HU0900538A2 - Laparo-endoscope system - Google Patents

Laparo-endoscope system Download PDF

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Publication number
HU0900538A2
HU0900538A2 HU0900538A HU0900538A HU0900538A2 HU 0900538 A2 HU0900538 A2 HU 0900538A2 HU 0900538 A HU0900538 A HU 0900538A HU 0900538 A HU0900538 A HU 0900538A HU 0900538 A2 HU0900538 A2 HU 0900538A2
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preferably
tube
characterized
according
end
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HU0900538A
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Hungarian (hu)
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HU0900538D0 (en
Inventor
Laszlo Dr Csiky
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Laszlo Dr Csiky
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Priority to HU0900538A priority Critical patent/HU0900538A2/en
Publication of HU0900538D0 publication Critical patent/HU0900538D0/en
Publication of HU0900538A2 publication Critical patent/HU0900538A2/en
Priority claimed from US15/833,250 external-priority patent/US20180092635A1/en

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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B34/70Manipulators specially adapted for use in surgery
    • AHUMAN NECESSITIES
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    • A61B17/062Needle manipulators
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    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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    • A61B17/2909Handles
    • A61B2017/291Handles the position of the handle being adjustable with respect to the shaft
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Description

EXTRACT

LAPAPP 'Ε &Μ'ΓζϊρΡμ

'J <í ... · L 1 ~>'Ja.l'Á / .íaU-k i ^ joDÁTIY

The present invention relates to a system of devices enabling the complete accomplishment of a novel type of surgical intervention (surgery through natural body orifices - NOTES, single surgery surgery - SPS, and interventions in hollow organs - intervention endoscopy). It applies.

Preferably, the device according to the invention preferably has laparoscopic endoscopic instruments / 6 /, trocar tubes / 7 / tube / 28 / endoscopic device / 66,103 /, respectively. there are additional devices that can be connected to the former.

Typical Figure 25

• · · * ·· ♦ • · · ·

Jk A - <-xi K XUj-Yi-l -IELY

90 0 90 Ο 538

LAPARO ENDOSCOPIC SYSTEM

The present invention relates to a novel type of surgical intervention (surgery through natural body orifices - NOTES, unicellular surgery - SPS, and interventions in hollow organs - intervention endoscopy) (intrusion, surgery, closure), preferably in a manner similar to the laparoscopic technique. a tooling system that is advantageously provided by laparo-endoscopic instruments, trocar tubes, tubes, or endoscopic devices; it consists of additional devices that can be connected to the former.

A few years ago, the minimally invasive surgery (ie, laparoscopic surgery, which typically uses thin, rigid instruments) and endoscopy (intrinsic intracranial interventions within the hollow organs with typically flexible devices) have resulted in NOTES, currently the most experimental one. endoscopic surgery through natural body orifices). The planned advantage of NOTES is that it intends to treat certain illnesses with less strain and risk compared to surgery on the laparoscopic (small openings in the abdominal wall). For such abdominal interventions (eg, gall bladder removal, wormhole removal, ovarian tethering, etc.), it is necessary, e.g. the flexible endoscopic device system supplied to the hollow organ via the oral, vaginal or rectal means is inserted through the wall of the hollow organ into the abdominal cavity, the device is performed by the device in the abdominal cavity, the necessary tissue or organ is removed from the body, and the artificial wall formed at the end of the hollow organ is removed. the opening is securely closed and the device system removed through the body opening.

According to the present knowledge, there is no device or device system that alone would be capable of performing the aforementioned complete intervention sequence (i.e., complete NOTES surgery). At the same time, the tools that are currently known to perform only partial tasks are neither reliable nor reliable. their use is often uncomfortable, cumbersome. It is a serious problem to fix the devices in the abdominal cavity, to control them, to coordinate the instruments, to coordinate them and to coordinate them. secure closing of the wound on the hollow body wall. These unresolved issues can lead to serious, sometimes life-threatening complications, such as injuries to vital organs, bleeding, peritonitis, etc.

The tools developed for NOTES interventions are multi-purpose. Generally, they are different combinations of laparoscopic and endoscopic properties.

One of the prior art known solutions of the present invention is described in U.S. Pat. No. 2007/086079, which discloses the use of flexible instruments through work channels in a device similar to an endoscopic tube. The end of the endoscopic tube can be guided from the outer end by the conventional technical solution. The inner end of the introduced instruments can also be controlled by means of a dimensional device connected to the outer end of the endoscopic tube. The disadvantage of the solution is that the endoscope and the inner ends of the instruments are not fixed. Another disadvantage is that the device for controlling the inner end of the instrument requires a large, new instrument to be inserted separately, and because of its large size it requires a lot of instrumentation. However, it does not follow previous, well-developed, safe laparoscopic sequences of motion, new combinations of motion /

·····

-2 learning is required. This is not a problem because you have to master another technique, but because if a complication occurs during the operation, it is best to solve it with laparoscopic technique. Using the two techniques together can be confusing.

Another imaginative concept is described in WO / 2008/131046. . The instrument shown here is a simple modification of conventional laparoscopic devices: both the head and the grip of the instrument can be bent at the same time and towards each other. The deflection of the grip guides the deflection of the head through wires. This instrument is in fact the so-called. It has been invented for Single Port Surgery, usually using the navel for penetration. This new technique (SPS) is considered to be an alternative to NOTES. The SPS technique is actually a variant of laparoscopy. The disadvantage of the said device is that it is difficult to learn the movement of the artificial arm in the opposite direction to that used in laparoscopy. It is also a disadvantage in the case of the above solutions that the instruments are overcrowded at the expense of efficiency and safety.

As a result of the above, there is a need to develop a laparo-endoscopic device system that allows reliable intervention of NOTES, SPS, or interventional endoscopes through the natural body orifices using well-proven and well-developed laparoscopy techniques.

It is an object of the present invention to provide the presently non-articulated and / or non-limiting compositions. To reduce possible complications due to unsolved problems of NOTES, SPS, or interventional endoscopic techniques, the development of a system of means for applying the complete NOTES, SPS, and, through the use of natural body openings, techniques such as reliable and well-developed laparoscopy. the simpler, faster and safer completion of the interventional endoscopic intervention line.

The invention is based on the discovery that when the outer and inner composite ends of the system according to the invention are a continuous laparoscopic unit, while the middle part connecting the former is considered to be a flexible endoscopic unit, and accordingly by means of a flexible endoscope like a natural body orifice. aligning both the inner and outer ends of the introduced instrument at the same time, as if the inner end and the outer end were part of a single conventional laparoscopic instrument; using the appropriate additional devices to connect to the system we use a properly modified endoscopic sewing machine, then the complete NOTES, SPS, or. we get the opportunity to make interventional endoscopic intervention easier, faster and safer.

In view of the above, the object of the present invention is achieved by means of a laparoendoscopic system and its auxiliary means, preferably a laparo-endoscopic instrument, a trocar tube, a tube or an endoscopic device. there are additional accessories that can be connected.

In a preferred embodiment, the trocar tubes can be introduced into the partially or fully flexible tube or endoscopic device and the instruments into the trocar tubes. Preferably, there is a connection between the tube or endoscopic device, the trocar tubes, and the instruments, allowing for displacement and rotation about the longitudinal axis parallel to the longitudinal axis. Additional external devices can be connected to their external and internal surfaces, for example: protective cover, wound closure, sewing machine. Preferably, all joints allow movement, sliding along the longitudinal axis, and rotation around the longitudinal axis of the instrument.

According to one preferred embodiment of the instruments, the instrument is preferably divided into three main parts: the partially flexible middle portion and the telescopically extending outer and inner rigid ends extending hingedly to the side. Preferably, any section of the middle portion close to the hinges is also rigid. Preferably, the cross-section of the instruments is circular.

Preferably, the outer and inner ends of the instrument are simultaneously, in the same direction, in the same direction of rotation (the parallel rotation axes are perpendicular to the hinges perpendicular to the longitudinal axis) and can only be bent at one joint plane extending along the longitudinal axis and perpendicular to the two parallel rotary axes. compared to the middle part, as if the two ends were part of a single traditional laparoscopic instrument. Preferably, the simultaneous inflating and unloading of the ends in a single plane is preferably provided by a pair of wire systems extending from the inner end through the hinges and the middle portion to the outer end. Of course, any technical solution known today may also be suitable for providing the deflection described above.

Preferably, the central and outer joints have a soluble-lockable ratchet structure. The ratchet structure and fastener allow temporary or permanent fixing of the angles between the middle part and the ends.

Preferably, the telescopic ends are comprised of rigid tubes which can be pushed into one another. The head of the instrument is located on the inner telescopic end, the design of which is preferably the same as the head of any laparoscopic instrument (including the camera) in use today. The outer telescopic end has a grip on the instrument, which, according to a preferred embodiment, is also the same as that of the end of the laparoscopic instruments. Opening and closing the handle of the instrument controls the operation of the head of the instrument through the guide wire running through the outer and inner ends and the middle part.

Despite the fact that the two telescopic ends are separated from each other by the central portion connecting them, they move or move. their movement is as if the two ends were a continuation of each other, like a traditional laparoscopic instrument. For example, if the outer telescopic end is pressed, i.e. shortened, so that the inner telescopic end is extended by the same amount or length. the same goes for the reverse. This movement is made possible by the power transmission system located inside the instrument.

In one preferred embodiment, this transmission system is preferably a ball-shaped power transmission unit arranged in succession in the internal channel of the instrument. The channel extends from the inner telescopic end through the middle portion to the outer telescopic end. The bullet is filled with bullets in its full length. The diameter of the balls is slightly smaller than the inside diameter of the channel. The center of the balls is preferably holes, through which the head-to-head guide runs from the handle to the head. Preferably, the channel is provided with a friction reducing material. Preferably for ball-like transmission »··

-4 units are also able to move freely in the canal even at the joints. When the hand grip of the instrument is pushed forward, the grip pushes the last ball in the outer telescopic end channel. The adjacent balls pass this compression force onto each other, and finally the first ball of the inner end channel pushes the head of the instrument forward, thereby stretching the inner telescopic end. For reverse movement, i.e. to shorten the internal telescopic end of the instrument, it is advantageous to use a wire connecting the two telescopic ends, in this case this role can also be filled by the guide wire. Tightening the handle of the instrument extends the telescope of the outer end, and the wire attached to it pulls the inner telescopic end. Of course, any other form that is suitable for barrier-free transmission can be used instead of the bullet.

Another preferred embodiment of the power transmission may be a closed, preferably flexible, hydraulic unit placed in the channel described above. In a preferred embodiment, the hydraulic unit can be divided into three parts: an outer and an inner implement and a central part. The three parts are the free-running parts of a single cavity system. The unit is closed, the hydraulic fluid does not travel with the outside world, it flows only in three parts of the common cavity. The center portion of the unit is preferably located in the channel of the central portion of the instrument, its length being equal to its length and, preferably, it is fixed to the channel and does not move relative thereto. The outer and inner ends of the hydraulic unit are located in the channel of the outer and inner telescopic ends of the instrument. The ends of the unit are designed to be able to increase volume or preferably in the direction of the longitudinal axis. decrease, i.e. elongation or contraction, with unchanged cross section. The walls of the ends of the hydraulic unit may preferably move along the longitudinal axis in the channel of the ends of the instrument. One possible solution of the ends of the unit would be a harmonic-like arrangement of the wall of the end portions. When the hand grip of the instrument is pushed into the outer telescopic end, the outer end of the hydraulic unit is also compressed along the longitudinal axis. The increased internal pressure at the outer end of the hydraulic unit is transmitted through the central fixed hydraulic section to the inner hydraulic section, which, as a result, protrudes like a harmonic, thereby extending the telescopic inner end. Preferably, the elongation of the telescopic ends or the elongation of the telescopic ends is preferred. shortening is the same. Besides the harmonic-like design of the ends, it can give a similar result if the wall of the hydraulic unit is made of stretchable material. For reverse movement, i.e. to shorten the internal telescopic end of the instrument, it may be advantageous to use two telescopic ends connecting the wire, which may also be the guide wire. Tightening the handle of the instrument extends the telescope of the outer end, and the wire attached to it pulls the inner telescopic end.

Preferably at least one connecting ring may be provided at the center of the instrument for connection to the tube. In the ring, the instrument is freely rotatable. A connecting passage is provided on the outer surface of the ring. In another preferred embodiment, the ring is provided with a threaded needle that allows the central portion of the instrument to be attached to the abdominal wall as desired.

The apparatus may also be connected to the tube by another simple trocar tube. There is a sliding connection between the tube and the trocar tube, and the center of the instrument is in the trocar tube. The middle

· · ·

Part 5 is preferably longer than the length of the trocar tube. The instrument can be rotated in the trocar tube, pushed back and forth. The outer end of the trocar tube is preferably provided with a valve and an insulating ring.

In another preferred embodiment of the apparatus, the instrument is preferably divided into three main parts: the partially flexible middle portion and the telescopically extending outer and inner rigid ends extending hingedly on both sides. The transmission system is the same as described above. The instrument does not have wires for bending telescopic ends. In this embodiment, the instrument is connected to the tube by means of a trocar tube having a partially or fully flexible middle portion and hinged outer and inner ends joining it. The ends are folded in and out in the wall of the trocar tube with photo wires. The ratchet structure may also advantageously be located at the outer joint. The outer end of the trocar tube is preferably provided with a valve and an insulating ring. The length of the middle portion of the trocar tube is preferably greater than the length of the tube. A sliding connection is preferably provided between the trocar tube and the tube. The length of the middle portion of the instrument is preferably greater than the length of the middle portion of the trocar tube. The instrument in the trocar tube can be freely moved around the longitudinal axis and around it. rotated.

In another preferred embodiment of the apparatus, the instrument is preferably divided into three main parts: the flexible middle part and the non-telescopic outer and inner rigid ends. The actuator line runs inside the instrument. There is no separate power unit in the instrument, this function is performed by the flexible middle section and the two rigid ends.

Such a device is preferably connected to the tube by a trocar tube having a partially or fully flexible middle portion and a telescopic outer and inner rigid end attached to the tube. Preferably, the synchronous engagement and deflection on the hinges is carried out by photo wire pairs in the wall of the trocar tube. The ratchet structure may also be provided at the outer joint. The synchronous stretching and shortening of the telescopic ends is exerted by the force exerted on the telescopic ends by a device moved inwards or outwards in the trocar tube. A sliding connection for free movement along the longitudinal axis is preferably provided between the trocar tube and the tube. Preferably, the at least one freely rotatable coupling ring located at the center of the trocar tube is engaged in forming the sliding joint. The ring preferably has a connecting passage which is connected to a rail formed on the inner surface of the tube. The outer end of the trocar tube is preferably provided with a valve and an insulating ring.

In a preferred embodiment of the trocar tubes, a plurality of trocar tubes are circularly connected with the sliding joints on their sides in such a way that each trocar tube is connected to its adjacent neighbor. Preferably, the connection of four trocar tubes is sufficient to perform most surgical procedures. In this case, the cross-section of the connected trocar tubes is preferably a quarter-circular cross section, which together gives a complete cross-section, thus making the common external cylindrical form more gentle during the interventions (e.g., penetration through the stomach wall). There are sliding joints (matching passageways and rails) on the flat side facing facing each other, allowing the trocar tubes to move relative to each other along their longitudinal axis. Such a trocar tube has two flat edges, preferably one on the one and the other on the other. Preferably, the working channels in the trocar tubes are circular in cross-section. Such trocar tubes may be partially or fully flexible or rigid. The inner end of the trocar tubes may also have an oblique plane, which may facilitate the passage through the stomach wall.

Also, in this possible embodiment, the quarter-circular trocar tubes have external and internal, preferably telescopic, rigid ends connected through the hinges. Preferably, the cross-section of the telescopic ends is circular and rotatable about the longitudinal axis relative to the central portion. In this case, there is no power unit to operate the telescopes. This task is accomplished by a device with a flexible center section and rigid ends inserted into the telescopic trocar tube working channel and moving in and out along the longitudinal axis. Preferably, the telescopic ends are synchronized in and out of the hinges by a wire pair running in the trocar tube. The outer end of the trocar tube is preferably provided with a valve and an insulating ring.

In addition to the solution described above, there may be several other variations of the connection of the trocar tubes. In a preferred embodiment, additional trocar tubes can be attached to the outer surface of a double trocar tube by means of a sliding connection. Preferably, the trocar tubes can be connected to the portion connecting the double trocar tubes. In addition, additional connecting lines may be provided on the outer surface of the double trocar tube or the attached trocar tubes through which e.g. the thread, rod or rod that allows attachment to the abdominal wall may be attached. In another preferred embodiment, the trocar tubes are connected to the outer side of a central trocar through the sliding connections. Connecting lines for connecting trocar tubes are formed on the leading outer surface of the central trocar. Inside the trocar, a smaller working channel may be provided, e.g. balloon inlet catheter is guided. The inner end of the trocar may preferably be pointed. In a further preferred embodiment, a further trocar tube is connected to a central trocar tube through the sliding connections. The outer cross-section of the central trocar tube may be arbitrary, while the working channel running therein is preferably circular. Preferably, further channels, such as e.g. gas or suction rinsing channels. The outer surface of the central trocar tube is provided with suitable connections or rails for connection.

There is no need for a tube for connecting the connected trocar tubes. The trocar tubes may be temporarily or permanently secured to the abdominal wall by means of a ring located in the proximal end of the central portion. The fastening is preferably carried out with a threaded needle, a rigid rod or a guide rod. In the ring, the connected trocar tubes can be moved freely along and along the longitudinal axis. rotated. If no tube is used, an outer endoscopic means for connecting external endoscopic devices may be provided on the outer surface of the trocar tubes.

The trocar tubes connected with the sliding joints can also be introduced into the abdominal cavity by means of a simple, partially or fully flexible tube. can be attached to the abdominal wall. In this case, there is preferably no rail or passage inside the tube, only on the outer surface of the tube. The inner end of the tube may be straight, inclined or stepped open. It is also possible to create a thread, rod or rod for attachment to the abdominal wall on an outer surface close to the inner end. The rod may also have a sliding foot which fits into a preferably longitudinal joint passage on the outer surface of the tube and movable therein as desired. In this case, the end of the inner tube attached to the abdominal wall with the rod can be adjusted back and forth over the designated surgical area using a sliding foot sliding in the passage. However, the inner end of the tube can be directed to any desired area of the abdominal cavity by means of a rigid rod or rod. Stable with the help of a rod or rod at the desired location and position. Other external endoscopic devices (eg wound sealing device, camera, pliers, etc.) can also be connected to the outer surface of the tube.

Hereinafter referred to as instruments and devices. possible advantageous solutions of tubes and endoscopic devices for receiving trocar tubes.

In the case of a tube, a solution is that the long cylindrical body is preferably a single cavity tube into which instruments, trocar tubes or other auxiliary devices can be inserted.

According to the simplest preferred method, a straight tube of straight ends at both ends of the tube. Preferably, the outer and inner ends of the tube are rigid and the middle portion may be flexible. The inner diameter of the tube allows more than one, preferably four, trocar tubes to be accommodated. The inner surface of the tube may be completely smooth or, in a preferred embodiment, preferably have longitudinal connecting lines or rails on its inner surface. The outer surface of the tube may also preferably have longitudinal connecting lines or rails. Preferably, the inner surface of the tube may have a thread, rod or rod at its inner end. A hinge connection is preferably provided between the inner end of the tube and the center portion. The inner end relative to the middle portion may be bent and wound in the hinge area by means of the wire pairs preferably extending through the tube and the tubular bending device at the outer end. The inner end of the tube may be straight or oblique open or stepped open. Open straight when the plane of the inner opening is perpendicular to the longitudinal axis of the tube. Slanted when the plane of the inner opening is at an angle other than the perpendicular to the longitudinal axis. It is opened stepwise when the inner straight or inclined opening is combined with an opening (preferably a plane parallel to the longitudinal axis) formed on the side end of the inner end. The stepped open end means a greater advantage because it greatly increases the area of intervention and provides easier maneuvering. The greater the cross-section of the inner end opening facing the surgical area, the greater the maneuverability of the instruments. This surface can be increased to any extent by adding an arbitrary size opening on the side panel. A separate opening may also be located on the side panel of the central part of the tube. Preferably, at the outer end of the tube, the tubular bending device, the gas connection, and the opening of the outer end, optionally removable or displaceable, are preferably provided. can be fitted with a cap. The cap can be attached to the outer end with a screw thread or any other air tight connection. The cap is equipped with valve openings with valve.

• · · ·

In the case of -8SPS surgeries, the entire tube may preferably be rigid.

In either case, the outer end of any instrument, trocar tube, tube, or endoscopic device may optionally be provided with an external attachment device capable of temporarily or permanently securing the outer end in any desired position.

In either case, the thread, rod or rod attached to the inner end of any instrument, trocar tube, tube or endoscope device may also be attached to an external fastening device.

In the case of the endoscopic device, we mean a solution in which several working channels are formed in the long cylindrical body. Preferably, connecting lines or rails may be provided on the outer surface of any type of endoscopic device to provide additional external connections (e.g., thread, rod, guide rod, stomach closure, etc.). Preferably, any type of endoscopic device at the inner end is provided with a wrist and a bendable joint through a bending device. The wire pair runs through the device connected to the bending device at the end of the device. The outer and inner ends of any type of endoscopic device are preferably rigid, the middle part being flexible or rigid. Also, any endoscopic device may have a gas and suction rinse as desired.

In one possible preferred embodiment, the endoscopic device is divided. In this case, the endoscopic device is preferably divided into two parts, lower and upper, in part or in whole, preferably in a plane parallel to the longitudinal axis. The two parts are connected to each other by a sliding connection and can be moved forward and backward relative to each other along their longitudinal axis. The separating plane can also divide the work channel running in the endoscopic device into two complementary submerged work channels. If the two endoscopic portions are slid apart, the half channels in the inner end area are opened on their sides. On their side open side work channels, they can be moved backwards and forwards to any bending device with or without trocar tubes at their internal joints. The advantage of open open work channels is that the inner telescopic end and head of the instrument can be deployed over the entire length of the device during the entire length of the open area. The openness of the split work channels by the longitudinal sliding of the two endoscopic sides relative to each other can be increased as desired. reduced. In the preferred arrangement of four work channels, the separating plane separates two longitudinally opposed working channels. The other two working channels, preferably the top and bottom, remain intact. The straight or oblique open end ends can be staggered openly by sliding the two halves of the split endoscopic device in a longitudinal direction to achieve the above-mentioned advantages.

In a preferred embodiment, the outer end of the split endoscopic device is rigid. The rigid end of the upper part of the device is complemented with a complete cylinder so that the end of the sliding lower part is also located within this common cylinder. The outer end, complete with the cylinder, is airtight, with only four insulated openings with valve, preferably with openings, that lead to the entire or split work channels running in the endoscopic device. The air-tight closure of the cylindrical outer end can be locked in any way with a valve

(can also be fitted with a cap with external openings).

Preferably, the rigid tubular continuation of the bottom portion of the cylindrical end exits the lower outer opening, the trocar handle. The trocar handle is the outer end of the undivided work channel of the lower endoscopic portion, which has a tab that facilitates longitudinal forward and backward movement of the lower endoscopic portion at the end of the valve having a valve outside the outer opening. Preferably, the tab can be pulled out by means of the tab. the trocar handle can be pushed through the lower outer opening relative to the cylindrical end, which also means moving the inner end of the bottom end of the split endoscopic device in the longitudinal direction. Thus, it is possible to control the magnitude of the opening of the inner end, i.e. the size of the operation area.

Alternatively, the planar working channel that divides the split endoscopic device parallel to the longitudinal axis is not affected. Preferably, the two undivided work channels are provided by the top and bottom split endoscopic portions. In this case, the end end of the outer endoscopic device may be a common cylindrical outer end similar to the previous one, except that two rigid trocar shafts of the two work channels of the lower part now exit the two lower outer openings. Alternatively, the outer end of the split endoscopic device may be similarly distributed, and both outer ends are sealed. The upper and lower outer ends have external openings with a valve. In this case, either side joining with each other by a sliding joint can simply be pulled out of the patient, and a larger instrument can be introduced instead (e.g., an endoscopic sewing machine). the required tissue or organ can also be removed through the site of the extended endoscopic portion.

In another preferred embodiment, the endoscopic device is undivided, uniform. The inner end can be straight, slanted or stepped open. In the case of a stepped open end, preferably only one or more working channels in the inner end section may be halved due to the advantages described above. In a preferred embodiment, the top and bottom of the four work channels and the two side are half-worked internal work channels. Of course, two top and two bottom undivided work channel layouts are also possible. The outer end of the undivided endoscopic device has hermetically sealed outer valves with valves attached to it.

A sliding connection (eg sliding flange, passage or rail) for securing the trocar tube or instrument introduced therein in a halved working channel of any type of endoscopic device is provided. These connecting elements are fitted with connecting elements on instruments or trocar tubes.

Preferably, any type of tube or endoscopic device may have an outer end funnel-like. This design facilitates easier handling of instrument ends.

Any type of tube or endoscopic device may advantageously have a protective cover. The protective cover is preferably a funnel-shaped, strong foil-like device, the outer end of which is preferably an anchor-sealing ring or tube to the outer end of the tube or endoscopic device, and an elastic ring at the inner end.

-Who is. The cover can be pulled up on the tube or endoscopic device. The protective cover may be inserted into the abdominal cavity through the opening on the wall of the hollow organ through the natural body orifice to the tube or endoscopic device. When it reaches the abdominal cavity, the elastic ring causes the inner end of the protective cover to be funnel-like, and the draining wound prevents the gas from escaping from the gas inflated abdominal cavity. At the same time, the protective cover also protects the walls and the environment of the hollow organs from the damage of moving instruments and prevents the patient from contacting with the secretions, tissues or organs. The funnel-like shape (i.e., the larger end of the circumference) also means easier removal of tissues and organs. Of course, any other form of protective cover may be one of the possible solutions.

Alternatively, an inflatable balloon endoscopic ring may be drawn separately for the tube or endoscopic device in the area close to the inner end. This device can be inserted into a hole formed on the wall of the hollow body and prevents the gas from escaping. The ends of the balloon wires extend beyond the natural body orifice when the endoscopic ring is inserted.

For any instrument trocar tube tube or endoscopic device, instrument trocar tube, or instrument tube or endoscopic device system described above, the introduced instrument is capable of performing well-proven three-dimensional laparoscopy by means of sliding connections, bends, rotations and telescopic lowerings and elevations. for reliable reproduction of motion combinations.

Below is a description of the additional tools.

One such device in the penetration phase is the introductory catheter that facilitates the formation of a wound opening on the hollow body wall (e.g., stomach). The catheter can be introduced into any suitable work channel. At the inner end of the catheter, at the tip of a catheter, is an electrical unit operating preferably at a radio frequency, the associated electrical conductor extending through the catheter and being connected to the power supply outside the natural body opening. Preferably, the RF unit is slightly recessed in the tip of the catheter to prevent more direct contact with the tissues. There are two balloons in the catheter one after the other. The proximal end is preferably an umbrella-shaped balloon, the most important feature of which is that the diameter perpendicular to the longitudinal axis is preferably greater than the diameter of the tube or endoscopic device. The second is the expansion balloon, typically in the form of a spindle or cylinder, and preferably having a diameter smaller than the diameter of the tube or endoscopic device. Balloons can blow up independently of each other. they can be lowered and the ends of their wires over the outer end of the trocar tube, tube or endoscopic device. Another such device is a device for closing the wound on the wall of the hollow body. According to a preferred embodiment, the wound closure system according to the invention comprises a sleeve, an implant tube, a duct, a thread and a pushing rod. The rail or passageway formed on the outer surface of the tubular sleeve can be connected by a sliding connection to a passage or rail on the outer surface of the trocar tube, tube or endoscope device. The inner end of the yarns has a stacking element, an external locking button. The dummy elements are located in the implant tube, and the implant tube and the yarns are surrounded by the vagina. The inner end of the implant tube is preferably pointed, with a longitudinal slot on its side, a wand pushing over the duct elements. The docking elements, the pushing rod, the implant tube, the yarns and the sleeve are interlocked. movable relative to the trocar tube, tube or endoscopic device. The slide bar, the implant tube and the sleeve are sufficiently flexible.

The third additional tooling system is the structure of the rigid elements that can be used to secure the outer and inner ends of the trocar tubes, the tube or the endoscopic means. Preferably, one end thereof is located at a site independent of the patient, e.g. can be attached to the operating table. One type of fastening means may be suitable for attaching a thread, rod or rod attached to the outer surface of the inner ends, and another type for fixing the outer ends. The shape, angle and position of the fastening device can be locked as desired. changed.

A fourth such auxiliary device may be a modified endoscopic sewing machine. Preferably, the head of the sewing machine is rigid and its body is partially or fully flexible. Preferably, the head and body are joined by a hinge. The seam surface of the head is preferably perpendicular or parallel to the longitudinal axis of the device, but may also close at any other angle. Between the free ends of the sewing surfaces there is a tensioning wire that can be tensioned or relaxed as desired. The wire is preferably located in a channel running through the head and the body. The end of the wire at the outer end of the sewing machine is preferably superior. When the wire is tensioned, the tissue part to be sewn into the jaws. When fully stretched, it also facilitates smoother (e.g., parallel) closure of the moving jaw of the sewing head. Preferably, a passageway or rail suitable for connecting a work channel or an external accessory device (e.g., a work channel, camera, pliers, etc.) on the body of the sewing machine may be provided. The seam surface may be straight, curved, wavy or of any other known shape. The diameter of the sewing machine is preferably less than the diameter of the tube.

The preferred embodiments of the present invention will now be described in detail with reference to the accompanying drawings.

In the drawings, Fig. 1A shows a possible solution of the hinge and bending system of the device according to the invention

Fig. 1B is a preferred embodiment of a telescopic device according to the invention with ball-like power transmission elements;

1 / C is a preferred embodiment of a telescopic instrument according to the invention with a hydraulic power unit;

Fig. 1D shows a possible solution of a preferably closed hydraulic unit, Fig. 1 / E is a possible solution of a ratchet structure in the field of the outer joint;

Fig. 2A is a preferred embodiment of a trocar tube according to the invention; Fig. 2B is a preferred embodiment of the telescopic device according to the invention; Figs. 3A and B are a possible preferred embodiment of the telescopic trocar tube according to the invention;

Fig. 3C shows a possible solution of a flexible middle part device according to the invention, a

Figure 4 / A is a preferred embodiment of a straight-ended tube according to the invention;

• · · ·

-124 / B is a preferred embodiment of a circular cross-sectional trocar tube coupled to one another by means of a sliding connection according to the invention;

Figures 4 / C, D and E show the inner and outer ends of a preferred embodiment of a circular cross-sectional and telescopic end trocar tube coupled to each other by a sliding connection according to the invention;

Fig. 5 shows the possible combinations of motion of the device according to the invention, respectively. depicting the identity of the laparoscopic motion combinations by depicting the inner virtual end;

Figures 6 / A, B, C, D, E and F illustrate the possible combinations of motion of the device according to the invention individually;

Fig. 7 shows a possible position of the laparo-endoscopic system according to the invention introduced into the patient, a

Figure 8 shows one possible setting of the laparo-endoscopic system according to the invention for gall bladder surgery;

Figure 9 / A is a preferred embodiment of a stepped open end tube according to the invention, a

Fig. 9B is an oblique inner end of the tube according to the invention, a

Fig. 9 / C is a preferred embodiment of an oblique and stepped open inner tube end according to the invention, a

Fig. 9 / D is a possible solution of a tubular balloon endoscopic ring, Fig. 9 / E is a possible solution of a hermetically sealing cap of the outer end of the tube;

Figure 10 is a preferred embodiment of a stepped inner tube end according to the invention, a

Fig. 11 shows a stepwise adjustment of the step-open end-end laparoscopic system according to the invention for epithelial surgery; a preferred solution for using the guide rod, a

Figure 12 / A is a preferred embodiment of a straight inner end split endoscopic device and a protective cover according to the invention;

Fig. 12B shows the sliding of the parts of the former device, the trocar handle, and the protective cover, Figs. in slippery condition, a

Figure 12 / E shows the possible ellipsoidal cross-section of the endoscopic device of the invention, a

FIGS. 13 / A and B are longitudinal sectional views of a preferred inclined internal endoscopic device according to the present invention; in slippery condition, a

Figures 13 / C and D show the possible preferred cross-sections of the split endoscopic device of the invention, a

Fig. 13 / E is a cross-sectional view of the instrument and associated ring or trocar tube which can be inserted into the working channel of the endoscopic device according to the invention;

Figures 14 / A and B show a straight internal end of the top and bottom portions of the split endoscopic device according to the present invention with two undivided work channels in a normal position, respectively. in sliding state, a

Figure 14 / C shows a common cylindrical end of the former device with two trocar handles and a bending device;

Fig. 15 is an oblong endoscopic device having an oblique inner end according to the invention at its outer end, which is already slid, with two undivided work channels;

-13low-enclosed, fully separate, top and bottom part only sliding connection

Figures 16 / A, B and C show further preferred embodiments of the connection of the trocar tubes, Figure 17 / A, an undivided, endless, open end endoscopic device, Figure 17 / B is a cross-sectional view of the former device;

Fig. 17 / C shows the inner oblique end of the undivided endoscopic device, a

Figures 18 / A, B and C are means for enabling the wound on the wall of the hollow organ to be closed, a

Fig. 19 / A is a device, which is inserted into the stomach wall in an obliquely staggered tube;

Figure 19 / B is a camera through the small opening, a

Figures 20 / A, B, C and D are another preferred embodiment of penetrating the hollow body wall and the operation of the balloon inlet catheter required for this purpose;

Figure 21 is a gallbladder operation with a stepped open end end-end laparoscopic system, the possibility of fixing the outer and inner end of the system, the anatomical conditions,

Figure 22 is a gall bladder surgery performed with rigid ends and a middle portion through a rigid end and a central portion of the SPS (Single Port Surgery) abdominal wall;

Figure 23 shows a SPS gall bladder surgery with a laparosendoscopic system with a stepped open-end rigid body tube,

Fig. 24 / A is an oblique and stepped open-ended endoscopic system with a lap-endoscope inserted into the patient through a natural body orifice;

Fig. 24 / B shows the removal of the gallbladder by the above-mentioned laparo-endoscopic system through a protective cover;

Fig. 25 shows a stepped open-ended laparoscopic endoscopic surgery, the possibility of fixing the outer and inner end of the system, the anatomical conditions,

Figures 26 / A and B show a wormhole surgery with an endoscopic and endoscopic sewing machine with an oblique and stepped open end end, and its removal through a protective cover,

Fig. 27 is a closure of a hollow organ on the wall of a stepped open end and camera-equipped tube and a wound closure device connected thereto;

Fig. 28 is a closure of a tube and a wound closure device attached to it and enclosed by a camera, closing the opening of the wall of the hollow organ;

Fig. 29 / A shows yarns and sleeves having circular elements inserted into the edges of the opening on the wall of the hollow organ;

Fig. 29 / B shows yarns and sleeves having dummy elements inserted around the abnormal lesion on the wall of the hollow organ;

Figure 29 / C shows the wound edges contracted with the yarns and drawn into the vagina, and the wall of the raised hollow body,

Fig. 30 / A is a straight endoscopic sewing machine open to the side with a guide wire and preferably a camera which is introduced along the vagina;

Fig. 30 / B is a detail of the intestinal wall with the wound or abnormal lesion drawn by the threads and sleeve into the open endoscopic suturing head and the tensioned guiding wire,

Figure 30 / C shows the wound of the wall of the hollow body sealed by the terminal sewing machine, the sleeve and the

• · • · · ·

-14 cut tissue, a

Figure 30 / D is an endoscopic sewing machine having a guide wire and connecting passage according to another preferred embodiment.

Figures 31 / A, B and C show a wound closure, similarly to the former, but with a curved sewing machine.

Fig. 32 is a hollow organ with a sleeve and yarn recessed in the straight open endoscopic sewing machine having a wound opening and a threaded connection to the connecting passage with a wrench bent at the wrist and a connection to the connecting passage.

Figs. 33 / A and B are a sectional view of the cut-off of the fabric section drawn into the sewing machine and the closure of the hollow body wall with a terminal suture;

Figures 34 / A and B show complete excision of the abnormal lesion formed on the wall of the hollow organ by the laparo-endoscopic system and the closure of the opening on the wall of the hollow organ by a threaded suture.

In a preferred embodiment, trocar tubes 7 can be introduced into the partially or wholly flexible tube or 66,103 endoscope device and the instrument 6 into the trocar tube 7. Preferably, there is a connection between the tube 28 or the endoscopic device 66,103, the trocar tubes 7 and the instruments 6, which allows parallel movement along the longitudinal axis and rotation about the longitudinal axis. Additional external devices can be connected to their external and internal surfaces, for example: 71 protective cover, wound closure, 88 sewing machines. Preferably, all joints allow movement, sliding along the longitudinal axis, and rotation around the longitudinal axis of the instrument.

As illustrated in Figures 1 / B and C, one of the preferred embodiments of the apparatus 6 is that the instrument is preferably divided into three main parts: the partially flexible middle part 2 and the two side hinged, telescopically extensible 3 outer and 1 inner rigid members. ends. Preferably, any section of the central portion 2 close to the hinges 4 is also rigid. Preferably, the instruments 6 have a circular cross-section.

Preferably, the outer and inner ends 1 of the instrument 6 are simultaneously, at the same rate, rotated in the same direction of rotation (parallel rotational axes perpendicular to the longitudinal axis of the joints 4) and only one common plane extending along the longitudinal axis and perpendicular to the two parallel rotation axes. at the joints 4 relative to the central portion 2, as if the two ends 1, 3 were part of a single conventional laparoscopic instrument. Preferably, the simultaneous folding and bending of the ends in only one plane is made possible by a pair of wire systems 5 extending from the inner end 1 through the hinges 4 and the middle portion 2 to the outer end 3. Of course, any technical solution known today may also be suitable for providing the deflection described above.

The hinge 4, which connects the middle and the outer end 3, preferably has a soluble-lockable ratchet 18. The ratchet structure 18 and the fastener 19 allow temporary or permanent fixing of the angles between the central part 2 and the ends 1, 3.

The telescopic ends 1, 3 preferably consist of rigid tubes which can be pushed into one another. The inner telescopic end 1 has the head 8 of the instrument 6, which is designed with the head of any laparoscopic instrument (including the camera) in use today

···· • · ···

-15 preferably equal. At the outer telescopic end 3, the handle 9 of the instrument 6 is provided, which, according to a preferred embodiment, is also the same as that of the end of the laparoscopic instruments. The opening and closing of the handle 9 of the instrument controls the operation of the head 8 of the instrument through the guide wire 13 running through the outer and inner ends 3 and the central part 2.

In spite of the fact that the two telescopic ends 1, 3 are separated from each other by the central portion 2 connecting them, they move or move. their movement is as if the two ends 1, 3 were continuous, as in the case of a conventional laparoscopic instrument (Fig. 5). For example, if the outer telescopic end 3 is pressed, i.e. shortened, so that the inner telescopic end 1 is extended by the same amount or length. the same goes for the reverse. This movement is made possible by the transmission system located inside the instrument 6.

In a preferred embodiment, this transmission system is preferably a ball-shaped power transmission unit 12 arranged in succession in the internal channel of the instrument. The channel extends from the inner telescopic end 1 through the central part 2 to the outer telescopic end 3. The full length of the channel is filled with 12 balls. The diameter of the balls is slightly smaller than the inside diameter of the channel. The center of the balls is preferably a hole, through which the head 13 of the head 6 runs from the handle 9 to the head 8. Preferably, the channel is provided with a friction reducing material. Preferably, the 12 ball-like transfer units are also able to travel in the channel without hindrance to the hinges. When the handle 9 of the instrument 6 is pushed forward, the grip pushes the last ball located in the outer telescopic end channel 3. The adjacent balls pass this compression force onto each other, and finally the first ball of the inner end channel 1 pushes the head 8 of the instrument forward, thereby extending the inner telescopic end. For reverse movement, i.e. to shorten the internal telescopic end of the instrument 6, it is preferred to use the wire 5 connecting the two telescopic ends 1, 3, in this case, the drive line 13 may also be loaded. Tightening the handle 9 of the instrument 6 extends the telescope of the outer end 3 and the attached wire 5 pulls the inner telescopic end 1. Of course, any other form suitable for transmission without the hinges 4 may be used instead of the ball mold.

Another preferred embodiment of the transmission may be a closed, preferably flexible, hydraulic unit 14 in the channel described above (Fig. 1 / D). In a preferred embodiment, the hydraulic unit 14 can be divided into three parts: an outer and an inner end 16 and a central portion 15. The three parts are the free-running parts of a single cavity system. The unit is closed, the hydraulic fluid does not run to the outside world, only flows in the common cavity of the three parts 15,16,17. Preferably, the central portion 15 of the unit 14 is located in the channel of the central portion 2 of the instrument 6, the length of which corresponds to its length, and is preferably fixed to the channel and does not move relative thereto. The outer and inner ends 16 of the hydraulic unit 14 are disposed in the channel of the outer and inner telescopic ends 3 of the instrument 6. The ends 16,17 of the unit 14 are designed so that they are preferably capable of increasing volume or only in the longitudinal direction. decrease, i.e. elongation or contraction, with unchanged cross section. The walls of the ends 16, 17 of the hydraulic unit 14 may preferably move along the longitudinal axis in the channel of the ends 1, 3 of the instrument. A preferred embodiment of the ends 16,17 of the unit 14 would be a harmonic-like arrangement of the wall of the end portions. When the 6 '.

By pushing the handle of the instrument, the outer telescopic end 3 is compressed, and the end of the hydraulic unit 14 formed in the outer harmonic-like manner is compressed along the longitudinal axis. The internal pressure thus exerted at the outer end 17 of the hydraulic unit 14 is transmitted to the inner inner hydraulic section via the preferably fixed central hydraulic section 15, which, in turn, protrudes like a harmonic, thereby extending the telescopic end 1. Preferably, the elongation of the telescopic ends 1, 3, respectively. shortening is the same. In addition to the bellows-like formation of the ends 16,17, a similar result can be obtained if the wall of the hydraulic unit 14 is made of a stretchable material. For reverse movement, i.e. to shorten the inner telescopic end of the instrument 6, it may be advantageous to use two wires connecting the telescopic ends 1.3, which may also be the guide wire 13. Tightening the handle 9 of the instrument 6, the telescope of the outer end 3 extends, and the wire attached thereto pulls the inner telescopic end 1, while the elevated pressure in the lower inner hydraulic end is transmitted to the outer hydraulic part 17, thereby extending the outer portion 17 while the inner portion 17 extends, while the inner portion 16 extends, part decreases. Preferably, at least one connecting ring 10 may be provided at the center portion 2 of the instrument 6 for connection to the tube 28. In the ring 10, the instrument 6 can be freely rotated. A connecting passage 11 is provided on the outer surface of the ring 10. According to another preferred embodiment, the ring 10 is connected to a thread 23 having 24 needles, by means of which the central part 2 of the instrument 6 can be attached to the abdominal wall 41 at will.

The instrument 6 may also be connected to the tube 28 by another simple trocar tube 7. A sliding connection 29 is provided between the tube 28 and the trocar tube 7 and the central portion 2 of the instrument 6 is located in the trocar tube 7. The middle part 2 is preferably longer than the length of the trocar tube 7. The instrument 6 can be rotated in the trocar tube 7, pushed forward and backward. Preferably, at the outer end of the trocar tube 3, a valve 22 and an insulating ring 21 are provided to permit an airtight closure.

In another preferred embodiment of the apparatus 6, the device 6 is preferably divided into three main parts: the partially flexible middle part 2 and the hinged 4 telescopically extending outer and 1 internal rigid ends (FIG. 2B). The transmission system is the same as described above. The instrument 6 has no wires 5 for bending the telescopic ends 1, 3. In this embodiment, the instrument 6 is connected to the tube 28 by means of a trocar tube 7 having a partially or fully flexible central portion 2 and 4 hinged rigid outer and 1 inner ends (FIG. 2A). The ends 1, 3 are pushed in and out by the wire pairs 5 running in the wall of the trocar tube. Also, the ratchet structure 18 is preferably located at the outer hinge 4. Preferably, at the outer end 3 of the trocar tube 7, a valve 22 and an insulating ring 21 are provided to provide airtight closure.

The length of the middle portion 2 of the trocar tube 7 is preferably greater than the length of the tube 28. A sliding connection 29 is preferably provided between the trocar tube 7 and the tube 28. The length of the middle portion 2 of the instrument 6 is preferably greater than the length of the central portion 2 of the trocar tube 7. The instrument 6 can be moved freely in and around the longitudinal axis in the trocar tube 7, as well. rotated. / '

In another preferred embodiment, the apparatus 6 is preferably divided into three main parts: the flexible middle part 2 and the non-telescopic outer and inner rigid ends 26 (Fig. 3 / C). The actuator line 13 is heated inside the instrument 6. A separate power transmission unit 14 is not present in the instrument 6, this function being performed by the flexible middle part 2 itself and the two rigid end portions 25, 26.

Such a device 6 is preferably connected to the tube 28 by a trocar tube 7 having a partially or fully flexible central portion 2 and 4 hinged telescopic outer and 1 inner rigid ends. Preferably, the synchronous engagement and deflection on the hinges 4 is performed by wire pairs 5 running in the wall of the trocar tube. The ratchet structure 18 may also be provided at the outer hinge 4. The synchronous stretching and shortening of the telescopic ends 1, 3 is carried out by the force applied to the telescopic ends 1, 3 by the instrument 6 which is moved inwards or outwards in the trocar tube 7. Preferably, a sliding connection 29 is provided between the trocar tube 7 and the tube 28 for free movement along the longitudinal axis. Preferably, at least one freely rotatable connecting ring 10 is provided in the central part 2 of the trocar tube 7 to form the sliding connection. The ring 10 preferably has a connecting passage 11, which is connected to a rail 50 formed on the inner surface of the tube. Preferably, at the outer end 3 of the trocar tube 7 there is a valve 22 and an insulating ring 21 (Fig. 3A, Fig. B).

According to a preferred embodiment of the trocar tubes 7, a plurality of trocar tubes 7 are circularly connected to the sliding joints 29 on their sides so that each trocar tube 7 is connected to its neighbor on its two sides (FIG. 4B). Preferably, the connection of four trocar tubes is sufficient for most surgical procedures. In this case, the cross-section of the connected trocar tubes 7 is preferably a quarter-circular section, which together gives a full circular cross-section, so that the common external cylindrical shape means greater humility during the interventions (e.g., penetration through 39 stomach bodies). The planar planar faces facing each other are provided with sliding connections 29 (matching passageway 11 and rail 50) which allow the trocar tubes 7 to move relative to each other along their longitudinal axis. Such a trocar tube 7 has two flat faces, preferably a passage 11, and a second rail 50 on the other. The working channels 27 running in the trocar tubes 7 are preferably circular in cross-section. Such trocar tubes may be partially or fully flexible or rigid. The inner end of the trocar tubes 7 may also have an oblique plane, which may facilitate passage through the stomach wall 39.

Also in this possible embodiment, the outer circular cross-sectional trocar tubes 7 have 3 outer and 1 inner, preferably telescopic, rigid ends 4 through hinges (Fig. 4C, Fig. D). Preferably, the telescopic ends 1, 3 have a circular cross-section and can be rotated about the longitudinal axis relative to the central portion. In this case, there are no 14 power transmission units to operate the telescopes. This task is accomplished by means of a flexible central part 2 and a rigid 1, 3, moving inward and outward direction along the longitudinal axis introduced into the working channel of the telescopic trocar tube 7. Advantageously, the telescopic ends 1, 3 are synchronized through the hinges 4 by the 5 wire pairs running in the trocar tube. Preferably, at the outer end 3 of the trocar tube 7, there is a valve 22 and an insulating ring 21.

· ♦ · • ·

The connection of the trocar tubes 7 may have other variants than the solution described above. In a preferred embodiment, additional trocar tubes 7 can be attached to the outer surface of a dual trocar tube 99 by a sliding connection 29 (FIG. 16 / A). Preferably, the trocar tubes 7 can be connected to the portion connecting the dual trocar tubes 99. In addition, the additional trocar tubes 99 or the outer surface of the trocar tubes 7 attached thereto may have additional connection lines 11 or 50, for example through which they are provided. a thread 23, rod 51 or rod 61 for attachment to the abdominal wall 41 may be attached. In another preferred embodiment, the trocar tubes 7 are connected to the outer side of a central trocar 98 via sliding connections 29 (FIG. 16 / B). Connecting lines 11 or rails 11 for connecting the trocar tubes 7 are formed on the leading outer surface of the central trocar 98. The trocar 98 may have a smaller working channel 27 having a smaller diameter, e.g. 104 balloon inlet catheters are guided. Preferably, the leading end of the trocar 98 may be pointed. In a further preferred embodiment, a further trocar tube 7 is connected to a central trocar tube 7 through the sliding connections 29 (FIG. 16 / C). The outer cross-section of the central trocar tube 7 may be arbitrary, while the working channel 27 is preferably circular. The central trocar tube 7 may preferably have additional channels such as e.g. the gas or suction rinses 65. The outer surface of the central trocar tube 7 is provided with connecting lines 11 or rails 50 suitable for connection.

It is not necessary to use 28 tubes to introduce the interconnected trocar tubes into the body cavity. The trocar tubes 7 may be temporarily or permanently secured to the abdominal wall 41 by means of a ring 10, preferably located at a portion close to the inner end 1 of the central part 2. The fastening is preferably carried out by means of a twisted needle 24, a rigid rod 51 or a guide rod 61. In the ring 10, the connected trocar tubes 7 can be moved freely along and around the longitudinal axis. rotated. If no tube 28 is used, a connecting passage 30 or a rail 50 may preferably be provided on the outer surface of the trocar tubes 7 to connect external endoscopic devices.

The trocar tubes 7 connected to the sliding connections 29 can also be introduced into the abdominal cavity by means of a simple, partially or fully flexible tube 28. attached to the abdominal wall 41. In this case, preferably, there are no 50 rails or passageways inside the tube 28, only on the outer surface of the tube. The inner end 31 of the tube 28 may be straight 102, oblique 101, or 100 inclined (Figures 4 / B and 9 / A, B, C and D). Also, a thread 23, rod 51 or rod 61 for attachment to the abdominal wall 41 may be provided on an outer surface close to the inner end 52. The rod 51 or rod 61 may also have a sliding foot 58 which fits into a preferred longitudinal connector 11 on the outer surface of the tube 28 and may be moved as desired (FIG. 10). In this case, with the rod 51, the inner tube end 52 fixed to the abdominal wall 41 can be adjusted back and forth over the selected surgical area using a slidable foot 58 in the passage. At the same time, the inner end 52 of the tube 28 can be directed to any desired area of the abdominal cavity by means of a rigid rod 51 or a rod 61. the rod 51 or rod 61 can be stably held in the desired position and position (Fig. 11). Other external endoscopic devices 30 (e.g., wound sealing device, camera 44, pliers, etc.) may also be connected to the passage 11 of the tube 28 on the outer surface. * '

-19The following 6 instruments, respectively. possible advantages of tubular tubes 28 and endoscopic devices 66, 103 receiving trocar tubes 7.

By means of the tube 28 is meant a solution where the long cylindrical body is preferably a single-cavity tube into which 6 instruments, 7 trocar tubes or other auxiliary devices can be inserted.

In the simplest preferred embodiment, the tube 28 at each end 52, 53 is a straight tube with a straight open end, preferably having a circular cross section or an ellipsoid. Preferably, the inner and outer ends 52 of the tube 28 are rigid and the central portion 2 is fully or partially flexible, but may be rigid if desired. The inner diameter of the tube 28 allows it to receive more than one, preferably four, trocar tubes. The inner surface of the tube 28 may be completely smooth or, in a preferred embodiment, preferably have longitudinal connecting lines 11 or rails 50 on its inner surface. The outer surface of the tube 28 may also preferably have longitudinal connecting lines or rails. Preferably, at the inner end 52 of the tube 28, a thread 23, a rod 51 or a rod 61 may be attached. Preferably, a hinge-like connection 4 is formed between the inner end 52 of the tube 28 and the central part 2 of the tube. The inner end 52 may be bent out and inwardly in the area of the hinge 4 with respect to the central portion 2, preferably through the wire pairs 5 extending through the tube 28 and the tubular bending device 54 on the outer end 53. The inner end 52 of the tube 28 may be either straight line 102 or oblique 101, or 100 stepped open (Figure 9). 102 Open straight when the plane of the inner opening 31 is perpendicular to the longitudinal axis of the tube. 101 Slanted when the plane of the inner opening 31 is at an angle other than the perpendicular to the longitudinal axis. 100 Slightly open when the inner straight line or sloping opening 101 is combined with an opening (preferably parallel to the longitudinal axis) formed on the side end of the inner end 52. The 100-step-open inner end 52 is of greater advantage, since with this solution the size of the intervention area can be significantly increased, while at the same time easier maneuvering of the instruments 6 can be ensured. The greater the cross-section of the opening 31 of the inner end 52 towards the surgical area, the greater the maneuverability of the instruments 6. This surface can be increased to any extent by adding an arbitrary size opening on the side panel. A separate opening may also be located on the side panel of the central portion 2 of the tube 28. Preferably, at the outer end of the tube 28, the tubular bending device 54, the gas connector 55, and the opening 32 of the outer end 53 are removable or optionally removable. can be fitted with 47 caps (9 / A, Fig. E). The cap 47 may be secured to the outer end 53 by any of the known air-tight connections. Caps 47 are provided on the cap 47 with valve 22.

For SPS surgeries, the complete tube 28 may preferably be rigid (Figure 23). In either case, the outer end of any of the 6 instruments, the trocar tube, the tube 28, or the endoscopic device 66, 103 may optionally be provided with an external fastening device 42 that can temporarily or permanently secure the outer end in any desired position.

In either case, any of the instruments 6, trocar tube 7, tube 23, or end of endoscopic device 66,103, rod 51, rod 61, or rod 61 may also be attached to an external fastening means 42.

In the case of the 66,103 endoscopic device, it is understood that it is preferably a circular or ellipsoidal cross section having a length of more than 27 in a long cylindrical body

there is a work record (Figures 12, 13, 14, 15, 17). The advantage of the ellipsoidal cross-section is that the distance between the two side working channels 27 is greater, which makes it easier to maneuver with the instruments 6 in it. Preferably, the connecting surface of any type of endoscopic device 66, 103 may have 11 connecting lines or rails 50 for additional external connections (e.g., 23 threads, 51 rods, 61 guide bars, stomach closure devices, etc.). Preferably, any type of endoscopic device 66, 103 is provided at its inner end with a possible 5 wedge pair and a bendable hinge 4 through a bending device. The wire 5 runs through the device connected to the bending device 54 at the end of the device. The outer and inner ends of any type of endoscopic device 66, 103 are preferably rigid, the middle part being fully or partially flexible or rigid. Also, any endoscopic device 66, 103 may optionally have 64 gas and 65 suction channels.

In one preferred embodiment, the endoscopic device 66 is divided. In this case, the endoscopic device 66 is preferably divided into two parts, the lower and the upper part, in whole or in part, preferably in a plane parallel to the longitudinal axis. The two parts are connected to each other by a sliding connection 29 and are movable along each other along their longitudinal axis to move back and forth as desired. The separating plane in the endoscopic device can also divide the work channel 27 into two complementary 70 halved work channels. If the two endoscopic portions 66 are slid apart, the interleaved channels 70 in the inner end area become open on their sides. The side open work channels 70 on their sides can be moved backwards and forwards to any of the instruments 6 bent at their internal joints, with or without trocar tubes. The advantage of the open-ended work channels 70 is that the inner telescopic end 1 and head 8 of the internal device 4 of the instruments 6 can be applied to the area of the operation over the entire length of the open part. The openness of the split work channels 70 can be increased or extended as desired by longitudinal sliding of the two endoscopic halves 66 relative to each other. can be reduced (Figure 12). In the preferred arrangement of four 27 work channels, the separating plane splits two longitudinally opposed work channels 70. The other two work channels 27, preferably the top and bottom, remain intact. The straight or sloped open ends 102 of the line 102 can be turned into 100 steps by sliding the two halves of the split endoscopic device 66 in a longitudinal direction to achieve the above-mentioned advantages.

In a preferred embodiment, the outer end of the split endoscopic device 66 is rigid. The upper outer end 67 of the device 66 is provided with a complete outer roll, so that the end of the sliding lower portion is also located within this common cylinder. The 67 common outer end, complete with the entire cylinder, is hermetically sealed, with only four insulated outer openings 48 provided with 22 valves, preferably with openings in the endoscopic device 66, leading to full 27 or 70 split work channels. The air-tight closure of the cylindrical outer outer end 67 can also be accomplished by a cap 47 having external openings 48 with a valve 22 in any way.

Advantageously, the rigid tubular continuation of the lower portion 66 from the cylindrical joint end 67 extends through the lower outer opening 48, the trocar handle 68. The trocar handle 68 is the outer end of the undivided work channel 27 of the lower endoscopic portion 66, having

at the end with a valve 22 outside the outer opening, a tab 69 for facilitating longitudinal forward and backward movement of the lower endoscopic portion 66 is provided. Advantageously, the tab 69 can be pulled out or removed. the trocar handle 68 can be inserted through the lower outer opening 48 relative to the cylindrical outer end 67, which also means moving the inner end of the bottom end of the split endoscopic device 66 in the longitudinal direction. Thus, it is possible to control the size of the 100-step opening of the inner end, i.e. the size of the operation area (Fig. 13 / A, Fig. B).

Alternatively, the plane 66 that divides the split endoscopic device 66 parallel to the longitudinal axis does not touch the work channel. Preferably, two undivided 27 work channels are provided by the top and bottom 66 split endoscopic portions (Figure 14). In this case, the end of the upper end of the split endoscopic device 66 may be similar to the previous 67 cylindrical outer end, except that the two rigid trocars 68 of the two working channels 27 of the lower portion now exit the two lower openings 48. Alternatively, a split endoscopic device 66 in its length may comprise two similar but independent end and end sealed lower and upper halves (Figure 15). The upper and lower outer ends have outer openings with valve 22. In this case, any of the 66 endoscopic devices connected to each other by a sliding connection 29 can simply be pulled out of the patient and a larger instrument can be introduced instead (e.g., 88 endoscopic sewing machines). the required tissue or organ can also be removed through the site of the extended endoscopic portion 66.

In another preferred embodiment, the endoscopic device 103 is undivided, uniform. The inner end may be straight line 102, slanted 101, or 100 stepped. In the case of the staggered inner end 100, preferably one or more working channels 27 may also be one half of the inner end of the inner end due to the advantages described above (Figs. 17 / A, B, C). Preferably, the top and bottom sides of the four work channels 27 are two, and the two sides are a 70-end inner end work channel. Of course, there are also two top and two bottom undivided 27 work channel layouts. The outer end of the undivided endoscopic device 103 has hermetically sealed openings 22 with valves 27 associated with the work channels.

A sliding connection 29 (e.g., 74 sliding flange, 11 passageways or 50 rails) for securing the trocar tube or instrument 6 introduced therein into the halves of the endoscopic device 66, 103 of any type is provided for securing it sufficiently in the direction of the longitudinal axis. . These connecting elements are fitted with connection elements (eg 75 troughs) formed on the instruments or on the trocar tubes.

Preferably, any type of tube 28 or endoscopic device 66, 103 may have an outer end 105 funnel-like (FIGS. 21 and 25). This design can facilitate the handling of the outer ends 9 of the 6 instruments.

Preferably, any type of trocar tube 7, tube 28, or endoscopic device 66,103 may have light sources / LEDs 106 at its inner end. Multiple light sources 106 allow for more even illumination.

·· ··· ·· · · «·· ·····

Preferably, any of the described laparo-endoscopic system combinations may also be suitable for carrying out interventions within the hollow organ (e.g., excision of abnormal lesions, closing of the wound opening, implantation of a feeding probe, etc.). In this case, the relative fixation of the inner end is provided by the trocar tubes 7, the tube 28, or the inflatable balloon connected to the inner end of the endoscopic device 66,103 (Figure 34). Preferably, the balloon 45 may be slidable and its outer diameter may be greater than that of the esophagus 38. diameter of other 39 hollow organs.

In any instrument trocar tube tube or endoscopic device, instrument trocar tube, or instrument tube or endoscopic device system described above, the introduced instrument 6 is capable of performing well with sliding joints 29, bends, rotations and telescoping. for reliable reproduction of three-dimensional laparoscopic motion combinations.

Below is a description of the additional tools.

One such device is preferably an externally connected protective cover 71 (12 / A, Fig. B) for trocar tubes 7 or tubing or 66,103 endoscope devices connected to one another. The protective cover 71 is preferably a funnel-shaped, high-foil-like device having an outer ring 28 or an anchorage tube 97 of any length and an elastic ring 72 at the inner end, preferably at the outer end of the tube 28 or endoscopic device. Protective cover 71 can be pulled outwardly from the tube 28 or the endoscopic device 66,103. The protective cover 71 can be inserted into the abdominal cavity 40 through the opening 40 on the wall of the hollow organ through the natural body opening 28 to the tube or the endoscopic device 66,103. Upon reaching the abdominal cavity, the elastic ring 72, due to the funnel-like inner end of the protrusion 71, and the wound opening 40, which tightens the draft 71, prevents the gas from escaping from the gas inflated abdominal cavity. At the same time, the protective cover 71 also protects the wall and environment of the hollow organs from the damage of the moving instruments 6 and prevents the patient from contacting with the secretions, tissues or organs. The funnel-like shape (i.e., the larger end of the circumference) also means easier removal of tissues and organs. Of course, any other protective cover 71 may be one of the possible solutions.

As another possible accessory, the individually inflatable balloon 56 endoscopic ring (9 and 19 / A) can be drawn separately from the trocar tubes 7 or tubing 28 or the endoscopic device 66, 103 adjacent to the inner end. This device can be inserted into the opening 40 formed on the wall of the hollow body 39 to prevent gas escaping. The ends of the conduits 57 of the balloons 45 extend beyond the natural body opening when the endoscopic ring 56 is inserted.

The third possible accessory means in the penetration phase is the introductory catheter 104 to facilitate the formation of the wound opening 40 on the wall of the hollow body 39 (e.g., stomach) (FIGS. 20 / A, B, C). The catheter 104 may be introduced into any suitable work channel 27. At the inner end of the catheter 104, at its tip, an electrical unit 76 preferably operating at radio frequency, the associated electrical conductor extends through the catheter 104 and can be connected to the power supply outside the natural body opening. Preferably, the radio frequency unit 76 is in a slightly recessed position at the tip of the catheter, L) · · · ·

-23 to prevent more direct contact with tissues. The catheter 104 is provided with two balloons 77, 78 successively. The closest to the inner end is preferably the balloon-shaped balloon 77, the most important feature of which is that the diameter perpendicular to the longitudinal axis is preferably greater than the diameter of the tube or the endoscopic device 66, 103. The second is the expanding balloon 78, typically in the form of a spindle or cylinder, and preferably having a diameter smaller than the diameter of the tube or the 66,103 endoscopic device. The balloons 77, 78 can be blown up independently of each other. they can be lowered and the ends of their wires over the outer end of the trocar tube, tube 28, or 66,103 endoscopic device.

The fourth device is a device for closing the wound 40 on the wall of the hollow body 39 (Figure 18). In a preferred embodiment, the wound closure system according to the invention comprises a sleeve 85, an implant tube 82, a dummy element 84, a yarn 23, and a pushing rod 83. The rail 50 or line 11 formed on the outer surface of the tubular sleeve 85 can be connected by a sliding connection 29 to a passage 11 or a rail 50 on the outer surface of the trocar tube, tube 28, or endoscopic device 66, 103. At the inner end of the yarns 23, there is a stacking element 84 with an attachment button at the outer end. The dummy elements 84 are located in the implant tube 82, the implant tube 82 and the yarns 23 are surrounded by the sleeve 85. The inner end of the implant tube 82 is preferably pointed, with a longitudinal gap 86 on its side, and a pushing rod 83 above the dummy elements. The dummy elements 84, the pusher 83, the implant tube 82, the yarns 23, and the sleeve 85 are interlocked with each other. they can be moved relative to the trocar tube 7, tube 28 or endoscopic device 66, 103. The slide 83, the implant tube 82 and the sleeve 85 are sufficiently flexible.

The fifth additional tooling system is a structure of preferably rigid elements for securing the outer and inner ends of the trocar tubes 7, the tube 28, or the endoscopic means 66, 103. Preferably, one end thereof is located at a site independent of the patient, e.g. can be attached to the operating table. One type of fastening means 42 may be suitable for fixing the thread 23, rod 51 or rod 61 attached to the outer surface of the inner ends, and the other type for fixing the outer ends (e.g., Figure 21). The shape, angle, and position of the fastening means 42 can be locked at any time, as desired. changed. The attachment of the inner end preferably also allows the wall 41 of the body cavity to be raised. The inner end of the body cavity 41 may also be fixed to the wall by means of a magnetic device 107.

A sixth such additional device may be a modified endoscopic 88 machine. Preferably, the head of the sewing machine 89 is rigid and its body 90 is partially or fully flexible. Preferably, the head 89 and body 90 are joined by a hinge 4. The sewing surface 93 of the head 89 is preferably perpendicular or parallel to the longitudinal axis of the device, but may also close at any other angle. Between the free ends of the sewing surfaces 93, a deflection wire 91 is optionally tensionable or relaxable. The wire 91 is preferably located in the channel 92 running through the head 89 and the body 90. The end of the wire 91 preferably extends beyond the outer end of the sewing machine 88. When tensioning the wire 91, the fabric portion to be sewn is guided between the jaws. When fully stretched, the suturing head 89 also facilitates a smoother (e.g., parallel) closure of the moving jaw. Preferably, the groove 88 of the sewing machine 88 may be provided with a passage 27 or a rail 50 for connecting a work channel 27 or an external accessory 30 (e.g., a work channel 27, a camera, a pliers, etc.). Sewing surface 93 may be straight, curved, wavy, or any other known form

-2 432. Figures). The diameter of the sewing machine 88 is preferably less than the diameter of the tube 28.

The operation of the novel surgical procedures of the present invention (surgery through natural body openings - NOTES or single surgery - SPS, and interventions within the hollow organs - interventional endoscopy) allows the operation of the laparoscopic system, following:

1. Intrusion

Before the surgery, the laparo endoscopic system is assembled. In one preferred embodiment, the protective cover 71 is attached to the outside of the tube 28, and then folded. Trocar tubes 7 are introduced into the interior of the tube by means of sliding connections 29. A camera 44 is introduced into the work channel 27 of the lower trocar tube. In the top, for example, the induction catheter 104. The appropriately flexible system is then introduced into the esophagus 38 via the natural body orifice of the patient, in this case the mouth, and then into the stomach 39. Preferably, the opening 40 is formed on the front wall of the stomach 39. It is therefore advantageous to use a 100-step open and rigid inner end tube 52, which can be pivoted at the hinge 4 with the bending device 54 and the associated wires 5 towards the stomach wall 39. The tip of the inner end 52 is pushed into the stomach wall 39 and the inlet catheter 104 is advanced in the upper trocar tube 7 (Figure 20). Preferably, the radiofrequency unit 76 at the head of the catheter 104 is switched on, with the heat effect applied, to pass through the inlet catheter 39 at the designated point. The catheter 104 is then pushed further while the umbrella balloon 77 does not reach the abdominal cavity. At this point, blow the balloon 77, then pulling the catheter stem outward to draw the balloon 77 from the abdominal cavity to the outer surface of the stomach 39. At this point, the expanding balloon 78 is in the stomach wall 39. Inflate the expanding balloon 78 to a diameter not greater than the diameter of the tube 28, and lowering the expansion balloon 78, the inner tube end 52 gradually expanding through the expanded opening 40 into the abdominal cavity until the cover 28 is resiliently elastic. its ring does not enter the abdominal cavity. At this point, the inner ring of the elastic ring 72 and, thus, the funnel-shaped sheath 71 preferably extends, and the outer opening 40 presses the protective cover 71 to the tube 28. These two effects prevent the gas from escaping at the opening 40. The flexible ring 72 also prevents accidental pulling of the cover 71. At the outer end of the protective cover 71 there is an airtight sealing ring 73 or a closing tube 97 which prevents the escape of gas in the cover 71 at the outer end of the system. The outer ends of the trocar tubes, tubes 28, or endoscopic devices 66,103 are also hermetically sealed. After the inner end of the system enters the abdominal cavity, the event balloon 77 is lowered and removed from the trocar tube 7. At the time of penetration, the inflated balloon 77 pulled to the inner end protects the surrounding organs and tissues from accidental injuries.

According to another version of the penetration, instead of the introduction catheter 104, the head 8 of the instrument 6 is first passed through the stomach wall 39. Then, through this small opening, a camera 44 is passed and the abdominal cavity is checked (Figure 19). If all about the wound opening 40 is in order, the inside end 102 is opened gently on the stomach wall 39 after the camera, while the wound opening 40 gradually expands.

J '~ • ·

The penetration is similar for endoscopic devices 66, 103.

In the case of interconnected trocar tubes 7, the gastric system 39 is directed to the anterior stomach wall. Only one, preferably 1, telescopic inner end is passed through the induction catheter 104 or chamber 44 of the stomach body 39, and the procedure continues as before.

The draft space 71 can also be connected to the system by balloon 56 (Figure 19 / A). As the inner end penetrated into the abdominal cavity, the outer balloon 45 is blown through the conduit 57 and pushed inwards until the outer balloon 45 collides inside the stomach wall 39. The internal balloon 45 is then inflated through the separate conduit 57. The two balloons 45 at the wound opening 40 interact with the stomach lumen 39. Balloon 56 is slidable.

In the case of SPS intervention, penetration is preferably effected via the navel 60, preferably in the same manner as the laparoscopic technique. Preferably, under the eye control, a small wound is formed in the navel and then introduced into the laparo endoscopic system with the preferably rigid trocar tube, 28 tube or 66,103 endoscope device, provided with the cover 71 or the abdominal wall 81 (Figures 22 and 23). ). Due to the rigid system, it is sufficient to fix only the outer end to the outer fastening means 42.

2. Operation

This part is the purpose of the intervention: to remove, heal the sick organs and tissues. The laparo-endoscopic system of the present invention is similar to the well-developed laparoscopic surgery. Above the desired surgical area, the inner end 52 of the system is secured by means of the thread 23, the rod 51 or the guide rod 61 through the abdominal wall 41 to one of the external fastening means 42. When the inner end 52 is fastened, the abdominal wall 41 can also be raised with the inner end, so that the abdominal cavity does not collapse above the surgical area in case of gas loss, which means significantly greater safety. The outer end 53 of the system is provided for another external fastening device 42. It is preferred that the middle, sufficiently flexible part of the system 2 bend as little as possible. Through the working channels 27, the necessary instruments 6 are introduced and their position is adjusted by means of the hinges 4, the telescopic ends 3, the sliding connections 29 or the guide rod 61. Since the outer end 3 of the instruments 6 running in the tube 28 moves the inner end 1 as in the case of a conventional laparoscopic instrument (only shifted by the middle part 2), the operation can be carried out according to those developed in the laparoscopic technique, e.g. the gallbladder 34 or the 80 wormhole surgery. (Figures 21, 25). If the size of the surgical area changes during the surgery, the position of the inner end 52 can be adjusted to suit the type of fixation. In the case of the thread or rod 23, the abdominal wall 41 can be solved by piercing another location. The situation is simpler when using a guide rod 61, because it is rigid and strong enough to move the inner end 52 from the original position over the new desired area (Figure 11). The advantage of the control rod 61 can be further enhanced by introducing it into the abdominal cavity through the belly 60 (checking the system 44 camera).

and attached to the inner end 52. By this method, the inner end 52 can be delivered to any point of the abdominal cavity, thus allowing extensive surgery without the formation of any further wounds. With this technique, it is preferably any body cavity! surgery can be done.

For wormwood surgery, the 80 worm can also be removed using an endoscopic 88 machine (FIG. 26A). Removing two adjacent trocar tubes from the 28 tubes, the sewing machine 88 can be guided to the surgical area in their empty space. The sewing head 89 is opened and the worm extension 80 is retracted by means of a tool 6 between the loose guide wire 91 and the sewing surfaces 93. Then, by tensioning the guide wire 91 and closing the movable jaw 95, the sewing machine 88 is clamped to the base of the wormhole 80, and then the machine is removed.

The removed gallbladder 34 or the 80 worm protrusion is preferably withdrawn from the abdominal cavity through the inside of the tube 28, whereby the cap 47 is sealed by the cap 47, the cap 47 being removed. If the tissue or organ to be removed does not fit into the tube 28, the tube 28, together with the instrument or body holding device 6, is pulled into the protective cover 71 through the protective cover 71 (Figures 24 / B and 26 / B). Protective cover 71 provides the ability to return the pulled laparo endoscopic system through the abdominal cavity easily.

In the case of an indivisible endoscopic device 103, the procedure of the operation is similar to the above except that the sewing machine 88 can be guided outside the device.

With a split endoscopic device 66, by removing one of the split halves, we can place a sewing machine 88 for the introduction. By sliding the two split halves 66 together, the size of the inner 100-step-open end can be easily adjusted to the characteristics of the changing surgical area without any further wound.

For SPS surgery, preferably the rigid instruments 6 or the trocar tubes or the 28 tubes or the 66,103 endoscopic device are guided over the navel 60 through the inner end of the surgical area (Figures 22 and 23). The outer end of the set system can be secured with an external fastening means 42, if necessary. We can then perform the operation in a similar manner to the laparoscopic technique. In the case of a rigid device system, it is not always necessary to fix the inner end, but if desired, 23 threads or 51 rods or 61 guide rods can be solved in the known manner.

In the case of surgery within the 39 hollow organs (e.g. excision of 87 abnormal wall lesions), e.g. The relative fixation of the inner end of the laparo-endoscopic system, which is fed into the stomach 39, is provided in the area close to the inner end, and can be provided with a balloon 45 slidable relative to the system (Figure 34 / A, B). The balloon 45 is inflated to the appropriate size in the hollow body 39 and is supported by the attached laparo-endoscopic system. Likewise, a multipoint vacuum fixation may be equally effective.

3. Closing

By the closure, the closure of the opening 40 on the wall of the hollow body 39 is primarily understood. After the abdominal surgery was completed, the patient tissue or organ was removed, the surgical site was checked once more, the connected trocar tubes, or the inner end of the endoscopic device 66, 103, were removed.

While leaving the cavity, the draft 71 or endoscopic balloon 56 is retracted and removed orally. Preferably, the inner end opening is provided with only one bended camera 44 for visual inspection of the area of the wound opening 40 (Figure 27). The coupled 7 trocar tubes, or the tube 28 or the outer surface 29 of the endoscopic device 66, 103, are connected to the wound closure system (preferably via a connecting passage 11 and a rail 50). The sleeve 85 is pushed into the inner surface of the stomach wall 39 by the implant tube 82 therein, with adherent elements 84, 23 yarns, and 44 cameras. The distance between the laparo-endoscopic system and the attached sleeve 85 is sufficient to allow the insertion elements 84 to hold the wound edges 40 upwardly drawn with the help of the yarns 23. Under the control of the camera 44 of the sleeve 85, the tip of the implantation tube 82 is pierced by the stomach body 39 and the pushing rod 83 to expel a dummy element 84 having a braid 23. The outer path of the implant tube 82 and the precise positioning of the adherent element 84 are checked by the returning abdominal cavity 44 camera. Hereinafter, this step is repeated by rotating the laparo-endoscopic system in the wound opening 40 until the portions 84 of the wound opening 40 are not circularly wound (Figure 28). The laparo-endoscopic device is then retracted through the opening 40 and pulled out of the patient while sliding from the sleeve 85 by the sliding connection 29. Thus, inside the stomach 39, the yarns 23 securing the edges of the aperture 40 with adhering elements 84 and the sleeve 85 containing the yarns 23 remain. By pulling the yarns 23 up simultaneously and pushing the sleeve 85 in the opposite direction, the edges of the wound opening 40 can be drawn into the sleeve 85 (Figure 29). The outer end 85 of the sleeve 85 is wound between the sewing surfaces 93 of the sewing machine 88 and the deflector wire 91, and then passed through the mouth 85 to the waist opening 40 (Figure 30). The sewing machine 88 is preferably equipped with a camera 44. The sewing machine 88 can be bent at the hinge 4, thereby making it easier to control the closing process. Between the open sewing surfaces 93, the deflection wire 91 is tensioned, and a portion of the stomach wall 39 containing the wound opening 40 is then drawn into the area using the sleeve 85 and the yarns 23. Attach the movable jaw 95 under constant tensioning of the guide wire 91 and then check the position once again with the camera 44. Activate the sewing machine 88, shut the wound opening, and check the closed wound 94 again with 44 cameras. This operation can be carried out using various sewing machines (Figures 31, 32 and 33).

In SPS surgery, closure is the conventional closure of the abdominal wall 41, preferably the navel 60.

Closure inside the hollow body 39 may be accomplished by the above-described wound closure system (Fig. 29B), or by an end-end laparoscopic system fixed to the balloon 45. In the latter case, as in the laparoscopic technique, the wound 40 is wound from the inside with 96 sutures (Figure 34 / b).

The main advantage of the preferred embodiments of the invention is that it allows

During NOTES, SPS, or interventional endoscopy interventions, the complete intervention line through natural body orifices can be reliably performed using well-known and well-developed laparoscopic technologies and motion combinations. /

Claims (107)

  1. PATIENT INDIVIDUAL POINTS
    1. Laparo endoscopic system (LER) preferably performs the full function of the new type of surgical procedures (surgery through natural body orifices - NOTES, interstitial surgery - SPS, and interventional endoscopy in hollow organs) (intrusion, surgery, closure). a device system similar to the laparoscopic technique, which preferably is preferably attached to an external fastening device / 42 / or to the body cavity wall 41 / optional. laparoendoscopic instruments with internal and external ends suitable for lifting the body cavity wall / 41 /, trocar tubes / 7 /, tube / 28 / or endoscopic device / 66,103 /, respectively. there are additional devices that can be connected to the former.
  2. The laparo-endoscopic system (LER) according to claim 1, characterized in that it is capable of being connected to at least one of the LERs, preferably to the central part / 2 / bendable hinges / 4 / connector internal / 1 / and external / 3 / ends / hinge bending element / 5 /, with head / 8 /, handle / 9 /, preferably with power transmission / 12, 14 /, ratchet / 18, 19 / and coupling means / 10 / having / 6 / van (1. figure).
  3. Device / 6 / according to claim 2, characterized in that the central / 2 / portion preferably has a bending joint 4 / connected, preferably longitudinal, with a telescopic rigid internal / 1, with the same sign opposite to the opposite sign. / and external / 3 / end.
  4. Device / 6 / according to claim 2 or 3, characterized in that it is preferably partially or completely flexible or, in another preferred embodiment, rigid, with the ends / 1.3 / bendable joints / 4 / connector center / 2 / it is.
  5. 5. Device / 6 / according to claims 1 to 3, characterized in that the inner / 1 / and outer / 3 / ends are connected to the central part / 2 / coupling, preferably only in one plane, allowing for equal and rotational bending / 4 / .
  6. 6. Device / 6 / according to claims 1 to 4, characterized in that the hinges / 4 / a are perpendicular to and parallel to each other on the axis of rotation of the instrument / 6 / longitudinal axis, preferably only in a preferred plane, in the same direction of rotation, to the same extent and with synchronous bendable ends / 1.3 / - as if the outer / 3 / and the inner / 1 / end were part of a single conventional laparoscopic instrument (Figure 5).
  7. 7. Device / 6 / according to claims 1 to 3, characterized in that it has a hinge bending device for synchronous, equal and rotationally deflection of the inner / 1 / outer / 3 / hinges at the hinges / 4 / preferably only one plane.
  8. 8. Device / 6 / according to claims 1 to 3, characterized in that the inner / 1 / and the outer / 3 / ends of the bending / 4 / synchronous bending wires / 5 / are provided.
  9. 9. Device / 6 / according to one of Claims 1 to 3, characterized in that it is preferably a means for temporarily or permanently securing the position of the angled ends / 1.3 in the outer hinge / 4, preferably a ratchet (18,19).
  10. 10. Referring to FIGS. Device / 6 / according to claims 1 to 3, characterized in that one of the telescopic ends is e.g. 3 / length of the change in the other telescopic perform / eg. 1 / to the same extent, but has a reverse signal and a synchronous transmission means.
  11. 11. Referring to FIGS. Device / 6 / according to claims 1 to 6, characterized in that the device / 6 / inside the end / 1, 3 / and the central channel / 2 / end is preferably arranged in series, preferably the handle / 9 / and the head / 8 / a linkage actuating line / 13 / mounted, preferably with center hole, preferably ball-like power units / 12 / (FIG. 1 / B).
  12. 12. Referring to FIGS. Device / 6 / according to claims 1 to 6, characterized in that the instrument / 6 / inside is preferably provided at the ends / 1, 3 / and in the central passage / 2 / extending through the end / 1.3 / telescopic movement of the fluid. hydraulic unit / 14 / Fig. 1 / C and D).
  13. 13. Referring to FIGS. Device / 6 / according to claims 1 to 3, characterized in that the inner / 1 / and the outer / 3 / telescopic ends preferably have a longitudinally extensible or compressible inner / 15 / outer / 16 / portion of the harmonic and / or of the instrument / 6 / center. / 2 / preferably a non-displaceable hydraulic unit (14), preferably resilient, bendable or extensible with a central portion / 17 / with a single cavity unit forming the inner / 15 / outer / 16 parts.
  14. 14. Referring to FIGS. Device / 6 / according to claims 1 to 6, characterized in that it is preferably connected to another instrument / 6 /, to a trocar tube / 7 /, to a tube / 28 / or an endoscopic device / 66, 103 / to allow longitudinal displacement and rotation around the longitudinal axis has a connecting tool.
  15. 15. Referring to Figures 2-14. Device / 6 / according to claims 1 to 6, characterized in that it is advantageously slidable on the outer surface by means of a connecting line / 11 /, rail / 50 /, thread / 23 / or rod / 51, preferably along the instrument / 6 / longitudinal axis and its longitudinal axis. can be rotated around or preferably a ring of at least one connector / 10 / which allows the body cavity wall 41 to be raised.
  16. The laparo-endoscopic system (LER) according to claim 1, characterized in that it can be connected with at least one trocar tube / 7 / preferably with telescopic ends, preferably a rigid inner / 25 / outer / 26 / end. and a flexible middle section / 2 / and a head / 8 / and handle / 9 / having a / 6 / (FIG. 3 / C).
  17. 17. The laparo-endoscopic system (LER) of claim 1, wherein at least one outer and inner end of the at least one, optionally connected to the LER, preferably with a work channel / 27 /, air-tight valve / 22, is provided. device / 42 / and / or body cavity wall / 41 / optional, rigid or flexible trocar tube / 7 / as required.
  18. A trocar tube / 7 according to claim 17, characterized in that the center / 2 / preferably has a bendable hinge / 4 / rigid inner / 1 / outer end (3/2).
  19. 19. A trocar tube / 7 according to claim 17 or 18, characterized in that the central / 2 / portion preferably has a bendable joint 4 / connected, preferably longitudinal, to one another, telescopically, to the same degree, but with a opposite sign, rigid inner / 1 / and outer / 3 / end (Figures 3 / A and B).
  20. 20. The 17-19. A trocar tube / 7 according to claim 1, characterized in that it is preferably partially or completely flexible or, in another preferred embodiment, a rigid, central portion of the / 1.3 / bendable hinges / 4 / connector / 2 / van.
  21. 21. The 17-20. Trocar tube / 7 / according to claims 1 to 3, characterized in that the inner / 1 / and outer / 3 / ends are connected to the center portion / 2 / joints, preferably only in a single plane, with equal and rotational bending possibilities. / 4 / are.
    17-21. Trocar tube / 7 / according to one of Claims 1 to 4, characterized in that the hinges / 4 / the trocar tube / 7 / longitudinal axis are perpendicular and parallel to each other, preferably only in one plane, in the same direction of rotation, to the same degree and with synchronous bendable ends / 1.3 / - as if the outer / 3 / and the inner / 1 / end were part of a single tube - there are.
    17-22. A trocar tube / 7 / according to claims 1 to 3, characterized in that the inner / 1 / and outer / 3 / end hinges / 4 / sync, which allow equal and rotational bending, are preferably bending wire / 5 /. See pages 17-23. Trocar tube / 7 / according to one of Claims 1 to 4, characterized in that it is preferably a means for temporarily or permanently securing the position of the external hinges / 4 / at the angles bent at any angle, preferably ratchet structure (18, 19).
    17-24. Trocar tube / 7 according to one of Claims 1 to 4, characterized in that it is preferably for thread / 23 /, for rod / 51 /, for guide rod / 61 /, for another instrument / 6 /, for trocar tube / 7 /, for tube / 28 / or endoscopic device / 66, 103 /, is a connecting means for enabling longitudinal displacement and preferably rotation around the longitudinal axis.
    The 17-25. Trocar tube / 7 / according to one of Claims 1 to 5, characterized in that it is advantageous for another instrument / 6 /, for trocar tube / 7 /, tube / 28 / or endoscopic device / 66, 103 / to be connected, longitudinal displacement coupling passage / 11 /, or track / 50 / van.
    Referring to FIGS. Trocar tube / 7 / according to claims 1 to 3, characterized in that it is preferably provided with an air-tight valve / 22 / at its outer end / 3.
    See pages 17-27. Trocar tube / 7 / according to claims 1 to 3, characterized in that it has an arbitrary outer cross-section and a circular cross-sectional internal working channel / 27 /.
    1 and 17-28. Laparo-endoscopic system (LER) according to claims 1 to 3, characterized in that a circular cross-sectional inner working channel / 27 / and preferably circular trocar tubes with an outer cross-section / 7 / standing, each with a trocar tube / 7 / a, has a sliding connection at its sides at its sides. / 29 / associated trocar tube system (Figure 4).
    17-29. Trocar tube / 7 / according to claims 1 to 3, characterized in that it preferably has an external cross-section, an internal working channel of circular cross section / 27 /, and a gas channel / 64 /, respectively. a suction rinse / 65 /, and a connecting passage for connecting at least one other trocar to the outer surface of the tube / 7 / slider / 29/11 /, respectively. rail / 50 / (FIG. 16 / C). The laparo-endoscopic system (LER) according to claim 1, characterized in that it is capable of engaging with any external cross-section, two circular cross-sectional working channels / 27 /, and at least one other trocar tube / 7 / slider on its outer surface with connecting flight / 11 /, respectively. rail / 50 / double trocar tube / 99 / Fig. 16 / A.
    The laparo-endoscopic system (LER) according to claim 1, characterized in that it is preferably provided with a tip-over end, a working channel / 27 /, and a connecting passage for connection to at least one trocar tube / 7 / sliding connection / 29 / , or with a rail / 50 / having a central or fully flexible central trocar / 98 / van (FIG. 16 / B). The laparo-endoscopic system (LER) according to claim 1, characterized in that the instruments / 6 /, trocar tubes / 7 / or other auxiliary means are
    a suitable undivided cavity, preferably a circular or elliptical cross-section, preferably a needle / 24 with a needle / 24 on the inner end / 52 / outer surface, or a rod / 51 / tube / 28 / (FIG. 9).
    A tube / 28 according to claim 33, characterized in that it is preferably a rigid inner / 52 / outer / 53 / end and partially or fully flexible middle portion / 2 /.
    A tube / 28 / according to claim 33 or 34, characterized in that it has a straight / open / 102 / inner end 52/52 in the longitudinal direction (FIG. 4A).
    A tube / 28 / according to claim 33 or 34, characterized in that it has an obliquely open, i.e. non-perpendicular / 101 / inner end 52/52 (Fig. 9 / B).
    A tube / 28 / according to claim 33 or 34, characterized in that it is a stepped-open version, i.e., a combination of the line / 102 / or slant / slot 101 with the opening of the side-slit - / 100 / inner end / 52 / van ( 9 / A, C, D).
    38. The 33-37. Tubes / 28 according to claims 1 to 4, characterized in that the inner end / 52 / and / / the bend of the center / 2 in the area is preferably a bendable wrist / 4 /, allowing the hinge / 4 to bend at the outer end / 53 / a bending structure / 54 /, and a wire / 5 extending through the tube / wall 28 connected thereto.
    39. The 33-37. Tube / 28 according to claims 1 to 3, characterized in that it has a rigidly shaped body (Figure 23).
    40. Articles 33-39. Tube / 28 according to one of claims 1 to 3, characterized in that the outer end / 53 / hermetically sealed solenoid / 49 / and cap / 47 / cap / 47 / cap (47) is provided.
    41. Articles 33-40. A tube / 28 according to claims 1 to 3, characterized in that it preferably has a gas connector / 55/55 at its outer end.
    42. The method of 33-41. A tube / 28 / according to claims 1 to 3, characterized in that the inside is provided with means / 6 /, trocar tubes / 7 / or other attachment means for sliding connection / 29, at least one connection passage / 11 /, or. rail / 50 / (Figure 10).
    43. Tube / 28 according to claims 1 to 3, characterized in that the outer surface has instruments / 6 /, trocar tubes / 7 /, thread / 23 /, rod / 51 / or guide rod / 61 / or other auxiliary means with sliding connection / 29 / connection suitable for at least one connection / 11 /, respectively. track / 50 / van.
    44. The laparo-endoscopic system (LER) according to claim 1, characterized in that it is capable of receiving instruments / 6 /, trocar tubes / 7 / or other auxiliary devices with working channels / 27, partially or wholly flexible, preferably circular or an elliptical cross-section, two longitudinal, endoscopic means / 66 / vanes spaced apart along a longitudinal axis of the device, slidably spaced apart along their longitudinal axis.
    45. The laparo-endoscopic system (LER) according to claim 1, characterized in that it is capable of receiving instruments / 6 /, trocar tubes / 7 / or other auxiliary devices with working channels / 27, preferably circular or elliptical, in part or in part. a fully flexible undivided endoscopic device / 103 / Figure 17 / A.
    A split / 66 / or undivided / 103 / endoscopic device according to claim 44 or 45, characterized in that it has a straight / open / 102 / inner end (i.e., FIG. 12A) that is perpendicular to the longitudinal axis.
    47. Articles 44-46. A split / 66 / or undivided / 103 / endoscopic device according to claim 1, characterized in that it has an obliquely open, i.e., non-perpendicular / 101 / inner end (Figure 12 / C).
    48. The split / 66 / or undivided / 103 / endoscopic device according to claims 1 to 4, characterized in that it is preferably a bendable wrist in the inner end area / 4, a bending structure allowing the bending of the wrist / 4, and / / / and a wire / 5 attached to the wall of the split / 66 / or undivided / 103 endoscopic device.
    49. The 44-48. Split / 66 / or undivided / 103 endoscopic device according to claims 1 to 3, characterized in that the outer end / 53 / hermetically sealable connection / 49 / and the cap / 47 / cap is provided.
    50. Articles 44-49. A split / 66 / or undivided / 103 / endoscopic device according to claims 1 to 3, characterized in that the outer surface has a thread / 23 / or rod / 51 / or. preferably, instruments / 6 /, trocar tubes / 7 / or guide rod / 61 / or other auxiliary means are preferably connected by sliding connection / 29, at least one connecting passage / 11 /, or. track / 50 / van.
    51. A split / 66 / or undivided / endoscopic device according to claims 1 to 7, characterized in that it is preferably a gas channel / 64 /, or. suction rinse / 65 / and connection to the external end gas / 55 /, respectively. suction rinse connection / 63 / s.
    52. Articles 44 and 46-51. Split endoscopic device / 66 / according to claims 1 to 3, characterized in that the sliding connection between the two halves slidable along their longitudinal axis relative to each other is / 29 /, preferably a connecting passage / 11 / and a rail / 50 / van.
    53. Articles 44 and 46-52. Split endoscopic device / 66 / according to claims 1 to 6, characterized in that one, preferably the outer end of the second longitudinal half, preferably including the outer end of the lower longitudinal half, preferably has a cylindrical outer end / 67/12 (12) / A, Figures B).
    54. Articles 44 and 46-53 A split endoscopic device / 66 / according to claims 1 to 6, characterized in that one of the, preferably the outer end of the lower longitudinal half, has an air-tight valve / 22 / inside with a handle / 69, and a cylindrical joint end extending from a work channel / 27 / rigid. at least one trocar handle / 68 (FIGS. 12 / A, B and 13 / A, B).
    55. Articles 44 and 46-54. A split endoscopic device / 66 / according to claims 1 to 6, characterized in that it is preferably an instrument / 6 /, trocar tube / 7 / or other attachment means for sliding connection / 29 /, preferably with sliding flange / 74 /, coupling flight / 11 / or with the rail / 50 / having a split endoscopic device / 66 / longitudinally divisible by the longitudinal displacement of the split endoscopic device / 66 / one or the other half, and can be opened at the inner end, at least one fully split work channel / 70 / (Figures 12 / B, D).
    56. Articles 44 and 46-52. A split endoscopic device / 66 / according to claims 1 to 7, characterized in that it is preferably in its entire length with a sliding joint / 29 /, preferably a connecting passage / 11 / and a matching rail / 50 / connector, which allows separate longitudinal displacements and, if necessary, complete dissolution. at its outer ends are two halves with an air-tight valve / 22 / complete working channel / 27 / (Fig. 15).
    57. The undivided endoscopic device / 103 / according to claim 1, characterized in that it has a stepwise open / 100 / inner end.
    58. Undistributed endoscopic device / 103 / according to claims 57 and 57, characterized in that the stepped / 100 / inner end has at least one partially halved working channel / 70 / (FIG. 17 / A).
    59. Articles 44-58. A divided / 66 / or undivided / 103 endoscopic device according to claim 1, characterized in that it has a completely rigid design according to another preferred embodiment.
    60. A divided / 66 / or undivided / 103 endoscopic device according to claim 1, characterized in that it is preferably a funnel-shaped outer end / 105 (Figure 21).
    61. Preferably, a trocar tube / 7 /, tube / 28 / endoscopic device / 66, 103 / externally, is provided with a protective cover / 71 / preferably extending from the natural body orifice to the body cavity, preferably having a funnel-like shape extending towards its inner opening and strong , a foil-like material, an elastic ring at its inner opening HU, an air-tight fastening ring / 73 / or a fixing tube / 97 / at its outer opening (FIGS. 12 and 15).
    62. Preferably a trocar tube / 7 /, tube / 28 / endoscopic device / 66,103 / extrudable, hollow body / 39 / wall / 40 / insert endoscopic ring / 56 /, characterized by two independently inflatable balloons / 45 /, and an overhang of the natural body orifice / 57 / (Figure 9 / D).
    63. Preferably, the inlet catheter / 104 /, which facilitates the introduction of the laparo-endoscopic system (LER) through the wall / 39 of the hollow body, is independently inflatable, preferably larger than the tube / 28 / or endoscopic device / 66,103 / diameter. a diameter / 78 / end of the tube / 28 / endoscopic device / 66,103 / diameter preferably has a smaller diameter expanding balloon / 78 / and preferably an electrically operated radio frequency unit located at the tip of the inner end / 76 / (FIG. 20).
    64. Preferably, it can be attached to the laparo-endoscopic system (LER), the wound / 40 / closure on the hollow body / 39 / wall, or to the wound. a partially or wholly flexible wound closure to aid in the healing of the hollow body wall / 87 / safely removable, comprising: spun / 23 / bladder elements / 84 /, containing blistering elements / 84 / and blade rod / 83 / longitudinal slit / 86 / implant tube / 82 /, camera / 44 /, and implant tube / 82 / and preferably camera / 44 /, preferably connector / 11 / or rail / 50/85 / is (Figure 18).
    65. The laparo-endoscopic system (LER) according to claim 1, characterized in that the instrument / 6 /, the trocar tube / 7 /, the tube / 28 / or the endoscopic device / 66,103 / inner end is spun / 23. /, with a rod / 51 / or guide bar / 61 / preferably on the body cavity wall / 41, the outer end of the external body outside the natural body orifice of the patient at the desired position, which can be freeze at any desired position / 42 / (FIG. 25) .
    66. The laparo-endoscopic system (LER) according to claim 1, characterized in that the instrument / 6 /, the trocar tube / 7 /, the tube / 28 / or the endoscopic device / 66, 103 / inner end is preferably a magnetic device for fixing the body cavity wall / 41 / externally / 107 / van.
    67. An endoscopic sewing machine / 88 /, which can be inserted through a natural body orifice for making a surgical suture, characterized in that it has a straight or curved fitting surface / 93 /, preferably a rigid sewing head / 89 / and a partially or fully flexible sewing machine / 90 / at the junction of the bending wrist / 4 /, preferably a connecting passage / 11 /, suitable for forming the sewing machine / body / sliding connection / 29 /, the weaving machine head / 89 / and body / * / 0 / formed / 92 /, and preferably the movable jaw / 95 / fixed and loosely loosened between the two suturing surfaces / 93 / creep / wound, the wire / 92 / running guide wire / 91 / van (Fig. 30).
    68, / Preferably for instrument / 6 /, trocar tube / 7 /, tube / 28 / or endoscopic device / 66, 103 / exterior, guide rod / 61 / to be connected to abdominal wall / 41 /, characterized in that it is rigidly tubular ( a rod for infusion of the abdominal cavity or a thin camera / 44) and a handle for attaching to its outer end / 62 / (FIG. 11).
    69. The laparo-endoscopic system (LER) according to claim 1, wherein the trocar tube is / 7 /, tube / 28 or endoscopic device / 66, 103 /, preferably having at least one light source / 106 / on the surfaces of the inner end.
    ·· ««
    REFERENCE LIST LIST
    1. Internal (telescopic) end
    2. Mid section
    3. External (telescopic) end
    4. Wrist
    5. Bending wire
    6. Laparo endoscopic instrument
    7. Laparo endoscopic trocar tube
    8. Head of instrument
    9. Hand grip
    10. Connecting device / ring
    11. Connecting flight
    12. Power unit (balls)
    13. Moving wire
    14. Hydraulic unit
    15. Central part of hydraulic unit
    16. Internal part of hydraulic unit
    17. External part of hydraulic unit
    18. Ratchet structure
    19. Ratchet fastener
    20. Internal opening
    21. External opening
  22. 22. Air-tight valve
  23. 23. Thread
  24. 24. Needle
  25. 25. Internal rigid neck of the instrument
  26. 26. External stiffening device
  27. 27. Work channel
  28. 28. Tube
  29. 29. Sliding connection
  30. 30. External device
  31. 31. Tubular inner opening
  32. 32. Outer opening of the tube
  33. 33. Virtual end of instrument
  34. 34. Gallbladder
  35. 35. Common bile duct
  36. 36. Virtual gallbladder
  37. 37. Virtual common bile duct
  38. 38. Esophagus
  39. 39. Hollow body wall / stomach
  40. 40. Swallow
  41. 41. Trap
  42. 42. External fixing device
  43. 43. Liver
  44. 44. Camera / Optics
  45. 45. Balloon
  46. 46. Thread fastener
  47. 47. Air-tight cap
  48. 48. Capsule opening
  49. 49. Soluble air-tight connection
  50. 50. Rail
  51. 51. Wand
  52. 52. Tubus inner end
  53. 53. Tubus outer end
  54. 54. Bending structure
  55. 55. Gas connection
  56. 56. Endoscopic ring
  57. 57. Cord
  58. 58. Sliding foot
  59. 59. Gall bladder and vasoconstrictor
  60. 60. Navel
  61. 61. Control rod
  62. 62. Handle
  63. 63. Suction rinse connector
  64. 64. Gas connection
  65. 65. Suction rinsing channel
  66. 66. Split endoscopic device
  67. 67. Common external end
  68. 68. Trokámyél
  69. 69. Ear
  70. 70. Partially or fully divided work channel
  71. 71. Protective cover
  72. 72. Flexible ring
  73. 73. Fixing ring
  74. 74. Sliding rim
  75. 75. Trough
  76. 76. Electrical-radio frequency unit
  77. 77. Umbrella balloon
  78. 78. Expanding balloon
  79. 79. Colon
  80. 80. Wormhole
  81. 81. Hasfal tube
  82. 82. Implant tube
  83. 83. Sliding stick
  84. 84. Accumulating element
  85. 85. Sleeve
  86. 86. Slit
  87. 87. Abnormal lesions
  88. 88. Endoscopic sewing machine
  89. 89. Sewing machine head
  90. 90. Sewing machine body
  91. 91. Guiding wire
  92. 92. Wire channel
  93. 93. Sewing surface
  94. 94. Closed wound with clip
  95. 95. Moving jaw
  96. 96. Thread
  97. 97. Fastening tube
  98. 98. Central trocar leader
  99. 99. Double trocar tube
  100. 100. Stairway open end
  101. 101. Slanted open end
  102. 102. Straight open inner end
  103. 103. Indivisible endoscopic device
  104. 104. Introductory catheter
  105. 105. Conical end
  106. 106. Light source / LED
  107. 107. Magnetic device icucfo F • ·
    DISCLOSURE
    EXAMPLE • ·
    2./29
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    7/23 cO -Γ • · · ·· ·· · ·
    90 0 90 ο 5 38
    EXAMPLES ···· «· J: 3rd
    Ρ090 □ 538 ·· · · · · · · · ··· ··
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    40/29
    DISCLOSURE
    EXAMPLE 2.2.
    - THE
    P 090 0 538 v
    · * · Cs
    -T ο
    43/29 ···· t
    DISCLOSURE
    EXAMPLE ρ 0 90 0 5 38
    82nd
    Figure 19
    P09Q0 53S s K * - '
    47/29
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HU0900538A 2009-09-02 2009-09-02 Laparo-endoscope system HU0900538A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
HU0900538A HU0900538A2 (en) 2009-09-02 2009-09-02 Laparo-endoscope system

Applications Claiming Priority (10)

Application Number Priority Date Filing Date Title
HU0900538A HU0900538A2 (en) 2009-09-02 2009-09-02 Laparo-endoscope system
EP10773698.5A EP2473119B1 (en) 2009-09-02 2010-09-02 Surgical device and accessories
US13/393,884 US9877794B2 (en) 2009-09-02 2010-09-02 Surgical device and accessories
CA2772954A CA2772954A1 (en) 2009-09-02 2010-09-02 Surgical device and accessories
CN201080049180.2A CN102665577B (en) 2009-09-02 2010-09-02 Surgical devices and accessories
PCT/HU2010/000095 WO2011027183A2 (en) 2009-09-02 2010-09-02 Surgical device and accessories
AU2010290955A AU2010290955A1 (en) 2009-09-02 2010-09-02 Surgical device and accessories
BR112012004792A BR112012004792A2 (en) 2009-09-02 2010-09-02 surgical device and accessories.
IN2773/DELNP/2012A IN2012DN02773A (en) 2009-09-02 2012-03-30 "surgical device and accessories"
US15/833,250 US20180092635A1 (en) 2009-09-02 2017-12-06 Surgical device and accessories

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EP2473119B1 (en) 2015-04-01
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US20120232339A1 (en) 2012-09-13
BR112012004792A2 (en) 2018-03-13
CN102665577B (en) 2015-11-25
US9877794B2 (en) 2018-01-30
CN102665577A (en) 2012-09-12
WO2011027183A2 (en) 2011-03-10
HU0900538D0 (en) 2009-10-28
EP2473119A2 (en) 2012-07-11
CA2772954A1 (en) 2011-03-10

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