least one laparoscopic grasper having a shaft arranged along an axis, said shaft being rotatable around said axis in both rotation directions.
  • said laparoscopic grasper may comprise at least one magnetic element fixed on said shaft.
  • figure 1 shows schematically an example of embodiment of an intracorporeal knot, according to the prior art
  • figure 2 shows, in perspective view, a first embodiment of the laparoscopic needle holder, according to the present invention
  • figure 3 shows, in perspective view and in detail, the laparoscopic needle holder according to figure 2;
  • figure 4 shows a partial longitudinal section of the laparoscopic needle holder, according to figure 3;
  • figure 5 shows, in perspective view, a second embodiment of the laparoscopic needle holder, according to the present invention.
  • figure 6 shows, in perspective view, an embodiment of a laparoscopic grasper, according to the present invention.
  • the laparoscopic device according to the present invention will be complexively indicated with the reference number 1 .
  • said device 1 is a laparoscopic needle holder; however, in further embodiments said device 1 can also comprise laparoscopic graspers or the like.
  • Said device 1 can couple with a needle 100 connected to one end of a suture thread 101 , locking it.
  • Said device 1 substantially comprises a first shaft 2 and a handle 4, to which said first shaft 2 is coupled to a proximal portion 2'.
  • Said device 1 also comprises a grasping clamp 3 for holding said needle 100, arranged on the distal portion 2" with respect to said handle 4 of said first shaft 2.
  • Said device 1 also comprises a second shaft 8, which is hollow and concentric with said first shaft 2 and arranged between said proximal portion 2' and said grasping clamp 3.
  • said first shaft 2 is preferably made with biocompatible metallic materials, such as for example titanium or steel.
  • Said grasping clamp 3 of said needle 100 and/or of said suture thread 101 comprises two jaws 3' , 3".
  • the first jaw 3' is movable, while the second jaw 3" is fixed.
  • the grasping clamp 3 is capable of passing from a closed configuration, in which said needle 100 and/or said suture thread 101 can be blocked and operated during the laparoscopic surgical operation, to an open configuration, in which said needle 100 and/or said suture thread 101 can be released.
  • said two jaws 3', 3" are substantially parallel to each other and aligned to said axis of symmetry A, while in said open configuration said first jaw 3' of said grasping clamp 3 is movable forming a non-zero angle with said axis of symmetry A.
  • said two jaws 3', 3" when in said open configuration can form for example an angle equal to about 60 °.
  • Said handle 4 is operatively connected to said grasping clamp 3.
  • said handle 4 comprises a movable lever 41 and a fixed lever 42, between which elastic means 5 are arranged, in particular a return spring 5.
  • the grasping clamp 3 By acting on said handle 4, or by moving said movable lever 41 with respect to said fixed lever 42, at the hands of an operator, such as a surgeon, the grasping clamp 3 is closed or opened.
  • Said second shaft 8 (in jargon "shirt") is hollow and arranged concentrically with respect to said first shaft 2.
  • said second shaft 8 is preferably made of biocompatible materials, be they plastic or metallic.
  • said second shaft 8 can rotate around said axis of symmetry A in both directions of rotation to an operating knob 7 arranged in correspondence with said handle 4.
  • said actuation knob 7 is connected to said second shaft 8, so that by rotating said actuation knob 7, said second shaft 8 in its turn rotates with respect to said first shaft 2 and said handle 4.
  • said operator can rotate said actuation knob 7, for example by manually acting on it.
  • said second shaft 8 comprises a magnet 6, or coupling means 6, capable of magnetically coupling to said needle 100, allowing the winding of the thread suture 101 connected to said needle 100, when said second shaft 8 is rotating.
  • Said magnet 6 is arranged in correspondence with said distal portion 2", in particular in correspondence of the third distal of said first shaft 2.
  • third distal means a portion equal to one third of the total length of said first shaft 2, and comprising said distal portion 2".
  • said device 1 has only said first shaft 2 that is rotatable.
  • said first shaft 2 in its turn comprises said magnet 6, or said coupling means 6, which are capable of magnetically coupling to said needle 100, allowing the winding of the connected suture thread 101 to said needle 100, when said first shaft 2 is rotating.
  • said first shaft 2 can rotate in both directions of rotation together with said magnet 6 and said grasping clamp 3.
  • first shaft 2 and said second shaft 8 of said device 1 are then inserted inside the surgical area by means of laparoscopic guides or trocars.
  • said first shaft 2 and said second shaft 8 have a cross section with respect to said axis of symmetry A of smaller or equal dimensions of the section of the guide.
  • the device 1 according to the present invention allows the creation of intracorporeal knots through the following steps:
  • the aforementioned steps allow the creation of intracorporeal knots in a simple, easily reproducible way and using just a laparoscopic surgical instrument in the semiknots formation step.
  • Figure 6 shows a laparoscopic grasper 10 according to the present invention.
  • Said laparoscopic grasper 10 is configured to be used, for example, in the formation of intracorporeal knots, in combination with said device 1.
  • Said laparoscopic grasper 10 comprises:
  • Said gripper 13 is also equipped with two further movable jaws 13', 13" .
  • said two further movable jaws 13', 13" can assume a closed configuration, in which they are substantially parallel to each other and aligned with the axis of symmetry A2, and an open configuration, in which both said two further movable jaws 13', 13" form a non-zero angle with said axis of symmetry A2.
  • said magnetic elements comprise at least one magnet 16, arranged in correspondence with said distal portion 12", in particular in correspondence with a third distal of said first shaft 12.
  • said actuation knob 17, operatively connected to said coupling means 16, is configured to rotate said shaft 12 around said axis A2.
  • the laparoscopic grasper 10 can be used for the formation of intracorporeal knots using the same procedure described for the laparoscopic needle holder 1.
  • said laparoscopic gripper 10 can be used in combination with said laparoscopic needle holder 1 for the creation of intracorporeal knots.
  • said laparoscopic gripper 10 allows to uncouple the suture needle 100 from the needle holder according to the present invention to complete an intracorporeal knot performed with said needle holder.
  • the combined use of the two laparoscopic devices allows to optimize the times for the formation of intracorporeal knots.
  • An advantage of the laparoscopic device according to the present invention is that of guaranteeing greater manageability, an intuitive and simple use, which entail both a less steep learning curve for the surgeon, and a higher speed of execution of the intracorporeal knot.
  • a further advantage of the laparoscopic device according to the present invention consists in optimizing the formation of the intracorporeal knots, through the use of a single hand in the realization phases of the knot, excluding the conclusive step, in which said intracorporeal knot is pulled. In this way, complicated coordination maneuvers between laparoscopic instruments are advantageously avoided.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Magnetic Treatment Devices (AREA)
  • Electrochromic Elements, Electrophoresis, Or Variable Reflection Or Absorption Elements (AREA)
  • Golf Clubs (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif laparoscopique (1), destiné à la formation de nœuds intracorporels par un opérateur au moyen d'un fil de suture (101) relié à une aiguille (100), comprenant : une première tige (2) comprenant une partie proximale (2') et une partie distale (2") ; une pince de préhension (3) pour saisir et libérer ladite aiguille (100) et/ou ledit fil de suture, agencée en correspondance de ladite partie distale (2") de ladite première tige (2) ; et une poignée (4), agencée en correspondance de ladite partie proximale (2') de ladite première tige (2), et reliée fonctionnellement à ladite pince de préhension (3) pour l'ouverture et la fermeture de cette dernière ; ledit dispositif (1) étant caractérisé en ce qu'il comprend des moyens d'accouplement (6) devant être accouplés avec ladite aiguille (100), lesdits moyens d'accouplement (6) étant agencés entre ladite pince de préhension (3) et ladite partie proximale (2'), et lesdits moyens d'accouplement (6) pouvant tourner autour de l'axe de symétrie (A) de ladite première tige (2) dans les deux sens de rotation ; et en ce qu'il comprend une poignée d'actionnement (7), reliée fonctionnellement auxdits moyens d'accouplement (6), et conçue pour faire tourner lesdits moyens d'accouplement (6) lorsqu'elle est activée par un opérateur.
PCT/IT2019/050263 2018-12-13 2019-12-11 Porte-aiguille laparoscopique magnétique rotatif Ceased WO2020121354A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT102018000011049A IT201800011049A1 (it) 2018-12-13 2018-12-13 Porta aghi laparoscopico magnetico rotante.
IT102018000011049 2018-12-13

Publications (1)

Publication Number Publication Date
WO2020121354A1 true WO2020121354A1 (fr) 2020-06-18

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PCT/IT2019/050263 Ceased WO2020121354A1 (fr) 2018-12-13 2019-12-11 Porte-aiguille laparoscopique magnétique rotatif

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IT (1) IT201800011049A1 (fr)
WO (1) WO2020121354A1 (fr)

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070135678A1 (en) * 2005-12-14 2007-06-14 Olympus Medical Systems Corp. Lifting method for lesion area, and anchoring device
US20140277104A1 (en) * 2013-03-12 2014-09-18 Levita Magnetics International Corp. Grasper with magnetically-controlled positioning

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070135678A1 (en) * 2005-12-14 2007-06-14 Olympus Medical Systems Corp. Lifting method for lesion area, and anchoring device
US20140277104A1 (en) * 2013-03-12 2014-09-18 Levita Magnetics International Corp. Grasper with magnetically-controlled positioning

Also Published As

Publication number Publication date
IT201800011049A1 (it) 2020-06-13

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