CN102355865A - 用于微创外科手术的引导和遥控牵引系统 - Google Patents

用于微创外科手术的引导和遥控牵引系统 Download PDF

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CN102355865A
CN102355865A CN2009801581076A CN200980158107A CN102355865A CN 102355865 A CN102355865 A CN 102355865A CN 2009801581076 A CN2009801581076 A CN 2009801581076A CN 200980158107 A CN200980158107 A CN 200980158107A CN 102355865 A CN102355865 A CN 102355865A
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M·罗德里格斯费尔南德斯
A·罗德里格斯纳瓦罗
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Abstract

本发明涉及一种用于微创外科手术的遥控牵引和引导系统，它容易定位和附接并引起较小损伤，该系统包括：至少一个可去除的外科手术内部夹(10)，该外科手术内部夹具有附接装置(11、12)，该附接装置与插入引导件(20)装配在一起，具有初始打开位置和当通过去除机构而从所述插入引导件(20)上去除时的自然关闭位置，所述内部夹(10)包括在与所述附接装置(11、12)相反的端部处的一部分铁磁材料；圆柱形的插入引导件(20)，该插入引导件与前述内部夹(10)装配在一起，并包括去除内部夹(10)的机构；和至少一个装置(30)，在施加电磁场的情况下允许对内部夹(10)进行遥控牵引，所述电磁场施加在前述铁磁材料部分上。

Description

用于微创外科手术的引导和遥控牵引系统
技术领域
本发明涉及一种用于微创外科手术或腔内外科手术的引导和遥控牵引系统，所述系统容易操纵、定位、钩住和使用，它减少了进行外科手术处理过程所需的切口数目。特别是，本发明涉及一种用于微创外科手术或腔内外科手术的引导和遥控牵引系统，它很容易定位和钩住，该系统包括：可分离的外科手术内部夹(endoclamp)；可分离和自封闭的引入引导件，该引入引导件与所述外科手术内部夹装配在一起；以及遥控磁性牵引装置，用于所述内部夹。
背景技术
外科手术处于持续的变化和发展中。当前，外科手术处理过程和技术的方向是使得进行的外科手术对于患者的损伤尽可能最小。应用的概念是对于个人获得优点，例如更低疼痛、更低的术后恢复时间、住院治疗缩短、与处理过程相关联的并发症更少、以及更好的美容结果，这使得患者有更好的生活质量，并节省健康保险系统。在这种想法下，发展了内窥镜的或微创的外科手术，它能够通过在患者体内的较小切口来进行外科手术介入，因此避免开放式外科手术的较大切口和较高代谢值(metabolic cost)。
在美国专利No.7169104中公开了一种解决这种需要的方案，该美国专利No.7169104的公开日为2004年3月18日，它公开了一种遥控引导锚固系统，该遥控引导锚固系统包括：钩装置，该钩装置钩在患者体内的身体部分上；磁性夹，该磁性夹由磁性材料制成，它与钩装置连接；以及位于患者身体外部的磁性装置，用于引导该夹，该磁性装置产生磁场，以便使得所述磁性夹运动。如该文献和它的附图所示，在该文献中的发明需要第二夹，以便关闭磁性夹或者使得该夹钩在锚固系统上。前面的方案涉及用于消化内窥镜的方案，它很难用于腹腔镜的外科手术中，因为用于夹和它的牵引系统的装配方案很难在体腔内部进行。
发明内容
技术问题
这些外科手术的技术需要进入个人体内的入口点，该入口点需要进行全壁切口(total wall incision)，并通常插入工作套针(或者口)。所需的元件通过这些入口引入，这些元件为光学装置(用于内部可视化的照相机)和外科手术工具(例如夹子、电解剖刀、剪刀等)。在这种外科手术中，需要分开和提高周围器官或组织，用于更清洁和更有效的外科手术结果。通常，这样的分开和提高通过使用夹子或钩装置来进行，这些夹子或钩装置通过工作口从外部被直接操纵。
这些工作口是必须在个人的体壁中执行的切口点，并具有与全厚度体壁切口相关联的危险和并发症，主要是：严重的术后疼痛、术中和术后的出血危险、感染危险和随后形成疝气的危险。所有这些并发症降低了患者的生活质量，并增加了健康保险的成本。另外，还有重要的美学问题，因为这些切口必然随后留下作为后果的疤痕。因此，需要使用尽可能最少数目的切口来执行所需的外科手术处理过程，从而降低术中和术后的并发症，并因此获得最佳的术后结果。
解决问题的技术方案
本发明解决了使得内部夹定位和有效钩住要被拉动的器官或组织以及使得组件容易使用的问题，因为本发明包括由引入引导件驱动的自关闭内部夹。随后，该内部夹通过使用遥控牵引装置穿过体壁施加磁力而运动。
本发明的有益效果
本发明涉及一种用于微创外科手术的引导和遥控牵引系统，它容易定位和钩住，且损伤较小，因为它能够避免现有技术产生的一个或多个切口，这给患者带来益处。这能够明显减少患者的恢复时间，消除与切口相关联的潜在危险，并避免不希望的疤痕。而且，本发明提出一种引导和遥控牵引系统，它包括钩住机构，该钩住机构钩住要处理的器官或组织，它将容易和安全地操作，这便于由医生使用。因此，本发明很有利，因为它减少用于进行外科手术的切口数目，并容易使用。本发明解决定位和有效钩住要被拉动的器官的问题，从而能够在对患者的损伤较小的情况下很容易地使用和进行外科手术。
附图说明
图1是根据现有技术的微创外科手术的示意图，特别是腹腔镜胆囊切除术。
图2是使用根据本发明的、具有遥控牵引装置的引导系统进行的微创外科手术的示意图。可以看见，进入点的数目减少。
图3是本发明的引导系统和遥控牵引装置在初始结构中的示意图，该引导系统和遥控牵引装置包括引入引导件和装配的打开夹。
图4是本发明的引导系统和遥控牵引装置在分开位置中的另一示意图，其中具有关闭夹。
图5是处于牵引操作位置的、与引入引导件分开的内部夹的示意图。
图6表示由根据本发明的遥控牵引装置产生的、作为距离的函数的磁场密度的曲线图。
图7表示由根据本发明的遥控牵引装置在内部夹上产生的、作为距离的函数的磁场力的曲线图。
图8表示具有稀土磁体的牵引装置的磁感应强度与由所述磁感应强度、根据本发明的所述牵引装置和所述内部夹在内部夹上产生的力的关系的曲线图。
图9表示作为在根据本发明的牵引装置的电磁体上的电压的函数的磁感应强度的曲线图。
具体实施方式
本发明涉及一种用于在体腔中进行微创外科手术的引导和遥控牵引系统，它很容易地定位和钩住，并引起较小损伤，该系统包括：
至少一个内部夹，该内部夹具有外科手术钩装置，该外科手术钩装置与引导件装配在一起，并处于初始打开位置；当通过分开机构而与所述引导件分开时处于自然关闭位置；所述内部夹包括在与所述钩装置相反的端部处的一部分铁磁材料；
圆柱形的引入引导件，该引入引导件与所述可分开的外科手术内部夹装配在一起，所述引导件包括用于分开所述内部夹的机构；
至少一个遥控牵引装置，用于所述至少一个内部夹，通过从所述体腔的外部在所述内部夹的铁磁部分上面施加电磁场而产生作用。
如图1中所示，微创腹腔镜类的外科手术通过现有技术的手段来进行，在这种情况下，在腹壁中产生4个切口，以便布置套针，其中，1个套针a用于插入内窥镜照相机，3个套针b、c和d用于通过钩装置(例如普通的腹腔镜夹)来升高、操纵和切开要治疗的器官，例如胆囊v。
与图1不同，图2表示使用本发明的引导系统和遥控牵引装置进行的微创外科手术，其中，可以看见，在腹壁中只形成一个切口，用于仅仅一个套针a，一个或多个夹p通过该套针而引入，该夹由一个或多个磁体或电磁体e来驱动，以便操纵器官v；用于观察微创外科手术的内窥镜照相机以及用于剖开和随后取出组织或切割的元件也通过该相同套针引入。
如图3中所示，一种引导和遥控牵引系统用于体腔内的微创外科手术，它容易定位和钩住，并引起较小损伤，该系统包括：引入引导件20，该引入引导件20与可分开的外科手术内部夹10装配在一起；以及所述内部夹10的遥控牵引装置30，以便通过从所述体腔外部在所述夹的端部上面施加磁场而使得所述内部夹运动，所述磁场例如电磁体。
所述内部夹10包括两个分离件，这两个分离件基本在它的中心可绕轴线11旋转，各所述分离件限定钩住端12和操作端13，该操作端13具有径向弹簧(图中未示出)，该径向弹簧使得内部夹10保持在它的自然关闭位置。第一操作端13与凸起14连接，该凸起14与直径比该凸起14宽的圆柱形抵靠装置15连接，所述抵靠装置15延伸至锚固装置16，该锚固装置16被引入该引导件20内部；其中，抵靠装置15和锚固装置16包括由铁磁材料制造的部分，铁磁材料例如为铁、镍、钴、氧化铁等。
所述引入引导件20的所述分开机构包括固定环21，该固定环21与基本为杆形的连接件22的第一端连接，所述连接件22穿过引导管23的内部，所述引导管23在一端处与内部夹10的锚固装置16连接，在另一端处与用于分开所述内部夹10的分开设备24连接；所述连接件22在它的第二端处与开锁件28连接，该开锁件28与固定在分开设备24的后壁25上的拉伸弹簧26连接；所述开锁件28具有孔眼，销29穿过该孔眼。所述销29在它的端部处固定在促动器27上，该促动器27可绕中心轴线27a旋转，该促动器27限定操作端27b和促动器端27c。
在初始位置中，所述可旋转的促动器27处于第一位置，其中，操作端27b比促动器端27c更靠近开锁设备24，该促动器端27c远离开锁设备24；销29穿过开锁件28的孔眼，开锁件定位在离后壁25比自然的弹簧长度26更长的距离处，以便在它的第一位置中使得弹簧保持拉伸。在这样的初始位置，连接件22使得固定环21保持环绕和连接操作端13，以便使得内部夹10保持打开，即具有分开的钩住端12。
当通过安装在进行微创外科手术的体腔中的套针来引入装配有内部夹10的引入引导件20时，引入引导件20和内部夹10能够通过所述套针而被引导、引入和对齐地驱动。当内部夹10处于它的初始位置时，内部夹打开和被导向要治疗的器官或组织v。当内部夹10正确地布置在器官或组织v处时，内部夹处于如图4中所示的开锁位置，该开锁位置通过按压促动器端27c以便从开锁件28的孔眼中取出销29而实现；这样，施加在弹簧26上的限制被释放，弹簧返回它的自然位置，从而将开锁件28和后壁25聚集，并通过连接件22而将固定环21从内部夹10上取下。然后，内部夹10被释放至它的自然位置，钩住端12关闭，从而捕获器官或组织v。
如图5中所示，当内部夹10固定在器官或组织v上时，引入引导件20从套针中取出，该引入引导件能够用于将另一元件引入体腔内；而且，内部夹10被带动靠近遥控牵引装置30附近的体腔壁50，并且磁场被激发，以便使得所述内部夹10由所述遥控牵引装置30吸引，并使得它的抵靠装置15和钩装置16朝着体腔壁50的内侧定向。这样，遥控牵引装置30能够从体腔的外部遥控地引导和定位内部夹10。
然后，以前述方式，体腔内的器官或组织能够通过重复所述步骤而由一个或多个内部夹来操纵。器官保持位于最佳位置，以便通过安装单个套针的仅一个切口实现相应的外科手术介入。
由于所述内部夹的一个或多个遥控牵引装置，通过从所述体腔外部在所述内部夹的铁磁部分上面施加电磁场，所述一个或多个内部夹保持固定在它们的位置，或者能够沿体腔运动。
优选地，所述遥控牵引装置在所述牵引装置的周围产生磁感应强度范围从0.1至1特斯拉(1000至10000高斯)的电磁场，以便在离腹壁距离为10至30mm范围内在本发明内部夹上产生范围为2.94至4.9N(300至500克力)的力；当肥胖时达到高达80mm的体壁宽度。因此，所述遥控牵引装置包括永磁体，例如磁化钢或铝镍钴合金(包括24％重量的钴、8％重量的铝、14％重量的镍、51％重量的铁和3％重量的铜的合金)、或者铁氧体(80％重量的氧化铁和20％重量的氧化锶)磁体。
更优选地，所述牵引装置包括稀土矿磁体，例如：RE-M5和RE2M17类型，其中，“RE”是钐(Sm)、钷(Pr)和钕(Nd)，“M”是钴(Co)与金属例如铁(Fe)、铜(Cu)、锆(Zr)、钛(Ti)、铪(Hf)和锰(Mn)的合金，例如，由Schenectady，Nueva York的GE Research Lab(EEUU)制造的SmCo5或者由Sumitomo(日本)和General Motors(EEUU)在1983年开发的“钕-铁-硼”，Nd2Fe14B。
本发明实施例
根据本发明的另一优选实施例，所述遥控牵引装置能够包括电磁体和电压调节器，以便通过改变在电磁体上的电压来改变产生的磁感应强度。优选地，所述电磁体在所述牵引装置的周围产生磁感应强度范围为从0.1至1特斯拉(1000至10000高斯)的电磁场，以便在距离为10至30mm范围内在本发明内部夹上产生所需的力。
根据本发明的另一优选实施例，所述遥控牵引装置能够包括电磁体和电流调节器，以便通过改变在电磁体上的电流强度来改变产生的磁感应强度，根据本发明，所述磁感应强度范围从0.1至1特斯拉(1000至10000高斯)。
根据本发明的一个实施例，所述电磁体能够包括顺磁材料芯，该顺磁材料芯包括以下材料中的一种或多种：空气、铝、镁、钛、氯化铁和钨。
根据本发明的另一实施例，所述电磁体能够包括铁磁材料芯，该铁磁材料芯包括以下材料中的一种或多种：铁、镍、钴、铝、铁-硅或者铝镍钴合金和坡莫合金，该坡莫合金包括20％重量的钢和80％重量的镍。
在本发明的第一示例中，图6表示由根据本发明的、包括稀土磁体的遥控牵引装置产生的、作为距离的函数的磁场密度的曲线图。图7表示由根据本发明的所述遥控牵引装置在内部夹上面产生的、作为距离的函数的磁场力的曲线图。由图7可见，特性化磁体曲线能够使用公式(a)F＝5.3757e-0.0967d来插值，其中，用R2＝0.9897进行二次拟合(quadratic fit)，F是在内部夹上面产生的力(单位N)，d是在遥控牵引装置和内部夹之间的距离(单位mm)；具有这些特征的磁体能够根据体腔的宽度需要和要由该第一示例的内部夹操纵的器官而在11mm的距离处产生1.76N(180克力)。
根据患者体腔的厚度和要操纵的器官的重量，在第二示例中，可能需要2.94N(300克力)以便通过20mm的体腔来保持和操纵器官。由于图7和公式(a)，新的特性曲线能够很容易地插值产生：2.94＝5.3757e-0.0967＊20+B；因此，B＝2.1628，形成的公式为：(b)F＝5.3757e-0.0967＊d+2.1628；其中，对于0mm距离，所述磁体必须在所述内部夹上面产生7.5385N(739克力)的力。
图8表示稀土磁体的磁感应强度和在根据本发明的内部夹上面产生的力的关系的曲线图，其中有公式：(c)B＝0.0917＊F0.66，其中，用R2＝0.9915进行二次拟合，其中，F是力(单位为牛顿)，B是磁感应强度(单位为特斯拉)；对于该第二示例，根据本发明的遥控牵引装置所需的磁体的尺寸应当设置成用于0.3478特斯拉(3478高斯)的磁感应强度。
根据本发明的另一优选实施例，所述遥控牵引装置能够包括电磁体和电压调节器，以便通过改变在电磁体上的电压来改变产生的磁感应强度。图9表示作为在电磁体上面的电压的函数的磁感应强度的曲线图，其中电流I为2A；通路长度为8.3cm；螺线数(spire number)为4.245；冷叠层钢芯的直径为10mm，磁导率为1.99。图9的所述曲线图能够获得由公式(d)B＝0.1621＊V0.5018表示的特性电磁体曲线，其中，具有R2＝0.9956进行的二次拟合，其中，B是在离电磁体距离为0mm处的磁感应强度(单位为特斯拉)，V是施加在所述电磁体上面的电压(单位为伏特)。
对于前述示例，当必须通过20mm的体壁在根据本发明的内部夹上面产生2.94N(300克力)的力时，应当在0mm的距离处产生0.3478特斯拉(3478高斯)的磁感应强度，因此，根据图9的曲线图和使用公式(d)，所需的电压为V＝(0.3478/0.1621)1/0.5018＝4.58伏特。因此，所述牵引装置的电压调节器必须被调节，以便获得推导出的4.58伏特的电压。这样，包括电磁体以及电压调节器或电流调节器的牵引装置能够被调节成在内部夹上面施加最小必需力，以便将它牢固保持在抵靠体腔的位置，而不会在外科手术中施加可能损坏体腔的组织和其它器官的过大力。
工业实用性
本发明在微创外科手术或腔内外科手术工具的制造业中具有工业实用性。本发明特别有利于视频腹腔镜胆囊切除术，但是并不局限于该使用过程。

Claims (13)

1.一种用于在体腔中的微创外科手术的引导和遥控牵引系统，所述引导和遥控牵引系统容易被定位和钩住，并产生较小损伤，所述引导和遥控牵引系统包括：
至少一个可分开的外科手术内部夹(10)，所述外科手术内部夹具有钩装置(11、12)，所述钩装置与引入引导件(20)装配在一起并处于初始打开位置；当通过分开机构而与所述引入引导件(20)分开时处于自然关闭位置；所述内部夹(10)包括位于与所述钩装置(11、12)相对的端部处的由铁磁材料制成的部分；
圆柱形的引入引导件(20)，所述引入引导件与所述可分开的外科手术内部夹(10)装配在一起，所述引入引导件(20)包括用于分开所述内部夹(10)的分开机构；
用于所述内部夹(10)的至少一个遥控牵引装置(30)，通过在所述内部夹(10)的铁磁部分上面施加电磁场而产生作用。
2.根据权利要求1所述的引导和遥控牵引系统，其中：所述内部夹(10)包括：
两个分离件，所述两个分离件基本在所述内部夹的中心绕轴线(11)可旋转，所述分离件的每一个都限定钩住端(12)和操作端(13)，所述操作端(13)具有将内部夹(10)保持在它的自然关闭位置的径向弹簧；其中，所述操作端(13)与凸起(14)连接，所述凸起(14)与直径比所述凸起(14)大的圆柱形的抵靠装置(15)联接，所述抵靠装置(15)延伸到被引入所述引入引导件(20)的内部的锚固装置(16)；其中，抵靠装置(15)和锚固装置(16)包括由铁磁材料制造的部分。
3.根据权利要求2所述的引导和遥控牵引系统，其中：所述铁磁材料包括铁、镍、钴和氧化铁。
4.根据权利要求1所述的引导和遥控牵引系统，其中：将所述内部夹(10)与所述引入引导件(20)分开的所述分开机构包括：
固定环(21)，所述固定环(21)与基本为杆形的连接件(22)的第一端连接；
所述连接件(22)穿过引导管(23)的内部；
所述引导管(23)在一端与内部夹(10)的钩装置(16)连接，在另一端与用于分开所述内部夹(10)的分开设备(24)连接；
所述连接件(22)在它的第二端处与开锁件(28)连接，所述开锁件(28)与固定在分开设备(24)的后壁(25)上的拉伸弹簧(26)连接；
所述开锁件(28)具有孔眼，销(29)穿过所述孔眼；以及
所述销(29)在它的端部处固定在促动器(27)上，所述促动器(27)绕中心轴线(27a)可旋转，所述促动器(27)限定操作端(27b)和促动器端(27c)；其中，按压促动器端(27c)以便从开锁件(28)的孔眼中取出销(29)将释放施加在拉伸弹簧(26)上的限制，所述拉伸弹簧(26)返回它的自然位置，从而将开锁件(28)和后壁(25)带动到一起，并通过连接件(22)将固定环(21)从内部夹(10)上取下，从而将内部夹(10)释放至它的自然关闭位置。
5.根据权利要求1所述的引导和遥控牵引系统，其中：所述遥控牵引装置(30)具有磁场，所述磁场在所述遥控牵引装置(30)的周围具有范围在0.1至1特斯拉(1000至10000高斯)的磁感应强度。
6.根据权利要求5所述的引导和遥控牵引系统，其中：所述遥控牵引装置包括一个或多个永磁体。
7.根据权利要求6所述的引导和遥控牵引系统，其中：所述永磁体中的一个或多个由磁化钢制成。
8.根据权利要求6所述的引导和遥控牵引系统，其中：所述永磁体中的一个或多个由铝镍钴合金制成。
9.根据权利要求6所述的引导和遥控牵引系统，其中：所述永磁体中的一个或多个由铁氧体制成。
10.根据权利要求5所述的引导和遥控牵引系统，其中：所述遥控牵引装置包括一个或多个稀土磁体。
11.根据权利要求10所述的引导和遥控牵引系统，其中：所述稀土磁体能够包括以下元素中的一种或多种：钐、钷和钕。
12.根据权利要求5所述的引导和遥控牵引系统，其中：所述遥控牵引装置(30)包括电磁体和电压调节器，以便通过改变施加在电磁体上的电压来改变产生的磁感应强度，从而获得范围从0.1至1特斯拉(1000至10000高斯)的、所述遥控牵引装置的磁场。
13.根据权利要求5所述的引导和遥控牵引系统，其中：所述遥控牵引装置(30)能够包括电磁体和电流调节器，以便通过改变施加在电磁体上的电流来改变产生的磁感应强度，从而获得范围从0.1至1特斯拉(1000至10000高斯)的、所述遥控牵引装置的磁场。
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US20110295067A1 (en) 2011-12-01
US20140336470A1 (en) 2014-11-13
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US9974546B2 (en) 2018-05-22
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US8790245B2 (en) 2014-07-29
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IL214495A (en) 2013-10-31

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