GB2532007A

GB2532007A - Laparoscopic specimen elongation and retrieval bag

Info

Publication number: GB2532007A
Application number: GB1419606.7A
Authority: GB
Inventors: Molyneux Matthew; Rasburn Neil; Casali Gianluca
Original assignee: Individual
Current assignee: Individual
Priority date: 2014-11-04
Filing date: 2014-11-04
Publication date: 2016-05-11
Also published as: GB201419606D0

Abstract

A laparoscopic specimen retrieval bag comprises an elongated conical bag 4 which tapers towards the tail 7. The wider end is open and may be sealed by a string 1. In use the specimen 5 is placed in the bag and may be drawn further into the bag using forceps inserted into the tail of bag, compressing the specimen. The tail may be sealed using a tie (fig 3, 10). This reduces the sample width and minimises the surgical incision required to remove the sample from the body cavity.

Description

Descripti Title Laparoscopic specimen elongation and retrieval bag

Background

This invention relates to a retrieving tissue or organs in laparoscopic surgery.

When diseased tissue or an organ is released from its surrounding structures using laparoscopic, or 'keyhole', surgery, it is must subsequently be removed from the body cavity. This is a problem as the port sites, or keyholes' are small (typically less than 10mm in diameter) but the tissue removed may be very large. Normal practice is to place the sample in a bag and pull it through the largest port site (or keyhole).This may need significant force from the surgeon. Often the sample is too big requiring an incision to be made to extend the size of the port site. This means the patient requires more stitches, suffers more pain and stays in hospital longer. It follows that it is in the patients' best interest to keep the incisions as small as possible. There a two issues to highlight: a) One of the characteristics of the sample getting stuck inside the body cavity is known as bunching'. Bunching is the compression of the tissue in the bottom of the retrieval bag making the sample flatten out and removal requires a larger incision. The more elongated the sample, the smaller the incision is required to remove it. There have been a number of initiatives to reduce bunching including: i. the addition of a taper to the end of the bag so the sample is forced into a cone shape rather than 'bunched' Morcellation: This involves converting the solid sample into a semi-liquid by passing a blender into the bag whilst it is still in the body cavity. The liquid can then be sucked out eliminating the need for a large incision. (This can only be applied to a small subset of surgical procedures because it destroys the specimen meaning lab analysis and identification of tumour margins are impossible) iii. Draw strings: These are placed around the bag and pulled to effectively elongate the specimen and aid retrieval.

In all the above elongation is limited by the sample reaching the tail of the bag.

b) A further, sometimes complex, aspect of laparoscopic surgery is getting the sample into the bag, within the body cavity. This is more difficult with large samples (eg lungs, intestines) and can cause increased length of surgery/anaesthesia and the associated complications. There are a number of designs in use that aid this by having a system that keeps the neck of the bag open which facilitates manoeuvring the sample into the bag. These include semirigid or rubber ring materials that spring open when the bag is placed into the body cavity.

Statement of Inventiffil

To achieve maximum elongation of the sample the present invention proposes a long bag with a very shallow taper. This length gives the option of an open tail end though which forceps can be used to pull the sample into the bag.

Advantages The longer bag means, as the surgeon pulls on the bag, the sample moves down the inside of the bag becoming more and more elongated. The sample only stops moving down the bag when it is maximally compressed laterally (or maximally elongated). The compression of the sample is governed only by the width of the bag and not by its length. Any excess fluid or air can pass into the tail of the bag. The result is that any incision that has to be made is governed only by size of the sample rather than the shape of the bag.

This long sample bag also allows the dependent claim that the tail end can be left open allowing a long pair of forceps to pull the sample into the bag from within. This facilitates the placement of the sample into the bag and also allows the narrowest part of the sample to be pulled first, further maximising the elongation potential of the sample. Once the sample is in place, the forceps are removed, the tail of the bag is closed and the bag removed as normal.

Introduction to drawings

An example of the invention will now be described by referring to the accompanying drawings: Figure 1 (page 1) shows how the long tail of the retrieval bag aids maximal elongation of the specimen to aid removal from the body cavity.

Figures 2,3 and 4 (page 2). These figures show how the long tail allows the introduction of forceps from the tail end of the bag to aid getting the sample into the bag.

Figure 2: forceps being held outside the body cavity but inside the bag. The tips have gripped the sample.

Figure 3: Forceps removed with sample in the bag. Tail sealed.

Figure 4: Tail dropped into body cavity and entire bag removed through single port.

Detailed escri do The bag has a long conical shape with an open top end, or mouth at the widest end (2). The shape is then a long taper to the body (4) and tail (7) of the bag. The angle at the tail of the bag is less than 20 degrees. The narrow end (13) is sealed. The top end (or mouth) has a long string (1). The bag is made from non-porous rip stop nylon or similar strong waterproof material. The inner surface may be waxed to minimise friction of the sample against the bag.

The body cavity is formed by muscle (8) and skin (9). It is breached by the port site (10) though which the operation is carried out. At the end of the operation the retrieval bag is inserted through a port into the body cavity, with only the string (1) left outside the cavity to enable the bag to be removed at a later stage. Once removed from its attachments the diseased sample or organ (5) is placed into the mouth of the bag (2). The top of the bag is then drawn through the port site (10) using the string (1). The sample is elongated and becomes narrower by being pushed into the body (4) and tail of the bag (7). The long tail ensures that the only limitation on how far down the tail (7) the sample moves is the width of the sample and, crucially, not by the length of the bag. The tail (7) also acts as a reservoir for air and fluid (6) squeezed out during the compression.

The long tail portion ensures maximal elongation of the tissue but may also be used to insert forceps to facilitate manoeuvring the sample into the bag. Figures 2, 3 and 4 (drawings page 2) show how this is done: Figure 2: the bag (4,2) is inserted into the body cavity with both ends extending back out of the cavity via two port sites (7). Forceps (8) are then passed into the open tail portion (9) of the bag. These are then used to pull the sample (3) into the mouth (2) and down into the body (4) of the bag. Figure3: The forceps are then removed, the tail of the bag is sealed (using a knot or tie) (10) and the tail portion is then pushed back into the cavity. The whole bag is elongated and pulled through the other port site (7) (as described above) using the attached string (1).

Claims

Claims 1) A long laparoscopic sample retrieval bag with a shallow taper.
2) A retrieval bag according to claim 1 with an open end to allow the insertion of forceps to facilitate manoeuvring the sample into the bag.