ES2319954B2 - HANDLE FOR A DISTAL TOOL AND ENDOSCOPIC OR LAPAROSCOPIC SURGERY SYSTEM. - Google Patents

Abstract

Handle for a distal tool and system endoscopic or laparoscopic surgery.

Handle for a distal tool (17) of laparoscopic surgery provided with means to operate said distal tool, which comprise a handle and two solidarity levers (3,4) that are configured to operate the distal tool and are arranged one on each side of the handle, so that one of the levers is configured to be operated by the thumb and the other lever is set to be operated by the index finger while the grip is configured to be held by the other three fingers together with The palm of the hand. The levers (3; 4) comprise an arm exterior (3rd; 4th) and an inner arm, having a space between both arms to accommodate a finger, so that each lever is configured so that the finger exerts a closing force on the inner arm and an opening force on the outer arm.

Description

Handle for a distal tool and system endoscopic or laparoscopic surgery.

The present invention relates to a handle for a distal endoscopic or laparascopic surgery tool, which comprises means for manually activating said tool distal, and also to a system for endoscopic surgery or laparascopic comprising a handle of this type.

The handle is a mechanical system located in the proximal end of the tool and allows the surgeon to operate from the outside the distal tool introduced through Small incisions inside the patient.

State of the art

Since the 80s laparascopic surgery has has gained enormous importance and interest due to the advantages that provides in the patient. In laparascopic surgery the surgeon access the patient's abdominal cavity through small incisions using special surgical tools that They allow to be handled from the outside. Among the advantages of This technique should be noted that produces less pain and loss of blood, shorter periods of convalescence and even, from the point aesthetic view, minor scars. However, in comparison with open surgery laparoscopic surgery makes work difficult of the surgeon, since it considerably reduces the sensitivity touch that it has on the organ in which it is acting, limits the possibilities of movement of the tool, and generates muscle fatigue due to poor ergonomic characteristics that They generally have these tools. All this increases even more the mental and physical stress to which they are already subjected surgeons during their interventions, and may have an impact on Poor performance on the other hand.

The problem of lack of ergonomics has been addressed since the late 1990s and has resulted in several publications up to recent dates. However, the vast majority of these publications do not address the design of new tools with ergonomic considerations, but are limited to analyzing and comparing several tools existing in the market from the point of view of their ergonomics. An example of these works is that carried out by Marten et al ., And Van Veelen et al . The fundamental reason why this problem has not been satisfactorily resolved is because in the design of laparoscopic surgery tools, functional characteristics have prevailed over purely ergonomic aspects. In addition, according to Berguer, these tools are nothing more than a mere adaptation of the tools used by surgeons in open surgery, are not comfortable to touch and have areas of contact with the hand, and especially in certain parts of the fingers, high Pressure.

Another problem with laparoscopic surgery tools that concerns surgeons is the loss of sensation in the palpation of the organs. This loss of palpation is due to the fact that the force exerted on the distal tool when an organ is compressed is not adequately transmitted to the handle, and this causes the surgeon to be unaware of the force he is performing, which can cause damage involuntarily. In other cases, for example in the appearance of metastases in cancer diseases, the sensitivity of the tool is important to detect the changes in texture and hardness that have occurred in certain areas of the patient's organs. The problem of tactile sensitivity has not been satisfactorily resolved to date, and as in the problem of ergonomics, most of the publications that study this problem, such as the work done by Ottermo et al ., limited to comparatively study different tools from the point of view of tactile sensitivity. In the US Pat. No. 6447532, it is considered a tool design that allows to feel to a certain extent the variations of force in the claw. US Pat. No. 6096058, proposes a system that limits the force that can be exerted manually on the tool. In the US Pat. No. 5476479, the strength of the tool is limited by the use of flexible claws.

The tactile sensitivity and ergonomics of the tools are two concepts that are faced in most of the cases. That is, if ergonomics is improved, you lose sensitivity and vice versa. This for example occurs in those tool handles that incorporate springs to facilitate claw opening. These tools allow better contact between the hand and the handle improving ergonomics. But the force that the surgeon must do to beat the spring and close the claw it sum to the resistance exerted by the organ on which it is acting at that time, impairing tactile sensitivity. In addition the handles provided with spring must have a ratchet mechanism in order to fix the position of opening of the claw without the need for the surgeon to be exerting pressure on the handle.

On the other hand, the tactile sensitivity of a tool is also harmed when force must be exerted About the tool A manual tool designed to make a strength work is generally subjected very differently to when sensitivity is required. Surgery tools laparoscopic often require these two characteristics, what which complicates its design.

Various types of mango used in laparoscopic surgery can be found in the literature. For example Matern et al . they present in their publication examples of this diversity, and the US Pat. No. 0187575, shows an example of current ergonomic handle design. However, currently two types of handle are used: the axial handle and the ring handle.

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The axial handle is formed by a fixed support parallel, or almost parallel, to the main axis of the tool and a lever that folds over it. This handle is provided in general spring and therefore has ergonomic advantages in as far as the support of the fingers on the tool is almost complete, eliminating areas of excessive tension. It also offers a greater comfort in certain operations where the rotation of the tool on its axis, such as in sutures. However, the spring and the form of attachment worsen the sensitivity characteristics of the tool. Also in certain operations the surgeon's wrist can be seen excessively forced and this effect can also be transferred to arm, forearm and shoulder. According to the studies carried out by Matern It is the tool that requires more muscular effort. Examples of This type of handle can be found in different patents. By example in U.S. Pat. No. 6540737, the handle can modify the orientation with respect to the axial position to a position of 60º with respect to the axis of the tool. In U.S. Pat. Do not. 5624431, the handle, in addition to the opening and closing of the claw, It allows the rotation of the shaft by means of a thumb drive. U.S. Patent Pat. No. 5382254 shows a case for the application of surgical clips.

The ring handle is surely the most handle currently used in laparascopic surgery. Examples of this Type of handle can be found in U.S. Pat. Pat. Do not. 5626608, and U.S. Pat. No. D541416. The ring handle consists of a mobile lever that is generally operated with the thumb and a fixed support to the tool where the rest of the fingers Depending on the type of tool you can find with spring and ratchet or free movement. In any case the Ergonomics of this tool is poor, since it generates a high  pressure on the contact areas with the fingers and the lever it works only with very specific areas of the thumb which It generates significant muscle fatigue.

Description of the invention

The present invention provides a new handle of surgical tool for applications in endoscopy and surgery laparoscopic This handle meets the general characteristics that are required of such a tool, being light and easy to use, so that your job requires only one hand and can be used interchangeably by the right or left hand of the surgeon It can be used in different types of operations of this type of surgery by locating the corresponding distal tool at the end of the extension tube (e.g. claws, scissors, dissectors, retractors, etc.), and can work with or without opening spring. It allows cauterization through different techniques, and can be used both in tools disposable as in reusable tools, since its disassembly for sterilization and subsequent assembly is simple. It is also possible to use various extension tubes conventional lengths and diameters of 5 mm 10 mm and 12 mm or others diameters if necessary.

According to one aspect of the invention, the means provided on the handle to manually operate the distal tool comprise a handle and two levers that are configured to operate the tool together distal and are arranged one on each side of the handle, of so that one of the levers is configured to be operated by the thumb and the other lever is set to be operated by the index finger while the grip is set to be grabbed by the other three fingers, heart, ring and little finger, along with the palm of the hand.

In one embodiment, the two levers move in solidarity.

In one embodiment, the two levers are arranged symmetrically with respect to the handle, so that each lever can be operated interchangeably with the thumb or with the index, depending on whether they are from the right hand or from the left.

In one embodiment, at least one of the levers It is configured to be activated both by opening and closing the drive fingers.

In one embodiment, at least one of the levers it comprises an outer arm and an inner arm, having a space between both arms to accommodate the finger, so that the lever is configured so that the finger exerts a force of closure on the inner arm and an opening force on the outer arm

In one embodiment, at least one of the levers it comprises an additional arm for the middle finger, so that it can also operate the lever together with your finger index.

In one embodiment, the handle comprises a wheel of orientation that allows to rotate the distal tool, being the surface of said orientation wheel a surface of revolution and substantially semi-elliptical, which It can be operated by the thumb. To facilitate this drive the surface of the wheel can incorporate a fluted.

The orientation wheel allows the support of the finger on a surface larger than other wheels used in the known tools, bringing pressure on the thumb It may be less for the same force exerted. Alternatively the index finger can be used to drive this wheel of orientation.

In one embodiment, the handle comprises a spring connected to the levers in order to exert a slight force of opposition to the drive of the distal tool.

In one embodiment, the handle comprises a mechanism of retention of the position of the levers.

In one embodiment, the handle comprises a box of mechanisms located on the levers, which houses the drive mechanism of the distal tool.

In one embodiment, the mechanism box it comprises an upper cover that is provided with a connection of cauterization.

There are several ways to perform the cauterization, although only the monopolar electrocautery. In this type of cauterization the current is generated in an external device and introduced into the tool through the corresponding connection. Electricity travels from the tool connection to the tool distal, and from here through the patient, acting as ground and closing the circuit by another connection in the body (usually on the patient's thigh). So it is not necessary replace the tool or any element of it; it's just it is necessary that the electric current can circulate freely between the connection of the tool and the patient (or the tool distal where contact with the patient occurs). To do this you must ensure that the elements involved in the tool transmit the electric current. This is not a problem since They are all metallic elements. Electrocautery, although very usual in this type of operations, it is only done during Very short periods of time.

According to another aspect of the invention, a Endoscopic or laparoscopic surgery system comprises a handle with the characteristics described in the previous paragraphs, a extension tube, and a distal tool located in the region distal of said tube and actuated by said handle through the tube protractor

In one embodiment, the actuation of the levers are transmitted to the distal tool through an axis of drive, so that the drive shaft moves coaxially inside the extension tube to produce a opening and closing movement of the distal tool.

In one embodiment, the movement of the levers are transformed into a drive shaft shift by means of two connecting rods fixed to the levers by one end, said cranks being connected to a slide by its other end by two pivots provided at the bottom of said slide, so that the connection between the top of the slide and drive shaft makes movement possible relative rotation between them but prevents relative movement of both in the axial direction of the drive shaft.

In one embodiment, the orientation wheel is connected to the drive shaft through a connection that allows the relative movement of both in the axial direction of the axis of drive but prevents relative rotation movement between they.

In general, a tool system of Laparoscopic surgery is formed by the set of handle, tube protractor and distal tool. The handle object of this invention is located at the proximal end of the tool and is composed of a handle, two drive levers, a support that provides rigidity to the handle assembly, a box of mechanism containing the mechanical drive elements and which provides movement to the drive shaft, a wheel of orientation that allows the distal tool to rotate on the axis main tool and support that serves to improve the hand contact and improve ergonomic characteristics. He extension tube connects the handle with the distal tool and is composed of a hollow outer tube and inside is the drive shaft, which is a rigid element. The axis of drive is coaxially arranged with the extension tube and it also moves axially with respect to it when actuate the operating levers. At the distal end of extension tube is the distal tool that opens or closes depending on the opening or closing of the levers of drive with respect to the handle. The distal tool It is composed of both upper and lower claws, and has a drive mechanism located at the same distal end and which transforms the axial movement of the drive shaft into the opening and closing movement of the operation tool.

In one embodiment, the distal tool It comprises two claws that rotate both on the same fixed axis to open or close. The drive shaft moves closer one of its ends to the claws. Each of the claws connects its end to the nearest end of the drive shaft by a small connecting rod and in this way the movement of translation of the drive shaft in rotation of the claw.

An important innovation of this tool lies in the improvement it provides in aspects of ergonomics and touch sensitivity compared to other tools existing. Therefore, the first objective is to provide a handle Comfortable that reduces surgeon muscle fatigue during Your interventions The tool object of this invention Provides all easy-to-reach manual controls by the index and thumb fingers of the surgeon's hand. Besides, the hand grip is done in a posture that provides adequate clamping force along with ergonomic features The most sensitive fingers of the hand, In addition to providing a certain degree of support, they are used mainly for opening and closing the tool operation, while the rest of the fingers are used in the firm grip of the tool. The tool is fastened with virtually the entire surface of the hand resting on the handle assembly and two operating levers. The handle has a cross section that allows you to grab it surrounding it with enough firmness and comfort with your fingers Heart, ring and little finger. On this handle the drive levers one and two so that they can rotate on handle allowing the tool to open and close the distal tool. Once the levers of actuation on the handle the arrangement is such that the shaft main handle is perpendicular, or approximately perpendicular, to the main length of the two levers of drive on which the drive fingers rest. He actuation of the operating levers is achieved pressing with the thumb and index finger, placing each of them on one of the respective drive levers. By therefore, the operating levers have a surface on the that support your fingers that is smooth and ergonomically adapted to your shape. The drive levers have relative movement the one with respect to the other, but also this relative movement between them is synchronized so that the relative position of both is always symmetric with respect to the central plane of tool symmetry This synchronization is achieved through of the drive mechanism that coordinates the movement of the two drive levers and has the additional advantage that the tool can only be operated with one of the fingers, forefinger or thumb, if necessary. So, the surgeon's hand you can grab the fixed part of the handle with the three fingers mentioned, heart, ring and little finger, and the two levers of thumb drive on one of them and the index over the other. When the operating levers do not have a spring for opening, they will have two surfaces of finger support, keeping index and thumb fingers confined between both surfaces on each of the levers of drive A surface allows closing by pressure with the palmar area of the fingers and the other surface allows the opening of the distal tool by pressing the zone dorsal of the fingers. Both surfaces are adapted ergonomically to the shape of the fingers and pressure will be exerted on them, in one case closing the fingers to get the closure of the distal tool and in the other case opening the fingers to Get the opening. The opening surface of the levers of drive will not be necessary when the tool has A spring for opening. Sometimes it can be it is necessary to exert greater force during the closing of the tool of operation, for this the operating levers have an additional support that allows to use the middle finger, in addition to the index finger on the same drive lever. Each of The two drive levers must be ergonomically adapted to the two drive fingers, index and thumb, since these fingers will change the drive lever when the tool is drive with the right hand or the left hand.

In summary, the clamp provides all three Main innovative features to the tool: (1) provides sufficient firmness in the tool grip and allows its handling, (2) allows practically support complete the hand avoiding areas of higher tension, and (3) allows use the thumb and the finger as the operating fingers of the claw index finger, fingers that from an ergonomic point of view They provide greater tactile sensitivity. These features can  be fulfilled independently in other existing tools at present, but not all three together as is the case with the tool object of this invention.

Another innovation present in this tool is that the internal opening and closing drive mechanism of the distal tool is not a simple lever, which allows regulate the movement according to the opening position of the distal tool and manual actuation opening. This shape improves the mechanical advantage of the tool without increasing the mechanical comfort of the system The mechanism is simple, the number of parts that compose it is low and are easy to manufacture and  mount. In addition, the arrangement of these pieces provides a great  precision in movement. In other existing tools the drive mechanism is a simple lever that only provides an amplification of the force exerted, but does not regulate the force depending on the opening position of the tool. The mechanism of this new tool allows the regulation of force depending on the opening of the tool providing an improvement in touch sensitivity by modifying the advantage mechanics in the transmission of movement.

It is also presented as an innovation in the tool a drive wheel located at the end proximal of the tool for the orientation of the tool distal They are intended to allow tool rotation distal up to 360º with respect to the main axis of the tool during handling, to allow operating on the desired area in the most appropriate address. This prevents the awkward turn of The surgeon's wrist. This wheel spins the axis of drive, which in turn rotates the extension tube and the distal tool with its drives. Compared to others drive wheels on similar tools this is distinguished for its location on the back of the tool and for have a larger surface to be operated with the finger thumb or, alternatively, with the index finger. In this way the surgeon can easily trigger the rotation of the claw to it time holding the tool with one hand.

The surgery tool handle subject to This invention can be used with or without a spring for opening and retention mechanism In the case of using a spring for the tool opening sensitivity features Touch may be diminished. However, the handle allows It is also setup. In this case the levers of drive does not require a surface to press with the dorsal area of the fingers during the opening, since this operation will be performed by the opening dock. As dock of opening you can use a sheet of small thickness on the handle that internally presses the levers of drive to force them to turn outward and keep the opening position when no force is applied Exterior. A mechanism is incorporated together with the opening spring  retention or ratchet that can be operated by the surgeon to retain the position of the distal tool in any position. This retention mechanism is formed by one of the drive levers that are given a tooth shape of saw on its outside and a ratchet that can be approached or zoom out retaining or not the position of the levers of drive When the retention mechanism is deactivated surgeon should exert sufficient pressure with the index fingers and thumb over the respective drive levers to beat spring force and close the distal tool. To obtain the opening of the operation tool is enough to stop press on the levers. When the mechanism of retention is activated and no pressure is exerted with the index fingers and thumb, both the operating levers and the tool distal remain in the position they were in when they I activate this mechanism. However, it is possible to continue closing the distal tool by applying a superior force with the index and thumb fingers on the respective levers of drive This way the tool closes step by step, corresponding each step with the rotation of the equivalent levers to the passage of a sawtooth of the retention mechanism and being retained in each of these positions.

Brief description of the drawings

It will be described below, by way of non-limiting example, an embodiment of the invention, making reference to the attached drawings, in which:

Figures 1-5 show several perspectives of the tool object of this invention for use in endoscopy and laparoscopic surgery;

Figure 6 shows the drive of the drive levers for tool opening distal;

Figure 7 shows the drive of the drive levers for tool closure distal;

Figure 8 shows an internal perspective of the drive mechanism together with detail A of this same extended mechanism;

Figure 9 shows a perspective of the tool and drive the rotation of the distal tool by means of the orientation wheel;

Figure 10 shows a perspective of traditional tool with ring handle held by the hand of the surgeon;

Figures 11 and 12 show two different perspectives of the tool object of the invention held by the surgeon's hand;

Figures 13 and 14 show a profile view and plant the tool assembly held by the hand of the surgeon in closed position;

Figure 15 shows a plan view of the tool held by the surgeon's hand, similar to the view presented in figure 14 but in the open position of the tool;

Figures 16 and 17 show a profile view of the tool held by the surgeon's hand. In figure 17 increasing the pressure exerted on the distal tool by means of application of the middle finger along with the index on the lever drive;

Figure 18 shows a profile view of the tool held by the surgeon's hand and driving the wheel of orientation;

Figure 19 shows a perspective exploded representing the mounting of the handle, support, operating levers, mechanism box and support;

Figure 20 shows an exploded profile of the assembly of the mechanism box and the support on the handle and the two drive levers already assembled;

Figure 21 shows a perspective exploded representing the assembly of the cranks of the mechanism and the slide that constitutes the central support of the axis of drive;

Figure 22 shows a perspective exploded from the orientation wheel assembly, the cover of the mechanism and assembly housing formed by the shaft drive, the extension tube and the distal tool, on the  mechanism case;

Figure 23 shows a perspective exploded from the orientation wheel assembly on the shaft drive and on the mechanism box;

Figure 24 shows a section of the tool for its main plane of symmetry showing the scheme inside of it;

Figure 25 shows a perspective exploded mounting a tool variation with two pivots on the handle;

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Figure 26 shows a perspective exploded mounting the bottom of the handle of the tool when using an opening spring and mechanism ratchet retention;

Figure 27 shows the perspective of the operating lever containing the saw teeth of the retention mechanism and recess for the opening spring;

Figure 28 shows a perspective exploded mounting of the retention mechanism located above the support;

Figures 29 and 30 show two perspectives of the retention mechanism located on the support; Y

Figure 31 shows the position of the hand of the surgeon to activate or deactivate the retention mechanism.

Description of preferred embodiments

Figs. 1 to Fig. 5 show some Overview of the tool for laparoscopic surgery or endoscopic object of this invention. The tool in general It will consist of the handle assembly (40), located in the proximal end, extension tube (14) and distal tool (17) located at the opposite end of the handle. The mango in turn is composed of a series of pieces where the most important since the functional point of view are the handle (1), the two levers drive, (3) and (4), the mechanism box drive, formed by the box itself (5) and its cover (22), and the orientation wheel (13). In Figs. 1 to 5 also the support (6) that allows the surgeon a firm hold is appreciated of the tool.

Fig. 6 and Fig. 7 show respectively the way of actuating the handle for opening and closing the distal tool (17). This operation is performed through the manual operation of the levers (3) and (4) of the tool. In this way when the levers open turning around its pivot out of the tool, as shown by arrows (6A) on the operating levers in Fig. 6, the Distal tool opens as indicated by the arrows (6B). When the  drive levers close, approaching simultaneously towards the inside of the tool, as shown by the arrows (7A) on the levers in Fig. 7, the distal tool (17) is Close as indicated by the arrows (7B). The movement of the levers of drive (3) and (4) is not independent but is synchronized and is symmetric with respect to the central plane of tool symmetry This synchronization is guaranteed by the tool drive mechanism shown in the Fig. 8 and in detail A. How can the mechanism of drive is placed in the mechanism box (5), above the drive levers (3) and (4) and connected to them so that can transmit its movement. The operation of this mechanism is seen in detail A of Fig. 8. The movement for opening and closing the operating levers (3) and (4) manually operated transforms into an axial movement of the shaft drive (15) inside the mechanism housing (5) and (22). This drive shaft (15) coaxially travels along the inside of the extension tube to become the opening and closing movement of the distal tool (17). At detail A of Fig. 8 can be seen the connections that make the rotation of the operating levers (3) and (4) actuate the movement of the two connecting rods (9). These cranks (9) transmit the movement to the slide (12) since they are connected to the latter by means of two pivots at the bottom of said sliding (12). The slide (12) is connected at its top with the drive shaft (15) through a slot, transforming the movement of the cranks (9) in a displacement movement Axial shaft (15). Connecting rods of the drive mechanism (9) they are fixed to the operating levers (3) and (4) by means of screws (10) that allow relative rotation between these elements. This mechanism, in addition to guaranteeing the symmetrical movement of the operating levers (3) and (4) with respect to the central plane tool symmetry, allows the drive of Opening and closing of the tool can be provided by acting  on the two levers at the same time, or only on one of they.

Fig. 9 shows the rotation drive of the distal tool (17) on the axis of the extension tube. This movement allows turning the distal tool (17) up to 360º around the axis of the extension tube by actuating the orientation wheel (13). The orientation wheel (13) is located in the proximal area of the tool and connects coaxially with the drive shaft (15) inside the box of the mechanism formed by the elements (5) and (22). The connection between the drive wheel (13) and drive shaft (15) allows the relative movement of both in the axial direction of the axis of drive However, the relative rotation movement between them is impeded, and therefore when the wheel of orientation (13) rotates, so does the drive shaft (15) turning the extension tube (14) and the tool in turn distal (17). For this, the axis (15) has a tab on its connecting end with the orientation wheel (13) that prevents the relative rotation movement between them.

Fig. 10 shows an example of a tool for laparoscopic ring handle surgery found currently on the market and the way of securing this tool by hand. The way of holding the tool of the Fig. 10 is the most common when the tool does not contain spring for easy opening. Fig. 11 and 12 show the way of holding the tool object of this invention by the Surgeon's hand. As can be seen in Fig. 11 and Fig. 12 hand contact with the tool is almost complete and uniform, preventing localized areas of increased pressure in the hand as it happens in tools like the one represented in the Fig. 10. The palm of the hand and the fingers heart, ring and little finger firmly surround and hold the handle (1), while the finger thumb rests on the operating lever (3) as seen in Fig. 11, and the index finger rests on the lever of drive (4), as seen in Fig. 12. In this way both fingers, thumb and index, are used for opening and closing of the tool. This hand arrangement provides the ergonomics and sensitivity characteristics, since the tool is held in a relaxed position of the hand and with a contact continuous on a surface that adapts to the shape of the hand. In addition, the use of the most sensitive fingers, index and thumb, for the opening and closing operation guarantees the improvement of the touch sensitivity of the tool.

Fig. 13 shows a profile view of the tool and its hand grip and in Fig. 14 and Fig. 15 a plan view of the tool and its clamping is shown in the closed and open position respectively. If the tool does not It has a spring to facilitate opening it is necessary that operating levers (3) and (4) have external support for the thumb or index finger. This external supports (3a) and (4a) of the operating levers can be easily seen in the plan view of Fig. 15 externally circling the fingers located on said drive levers. This way when the index and thumb fingers open away from the central plane of the tool, drag the drive levers (3) and (4) pressing with the dorsal part of these fingers on said supports exterior (3rd) and (4th). These outer supports of the levers of drive must be smooth and adapt to the outer shape of fingers to avoid areas of high pressure, and at the same time allow comfortable movement of the fingers for opening and closing  of the tool.

Fig. 16 and Fig. 17 shows how the lever external drive (the furthest from the surgeon's body) it can be operated only with the index finger as indicated by the Fig. 16, or additionally using the middle finger as indicated by the Fig. 17. The latter case represents the position of the hand only if necessary apply a greater force to close the distal tool (17).

Fig. 18 shows the wheel drive orientation (13) using the thumb. This wheel allows the finger support on a larger surface than other wheels used in current tools, bringing finger pressure Thumb is less for the same force exerted. Alternatively the index finger can be used for the movement of this wheel of orientation.

In Fig. 19 the structure of assembly of the lower part of the handle. At the bottom of the Fig. 19 the handle (1) is observed. At the upper end of this handle exists a pivot (the) to allow the placement of the support (2) and drive levers (3) and (4). In the upper horizontal surface of the pivot there is a threaded hole (1b) which allows the mechanism case (5) to be fixed later and the support (6) with a threaded joint or screw (7). Before the positioning of the operating levers on the handle (1) the support (2) must be placed. The mission of this support is provide greater rigidity to the handle assembly. This stand It has an angular shape and has a through hole in one of its ends that allow you to insert it into the pivot of the handle (the). The support contains a cylindrical projection (2a) in its part bottom that fits into an existing hole (1c) over the intermediate horizontal surface of the handle (1) with the aim to prevent the relative rotation between said handle and the support (2). The other end of the support (2) contains a vertical support and at its upper end there is a threaded hole (2b) that allows its fixing to the mechanism housing (5) by means of a screw (8). A Once the support (2) is placed on the pivot of the handle, place the operating levers (3) and (4). With this object the drive levers contain a through hole in a end that fits the pivot of the handle (1). The handle (3) It contains a recess in its lower part to allow the rotation without collide with the support (2). The geometric shape of the levers drive is not symmetric so they should be placed in rigorous order, the drive lever (3) is first introduced and then the drive lever (4) is introduced. In this arrangement the two operating levers (3) and (4) can turn freely on the pivot of the handle (the). At the same time, as can be seen in Fig. 19, at the top of the drive levers are located two pivots (3b) and (4b) with in order to subsequently place the connecting rods of the transmission (9). Finally, as shown in the perspective exploded in Fig. 19 and in the profile view of Fig. 20 the mechanism box (5) is placed on two points and fixed by screws. One of these points is the handle (1), on the upper end of its pivot (the), the other point is the end upper (2b) of the support (2), in this last support is fixed with a screw (8) once the mechanism box (5) is located. TO the support (6) is then fitted on the proximal hole (5a) of the mechanism box and screwed with the screw (7) leaving a solid union of the entire lower handle assembly. With this phase, the first part of the assembly ends continuation to the assembly of the transmission mechanism inside of the mechanism box (5).

In Fig. 21 the perspective of the explosion of the transmission mechanism whose mission is to transmit the hand movement, when the levers of drive (3) and (4), up to the drive shaft (15). For greater clarity in the illustration in Fig. 21 the section has been sectioned box (5). The holes (9a) of the connecting rod mechanism transmission (9) are introduced in the pivots (3b) and (4b) mentioned  previously and that are located at the top of the drive levers (3) and (4). These pivots of the levers drive reach inside the mechanism box (5) thanks to the partial opening that this box tempts in its part lower. This partial opening of the mechanism box (5) must also allow the free movement of rotation of the levers of drive without any collision in its range of Opening and closing. Both cranks of the mechanism (9) are fixed to the operating levers (3) and (4) for the placement of the screws (10) and washers (11). These fixations prevent the connecting rods move axially with respect to the pivots of the drive levers, but allow relative movement of rotation of said connecting rods around the pivots. At its end opposite, the cranks of the mechanism (9) contain two holes (9b), similar to those used for pivot placement of the operating levers. In these two holes you insert the slide (12), fitting each of the pivots (12a) containing said slide in its lower part in the respective holes (9b) of the connecting rods. In this way the cranks of the mechanism (9) have a relative rotation movement with with respect to the slide (12). On top of the slide (12) there is a notch (12b) in semicircular shape that it allows a groove of the drive shaft (15) to be fitted.

Fig. 22 shows the exploded perspective of the extension of the extension tube (14), the drive shaft (15), the orientation wheel (13) and the top cover (22). In first the orientation wheel (13) is inserted in the part drive shaft rear (15). To do this the wheel of orientation (13) has a circular hole (13a) where you can adjust the end of the drive shaft (15). How can observed more clearly in the detail of Fig. 23, in addition from the circular hole the orientation wheel contains a groove of the same length as the hole to insert the axis of drive (15) and its depth reaches the hole itself (13a). This slot is intended to insert the tab (15a) of the drive shaft end (15). With this provision, once  the drive shaft (15) is inserted in the orientation wheel (13), the drive shaft can move axially with with respect to the latter, but when the orientation wheel (13) rotates on the drive shaft both, orientation wheel and drive shaft, experience the same rotation. The axis of drive (15) joins the distal tool (17) and the tube extension (14) at the opposite end of the orientation wheel  (13). This union is done through the mechanism of the distal tool (19) that transforms the axial movement of the shaft drive (15) in the opening and closing movement of the operation tool (17). The orientation wheel assembly (13), drive shaft (15), extension tube (14) and the distal tool (17) and its drive mechanism (19) are inserted in the mechanism box (5) based on three points. Two of these points are the fixed supports and are on the sides opposite of the mechanism case (5b) and (5c) respectively. He third point is mobile and it is the top of the slide (12) belonging to the drive mechanism previously described. As shown in detail in Fig. 23, the drive shaft (15) fits into the slide (12) in the upper groove (12b) that it has in a semicircular shape. To its time, as seen in the same figure, the drive shaft (15) contains a protrusion (15b) at its contact point with the slide (12), which allows the rotation of said axis with respect to its axis but not the relative displacement in the axial direction with with respect to the slide (12). In this way, when the slide (12) moves due to the actuation of the two operating levers (3) and (4), is transformed into a movement in the axial direction to the drive shaft (15), the latter activating the system (19) for opening and closing the distal tool (17). When the orientation wheel (13) is drives the drive shaft (15) in its rotation movement also rotates, but the slider (12) does not move if the drive levers remain static. Therefore this system guarantees the independence of the two drives of the distal tool, opening-closing and turning orientation.

As can be seen in Fig. 23, the fixed supports (5b) and (5c) on which the extension tube (14) and the orientation wheel (13) respectively on the box of the mechanism (5) have semicircular shape. For the correct operation of the extension tube (14) and the orientation wheel (13) have two recesses, (14a) and (13c) respectively, which allow adjustment in the mechanism box (5). When the cover of the mechanism box (22) is adjusted with the screws (25) and the washers (26) the extension tube (14) and the orientation wheel (13) can rotate when the latter is operated manually, but they are retained in the axial direction of the tool.

Fig. 24 shows a sectional view of the tool for its central plane of symmetry. This figure allows observe the arrangement of the different connections between elements previously described inside the box of the mechanism. The top cover (22) contains the connection for cauterization (23) that can be easily connected to the axis of drive via a plate (24). The current of cauterization is carried to connection (23) in the usual way to the distal tool for which its description is unnecessary

Fig. 25 shows a configuration alternative of the surgery tool where each of the drive levers (3) and (4) are inserted in their respective pivot (le) and (1d) on the handle (1). In this configuration the drive levers have a symmetrical geometry with with respect to the central plane of symmetry of the tool and allows improve the characteristics of force transmission to the operation tool (17). Also the support (2) and the box of the mechanism (5) must contain the respective holes to be inserted on the handle (1). Except the bottom of the handle shown in Fig. 25, the rest of the tool is not visible practically affected by this alternative modification.

Although the best features of Touch sensitivity are reached without spring for opening the drive levers, this can be easily implemented in the handle of the surgery tool object of this invention. As seen in the exploded perspective of Fig. 26, the configuration of the lower part of the handle is altered when this opening spring (30) is introduced. In this case it is observed in said Fig. 26 that the drive levers do not require support surface of the fingers for opening, since this operation is performed by the dock. The opening spring (30) it consists of a metallic element of small thickness that contains a circular zone (30a) and extends into two straight arms (30b), which will be located on the respective drive levers. As seen in Fig. 26, the opening spring (30) is mount just after the bracket (2) and the operating lever (3), so that the circular area of the spring surrounds externally to the pivot (the) of the handle (1) and internally to the lever drive (3) being placed in a recess (3d) made to such effect. One of the arms of the opening spring (30b) fits in the extension of the recess (3d) of the operating lever (3). Finally, the operating lever (4) is fitted by fitting the other arm (30b) of the opening spring (30) on a recess similar to that of the other operating lever (3). With this mount it is necessary to apply pressure on the operating levers to bring them closer since the spring (30) applies a torque that tries separate them.

The drive lever (3) must contain in this case a sawtooth finish (3c) in its part bottom so that the ratchet mechanism acts on he. This sawtooth finish (3c) can be seen both in Fig. 26 as in Fig. 27, the latter shows the operating lever (3) in detail.

In Fig. 28 it is observed that the support (2) It is also modified when the opening spring is inserted (30). In this case the support (2) contains the mechanism of ratchet retention. The exploded perspective of this mechanism can be seen in detail in this Fig. 28 and contains, in addition to the support itself (2): the trigger trigger (31), the ratchet head (32), a compression spring (29), a spring of flexion (27) and the fastening screw of the latter (28). He bending spring is placed on the groove (2c) of the support (2) and is secured with the screw (28). The compression spring (29) and the ratchet head (32) is introduced in this order in the support hole (2d) and are retained by contact between the flange (27a) of the bending spring (27) and the flange (32a) of the ratchet head (32). The trigger of the ratchet (31) rotates around its hole (31a) located above the pivot (2e) on the support (2). The pivot (32b) is introduced into the slot (31 b) of the drive trigger (31). Thus when the trigger (31) rotates around the support (2) the cam formed by (32b) and (31b) axially displaces the head of the ratchet (32). Fig. 29 and Fig. 30 show two perspectives of the support and ratchet assembly. Once assembled complete with the handle, the ratchet is deactivated in the configuration of Fig. 29 and Fig. 30, since the head of the ratchet (32) and its saw teeth (32c) do not come in contact with the saw teeth (3c) of the drive lever (3). In this case, the surgeon can freely open and close the drive levers (3) and (4). During this operation the spring (30) will slightly oppose the closing of the tool when the surgeon press with your index fingers and thumb the respective drive levers. On the other hand, the pier it will help its opening, avoiding the need for the surgeon press with the dorsal part of the fingers in this operation. Ratchet drive is achieved when the surgeon push the trigger (31) with the middle finger, or alternatively with another finger of the same hand, towards the distal end of the tool, and with sufficient force to overcome the retention exerted by the bending spring (27) using the tab (27a). When you perform this operation the head of the ratchet (32) is pushed by the compression spring (29) fitting your saw teeth (32c) into the tooth finish of saw (3c) of the drive lever (3). In this way the operating lever (3) is retained by the pressure of the compression spring (29) and ratchet head (32), retaining in turn to the operating lever (4) and therefore preventing the opening or closing of the distal tool (17). However the surgeon can continue to close the tool if you apply a enough force with your index fingers and thumb over the respective drive levers (3) and (4). If this force is enough the ratchet head can be pushed back (32) overcoming the pressure exerted by the compression spring (29). From this way the tool can be closed point to point each point corresponding to the angle rotated by the levers of actuation when exceeding a sawtooth of the mechanism of ratchet. To deactivate the ratchet mechanism it is only it is necessary to push the trigger (31) with your finger heart towards the proximal end of the tool as shown in Fig. 31.

Although in the present report only represented and described particular embodiments of the invention, the person skilled in the art will know how to introduce modifications and replace some technical characteristics with equivalent ones, depending on the requirements of each case, without departing from the scope of protection defined by the appended claims.

Claims (15)

1. Handle (40) for a distal endoscopic or laparoscopic surgery tool (17), comprising means for manually activating said distal tool, said means comprising a handle (1) and two levers (3, 4) that move in solidarity, they are configured to actuate the distal tool together and are symmetrically arranged one on each side of the handle, so that one of the levers is configured to be operated by the thumb and the other lever is configured to be operated by the index finger, and each lever is configured to be operated both by opening and closing the operating finger, while the handle is configured to be grasped by the other three fingers, heart, ring and little finger, together with the palm of the hand, characterized by the fact that each lever (3; 4) comprises an outer arm (3a; 4a) and an inner arm that define substantially separate and smooth surfaces for the support of the finger, which can be housed between said surfaces, which are configured to provide a substantially maximum area of contact with the dorsal and palmar areas of the finger during the entire movement of opening or closing the lever, so that the finger can exert a substantially uniform opening force on the outer arm and a substantially uniform closing force on the inner arm. 2. Handle according to claim 1, characterized in that each lever (3; 4) is articulated to the handle (1) in the proximal part of the lever. 3. Handle according to claim 2, characterized in that the handle (1) comprises a pivot (1a) in which the two levers (3, 4) articulate. 4. Handle according to claim 2, characterized in that the handle (1) comprises two pivots (1d, 1e) on each of which one of the levers (3, 4) is articulated. 5. Handle according to claim 3, characterized in that it comprises a support (2) provided with a through hole in one of its ends that is inserted into said pivot (1a). 6. Handle according to claim 4, characterized in that it comprises a support (2) provided with two through holes at one of its ends each of which is inserted into one of said pivots (1d,
1e). 7. Handle according to claim 5 or 6, characterized in that said support (2) comprises at its other end an angular appendix that serves as a reinforcement to the handle. 8. Handle according to any of the preceding claims, characterized in that the outer arm (3a; 4a) of each lever (3; 4) is connected to the inner arm thereof by an upper strip. 9. Handle according to any of the preceding claims, characterized in that the inner and outer arms of each lever (3; 4) are symmetrical with each other. 10. Handle according to any of the preceding claims, characterized in that at least one of the levers (3; 4) comprises an additional arm for the middle finger that is an extension of the inner arm, so that the middle finger also can operate the lever together with the index finger. 11. Handle according to claim 10, characterized in that each lever (3; 4) comprises said extension, the two extensions being symmetrical with each other. 12. Handle according to any of the preceding claims, characterized in that it comprises an orientation wheel (13), located in the proximal area of the handle above the two levers (3, 4), which allows the distal tool to rotate (17), the surface of said orientation wheel (13) being a surface of revolution and substantially semi-elliptical, which can be operated by the thumb of the same hand that holds the tool while the handle is held firmly with the rest of the hand. 13. System for endoscopic surgery or laparoscopic comprising a handle (40) according to any of the previous claims, an extension tube (14), and a distal tool (17) located in the distal region of said tube (14) and operated by said handle through the extension tube, of so that the actuation of the levers (3; 4) is transmitted to the distal tool (17) through a drive shaft (15), whereby the drive shaft moves coaxially along the inside the extension tube (14) to produce a movement of opening and closing of the distal tool. 14. System according to claim 13, characterized in that the movement of the levers (3; 4) is transformed into a displacement of the drive shaft (15) by means of two connecting rods (9) fixed to the levers by a end, said connecting rods being connected to a slide (12) at its other end by two pivots (12a) provided in the lower part of said slide, so that the connection between the upper part of the slide and the drive shaft makes it possible the relative movement of rotation between them but prevents the relative movement of both in the axial direction of the drive shaft. 15. System according to claim 13 or 14 characterized in that the orientation wheel (13) is connected to the drive shaft (15) by means of a connection (13a, 13b, 15a) that allows the relative movement of both in the axial direction of the drive shaft but prevents relative rotation movement between them.