GB2459902A

GB2459902A - A laparoscopic tool for hernia repair

Info

Publication number: GB2459902A
Application number: GB0808538A
Authority: GB
Inventors: George Bazoua
Original assignee: Individual
Current assignee: Individual
Priority date: 2008-05-10
Filing date: 2008-05-10
Publication date: 2009-11-11
Also published as: GB0808538D0

Abstract

A laparoscopic tool 10 for use in repairing an abdominal wall hernia, comprises a plurality of semi-rigid elongate support members 14 connectable to a mesh prosthesis 38 for location over a defect site of patient, and a cavity 12 for receiving the support members 14. The support members 14 are movable between a retracted position within the cavity 12, and an extended position outside the cavity 12. The tool includes a biasing means 28 which urges the support members 14 from the retracted position to an extended position. A control mechanism 30 positioned near the handle 20 is moveable by the user between retaining, release and locking conditions to control the movement of the support members. In use the tool is introduced through an incision in the body wall, and the support members extended causing the mesh prosthesis to be expanded. In this position the mesh is secured in position and the tool removed.

Description

TITLE

A Laparoscopic Tool for Hernia Repair

TECHNICAL FIELD

The present invention relates generally to a laparoscopic tool for use in repairing a hernia, and more particularly but not exclusively for use in repairing an abdominal wall hernia such as an inguinal hernia.

BACKGROUND ART

Abdominal wall hernias, such as inguinal hernias, are common types of hernia that develop when a weakness in the abdominal wall develops into a localised gap or defect through which tissue or abdominal organs may protrude.

A number of surgical procedures are currently available for repairing such hernias, including open surgical repair procedures and laparoscopic surgical repair procedures.

There are generally two steps in any surgical repair procedure. The first step involves pulling or reducing the hernia through the defect or gap through which it protrudes.

The second step involves covering the defect or gap with a mesh prosthesis (commonly referred to as a mesh) to prevent the hernia from sliding once again through the defect or gap.

Laparoscopic surgical repair procedures are often favoured over open surgical repair procedures since they are less invasive and, therefore, tend to result in more rapid patient recovery. In one known laparoscopic repair procedure, a mesh prosthesis is grasped using one or more grasping tools which are suitably manipulated to manoeuvre the mesh prosthesis into position over the site of a reduced hernia, that is to say over the defect or gap that remains after the hernia has been reduced. Those one or more grasping tools are used to stabilise the mesh prosthesis in the correct position over the defect site whilst clips are positioned and applied to the mesh, using a suitable clip applier. Once applied, the clips hold the mesh firmly in position over the defect site and the one or more grasping tools and clip applier can thus be removed.

The above procedure can be time consuming, cumbersome and difficult to perform, in particular due to the number of tools that are needed. The need to use one or more grasping tools can introduce particular difficulties, since it can be difficult to securely grasp a mesh prosthesis using such tools and, therefore, difficult to accurately position and stabilise the mesh prosthesis over the defect site and, indeed, maintain the mesh prosthesis in the correct position prior to and during application of the clips.

Occasionally, manoeuvring of the various tools could cause iatrogenic injury to surrounding stricture, including blood vessels.

It would, therefore, be desirable to provide an improved laparoscopic tool for use in repairing hernias, and in particular abdominal wall hernias such as inguinal hernias, which facilitates correct placement of a mesh prosthesis over a defect site following reduction of a hernia.

SUMMARY OF THE INVENTION

According to one embodiment *of the present invention, there is provided a laparoscopic tool for use in repairing a hernia, the laparoscopic tool comprising: a plurality of semi-rigid elongate support members connectable to a mesh prosthesis for location over a defect site following reduction of a hernia; a cavity for receiving the plurality of semi-rigid elongate support members; the plurality of semi-rigid elongate support members being movable between a retracted position in which they are located inside the cavity and an extended position in which they project from the cavity.

Preferred, but optional, features of the invention are defined in claims 2 to 20.

DRAWINGS

Figure 1 is a diagrammatic cross-sectional view of a laparoscopic tool according to the invention in which a plurality of semi-rigid elongate support members are in a retracted position; and Figure 2 is a diagrammatic view of the laparoscopic tool of Figure 1 with the elongate support members in an extended position.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

Embodiments of the present invention will now be described by way of example only and with reference to the accompanying drawings.

The drawings show generally a laparoscopic tool 10 for use in repairing a hernia. The laparoscopic tool is particularly suitable for use in repairing abdominal wall hernias, in which tissue or abdominal organs protrude through a localised defect or gap in the abdominal wall. A common example of such an abdominal wall hernia is an inguinal hernia.

In more detail, the laparoscopic tool 10 comprises a cavity 12 and a plurality of elongate support members 14 locatable inside the cavity 12. In typical embodiments, the laparoscopic tool 10 comprises a tubular member 16 in which the cavity 12 is defined, the tubular member 16 being insertable into the bodily cavity of a patient through a suitable incision and having an opening 18 at the distal end of the tool 10.

The laparoscopic tool 10 also comprises a handle member 20 which is located at the proximal end of the tool 10 to remain outside the bodily cavity and via which a medical practitioner may manipulate the tool 10.

The elongate support members 14 are movable between a retracted position, shown in Figure 1, in which they are located inside the cavity 12 and an extended position, shown in Figure 2, in which they project from the cavity 12 through the opening 18.

The elongate support members 14 each have a proximal end 22 and a distal end 24. At their proximal end 22, the elongate support members 14 are mounted for movement on a mounting member 26 which is slidably movable within the cavity 12 in forward and rearward directions, illustrated respectively by the arrows A and B in Figures 1 and 2.

The laparoscopic tool 10 includes biasing means 28, for example in the form of a compression spring, which is operable to bias the mounting member 26 in the forward direction and which is thereby operable to urge the elongate support members 14 from the retracted position shown in Figure 1 to the extended position shown in Figure 2.

The mounting member 26 is movable in the rearward direction by a user against the bias of the biasing means 28, such movement of the mounting member 26 thereby also resulting in movement of the elongate support members 14 from the extended position shown in Figure 2 to the retracted position shown in Figure 1.

The laparoscopic tool 10 further includes a control mechanism 30 movable by a user between retaining, release and locking conditions, to control the movement of the elongate support members 14 between the retracted and extended positions, for example by controlling the forward and rearward movement of the mounting member 26. In the illustrated embodiment, the control mechanism 30, which is connected to the mounting member 26 by a link member 36, comprises a projection 32 locatable in a conesponding channel 34 in the laparoscopic tool 10, and in particular in the handle member 20. The channel 34 includes a retaining portion 34a, a release portion 34b and a locking portion 34c. The projection 32 may be biased, for example by the link member 36 or otherwise, in a direction such that it tends to self-locate in the retaining and locking portions 34a, 34c when aligned with a respective one of those portions 34a, 34c. The bias is typically at a level that can be overcome by a user, such that the projection 32 can be easily released from a respective one of the retaining portion 34a and the locking portion 34c into the release portion 34b upon manipulation by a user.

When the control mechanism 30 is in the retaining condition, which is when the projection 32 is located in the retaining portion 34a of the channel 34, movement of the mounting member 26 in the forward direction is prevented, and thus movement of the elongate support members 14 from the retracted position to the extended position is also prevented. When the control mechanism 30 is in the locking condition, which is when the projection 32 is located in the locking portion 34c of the channel 34, movement of the mounting member 26 in the rearward direction is prevented, and thus movement of the elongate support members 14 from the extended position to the retracted position is also prevented. When the control mechanism 30 is in the release condition, which occurs upon movement of the projection 32 by a user into the release portion 34b of the channel 34, movement of the mounting member 26 in the forward direction under the bias of the biasing means 28 or in the rearward direction by a user against the bias of the biasing means 28, is permitted, thereby permitting movement of the elongate support members 14 from the retracted position to the extended position under the bias of the biasing means 26 or from the extended position to the retracted position by a user against the bias of the biasing means 26. A user may effect movement of the elongate support members 14 from the extended position to the retracted against the bias of the biasing means 26 by sliding the projection 32 along the release portion 34b of the channel 34 in a rearward direction, from the locking portion 34c towards the retaining portion 34a.

In accordance with the invention, the elongate support members 14 are connectable, typically via their distal ends 24, to a mesh prosthesis 38 intended for location over a defect site following the reduction of a hernia. Mesh prostheses (also commonly known as meshes) are well known in the field of hernia repair. Typically, such mesh prostheses are fabricated from polypropylene or polyester, although other materials can of course be used.

In more detail, each of the elongate support members 14 is connectable in use to a respective corner of a mesh prosthesis 38. In the illustrated embodiment, the mesh prosthesis 38 is rectangular and the laparoscopic tool 10 therefore comprises four elongate support members 14, each of which is connected to a respective corner of the mesh prosthesis 38. In other embodiments, the laparoscopic tool 10 may include more or less than four elongate support members 14, depending on the configuration of the mesh prosthesis 38 with which it is to be used. For example, if the mesh prosthesis 38 was triangular, the laparoscopic tool 10 would typically comprise three elongate support members 14, each of which would be connected to one of the three vertices of the triangular mesh prosthesis 38.

In order to permit connection of the elongate support members 14 to the mesh prosthesis 38, each of the elongate support members 14 includes at its distal end 24 a connection point 40. Each connection point 40 may comprise an aperture 42, for example in the form of a loop 44 defined by the distal end 24 of each respective elongate support member 14.

In typical embodiments, each connection point 40 is adapted to receive a connection member 46, for example in the form of a stitch or suture, which is also attached to a respective corner of the mesh prosthesis 38. Each connection member 46 is releasable, and in the case of a suture or a stitch, this releasability is provided by the ability to readily cut the suture or stitch. The connection members 46 thus securely releasably connect the mesh prosthesis 38 to the plurality of elongate support members 14.

The mesh prosthesis 38 is typically flexible so that it can deform to properly follow the contours of a hernia site and is deformable between a compressed condition and an expanded condition. In the expanded condition, illustrated in Figure 2, the mesh prosthesis 38 is ready for location over a defect site following reduction of a hernia.

However, the mesh prosthesis is too large to enter into the cavity 12 of the laparoscopic tool 10 when it is in the expanded condition. The mesh prosthesis 38 can, therefore, also assume a compressed condition, illustrated in Figure 1, in which its size is reduced sufficiently to enable it to enter into the cavity 12.

In accordance with the invention, the elongate support members 14 are semi-rigid and can thus be used to control the compression/expansion of the mesh prosthesis 38. The elongate support members 14 are typically rigid in their longitudinal direction but flexible in their lateral direction, and may thus comprise semi-rigid wires or wire-like elements. In order to provide the requisite rigidity/flexibility characteristics, the elongate support members 14 may be formed from a resilient material, such as a suitable plastics material or metal. Typically, the distal ends 24 of the elongate support members 14 are biased apart in the lateral direction, such that when the elongate support members 14 are in the extended position, the distal ends 24 tend to spread apart and move away from each other. This bias may, for example, be provided by the particular manner in which the elongate support members 14 are mounted on the mounting member 26, but could of course be provided by any other suitable means. When the elongate support members 14 are in the retracted position shown in Figure 1, the lateral bias is overcome, for example due to abutment of the elongate support members 14 with the inner surface of the tubular member 16. This ensures that the elongate support members 14 can be fully received inside the cavity 12.

As will be appreciated, the laparoscopic tool 10 according to the invention makes use of the lateral bias of the elongate support members 14 to move the mesh prosthesis 38 from the compressed condition, when it is located inside the cavity 12 of the tool 10, to the expanded condition, when it is located outside the cavity 12. When the elongate members 14 are in the extended position with the mesh prosthesis 38 in the expanded condition, the expanded mesh prosthesis 38 laterally constrains the distal ends 24 of the elongate support members 14 and prevents them from spreading apart any further.

Since each elongate support member 14 is thus constrained at both its proximal and distal ends 22, 24 and substantially rigid in its longitudinal direction, the elongate support members 14 together ensure that the mesh prosthesis 38 is stably supported and can be easily manipulated using the laparoscopic tool 10.

The laparoscopic tool 10 according to the invention may be used as follows to repair a hernia, for example an abdominal wall hernia such as an inguinal hernia, following reduction of the hernia using an appropriate technique.

Initially, the semi-rigid elongate support members 14 are moved to the extended position under the bias of the biasing means 28, upon user manipulation of the projection 32 to release it from the retaining portion 34a of the channel 34. Once the elongate support members 14 have moved to the extended position under the bias of the biasing means 28 and typically once the projection 32 has engaged in the locking portion 34c of the channel 34, suitable connection members 46, such as sutures or stitches, are attached to each corner of the mesh prosthesis 38 when in its expanded condition (if they are not already pre-attached), and to a respective connection point 40 at the distal ends 24 of the elongate support members 14 to thereby connect the mesh prosthesis 38 to the elongate support members 14.

The projection 32 is then manipulated by a user to release it from the locking portion 34c of the channel 34, slide it in a rearward direction along the release portion 34b of the channel 34 and engage it in the retaining portion 34a of the channel 34.

Manipulation of the projection in this way causes movement of the elongate support members 14 into the cavity from the extended position to the retracted position, against the bias of the biasing means 28. At the same time, the mesh prosthesis 38 may be suitably manipulated to move it from the expanded condition to a compressed condition in which its size has been reduced sufficiently for it to be received inside the cavity 12. When the elongate support members 14 are in the fully retracted position, the location of the projection 32 in the retaining portion 34a of the channel 34 holds the elongate support members 14 in the retracted position, against the bias of the biasing means 28, and the laparoscopic tool 10 can thus be considered to be in a primed or loaded condition, ready for use.

At this stage, with the laparoscopic tool 10 primed and ready for use in repairing a hernia, the laparoscopic tool 10 is inserted through a suitably positioned incision in the body of a patient, for example in the abdominal wall in the case of an inguinal hernia repair, to introduce it into the patient's body. Once suitably positioned inside the body, for example over the defect site following reduction of the hernia under repair, the projection 32 is manipulated by a user to release it from the retaining portion 34a of the channel 34, and the elongate support members 14 rapidly move from the retracted position shown in Figure 1 to the extended position shown in Figure 2, under the bias of the biasing means 28 which causes forward movement of the mounting member 26. During this rapid movement, the projection 32 slides in a forward direction along the release portion 34b of the channel 34 before self-locating in the locking portion 34c thereof.

During movement of the elongate support members 14 out of the cavity 12, from the retracted position towards the extended position, the distal ends 24 of the elongate support members 14 spread apart as explained above, thereby moving the mesh prosthesis 38 from the compressed condition to the expanded condition. In this expanded condition, the laparoscopic tool 10 may now be manipulated to accurately locate the mesh prosthesis 38 over the site of the defect and hold it in position whilst a clip applier, inserted through another incision in the patient's body, is used to apply clips to the mesh prosthesis 38 to secure it in position over the defect site. Movement of the elongate support members 14 from the extended position to the retracted position is prevented when the mesh prosthesis 38 is pressed against the defect site due to the location of the projection 32 in the locking portion 34c of the channel 34.

Once the mesh prosthesis 38 has been secured in position using the clips, the clip applier may be removed and a suitable cutting tool, which may be inserted via the same incision through which the clip applier was inserted or through another incision, may be used to cut the sutures or stitches that were used to connect the elongate support members 14 to the corners of the mesh prosthesis 38, thereby disconnecting the mesh prosthesis 38 from the elongate support members 14. The elongate support members 14 can now be moved from the extended position to the retracted position, against the bias of the biasing means 28, by appropriate manipulation of the projection 32 out of the locking portion 34c of the channel 34, along the release portion 34b and into the retaining portion 34a, before the laparoscopic tool 10 is finally withdrawn from the patient's body.

Although in the above example the mesh prosthesis 38 is connected to the distal ends 24 of the elongate support members 14 by a suitable medical practitioner or technician just prior to hernia repair, it is conceivable that the laparoscopic tool 10 could be supplied as part of a laparoscopic tool assembly with a mesh prosthesis 38 pre-connected to the elongate support members 14.

There is thus provided a laparoscopic tool 10 and/or a laparoscopic tool assembly which significantly facilitate(s) the repair of a hernia, for example an abdominal wall hernia such as an inguinal hernia. In particular, the laparoscopic tool 10 permits a mesh prosthesis 38 to be easily manoeuvred into position and stabilised over the defect site until clips have been applied to secure the mesh prosthesis 38 in position.

Although embodiments of the invention have been described in the preceding paragraphs with reference to various examples, it should be understood that various modifications may be made to those examples without departing from the scope of the present invention, as claimed.

For example, the control mechanism 30 could have a different configuration to that shown. A biasing means 28 other than a compression spring could be used to bias the elongate support members 14 from the retracted position to the extended position. The lateral biasing of the elongate support members 14 may be provided by any suitable means other than by the particular manner in which they are mounted on the mounting member 26.

Claims

CLAIMSI. A laparoscopic tool for use in repairing a hernia, the laparoscopic tool comprising: a plurality of semi-rigid elongate support members connectable to a mesh prosthesis for location over a defect site following reduction of a hernia; a cavity for receiving the plurality of semi-rigid elongate support members; the plurality of semi-rigid elongate support members being movable between a retracted position in which they are located inside the cavity and an extended position in which they project from the cavity.
2. A laparoscopic tool according to claim 1, wherein the tool includes a tubular member in which the cavity is defined.
3. A laparoscopic tool according to claim I or claim 2, wherein the tool includes a handle member from which the tubular member extends.
4. A laparoscopic tool according to any preceding claim, wherein the tool includes biasing means to urge the semi-rigid elongate support members from the retracted position to the extended position.
5. A laparoscopic tool according to claim 4, wherein the semi-rigid elongate support members are movable by a user from the extended position to the retracted position against the bias provided by the biasing means.
6. A laparoscopic tool according to any preceding claim, wherein the tool includes a control mechanism movable by a user between a retaining condition in which it is operable to retain the semi-rigid elongate support members in the retracted position, a release condition in which it is operable to permit movement of the semi-rigid elongate support members between the retracted position and the extended position, and a locking condition in which it is operable to retain the semi-rigid elongate support members in the extended position. -12-
7. A laparoscopic tool according to claim 6, wherein the control mechanism is operable, upon movement by a user from the retaining condition to the release condition, to permit the biasing means to move the semi-rigid elongate support members from the retracted position to the extended position.
8. A laparoscopic tool according to claim 6 or claim 7, wherein the control mechanism is operable, upon movement by a user from the locking condition to the retaining condition, to move the semi-rigid elongate support members from the extended position to the retracted position.
9. A laparoscopic tool according to any preceding claim, wherein each of the semi-rigid elongate support members is connectable in use to a respective corner of a mesh prosthesis.
10. A laparoscopic tool according to any preceding claim, wherein each of the semi-rigid elongate support members includes at its distal end a connection point to permit connection of a mesh prosthesis thereto.
11. A laparoscopic tool according to claim 10, wherein each connection point comprises a loop defined by a respective distal end of each of the semi-rigid elongate support members.
12. A laparoscopic tool according to claim 10 or claim 11, wherein each connection point is adapted to receive a connection member to releasably connect the mesh prosthesis in use to the semi-rigid elongate support members.
13. A laparoscopic tool according to any preceding claim, wherein the semi-rigid elongate support members comprise semi-rigid wires.
14. A laparoscopic tool assembly for use in repairing an internal hernia, the assembly comprising a laparoscopic tool as defined in any preceding claim and a -13 -mesh prosthesis releasably connected to the plurality of semi-rigid elongate support members.
15. A laparoscopic tool assembly according to claim 14, wherein a semi-rigid elongate support member is connected to each corner of the mesh prosthesis.
16. A laparoscopic tool assembly according to claim 14 or claim 15, wherein a semi-rigid elongate support member is connected to each corner of the mesh prosthesis by a respective connection member.
17. A laparoscopic tool assembly according to claim 16, wherein each connection member comprises a suture.
18. A laparoscopic tool assembly according to any of claims 14 to 17, wherein the mesh prosthesis is located inside the cavity of the laparoscopic tool when the semi-rigid elongate support members are in the retracted position and outside the cavity of the laparoscopic tool when the semi-rigid elongate support members are in the extended position.
19. A laparoscopic tool assembly according to claim 18, wherein the mesh prosthesis is movable between a compressed condition when it is located inside the cavity of the tool and an expanded condition when it is located outside the cavity of the tool.
20. A laparoscopic tool assembly according to claim 19, wherein the semi-rigid elongate support members are operable to move the mesh prosthesis from the compressed condition to the expanded condition upon movement of the semi-rigid elongate support members from the retracted position to the extended position.
21. A laparoscopic tool for use in repairing a hernia substantially as hereinbefore described and/or as shown in the accompany drawings.-14 -
22. A laparoscopic tool assembly for use in repairing a hernia substantially as hereinbefore described and/or as shown in the accompany drawings.