WO1992006640A1

WO1992006640A1 - Multifunctional device fitted with a disposable cannula for use in laparoscopic surgery

Info

Publication number: WO1992006640A1
Application number: PCT/FR1991/000795
Authority: WO
Inventors: Jean-François Ognier; Hubert Manhes
Original assignee: Sinergy S.A.
Priority date: 1990-10-15
Filing date: 1991-10-14
Publication date: 1992-04-30
Also published as: AU8878891A; FR2667780B1; FR2667780A1

Abstract

The invention relating to surgical devices has as its subject matter an instrument used in laparoscopic surgery. The device consists of, firstly, a cannula (1) adapted for receiving instruments and including channels for the flow of liquids, and secondly, a control handle associated with the cannula (1). Said device is characterized in that the series of channels (4, 8) opening onto the distal cannula end (1) are coaxial, the cannula (1) and the handle (2) being linked by means of a ball valve (11), the insertion of an instrument causing lateral displacement of the balls.

Description

"MULTI-FUNCTIONAL OPERATIVE LAPAROSCOPY DEVICE WITH DISPOSABLE CANNULA

The present invention is in the field of surgical apparatus and it relates to a multifunctional instrument used for the interventions of endoscopic surgery, also called laparoscopic. We know by a publication

FR2625428 (SINERGY SA, inv.MAHNES, OGNIER) a multifunctional surgical device comprising a cannula combining a plurality of spaces for circulation of fluids and for guiding surgical instruments, the said cannula being connected at its proximal end to an operating handle and being able to be separated therefrom for its sterilization, the nozzles opening into a connecting part of the cannula, a main conduit for introducing rigid operating instruments is located in its proximal part inside the handle and its distal part inside the cannula, the junction and sealing between the two parts being ensured by a slide valve operable by the practitioner at the time of the introduction of a rigid surgical instrument. This device of the prior art has demonstrated its effectiveness; however, its use has identified a number of drawbacks.

One can thus deplore, that to introduce the cannula, it is necessary beforehand to make an incision of the cutaneous tissues with a scalpel, then to perforate the subcutaneous tissues using a trocar remaining in place to constitute a pathway 'permanent first.

This results in a functional redundancy between the cannula and the trocar with regard to the permanent approach suitable for allowing the introduction of surgical instruments.

A second drawback is the obligation for the practitioner, when inserting an instrument into the cannula, to abandon any gesture in progress in order to actuate a valve with his first hand. cannula drawer and with his other hand, insert the instrument.

A third drawback results from the fact that it is increasingly necessary to resort to single-use surgical equipment, the sterilization methods not fully guaranteeing the absence of pathogenic germs; in view of this necessity, the simultaneous use of trocars and cannulas according to the prior art entails a significant cost borne by the community or by patients.

A first object of the present invention is to provide an apparatus intended for endoscopic surgery, the cannula of which jointly performs the functions of the trocar. A second object of the invention is to provide a simplified cannula in its design and construction so that it is less costly to consider replacing it with each intervention rather than reusing it after sterilization. A third object of the present invention is to provide said device with a sealed connection device between the proximal and distal parts of the passage passage for rigid surgical instruments, that is to say requiring no specific operation for its setting implemented during the introduction of said instruments into the device.

A fourth object of the invention resides in instruments of the rigid type and in means of reciprocal adaptation of these with the apparatus, means such that these instruments can be operated by the thumb or by the index finger of the hand. holding the device, and can be introduced or removed from the device by the other hand remained free, all these operations to be performed without modification of grip. According to the present invention, a surgical device for operative laparoscopy roof, known as a multifunctional instrument, of the type made up of a tube, known as a cannula, inside which various instruments can be introduced, said cannula being able to allow the passage of body or irrigation liquids, and comprising in the vicinity from its so-called proximal end a connection assembly to a grip handle, from which it can be separated after use, said handle comprising a connection piece to the cannula, this piece supporting a plurality of means for implementing the various functions of the device, while the cannula comprises at its proximal end a connecting part to the handle, this connecting part comprising nozzles for the passage of liquids, is mainly characterized in that all of the conduits opening out to the distal end of the cannula, such as that allowing the passage of the various instruments and those allowing the functions of irrigation or aspiration, are coaxial.

It follows from this arrangement that, the outside diameter of the distal part of the cannula having been considerably reduced compared to the prior art, the perforation operation is carried out by the introduction of a mandrel inside of the cannula, the said mandrel then being removed to allow the passage of the various instruments, the cannula thus bringing together the functions of trocar and laparoscopic cannula.

According to a preferred embodiment, the communication between the cannula and the operating handle is controlled by a ball valve device included in the connecting part of the cannula, the ball being movable laterally under the effect of the introduction of 'an instrument to free the passage and resuming its obstruction position under the effect of a spring when removing the instrument. It follows from this arrangement that the practitioner holding the handle with one hand can exchange the instrument with his other hand without having to let go of the handle.

Advantageously, the cannula is constituted in its distal part, of two concentric tubes, respectively inside and outside. An irrigation pipe is formed by an annular space formed between the two tubes. The said inner tube is preferably stamped at its distal end at three equally spaced points on its periphery, this stamping forms three grooves on the outer surface of said tube, and three bosses on its inner surface of dimension such that the cumulation of their sections corresponds to the section of the annular space, and such that the diameter of a fictitious circumference passing through the three apexes of the bosses is slightly greater than the largest external diameter of the instruments. The so-called distal end of the outer tube is advantageously constricted, so that the diameter of the orifice of the outer tube cor corresponds to that of the outer diameter of the inner tub: the distal ends of said two inner and outer tubes being in close contact , these are welded on their periphery.

Advantageously also, the outer tub is also constricted at its proximal end so as to be in close contact with the inner tube and to be welded to the latter, a passage being provided in the said outer tub and communicating with a nozzle duct in the section is equivalent to that of said annular space and whose orifice opening to the outside of the cannul is equipped with a valve and a spring-loaded valve. In a preferred embodiment, the communication is carried out by stamping the outer tube identically to that carried out on the distal end of this same tube In another embodiment, the communication is carried out by means of grooves made at 1 proximal end of the outer tube and opening onto its orifice According to a third embodiment, the communication is made through a perforation arranged near the proximal orifice of the outer tube.

Advantageously also, the ball valve device is located in a cylindrical cavity formed inside the proxima end of the cannula. This advantageously includes the following elements:

- a first element made up of a ball of a diameter greater than the instrument passage, the ball being biased radially by a leaf spring,

a second element constituting a cylindrical plunger in the shape of a piston provided with axial bore and comprising in its upper part a collar whose upper face is provided with a groove the groove is of a width less than the diameter of the ball and its depth is such that the ball rests only on the two edges of the groove without obstructing the bore; the pusher comprises a hollow rod, the internal diameter of which corresponds to that of the instrument passage duct, the external diameter of the flange corresponding to that of the cavity, so that the pusher is guided axially in the cavity,

a third element constituting a helical compression spring axially urging the plunger in the direction of the ball,

- A fourth element formed a valve seat, consisting of a washer provided on its lower flat face with a concave concave bearing surface provided with a central orifice whose diameter corresponds to that of the conduit for passage of the instruments.

The ball, in the absence of instrument in the duct, obstructs the orifice of the seat and prevents any leakage, through the proximal end of the duct of the fluid usually used to dilate the operating cavity; when an instrument is inserted into the leads the ball is retracted following a lateral movement initiated by a leaf spring, and axial to the en¬ against the pusher and its helical spring; when removing the instrument, the ball returns to apply against the second valve seat.

According to another general characteristic of the invention, the handle being perpendicular to the axis of the cannula, the operation of a rigid instrument present in the device results from the operation of an eyelet supported above the handle by a couple of arms and a couple of links, while the transverse operation of the eyelet, on either side of the rest position materialized by the axis of the handle, respectively activates one or the other of two suction and irrigation control microswitches, each of the operations of the eyelet having an effect inde¬ hanging from the position of the eyelet resulting from the other operation.

The present invention will be better understood and details will be apparent from the description which will be given of a preferred embodiment, in relation to the figures of the appended plates, in which:

Fig.l is a perspective view of the apparatus of the invention,

Fig.2 is a longitudinal section of the distal part of the cannula, with in the extension a mandrel intended to form with it a trocar, Fig.3 is - a section of the distal part of the cannula,

Fig.4 is a longitudinal section of the device,

Fig. 5 is a partial section of the ball valve device,

Fig. 6 is a top view of the device,

Fig.7 is an axial (or longitudinal) section of adaptation means, integral with the device, of a rigid instrument according to the invention, Fig.8 is a similar view of the opposing means specific to the instrument, and

Fig.9 is a similar view illustrating the cooperation of the means of the two previous figures. In fig.l, a chi¬ rurgical device intended for operative laparoscopy consists on the one hand of a cannula 1 provided with a connecting piece 01, and on the other hand of an operating handle 2 provided with a connecting piece 02 perpendicular to the axis of said cannula. An operating eyelet 24, located in the proximal part of the operating handle 2 allows the practitioner to control the irrigation or aspiration of liquids and to control the operation of surgical instruments introduced inside the device, thanks to movements along two axes of a plane perpendicular to the operating handle.

In fig.2, the distal part of the cannula 1 consists of two concentric tubes, one inside 5 and the other outside 6, welded to each other at their ends, the outside tube 6 being constricted so that the diameter of its orifice corresponds to that of the outside of the inner tube 5.

A ring 26 enclosing the inner tube 5 near its proximal end, or other expansion of the inner tube, said inner tube 5 extending beyond the proximal end of the outer tube 6, provides sealing between the parts . distal and proximal of the cannula.

In the particular embodiment of the figure, the section of the annular space defined between the two tubes called exterior and interior is substantially equal to 1.7 mm ^, the diameter of the fictitious cir¬ conference defined by the three vertices of the bos¬ sages is equal to that of the rigid utensils plus 0.2 mm, or 5.2 mm, and the outside diameter of the said outer tube is 8 mm and that of the said inner tube is 7.2 mm.

Note also in the figure, as an extension of the distal part of the cannula, a mandrel 90 consisting of a distal end 91 swollen and sharp, a rod 92 and a proximal end shaped like a pommel 93; the distal end 91 has an outside diameter which closely follows the inside diameter of the end of the cannula and it has three grooves 94 at 120 ° which also follow the bosses 7 of the internal face of the cannula, so as to completely fill its interior space at its distal end; the knob 92 has a shape adapted to the face of the connecting piece 01 of the cannula recalled in dashes; the assembly of the cannula and the mandrel forms a trocar.

In Fig.3, the outer tube 6 is stamped at its ends at three points 7, 7 'and 7 "equally spaced on its periphery, forming on its outer surface three grooves and on its inner surface three bosses.

As a result, firstly, the annular space 4 arranged between the two tubes 5 and 6 corresponds to an irrigation conduit, the liquid circulating initially in said annular space 4, and secondly s 'evacuating the cannula through the conduits formed by said grooves 7,7' and 7 ".

Secondly, it follows that the annular space 9 formed between on the one hand the internal surface of the inner tube 5 and on the other hand the external surface of a rigid surgical instrument 8 introduced 1 * inside the cannula and guided axially by the said bosses 7,7 ′ and 7 ″, corresponds to a suction pipe.

In Fig.4, the connection between the connecting piece 01 of the cannula and the connecting piece 02 of the handle is provided by a device of the "bayonet" type. This consists of a ring 25 integral with the operating handle 2, which ring penetrates inside a cylindrical cavity 10 formed inside the proximal part of the cannula 1, and is maneuverable therein. by means of a lever 35 (fig. 6).

The proximal part of the cannula 1 is provided with two conduits arranged transversely to the cannula, one 21 intended for the passage of the irrigation liquid, the other 23 intended for the passage of the aspirated liquid. The irrigation conduit 21 communicates with the annular space 4 formed between the two exterior and interior tubes 6 and 5 by means of grooves 29 stamped on the proximal end of the exterior tube 6, and its orifice opening out of the cannula is fitted with a valve 22. The suction duct 23 opens onto the duct 9 formed by the internal space of the inner tube 5.

In fig.5, the cylindrical cavity 10 contains an automatic ball valve device. This consists of a ball 11 obstructing a conduit 12 for the passage of rigid instruments, the latter resting on a cylindrical pusher 13 provided with a transverse groove 15 on its upper surface, itself resting on a spring 17 compression whose base is supported by the bottom of said cylindrical cavity 10. A washer 18, the lower flat face of which comprises a conical concave ramp 19 is supported on the upper surface of the ball 11. A leaf spring 20 is fixed close to the periphery of the washer 18. With fig.1,4, 6-9 there will be described details of embodiment, pertaining to the invention. means for operating instruments of the "rigid" type that can be used with the above-described device, for which it is important to note that the handle 2 is perpendicular to the axis of the cannula. First of all, it should be recalled that conventional rigid instruments include a fixed part intended to be made integral with the apparatus and a mobile part intended to be operated, the relative movement of these two parts inducing the operation of a tool (scissors, pliers, etc.) not shown in the figures.

The apparatus described in fig.l and / or 6 allows the use of conventional laparoscopic surgical instruments commercially available today; in these figures it appears that the operation of specific surgical instruments by the practitioner can be carried out by means of the eyelet 24 secured to two arms 27 articulated on a ring 29 with a cam function, and to two connecting rods 30 connected to each other. same to a member 33 for axial operation of the rigid instruments; the ring 29 makes, by turning, pivot a lever 31 which acts on the pushers of - two microswitches 32, 32 '(fig.4) respectively for controlling the irrigation and the aspiration. The articulation of the links the arms on the one hand, is on the operating member on the other hand, provides a significant reduction in the movement of the thumb of the practitioner.

It will be noted that each of the operations of the eyelet having an effect independent of the position of the eyelet, resulting from the other operation.

We also notice below the handle 2 in fig.4 a microswitch 34 for controlling various functions (laser, electrosurgery, etc.) electrically relayed by a cable 81. On the other hand the invention proposes in its fourth object, shown in figs. 7-9, a provision to facilitate the exchange of specific instruments by the practitioner alone; in this arrangement, as in the previous one, the operation of a specific rigid instrument introduced into the device results from the operation or axial of the eyelet 24 disposed above the handle 2 (fig.l); each of the operations of the leton eye having an independent effect.

The instrument (fig. 7) is held on the apparatus, and is maneuvered there, by means of, on the one hand, a first assembly, called the reception assembly, included in the apparatus, and on the other hand d '' a second assembly, known as the coupling head of the instrument (fig. 8), which can be made functionally integral with the first assembly by a double clutch device with balls which can be operated with one hand, the receiving assembly supporting the 'oeil¬ leton via the pair of arms 27 and the pair of links 30 (fig.l) articulated on it.

In fig.7 the reception assembly mainly consists of three hollow coaxial parts, namely:

- A first part 28 called for connecting the receiving assembly to the instrument, said first part comprising an internal circumferential groove 44, called first, - a second part 29 mounted pivoting on the first, and comprising a pair of trunnions 46 external, called prime,

- A third part 48 slidingly mounted on the second and comprising an internal circumferential groove 50, called the second, and a pair of external pins 52, called second, the first and second grooves being intended to cooperate with balls to form a first and a second interconnection member, while the first and second pair of journals constitute articulation pivots for, respectively, the arms 27 and the links 30. In fig. 8 the coupling head mainly consists of four coaxial hollow parts, namely:

a first part 54 provided with a pair of oblong slots 56 and, at its distal extremi, with an external conical bearing 58, called the first proximal end being shaped as a pusher 59,

- A second part 60 provided with a pair of oblong lights 62 and a plurality of housings 64 of balls, said second part is connected to the fixed part 41 of the instrument, while q the balls complete with the first conical bearing the first groove, the first dog clutch,

- a third part 66 provided with a traction collar 68 and a conical reach

70 external, called second, and

- A fourth part 72 provided with a plurality of housings 74 of balls, said fourth part being traversed by a pin 76 passing freely in the oblong slots 56,62 and being integral with one end of the movable part 43 of the instrument, while the balls complete with the second conical bearing 70 and the second groove 50 the second clutching member and that compression springs 78,80 urge the ball housings distantly, conical bearings so as to push the balls back into the circumferential gorges.

The operation explained using the figures, is as follows: When the instrument (fig. Is lowered into the receiving assembly (fig. 7) the bills are stopped by the edges of the grooves 44 and 50; it is then necessary to d '' press, with the thumb for example on the pusher 59, while lifting the flange 6 held between two other fingers, for example; this double movement represented by arrows 82, places the worn conical in front of the balls which can then return to their respective housings, then cross the edges of the flanges and come in front of the grooves; the relaxation of the fingers allows the return of the parts 54 and 66, under the effect of the respective springs 78 and 80 and the blocking of the balls in the grooves. Consequently, the parts 41 and 60 are integral with the parts 48 and 29, that is to say with the handle 2, therefore fixed in translation, while the part 43 is integral in translation by means of the pin 76, parts 72 and 48, that is to say biel¬ lettes and the eyelet which can thus by its axial movement cause the displacement of the movable part 43 of the instrument. The uncoupling of the head and the receiving assembly is carried out by an identical manipulation of the parts 54 and 66 followed by the withdrawal of the instrument.

Although a particular embodiment of the invention has been described and shown, it should be understood that the scope thereof is not limited to this form, but extends to the definitions which have been given above.

Claims

1.- Surgical apparatus intended for operative laparoscopy, called multifunctional instrument, of the kind of those made up of a tube, called cannula, inside which various instruments can be introduced, said cannula being able to allow the passage of body fluids or irrigation, and comprising in the vicinity of its so-called proximal end a connection assembly to a grip handle, from which it can be separated after use, said handle comprising as a connection piece to the cannula, this piece supporting a plurality of means for implementing the various functions of the device, while the cannula comprises at its proximal end a connection piece to the handle, this connection piece comprising nozzles for passage of liquids, characterized: in that the '' set of conduits opening at the so-called distal end of the cannula (1) such as those allowing the passage of different instr elements as well as those allowing the functions of irrigation or aspiration, are coaxial,

2.- Apparatus according to claim 1, characterized: in that the cannula is consti¬ killed by two concentric tubes, in that the communication between the cannula (1) and the operating handle (2) is provided by a device ball valve, the ball being laterally displaceable under the effect of the introduction of an instrument to free the passage, and regaining its obstruction function when the instrument is removed.

3.- Apparatus according to claim 1, characterized: in that an irrigation conduit consists of an annular space (4) located between two concentric tubes (5 and 6) respectively interior (5) and exterior ( 6), and in that the tube says inside

(5) is stamped at its so-called distal end at three seepage points distributed over its periphery, this stamping forming three grooves (7, 7 'and 7 ") on the exterior surface of said tube, and three bosses (7, 7' and 7" ) on the inner surface of said tube, of dimensions such that the sum of their sections corresponds substantially to the section of the annular space, and such that the diameter defined by a fictitious circumference (8) passing through three vertices of said bosses (7, 7 'and 7 ") is slightly greater than that of the instruments, and in that the so-called distal end of the outer tube (6) is narrowed, so that the diameter of the orifice of the outer tube

(6) corresponds to that of the outer diameter of the inner tube, and in that the distal ends of said two inner (5) and outer (6) tubes being in close contact, these are welded on their periphery, whence it Thirdly, it follows that the suction duct corresponds to the annular space (9) defined between the internal wall of the inner tube (5) and the external surface of the instruments.

4.- Apparatus according to claim 2, characterized: in that the ball valve device is located in a cylindrical cavity (10) formed inside the proximal end of the cannula (1), and in that the ball valve device consists of at least the following elements:

a first element consisting of a ball (11) with a diameter greater than the passage for passage of the instruments (12),

- A second element consisting of a cylindrical pusher (13) comprising in its upper part a flat washer (14) whose upper face is provided with a groove (15), and comprising in its lower part a tube (16 ), the internal diameter of the pusher (13) corresponding to that of the instrument passage duct (12), and the external diameter of the washer (14) corresponding to that of the cavity (10), so that said pusher ( 13) is guided axially therein by the outer surface of the washer (14),

a third element consisting of a cylindrical compression spring (17), the internal diameter of which corresponds to the diameter of the tube of the pusher (16), so that it is guided axially by the latter,

a fourth element consisting of a washer (18) provided on its lower planar face with a conical concave bearing surface (19) and whose internal diameter corresponds to that of the instrument passage duct (12),

- a leaf spring (20) fixed close to the periphery of the washer (18), and in that the ball (11) rests in its lower part on the upper part of the pusher (13) which is supported on the spring compression (17) which even when pressing on the bottom of the cylindrical cavity (10) the ball (11) obstructing the passage duct (12) of the pushing instruments (13), and in that the ball (11) is in close contact with the bearing surface (19) of the washer (18),

5.- Apparatus according to claim 1, characterized: in that the outer tube

(6) is constricted at its proximal end to be in close contact with the inner tube (5) and to be welded thereto, a passage being formed in said outer tube (6) and communicating with a conduit

(21) practiced transversely to the cannula (1) whose section is equivalent to that of said annular space (4) and whose orifice is equipped with a valve

(22) and a spring-loaded valve, and in that the orifice of the inner tube (5) at its proximal end opens onto a conduit (23) of equivalent diameter formed transversely to the cannula (1)

6.- Apparatus according to claim 1, intended to implement so-called rigid instruments comprising a fixed part intended to be made integral with the apparatus and a movable part intended to be operated, the relative movement of these two parts inducing the operation of a tool (scissors, pliers), charac¬ terized: in that, the handle (2) being perpendicular to the axis of the cannula, the operation of a rigid instrument present in the apparatus results from the vertical (or axial) operation of an eyelet (24) supported above the handle (2) by a pair of arms (27) and by a couple of links (30), articulated on the, handle while the operation horizontal (or transverse) of the eyecup, on either side of the handle, respectively actuates one or the other of two microswitches (32,32 ') for controlling the suction and the irrigation, each of the maneuvers of the leton eye having an effect independent of the position d the eyecup resulting from the other operation,

7.- Apparatus according to claim 6, characterized: in that the instrument are maintained on the apparatus, and is maneuvered there, by means of a part of a first assembly (fig.7), said of reception, included in the apparatus and supporting the eyecup on the other hand of a second assembly

(fig. 8), said coupling head, which can be made functionally integral with the first set by a double locking device with balls which can be operated with one hand,

8.- Apparatus according to claim 7, characterized: in that the reception assembly mainly consists of three hollow coaxial parts, namely: - a first part (28) said to connect the reception assembly to the ins trument, said first part comprising an internal circumferential gorg (44), called pemière,

a second part (29) mounted journalling on the first, and comprising a coupling of external journals (46), called first,

- A third part (48) slidably mounted on the second and comprising an internal circumferential groove (50), called the second, and a pair of external pins (52), called second, the first and second groove being intended to cooperate with balls to form a first and a second locking member, while the first and second pairs of trunnions constitute articulation pivots for, respectively, the arms (27) and the links (30), that the coupling head mainly consists of four coaxial hollow parts, namely:

a first part (54) provided with a pair of oblong lights (56) and, at its distal end, with an external conical bearing (58), called the first, the proximal end being shaped as a pusher,

- a second part (60) provided with a pair of oblong lights (62) and a plurality of housings (64) of balls, said second part being connected to the fixed part (41) of the instrument, while the balls complete with the first conical bearing and the first groove, the first locking member,

a third part (66) provided with a flange (68) for traction and an external conical bearing (70), called the second, and

- A fourth part (72) provided with a plurality of housings (74) of balls, said fourth part being traversed by a pin (76) passing freely in said oblong slots (56,62) and being integral with one end of the movable part (43) of the instrument, while the said balls complete with the said second conical seat (70) and the second groove (50) the second locking member and only compression springs (78,80) urge the ball housings, and the conical bearing surfaces, so as to push the balls back into the circumferential grooves.

9. Apparatus according to claim 3, characterized: in that it implements a mandrel whose distal end 91 is swollen relative to its rod 92, so that its outside diameter closely matches the inside diameter of the cannula , and has three grooves 94 at 120 ° conforming to the bosses 7 of the internal face of the cannula so as to completely fill the interior space of the latter, at its distal end, the assembly of the cannula and mandrel then forming a trocar .