EP2713912A1 - Instrument d'opération pour la laparoscopie - Google Patents

Instrument d'opération pour la laparoscopie

Info

Publication number
EP2713912A1
EP2713912A1 EP12748154.7A EP12748154A EP2713912A1 EP 2713912 A1 EP2713912 A1 EP 2713912A1 EP 12748154 A EP12748154 A EP 12748154A EP 2713912 A1 EP2713912 A1 EP 2713912A1
Authority
EP
European Patent Office
Prior art keywords
trocar
cavity
patient
nozzle
trocar sleeve
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
EP12748154.7A
Other languages
German (de)
English (en)
Inventor
Alexander Hetzel
Marc A. Reymond
Tina Schwarz
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.)
Hetzel Alexander
Reymond Marc A
Original Assignee
Individual
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
Application filed by Individual filed Critical Individual
Publication of EP2713912A1 publication Critical patent/EP2713912A1/fr
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A61M13/003—Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3474—Insufflating needles, e.g. Veress needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0087—Environmental safety or protection means, e.g. preventing explosion
    • A61M16/009—Removing used or expired gases or anaesthetic vapours
    • A61M16/0093—Removing used or expired gases or anaesthetic vapours by adsorption, absorption or filtration
    • 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
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3494—Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A61B2218/003—Irrigation using a spray or a foam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M11/00—Sprayers or atomisers specially adapted for therapeutic purposes
    • A61M11/02—Sprayers or atomisers specially adapted for therapeutic purposes operated by air or other gas pressure applied to the liquid or other product to be sprayed or atomised
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M15/00—Inhalators
    • A61M15/02—Inhalators with activated or ionised fluids, e.g. electrohydrodynamic [EHD] or electrostatic devices; Ozone-inhalators with radioactive tagged particles

Definitions

  • the invention relates to a device for the directed application of a substance in a cavity, such as a hollow organ, a body cavity, in particular a therapeutic Pneumoperitoneum.
  • a cavity in the patient to be treated is needed.
  • this cavity is formed by introducing a gas, preferably carbon dioxide CO2, under a pressure of 12 to 15 mm Hg into the patient at a suitable location by means of a CC insufflator.
  • the access for the cavity and the surgery is provided by working trocars.
  • the surgical operations are still mechanical and / or electrical interventions that do not integrate other treatment methods such as drugs, nanomolecules, etc.
  • peritoneum peritoneum
  • the reason for this is that the therapeutic flushing of the abdominal cavity was previously relatively ineffective.
  • the peritoneum peritoneum
  • the rinsing solution thus often only reaches a small part of the peritoneal surface.
  • the diffusion of the therapeutic solution into the tissue is minimal.
  • a device for the directed delivery of a substance in a cavity comprising:
  • a trocar system with a trocar sleeve having a
  • a nozzle system which forms a lumen in its interior, with a
  • the nozzle system has a needle nozzle attached to the lumen at the distal end and is guided by the trocar sleeve.
  • An idea of the invention is to provide a device for therapeutically generating a pneumoperitoneum that reduces the administration of substances, incl.
  • Drugs and nanomolecules in the form of an electrostatically charged aerosol during a surgical procedure allows, in which the device according to the invention is applied.
  • Neutral electrode is grounded, forms an electric gradient field, which allows a better wetting distribution of the substance in the operating environment of the Pneumoperitoneum.
  • the lumen may be the natural lumen of a hollow organ such as the heart, blood vessel, bile duct, urinary tract, gastrointestinal tract, uterine or cerebral ventricle cavity.
  • cavity With the term cavity become but also includes so-called body cavities, wherein with a body cavity any natural, of mesothelium or epithelium, self-contained or with other rooms or the outside world related body cavity may be included, such as the abdominal, thoracic, cranial, Nasal, oral, pharyngeal, CSF, or joint cavities.
  • the nozzle system has no additional coaxial with the needle nozzle inside arranged passage for a surgical kit. This considerably simplifies the construction of the nozzle system.
  • the needle nozzle can be designed as a needle valve.
  • an electrostatic charging section for electrostatically charging the aerosol is provided.
  • the aerosol has medically active nanoparticles.
  • the electrostatic charge of the aerosol improves the adhesion and penetration depth of the nanoparticles to tissue.
  • a discharge port is formed on the trocar with a, to which a discharge line is connected.
  • the insufflation gas By opening the shut-off valve at the discharge port, the insufflation gas can be selectively discharged after the operation.
  • a pump in particular a micropump, can be connected to the nozzle system for pressurized delivery of the substance to the nozzle system, such that the substance can be converted into the aerosol by means of the needle nozzle or the needle valve or a needle nozzle.
  • the electrostatic charging section can be electrically connected to a first pole of a generator via an electrical line in order to electrostatically charge the aerosol by means of the electrical charge generated by the generator.
  • the electrostatic charge can be carried out targeted.
  • the generator has a second pole which can be connected via a second electrical line to a flat adhesive electrode.
  • the patient With the adhesive electrode, the patient can be grounded and it is created a flat electrical connection, which has a relatively large area. As a result, heating of the adhesive electrode or the skin on which it rests can be avoided.
  • a protective sleeve is mounted fluid-tight, the one
  • Rosette section for fluid-tight mounting on the trocar sleeve and an adjacent to the rosette section surface mounting portion for fluid-tight
  • Attachment to a skin surface of a patient has.
  • An advantage of the protective cuff is an improvement in occupational safety so that, for example, the risk of contamination of the surgical environment, i. H. the exposure of personnel to hazardous substances can be restricted or completely prevented.
  • the rosette section of the protective sleeve on the trocar is fluid-tight and detachably mountable.
  • the attachment portion is formed of an elastic material and on the side, which is provided for attachment to the patient, in particular the abdominal wall, provided with an adhesive, which is a fluid-tight connection with the skin of the
  • Insufflator connectable which provides the Insuffliergas for forming a cavity, in particular a therapeutic Pneumoperitoneum, in a patient at 12 to 15 mmHG up.
  • the device may be used in a method for the targeted delivery of a substance in a cavity, such as a hollow organ, a body cavity,
  • a therapeutic pneumoperitoneum comprising the steps of: a. Inserting a trocar sleeve a trocar system with a trocar sleeve, b. Pressurizing the trocar sleeve with an insufflating gas c. Penetrating the trocar sleeve with a nozzle system forming a lumen therein having a proximal end and a distal end, the nozzle system having a needle jet attached to the lumen at the distal end and passing through the trocar sleeve, d. Generating an aerosol via the needle nozzle in the cavity.
  • Electrostatic charging section is electrically connected.
  • FIG. 1 is a schematic overview of the device according to the invention for generating a therapeutic Pneumoperitoneum in a patient
  • FIG. 2 shows a view of the device according to the invention for producing a therapeutic pneumoperitoneum from FIG. 1.
  • FIG. 1 shows a schematic view of an apparatus 1 according to the invention for producing a therapeutic cavity 200, in particular a pneumoperitoneum, in a patient 300.
  • the patient may be a human, as shown schematically in FIG.
  • the application of the device according to the invention is not limited to humans, but can also be applied to other animals.
  • the term patient should therefore mean every living being
  • inventive device can be treated.
  • the abdominal cavity 303 has been formed as a cavity 200 for a laproscopic procedure and shown exaggerated for better understanding.
  • the cavity is preferably accessed by minimally invasive surgery (keyhole surgery) and is formed by introducing CO2 into the abdominal cavity.
  • keyhole surgery it is also possible to use the trocar system 40 according to the invention, which can be connected to an insufflator 80 for this purpose.
  • the cavity is conventionally made with carbon dioxide (CO 2) under a pressure of 12 to 15 mm Hg. Access for the surgical procedure is secured via a suitable trocar, such as the trocar system 40 according to the invention.
  • the device 1 according to the invention for producing a therapeutic cavity can be used, for example, in minimally invasive procedures in the following body cavities and in the treatments listed below:
  • Abdominal cavity Peri- and postoperative pain treatment, destruction of tumor cells (stomach cancer, ovarian cancer, other cancers), destruction of
  • Chest Peri- and postoperative
  • a cavity 200 can be formed, wherein additionally an aerosol 100 can be applied in the operating environment of the pneumoperitoneum 200, in particular directed.
  • directed spreading is to be understood in particular as meaning that an electrostatically charged aerosol corresponds to the gradient 101 of a
  • the adhesion of the aerosol 100 to the peritoneum 307 is improved. Furthermore, the penetration depth of the electrostatically charged aerosol into the tissue of the surgical environment can be significantly improved.
  • an adhesive electrode 90 is attached to the skin surface of the abdominal wall of the patient 300 by means of a suitable adhesive.
  • the adhesive electrode 90 is also connected to a generator 70 so that the patient is grounded.
  • the generator 70 is additionally electrically connected to the trocar system 40.
  • the trocar system 40 is preferably made of an electrically conductive material, preferably surgical steel.
  • the cavity 200 is formed by introducing a suitable insufflation gas, such as CO2, into the patient.
  • a suitable insufflation gas such as CO2
  • the device 1 additionally has a micropump 10 for conveying the liquid substance X.
  • the substance X may be a suitable liquid which may contain additional substances for various purposes such as cancer therapy, pain therapy, infectious therapy, and the prevention of adherence.
  • the micropump 10 may not in one embodiment by a illustrated syringe having a piston and a cylinder, wherein the syringe can be clamped in a device, not shown, and wherein the device compresses the piston and thereby generates a fluid pressure.
  • the device 1 according to the invention has a
  • Nozzle system 20 to which the micropump 10 is connected.
  • the micropump 10 and the nozzle system 20 are connected to one another in a fluid-conducting manner, so that a substance X conveyed under pressure by the micropump 10 is atomized in a mist-like manner at a needle nozzle 30 into an aerosol 100.
  • Trocar System 40 applied voltage electrostatically charged.
  • the substance may in particular contain drugs suitable for chemotherapy, such as cytostatics such as doxorubicin, lisplatin or other chemotherapeutic agents.
  • the nozzle system 20 extends completely through a lumen of the trocar system 40 and has at its one end portion a needle nozzle 30 for distributing the aerosol in the operating environment of the pneumoperitoneum 200.
  • the nozzle system 20 is designed to create an aerosol 100 of substance X.
  • the nozzle system 20 has a proximal end 21 and a distal end 22. At the proximal end 21, which protrudes upwards from the trocar system 40, a tube 24 can be connected via a thread 25.
  • the tube 24 is fluid-conductively connected to a micropump 10.
  • the nozzle system 20 forms in its interior a tubular lumen 26. With the lumen 26 at the distal end 22, for example, designed as a needle valve needle nozzle 30 is attached.
  • an access 306 in the abdominal wall of the patient 300 is closed by a protective cuff 50 fluidly attached to the skin surface around the access 306 on the one hand, and fluid-tight on the peripheral surface of the trocar system 40 with the trocar sleeve 45 on the other hand is applied.
  • a filter device 60 is connected to the trocar system 40, for
  • the filter device 60 may be fluidly connected to the trocar system 40 after surgery to drain insufflation gas and substance X therein from the cavity 200 without contaminating the operating room with the substance X.
  • a closed circuit can be provided, whereby a contamination of the operating room and the operating staff with contaminated aerosol is prevented during the operation, which in addition to
  • FIG. 2 again shows in detail the individual components of the device 1 according to the invention.
  • the device 1 then has a trocar system 40, a nozzle system 20 with a needle nozzle 30, a micropump 10 connected to the nozzle system 20, a CO 2 insufflator 80 connected to the trocar system 40 via an insufflating gas supply line 81 Filter device 60, which is connected to the trocar system 40, an electric generator 70, with the
  • Nozzle system 20 an adhesive electrode 90 for grounding a patient 300 electrically connected to the generator 70, a protective cuff 50 fluid-tightly mountable to a trocar sleeve 45 to the trocar system 40, and a filter device 60 attached to the trocar system 40 is connected.
  • the trocar system 40 has a connection section 47 for connecting the insufflator 80 and for connecting the filter device 60.
  • a gas connection 43 which can be shut off via a shut-off valve 48, is connected to the trocar system 40, at which point via a
  • Gas supply line 81 of the insufflator 80 is connected, and a lockable discharge port 62 for connecting a discharge line 61 is formed, which is connected to the filter device 60.
  • the trocar system 40 has a trocar sleeve 45 which can be introduced into a patient 300, which is used to guide a patient
  • nozzle system 20 As the nozzle system 20 according to the invention is formed.
  • suitable cavities are formed in the trocar system 40, in particular at the access opening 41 the trocar system 40 suitable sealing means are provided which can seal the nozzle system 20 at least at the access opening 41 fluid-tight.
  • the trocar system 40 at the opposite end to the access opening 41 on the trocar sleeve 45 on an output port 46 through which the needle nozzle 30 of the nozzle system 20 is movable.
  • the device 1 has an electrical generator 70 for electrostatically charging an aerosol.
  • the generator 70 is electrically conductively connected to the nozzle system 20. This is done by means of the Nozzle system 20 generated aerosol, in particular the substance X, electrostatically charged so that the individual aerosol droplets can move according to the gradients 101 of an electrostatic field.
  • an adhesive electrode 90 for grounding the patient is provided on the generator 70.
  • the adhesive electrode 90 has an attachment side 91, to which preferably a suitable adhesive layer is applied, so that an electrical connection can be formed between the adhesive electrode and the patient.
  • the adhesive electrode 90 is connected via an electrical connection 92 via an electrical line 71 with the
  • the insufflator 80 is connected via the gas supply line 81.
  • the insufflator 80 prepares the cavity required for a laparoscopy or thoracoscopy in a patient 300, wherein in the device 1 according to the invention, the insufflation gas can also be used in the nozzle system 20 for creating the aerosol.
  • a discharge line 61 is fluid-tightly connected, which is also connected fluid-tightly via a filter device connection to a filter device 60 with a suitable filter.
  • a protective sleeve 50 is mounted on the trocar sleeve 45.
  • the protective sleeve 50 has a Rosette section 51 for fluid-tight mounting on the trocar sleeve 45 and an adjacent to the rosette section surface mounting portion 52 for fluid-tight attachment to a skin surface of a patient.
  • the protective sleeve 50 is at least partially made of an elastic material to ensure movement to the trocar system 40 and at the same time to close the access 306 to the patient sufficiently fluid-tight.
  • a suitable adhesive is provided, which can ensure a fluid-tight connection with the skin of the patient and the attachment portion.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Surgery (AREA)
  • Environmental & Geological Engineering (AREA)
  • Pulmonology (AREA)
  • Emergency Medicine (AREA)
  • Environmental Sciences (AREA)
  • Ecology (AREA)
  • Pathology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biodiversity & Conservation Biology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgical Instruments (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)

Abstract

L'invention concerne un instrument (1) permettant de diffuser une substance (X) de manière orientée dans une cavité (200) telle qu'un organe creux, une cavité corporelle, notamment lors d'un pneumopéritoine thérapeutique, cet instrument comportant: - un système de trocart comprenant une chemise de trocart (45), le système de trocart (40) présentant un raccordement de gaz (43) auquel peut être raccordé un conduit d'amenée de gaz d'insufflation (81), - un système de buse (20) qui forme une lumière (26) intérieure dotée d'une extrémité proximale (21) et d'une extrémité distale (22), le système de buse (20) présentant une buse d'aiguille (30) fixée avec la lumière (26) à l'extrémité distale (22) et étant guidé à travers la chemise de trocart (45).
EP12748154.7A 2011-05-27 2012-05-29 Instrument d'opération pour la laparoscopie Ceased EP2713912A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE202011101151U DE202011101151U1 (de) 2011-05-27 2011-05-27 Mikropumpe zur Herstellung eines therapeutischen Pneumoperitoneums
PCT/DE2012/100159 WO2012163346A1 (fr) 2011-05-27 2012-05-29 Instrument d'opération pour la laparoscopie

Publications (1)

Publication Number Publication Date
EP2713912A1 true EP2713912A1 (fr) 2014-04-09

Family

ID=44508271

Family Applications (1)

Application Number Title Priority Date Filing Date
EP12748154.7A Ceased EP2713912A1 (fr) 2011-05-27 2012-05-29 Instrument d'opération pour la laparoscopie

Country Status (6)

Country Link
US (1) US9511197B2 (fr)
EP (1) EP2713912A1 (fr)
JP (1) JP2014523268A (fr)
CA (1) CA2836832C (fr)
DE (2) DE202011101151U1 (fr)
WO (1) WO2012163346A1 (fr)

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EP3427781B1 (fr) * 2017-07-11 2024-09-25 Pharma Resources GmbH Médicament et système de dispositif pour des thérapies d'aérosol sous pression dans un espace creux d'un mammifère
DE102018121496A1 (de) 2018-09-04 2020-03-05 Prof. Reymond & Hetzel GbR (vertretungsberechtigter Gesellschafter: Alexander Hetzel, 78667 Villingendorf) Medizinisches Instrument zum gerichteten Einbringen einer therapeutischen Substanz in einen Hohlraum und Werkzeug dafür
DE102018121513B4 (de) 2018-09-04 2020-04-02 Prof. Reymond & Hetzel GbR (vertretungsberechtigter Gesellschafter: Alexander Hetzel, 78667 Villingendorf) Medizinisches Instrument zum gerichteten Einbringen einer Substanz in einen Hohlraum eines Körpers und Werkzeug dafür
EP3669863A1 (fr) 2018-12-19 2020-06-24 CAPNOMED GmbH Micro ou nano émulsions comprenant des médicaments anticancéreux
EP3701943A1 (fr) 2019-02-26 2020-09-02 CAPNOMED GmbH Administration retardée de médicaments anticancer
EP3750523A1 (fr) 2019-06-13 2020-12-16 CAPNOMED GmbH Système de distribution de substances actives
EP3750524A1 (fr) 2019-06-13 2020-12-16 CAPNOMED GmbH Administration retardée et modifiée de médicaments anti-cancer
EP3791865A1 (fr) 2019-09-16 2021-03-17 CAPNOMED GmbH Système de distribution de substances actives avec distribution retardée
EP3795139A1 (fr) 2019-09-23 2021-03-24 CAPNOMED GmbH Composition ayant des particules micro-nano de médicaments d'un agent anticancéreux
DE102022104560A1 (de) 2022-02-25 2023-08-31 Capnopharm UG (haftungsbeschränkt) Medizinisches Instrument zum Einbringen einer fluidförmigen therapeutischen Substanz in einen Hohlraum eines Körpers
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Also Published As

Publication number Publication date
CA2836832C (fr) 2019-05-21
CA2836832A1 (fr) 2012-12-06
US20140142495A1 (en) 2014-05-22
US9511197B2 (en) 2016-12-06
WO2012163346A1 (fr) 2012-12-06
JP2014523268A (ja) 2014-09-11
DE202011101151U1 (de) 2011-07-26
DE102012104629A1 (de) 2012-11-29

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