GB2320683A

GB2320683A - Surgical stripper for use under endoscopic observation

Info

Publication number: GB2320683A
Application number: GB9727223A
Authority: GB
Inventors: Teruo Ouchi
Original assignee: Asahi Kogaku Kogyo Co Ltd
Current assignee: Pentax Corp
Priority date: 1996-12-25
Filing date: 1997-12-23
Publication date: 1998-07-01
Also published as: GB9727223D0; GB2320683A8; DK152997A; DE19757676A1; JPH10179594A

Abstract

A surgical stripper, which is used under endoscopic observation to strip an internal objective part within a body cavity from the surrounding connective tissue with safety, includes a part (21) insertable into a trocar (1), brush hairs (22) implanted on the top end of the insert part, and a grip (23) connected to the base of the insert part.

Description

- i - SURGICAL STRIPPER FOR USE UNDER ENDOSCOPIC OBSERVATION 2320683 The

present invention relates to a surgical stripper for use under endoscopic observation, which is adapted to be inserted into a trocar for stripping the internal organ or the like in the body cavity from the surrounding connective tissue under endoscopic observation.

In recent years, surgery under endoscopic observation has been widely employed for various medical and surgical treatments such as extirpation of the gallbladder since such surgery under endoscopic observation can be carried out without a large incision. Surgery under endoscopic observation is typically carried out such that a plurality of thin and tubular trocars, into which surgical instruments and an endoscope are inserted, are stuck into the somatic wall. As one of surgical instruments, a hook-shaped or spatula-shaped high frequency stripping forceps is used to strip or remove the internal organ or the like, which is an object of the operation, from the surrounding connective tissue by picking up the surrounding connective tissue and by applying high frequency current into the thus picked-up tissue therethrough. Such hook-shaped or spatulashaped high frequency stripping forceps are disclosed, for instance, by "ILLUSTRATED HANDBOOK OF LAPAROSCOPIC & THORACOSCOPIC SURGERY" and "SURGICAL LAPAROSCOPY".

However, the use of the high frequency stripping forceps requires a doctor to have skill and experience since a socalled accidental injury such as cutting and bleeding may be caused if a high frequency current is applied under a condition that the forceps carelessly contacts with the cystic duct, the cystic artery, or the like. Since the doctor generally operates the high frequency stripping forceps while watching a TV monitor indicating a two-dimensional image obtained by a rigid endoscope or an electronic endoscope, the doctor must judge the depth direction through his skill and experience.

Accordingly, an object of the present invention is to provide a surgical stripper adapted to be inserted into a trocar for use under endoscopic observation, which can strip the internal organ or the like from the surrounding connective tissue with safety.

According to an aspect of the present invention, there is provided a surgical stripper under endoscopic observation, which is adapted to be inserted into a trocar for stripping the internal organ or the like within the body cavity from the surrounding connective tissue. Brush hairs are provided at the top end of the insert part, and a grip is connected to the base of the insert part.

It is preferable that the inserted part has a diameter of less than or equal to 12 mm and a length of less than or equal to 500 mm. it is preferable that the insert part has a diameter of more than or equal to 5 mm and has a length of more than or equal to 250 mm.

An opening, which is used for at least one of sucking a liquid or the like out of a body cavity and ejecting a liquid into the body cavity, may be provided at the top end of the insert part. In such case, the opening can be formed at a position encircled by the brush hairs. The opening may be formed at a position outside the area where the brush hairs are provided, so that the opening is directed forwardly.

Further, control means for controlling at least one of sucking treatment and watersupplying treatment via the opening may be provided at the grip.

A portion where the brush hairs are provided may be removable from the top end of the insert part.

Moreover, a plurality of members having brush hairs provided in different shapes may be prepared so that they can selectively attached to the top end of the insert part.

The brush hairs may be provided elliptically bent shaft. Further provided on a distal end of the top end of the insert part.

Since the insert part adapted to be inserted into the trocar is formed such that the brush hairs are provided at the top end of the insert part, it is possible to safely strip the internal organ or the like in the body cavity from the on a i-shaped shaft or the brush hairs may an be - 4 surrounding connective tissue under the endoscopic observation by rubbing them with the brush hairs.

Additionally, in case where the sucking and/or liquidsupplying opening is provided at the top end of the insert part, it is possible to easily eliminate a spot due to bleeding or the like at the part to be stripped and thus to secure the clear field of vision for the endoscopic observation.

Moreover, in case where a member on which the brush hairs are provided is removably attached to the top end of the insert part, it is possible to facilitate washing and replacement of the brush hairs provided. Further, if a plurality of members having brush hairs provided in different shapes are selectively attachable on the top end of the insert part, it is possible to select a suitable one from the plurality of members depending on the location where it is to be used.

The present disclosure relates to the subject matter contained in Japanese patent application No. P08-344771 filed on December 25, 1997, which is expressly incorporated herein by reference in its entirety.

Examples of the present invention will now be described with reference to the accompanying drawings, in which:- Fig. 1 is a side view of a surgical stripper for use under endoscopic observation.

Fig. 2 is a schematic illustrational view of a surgery apparatus under endoscopic observation in which the stripper shown in Fig. 1 is used.

Fig. 3 is a front view of the stripper shown in Fig. 1.

Fig. 4 is a sectional side view of the top end of the stripper shown in Fig. 1.

Fig 5. is a sectional underside view of the top end of the stripper shown in Fig. 1.

Fig. 6 is a perspective view showing a utilized state of the stripper shown in Fig. 1.

Fig. 7 is a sectional side view of the top end of a second stripper.

Fig 8 stripper Fig. wherein a Fig.

is a sectional undersideview of the top end of the shown in Fig. 7. 9 is a side view of the stripper shown in Fig. 7, control valve is depicted as a sectional view.

is a sectional side view of the control valve at a sucking state.

Fig. 11 is a sectional side view of the control valve at a water supplying state.

Fig. 12 is a sectional side view of the top end of a third stripper.

Fig. 13 is a sectional side view of the top end of a fourth stripper.

Fig. 14 is a sectional side view of a control valve in a fifth stripper.

Fig. 15 is a perspective view of the top end of a sixth stripper.

Fig. 16 is a perspective view of the top end of a utilized state of a seventh stripper.

Fig. 17 is a side view of the top end of an eighth stripper.

Fig. 18 is a side view of the top end of a ninth stripper.

Fig. 19 is an exploded, perspective view of the top end of the stripper shown in Fig. 1.

Fig. 2 shows an arrangement of surgical instruments under endoscopic observation. Reference numeral 1 designates a trocar that is stuck or passed through the somatic wall 100 from the outside such that the top end thereof reaches the inside of the body cavity.

The trocar 1 is tubular with a collar at its proximal end side (operator side or side located externally when the trocar 1 is inserted into the body cavity) In the case shown in Fig. 2, four trocars 1 are utilized.

An endoscope 2 is inserted into a first trocar 1, which allows the surgery area within the body cavity to be observed from the outside of the body.

A rigid endoscope is used as the endoscope 2 inserted into the trocar 1 in this case. Image signal captured by a TV camera attached to an eyepiece part is processed in the video processor 3, so that an observed image with the endoscope is indicated in the TV monitor 4. Reference numeral 5 designates a pneumoperitoneum device f or supplying air into the body cavity via a channel of the endoscope.

A high frequency treatment tool 6 for cutting or the like within the body cavity is inserted into a second trocar 1. An electro-surgical unit 7 is connected to the high frequency treatment tool 6 as a power source thereof. The sucking device 8 and the water supplying device 9 are connected to the high frequency treatment tool 6 for performing sucking and water supplying via the high frequency treatment tool 6.

A clip device 10 for suture or the like is inserted into a third trocar 1, which can be remote -controlled from the outside of the body to suture a region cut by the high frequency treatment tool 6.

A stripper 20 is inserted into a fourth trocar 1. The stripper 20 has an inserted part 21 adapted to be inserted into the trocar 1, on the top end of which brush hairs 22 are provided and to the proximal end side of which a grip 23 is connected. The stripper 20 may be designed to possess the suck function and water-supplying function, and in this case the sucking device 8 and the water supplying device 9 are connected to the stripper 20.

Fig. 1 and Fig. 3 are a side view and a front view of the stripper 20, respectively. The insert part 21 is constituted such that a brush rod 24 on which the brush hairs 22 are implanted is removably attached to the tip of the connecting rod 25. Nylon or the like is used as a material of the brush 1 hairs 22. The brush hairs 22 extend from the brush rod 24 in one direction (downward direction in Fig. 3). The brush rod 24 is bent at a portion 24a so that a horizontal portion of the brush rod 24 is offset in a direction opposite to a direction in which the brush hairs 22 extend from the brush rod 24.

The outer diameter of the insert part 21 is set as less than or equal to 12 mm even at the largest part, taking the inner diameter of the trocar 1 into account. It is preferable that the outer diameter of the insert part 21 is equal to or more than about 5 mm taking strength and practicality into account.

The length L of the insert part 21 is preferably about 300 mm for an intrathoracic surgery. For an abdominal cavity surgery, the length L is preferably not more than 500 mm. However, it is desirable that the length L is equal to or more than about 250 mm taking the length of the trocar 1, etc. into consideration.

Fig. 4 and Fig 5 are a sectional side view and a sectional underside plan view of the insert part 21, respectively. The brush hairs 22 are circularly implanted as shown in Fig 5, when viewed in a direction from the distal end side of the brush hairs 22. The brush rod 24 is inserted into a slot 28 formed at the top end of the connecting rod 25. As shown in Fig. 19, the slot 28 is formed at least in an area where the brush rod 24 is to be inserted.

- 9 Two pins 26 mounted on the connecting rod 25 to traverse the slot 28 engage with expanded spaces of slit 27 axially formed on the brush rod 24. A forwardly-located pin 26 abuts against the forwardly-located expanded space, which is an axial terminus of the slit 27, so as to avoid the excessive insertion of the brush rod 24 into the connecting rod 25. As shown in Fig. 4, the thickness of the brush rod 24 in a longitudinal direction of the pin 26 is equal to or slightly smaller than the thickness of the slot 28. Further, as shown in Fig. 5, the slot 28 extends (passes) across the entire width of the connecting rod 25 in a direction perpendicular to both the longitudinal direction of the pin 26 and the longitudinal direction of the connecting rod 25, and the width of the brush rod 24 is equal to the width of the connecting rod 25 (the slot 28).

Accordingly, the brush rod 24 is normally fixed to the top end of the connecting rod 25 but the brush rod 24 can be removed from the connecting rod 25 if the brush rod 24 is strongly pulled forwardly while the connecting rod 25 is gripped. This removable design facilitates washing and replacement of the brush rod 24, and also selectively alters the brush rods having brush hairs implanted into different shapes.

The stripper 20 thus constituted is used as shown in Fig. 6 where the tip of the brush hairs 22 are pressed on the peripheral tissue 101 such as the cystic duct or the cystic artery and the stripper 20 is reciprocally moved along the axis thereof shown by the arrow A.

The surface of the cystic duct and the cystic artery is hard because, for example, the artery has a three-layer constitution consisting of the inner film, the intermediate film, and the outer film. In contrast, the peripheral tissue is relatively soft and is not covered with the outer film.

Therefore, the peripheral tissue is easily stripped by rubbing it with the brush hairs 22, while the outer film of the cystic duct or the cystic artery is not destroyed even if it is rubbed with the brush hairs 22. It is the same with other internal organs.

Regarding the brush hairs 22, a nylon hair of a diameter from about 0.05 mm to about 0.1 mm is desirable, when the object stripped from the peripheral tissue is a blood vessel or a tube of about 2 mm. A nylon hair of a diameter from about 0. 1 mm to about 0.3 mm is desirable, when the object stripped from the peripheral tissue is a blood vessel or a tube of about 3 mm.

Fig. 7 and Fig. 8 are a sectional side view and a sectional underside plan view of an insert part 21 of another stripper, respectively. An opening 31 for sucking and water supplying is formed at the center of the implanted area of the brush hairs 22.

A passage 33 is formed along the central axis of the connecting rod 25 over the entire length of the connecting rod 25. The rear half of the brush rod 24 is removably inserted 11 - into the top end of the passage 33. A pin 26 mounted on the connecting rod 25 to extend across the passage 33 is engaged with the slit 27 formed on the brush rod 24, similarly to the former stripper shown in Fig. 5. That is, the pin 26 is engaged with the expanded portion formed as an axial terminus of the slit 27.

A communicating bore 32 is opened rearwardly- from the opening 31 and communicated with the opening 31 for sucking and water supplying, and the opening 31 is communicated with the passage 33 of the connecting rod 25 via the communicating bore 32.

As shown in Fig. 9, a control valve 40 is provided in a grip 23 connected to the proximal end side of the connecting rod 25. A control piston 42 is inserted in a cylinder 41 arranged perpendicular to the connecting rod 25 and the grip 23 such that it reciprocally moves along the axis thereof.

One end of the passage 33 passing through the connecting rod 25 is opened at the center position in the cylinder 41. A sucking passage 43 and a water supplying passage 44 are opened in the cylinder 41 at opposite sides with respect to the opening of the passage 33. The sucking passage 43 is communicated with the sucking device 8 via a sucking tube 45, and the water supplying passage 44 is communicated with the water supplying device 9 via a water supplying tube 46.

The control piston 42 is formed with two annular grooves 48 and 49 spaced from each other within the cylinder 41. A plurality of 0-rings for sealing, which are not shown, are mounted on the control piston 42.

Both ends of the control piston 42 project from the cylinder 41. Control buttons 51 and 52 are attached to the projected ends, respectively. Reference numerals 53 and 54 designate compression coiled springs for returning. Reference numerals 55 and 56 designate washers for receiving springs.

Reference numeral 60 is a click mechanism provided for stopping the control piston 42 at the state shown in Fig. 9 wherein the control valve 40 is closed. This mechanism is designed such that a sphere energized by a spring is engaged with a V groove formed in the control piston 42.

The control valve 40 thus constructed is operated such that if the first control button 51 is fully depressed as shown in Fig. 10, then the sucking passage 43 is made in communication with the passage 33 via the first annular groove 48 to make it possible to carry out the sucking from the opening 31 located at the top end of the insert part 21.

If the second control button 52 is fully depressed as shown in Fig. 11, then the water supplying passage 44 is made in communication with the passage 33 via the second circumference groove 49 to make it possible to supply water from the opening 31 located at the top end of the insert part 21.

Accordingly, during the strip work with the insert part 21, a blood oozing out from capillary vessels, etc. is easily sucked and removed so that an excellent field of view under the endoscopic observation is ensured.

in addition, since the brush hairs 22 are placed around the opening 31 for sucking and water supplying, the vessels and internal organs are not attracted directly onto the opening 31 even if a sucking force is large, and therefore a sucking treatment can be performed easiiy and safely.

When a part to be stripped can not be seen due to bleeding, etc. which hinders a field of view under the endoscopic observation, the part may be washed by water supplied from the opening 31, and then the dirty liquid after washing can be removed by sucking.

Fig. 12 shows the top end of yet another stripper 20, wherein the brush rod 24 and the connecting rod 25 are connected together through threading engagement to facilitate removal and replacement of the brush rod 24.

Fig. 13 shows the top end of still another stripper 20, wherein the opening 31 for sucking and water supplying is formed at the tip face of the brush rod 24 where the brush hairs 22 are not implanted. Thus, it is possible to supply water directly and strongly with a diseased part for washing it when, for example, there is heavy bleeding. The sucking can also be carried out quickly.

Fig. 14 shows another control valve 40, wherein the sucking state and the water supplying state are switched each other by 14 - one action, cylinder 41.

The control valve 40 shown in Fig. 14 is designed such that a sucking tube 45 is connected to one end of the cylinder 41, and a vent-hole 61 is bored along the center axis of the control piston 42, which protrudes from the other end of the cylinder 41, so as to pass through the piston 42.

Therefore, even if the sucking device 8 is always activated for the sucking through the sucking tube 45, the sucking device 8 is free from a heavy load, because the ambient air can be sucked through the vent-hole 61. The first annular groove 48 for communicating the sucking tube 45 with the passage 33 is communicated with the vent-hole 61.

To return the control piston 42 to the standby position, a first return spring 53a with a small spring force and a second return spring 53b with a large spring force are mounted on the control valve 40 in series with a washer 55 interposed therebetween.

Therefore, when the control piston 42 is depressed into the cylinder 41 within the range that the first return spring 53a can be compressed, the water supplying tube 46 and the passage 33 are communicated together through the second annular groove 49 to establish the water supplying state.

When the control piston 42 is further depressed within the range that the second return spring 53b also can be compressed under a condition where the vent-hole 61 is closed with a i.e. depressing the control piston 42 into the fingertip, the sucking tube 45 and the passage 33 are communicated together through the first annular groove 48 to establish the sucking state.

A shape of implanted brush hairs 22 is not limited to the above-described strippers. That is, various brush shapes can be used corresponding to a status of a part to be stripped.

For example, the brush hairs 22 may be provided-in a long area as shown in Fig. 15, when the stripper 20 is used at a large region. The brush hairs also may be radially implanted on a i-shaped shaft as shown in Fig. 16, and the brush rod 24 is preferably moved in the lateral direction shown by the arrow B, when a back part relative to the stripper 20 is stripped.

When a small part is stripped, as shown in Fig. 17, the brush hairs 22 may be radially transplanted on the tip of the brush rod 24, and a part to be stripped may be picked by the tip. When a deep stripping is required, as shown in Fig. 18, the brush hairs may be radially implanted on an elliptically bent shaft.

Furthermore, the brush hairs 22 may be vibrated as with an electric toothbrush.

Claims

CLAIMS:

1. A surgical stripper insertable into a trocar for use under endoscopic observation to strip an internal objective part within the body cavity from surrounding connective tissue, said surgical stripper comprising: an elongated insert part; brush hairs provided at one end of said insert part; and grip provided at another end part.

of said insert A surgical stripper according to claim 1, wherein the brush hairs are provided on a top end of the insert part and wherein the grip is provided on a proximal end side of the insert part.

3. A surgical stripper according to claim 1 or 2, wherein said insert part has a diameter of equal to or more than 5 mm and less than 12 mm.

4. A surgical stripper according to any preceding claim, wherein said insert part has a length of equal to or more than 250 mm and less than 500 mm.

5. A surgical stripper according to any preceding claim, wherein said brush hairs are circularly provided when viewed from a distal end side of said brush hairs.

6. A surgical stripper according to any preceding claim, further comprising:

- 1 7 - an opening provided on a top end of said insert part, said opening being communicated with a proximal end side of said insert part.

7. A surgical stripper according to claim 6, wherein said opening is encircled by said brush hairs.

B. A surgical stripper according to claim 6, wherein said opening is located at a position outside an area where said brush hairs are provided, said opening being directed forwardly.

9. A surgical stripper according to claim 6, 7 or 8, further comprising:

means, provided in said grip. for operatively communicating said opening with at least one of an aspiration source and a water-supplying source.

10. A surgical stripper according to any preceding claim, wherein a top end of said insert part includes a first member on which said brush hairs are provided, and a second member removably supporting said first member.

11. A surgical stripper according to claim 10, further comprising:

a third member on which brush hairs are provided in a different configuration, said third member being connectable to said second member in place of said first member.

12. A surgical stripper according to any preceding claim, wherein a top end of said insert part is formed into a J-shaped shaft.

13. A surgical stripper according to any one of claims 1 to 11, wherein said top end of said insert part is formed into an elliptically bent shaft.

14. A surgical stripper according to any preceding claim, wherein said brush hairs radially project from a distal end of a top end of said insert part.

15. A surgical stripper according to any preceding claim, wherein said brush hairs are made of nylon.

16. A surgical stripper according to any preceding claim, wherein said brush hairs are provided in a long area, of greater length than width.

17. A surgical stripper substantially as hereinbefore described with reference to the accompanying drawings.