U.S. patent application number 13/660778 was filed with the patent office on 2013-02-21 for surgical instrument for endoscopic surgery.
This patent application is currently assigned to CORPORACION SANITARIA PARC TAULI. The applicant listed for this patent is Corporacion Sanitaria Parc Tauli. Invention is credited to Jordi Carrera Fabra, Enric LaPorte Rosello, Antonio Pena Gonzalez, Albert Tomas Justribo.
Application Number | 20130046141 13/660778 |
Document ID | / |
Family ID | 38458681 |
Filed Date | 2013-02-21 |
United States Patent
Application |
20130046141 |
Kind Code |
A1 |
LaPorte Rosello; Enric ; et
al. |
February 21, 2013 |
SURGICAL INSTRUMENT FOR ENDOSCOPIC SURGERY
Abstract
Surgical instrument for endoscopic surgery that permits the
simulation of the articulation movements of a surgeon finger,
comprising a rigid tube (3) whose distal end has a first phalanx
(4) articulated, being in turn articulated to a second phalanx (5),
which is linked to the rigid tube (3) by means of cables housed in
cross ducts (12), situated in the interior of the first phalanx
(4), linking the movement of the second phalanx (5) to that of the
first phalanx (4), whose articulation takes place due to the
actuation of the transmission rod (11), the rigid tube (3) being
attachable to a handle (1) that incorporates a controller (2) for
the actuating of the instrument articulation movement by the
surgeon, which operates a fork (14), which in turns actuates the
transmission rod (11).
Inventors: |
LaPorte Rosello; Enric;
(Barcelona, ES) ; Pena Gonzalez; Antonio;
(Barcelona, ES) ; Carrera Fabra; Jordi;
(Barcelona, ES) ; Tomas Justribo; Albert;
(Barcelona, ES) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Corporacion Sanitaria Parc Tauli; |
Barcelona |
|
ES |
|
|
Assignee: |
CORPORACION SANITARIA PARC
TAULI
Barcelona
ES
|
Family ID: |
38458681 |
Appl. No.: |
13/660778 |
Filed: |
October 25, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
12281614 |
Jan 19, 2009 |
8317811 |
|
|
PCT/ES2006/000284 |
May 24, 2006 |
|
|
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13660778 |
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Current U.S.
Class: |
600/104 |
Current CPC
Class: |
A61B 17/29 20130101;
A61B 17/0218 20130101; A61B 34/70 20160201; A61B 2017/32007
20170801; A61B 2017/292 20130101; A61B 2017/2927 20130101; A61B
2017/320044 20130101; A61B 2017/2929 20130101; A61B 2017/003
20130101; A61B 2017/2925 20130101 |
Class at
Publication: |
600/104 |
International
Class: |
A61B 1/00 20060101
A61B001/00 |
Foreign Application Data
Date |
Code |
Application Number |
Mar 3, 2006 |
ES |
P200600522 |
Claims
1. Surgical instrument for endoscopic surgery characterised in that
it comprises a rigid tube, whose distal end has a first phalanx
articulated, which in turn, at its distal end, has a second phalanx
articulated, which is linked to the rigid tube by means of cables
housed in cross ducts, situated in the interior of the first
phalanx, linking the movement of the second phalanx to that of the
first phalanx.
2. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the ends of the cables housed in the ducts
are fixed at the distal end of the rigid tube by means of anterior
anchoring holes, and at the proximal end of the second phalanx by
means of end anchoring holes.
3. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the interior of the rigid tube houses a
transmission rod which is connected at its distal end to a link,
which is in turn connected, by its opposite end, to the first
phalanx, whose articulation is produced by the actuation of the
transmission rod.
4. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the rigid tube is attachable to a handle,
which has an appropriate configuration for the holding, gripping
and handling of the instrument with just one hand by the
surgeon.
5. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the handle has a controller, for actuating
the instrument articulation movement by the surgeon, which operates
a fork, which in turn acts on the transmission rod.
6. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the interior of the handle is provided with
at least a spring, or some other equivalent cushioning element, for
regulating and increasing the precision of the movement of the
controller.
7. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the rigid tube is enabled to rotate around
its own axis in respect of the handle by means of a rotation crown,
which is situated in the coupling area between the handle and the
rigid tube.
8. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the rotation crown houses a mechanism
comprising at least a spring, or some other equivalent means of
cushioning, for locking the position of the rigid tube.
9. Surgical instrument for endoscopic surgery according to claim 1,
characterised in that the area of actuation of the fork with the
transmission rod is provided with an initial positioning wheel,
which permits the positional adjustment of the fork in relation to
the transmission rod, for regulating the initial position of
articulation of the first phalanx and of the second phalanx, prior
to the operation of the controller by the surgeon.
10. Surgical instrument for endoscopic surgery according to claim
1, characterised in that the interior of the rigid tube, of the
first phalanx and of the second phalanx has an internal axial hole,
which is connected to a duct for the tasks of irrigation and
suction of liquids during surgery.
11. Surgical instrument for endoscopic surgery according to claim
1, characterised in that the distal end of the second phalanx is
configured to incorporate a terminal of an electric or ultrasound
scalpel.
12. Surgical instrument for endoscopic surgery according to claim
1, characterised in that it is disposable.
13. Surgical instrument for endoscopic surgery according to claim
1, characterised in that the distal end of the rigid tube
incorporates sensors, which may consist of extensiometric gauges
according to the three axes of three-dimensional space, which
convert the forces that act on the instrument into electrical
signals, providing information on the forces that the instrument
exerts on the patient.
14. Surgical instrument for endoscopic surgery according to claim
13, characterised in that the actuation on the instrument is
carried out by means of a robot so that the instrument may be
actuated remotely in telesurgery operations.
Description
OBJECT OF THE INVENTION
[0001] The present invention refers to a surgical instrument for
endoscopic surgery which has its application in the field of
medicine, and more specifically in those operations connected with
endoscopic surgery in which an instrument is required that is
capable of executing a double articulation in an element inserted
in the interior of the body cavity of a patient in a precise way
controlled simply with just one hand by a surgeon.
BACKGROUND OF THE INVENTION
[0002] In the field of medicine, the endoscopic approach route has
now become consolidated for performing intra-cavity operations,
which offers numerous advantages over the open surgery techniques
used traditionally. Endoscopy, which comprises the visual
examination of a cavity or duct of the organism, is usually applied
as a technique that minimizes the invasion of the patient's body
cavity and is carried out by means of the insertion of an endoscope
by way of a minimal surgical incision through which the sheath
passes housing the instrument. The incorporation of cold light and
a video camera enables therapeutic manoeuvres to be carried out in
the abdominal cavity, ranging from the simple collection of a
biopsy to complete operations on the organs that it contains.
[0003] In the abdomen, the introduction of the endoscope and the
instruments is usually done by way of rigid or semi-rigid sheaths
that pass through the abdominal wall. During the operation they
facilitate the replacement of the instruments without the loss of
the gas that is used to keep the cavity distended, thanks to a
built-in valve system.
[0004] Similarly, in the particular case of laparoscopic surgery,
i.e. that endoscopic technique used for actuation in the abdominal
cavity, the use of surgical instruments is normally required for
the dissection by the surgeon of anatomical spaces of loose
conjunctive tissue, for which different types of tweezers and
separators are also used.
[0005] The design of instruments of this type to perform a surgical
operation by endoscopy is usually determined by a series of
functional requirements that the instrument has to be able to
fulfil, such as manipulation in the body cavity from the exterior,
permitting internal actuation on organs or tissues. For this
purpose, these instruments must be capable of performing a series
of movements controlled by the surgeon from the exterior. The
handling of the instruments in these conditions reduces the
operator's manoeuvring capability since he is unable to guide the
instrument grasped in his hand, making use of all the joints of his
upper limb. The point of penetration of the cannula through which
the instrument is inserted into the cavity restricts its movement
in the same way as an oar in relation to the rowlock that secures
it to the hull of the boat.
[0006] Accordingly, there is a tendency to incorporate articulated
instruments that facilitate surgical manoeuvre instead of or as a
supplement to traditional rigid instruments. These articulated
instruments have different technical features depending on the
surgery in which they are used and some of them are described
below.
[0007] In U.S. Pat. No. 4,178,920, held by the institution
`American Hospital Supply Corporation`, a urological instrument is
defined that comprises a swivel element for use in cystoscopies,
controlled manually by the operator, and which has a single element
susceptible to be articulated for facilitating the introduction of
a catheter in the mouth of a ureter. This instrument has a very
limited application, since it is no use for dissection in spaces of
difficult access or for those cases in which an instrument is
required that simulates the movement that would be made by the
surgeon's finger in open surgery operations. In addition, the
articulated element is controlled directly, with no means of
cushioning, so that the precision in the control of its movement is
not very high, with the result that it proves rather
rudimentary.
[0008] On the other hand, U.S. Pat. No. 5,366,479, applied for by
the institution `United States Surgical Corporation`, describes
another type of instrument used in endoscopy, which consists of a
surgical stapler which, as in the previous case, has an area for
gripping it, in the form of a handle, while coupled to this area
there is a hollow rod-like element which has an articulated element
at its free end that has its rotation in relation to an axis
permitted in both directions. This instrument is used in surgery
for applying staples, which are housed in a space in the interior
of said hollow rod.
[0009] Now, although this instrument permits the rotation of the
articulated element in both directions on account of its technical
features and its configuration, it presents the same problems as
the above-mentioned instrument, as it only permits a rotation
movement of the swivel element, i.e. it only comprises one
articulation and its use is limited as its purpose is strictly that
of setting lines of staples in place for the occlusion of a
specific segment of the digestive tube.
DESCRIPTION OF THE INVENTION
[0010] The present invention refers to a surgical instrument for
endoscopic surgery which permits the execution of movements that
emulate those performed by a surgeon's finger in open surgery
operations, by means of a double articulation, all this in an easy
and precise way, controlled simply by the surgeon with just one
hand, in order to obtain, for instance, the mechanical emulation of
the movements of dissection of anatomical spaces of loose
conjunctive tissue.
[0011] In view of its features, the surgical instrument proposed by
the invention has a special application in operations performed on
both the upper and lower abdomen, using the endoscopic route. In
the case of operations on the upper abdomen it is applicable, for
example, in cholecystectomy or in gastroesophageal fundoplicature,
in gastrectomy or in nephrectomy. In the case of operations on the
lower hemiabdomen, the instrument is used to carry out the
dissection of the preperitoneal space in the repair of a inguinal
hernia, in iliac lymphadenectomy or in prostatectomy, for which the
instrument is required to emulate the movements of a finger, so
that it is best for these to be performed mechanically on account
of the recurrence of the gestures.
[0012] In order to meet the above-mentioned functional
requirements, the instrument that is the object of the invention
comprises a handle, which has an appropriate configuration for it
to be gripped and handled by the surgeon with just one hand.
Attached to it there is a rigid tube, which is the invasive part of
the instrument, at the distal end of which it has a first phalanx
articulated in relation to the end of said rigid tube. Said first
phalanx has, in turn, a second phalanx articulated at its distal
end, the articulation movement of the second phalanx being linked
to the articulation movement of the first phalanx by means of
cables housed in cross ducts, emulating in this way the
articulation movement of a human finger.
[0013] The instrument is held by the handle with a single hand,
being controlled by means of placing preferably two fingers, such
as for instance the index and middle finger, on a controller
located in an area adjacent to the handle, in the form of a
trigger, on which an axial movement may be made either by pulling
or pressing said controller.
[0014] The interior of the handle holds at least a spring, or some
other equivalent cushioning element that regulates and increases
the precision of the movement of the controller, which actuates an
operating fork, which in turn actuates a transmission rod, which
undergoes linear forward movement, said transmission rod being
connected to a link, which is in turn connected by its opposite end
to the first phalanx.
[0015] In this way, when the surgeon actuates the controller, this
operates the transmission rod by way of the fork, causing it to
make a linear forward movement inside the rigid tube, while at the
same time operating in turn the end of the transmission rod and the
link, which is what produces a bending movement in the first
phalanx, which swivels in relation to a first axis of rotation.
[0016] The movement of a second phalanx takes place as a result of
the swivel movement of the first phalanx on account of the
connection that exists between them, so the second phalanx cannot
execute a movement separately from the first phalanx, i.e. without
this being articulated. The instrument therefore comprises the
disposition of cables linking the area of the distal end of the
rigid tube, in which these are fixed by means of anterior anchoring
holes, with the area of the proximal end of the second phalanx, in
which they are fixed by means of end anchoring holes, said cables
being crossed by means of cross ducts located in the interior of
the first phalanx.
[0017] By means of the cross cable ducts the second phalanx is
successfully connected to the first phalanx, with the result that
the movement of this produces a relative movement of the second
phalanx in relation to the first phalanx, so that an articulation
takes place in respect of a second axis of rotation, located at the
distal end of the first phalanx, produced by the actuation of the
cables situated on the opposite side to the direction of rotation,
which, through being crossover, produces an actuation on the side
of the direction of rotation of the second phalanx, acting
inversely when the first phalanx recovers its non-articulated
position, which constitutes a movement that emulates the
articulation movement performed by the phalanxes of a human
finger.
[0018] Furthermore, in order to endow the instrument with a
superior precision and range of positions, which affords it a
greater versatility, the whole rigid tube is provided with the
possibility of turning from its position on its own axis in
relation to the fixed portion or handle. This is achieved by means
of a rotation crown which is situated in the area of the handle
provided for the attachment of said rigid tube. The possibility is
contemplated of having a mechanism in the interior of said rotation
crown comprising at least a spring, or some other equivalent means
of cushioning, which permits the rigid tube to be locked or
unlocked in a given position after being turned, at the surgeon's
discretion, so that said rigid tube, which can turn through
360.degree., is endowed with complete freedom of rotation while
maintaining all the functions and capabilities of the
instrument.
[0019] The possibility is also contemplated of having an initial
positioning or neutral wheel in the area of actuation of the fork
with the transmission rod. By turning it we can adjust its position
in relation to the transmission rod, so that, given the position of
the fork in respect of said initial positioning wheel, we achieve a
given initial position in which the first phalanx and the second
phalanx are articulated prior to the operation of the controller by
the surgeon, when so required for a specific process.
[0020] In this way, the initial or neutral position of the first
phalanx and of the second phalanx may be kept perfectly straight,
without any articulation of same, or else an initial position of
said phalanxes of the instrument with a given articulation; it is
even possible to achieve the initial position, without acting on
the controller, with a given articulation when the instrument is in
the interior of the patient's body cavity, without the need to
withdraw it, which proves extremely useful during the course of an
operation.
[0021] In order to increase the versatility of the instrument, as a
variant the possibility is considered of providing an internal
axial hole both in the rigid tube and in the first and second
phalanx, which are connected to a duct in order to enable the tasks
of irrigation and suction of liquids to be performed during
surgery. The option is also contemplated of incorporating an
electric or ultrasound scalpel, of the types known in the state of
the art, at the distal end of the second phalanx, so that it may be
used in such processes as haemostasis.
[0022] In the instrument that is the object of the invention it is
considered incorporating elements that will enable it to be
operated remotely, i.e. that allow it to be used from a distance,
in telesurgery operations. For this the action of the forces
exerted by the surgeon is replaced by a robot, providing the distal
end of the rigid tube with sensors, which may consist of the
disposition of extensiometric gauges according to the three axes of
three-dimensional space. Thus, they convert the forces that act on
the instrument into electrical signals, providing information on
the forces acting on the instrument, or else on the forces that the
instrument is exerting on the patient, similar to the perception
that the surgeon's hand would have if the instrument were being
handled by him. This enables the magnitude of the forces and the
direction of the movements made by the instrument to be regulated
at all times.
[0023] Therefore, in accordance with the invention described, the
surgical instrument for endoscopic surgery proposed by the
invention represents an advance in the instruments for endoscopic
surgery used heretofore and it resolves the problems explained
above in a fully satisfactory way, in that it is a versatile
instrument that is provided with a double articulation in order to
permit access and its simple precise actuation from the exterior in
those areas of the body cavity which are of difficult access in
endoscopy, simulating the articulation of a human finger and
facilitating a wide variety of movements of the invasive part of
the instrument without the need to withdraw it from the patient's
body cavity during the course of the operation.
DESCRIPTION OF THE DRAWINGS
[0024] In order to supplement the description being given and to
assist a clearer understanding of the features of the invention, in
accordance with a preferred specimen practical embodiment of the
same, we adjoin as an integral part of said description, a set of
drawings wherein there is represented, for informative and
non-restrictive purposes, the following:
[0025] FIG. 1.--It shows a perspective view of the surgical
instrument for endoscopic surgery that is the object of the
invention.
[0026] FIG. 2.--It shows a perspective view, in which the outer
surfaces are represented as transparent in order to show the
interior elements, in which we may observe a close view
corresponding to the end area of the rigid tube as well as the
first phalanx and the second phalanx of the instrument.
PREFERRED EMBODIMENT OF THE INVENTION
[0027] In the light of the afore-mentioned figures, it may be
observed how in one of the possible embodiments of the invention,
the surgical instrument for endoscopic surgery comprises a rigid
tube (3), the distal end of which has a first phalanx (4)
articulated in relation to a first axis of rotation (6), which, in
turn, at its distal end, has a second phalanx (5) articulated in
respect of a second axis of rotation (7).
[0028] The interior of the rigid tube (3) houses a transmission rod
(11), which is connected at its distal end to a link (10), which in
turn is also connected, by its opposite end, to the first phalanx
(4), the actuation of this transmission rod (11) being what
produces the articulation of the phalanxes (4) and (5) of the
instrument.
[0029] The movement of the second phalanx (5) is linked to that of
the first phalanx (4) by means of cables housed in cross ducts (12)
situated in the interior of the first phalanx (4), which are fixed
at the distal end of the rigid tube (3) by means of anterior
anchoring holes (8), and at the proximal end of the second phalanx
(5) by means of end anchoring holes (9).
[0030] The rigid tube (3) is attachable to a handle (1), which has
a suitable configuration for the holding, gripping and handling of
the instrument by the surgeon with only one hand. It has a
controller (2), which, when operated, usually with the fingers,
actuates a fork (14), which in turn actuates the transmission rod
(11) for its operation.
[0031] The possibility is contemplated of having in the interior of
the handle (1) at least a spring--not represented--or some other
equivalent cushioning element, which regulates and increases the
precision of the movement of the controller (2).
[0032] Furthermore, in order to endow the instrument with a
superior precision and range of positions, the possibility is
contemplated of permitting the turning of the rigid tube (3) on its
own axis in relation to the handle (1) by means of a rotation crown
(13), which is situated in the area of attachment between the
handle (1) and the rigid tube (3).
[0033] The option is also considered of having in the interior of
said rotation crown (13) a mechanism--not represented--comprising
at least a spring, or some other equivalent means of cushioning,
for locking the position of the rigid tube (3).
[0034] The possibility is also contemplated of having an initial
positioning wheel (15) in the area of actuation of the fork (14)
with the transmission rod (11), which permits the positional
adjustment of the fork (14) in relation to the transmission rod
(11), so that it permits the regulation of the initial position of
articulation of the first phalanx (4) and of the second phalanx
(5), prior to the operation of the controller (2) by the
surgeon.
[0035] As a variant, the possibility is also considered of
providing an internal axial hole both in the rigid tube (3) and in
the first phalanx (4) and in the second phalanx (5), which permit
their connection to a duct--not represented--in order to enable the
tasks of irrigation and suction of liquids to be performed during
surgery.
[0036] The option is also contemplated of incorporating the
terminal of an electric or ultrasound scalpel, of the types known
in the state of the art, at the distal end of the second phalanx
(5), so that it may facilitate electrocoagulation haemostasis with
the same instrument.
[0037] In the instrument, consideration is also given to
incorporating elements that will enable it to be operated remotely
in telesurgery operations, permitting the forces exerted by the
surgeon for the actuation of the instrument to be applied by a
robot, providing the distal end of the rigid tube (3) with sensors,
which may consist of extensiometric gauges according to the three
axes of three-dimensional space, which convert the forces that act
on the instrument into electrical signals, providing information on
the forces that the instrument is exerting on the patient, thus
enabling the magnitude of the forces and the direction of the
movements made by the instrument to be regulated at all times.
[0038] The possibility is also considered of its being disposable
and being made with the intention of its being used in one
operation only. In this case the instrument would be sealed, not
permitting its disassembly and therefore not permitting its correct
resterilization for reuse.
[0039] In the light of this description and set of figures, an
expert on the matter would be able to appreciate that the
embodiments of the invention which have been described may be
combined in numerous ways within the object of the invention. The
invention has been described according to some preferred
embodiments of same, but for an expert on the matter it will be
evident that multiple variations may be introduced in said
preferred embodiments without exceeding the object of the invention
claimed.
* * * * *