IT201900016955A1 - Surgical device for lifting intra-abdominal structures - Google Patents

Description

Surgical device for lifting intra-abdominal structures.

Description.

A surgical device for lifting intra-abdominal structures is described below.

The surgical device described below is used in laparoscopic surgery.

In particular, the device described below is used in surgical operations involving the rectum, colon, stomach and other abdominal organs.

For the purposes of this description, the term "intra-abdominal structures" includes the peritoneum (the membrane that lines the abdominal cavity and the pelvic cavity covering and fixing the hollow organs), the intestine and the vascular axes (structures where the arteries and veins run). ).

To perform laparoscopic surgical operations it is necessary to make several incisions in the anterior wall of the abdomen, so as to be able to introduce the trocars to access the abdominal cavity and the organs it contains.

In order to then access the affected area and perform the resection operation, it is necessary to create a working chamber between the viscera contained in the abdomen and the anterior abdominal wall.

Currently this is achieved by introducing carbon dioxide (CO2) into the abdominal cavity until a pressure of 12-14 mm Hg is obtained.

For this purpose, CO2 insufflating devices are known which complete the videolaparoscopic column. To perform laparoscopic interventions it is also necessary to place some of the intra-abdominal structures in traction such as the intestine, vascular structures, peritoneum, lymph fat, etc.

Most of these tractions are performed with the use of grasping forceps, inserted through the trocars, such as, for example, the Johann forceps, the Grasper forceps or the Babcock forceps.

Each trocar insertion involves a full thickness incision in the abdominal wall, with a diameter of approximately 5 to 12 mm, resulting in scar and postoperative pain.

It should also be considered that each scar entails an aesthetic problem for the patient.

The need is also felt to be able to improve vision within the work space, in particular to obtain greater vision between the space of the lower rectum and the prostate or vagina.

The inventor's aim is to propose a surgical instrument that allows to obviate, at least in part, the drawbacks of the known art.

In particular, one of the inventor's goals is to find a surgical device to minimize the number of incisions to be made in the abdomen in order to perform laparoscopic surgery.

A further goal of the inventor is to propose a surgical device that allows you to operate in an easier and safer way.

Yet another goal of the inventor is to propose a surgical instrument of low cost, easy to manufacture and easy to use.

This object is achieved by means of a surgical instrument for lifting intra-abdominal structures as defined in claim 1.

Further advantages can be achieved by means of the additional features of the dependent claims.

A possible embodiment of a surgical instrument according to the patent claims is described below with reference to the attached drawing tables in which:

Figure 1 is an isometric view of an embodiment of a surgical device; Figure 2 is an axonometric view, partially in section, of a first detail of the device of Figure 1;

Figure 3 is an axonometric view, partially in section, of a second detail of the device of Figure 1.

With reference to the attached drawing tables and the numbering adopted in the drawing tables, the number 1 indicates, as a whole, a surgical device for lifting an intra-abdominal structure.

This device, in order to be used, must first be inserted, through a trocar already positioned, inside the patient's abdomen.

Device 1 allows you to lift an intra-abdominal structure, to allow the surgeon to access an organ contained in the abdomen or perineum, minimizing invasiveness from a clinical point of view.

The surgical device 1 comprises a needle 2, a thread 3, an extensible element 5 in contrast to an elastic return force, and a hook 4, adapted to be anchored to an intra-abdominal structure.

The needle 2 has a straight development axis X1 and has a first end, or tip, 21 and a second end, or tang 22.

The wire 3 has a first end 31 and a second end 32.

The extendable element 5 has a first end 51 and a second end 52.

The hook 4 comprises a first end 41, or tip, a curved portion 42 and a shank 43. The first end 31 of the thread 3 is bound to the second end 22 of the needle 2.

The first end 51 of the extensible element 5 is constrained to the shank 43 of the hook 4 while the second end 52 of the extensible element 5 is constrained to the second end 32 of the wire 3.

In the example shown, element 5, which is extendable in contrast to an elastic return force, has a development axis X2 (for example a straight axis) and has a constant cross section.

It should be noted that the surgical device 1 has a single needle 2 and a single hook 4.

In a nutshell, the use of device 1 is as follows.

The instrument 1 is first inserted inside the abdomen, through a trocar, already positioned. The surgeon, after inserting the instrument 1 into the abdomen, anchors the hook 4 to the intra-abdominal structure of interest.

The needle 2 of the instrument 1 is then passed through the wall of the abdomen, piercing it completely from the inside to the outside, so as to come out together with a part of the thread 3.

The operations of hooking the tissue that you want to lift, with the hook 4, and crossing the abdomen wall, with the needle 2, are performed by means of a conventional laparoscopic forceps.

The wire 3 can thus be put in traction so as to lift the previously attached intra-abdominal structure.

The extendable element 5 dampens the tensions created by the hook 4 in the abdominal structure avoiding, or at least reducing, the risk of lacerations or other damage to the attached tissues.

Thanks to instrument 1 it is possible to lift the peritoneum and intraperitoneal structures without the need to use additional gripping pliers and thus minimizing the number of full-thickness incisions created in the patient's abdomen.

The lifting of the intraperitoneal structures allows to improve the vision and facilitates the dissection maneuvers of the tissues in general, of the planes between the bands of Told and Gerota for operations on the colon, and of the space between the rectum and the prostate or the vagina for the interventions on the rectum.

The increase in the work space available for surgery makes it easier and safer to operate and therefore increases safety.

The number of instruments 1 used in the course of a laparoscopic procedure can vary according to needs.

At the end of the operation in laparoscopy, the wire 3 is cut and the hook 4 is detached from the peritoneal tissue and extracted, together with the extendable element 5, through one of the trocars already present.

Needle 2, which must pass through the abdominal structure, has a straight development axis X1, has a length of at least 60 mm.

To minimize invasiveness when crossing the abdominal tissues, needle 2 can have a circular cross section.

In a possible embodiment the needle 2 has a circular cross section with a maximum size equal to or less than 1.5 mm.

In the illustrated embodiment, the maximum diameter of the needle 2 is approximately 0.9 mm.

In the example described, needle 2 is a metal needle.

The fastening of the first end 31 of the thread 3 to the second end 22 of the needle 2 can be done, for example, by crimping.

For this purpose, the tang 22 of the needle 2, used to make the tool 1, must have an axial blind hole, designed to receive the end 31 of the wire 3.

After inserting the end 31 of the thread 3 into the tang 22, the latter is squeezed until an adequate connection is obtained between the thread and the needle.

The crimp connection, in addition to being reliable, helps to minimize the invasiveness of the operation of crossing the abdominal tissues by needle 2 and wire 3.

Wire 3 must have sufficient tensile strength to keep the intra-abdominal structure elevated.

In the illustrated example, the yarn 3 is a monofilament made of synthetic material such as polyamides (for example aliphatic polyamides) or polyester or polypropylene.

In the example shown, the average diameter of the wire 3 is less than the maximum diameter of the needle 2.

This solution helps to minimize the invasiveness of the tool 1.

The monofilament of the wire 3 can have, for example, an average diameter lower than or equal to 0.5 mm. In the example shown, the average diameter of the wire 3 is less than or equal to approximately 0.3 mm.

The wire 3 can have a length of between 250 mm and 320 mm, for example about 300 mm.

Thanks to the reduced diameter of needle 2 and thread 3, the hole created in the abdominal wall, due to the passage of needle 2 and thread 3, heals itself without leaving permanent traces.

The hook 4 has a suitable shape and size to be anchored to the intra-abdominal structures.

To limit the invasiveness of the operation of inserting the hook 4 into the hooked fabrics, the hook 4 can be a hook with a circular cross section.

To further reduce the risk of unwanted lacerations of the fabrics, the tip of the hook 4 can be blunted.

The hook 4 can be made with a rigid steel wire, having an average diameter equal to or less than 1.1 mm.

In a possible embodiment the hook 4 is made with a rigid steel wire having an average thickness of about 0.7 mm.

In a possible embodiment, the internal curvature radius of the hook 4 is greater than 3 mm and less than 8 mm.

In the illustrated embodiment, the extendable element 5 has a substantially and / or generally tubular shape.

The tubular shape of the extendable element 5 allows to contain the transversal dimensions of the same and can be advantageously used to fix the ends 51, 52 of the same to the end 32 of the wire 3 and to the shank 43 of the hook 4.

In a possible embodiment, the element 5, extensible in contrast to a return force, can be a silicone (or silicone-based) tube having a length between about 40 mm and 60 mm, an external diameter of about 3 mm and an internal diameter of about 1 mm.

In the example illustrated, a first joint, or mechanical connection 6, is provided to constrain the shank 43 of the hook 4 to the first end 51 of the tubular 5, and a second joint, or mechanical connection 7, to constrain the second end 32 of the wire 3 at the second end 52 of the tubular 5.

In the example shown to obtain the first junction 6, the shank 43 of the hook 4 is inserted, with interference, inside the first end 51 of the tubular 5.

It should be noted that the fact that this connection method distributes the tensile stress over the entire section of the tubular 5.

An external collar 61 is also provided, for example a collar made of heat-shrinkable material, which tightens the first end 51 of the tubular 5, so as to oppose the extraction of the shank 43 of the hook 4.

This solution allows to maximize the tensile stress that can be supported by the tubular 5.

In the example shown, the shank 43 of the hook 4 has a bent conformation, for example an approximately "U" conformation.

In particular, in the illustrated example, the bent portion of the stem 43 is shaped in such a way as to reduce the deformation of the tubular 5 at the outlet hole.

This feature further improves the sealing quality of the first joint 6 of the shank 43 of the hook 4 to the tubular 5 and therefore the quality of the second joint 7.

In a particular embodiment, the shank 43 of the hook 4 comprises a first rectilinear portion 431 and a second rectilinear portion 432.

The first and second portions 431, 432 are joined by a curved portion 434.

The second rectilinear portion 432 ends with a free end 434 which is located at a close distance from the rectilinear portion 431 of the shank 43.

It should be noted that the first junction 6 can be used as a gripping element for a laparoscopic forceps, thus facilitating the anchoring of the hook 4 to the tissues to be lifted.

In fact, the first junction 6 has a cross section greater than the section of the metal wire which constitutes the hook 4.

In the example shown, an anchoring element 72 is provided for the end 32 of the wire 3 to create the second junction 7, which is inserted with interference inside the second end 52 of the tubular 5.

In the example shown, the anchoring element 72 has a shape substantially identical to that of the shank 43 of the hook 4.

An external collar 71 is also provided, for example made of heat-shrinkable material, which tightens the second end 52 of the tubular 5 so as to oppose the extraction of the anchoring element 72 inserted therein.

This solution allows to maximize the tensile stress that can be supported by the tubular 5.

In the example shown, the anchoring element 72 of the second end 32 of the wire 3 is made, for example, with a rigid steel wire, having an approximately "U" shape.

The second end 32 of the wire 3 is then knotted to the anchoring element 72.

In the example shown, the anchoring element 72 is shaped in such a way as to reduce the deformation of the second tubular end 52 5 at the exit hole.

In other words, the free ends of the anchoring element 72 are located at a close distance. The solutions described above ensure adequate fastening between the wire 3 and the tubular 5 and between the tubular 5 and the hook 4.

Other solutions are of course possible for binding the wire 3 to the second end 52 of the tubular 5.

For example, in a cheaper embodiment of the device, the second end 32 of the wire 3 can be knotted directly to the second end 52 of the tubular 5.

Claims (7)

Claims 1. Surgical device (1), for lifting intra-abdominal structures, comprising a) a needle (2), having a first end, or tip, (21), and a second end, or tang of the needle (22), said needle (2) having a straight development axis (X1), b) a thread (3) having a first end (31) and a second end (32), said first end (31) of said thread (3) being constrained to said second end (22) of said needle (2), c) a hook (4), suitable for anchoring to an intra-abdominal structure, said hook (4) being a hook with a circular cross section; said hook (4) comprising a first end (41), or tip, a curved portion (42) and a shank (43), d) an extensible element (5) in contrast to an elastic return force, said element (5) having a development axis (X2), said element (5) having a first end (51), constrained to said shank (43) of said hook (4) and a second end (52) constrained to said second end (32) of said wire (3). Device according to claim 1, wherein said extensible element (5) has a constant cross section. 3. Device according to claim 2 wherein said extensible element (5) has a substantially and / or generally tubular conformation. 4. Device, according to claim 2 or 3, in which said shank (43) of said hook (4) is inserted, with interference, inside said first end (51) of said tubular element (5), said first end (51) of said tubular element (5) being tightened by a collar (61) which opposes the extraction of said shank (43) of said hook (4). 5. Device, according to claim 3 or 4, in which said second end (32) of said wire (3) is constrained to an anchoring element (72) inserted, with interference, inside said second end (52) of said extensible element (5), said second end (52) being tightened by a collar (71) which opposes the extraction of said anchoring element (72). 6. Device according to one of the preceding claims, in which one of the preceding claims, in which said needle (2) has a maximum diameter equal to or less than 1.5 mm and in which said thread (3) has a maximum diameter equal to or less than the maximum diameter of said needle (2). 7. Device according to one of the preceding claims, in which the transverse dimension of said hook (4) with circular cross-section is equal to or less than 1.1 mm and in which the internal radius of curvature of said hook (4) is equal or greater than 3 mm.