U.S. patent application number 11/729939 was filed with the patent office on 2008-10-02 for finger mounting for surgical instruments particularly useful in open and endoscopic surgery.
This patent application is currently assigned to T.A.G. Medical Products a Limited Partnership. Invention is credited to Dan Moor, Ran Oren, Eran Zakai.
Application Number | 20080243174 11/729939 |
Document ID | / |
Family ID | 39795675 |
Filed Date | 2008-10-02 |
United States Patent
Application |
20080243174 |
Kind Code |
A1 |
Oren; Ran ; et al. |
October 2, 2008 |
Finger mounting for surgical instruments particularly useful in
open and endoscopic surgery
Abstract
A finger mounting for a surgical instrument includes a sleeve
dimensioned to be received on the outer end of a finger of a user.
The sleeve has an open proximal end for application to the outer
end of the user's finger, an open distal end for exposing the outer
tip of the user's finger when mounted thereon, and an inner
diameter which decreases from the proximal end to the distal end
for facilitating the application of the sleeve to the user's
finger. The sleeve is formed of an elastic material and with a
longitudinal split along its length to permit its diameter to be
increased in order to accommodate fingers of different thicknesses.
The longitudinal split is defined by two opposed edges having
interengaging ribs and recesses of a length in the circumferential
direction to accommodate a wide range of finger thicknesses without
pinching The sleeve is also integrally formed at one side with a
socket for receiving a surgical instrument, such as retractor or
probe having a shank received within the socket, or a pair of
forceps having one arm received in the socket.
Inventors: |
Oren; Ran; (Kibbutz Gaaton,
IL) ; Zakai; Eran; (Moshav Yodfat, IL) ; Moor;
Dan; (Kibbutz Gaaton, IL) |
Correspondence
Address: |
Martin D. Moynihan;PRTSI, Inc.
P.O. Box 16446
Arlington
VA
22215
US
|
Assignee: |
T.A.G. Medical Products a Limited
Partnership
Doar-Na Oshrat
IL
|
Family ID: |
39795675 |
Appl. No.: |
11/729939 |
Filed: |
March 30, 2007 |
Current U.S.
Class: |
606/205 |
Current CPC
Class: |
A61B 17/30 20130101;
A61B 17/02 20130101; A61B 2017/00438 20130101; A61B 17/3423
20130101 |
Class at
Publication: |
606/205 |
International
Class: |
A61B 17/28 20060101
A61B017/28 |
Claims
1. A finger mounting for a surgical instrument, comprising: a
sleeve dimensioned to be received on the outer end of a finger of a
user; said sleeve having an open proximal end for application to
the outer end of the user's finger, an open distal end for exposing
the outer tip of the user's finger when mounted thereon, and an
inner diameter which decreases from said proximal end to said
distal end for facilitating the application of the sleeve to the
user's finger; said sleeve being formed of an elastic material and
with a longitudinal split along its length to permit its diameter
to be increased in order to accommodate fingers of different
thicknesses.
2. The finger mounting according to claim 1, wherein said
longitudinal split is defined by two opposed edges having
interengaging ribs and recesses of a length in the circumferential
direction to accommodate a wide range of fingers thicknesses
without pinching.
3. The finger mounting according to claim 1, wherein the inner
surface of said sleeve is formed with circumferentially-extending
ribs to firmly grip the user's finger when the sleeve is applied
thereto.
4. The finger mounting according to claim 1, wherein said sleeve is
made of an elastic plastic material.
5. The finger mounting according to claim 1, wherein said sleeve is
integrally formed at one side with a socket for receiving a
surgical instrument.
6. The finger mounting according to claim 5, wherein said socket
includes a retainer element engageable with a retainer element on
the surgical instrument for releasably retaining the surgical
instrument within said socket.
7. The finger mounting according to claim 6, wherein one of said
retainer elements is a projection releasably engageable with an
elastic tongue constituting the other retainer element.
8. The finger mounting according to claim 5, wherein said sleeve in
integrally formed at one side also with a pair of arms displaceable
towards and away from each other to closed and open positions,
respectively, for grasping and releasing objects.
9. The finger mounting according to claim 8, wherein said pair of
arms are spring-urged to a closed position but are manually
displaceable to an open position.
10. The finger mounting according to claim 9, further comprising a
cam element located between the pair of arms and manually
depressible to cam the two arms apart to their open positions.
11. The finger mounting according to claim 1, wherein said sleeve
is further formed with a hole therethrough for the attachment of a
suture strand.
12. A finger-mountable surgical instrument, including a finger
mounting in accordance with claim 5, and a surgical instrument
received in said socket formed in one side of said sleeve.
13. The finger-mountable surgical instrument according to claim 12,
wherein said surgical instrument is a retractor having a shank
received in said socket.
14. The finger-mountable surgical instrument according to claim 12,
wherein said surgical instrument is a probe having a shank received
in said socket.
15. The finger-mountable surgical instrument according to claim 12,
wherein said surgical instrument is a forceps having pair of arms,
one of said arms being received in said socket, and the other of
said arms being spaced away from said one arm but manually
displaceable towards said one arm to a closed position with respect
thereto for grasping an object.
16. A finger-mountable surgical instrument, comprising: a sleeve
dimensioned to be received on the outer end of a finger of a user;
and a pair of arms integrally formed at one side of said sleeve
which arms are displaceable towards and away from each other to
closed and open positions, respectively, for grasping and releasing
objects.
17. A finger-mountable surgical instrument according to claim 16,
wherein said pair of arms are spring-urged to a closed position,
but are manually displaceable to an open position by a cam element
located between said pair of arms and is manually depressible to
cam the two arms apart to their open positions.
18. A finger-mountable surgical instrument, comprising: a sleeve
dimensioned to be received in the outer end of a finger of a user,
said sleeve being formed at one side with a socket; and a surgical
instrument received in said socket.
19. The finger-mountable surgical instrument according to claim 18,
wherein said surgical instrument is a retractor or probe having a
shank received within said socket.
20. The finger-mountable surgical instrument according to claim 18,
wherein said surgical instrument is a forceps having a pair of
arms, one of which is received in said socket, and the other of
which is manually displaceable to closed and open positions with
respect to said one arm for grasping and releasing objects.
Description
FIELD AND BACKGROUND OF THE INVENTION
[0001] The present invention relates to finger-mountings for
surgical instruments for use in both open and endoscopic surgery.
The invention also relates to such finger-mountable surgical
instruments.
[0002] In an open surgery procedure, an incision is made through
the skin, and the tissues overlying the surgical site are retracted
in order to expose an area large enough to allow for access and
orientation by direct vision. The surgeon may use a wide range of
instruments to perform the specific procedure, and may also use the
surgeon's fingers to touch organs and receive tactile feedback.
However, fingers lack the delicacy to pick up fine tissue; they
require making larger divisions when dissecting tissues; and they
are subject to injury when holding tissue if sharp instruments or
energy modalities, such as ultrasound or RF, are used in the
treatment at the surgical site.
[0003] In recent years, more and more procedures are being
performed endoscopically. Endoscopy is a minimal invasive surgical
procedure in which illumination, cameras and surgical tools are
inserted into the patient's body via small incisions through the
skin, and are manipulated externally, guided by the image displayed
on a TV monitor. For the patient, trauma is minimized, and healing
time and length of stay in hospital are shortened. Particularly,
laparoscopy--endoscopy in the abdominal cavity--is being widely
used both for diagnosis and for performing full surgical
procedures.
[0004] However, several difficulties are inherent in this
technique. Thus, considerable skill and experience are required to
position the instruments spatially relative to internal organs
while viewed in a two-dimensional monitor. Also, the field of
vision displayable on the monitor is narrow making orientation even
more difficult. In addition, it is hard to control the instruments
because of their length, which is typically about 350 mm from the
handles outside the body to the tip that actually performs the
operations within the body cavity; this length is needed to reach
the organs within the abdomen when the cavity is insufflated as
required by the technique. Moreover, direct contact between the
organs and the surgeon's hand is not possible, so that tactile
feedback is lost.
[0005] Recently, a modified laparoscopic technique has evolved
which is referred to as Hand-Assisted Laparoscopic Surgery (HALS),
in which one hand of the surgeon has access to the body cavity
while maintaining insufflation. This technique, as described for
example in U.S. Pat. No. 5,640,977 to Patrick Leahy et al, is now
an alternative procedure of choice. As only a relatively small
additional incision is required, just sufficient for admitting the
surgeon's hand, the advantages of minimal invasiveness are
preserved. For the surgeon, less training is required because the
presence of his/her hand in the body cavity allows palpation of
internal organs, biophysical feedback, and easier manipulation of
various instruments within the body cavity while viewing the TV
monitor.
[0006] With the advancement of the HALS technique, a need arose for
instruments which could be mounted directly onto the fingers of the
hand within the body cavity, i.e, the "ported" hand. Miniature
forceps, graspers, scissors, dissectors, probes, retractors, etc.,
modeled on existing instruments used in open surgery and mounted on
the surgeon's finger, could perform delicate surgical tasks and aid
the laparoscopic instruments introduced through the "keyhole"
incisions. Obviously it would be advantageous to provide such
instruments for use in open procedures as well as in "keyhole"
procedures.
[0007] Several such instruments were suggested in U.S. Pat. No.
5,925,065 to Meyers et al, and US Application 20040193211 to
Voegele et al. However, all the instruments described therein must
be fixed to the finger outside of the body. Therefore, in HALS
procedures the hand must be withdrawn through the port for changing
instruments, which limits the advantages possible by this
procedure.
OBJECT AND BRIEF SUMMARY OF THE PRESENT INVENTION
[0008] An object of the present invention is to provide a finger
mounting for a surgical instrument which enables the surgical
instrument to be mounted on the surgeon's finger by other fingers
in the same hand to carry the surgical instrument, thereby
eliminating the need for withdrawing the hand from the body cavity
for purposes of mounting or changing surgical instruments. Another
object of the invention is to provide such finger-mountable
surgical instruments.
[0009] According to a broad aspect of the present invention, there
is provided a finger mounting for surgical instruments, comprising:
a sleeve dimensioned to be received on the outer end of a finger of
a user; the sleeve having an open proximal end for application to
the outer end of the user's finger, an open distal end for exposing
the outer tip of the user's finger when mounted thereon, and an
inner diameter which decreases from the proximal end to the distal
end for facilitating the application of the sleeve to the user's
finger; the sleeve being formed of an elastic material and with a
longitudinal split along its length to permit its diameter to be
increased in order to accommodate fingers of different
thicknesses.
[0010] According to further features in the described preferred
embodiments, the longitudinal split is defined by two opposed edges
having interengaging ribs and recesses of a length in the
circumferential direction to accommodate a wide range of finger
thicknesses without pinching. Such inter-engaging ribs and recesses
not only assure firm gripping of the (gloved) fingers around the
complete circumference of the sleeve, but also facilitate the
manipulation of the instrument onto the user's finger without
pinching the user's finger. In addition, the inner surface of the
sleeve is formed with circumferentially-extending ribs to firmly
grip the user's finger when the sleeve is applied thereto. In the
described embodiments, the sleeve is made of an elastic plastic
material.
[0011] According to further features in the described preferred
embodiments, the sleeve is integrally formed at one side with a
socket for receiving a surgical instrument. Various types of
surgical instrument are described for purposes of example,
including retractors, probes, and forceps.
[0012] According to another aspect of the present invention, there
is provided a finger-mountable surgical instrument, comprising: a
sleeve dimensioned to be received on the outer end of a finger of a
user; and a pair of arms integrally formed at one side of the
sleeve which arms are displaceable towards and away from each other
to closed and open positions, respectively, for grasping and
releasing objects.
[0013] According to yet another aspect of the present invention,
there is provided a finger-mountable surgical instrument
comprising: a sleeve dimensioned to be received in the outer end of
a finger of a user, the sleeve being formed at one side with a
socket; and a surgical instrument received in the socket.
[0014] As will be described more particularly below, the invention
enables one or more finger-mountable surgical instruments to be
enclosed within the surgeon's fist and introduced with the
surgeon's fist through the port into the body cavity in the
above-described HALS procedures. The instruments, when so
introduced into the patient's body, can be easily applied to and
removed from the finger of the ported hand of the surgeon by merely
manipulating the fingers of the ported hand, as will be described
below.
[0015] An additional advantage of the described preferred
embodiments is that the finger-mountable sleeves, and also the
instruments affixed thereto, can be produced in volume and at low
cost, thereby permitting one-time use.
[0016] Further features and advantages of the invention will be
apparent from the description below.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] The invention is herein described, by way of example only,
with reference to the accompanying drawings, wherein:
[0018] FIG. 1 schematically illustrates a hand-assisted laparoscopy
procedure in which the invention is particularly useful;
[0019] FIG. 2 illustrates the insertion of the surgeon's fist into
the abdominal cavity holding a number of finger-mountable surgical
instrument constructed in accordance with the present
invention;
[0020] FIG. 3 illustrates a finger-mountable surgical retractor
constructed in accordance with the present invention;
[0021] FIG. 4 is a fragmentary view of FIG. 3 illustrating the
finger-mountable sleeve with the surgical retractor mounted and
retained therein;
[0022] FIG. 5 illustrates the manner in which the illustrated
finger-mountable retractor may be mounted on the surgeon's finger
by merely manipulating other fingers of the surgeon's hand, thereby
eliminating the need for withdrawing the surgeon's hand from the
body cavity in a HALS procedure;
[0023] FIG. 6 illustrates a modification in the construction of the
finger-mountable retractor of FIG. 3;
[0024] FIG. 7 illustrates a finger-mountable probe constructed in
accordance with the present invention;
[0025] FIG. 8 illustrates a finger-mountable forceps or tweezers
constructed in accordance with the present invention, also capable
of mounting another surgical instrument, such as a retractor or
probe, if desired;
[0026] FIGS. 9 and 10 are top and bottom views, respectively, of
the finger-mountable forceps or tweezers of FIG. 8, and
[0027] FIG. 11 illustrates yet another finger-mountable instrument,
also in the form of a forceps or tweezers, constructed in
accordance with the present invention.
[0028] It is to be understood that the foregoing drawings, and the
description below, are provided primarily for purposes of
facilitating understanding the conceptual aspects of the invention
and possible embodiments thereof, including what is presently
considered to be a preferred embodiment. In the interest of clarity
and brevity, no attempt is made to provide more details than
necessary to enable one skilled in the art, using routine skill and
design, to understand and practice the described invention. It is
to be further understood that the embodiments described are for
purposes of example only, and that the invention is capable of
being embodied in other forms and applications than described
herein.
DESCRIPTION OF PREFERRED EMBODIMENTS
[0029] FIG. 1 illustrates a patient 1 lying prone on an operating
table, with the body (abdominal) cavity 2 insufflated to create
free space for surgery. An endoscope 3 is inserted through the
abdominal wall 4 to provide illumination and imaging. Through a
second small incision, a grasping instrument 5 is introduced into
the body cavity. The surgeon 6 manages the grasper with one gloved
hand 7, while the other gloved hand 8, introduced through a hand
port device 9, may be used for palpating an organ.
[0030] FIG. 2 illustrates the insertion of the gloved hand 8
through the hand port 9, which provides a seal around both the
gloved hand and the abdominal wall 4. One or more finger-mounted
surgical instruments are concealed in the closed fist, which
protects them from causing damage when introduced through the
port.
[0031] FIG. 3 illustrates a finger-mountable surgical instruments
that may be included within the closed fist of the surgeon's hand
shown in FIG. 2.
[0032] The finger-mountable surgical instrument illustrated in FIG.
3 includes a thimble or sleeve, generally designated 20, to be
received on the outer end of a finger of the surgeon, and a
surgical retractor, generally designated 30, fixed to the sleeve to
project forwardly of the sleeve. Sleeve 20 has an open proximal end
21 (with respect to the surgeon) for application to the outer end
of the surgeon's finger, and an open distal end 22 which exposes
the outer tip of the surgeon's finger when mounted thereon. As seen
in FIG. 3, sleeve 20 is of a tapered construction, having an inner
diameter and an outer diameter decreasing from its proximal end 21
to its distal end 22, which facilitates the application of the
sleeve to the surgeon's finger.
[0033] As further seen in FIG. 3, sleeve 20 is split along its
longitudinal axis so as to define two opposed edges, 23, 24
confronting each other. Each of the two edges 23, 24 includes
circumferentially-extending ribs (23a, 24a) and recesses (23b,
24b), interengaging each other: Sleeve 20 is made of an elastic,
preferably plastic, material such that the longitudinal-split
permits its diameter to be increased in order to accommodate
fingers of different thicknesses. In addition the interengaging
ribs and recesses not only better assure that the sleeve will
firmly engage the entire outer surface of the surgeon's gloved
finger when mounted thereon, but also facilitate the manipulation
of the sleeve onto the user's finger without "pinching" the
finger.
[0034] As further shown in FIG. 3, the inner surface of sleeve 20
is formed with circumferentially-extending ribs or rill-shaped
undercuts, 25, which better assure firm gripping of the surgeon's
gloved finger when the sleeve is mounted thereon.
[0035] Sleeve 20 illustrated in FIG. 3 is integrally formed at one
side with a socket 26 for receiving the surgical instrument 30. In
this case, socket 26 is in the form of a wide, rectangular
passageway adapted to receive the flat shank 31 of surgical
retractor 30. The flat shank 31 of surgical retractor 30 may be
introduced into socket 26 via the distal end 22 of sleeve 20.
[0036] As shown in FIG. 4 socket 26 may include a projection 28
which automatically seats within an elastic tongue 32 defining a
detent in shank 31 of retractor 30 upon the insertion of the shank
into the socket. The engagement of projection 28 with detent 32 may
be a permanent snap-fit if the sleeve and retractor are intended
for one-time use, or a releasable snap-fit if one (or both) of
these elements is intended for multiple-use.
[0037] FIG. 5 illustrates how a finger-mountable instrument as
illustrated in FIG. 3 may be gripped within the enclosed fist of a
surgeon's gloved hand, when introduced through a hand port device 9
(FIG. 1), and conveniently applied to the index finger 40 of the
surgeon's gloved hand by merely manipulating the sleeve using the
thumb 41 and middle finger 42 of the surgeon's hand.
[0038] FIG. 6 illustrates the finger-mountable instrument described
above except with a retractor 30' having a cylindrical shank 31'
rather than a flat shank. Accordingly, a socket 26 would be
suitably shaped to define a cylindrical passageway for receiving
the cylindrical shank 31'. In this case, the retractor would be
fixed within the socket by a friction fit.
[0039] Another modification illustrated in FIG. 6 is the provision
of a small hole, shown at 29, through sleeve 20 near its proximal
end 21. Hole 29 enables the attachment of a suture strand (not
shown) which, when led through the port to the outside, facilitates
tracing the instrument inside the body cavity during a HALS
procedure. It will be appreciated that the finger-mountable sleeve
illustrated in FIGS. 3-5, as well as those to be described below,
could also be formed with such a hole for this purpose.
[0040] FIG. 7 illustrates the finger-mountable sleeve 20 for
mounting another type of surgical instrument, in this case a probe
50 having a cylindrical shank 51 and a ball 52 at its outer
end.
[0041] FIGS. 8-10 illustrate another construction of the
finger-mountable sleeve 20 to include a forceps or tweezers,
generally designated 60, in addition to the socket 26 for mounting
a retractor, probe, or other like surgical instrument. Thus, the
finger-mountable sleeve 20 is integrally formed with an elastic
strip 61 at its proximal end 21. Elastic strip is in turn
integrally formed with a pair of arms 62, 63 and a cam member 64
projecting towards and past distal end 22 of the sleeve. The two
arms 62, 63 are normally biased to their closed position, as
illustrated in FIG. 8, but are displaceable by cam element 64, when
the distal end of its connecting strip 61 is manually pressed
inwardly, to cam-apart the two arms 62, 63 to their open
positions.
[0042] Thus, the construction illustrated in FIGS. 8-10 not only
permit a probe, retractor, or other surgical instrument to be
conveniently carried by the finger-mountable sleeve 20, but also
permits the finger-mountable sleeve to be used as a forceps for
grasping or releasing the various objects, such as tissue, sutures,
suture needles, etc.
[0043] FIG. 11 illustrates a further finger-mountable surgical
instrument of basically the same construction as described above
with respect to FIG. 3, and therefore corresponding elements have
been identified by the same reference numerals. In the construction
illustrated in FIG. 11, however, the socket 26 in the
finger-mountable sleeve 20 is used for receiving one arm 71 of
another type of forceps, generally designated 70, and the other arm
72 is integrally formed with an elastic strip 73 joined to arm 71.
The two arms 71, 72 of forceps 70 are normally biased to their open
positions, as illustrated in FIG. 11, but the lower arm 72 includes
a bend 74 which is engageable by the finger of the user, to move
arm 72 to a closed position with respect to arm 71.
[0044] All the components of the finger-mountable instruments
described above can be made of a suitable biocompatible material
according to conventional techniques, such as machining, forming,
molding, riveting, etc.
[0045] While the invention has been described with respect to
several preferred embodiments, it will be appreciated that these
are set forth merely for purposes of example, and that many other
variations, modifications and applications of the invention may be
made.
* * * * *