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 present invention relates to a device for removing anatomical parts, devised for surgical operations carried out by laparoscopy.
• this device comprises a bag wherein the aforesaid parts are placed back and a tube applicator wherein the bag is arranged for being introduced in an abdominal cavity to be operated; the applicator is also provided with means for ejecting the bag out into the cavity above.
• the operations herein considered consist of making on the patient's abdomen some apertures or laparatomies, usually at least two and no more than four, having diameter of few millimetres (from 5 to 15 mm) and devised for the insertion into the abdominal cavity of surgical instruments suitably adapted to this purpose; these instruments may be optical waveguide probes, scissors, pliers, suture devices or, like in the case of the present invention, devices for removing anatomical parts to be taken or extirpated.
• the first one generally considered as the best by the persons of the art even though more expensive, comprises a polyurethane bag on the mouth thereof there is applied a pretensioning metallic ring, resiliently folding and having a diameter of 10 or 15 cm depending on the models; the polyurethane bag is also provided with a twisted polyamide seam, that allows its tightening like a tobacco bag thereby separating it in an automatic manner from the pretensioning ring, by means of a cutting edge of the latter.
• the ring in an initial folded condition, together with the empty bag, is located in a cylindrical tube of 10 or 15 mm of diameter, which is inserted into the abdominal cavity to be operated through one of the laparatomies already referred to.
• the bag After having inserted a distal end of the cylindrical tube into the abdominal cavity of the patient, the bag is pushed out in said cavity by a cursor acting on it, similar to that of a normal syringe and operated from the proximal end of the tube: in this situation the pretensioning ring may thus unfold close to the area to be surgically operated by virtue of its spring action, thereby promptly disposing the related bag in an open condition, ready to accomodate an anatomical part to be removed.
• the bag After the part has been put into the bag, the latter is closed by narrowing its mouth pulling the aforesaid polyamide seam; following to this phase the bag is cut off the pretentioning ring and the latter, after having been previously folded, may be drawn out from the cylindrical tube while the former is pulled toward the distal and of the tube: afterward, also the bag may be slipped out of the cavity together with the tube.
• this known device has the advantage of an automatic and quick opening of the bag thanks to the resilient pretensioning ring, it is however marked by a scarce handyness because of the dimensions of the ring once the latter is open inside the cavity to be operated, and of a certain functioning labouriousness; above all it must be underlined the fact that in this known device, once the bag is closed it is no more possible to re-open it: in other words, with such a device it is not possible to carry out cycles of opening and subsequent closing of the bag which are useful in some kinds of operations, such as those wherein several anatomical parts must be removed (extirpations of small lymph nodes, multiple biopsies) in sequence inside the abdominal cavity, without the risk of their dispersion.
• the removing device discussed heretofore, there exists another one available in commerce.
• the latter device is provided with the usual bag wherein the anatomical parts are accommodated, whose mouth is however coupled with a flexible ribbon made of plastics such as nylon (registered trademark) or the like; the bag is applied on the distal end of a cannula and for this reason it is provided with an appendix in correspondence of its mouth, to be sealed on such an end.
• the above mentioned ribbon is located for a portion in a turn-up edge of the mouth of the bag, whereas its two free ends are arranged inside the above mentioned cannula and are connected to the tip of a cursor rod axially slidable within it: in this manner the ribbon takes a loop configuration that will be better appreciated later.
• the cursor is operated from the proximal end of the cannula like a syringe and moves between a forward end stroke position and a rearward one.
• the ends of the ribbon connected to it are placed, respectively, adjacent to the distal end of the cannula or inside to it: in the first case the ribbon protrudes basically for all its length off the distal end of the cannula and the loop that it forms has such a length as to allow the mouth of the bag to be in the maximum opening condition; in the second case, instead, the ribbon is located mainly inside the cannula so that the mouth of the bag is closed following to the relative sliding between its turned- up edge and the ribbon.
• This second model of device just referred to allows, differently from the first one, to carry out repeated opening and closing cycles of the bag, thereby representing under this point a technical improvement; this outcome is due essentially to the fact that it does not have a rigid pretensioning ring associated to the mouth of the bag, but rather a flexible element like the ribbon made of plastic material.
• the object that the present invention purposes to achieve is that of providing a device for removing anatomical parts, having such structural and functional features as to overcome the limits concerning the devices of the state of the art and that have been previously explained.
• the invention is aimed at providing a removing device wherein the first opening of the bag inside the abdominal cavity takes place in a quick and autonomous manner, i.e. without the intervention of the surgeon to unfold the material of the bag and to open the mouth thereof likewise it occurs in the first model above, as well as wherein the closing and opening for several times of the bag is possible.
• This object is achieved by a device for removing anatomical parts of the type referred to above, characterized in the claims annexed to this description.
• FIG - figures 1 and 2 show a perspective view of an open bag relating to first example of device according to the invention, in respective subsequent operating conditions;
• figure 3 shows a detailed view of the aforesaid bag, in the rolled up condition suitable for being introduced into an abdominal cavity;
• figure 4 shows a partially sectional view with a cut away portion, of the first embodiment above mentioned of device according to the invention;
• figure 5 shows the bag of the preceding figures, in a condition wherein its mouth is closed;
• figure 6 shows in detail the bag according to a second embodiment of the invention, in the rolled up condition suitable for being introduced in a abdominal cavity;
• figure 7 shows a partially sectional view with a cut away portion, of the second embodiment of device according to the invention.
• the figures 1-5 they show a device according to this invention generally indicated as 1.
• the device includes a bag 3, made preferably of plastic resistant material such as polyurethane, kevlar (registered trademark) or polypropylene, having a mouth 5 wherein a flexible element 7 is arranged; the latter advantageously consists of a helicoidal closed spring, that is to say without free ends, of the type similar to a wire, having such a resilient behaviour as to spring back in a loop configuration when it is not subjected to a deformation.
• plastic resistant material such as polyurethane, kevlar (registered trademark) or polypropylene
• the flexible element 7 is folded like an "8" and a ring 10 arranged astride the two lobes that form this "8" (best seen in figure 2), is provided as a clip for ensuring the stability of the folding: a first lobe 7a formed by flexible element 7, is arranged within a flap 11 extending along the edge of the mouth 5 of the bag 3, whilst the second lobe 7b is free.
• the portions of the lobes 7a and 7b are not fixed as will better result in the continuation of this description, but may vary by making the ring 10 to slide along the flexible element 7: for this reason the ring exhibits a certain clearance in its coupling with the flexible element.
• an applicator basically consisting of a cylindrical tube 21, having a distal end 21a open for permitting the ejection of the bag 3 as it will better result later, and a proximal end 21b closed by a base 22 in sealing relationship with a stem 23 axially slidable back and forth; on the tip of the stem which is located inside the tube, there is a small ram 24, whilst the seal on the stem ' is provided by an annular ship membrane 25, arranged transversely the tube and around the stem.
• the tube 21 is also provided with two wings 26 in connection with its proximal end 21b.
• the flexible element 7 associated to the bag 3 is first folded so as to overlap the two lobes of the "8" profile previously referred to, as shown in fig. 1; afterwards the bag is wrapped around the flexible element so as to take the tubular form shown in fig. 3: it is worth to consider that in this condition the flexible element, which consists of a spring, is deformed an thus exerts a resilient reaction giving rise to the effects that will be dealt with later. It is also to be stressed in connection with figures 3 and 4, that in this phase the ring 10 is located outside the wrapped bag.
• the distal end 21a of the tube is inserted into the abdominal cavity to be operated through a laparatomy, in the desired position; pushing the stem 23 in the tube
• the ram 24 solid therewith moves forward the distal end 21a and acts on the bag thereby ejecting it out of the tube.
• the bag becomes free to unroll; this takes place in an autonomous manner, within the meaning of this term already explained: indeed thanks to its resilience, the helicoidal spring constituting the flexible element 7 springs back into the "8" configuration already referred to and the elastic reaction that it exerts for assuming this configuration, allows to unroll the bag wrapped around it. It goes without saying that the resilience of the spring must be suitably chosen in order to achieve the effect just pointed out, for instance by taking into account the dimensions of the different parts that form the device, as well as the type of bag used and whatever else.
• the bag 3 will thus dispose with its mouth open in the condition shown in fig.
• the lobe 7b is pulled holding the ring 10 still (see fig. 5): the latter, indeed, in this manner has in practice the function of a noose and following to the pull, the proportions of the lobes 7a and 7b change so that the former narrows whereas the latter widens; the edge of the mouth 5 of the bag is therefore narrowed too in this connection, thereby obtaining the desired closing.
• the device according to the invention achieves the object set out initially. Indeed it has been shown that for what it concerns the first opening of the bag inside the abdominal cavity, it takes places in a quick manner and without the need for a specific intervention of the surgeon for unrolling the bag, likewise in the first known model of device previously considered; furthermore, the device according to the present invention allows to open and close many times the bag in order to put therein the anatomical parts subsequently removed, thanks to the resilient behaviour of the flexible element explained in connection with the embodiment described.
• the flexible element 7 gives the same performances of the already cited pretensioning ring of the state of the art, as regards the first opening of the bag: however, thanks to its flexibility and resilience, such element may be deformed repeatedly in order to allow the cyclic closing and opening of the bag.
• a further important effect related to the present invention resides in the fact that also from a medical point of view, it does not involve contraindications; more specifically, from the foregoing it may be appreciated that the use of the flexible element does not bring risks of lesions inside the abdominal cavity wherein the device is applied: indeed, even if such element during the opening of the bag hit the wall of the cavity or of any organ contained therein, its flexibility avoid damages to the tissues against which it comes into contact, thereby preventing the danger of injuries. It is also evident that such an advantageous effect is important when account is taken of the authorisations which must generally be obtained for put into commerce this kind of devices.
• this second embodiment differs from the preceding one in that the bag 3 is wrapped for being inserted into the tube 21 of the applicator (see fig.
• the ring 10 be replaced by a buckle, a clamp or any other suitable fastener, which might also be adjustable so as to better slide along the flexible element: indeed it should be appreciated that although the ring above is an easy manufacturing element in industry and thus with low costs, it could also be improved giving rise to several alternative solutions. It must be further emphasised that the arrangement of the ring astride the junction of the two lobes 7a and 7b (see fig.

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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)
• Laser Surgery Devices (AREA)

Applications Claiming Priority (3)

Publications (1)

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• 1997
  • 1997-07-01 IT IT97MI001548A patent/IT1292441B1/it active IP Right Grant
• 1998
  • 1998-06-26 EP EP98939582A patent/EP0925030A1/en not_active Withdrawn
  • 1998-06-26 WO PCT/EP1998/004034 patent/WO1999001068A1/en not_active Application Discontinuation

Non-Patent Citations (1)

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