CA1251369A - Surgical holder for a laparoscope or the like - Google Patents

Abstract

IMPROVED SURGICAL HOLDER FOR
A LAPAROSCOPE OR THE LIKE

ABSTRACT OF THE DISCLOSURE

Mechanical components for holding and positioning a laparoscope incident to its use during surgery, wherein a selectively tensionable cable-type component is released for moving the laparoscope almost into its desired position and then tensioned into a rigid structure, and then a ball and socket joint is rendered operational to complete the moving of the laparoscope, if need be, to precisely position this instrument in its required anatomy-viewing position.

Description

~L~5~3~;~

The present invention relates generally to surgical support structure or a laparoscope, and more particularly to a unique combination of rigid and flexible components which provide the capability oE precisely positioning the laparoscope incident to its use during surgery, but while maintaining, once said position is established, a necessary rigidity to avoid inadvertent slippage or other movement from that position.

The advantages are already well known, from such prior patents, for example, as U.S. patents 4,254,753 and 4,143,652, that surgical retractors, clamps and the like held by mechanical components result in a reduction in personnel and thus correspondingly in a reduction in expense, as well as providing other noteworthy benefits. Heretofore, however, the surgical instruments so held or supported did not impose critical requirements for positioning, so that they could be properly used during the surgical procedure. For example, if to allow unimpeded positioning, the support structure was comprised of a multiplicity of interconnected link elements on a flexible traction element in which such link elements, because possessing at one end a ball and at the other end a complementary ball socket, could be made to assume any shape necessary for positioning and then caused to assume a rigid mode by the tightening of said traction element, this unimpeded positioning would be at the expense of possible not having adequa~e retention forced to prevent slippage and other inadvertent movement from the surgical position established for the supported instrument. With a laparoscope, Eor example, a precise anatom~-viewing position must be ~5~6~

established, and once established securely maintained, otherwise the viewing and internally inserted end o~ the laparoscope might, due to slippage, exert pressure on tissues, and especially on soft organs, such as the liver, pancreas, or intestines, and othe~wise introduce a complication D

Broadly, it is an object of the present invention to provide structure for readily positioning a laparoscope prior to the use thereof, during surgery, which also is of noteworthy rigidity to obviate slippage or inadvertent movement in the laparoscope, and which otherwise overcomes the foregoing and other shortcomings of the prior art. Specifically, it is an object to provide a laparoscope-positioning component with a strategically located ball and socket joint component, so that in such combination the objectives of flexibility for positioning and of rigidity for secure weight support are uniquely balanced and readily achieved.

An improved suxgical holder and positioner for a laparoscope or the like, such as an endoscope, demonstrating objects and advantages of the present invention includes an open ring and means for supporting same in a fixed horizontal orientation over a patient having an incision for the ;nsertion of the laparoscope proximal end. A generally vertically oriented support rod is mounted adjacent its lower end at a selected location on the open ring and a selectively tensionable the laparoscope to engagement of its opposite end to the upper end of the support rod. As a result, prior to the tensioning of the tensionable member, the laparoscope proximal end is manipulatable into a position that is proximate to that ~ ~5~36~

which is necessary for proper viewi.ng of the anatorny on which the surgery is bein~ performed. Comple-ting the structure is a ball and socket joint that is provided at a strategic location at the lower end oi the .support rod for permitting the rod to be urged through conical m~vement wi.th one hnnd by the surgeon while sighting down -the~ laparoscope. As a consequence, the laparoscope proximal end partàkes of corresponding conical movement incident to assuming a more precise anatomy-viewing position while the wci~ht of thc supporting and positioning components remains supported on the open rlng.

The above brief description, as well as other objects, features and advantagcs o:f the prescnt invention will be more fully appreciated by reference to the rollowing de-tailed description of a presently preLerred, but nonetheless illustrative embodiment i.n accordance with the present invention, when taken in conjuncti.on w:ith the accompanying drawings, wherein:

FIG. 1 is a perspec-tive view illustrating the improved surgical holder for a la~ roSc~l)e or similar :ins-trument according to the prescnt invelltion during a -typical surgical procedure;

~ IG. 2 is a ~nrlial pelsl)ectiv( view o.l` the ball and socket joint oi` tl-e holder;

FIC. 3 is another pcrspcctiv(~ vi.ew illustrating degrees of motion of the ball and socket joint; and ~25~3~i~

FIG. 4 is a perspective view illustrating the corresponding movement of the interconnecting laparoscope and rod component having the ball and socket joint.

In FIG. 1 there is illustrated a typical 5mm diagnostic laparoscope 10 as it would be held in proper viewing position during a surgical procedure, which laparoscope could, of course, also be larger or lOmm in diameter if used for operative or instrument-inserting purposes. Included in the holding structure is a surgical ring assembly 11 for supporting the laparoscope 10 which is basically the assembly illustrated and described in U.S. patent 4,254,763. More particularly, the ring assembly 11 is illustrated attached to a surgical operating room table 12 in a position as it would assume during an op~ration on a simulated patient P. The main components comprising this surgical ring assembly are an elongated support post 14, an elongated extension rod 15 which is connected to support post 14 by a coupling device 16, and a substantially flat, oval-shaped ring member 18. The attachment to the surgical operating room table 12 is made by an adjustable clamp 20 attached to a rail 22 provided or.
each side of the table and generally extending the length thereof.

As may be readily appreciated from FIG. 2, and as is described in U.S. patent 4,254,763, the ring member 18 is substantially oval in shape and has an open center area which provides a large reglon for the surgical procedure. The ring member also ir.cludes a plurality of spaced indentations 24 to facilitate making a clamping connection thereto, all as will be subsequently explained. From what has been described, it should be readily appreciated that the cantilever effect of the elongated extension rod 15 and the further extension provided by the rigid member 18 allows the entire ring assembly to suf~iciently reach across the patientP so that this assembly can be located only on one side of the patient, without requiring a second support arm on the other side of the patient. It is for this reason that the ring assembly 11 is selected as the most preferable in providing the support to the improved laparoscope holder of the present invention, which will now be described in detail.

At a selected location about the open ring 18, as at 26, there is provided a C-shaped clamp 28 which frictionally engages an end o~ a plate 30 having at its opposite end an upstanding post 32. As is perhaps best understood from FIG. 2 in conjunction with FIG. 1, adapted to be attached to the post 32 is a mounting device or vise 34 of conventional and well understood construction which includes a movable jaw 36 operated by a rotatable lever 38 so that, in practice, the post 32 is securely engaged between the movable jaw 36 and an opposing stationary jaw 36a.

..
As shown in FIG. 2, an integral part or connection to vise 34 is a ball and socket joint, generally designated 40, of a well understood operational mode and construction. It will also be understood that the ball and socket joint 40 hereof is readily commercially available and is similar to the ball and socket joint described and illustrated in U.S. patent 4,143,652.

-r For present purposes, i-t su:f.Lices to note -that the ball and socket ~joint 40 includes a cyl.indr:i.cal housing 4~ in which there is rotatably disposed a .sleeve 44 which seats at its outer end in a socket-shaped compartment 46 a ball 48 which is provided at the lower end of a support rod 50.

As is perhap~ best ,sho\vn in FIG~ 3, to which figure reference should now ~e made, the lower end of the rod 50 operates in clearance provided by a .slot 52 in the sleeve 42, so that the rod is pivotable in the o~posi-te direc-tions noted by the reIerence arrows 5~1. The rod 50 is also movable in the opposite direc-tions denoted by the reference arrows 56 as a result of the rotative movement o-f sleeve 44 within the housing 42. ~s is well understood, a -turning of a lever 58 of the ball and socket joint 40 is opcratively efLective -to selec-tively engage or release the sle~eve 44 and ball 48 with respect to the movements 54, 56. That i.s, the -turning o-t I.ever 58 in one direction releases the sleeve ~4 and ball ~8, so that rod 50 can be moved in the directions 5~, 56, which, as will be subsequently explained is essentially a conical movement about the vertical axis 50a o:l -the rod 50, wh:ile rotation o:f the lever 58 in an OppOs:ita di r~ctioll causes, :in ~a well understood manner, frictional engagement of the sleeve 44 and ball 58 so that the rod 50 is fixed or ]ocked in the posi.ti.on o:f movement it occupies at the Lime leVYr 58 j S tUrned .

Reference should now be rnade to FIG. 1 in conjunc-tion ~ith FIG. l. Comple-ting the improved holder for the laparoscope lO hereo-f is a selectively tenslonable mernber 60 which will be underslood ~(? b~ re,1d.ily availa~le Irom ~L2~;13~9 numerous commercial sources and of a well understood construction composed of a multiplicity of link elements, individually and collectively designated 62, wherein each link 62 possesses at one end a ball and at the other end a complementary ball socket. The link elements 62, in turn, are threaded, in the manner of pearls upon a string of pearls, onto an internal flexible traction element (not shown). Completing the construction of the member 60 is a lever means 64 which, in a well understood manner, can effectuate the tightening of the traction element, so that the interconnected links 62, which, as already noted, are composed of a multiplicity of ball and socket joints which are arranged in a row, are caused to assume a rigid structure, i.e., a structure that can be arrested at any position selected by the surgeon or other user of the device, such as the arcuate shape of FIG. 4 or the S shape of FIG. 1. It will be understood that the selectively tensionable member 60 may be of the type described in U.S. patent 3,858,578 as well as in German Petty patent nos. 6,941,781 and 7,010,461.
In practice, effective results have been achieved using a selectively tensionable or flexible member 60 as illustrated and described in Flexbar Machine CorpO brochure of September 1~, 1966, identified as Fleximount Instrument Holder P-38A on page

2, as referenced in U.S. Design Patent D 239,131.

As illustrated in the drawings, member 60 includes at one end a vise clamp 66 which, by appropriate manipulation of its lever 68 achieves attachment of the flexible member 60 to the upper end of the rod 50. At its opposite end, flexible member 60 includes a clamp 70 which preferably has padded jaws 72 L3~

which in a well understood manner are engaged to -the exposed or distal end lOa of the laparoscope 10.

With specific reference to I~IC. 1, it will now be explained how the improved holder an~ positioner for the laparoscope lO according to the presknt invention, is used during a -typical surgic~~l proc~ur~.

As the firs-t step O:r the procedure il will be understood that the ring assembly 11 is .set in p]ace in overlying relation to the patient P. The rod 50 with its ball and socket joint 40 is then suppoIted on the open ring 18 o~ -the assembly 11, the rod 50 being in an ini-tial vertical orientation as illustrated in FIG. 1. Assuming that the surgical procedure is general abdominal surgery, an incisi~n 74 is made in the patient's abdomen, typically near the umbilicus, ior insertion o-~ the laparoscope proximal end lOb. It will be understood that at this time -the laparoscope 10 and rod 50 are interconnected wlth tl~c lle.~il)le meml)~r 60 and that the control member 64 is in its opera~ive posi~ion rel.easing the individual links 62 so that member 60 is readily flexed and thus does not impede positioning movement of the laparoscope 10. The surgeon sighting down the eyepiece lOc can thus efectively manipula-te the laparoscope proximal end lOb so -that it is in a posiltion very close to that which is require~ ior ~roper viewing o:E the internal ana-tomy or the pa~ient thllt is the object of -the surgical procedure. Once this positioning is achieved ~or the laparoscope 10, the control lever 6~ is turned to lock or ~ix the ~lexible member 60 in whatever shape it has assumed in order to allow for the p~si~ionin~ ~r the laparoscope 10.

Once the member 60 has been rigidified it will be understood tha-t it will not inadvertently move from its assumed shape since it will be understood that the member 60 is designed to readily suppor-t :four pounds. That i.s it wi.ll be unclerstood that member 60 is approximately l0 inchcs and that the individual links ~2 which provide this length are readily ~ixed in relative position to each other upon the twisting of lever 64 which pulls taut the internal cable or flexible traction element such thlt the ~rictional engagement between the balls and their cooperating socket compartments will resist movement against at least four pounds of force.

Although it is possiblc that the laparoscope proximal end lOb will be in -the precise viewing position required Ior -the surgical procedure solely as the result of the initial manipulation by the surgeon and the po.sition o~ movement achieved in the rigidified i`lexiblc- member 60 the present invention contempla-tes that this might not always be the case and that some additional movement .is necessary in positioning the laparoscope proximal. en(l l0b. It i~ thus an essential contribution Or the present :inverlti.on -to provide the ball and socket joi.nt 40 -Lo-r -the lower e~nd o1 the support rod 50. It should of course be apr)Teciate(l thlt the ent:ire weigh-t O.r the laparoscope l0 inte.rconnecting member ~0 .Ind the support rod itself are suppor-ted in the s.leev( 14 o~f the ball and socket ~joint 10 which joint 40 is, in tllrl-l, slll)por~ed orl tllc :fixed open ring 18. To achieve the acld:i.tional degree o.i rnovement i.n the laparoscope proximal end l0b that may be neede~d fOr its proper anatomy-viewing positioning the surgeon merely rnoves the lever 58 into its operative position relensing the support 1L3~9 rod 50 for universal movemen-t a~ prcvi.ollsly descril)ed and illustrated in specific re~exence to FIG. 3. The surgeon, however, may mailltain his phys.ical contact with one hand on the lever 58 and using his other hand grasp the upper end of support rod 50 and manipu]ate saicl rod 50 through the degrees o~ movement 54, 56, which essentially would be a conical movement about the vertical axis 50a of the support rod 50.
This conical movement is illustrated in FIG. 4 by the reference arrow 76. While engaged in this mani.pulation of the support rod 50 it will of course be understood that the surgeon continues to sight down the laparoscope 10, so that he can determine when the laparoscope proximal end lOb is in the precise anatomy-viewing ~ositi.on which he requires.

Still re~erring to FIG. 4, it will be understood and appreciated that the physical :rela-tionship O:e the components which comprises the present i.nven-tion is such that -the conical traverse 76 of the support rod 50 provides a corresponding conical traverse in the lap~roscope 10, said traverse being designated 76a in FIG. 4, and, e~ven more important, that there also results a corresponding conical traverse in the laparoscope proximal end lOb, but of a signi.ri.cantly diminished ex-tent, designated 76b in FIG. 4. In -this regard and still referring to FIG. 4, it will be noted that the mecha.nical relationship between the location of the ball and socket joint 40 and the incision 74 in the patient :ror the laparoscope proximal end lOb .
are approximately in the same plane, which in FIG. 4 is signi~ied by the reference line 78, such that there is the relationship between the movements 76 and 76b, as jus-t noted.

This is important since wi.th oxl)elience the surgeon can ~2S~L369 achieve proper ana-tomy-viewing positioning ior the laparoscope proximal end lOb with deft manipu]ation of the upper end of the support rod 50. Stated another way, it can be readily appreciated that there is a corresponding relationship in the movements 76a and 76 of the respec-tlve upper ends of the laparoscope 10 and support rod 50, and that therefore likening the exposed length portion O:r -the 1.aparoscope 10 to a lever with a fulcrum located at the incision 74, it will be readily appreciated that angular movement of the upper end lOa in a conical movement 76a will result in an equal annular or conical movement of the laparoscope proximal end lOb, but at a diminished extent because of the difference in distances from the fulcrum 74 of these -two opposite ends.

It also should be noted and recognized as a significant contribution of the present invention that during the time that the laparoscope 10 is being positioned as just described, that the weight thereof, as well as the weigh-t of the connecting member 60, as well as that of the support rod 50 itself, is effectively supported in the seat or socket compartment of the sleeve 44 inasmuch as the sleeve is in supporting relation beneath thc ba]l ~8 oi -the ball and socket joint 40, all as is clearly :illustrated i.n FIG. 2. Since the components just described are in turn ei~ective:ly supported on the fixed open ring 18, there is -thus no possibil.ity tha-tclue to the weight o -the components, even during the piv~tal.-traverses 76 of the laparoscope proximal end lOb, that said end of the laparoscope will exert pressure on -tissues, and especially on soft organs, such as the liver, pancreas, intestines, etc., which, of course, it is important to avoid ~2 6g Once the laparoscope proximal end 10b is in the precise viewing position required by the surgeon and fi~ed in said position, the surgical procedure then contemplates the making of an additional incision 80 in the approximate location of the laparoscope to be used by the surgeon in achieving the surgical objective or result. It will of course be understood that the.size of the incision 80 is characterized by being of a nominal extent because the surgeon is not required to use the incision opening 80 to view the internal anatomy, since this is the function of the laparoscope 10.

For completeness sake, it is noted that the laparoscope 10 is equipped with a conventional light source attachment 82 and also an attachment 84 to a source of carbon dioxide, which, in a well understood manner, is used during surgery to separate the abdominal contents and also reduce the risk of puncturing a bowel.

In addition to the surgeon sighting through the laparoscope 10, it is also a known pra¢tice, and therefore illustrated in phantom perspective in FIG. 1, to mount a television camera 86 in viewing relation tothe laparoscope eyepiece 10c and to operatively connect the camera 86 via the electrical connector 88 to a TV monitor 90 having a display screen 92. In this manner, a number of surgeons can attend the patient P during the surgical procedure and can offer assistance based on observation of the images transmitted and displayed on the screen 92. A TV camera 86 which is under the weight limit which could inadvertently produce movement in the rigidified member 60 is readily available from numerous ~25~36~

commercial sources, one such source being model S2-2 from Codman Instruments of Randolph, Mass.

Although the surgical procedure described herein is in the category of general surgery, it will be understood that the holder and positioner for the laparoscope is equally applicable for orthopedics, pediatric surgery, urology, gynecology, thoracic surgery, heart and vascular surgery, neurosurgery, animal surgery and veterinary surgery. Also, the holding and positioning components described herein are preferred for use with a laparoscope, but are equally applicable for use with an endoscopic system.

A latitude of modification, change and substitution is intended in the foregoing disclosure, and in some instances~
some features of the invention will be employed without a corresponding use of other features. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the spirit and scope of the invention herein.

Claims (4)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE PROPERTY OR
PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. For surgical manipulation of a laparoscope engaged adjacent its exposed distal end and requiring its inserted proximal end to be positioned in proper viewing relation to anatomy to be observed therethrough, an assembly comprising, in combination, an open ring and means for supporting same in a fixed horizontal orientation over a patient having an incision for the insertion of said laparoscope proximal end, a generally vertically oriented support rod mounted adjacent its lower end at a selected location on said open ring, a selectively tensionable [member extending from an end therof engaged to said laparoscope to engagement of its opposite end to the upper end of said support rod such that prior to the tensioning of said tensionable member said laparoscope proximal end is manipulatable into a position that is proximate to that for proper viewing of said anatomy, and a ball and socket joint at said lower end of said support rod for permitting said rod to be urged through conical movement, whereby said laparoscope proximal end partakes of corresponding conical movement incident to assuming a more precise anatomy-viewing position while the weight of said assembly and laparoscope remains supported on said open ring.

2. The assembly for holding and positioning a laparoscope as claimed in claim 1 wherein said tensionable member is comprised of interconnected link elements each having a ball-shape at one end and a complementary ball socket at its other end, and is of the type effective to assume a wide range of selected rigid shapes so as to contribute to providing said anatomy viewing position of said laparoscope.

3. The assembly for holding and positioning a laparoscope as claimed in claim 2 including a TV camera operatively disposed on said laparoscope for viewing therethrough, and a TV monitor electronically connected to said TV camera to display images as seen through said laparoscope.

4. For surgical manipulation of a laparoscope engaged adjacent its exposed distal end and requiring its inserted proximal end to be positioned in proper viewing relation to anatomy to be observed therethrough, an assembly comprising, in combination, an operating table support operatively disposed to extend over a patient having an incision for the insertion o-said laparoscope proximal end, a generally vertically oriented support rod mounting adjacent its lower end on said operating table support, a selectively tensionable interconnected operative arrangement of link elements extending from an end thereof engaged to said laparoscope to engagement of its opposite end to the upper end of said support rod such that prior to -the tensioning of said interconnected link elements into a rigid shape said laparoscope proximal end is manipulatable into a position that is proximate to that for proper viewing of said anatomy, and a ball and socket joint at said lower end of said support rod for permitting said rod to be urged through conical movement, whereby said laparoscope proximal end partakes o e corresponding conical movement incident to assuming a more precise anatomy-viewing position while the weight of said assembly and laparoscope remains supported on said operating table support.