DE29822955U1 - Rod instrument for laparoscopic surgery - Google Patents

Description

Erik Weise 16.12.1998

Bochumer Strasse 2
10555 Berlin

Rod instrument for laparoscopic surgery

The invention relates to a rod instrument for laparoscopic surgery, in particular for use in the minimally invasive surgical treatment of gastroesophageal reflux disease.

Some people may experience chronic reflux of acidic gastric juice from the stomach into the esophagus, which exceeds the normal level. One of the causes of this condition is considered to be insufficiency of the lower esophageal sphincter (LES).

The constant reflux of gastric juice can have pathological consequences, such as so-called reflux esophagitis. The patient then suffers from restosteral pain and constant heartburn, especially when lying down. In addition to conservative treatment methods using proton pump inhibitors, etc., there is the possibility of surgical treatment. This would be indicated, for example, in cases that are resistant to drug therapy.

The basis of the surgical treatment is the reinforcement of the gastroesophageal junction. To do this, a small part of the stomach (gastric fundus part) is placed in a cuff-like manner around the junction in question and fixed in place to reinforce the lower esophageal sphincter in this area. This surgical procedure is called fundoplication. Depending on the school, the cuff is placed circularly (360°) or hemicircularly (180°). The latter is called hemifundoplication.

For some time now, it has been possible to perform this operation using laparoscopic techniques, i.e. using the so-called minimally invasive surgical technique (MIC).

In the context of such a laparoscopic operation, it is particularly important to set up the operation site in such a way that trouble-free preparation and operation with the laparoscopic instruments is possible. Typical problem with

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The liver, especially the left lobe, is used to set up the surgical site for a fundoplication operation. For anatomical reasons, this is located directly above the working or surgical field to be prepared, i.e. above the gastroesophageal junction when the patient is lying down.

At the beginning of the free preparation, the left lobe of the liver, the size of which naturally varies from individual to individual, must be pushed out of the site in such a way that not only access to the actual surgical area is guaranteed, but also a clear view via laparoscope over the entire duration of the operation.

There are now two ways to achieve this goal:

1. A retractor ("black hand") is inserted through a working trocar (10 mm skin incision). This allows the left lobe of the liver to be kept out of the surgical field without damaging the tissue. However, an assistant's hand is required throughout the entire operation, as the retractor cannot be fixed intra-abdominally and must therefore be kept in position at all times. This means that in addition to the surgeon, a total of 2 assistants are required for the operation.

2. A "sharp clamp" is inserted through a working trocar (5mm skin incision) and passed underneath the left lobe of the liver. It is clamped to the diaphragm in such a way that the left lobe of the liver is held out of the surgical field by the rod of the clamp.

However, the clamp must be positioned very precisely. Because the liver lobe only has the tube of the rod clamp as a support surface, which only has a diameter of about 5 millimeters, it is rarely possible to hold the liver satisfactorily for the entire duration of the operation. Frequent adjustments to the clamp position can therefore easily lead to liver injuries, and with a very large left liver lobe, this technique is not possible.

The invention is based on the object of designing a rod instrument of the type mentioned above in such a way that a satisfactory, tissue-protecting retraction of the liver and thus an optimal situs adjustment over the entire duration of the operation is achieved.

This object is achieved according to the invention with the features specified in the characterizing part of claim 1. The further development of the subject matter of the invention emerges from the features of the subclaims.

The inventive combination of "sharp clamp" and retractor represents an ideal solution for the operation described above, i.e. the reinforcement of the gastro-esophageal junction, in terms of optimal situs adjustment.

A significant advantage of the invention is that there is no need to hold the rod instrument by hand, as it is clamped and thus fixed. This leaves a "valuable" assistant's hand free for other tasks. Another advantage is that even with a large liver, tissue-sparing liver evacuation is possible without any problems using the variable-size "palm" of the retraklor.

The optimal surgical site setting that can be achieved with the subject matter of the invention ensures safe, rapid and cost-effective surgery.

An embodiment of the invention is shown in the drawing and is described below using a figure which is a more basic representation of the bar instrument.

The rod instrument consists of a combination of a "sharp" or "semi-sharp" rod clamp 1, 1' with a retractor 2, 2', i.e. with a so-called "black hand", which has fingers 3 that can be spread out like a fan, which can be moved out of a longitudinal opening in the cylindrical casing tube 4 of the instrument and can be tilted together in a known manner.

In order to be able to change the distance between the clamp 5 and the fingers 3, the fingers 3 can be moved together over a range of the instrument's longitudinal axis.

To avoid damage to the liver, which is held back by the fingers 3, the fingers are enclosed in a single elastic pouch (not shown).

Claims (4)

-4- Protection claims 1. Rod instrument for laparoscopic surgery, in particular for use in minimally invasive surgical therapy of gastroesophageal reflux disease, characterized by the combination of a "sharp" or "semi-sharp" rod clamp (1,1') with a retractor (2, 2'), ie with a so-called "black hand" which has fingers (3) which can be spread out like a fan. 2. Rod instrument according to claim 1, characterized in that the fingers (3) of the retractor (2, 2') can be moved out of a longitudinal opening of the cylindrical casing tube (4) of the instrument and can be tilted together in a known manner. 3. Bar instrument according to claim 1 or 2, characterized in that the fingers (3) can be moved together over a region of the instrument's longitudinal axis. 4. Stick instrument according to one of the preceding claims, characterized in that the fingers (3) are enclosed by a single elastic bag.