Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
  • A61B2017/00287—Bags for minimally invasive surgery

Definitions

• the invention relates to a device for removing material from the abdominal cavity in endoscopic surgery.
• tissue samples or pathological tissue very often have to be removed from the abdominal cavity.
• the usual method is suctioning, if necessary with prior shredding of the tissue, or removal as a whole using a grasping forceps through a trocar sleeve.
• a grasping forceps through a trocar sleeve.
• kornr ⁇ t that crushing is very tedious and time-consuming.
• the object of the present invention is to create a device with which tissue to be removed safely in the abdominal cavity can be collected and removed from the abdominal cavity.
• this object is achieved by a device which is characterized in that it comprises a bag made of tear-resistant elastic material with an elongated extension piece for pulling the bag out of the abdominal cavity.
• the invention therefore relates to a device for removing material from the abdominal cavity in endoscopic surgery, characterized in that it comprises a pouch made of tear-resistant elastic material with a nem elongated extension for pulling the bag out of the abdomen.
• the attachment piece firmly connected to the bag is designed as a tab, but preferably as a rod or tube.
• the length of the extension piece is dimensioned such that all parts of the abdominal cavity can be reached and the extension piece protrudes proximally from the abdominal cavity to a sufficient length for the surgeon. Allow manipulation.
• the extension piece accordingly has a length of 30 to 60 cm, preferably about 40 to 50 cm. If the attachment piece is designed as a rod or tube, the attachment piece preferably extends into the bag, the part of the attachment piece projecting into the bag also being at least partially non-detachably connected to it. In a special embodiment, the tubular or rod-shaped extension piece extends to the bottom of the bag.
• the diameter of the tubular or rod-shaped attachment piece corresponds to the diameter as is customary in devices for endoscopic surgery and is generally 2 to 5, preferably 2.5 to 3.5 mm.
• the bag is designed like a bag, i.e. it has an essentially rectangular cross section.
• the bottom of the bag can also be hemispherical.
• the bag is essentially like a lace bag, i.e. essentially tapered towards the bottom. Bags with an upper edge that runs obliquely downward from the attachment piece are particularly preferred.
• the capacity of the bag is adapted to the intended purpose and is, for example, between 20 and 300 ml, preferably 40 to 150 ml.
• the bag is preferably designed to be closable.
• the bag is expediently closed by means of a pull thread which runs in a tunnel passage at the upper edge of the bag.
• the bag can be closed by pulling on the two free ends of the pull thread.
• the pull thread is preferably so long that its free ends extend at least to the proximal end of the extension piece, so that the surgeon holds the pouch by pulling on the two free ends of the pull thread. It is also possible to fix one end of the pull thread on the attachment piece at the level of the bag edge. In this case the bag can be closed by pulling the other free end.
• the drawstring has a stiffness, at least in the area that is located in the tunnel passage of the upper bag edge, which keeps the upper bag edge open as long as tension is not exerted on the free or free ends of the drawstring.
• the upper edge of the bag can be reinforced so that the bag opening is open in the rest position.
• this can have one or two longitudinal grooves in which the free end or ends of the pull thread are guided to the proximal end of the extension piece.
• the free ends of the pull thread can be guided in the inner lumen of the extension piece.
• a tubular or tubular sleeve pushed over the extension piece can be pulled, which extends to just before the upper edge of the bag.
• the device according to the invention is produced from the materials customary in medical technology, material which is as tear-resistant as possible should be used for the bag and the pull thread.
• the tubular or rod-shaped extension piece is made of plastic or metal, plastic being preferred.
• the tension thread can also be designed as a plastic-coated wire strand.
• a relatively large-lumen trocar sleeve is usually inserted into the abdominal wall at the beginning.
• This first trocar sleeve has a valve slide in the area of the proximal end, which can be opened, for example, by actuating a lateral pressure plate against a return spring.
• This lockable first trocar sleeve introduces the devices required during the operation.
• the required device for example a grasping forceps, is inserted into a second trocar sleeve, the outside diameter of which is adapted to the inside diameter of the first trocar sleeve in such a way that a sealing effect is achieved.
• the second trocar sleeve has a connection piece at the proximal end, onto which a sealing cap with a central passage can be inserted. From a standard set of sealing caps, the one is selected whose central passage sealingly surrounds the trunk of the device to be inserted, without being displaceable to hinder too much.
• the device according to the invention in which the attachment piece of the bag is designed as a tab, can be introduced into the abdominal cavity by pulling the bag over one end of a rod or tube.
• the proximal end of the rod or tube, together with the proximal end of the tab and optionally the free ends of the pull thread, is inserted so far through the distal end of a second trocar sleeve mentioned above. until the bag is completely inside the second trocar sleeve.
• a suitable sealing cap is then pulled from the proximal end over the rod or the tube and the tab and placed on the proximal connecting piece.
• the second trocar sleeve is now inserted into the first trocar sleeve that is already running through the abdominal wall.
• the tube or rod can now be moved distally to bring the bag into the desired position.
• the bag can now be unfolded, as long as the bag does not unfold automatically due to material-related restoring forces, for example with the aid of a grasping forceps inserted into the abdominal cavity through a second access or can be unwound from the end of the insertion rod.
• the bag is optionally closed via the pull thread and pulled on the tab-shaped extension piece against the distal end of the second trocar sleeve. If the degree of filling of the bag allows it, it is pulled into the second trocar sleeve and removed together with this from the abdominal cavity. If there is no space in the second trocar sleeve, the two trocar sleeves are pulled out of the surgical incision together with the bag.
• the incision can be expanded accordingly.
• the bag that is still in the abdominal cavity can be emptied from the outside by removing the contents in portions, if necessary after prior mechanical comminution, until the bag has been removed can be removed through the surgical incision.
• the contents of the bag consist, for example, of a voluminous, liquid-containing cyst, this can be pierced and the outflowing liquid can be suctioned off and then the non-liquid part of the bag contents can be crushed if necessary.
• connection piece for example a Luer lock attachment
• a connection piece can be plugged onto the proximal end if necessary, to which e.g. a suction device can be connected.
• the connecting piece can be closed with a sealing cap.
• distal examiners are to be understood as proximally and near proximally.
• Fig. 5 shows a cross section through an embodiment
• FIG. 1 shows the simplest embodiment of a device according to the invention. It consists of a sack-like bag 1 on the upper edge of which an attachment piece 3 in the form of an elongated tab 3a is attached.
• FIG. 2 shows an embodiment in which the bag 1 tapers conically towards its base 7 and thus has a quiver-like shape.
• the distal end of an extension piece 3 designed as a rod 3b projects firmly into the interior of the bag 1.
• the extension piece 3 is designed as a tube 3c.
• the tube 3c extends to the bottom 7 of the bag 1 and has lateral openings 8 in the region of its distal end projecting into the bag 1.
• the upper end of the bag 1 has a so-called drawstring 4, ie the upper edge of the bag 1 is formed as a hemstitch in which a drawstring 5 runs.
• the opening of the bag 1 can be closed by exerting tension on the free ends of the tension thread.
• the two free ends of the pull thread 5 are guided distally along the rod 3c, rod 3c and the two free ends of the pull thread 5 being partially surrounded by a tubular sleeve 10a.
• the bag 1 is folded around the distal end of the tube 3c projecting into the bag 1. Its opening 2 is closed by tension on the free ends of the tension thread 5 running in the tunnel passage 4. The free ends of the pull thread 5 run proximally along the tubular extension 3c.
• a tubular sleeve 10b encloses the tubular extension 3c and the free ends of the pull thread 5 approximately from above the upper edge of the bag 1. The tubular extension 3c and the free ends of the pull thread 5 protrude proximally out of the tubular sleeve 10b, that there is sufficient space for manipulation of the tubular extension 3c and the pull thread 5.
• the device according to the invention can be inserted into the abdominal cavity of the patient through a conventional trocar sleeve (not shown).
• a conventional trocar sleeve (not shown).
• a Luer-Lock approach can be attached in order to provide connection options, e.g. with a suction device.
• a cap can be provided.
• FIG. 5 shows a schematic cross section through a device according to the invention along the line V in FIG. 4.
• the free ends of the pull thread 5 lie here in longitudinal grooves 6 of the tubular extension piece 3c running in the tubular sleeve 10b.
• FIG. 6 schematically shows the use of a device according to the invention in an endoscopic operation.
• a second trocar sleeve 15 is inserted from the proximal end into a first trocar sleeve 14 which is guided through the abdominal wall 13 and has a valve slide 16 which can be actuated via a pressure plate 17.
• a connector 18 with attached Sealing cap 19 at the proximal end of the second trocar sleeve 15 extends the rod-shaped extension piece 3b and the free ends of the pull thread 5 of a device according to the invention.
• the rod-shaped connecting piece 3b is surrounded above the bag 1 by a tube-like sleeve 10a, in which the two ends of the pull thread 5 drawn through the drawstring 4 of the bag 1 also run.
• the rod-shaped connecting piece 3b has already been displaced so far distally into the second trocar sleeve 15 that the pouch 1 located inside the second trocar sleeve 15 when the second trocar sleeve 15 is inserted into the first trocar sleeve 15 can be unfolded freely and thus for the reception of to be removed Material is ready.
• the bag 1 After the bag 1 has been filled, it can be closed by pulling on the ends of the pull thread 5 held together by a clamping sleeve 20.
• FIG. 7 schematically shows the distal part of a device according to the invention, after bag 1 was filled with tissue parts 11 and liquid material 12 in the course of a laparoscopic procedure and the rod-shaped extension piece 3b was then moved proximally until the opening 2 of the bag 1 comes to lie outside the abdominal wall 13. After opening the opening 2 of the bag 1 by releasing the tension thread 5, the contents of the bag can now be removed. Non-extractable parts are e.g. removed with the aid of suitable pliers, if necessary after prior comminution.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Heart & Thoracic Surgery (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (2)

Publications (1)

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ID=6864257

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Family Applications After (1)

Country Status (3)

Families Citing this family (19)

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• 1991
  • 1991-02-14 DE DE9101684U patent/DE9101684U1/de not_active Expired - Lifetime
• 1992
  • 1992-02-13 EP EP19920904025 patent/EP0571428A1/de not_active Withdrawn
  • 1992-02-13 WO PCT/EP1992/000315 patent/WO1992014407A1/de not_active Application Discontinuation
  • 1992-02-13 EP EP92102395A patent/EP0499243A1/de active Pending

Non-Patent Citations (1)

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