EP0579674A1 - Expanseur de la cavite abdominale - Google Patents

Expanseur de la cavite abdominale

Info

Publication number
EP0579674A1
EP0579674A1 EP92908195A EP92908195A EP0579674A1 EP 0579674 A1 EP0579674 A1 EP 0579674A1 EP 92908195 A EP92908195 A EP 92908195A EP 92908195 A EP92908195 A EP 92908195A EP 0579674 A1 EP0579674 A1 EP 0579674A1
Authority
EP
European Patent Office
Prior art keywords
rod
abdominal cavity
expander according
expander
cavity expander
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP92908195A
Other languages
German (de)
English (en)
Inventor
Kurt Semm
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Wisap Gesellschaft fuer Wissenschaftlichen Apparatebau mbH
Original Assignee
Wisap Gesellschaft fuer Wissenschaftlichen Apparatebau mbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE9104383U external-priority patent/DE9104383U1/de
Application filed by Wisap Gesellschaft fuer Wissenschaftlichen Apparatebau mbH filed Critical Wisap Gesellschaft fuer Wissenschaftlichen Apparatebau mbH
Publication of EP0579674A1 publication Critical patent/EP0579674A1/fr
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0281—Abdominal wall lifters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/02—Devices for expanding tissue, e.g. skin tissue

Definitions

  • the invention relates to an instrument for expanding the pneumoperitoneum for endoscopy (abdominal cavity expander).
  • the pneumoperitoneum In endoscopic examinations and operations, especially in the abdominal area, the pneumoperitoneum is generally flooded with carbon dioxide so that the internal organs to be treated are easily accessible to the optics and the surgical instruments. In rare cases, the pneumoperitoneum can collapse, with the risk that the inserted surgical instruments will injure the internal organs when the abdominal wall descends.
  • an abdominal cavity expander for endoscopy which has a rod, at the proximal end of which at least one folding element is hinged between a first position aligned with the rod and a second position essentially directed transversely to the rod.
  • this rod In the first position, this rod can be inserted into the pneumoperitoneum directly or through a trocar sleeve through the patient's abdominal wall. If the rod is inserted so far that the folding element is completely in the pneu moperitoneum, it is folded out into its second position.
  • the abdominal cavity expander in an advantageous further development has an annular sealing plate which can be fixed axially in any position on the rod.
  • the sealing plate is formed on the proximal longitudinal end of a sleeve which surrounds the rod without play and which can be fixed to the rod by means of a radial clamping screw.
  • the abdominal wall is clamped between the folding element and the sealing plate, which reliably prevents the gas from escaping through the puncture point.
  • the exact fit between sleeve and rod is not necessary when using a ring seal.
  • the abdominal cavity expander can be designed in the manner of a folding anchor with a plurality of folding elements, for example in the manner of an expansion screen, the folding elements then preferably being arranged rotationally symmetrically around the rod.
  • the folding elements can be hinged to the rod at their proximal end.
  • an elongated folding element is articulated in the middle of the rod and forms a cylinder with the rod in the first position, which can be inserted through a trocar sleeve without any problems.
  • the end of the folding element which is proximal in the first position can taper to ensure that the abdominal wall is traumatized as little as possible during the puncture.
  • the longitudinal ends of the folding element are preferably rounded in order to avoid injuries.
  • the abdominal cavity expander can be introduced through an already inserted trocar sleeve.
  • the expander or elevator is advantageously perforated. This can be achieved, for example, by forming an air duct parallel to the axis of the expander, which connects the pneumoperitoneum to the ambient air.
  • a one-sided closing valve could also be arranged in the air duct, which only allows gas to pass in one direction. If this valve is rotatably arranged in the gas channel, it can be set for the expansion or collapse of the pneumoperitoneum are so that in the first case only gas, in particular air, can penetrate into the pneumoperitoneum and in the latter case only gas can escape from the pneumoperitoneum.
  • the perforated expander is usually inserted through a trocar sleeve, which can also be pulled when the folding element is inserted or expanded.
  • Another advantage of the perforated expander is the self-sucking effect when the abdominal wall is raised, so that air can flow into the intra-abdominal area from the outside. With the help of the expander, it is now relatively easy to inspect difficult topographic sites.
  • Figure 1 is a partially sectioned side view of a double-sided insertable abdominal cavity expander with a sealing plate.
  • Fig. 6 is a partially sectioned side view of a perforated expander.
  • the expander 10 consists of a rod 12, to the distal end 14 of which a hinged element 16 is articulated, which is aligned with the rod 12 in a first position (illustration) and, in a second position (FIGS. 3 to 5), is folded out transversely to the rod .
  • a sleeve 18 is slid onto the rod 12 and can be fixed to the rod by means of a radial clamping screw 20.
  • the sleeve 18 has at its distal end a sealing plate 22 which, after inserting the expander 10 into the pneumoperitoneum, unfolding the folding element 16 and expanding the pneumoperitoneum, is pressed against the abdominal wall in the proximal direction by pretensioning the expander 10 to avoid gas loss at the puncture site of the abdominal wall.
  • the sleeve 18 surrounds the rod 12 with as little play as possible and / or a seal is provided between the sleeve 18 and the rod 12.
  • This seal is advantageously designed as a ring seal made of known types of rubber or plastic.
  • the flap elements 12 of the two longitudinal ends 14 of the expander can preferably be folded in opposite directions or in the same direction. In contrast to the illustration, the diameters of the longitudinal ends can be different, for example 5 and 10 mm. A longitudinal end can be perforated in the manner described below.
  • the double-sided insertable expander can be easily held and replaced.
  • the mode of operation of the abdominal cavity expander 10 will be described below with reference to FIGS. 2 to 5. Parts identical to FIG. 1 are provided with identical reference numerals.
  • the expander 10 is inserted into the pneumoperitoneum 28 by means of a trocar sleeve 24 through the abdominal wall 26 of a patient (FIG. 2). Subsequently, the elongated folding element 16, which was previously aligned with the rod 12, is folded out into a second position which is transverse to the rod 12. In the present case, this is done with the help of another medical instrument that was introduced through a further trocar sleeve of the pneumoperitoneum.
  • a folding element can also be folded in and out by means of an actuating linkage guided in or on the rod or purely in terms of weight or spring preload.
  • the trocar sleeve 24 is first pulled out of the pneumoperitoneum in the proximal direction.
  • the expander is then also moved in the proximal direction (FIG. 4) until the folding element 16 lies against the inside of the abdominal wall 26 of the patient (FIG. 5). Now the expander is prestressed in the proximal direction, whereby the abdominal wall 26 is raised and the pneumoperitoneum 28 is inflated or expanded accordingly.
  • a proximal expander end with a different diameter or a different length of the folding element can also be formed on the expander, so that an expander can have different folding elements at its opposite ends.
  • the sealing plate 22 is pressed onto the outside of the abdominal wall 26 and fixed on the rod 12 by means of the clamping screw 20.
  • the sealing plate can preferably have a diameter of 50 mm, while a diameter of 5 or 10 mm is provided for the expander, for example.
  • 6 shows a perforated expander 30, which can be inserted on both sides, with an elongated rod-shaped body 32.
  • Axial channels 36 open into the longitudinal ends 34 of the rod 32, which provide pressure equalization between the pneumoperitoneum and a gas storage space located outside the pneumoperitoneum, for example the operating room Room or the ambient air. The negative pressure that occurs when the abdominal cavity expands is thus compensated for by this channel 36.
  • a valve 38 is arranged (screwed on) at the opening of the channel 36, which valve allows gas to pass through in one direction only.
  • the valve is rotatably arranged about an axis protruding from the plane of the drawing, so that the direction of passage can be reversed. In this way, it can be specifically controlled that gas can only pass in one direction.
  • the outlet of this valve 38 can be open or can be connected to a gas storage container with a defined pressure and / or a certain gas.
  • the expander can also be used to set a certain pressure in the pneumoperitoneum.
  • the expander or elevator which can be inserted or stretched on both sides, is applied through a trocar sleeve with a diameter of 5 mm or 10 mm. After the intra-abdominal application, the trocar sleeve can be removed.
  • the perforated expander sucks the air from the environment into the pneumoperitoneum, which is advantageous for techniques in which a CO pneumoperitoneum is not desired.

Landscapes

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

Abstract

L'expanseur de la cavité abdominale prévu pour l'endoscopie se compose d'une tige (12), dont l'extrémité distale (14) comporte au moins un élément pivotant (16) articulé entre une première position en alignement précis avec la tige et une seconde position orientée sensiblement transversalement à la tige. En outre, il est proposé que l'élément pivotant forme avec la tige, un cylindre correspondant au diamètre intérieur d'une gaine de trocart que l'élément pivotant soit maintenu dans une position par un ressort; qu'une plaque étanche en forme d'anneau (22) entourant la tige puisse y être fixée; que l'expanseur dispose à ses deux extrémités longitudinales d'un élément pivotant et qu'il comporte un canal axial (36) pour adapter un pneumopéritonie.
EP92908195A 1991-04-10 1992-04-09 Expanseur de la cavite abdominale Ceased EP0579674A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DE9104383U DE9104383U1 (de) 1991-04-10 1991-04-10 Abdominalhöhlenexpander
DE9104383U 1991-04-10
DE9106553U 1991-05-28
DE9106553U DE9106553U1 (de) 1991-04-10 1991-05-28 Abdominalhöhlenexpander

Publications (1)

Publication Number Publication Date
EP0579674A1 true EP0579674A1 (fr) 1994-01-26

Family

ID=25958059

Family Applications (1)

Application Number Title Priority Date Filing Date
EP92908195A Ceased EP0579674A1 (fr) 1991-04-10 1992-04-09 Expanseur de la cavite abdominale

Country Status (4)

Country Link
EP (1) EP0579674A1 (fr)
JP (1) JPH0761331B2 (fr)
DE (1) DE9106553U1 (fr)
WO (1) WO1992018056A1 (fr)

Families Citing this family (35)

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US5676636A (en) * 1994-07-22 1997-10-14 Origin Medsystems, Inc. Method for creating a mediastinal working space
US5505689A (en) * 1991-05-29 1996-04-09 Origin Medsystems, Inc. Propertioneal mechanical retraction apparatus
US5836871A (en) * 1991-05-29 1998-11-17 Origin Medsystems, Inc. Method for lifting a body wall using an inflatable lifting apparatus
US5370134A (en) 1991-05-29 1994-12-06 Orgin Medsystems, Inc. Method and apparatus for body structure manipulation and dissection
US5183033A (en) * 1991-07-15 1993-02-02 Wilk Peter J Surgical instrument assembly and apparatus and surgical method
US5289817A (en) * 1991-08-20 1994-03-01 Linvatec Corporation Endoscopic surgical retractor
US5407427A (en) * 1992-06-16 1995-04-18 Loma Linda University Medical Center Trocar facilitator for endoscopic surgery
US5443484A (en) * 1992-06-16 1995-08-22 Loma Linda University Medical Center Trocar and method for endoscopic surgery
DE4307228A1 (de) * 1993-03-08 1994-09-15 Tomic Dobrivoje Chirurgische Trokarhülsen
US5755661A (en) * 1993-06-17 1998-05-26 Schwartzman; Alexander Planar abdominal wall retractor for laparoscopic surgery
DE19604618A1 (de) 1996-02-08 1997-08-14 Storz Karl Gmbh & Co Vorrichtung zum Anheben der Bauchdecke für die Durchführung laparoskopischer Untersuchungen
US10166376B2 (en) 2013-06-11 2019-01-01 Covidien Lp Restricted expansion dissector
US10070853B2 (en) 2013-08-14 2018-09-11 Covidien Lp Expandable balloon desufflation assembly
US11369400B2 (en) 2019-03-20 2022-06-28 Covidien Lp Balloon dissector
US11484337B2 (en) 2020-02-06 2022-11-01 Covidien Lp Surgical access device including anchor with rachet mechanism
US11672563B2 (en) 2020-02-07 2023-06-13 Covidien Lp Surgical access device with rotatably actuated fixation mechanism
US11547441B2 (en) 2020-02-20 2023-01-10 Covidien Lp Retention anchor for surgical access devices
US11786233B2 (en) 2020-03-27 2023-10-17 Covidien Lp Retention anchor with suture tie down for surgical access devices
US11432846B2 (en) 2020-05-05 2022-09-06 Covidien Lp Surgical access device including alternating cutout fluid flow pathway for anchor inflation and deflation
US11376037B2 (en) 2020-05-08 2022-07-05 Covidien Lp Surgical access device including dual lumen cannula for anchor inflation and deflation
US11439430B2 (en) 2020-05-11 2022-09-13 Covidien Lp Surgical access device with air release mechanism
US11896263B2 (en) 2020-05-11 2024-02-13 Covidien Lp Surgical access device with fixation mechanism
US11564708B2 (en) 2020-06-15 2023-01-31 Covidien Lp Cannula assembly including an adjustable elongate shaft assembly
US11839404B2 (en) 2020-07-28 2023-12-12 Covidien Lp Surgical access assembly having pre-filled air chamber
US11717322B2 (en) 2020-08-17 2023-08-08 Covidien Lp Flexible cannula having selective rigidity
US12059176B2 (en) 2020-10-05 2024-08-13 Covidien Lp Surgical access device with differential pressure induced fluid evacuation
US11844549B2 (en) 2020-10-15 2023-12-19 Covidien Lp Surgical access device including a universal fluid flow valve
US11471189B2 (en) 2020-10-29 2022-10-18 Covidien Lp Surgical access device with fixation mechanism and illumination mechanism
US11751906B2 (en) 2020-10-29 2023-09-12 Covidien Lp Adapter for use with surgical access device for evacuation of smoke
US11583315B2 (en) 2020-11-09 2023-02-21 Covidien Lp Surgical access device including variable length cannula
US11849969B2 (en) 2020-12-04 2023-12-26 Covidien Lp Cannula with smoke evacuation housing
US11944348B2 (en) 2021-04-07 2024-04-02 Covidien Lp Surgical access device including an anchor having a suture retention mechanism
US11751907B2 (en) 2021-04-13 2023-09-12 Covidien Lp Surgical access device with self-inflating balloon
US12121689B2 (en) 2021-05-03 2024-10-22 Covidien Lp Surgical access device having a hollow anchor
US11864761B2 (en) 2021-09-14 2024-01-09 Covidien Lp Surgical instrument with illumination mechanism

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Publication number Priority date Publication date Assignee Title
US4517965A (en) * 1983-06-27 1985-05-21 Ellison Arthur E Tissue retractor
US4909789A (en) * 1986-03-28 1990-03-20 Olympus Optical Co., Ltd. Observation assisting forceps
US4890612A (en) * 1987-02-17 1990-01-02 Kensey Nash Corporation Device for sealing percutaneous puncture in a vessel
DE8711051U1 (de) * 1987-08-13 1988-01-07 Jakoubek, Franz, 7201 Emmingen-Liptingen Biopsie- und Fremdkörperzange
EP0449663B1 (fr) * 1990-03-29 1996-06-19 United States Surgical Corporation Rétracteur pour les organes de la cavité abdominale
DE9102759U1 (de) * 1991-03-08 1991-05-29 Storz, Karl, Dr.med.h.c., 7200 Tuttlingen Retraktor

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9218056A1 *

Also Published As

Publication number Publication date
WO1992018056A1 (fr) 1992-10-29
JPH06503024A (ja) 1994-04-07
JPH0761331B2 (ja) 1995-07-05
DE9106553U1 (de) 1991-08-08

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