ES2324267B1 - SURGICAL APPARATUS OF LAPAROSCOPY AND ENDOSCOPY. - Google Patents

Abstract

Laparoscopy and endoscopy surgical device which can be used in operations with a single incision. Consists of a shirt (1) that is inserted into the tissue through the incision, on which a body (5) is fixed and, on it, a cover (4) in which a variable number of subsets (3), whose mission is to serve as access and support to instruments (7, 8) necessary to do the intervention, at the same time that the closing system guarantees the system tightness. It carries a gas inlet provided with a stopcock (2), to the introduction of the gas to be used in order to provide an adequate atmosphere in the intervention area.

Description

Laparoscopic surgical apparatus and endoscopy

Background of the invention

Laparoscopy is one of the procedures endoscopic that more development has experienced in the last 20th century This progress has been both at the level of surgical techniques such as materials and technology. And is the seed of telesurgery and the application of robotics to is.

The term laparoscopy derives from the roots Greek "lapára" which means abdomen and "skopéin" examine. Strictly speaking, define a diagnostic procedure through which the intraperitoneal cavity is explored. In the not only is it limited to the exploration of the abdomen, but it extends to minimally invasive surgery of abdomen performed through an optical system.

It is Hippocrates (460-375, B.C.) the first of which there are references that will make a endoscopic procedure, when using a rectal speculum. Already in ours was Abul Qasin Khalaf ibn al-Albas Al-Zahravi, Abulcasis, introduces a tube into the vagina and illuminated it reflecting the light in a mirror, so it is considered the precursor of endoscopy. With the development of first complete cystoscope, called "lichtleiter" (light conductor), made by Philip Bozzini in 1805, is when the foundations of modern endoscopy and by extension are laid of laparoscopy. But it won't be until the mid-sixties with the arrival of the considered father of laparoscopy, the German Kurt Semm, when this surgical procedure begins his vertiginous ascent. This surgeon and engineer designs an insufflator automatic to measure intra-abdominal gas pressure and measure the inlet flow, mount cold light externally, design multiple instrumental and even describes new surgical techniques. In the minimally invasive surgery has displaced the open surgery in almost all specialties Surgical

This vertiginous advance in the technique laparoscopic has been able to thank many other authors who they have also contributed their studies, research and discoveries. This is the case, among others, of the following researchers. Desormeaux, who in 1865 evolves the "lichtleiter" with a system of lenses, mirrors and introduces a kerosene lamp Bruck, 1867, idea a shirt to cool The platinum wire. Nitze in 1877 introduces the use of lenses increase. George Kelling, in 1901, introduces the first cystoscope in the abdomen of an animal and performs numerous studies on the pneumoperitoneum Jacobeus uses a valve trocar as the only input device Bernheim in 1911 performs organoscopy, technique that consists of visualizing the peritoneal cavity through of a proctoscope. Goetze, 1918, develops a needle with support Automatic to blow the gas. Zollikofer in 1924 blows dioxide carbon Veress, 1934, describes a needle mounted on a spring, is the one used today to perform gas insufflation In the cavities Hopkins in 1960 makes improvements in contrast and resolution of the optics with the introduction of the lenses in bar.

The useful surgical motive of this invention is the result of the sum of the works and studies carried out for years in the field of endoscopy. It is more than a instrument, as it can be used as a multi-system instrument inputs, including optics, in a single sheath or shirt, which in turn can have different diameters and shapes. It can also be used as a system to open space for Maintain the surgical field. All this is done through a mini incision And it is applicable to all specialties Surgical All these features make the device surgical object of this invention a new concept in surgery minimally invasive

Various techniques are known in the state of the art laparoscopy tools or associated with it, as described in EP1066798, EP1131009 or EP1248572; However, I don't know know in the state of the art any document with the characteristics described by the present invention.

Brief Description of the Invention

The present invention relates to an apparatus laparoscopy and endoscopy surgery consisting of following elements:

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a shirt, whose mission is to separate the tissues to access the field surgical,

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a body, attached to the previous shirt, in which a key is inserted passing that allows the supply of gas in order to promote an adequate atmosphere in the intervention area, as well as achieve tissue separation if it is necessary,

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some anchors that allow to fix the device to the patient and allows its Quick disassembly for cleaning or removal in case of emergency,

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a cover assembly, attached to the body,

so that over the lid they go mounted a series of subsets with a double closure system, whose mission is to support and access the instruments necessary to perform the intervention, so that the  gas tightness, while also ensuring mobility necessary of said instruments.

The previous cover set is formed by three main pieces:

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a first piece, called the inner cover, which fits over the body,

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a second piece, called the outer cover, which is assembled on the anterior, making the connection between the inner lid and the lid exterior with several screws to be removable,

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a nut that assembles the cover assembly on the body,

where the aforementioned inner lid and outer cover are perforated to allow the passage of sub-assemblies with double closure system and, as a result of assembly, an o-section cavity is formed in each hole approximately circumferential for housing and tightness of the subsets with double system closing.

In turn, each of the subsets with Double closure system of the lid assembly is composed of:

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a guide body, which acts as a centerpiece, in the form of a section tube circular or oval,

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a tubular guide made of rigid material, which gives rigidity to the guide body of the subset with double locking system, and serves as a support for a second closure, for which there is a flare in one of the extremes,

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a First closure with oblong section that ensures tightness when there is no instrument inserted in the subset with system double closure, thanks to the existence of a deformable groove, with a reinforcing lip at the end adjacent to the closure that prevents against the folding of its edge against itself,

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a second closure, conical, made of elastomeric material, which disposes at the end of the guide body opposite the first closure, and provides a second seal when an instrument is inserted in the subset with double locking system,

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a cylindrical tubular shaped ring that fits inside the conical closure, which prevents the folding of the conical closure on itself same, and generates an adjustment with interference between the tubular guide and the second conical closure that allows the assembly between they.

It should be noted that the guiding body that acts as the centerpiece of each subset with a double closing system, also consists of a membrane in the central position, approximately, with a flange that fits in fit with interference in a housing of the lid assembly, presenting said housing a cavity shape
toric

In a first stage, when there is no instrument inserted in the surgical apparatus, over the area inside each subset with double locking system acts the atmospheric pressure P_, and, on the lower outer part of each subset, the gas pressure P_ {I}, where P_ {I}> P_ {A}, so that:

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in the outer area of the bottom of the subset with system double closure, located under a groove, there is an internal pressure P_ {I} on both sides, therefore there is equilibrium, so the guiding body that acts as the centerpiece of said subset is not so,

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in the outer area of the bottom of the subset with system double closure, located on the mentioned groove, on one side it acts P_ {I} and the other P_ {A}, which produces an imbalance that brings as a consequence that the wall deforms inwards, producing the closure on said groove,

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Y over the outer zone of the bottom of the subset with double closure system, located on said groove and adjacent to the tubular guide, the same pressure distribution occurs as in the outer zone, but in this case there is no deformation of the part bottom of the subset with double locking system since the Tubular guide is rigid.

During the introduction of an instrument into a subset with double closing system, an adjustment of the second conical closure against the instrument wall in the area given and, as the instrument continues to advance, its encounter occurs with the subset body with double closure system in one area above the deformable groove. This brings with it the deformation of said groove, opening it, and generating zones open through which the gas circulates, so inside the subset with double locking system increases the pressure, but the gas does not escape outward because it is confined by the second seal in the area, where again the pressure difference between P_ {I} and P_ {A} play in favor of closing.

The laparoscopic surgical apparatus and endoscopy described in the present invention has the shirt tubular, with circular section and with a fixed depth of tissue penetration This shirt is interchangeable, so that a seal is available inside the body of the apparatus that ensures its tightness.

In another configuration the device jacket is telescopic, having an adjustable depth L, composing in this case of two parts that are fixed by a device elastic collar

The union of the cover and the body of the laparoscopy and endoscopy surgical device invention describes is materialized with a drive mechanism fast, preferably threaded with several entries and drive with a fraction of a turn, the thread being carved in the body, which together with a nut, which turns crazy with respect to the lid, form the joint mechanism.

At the junction of said lid and said body there are two closing seals, where one of them ensures tightness between the shirt and the body, and the other board has the same purpose between the body and the so-called inner cover of the set of  cover, said joints presenting radial housings that prevent accidental fall.

In an alternative configuration, the lid inner and outer lid of the lid assembly can be joined with a non-detachable or semi-detachable clip type system. Other option is that the inner cover and the outer cover of the set of lid are formed in one piece.

The invention also describes a process. of use of the surgical apparatus of laparoscopy and endoscopy described, in which the intervention performed is the next:

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be makes the incision to the patient and then introduces the shirt along with the body and proceeds to the suture tied to the patient's skin,

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then, with a longitudinal movement, the cover assembly is assembled on the body and then thread the nut onto the body to ensure assembly and ensure tightness,

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be open the key with a turning movement to introduce the gas into the inside the surgical apparatus,

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be introduce the instruments through the different subsets with double closure system.

Brief description of the drawings

Figure 1 shows the appearance of the device Surgical elevation, floor and general perspective.

Figure 2 shows a section of the inside the surgical apparatus.

Figure 3 shows the arrangement of the surgical apparatus in a surgical intervention.

Figure 4 shows different shirt settings.

Figure 5 shows an overview of the body and cover subsets, well assembled (left) or disassembled (right).

Figure 6 shows in detail the section of the assembly of the body and cover subsets.

Figure 7 shows the scanning area of the subset with double locking system, as well as two different configurations as to the possible number of subsets with double closure system.

In Figure 8 different details are observed in detail views of the shape and elements that make up the subset with double closure system.

Figure 9 shows, in different views, the operation of the subset with double closing system before The insertion of an instrument.

Figure 10 shows, in several images, the operational sequence of maneuvers for device placement surgical.

Detailed description of an embodiment preferential

Although the invention is described both with a embodiment as with a preferred procedure, it will be understood that it is not intended to limit it to said embodiment or procedure. By on the contrary, they are intended to cover all alternatives, modifications and equivalents as may be included within the spirit and scope of the invention as defined in the attached claims.

Figure 1 and Figure 2 show a Overview of the invention The surgical apparatus consists of several parts. On the one hand there is the shirt (1), whose mission is separate the tissues to access the surgical field; attached to her is the body (5), in which a stopcock (2) is inserted that allows the supply of gas in order to promote an atmosphere adequate in the intervention area, as well as getting the tissue separation if necessary. He surgical apparatus is fixed to the patient through the anchors (6), which allows rapid disassembly at any given time to cleaning, emergency etc. A cover set (4) (or simply lid (4)) is attached to the body (5), and on said lid (4) they go mounted a series of subsets (3) with double locking system. The mission of the subsets (3) with double locking system is serve as support and access to the instruments (8) necessary to perform the intervention (camera (7), clamp, stapler, etc.), of way to ensure gas tightness, while also the necessary mobility of these instruments is guaranteed (8).

Figure 3 shows the section of the preferential arrangement of the surgical apparatus in an intervention. It is about accessing the surgical field (12), for which it is it is necessary to make a mini incision on the outer layers of tissue (10) and (11) and insert the surgical device to the layer of internal tissue (9). Subsequently, to expand the cavity, gas is introduced through the stopcock (2) (Figures 1 and 2). The chamber (7) provides the necessary vision of the surgical field, and the instruments (8) are those used in handling necessary to carry out the intervention.

Figure 4 shows different shirt configurations (1). In principle the preferred design of the jacket (1) is tubular with circular section and with depth fixed penetration L in the tissues. The shirt (1) is interchangeable to provide the surgical apparatus with great versatility. For this, a closing joint is available (element (24) of Figure 6) inside the body that ensures the tightness; in this way, by entering a distance D in the body of the surgical apparatus, it is assembled. In a alternative configuration the shirt is telescopic (top drawing right of figure 4) consisting, in this case, of two parts (13) and (15) that are fixed by a collar device (14) elastic; in this way the depth L is adjustable. I also know the shape of the shirt section (oval or other) may vary (16), to adapt to the surgical field and thus reduce The extent of the incision.

Figure 5 and Figure 6 detail the preferred structure of the subset body (5) and cover (4). The First of these parts is the body (5) that is fixed to the patient with stitches tied to the anchors (6), and that together with the flap (17) ensures its immobility. The stopcock (2) goes inserted over the body (5). At any time you can remove the surgical device immediately by cutting the stitches. The second part is the cover (4), which is Detachable body (5). On the cover (4) the sub-assemblies (3) with double closing system, to introduce the instruments (8).

The union of the cover (4) and the body (5) is it materializes with a fast-acting mechanism, which can be preferably thread with several entries and drive with a fraction of a turn. For this, a thread (19) has been carved in the body (5) which, together with the nut (18) that rotates madly with respect to the cover (4), form the joining mechanism. Any possible other mechanism of the harpoon or similar type, provided that it complies with the Require it to be fast. This allows to establish an access immediate for cleaning, emergency situation, etc.

A section of the body is shown in Figure 6 (5) and the cover (4) in which the interior of both elements There are two closing joints, preferably O-rings: the seal (24), which ensures the tightness between the jacket (1) and the body (5), and the gasket (23) with the same purpose between the body (5) and the part (22) of the cover (4). The accommodations Radial joints (23) prevent accidental fall of these.

The cover (4) is formed by three pieces. A First piece is the inner cover (22) that fits over the body (5). A second piece is the outer cover (21) that is assembled over the previous one. Both pieces (22) and (21) are perforated to allow the passage of the subsets (3) with double system closing. Due to the assembly, each hole creates a O-shaped housing (25) section approximately circumferential, which serves for accommodation and tightness of the subsets (3) with double closure system. To the being these independent accommodations guarantees that, when moving any of the instruments (8), there is no alteration of the position of adjacent instruments (8). The joint of the lid inside (22) and the outer cover (21) is made with several screws (20) so that everything is removable. And finally, a nut (18) is the third piece that executes the lid assembly (4) on the body (5).

In an alternative embodiment the inner cover (22) and the outer cover (21) can be joined with a non-system detachable or semi-detachable clip or similar type, and even form a single piece in case it is manufactured with molding procedures

Figure 7 shows the distribution of the sub-assemblies (3) with double closure system on the device Surgical, which supports various configurations. Preferably said distribution will be with a subset (3) in the center of the lid (4) where the camera (7) and several subsets (3) will be inserted around, in sufficient numbers to access and manipulate Effective to the surgical field. The subset (3) is subject to the cover (4) by means of a membrane (element (35) of Figure 8) which allows its movement, sweeping the volume (27) defined inside the shirt (1). In this way, any instrument (8) has sufficient mobility to access the field exploratory. This movement is approximately a pivot with center at point (26) and, since the instrument (8) is free to penetrate the double closing system, the accessibility to surgical field is guaranteed.

Figure 8 shows in several views a detailed representation of the composition of the subsets (3). Each subset (3) is a double-closing system: one is the closure (33) in the rest position, and the other is the one formed when inserting the instrument (8) through the conical closure (30). Each subset (3) is composed of four elements fundamental. The centerpiece of each subset (3) is the guide body (31), which is basically a section tube circular with a membrane (35) in the central position approximately, and with one end open and the other closed, Made of elastomeric material. The membrane (35) has a double committed: on the one hand, provide each subset (3) of mobility sufficient for the instrument (8) introduced in them and, on the other side and at the same time, ensure the gas tightness in the inside the surgical apparatus. For this, the membrane (35) has a flange (34) that fits into fit with interference in the housing (25) (Figure 6) of the cover (4). At the closed end there is a zone, closure (33), with oblong section, and a groove flat (36); This is the resting position and ensures the tightness when there is no instrument (8) inserted in the subset (3). There is also a reinforcing lip (32) at the end adjacent to the closure that prevents against the folding of the edge against itself same.

The second piece that integrates each subset (3) is a tubular guide (29) of rigid material, whose mission is double: on the one hand, provide rigidity to the body of each subset (3) and, on the other hand, to support the second closure (30), for which a flare is available at one end.

A third piece is a conical closure (30) that It is made of elastomeric material and is arranged at the end of the guide body (31) opposite the closure (33). The purpose of the closure Conical (30) is to provide a second seal when the instrument (8) is introduced in subset (3), since the first closure (33) opens. The conical shape is necessary to ensure the adaptability of the seal to the different diameters of the instruments (8).

The fourth piece of each subset (3) is a ring (28) with cylindrical tubular shape that fits inside of the conical closure (30). The mission of this ring is also twofold: on the one hand to prevent the folding of the conical closure (30) on whether same and, on the other, generate an adjustment with interference between the guide tubular (29) and conical closure (30), thus allowing assembly between these pieces

Figure 9 shows, from left to right, the sequence of operation of the subset (3) when an instrument is introduced through it, for example, the camera (7). In a first stage there is no instrument introduced in the subset (3), therefore on the inner zone acts the atmospheric pressure P_ {A}, and on the outside, internal to surgical apparatus, the gas pressure is P_, where P_ {I}> P_ {A}. Both pressures have been represented by a series of vectors, where those corresponding to P_ {I} are of longer than those of P_ {A} for clarity. In the zone (37) there is internal pressure P_ on both sides, therefore there is balance and the body of the subset (3) does not deform. However, in the zone (38), on one side acts P_ {I} and on the other P_ {A}; this produces an imbalance that results in that the wall deforms inwards causing the closure over the groove (36). The same occurs in the area (39) as in the zone (38), but in this case there is no deformation since the guide Tubular (29) is rigid.

When an instrument is inserted, in this case the chamber (7), there is an adjustment of the conical closure (30) against the wall of the chamber (7) in the area identified as (40). To the continue advancing the camera (7) its encounter with the body of the subset (3) in the area (41); this brings with it the deformation of the groove (36) deforming the material and opening said slot (36). It deforms and generates open areas (43) through which the gas circulates, which makes it inside the subset (3) increase the pressure. But the gas does not escape to the exterior because it is confined by the second seal in zone (42), where again the pressure difference between P_ {I} and P_ {A} Play in favor of closing.

When the instrument is removed, the sequence is reverses and the tightness is recovered when the slot (36).

Figure 10 shows the insertion of the surgical apparatus during the sequence of the intervention. In a First step the incision is made to the patient (not shown in the figure), and then the shirt (1) is inserted along with the body (5), proceeding to suture tied to the skin of the patient. Then, with a longitudinal movement (44), assemble the cover (4) on the body (5). Then it is threaded (45) the nut (18) on the body (5) to ensure assembly and ensure tightness in a second step. The third step consists of opening the key (2) with a turning movement (46) to introduce the gas inside the surgical apparatus. The last and fourth step consists of the introduction (47) of the instruments (8) and the camera (7) by the subsets (3).

Claims (12)

1. Laparoscopic surgical apparatus and Endoscopy consisting of:

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a shirt (1), whose mission is to separate the tissues to access the field  surgical,

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a body (5), attached to the shirt (1), into which a key is inserted step (2) that allows the supply of gas in order to promote an adequate atmosphere in the intervention area, as well as achieve tissue separation if it is necessary,

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some anchors (6) that allow to fix the device to the patient and allows Quick disassembly for cleaning or removal in case of emergency,

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a cover assembly (4), attached to the body (5),

characterized in that a series of sub-assemblies (3) are mounted on the cover (4) with a double closing system, whose mission is to serve as support and access to the instruments (8) necessary to perform the intervention, so that it is ensured the gas tightness, while also guaranteeing the necessary mobility of said instruments (8). 2. Surgical apparatus for laparoscopy and endoscopy according to the preceding claim characterized in that the cover assembly (4) is formed by three parts:

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a first piece (22), called inner cover, that fits over the body (5),

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a second piece (21), called outer cover, which is assembled on the previous one, realizing the union between the inner cover (22) and the outer cover (21) with several screws (20) to make it removable,

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a nut (18) that assembles the cover assembly (4) on the body (5),

where the inner cover (21) and the outer cover (22) are perforated to allow the passage of sub-assemblies (3) with double closing system and, as a result of assembly, in each perforation an O-ring (25) of approximately circumferential section for housing and tightness of subsets (3). 3. Laparoscopic and endoscopic surgical apparatus according to any of the preceding claims characterized in that each of the sub-assemblies (3) with double closure system of the lid assembly (4) is composed of:

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a guide body (31), which acts as a central part, in the form of a tube circular or oval section,

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a tubular guide (29) of rigid material, which provides rigidity to the body guide (31) of the subset (3) and supports a second closure (30), for which a flare is available in one of the extremes,

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a first closure (33) with oblong section that ensures tightness when there is no instrument (8) inserted in the subset (3) thanks to the existence of a deformable groove (36), with a lip reinforcement (32) at the end adjacent to the closure that prevents against the folding of its edge against itself,

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a second closure (30), conical, made of elastomeric material, which it is arranged at the end of the guide body (31) opposite the closure (33), and provides a second seal when an instrument (8) is introduced in subset (3),

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a ring (28) with cylindrical tubular shape that fits inside of the conical closure (30), which prevents the folding of the conical closure on itself, and generates an adjustment with interference between the guide tubular (29) and conical closure (30) that allows the assembly between these pieces.

4. Laparoscopic and endoscopic surgical apparatus according to the preceding claim, characterized in that the guide body (31) of each subset (3) with double closure system, also consists of a membrane (35) in the central position, approximately, with a flange (34) that fits in fit with interference in a housing (25) of the cover (4), said housing (25) having an O-ring shape. 5. Laparoscopic and endoscopic surgical apparatus according to any of claims 3 or 4 characterized in that in an initial stage, when no instrument (8) is inserted, the atmospheric pressure P_ {acts on the inner zone of each subset (3). A}, and on the lower outer part of each subset (3) the gas pressure P_ {I}, where P_ {I}> P_ {A}, so that:

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in the outer zone (37) of the lower part of the subset (3), located under the groove (36), there is an internal pressure P_ {both} sides, there being therefore balance and the guide body (31) of the subset (3) does not deform,

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in the outer zone (38) of the lower part of the subset (3), located on the groove (36), on one side acts P_ {I} and on the other P_ {A}, the which produces an imbalance that results in the wall deforms inwards, producing the closure on the slot (36),

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Y over the outer zone (39) of the lower part of the subset (3), located on the groove (36) and adjacent to the tubular guide (29), the same pressure distribution occurs as in the area exterior (38), but in this case there is no deformation of the part bottom of the subset (3) since the tubular guide (29) is rigid

6. Laparoscopic and endoscopic surgical apparatus according to any of claims 3 or 4 characterized in that when an instrument (8) is inserted into a subset (3), an adjustment of the conical closure (30) against the instrument wall ( 8) in the area identified as (40) and, as the instrument continues to advance (8), its encounter with the body of the subset (3) occurs in the area (41) above the deformable groove (36), which brings about the deformation of said slot (36), opening it, and generating open areas (43) through which the gas circulates, so that inside the subset (3) the pressure increases, but the gas does not escape towards the exterior because it is confined by the second seal in zone (42), where again the pressure difference between P_ {I} and P_ {A} plays in favor of closing. 7. Surgical apparatus for laparoscopy and endoscopy according to any of the preceding claims, characterized in that the sleeve (1) is tubular with a circular section and with a fixed depth of penetration into the tissues, said sleeve (1) being interchangeable, for what is provided of a seal (24) inside the body (5) that ensures its tightness. 8. Laparoscopic and endoscopic surgical apparatus according to any one of claims 1 to 6, characterized in that the jacket (1) is telescopic, thus being the depth L adjustable, in this case being composed of two parts (13) and (15) which are fixed by means of an elastic collar device (14). 9. Laparoscopic and endoscopic surgical apparatus according to any of the preceding claims characterized in that the joint of the lid (4) and the body (5) is materialized with a quick-acting, threaded mechanism with several entries and actuation with a fraction back, the thread (19) being carved in the body (5), which together with the nut (18), which rotates Zoca with respect to the cover (4), form the joining mechanism. 10. Surgical apparatus for laparoscopy and endoscopy according to any one of the preceding claims, characterized in that in the joint of the lid (4) and the body (5) there are two sealing joints (23), (24), where the joint (24 ) ensures the tightness between the jacket (1) and the body (5), and the gasket (23) has the same purpose between the body (5) and the piece (22) of the cover (4), presenting said gaskets ( 23), (24) radial housings that prevent accidental fall. 11. Laparoscopic and endoscopic surgical apparatus according to any of claims 2 to 10 characterized in that the inner lid (22) and the outer lid (21) of the lid (4) can be joined with a non-detachable or semi-detachable system of the type clip 12. Laparoscopic and endoscopic surgical apparatus according to any of claims 2 to 10 characterized in that the inner lid (22) and the outer lid (21) of the lid (4) are formed in one piece.