CN102215759A - 网施展装置 - Google Patents

网施展装置 Download PDF

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CN102215759A
CN102215759A CN2008800049966A CN200880004996A CN102215759A CN 102215759 A CN102215759 A CN 102215759A CN 2008800049966 A CN2008800049966 A CN 2008800049966A CN 200880004996 A CN200880004996 A CN 200880004996A CN 102215759 A CN102215759 A CN 102215759A
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CN102215759B (zh
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萨姆尔·埃尔达尔
沙洛姆·雷文
伊扎克·法比安
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Abstract

一种网施展装置包括：施展杆，该施展杆在其近端部具有手柄并且在其远侧部具有辊部分，所述辊部分具有用于将网片附着于其上的网片连接元件，其中所述辊部分利用接头而相对于施展杆铰接；以及联接到辊部分上的操作元件，以将辊部分绕接头移动到辊部分与施展杆不共线的位置。

Description

网施展装置
技术领域
本发明通常涉及一种在体内施展(deployment)并放置网片的装置和方法，诸如用于在腹腔镜手术中的疝修复。
背景技术
疝是指一个(或多个)器官穿过覆膜、肌肉或骨骼中缺损或自然开口的异常凸出。大多数疝在腹股沟区域突出，如腹股沟疝(直接或间接)或股疝，以及在前腹壁区域突出，如切口疝、脐疝、上腹疝或半月线疝。
疝修复可能需要外科手术。小的缺口可通过缝合关闭，如果是较大的缺口，可能需要在缺口上覆盖网片(或简称为网)。在一些情况下，网片可用于加固腹壁中初步(primary)缝合过的缺口。网片在其外周边缘处利用缝线固定在腹壁上。
已经研制出了用于在腹腔镜手术中辅助施展并放置网片的工具。例如，美国专利5,464,403描述了一种用于在腹腔镜手术中放置柔性网片的工具。该工具包括细长管状组件和具有孔的细长管状元件。一杆置于孔中并在不到细长管状组件的远端处终止。一可旋转元件固定在杆的近端。一手柄固定在细长管状组件近端并接收可旋转元件。所述管状组件具有允许通向环形腔和杆末端的纵向延伸的槽。杆的远端啮合网的一个边缘，从而当杆向一个方向旋转时，网片从杆上松散开来并进入患者体内。
美国专利5,957,939描述了用于在患者体腔内施展诸如网片的外科织物的医疗设备。该设备包括施展元件和支撑在施展元件的远端处用于将织物保持卷起或解开构造的夹紧元件。夹紧元件能够啮合一片外科织物的一部分，并能够相对于施展元件旋转从而使得解开构造的织物能够围绕夹紧元件卷曲至卷起构造。该设备还包括位于施展元件远端的自展开(unwinding)元件，自展开元件可有效地将织物从卷起构造自动展开到解开构造。
上述专利涉及展开网片的方法但没有提及将网片放置到其位于腹腔中的位置处。
本发明人的PCT公开专利申请WO2004/080348，描述了包括形成有手柄部及同轴辊部分的杆的装置，其公开的内容在此引入作为参考。网片缠绕辊部分。在一个应用中，辊部分具有设有组织锚钉(anchoringstud)的远端。所述辊部分可旋转地连接到手柄部分。网片的后边缘可拆卸地连接到装置的辊部分，例如可通过外科线或诸如粘合材料的任何其它方式，在使用前将网片缠绕在辊部分上。
上面缠绕有网片的杆的辊部分被置于一套管内并通过切开口插入体内。在辊部分的远端处的上述组织锚钉例如通过刺的方式锚固在组织上，其便利解开网片并定位网片的后缘。
通过向体腔/空间内的预定位置牵拉前缘的外科线将网片放置于腹腔或腹股沟内以覆盖疝缺口。这由用于操作针的合适的镊子实现。在外科线端部提供的针随后用于缝合到患者适当的组织上，其可能通过从腹腔向患者体外刺穿患者的组织。在通过外科线牵拉网片的前缘的期间，杆保持固定，而辊自由旋转，以使得网片能够顺利且容易地施展并置于疝缺损上。
为完成疝修复，将网片的边角缝合到患者的身体上，或以其它形式连接于患者的身体，例如，通过纤维包扎(stapling)等等，然后剪断并丢弃外科线。随后，网片从杆的辊部分脱离，从而杆可被移除。
发明内容
本发明旨在提供用于在体内，例如腹腔或腹股沟内，施展和放置网片的装置和方法，例如，用于在腹腔镜手术中的疝修复的过程中覆盖患者的疝缺口。
所述装置为用户提供了在任何方向上展开网且在整个展开过程中保持卷起网的轴线与其开始的方向平行的较大的灵活性和能力。
本发明通过提供改善该装置的辊部分的可操控性的接头而提供对PCT公开专利申请WO2004/080348的设备的改进，如下面的详细描述。
在说明书和权利要求书中各处的术语疝包括任何类型的疝，例如但不限于：腹疝(切口疝、脐疝、上腹疝、半月线疝)，腹股沟疝(腹股沟疝或股疝)及其它。应注意本发明不限于疝修补还可用于需要某种网施展的任何医疗操作。
本发明可用于前面提到的任何类型的腹疝的修复，例如：切口疝、脐疝、上腹疝、半月线疝。另外，还应理解本发明可用于多种类似的手术，诸如：腹股沟疝等(直接或间接)和股疝。
在此提供根据本发明的实施例的网施展装置包括：施展杆，该施展杆在其近端部具有手柄并且在其远侧部具有辊部分，所述辊部分具有用于将网片附着于其上的网片连接元件，其中辊部分利用接头而相对于施展杆铰接；以及联接到辊部分的一操作元件，以将辊部分绕接头移动到辊部分与施展杆不共线的位置。
操作元件可包括安装在施展杆上的杠杆臂。操作元件可通过连接元件联接在辊部分上，该连接元件延伸贯穿形成于施展杆内的腔。该连接元件可绕接头上的枢轴旋转。
根据本发明的实施例，辊部分可通过摆动杆和推拉杆机构致动，该机构例如在±90°的范围内容易地改变它相对于施展杆的相对角度。摆动杆可具有便于从套管针插入或抽出装置的零点位置。通过改变施展杆相对于患者身体的角度和辊部分的相对角度，外科医生能够容易地以任何方向将网放置于任何位置。
所述操作元件可枢转地安装在施展杆上。
所述辊部分可置于套管中。所述辊部分可装配在套管内的轴承上。所述辊部分可包括一对位于轴(shaft)的相对端上的端盖，端盖上形成有孔隙(aperture)，该孔隙用于穿过孔隙放置网片的外科线。
附图说明
可从下面的详细描述结合附图更全面地理解本发明，其中：
图1是根据本发明的一个实施例构造并操作的网施展装置的简化图示；
图2是根据本发明的一个实施例的图1中的网施展装置的近端部的简化图示，示出了手柄和操纵元件；
图3A和3B是根据本发明的一个实施例的图1中的网施展装置的远侧部的简化图示，从两个不同的角度方向示出了辊部分、接头以及套管；
图3C是根据本发明的另一个实施例的图1中的网施展装置的远侧部的简化图示，示出了辊部分(具有非旋转轴)、接头以及套管；
图4A是网的简化图示，该网可由图1中的网施展装置展开；
图4B是网的简化图示，该网可由图1中的网施展装置施展，包括具有较弱粘合强度的粘性带；
图5是图1中的网施展装置的辊部分的简化透视图；
图6是图1中的网施展装置的辊部分和套管的简化端视图；
图7A、7B、7C是根据本发明的一个实施例的伞型网的简化图示，其可由图1中的网施展装置施展；
图7D-7G是根据本发明的另一个实施例的伞型网的简化图示，其可由图1中的网施展装置施展；以及
图8A和8B是根据本发明的一个实施例的线型折叠展开网的简化图示，其可由图1中的网施展装置施展。
具体实施方式
现在参考图1-6，其示出了根据本发明的一个实施例构成和操作的网施展装置10。
网施展装置10可包括施展杆12，该施展杆12具有位于其近端部的手柄14和位于其远侧部的辊部分16。
如图5所见，辊部分16可由轴18(其可以是如下述的旋转轴，但不必须如图3C的实施例所示)构成，且轴18具有位于其相对端上的端盖20。由本领域公知的生物相容材料制成的网片22可拆卸地附着到轴18上(轴18因此是用于将网片22附着于其上的网片连接元件)。如图4A所示，网片22可包括一对线24，所述线24可系在或以其它方式连接在辊部分16的轴18上。最靠近轴18的网片22的边缘在其角落处可具有一对外科线26。同样，网片22的自由边缘或前缘在其角落处可具有一对外科线28。该外科线28可具有便于例如通过标准的“内抓(endocatch)”工具而容易抓住的针(未示出)或环29。
如图6所示，辊部分16的端盖20可形成有孔隙30，用于穿过其放置网片22的外科线24。
如图3A和6所示，辊部分16可置于套管32中。如图3A所示，辊部分16分的轴18可装配在套管32中的轴承34上。套管32可具有纵向狭缝36(图6)，可通过该纵向狭缝36牵拉网片22。以这样的方式，随着辊部分16的轴18绕轴承34旋转，网片22能够容易地穿过狭缝36而从套管32内被拉出。
辊部分16可通过接头38相对于施展杆12枢转。在非限定的例示实施例中，接头38由位于施展杆12和辊部分16之间的两个销轴连接器(pinned connection)形成。
操作元件44可安装于施展杆12上。例如，操作元件44在枢轴45处可包括枢转地安装在施展杆12上的杠杆臂(图2)，所述枢轴45也称为销45(因为枢轴可以是销轴连接器)。操作元件44可通过连接元件46联接到销45上，该连接元件46延伸贯穿形成在施展杆12中的腔48。连接元件46可包括在位于接头38处的销40和42。连接元件46的近端可通过枢轴销50(也称为枢轴或销)固定在操作元件44上。通过绕枢轴45枢转操作元件44(通过向手柄14牵拉操作元件44的任意一侧)，操作元件44将辊部分16绕接头38移动到某一位置，在该位置上，辊部分16与施展杆12不共线(该位置在图3A和3B中示出)。施展杆相对辊部分的零点位置(即，施展杆和辊部分共线)可通过直线51(图3B)的对准而标记，从而便于通过套管针插入或移除装置。
特别参考图3B。根据本发明的一个实施例，在施展杆12相对辊部分16的一预定角度方向上，施展杆12的远端52可邻接辊部分16的近端54。这作为止挡或角运动限制器，其阻止施展杆12相对辊部分16的进一步角运动。
应当注意操作元件44和辊部分16之间的连接可用其它方式实现。例如，操作元件44可通过滑轮、齿轮或其它机构的方式连接到辊部分16上。
网施展装置10可以是由廉价材料制成的一次性装置，或者其可能意图用于多次使用，其中，其由适于消毒的材料制成，以及其中，新的网片22可附着在其辊部分上。
网施展装置10的接头连接使得能够显著更加灵活地将网片22放置在患者体内，并能实现在此之前尚不能实现的移动。
应注意网22能够进入任何类型的容器或胶囊(外形像或不像上面所示的套管32)。再者，网22并非必须如上所述穿过套管32中的狭缝36付出。替代的，能够省略套管32，当辊部分16的轴18在其轴承34上转动时，网22能够简便地从辊部分16上旋转卸下。如图4B所示，当网22缠绕到辊部分16上时，可采用软性(soft)粘合剂27(即，不具有很大粘合强度)临时将网22的卷彼此粘贴。该软性粘合剂将屈服于外科医生施加的拉力而付出网22并容易地从辊部分16上将网卷开。
需注意网22并非必须采用卷的形状。下面的实施例示出了卷型网的其它备选。在这些实施例中，网仍然附着在网施展装置10的辊部分16上，在这种情况下由于网实际上不从辊部分16上转下，“辊部分”可被重命名为“施加部分”。术语“辊部分”在权利要求中还包括这种施加部分。
现在参考图7A、7B和7C，其示出了伞型网60。网60可附着在辊部分16上。辊部分16可通过形成在组织(图7A)中的切口62插入，直到网60位于组织的远侧为止。如图7B所示，网60随后像伞一样展开，例如通过展开伞骨64(例如，连接到操作元件，未示出)。网60可通过缝合或其它本领域公知的任何方式附着于组织上。如果需要，可通过关闭伞将网60抽出，如图7C所示。
在图7D-7G中示出了另一种伞形网的(不同插入角度处的)相似的施展。
现在参考图8A和8B，其示出了线型折叠和展开的网70。网70可附着于辊部分16上。可在形成于辊部分16中的中空部分内设置弹性力施加器72。该弹性力施加器72可包括多个连接到网70的侧部或边缘的板簧或其它弹性元件。当从辊部分16向远侧推动弹性力施加器72时，板簧向外弹出，从而展开网70。
本领域技术人员应当理解本发明不限于前面所特别示出和描述的内容。本发明的范围实际上包括现有技术中不存在的以及本领域技术人员通过阅读前面的描述后能做出的对上述特征的结合和再结合以及它们的变形和改变。

Claims (13)

1.一种网施展装置，包括：
施展杆，其具有位于其近端部的手柄和位于其远侧部的辊部分，所述辊部分包括用于将网片附着于其上的网片附着元件，其中所述辊部分利用接头而相对于所述施展杆铰接；以及
操作元件，其联接到所述辊部分上，用于将所述辊部分绕所述接头移动到使所述辊部分与所述施展杆不共线的位置。
2.根据权利要求1的网施展装置，其中所述操作元件包括安装在所述施展杆上的杠杆臂。
3.根据权利要求1的网施展装置，其中所述操作元件利用连接元件联接到所述辊部分，所述连接元件延伸贯穿形成在所述施展杆中的腔。
4.根据权利要求3的网施展装置，其中所述连接元件绕所述接头处的枢轴旋转。
5.根据权利要求1的网施展装置，其中所述操作元件被枢转地安装于所述施展杆上。
6.根据权利要求1的网施展装置，还包括套管，所述辊部分被置于该套管内。
7.根据权利要求6的网施展装置，其中所述辊部分安装在位于所述套管内的轴承上。
8.根据权利要求1的网施展装置，还包括附着于所述辊部分上的网片。
9.根据权利要求1的网施展装置，其中所述操作元件以±90°范围内的相对于所述施展杆的角度操作所述辊部分。
10.根据权利要求1的网施展装置，其中所述辊部分包括位于轴的相对端处的一对端盖，所述端盖中形成有孔隙，所述孔隙用于穿过所述孔隙放置所述网片的外科线。
11.根据权利要求1的网施展装置，还包括附着在所述辊部分上的伞型网片和用于以伞的形式展开所述网片的伞骨。
12.根据权利要求1的网施展装置，还包括线型折叠和展开网片以及置于所述辊部分内并附着到所述网片上的弹性力施加器。
13.根据权利要求1的网施展装置，其中所述网片包括在端部处形成有环的外科线。
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