NZ275130A

NZ275130A - Surgical suction instrument; cannula and two needles

Info

Publication number: NZ275130A
Application number: NZ275130A
Authority: NZ
Inventors: Maher Fourati
Original assignee: Ethnor
Priority date: 1993-10-26
Filing date: 1994-10-25
Publication date: 1997-05-26
Also published as: AU8063694A; DE69410815D1; EP0725600A1; EP0725600B1; MA23360A1; FR2711504B1; GR3027732T3; ATE166781T1; TNSN94111A1; WO1995011634A1; DZ1821A1; ES2119235T3; BR9407906A; FR2711504A1; AU682416B2

Abstract

A surgical instrument for treating a hydatid cyst, including a cannula (100) provided with a suction cup (200) at its distal end (118, 218) and connected to a vacuum source at its proximal end (119), and at least one hollow aspirating needle (300, 400) with its distal end (302, 402) surrounded by the cannula (100), said needle being translatable relative to the cannula (100) between a first position in which the tip (302, 402) of the needle (300, 400) is retracted into the suction cup (200) or the cannula, and a second, aspirating position in which the tip (302, 402) of the needle projects beyond the suction cup (200).

Description

New Zealand No. International No. 275130 Priority Date(s): Site].!®. 1,3.3 _ Compi&t*Specification Filed: Clae*: (6) &k>.).&.\3.{!>.%....I.I.1.98 Publication DeW: P.O. Journal No: \M:).)(?.

NEW ZEALAND PATENTS ACT 1953 COMPLETE SPECIFICATION Title of Invention: Surgical instrument for treating a hydatid cyst Name, address and nationality of applicant(s) as in international application form: ETHNOR, of 192, avenue Charles-de-Gaulle, F-92523 Neuilly-sur-Soine, France / a. sVocX 27 5 1 3 0 A SURGICAL INSTRUMENT FOR TREATING A HYDATID CYST The present invention relates to the field of surgical instruments.

More precisely, the present invention relates to a 5 surgical instrument for treating watery gatherings in the human body.

A particular application of the present invention lies in sterilization and in aspiration of hydatid cysts. Nevertheless, in more general manner, the present 10 invention can be applied to treating any "watery gathering", in particular watery cysts, such as hydatid cysts, suspect cysts, e.g. cysts of the ovary, and gatherings of pus or abscesses.

The conventional technique for surgical treatment of 15 hydatid cysts consists in: making an access passage in the human body of sufficient size to access the cyst and the entire environment thereof; enveloping the cyst made accessible in this way by 20 means of compresses soaked in a parasiticidal liquid; puncturing the cyst; then using puncture needles to sterilize the contents of the cyst by evacuating it and, usually simultaneously, refilling it with a sterilizing liquid; 25 and once the pocket forming the cyst has been sterilized satisfactorily in this way, removing the membrane constituting the wall of the cyst by aspiration.

That conventional technique does not give tc^/tal 30 satisfaction.

Firstly, the dimensions of the access passage required for performing the surgical treatment undel conditions impose a long period of hospitalization, sometimes give rise to operative and post-operative 35 complications, cause scars, lead to an intervention that is not comfortable for the patient, and that is sometimes accompanied by considerable pain requiring a large amount 27 5 13 2 of additional medication to be consumed, in particular pain-killing and analgesic medication.

Secondly, it should be observed that the conventional technique requires very careful precautions 5 to be taken because the slightest leakage of infected liquid from the hydatid cyst into the human body can induce subsequent growth of new cysts that require new interventions.

Document EP-A-450 886 teaches an endoscopic 10 instrument for the aspiration of fluid in an ovarian cyst. Said instrument comprises a hollow puncture needle and a cannula provided with an aspiration endpiece at its distal end, and designed to be connected to a suction source at its proximal end. The cyst is punctured by 15 displacing the tip of the needle in the cyst beyond the aspiration endpiece. The cannula is put under suction in order to prevent any liquid from escaping.

The present invention now seeks to improve surgical instruments for treating watery gatherings, and in 20 particular hydatid cysts.

A particular aim of the present invention is to propose a novel surgical instrument enabling treatment to be performed in full endoscopically.

In the context of the present invention, these aims 25 are achieved by a surgical instrument for treating a watery gathering, in particular for sterilization and aspiration of a hydatid cyst, the instrument being of the type comprising, in accordance with document EP-A-450 886: a cannula provided with a suction cup at its distal end and designed to be connected to a suction source at its proximal end; and at least one hollow puncture needle whose distal end is surrounded by the cannula, which needle is suitable 35 for being displaced in translation relative to the cannula between a first position in which the tip of the 27 5 1 3 0 and a puncturing, second position in which the tip of the needle projects beyond the suction cup, the instrument being characterized by the fact that it includes two hollow needles and at least one operating channel in the 5 cannula, adapted to receive at least one intervention tool.

Other characteristics, aims and advantages of the present invention appear on reading the following detailed description referring to the accompanying 10 drawings given as non-limiting examples, and in which: Figure 1 is an external side view of an instrument of the present invention prior to assembly of the suction cup on the cannula; Figure 2 is an axial section view through the 15 cannula in accordance with the present invention; Figure 3 is a similar axial section view of the cannula fitted with two puncture needles; Figure 4 to 7 are diagrams showing four successive steps in the use of the surgical instrument of the 20 present invention as shown in Figures 1 to 3; Figure 8 is a longitudinal axial section view of an outer tubular body of the cannula suitable for use in the context of a variant embodiment of the present invention; Figure 9 is a similar section view of the same outer 25 tubular body of the cannula placed on the instrument of Figures 1 to 3; Figure 10 shows a variant outer tubular body fitted with a suction cup; Figure 11 is a section view of a suction cup in 30 accordance with the present invention; Figure 12 is a plan view of a piece of absorbent material suitable for use in combination with the above-specified sterilization instrument; Figure 13 is a cross-section through a cannula in 35 accordance with a variant embodiment of the preset);) invention; 27 5 1 3 0 Figure 14 is a longitudinal axial section view of an instrument in accordance with a variant of the invention; Figure 15 is a cross-section view of the instrument on section plane referenced XV-XV in Figure 14; and 5 Figure 16 is an axial end view of the same instrument as seen on arrow XVI in Figure 14.

The surgical instrument of the present invention shown in accompanying Figures 1 to 3 essentially comprises a cannula 100 fitted with a suction cup 200 and 10 two needles 300 and 400.

The cannula 100 comprises a hollow cylindrical central tube 110. The tube 110 is centered on an axis 112.

The distal portion 114 of the tube 110 is surrounded 15 by an outer sheath 120. An annular chamber 122 is thus defined between the central tube 110 and the outer sheath 120.

The length of the outer sheath 120 is advantageously about half that of the central tube 110. The proximal 20 end 124 of the sheath 120 is thus situated about halfway along the tube 110.

This proximal end 124 of the sheath 120 is connected in sealed manner to the outside surface 116 of the central tube 110, by a closing partition 126 which 25 extends transversely to the axis 112.

Nevertheless, this wall is pierced by two orifices 130 and 132 whose axes are parallel to the axis 112 and which are diametrically opposite about the axis 112. As shown in Figure 3, the diameter of these orifices 130 and 30 132 is adapted to enable the needles 300 and 400 to move in translation parallel to the axis 112, when they are engaged in respective ones of these orifices.

The orifices 130 and 132 open out into the annular space 122. Thus, the distal ends of the needles 300 and 35 400 are situated in said annular space 122. 27 5 1 3 0 As can be seen in particular in Figure 2, it is preferable for the distal end 118 of the central tube 110 to be set back from the distal end 128 of the sheath 120.

The suction cup 200 is placed on the distal end 128 5 of the cannula, and more precisely of the sheath 120.

The suction cup 200 may be permanently secured to the distal end 128 of the sheath 120.

Nevertheless, in the particular and non-limiting embodiment shown in the accompanying figures, the suction 10 cup 200 is independent of the cannula 100 and is adapted to be assembled to the end thereof inside the human body at the site of use. For this purpose, the suction cup 200 and the cannula 100 are engaged in succession inside the human body, preferably via a trocar.

Thus, in the embodiment shown in the accompanying figures, the suction cup 200 comprises a frustoconical skirt 210 which is terminated at its radially outer free edge by a flexible annular lip 212. The skirt 210 is extended at its radially inner edge by a cylindrical 20 sleeve 220 whose inside diameter is complementary to the outside diameter of the sheath 120. The sleeve 220 is coaxial with the skirt 210.

To facilitate manipulating the suction cup 200 inside the body for the purpose of assembling it to the 25 distal end of the cannula, the sleeve 220 is advantageously provided on its outside surface and in the vicinity of its free edge with a tongue 222 that projects radially relative to the axis of the suction cup 200.

The needles 300 and 400 are conventional rectilinear 30 hollow puncture needles.

As mentioned above, they are engaged to move freely in translation in the orifices 130 and 132, respectively.

The needles 300 and 400, and also the cannula 200, must be of sufficient length to remain accessible outside 35 the body while being in contact with the cyst to be treated inside the human body. ^ * r o 6 27 5 1 3 0 By way of non-limi-ting example, the length of the central tube 110 may be about 16 cm, the length of the sheath 120 may be about 6 cm, the outside diameter of the central tube 110 may be about 12 nun, and the outside 5 diameter of the sheath 120 may be about 18 mm.

The outside diameter of the lip 212 of the suction cup 200 may typically be about 5 cm to 8 cm. More precisely, it is preferable to provide several sizes of suction cup 200 so as to enable the surgeon to select the 10 suction cup that is best adapted to the intervention as a function of the cyst to be treated and as a function of the patient. By way of non-limiting example, it is thus possible to provide three sizes of suction cup 300, a small suction cup having a diameter of about 3 cm to 15 5 cm, a middle-sized suction cup having a diameter of about 5 cm to 7 cm, and a large suction cup having a diameter of about 7 cm to 9 cm.

The method of using the above-described instrument is described below with reference to Figures 4 to 7. In 20 these figures, the cyst to be treated is referenced K while the skin of the patient is referenced P.

To simplify the drawing, the trocar for inserting the cannula 100 is omitted from Figures 4 to 7. Such a trocar is conventional per se. In addition, the trocar 25 is used only during the stage of cannula insertion, and plays no particular role thereafter, it being possible to withdraw it once the cannula 100 has been positioned on the site of use.

As shown in Figure 4, after the suction cup 200 and 30 the cannula 100 have been inserted into the human body, the suction cup 200 is assembled to the distal end of the cannula 100.

Then, as shown in Figure 5, the suction cup 200 is brought into contact with the cyst K over its projecting 35 dome or flush portion selected for puncture purposes.

The proximal end 119 of the tube 110 is then connected to a suction source. Thus, the entire' anside'^ o1 v 27 k * t r\ ^ ii nj- volume of the cannula 100 and of the suction cup 200 is placed in suction .or negative pressure relative to the surroundings. As a result, the suction cup 200 adheres closely to the cyst K so as to confine the puncture zone. 5 Also, because of the suction created inside the suction cup 200, there is no risk of hydatid liquid leaking.

During the above steps, the distal ends 302 and 402 of the needles 300 and 400 are set back inside the suction cup 200 or the annular chamber 122 of the cannula 10 100.

However, as shown in Figure 6, the needles 300 and 400 are then moved towards the cyst K so that their distal ends 302 and 402 penetrate into the cyst K.

The needles 300 and 400 can then be used to empty 15 the cyst K of its hydatid liquid and to fill it with a sterilization liquid.

During this step, it is preferable to use one needle 300 for removing the infected liquid from the cyst K by aspiration while simultaneously using the other needle 20 400 for filling the cyst K with sterilization liquid.

More precisely, care is preferably taken to reinject a quantity of sterilization liquid into the cyst K equal to the quantity of liquid that is withdrawn therefrom, so as to ensure that the volume of the cyst K remains 25 substantially constant, particularly for the purpose of guaranteeing that the suction cup 200 remains properly secured thereto.

Once the cyst K has been properly sterilized, as shown in Figure 7, the distal ends 302 and 402 of the 30 needles 300 and 400 are retracted into the suction cup 200 or into the annular chamber 122.

Naturally, suction in the cannula is maintained throughout the preceding steps by means connected to the proximal end of the tube 100.

It is then possible to sterilize the inside volume of the suction cup 200 and of the cannula 100 so aj 8 27 5 1 3 0 treat any liquid that may have escaped into this volume over the outsides of the needles 300 and 400.

For this purpose, suction must be maintained inside the suction cup 200 via the tube 110 or via at least one of the needles 300 and 400, while other means, in particular at least one of the needles 300 and 400 or the tube 110, can i)e used to sterilize the suction cup 200 and the cannula 100 by aspiration and refilling using a sterilization liquid. It is important to take care that the suction cup continues to remain under negative pressure relative to its environment.

This step may also be used to complete sterilization of the membrane of the cyst K after a cutting tool engaged via the central tube 110 has been used to form an opening in the membrane in the zone thereof that is contained within the suction cup.

By retracting the distal ends of the needles 300 and 400 away from the distal ends of the tube 110 and the sheath 120, i.e. by retracting them into the annular chamber 120, any risk of the needles 300 and 400 being shut off by the membrane of the cyst K is avoided. This membrane bears against the distal ends of the central tube 110 and of the sheath 120 and therefore cannot reach the ends of the needles.

The membrane of the cyst K can then be removed by any appropriate means, preferably by aspiration through the central tube 110.

The means enabling the proximal ends 119 of the cannula 110 and 304 or 404 of the needles to suction means, aspiration means, or means for refilling with sterilization material are omitted from the accompanying figures in order to simplify the drawing.

In practice, the suction means may be constituted merely by evacuated flasks connected by hose to the proximal end(s) of the cannula 110 or of the needles. syringes connected to the same ends.

The aspiration and/or filling means may b 9 27 5 13 0 Naturally the present invention is not limited to the particular embodiment described above, but extends to any variant within the scope of the invention.

Thus, the cannula 100 may be formed as a single 5 molding or may comprise an assembly of different parts, e.g. a sheath 120 assembled on a central tube 110.

Where appropriate, it is also possible to provide sealing means at the orifices 130 and 132 around the needles 300 and 400.

The suction cup 200 may be provided with annular bellows to increase its flexibility.

When performing an intervention on a cavity in the human body that has been dilated by blowing in air, as is now conventional for endoscopic interventions, 15 particularly interventions in the abdomen, removable closure means are preferably provided on the proximal ends of the cannula 100 and of the needles 300 and 400 to avoid air leaking out when the instrument is inserted into the human body. This can be done, for example, by 20 making provision to connect the proximal ends of the cannula and of the needles to the suction means, to the aspiration means, or to the sterilization liquid injection means, via valves that are manually controlled.

According to an advantageous characteristic of the 25 present invention, the material constituting the cannula 100 is optically transparent so as to make it easy to monitor the nature of the fluids and of the membrane passing therethrough.

Where appropriate, pirovision may be made for means 30 that constitute a resilient abutment so as to index the needles 300 and 400 relative to the cannula 100 in their retracted and projecting positions, respectively.

In another variant embodiment shown in accompanying Figures 8 and 9, the above-described cannula 100 can be 35 placed inside an outer tubular body 500 of the cannula. This body is preferably a cylindrical tube whose insi diameter is closely adapted to the outside diametefv- of / '' v2l vm^ 27 5 1 3 0 the cannula 100 while nevertheless allowing them to move in relative translation.

As can be seen in Figures 8 and 9, in this case the suction cup 200 is no longer fixed on the distal end of 5 the sheath 120, but is fixed on the distal end of the outside body 500 of the cannula.

More precisely, the suction cup 200 may be permanently fixed to the distal end of the outside body 500 or the suction cup 200 may be independent of the body 10 500 and fixed thereto on the site of use when the intervention is taking place.

The tabular outside body 500 of the cannula must be inserted into the human body together with the cannula 100. Sterilization is performed in the manner described 15 above. Nevertheless, once the membrane has been sterilized, the central cannula 100 can then be withdrawn so that only the tubular outer body 500 of the cannula then remains in place, thereby providing a larger section for aspiration of the cyst membrane under good 20 conditions.

Figure 10 shows a variant embodiment of such a cannula outside tubular body 500 which is permanently fitted with a suction cup 200 that is adapted to L3 folded up prior to use inside the distal end of the body 25 500. After the cannula body 500 has been inserted into the human body, it then suffices to engage the central cannula 100 inside the tubular body 500 to deploy the suction cup 200.

It is even possible, in the context of the 30 embodiment shown in Figures 1 to 3, to provide such a suction cup 200 that, prior to use, is folded up inside the distal end of the central tube 110. To deploy the suction cup 200, it then suffices to engage a pusher or any equivalent means inside the central tube 110. 35 Figure 11 shows a variant embodiment of the suction cup 200 in which the flexible lip 212 is folded towards the inside of the suction cup. This ve 27 5 130 n makes it possible firstly to increase the area of the suction cup which is in contact with the membrane of the cyst K. It also serves to define an anti-leakage rim.

Finally, Figure 12 shows a piece 600 of absorbent 5 material that is suitable for use in combination with the above-described sterilization instrument.

While in the folded position, the piece 600 is adapted to be inserted into the human body via the trocar, and then to be deployed inside the human body so 10 as to be placed in contact with the cyst K.

The piece 600 has a central opening 610 of dimensions that are complementary to the suction cup 200. The piece 600 is designed to surround the suction cup 200 while the intervention is taking place. It is soaked in 15 a parasiticidal liquid so as to further improve the safety of the intervention.

In the embodiment shown in accompanying Figure 12, the outline of the piece 600 is circular. However, the invention is not limited to that shape. The outline of 20 the piece 600 can, indeed, easily be adapted by the surgeon when the intervention is taking place so as to match the shape of the projecting dome of the cyst K.

In another variant embodiment, the cannula 100 may have constant outside diameter over its entire length. 25 The step visible in Figures 1 to 3 at the proximal end of the sheath 120 is then omitted. As shown in Figure 13, it is thus possible to provide a cannula 100 having two parallel longitudinal ducts 140 and 142 receiving the needles 300 and 400 so that they can move in translation 30 and opening out into a distal annular chamber, or equivalent means comparable to the above-described annular chamber 122. In this case, the free section of the central duct 110 used for aspiration of the membrane of the cyst K can be non-circular so as to take maximum 35 advantage of the available cannula volume. 12 27 5 1 3 0 In another variant, it is possible to provide for the suction means to be originally connected to the annular chamber 122 and to the central tube 110.

As mentioned above, the instrument of the present 5 invention is particularly advantageous for performing an endoscopic intervention. Nevertheless, the instrument of the present invention can also be used via an open section.

In addition, the present invention is particularly 10 applicable to interventions in the chest and in the abdomen. However the instrument of the present invention can also be used for interventions in other parts of the human body.

Figures 14 to 16 show an instrument comprising a 15 central cannula 100 associated with a suction cup 200 and an outer tubular body 500.

The cannula 100 is preferably constituted by a cylindrical rectilinear tube of optically transparent material suitable for sliding longitudinally inside the 20 outer body 500.

The suction body 200 is provided at the distal end of the cannula 100. The suction body 200 is preferably in the form of a bell of silicone material. It is generally in the form of a truncated cone or of a 25 hemisphere. The suction cup 200 is preferably provided with an annular lip 212 around its large base remote from the cannula 100. At its apex, the suction cup 200 is provided with an endpiece 220 which is engaged in the distal end of the cannula 100. The endpiece 200 has a 30 through longitudinal channel 224. It also has two parallel longitudinal passages 225 designed to receive in translation and to guide the puncture needles 300 and 400. In order to simplify the drawing, these needles are not shown in Figures 14 to 16. According to an important 35 characteristic of the variant shown in Figures 14 to 16, the silicone suction cup 200 is reinforced by ribs equivalent 226. These ribs 226 can be made of any 13 27 5 13 0 suitable material, and they are preferably made of plastics material. They are designed to make it easier to deploy the suction cup 200. The ribs 226 may be integrally molded with the distal end of the cannula 100 5 as shown in Figure 14.

Nevertheless, in a variant, the ribs 226 may be constituted by separate parts that are secured to the suction cup 200, e.g. by adhesive or by overmolding.

At its proximal end, the cannula 100 has a cap 250. 10 The cap 250 has a transverse pipe 252 designed to be connected to suction means so as to subject the inside volume of the cannula 100 to controlled suction. The cap 250 also has two channels 254 in respective alignment with the above-mentioned channels 225 for receiving and 15 guiding the needles 300 and 400. Finally, the cap 250 has removable closure means 256 e.g. constituted by a transverse wall that is split by a cross. Such closure means 256 enable any appropriate utensil to be inserted inside the cannula 100. in particular any aspiration 20 utensil for removing the pocket of the cyst after it has been punctured.

The endpiece 220 may be fixed to the distal end of the cannula 100 by any suitable means, e.g. by adhesive.

The outer body 500 preferably comprises a 25 transparent tube.

To use the instrument shown in Figures 14 to 16, the method is essentially as follows. The suction cup 200 is retracted inside the outer body 500. The outer body is moved close to the location in which it is to be used. 30 The suction cup 200 is moved out from the outer body 500 by sliding the cannula 100 therein. Deployment of the suction cup 200 so that it takes up its bell-shape is facilitated by the presence of its ribs 226.

Thereafter, the suction cup 200 is secured to the 35 pocket of the cyst by applying suction to the cannula 100, after which the cyst is punctured and evacuated by means of the needles 300 and 400 in the same manp*. described above. P "■ 14 27 5 ? 3 0

Claims

1. A surgical instrument for treating a watery gathering, in particular for sterilization and aspiration of a hydatid cyst, the instrument comprising: a cannula provided with a suction cup at its distal end and designed to be connected to a suction source at its proximal end; and at least one hollow puncture needle whose distal end is surrounded by the cannula which needle is suitable for being displaced in translation relative to the cannula between a first position in which the tip of the needle is set back inside the suction cup or the cannula, and a puncturing, second position in which the tip of the needle projects beyond the suction cup, the instrument being characterized by the fact that it includes two hollow needles and at least one operating channel which is separate from or independent of the needles in the cannula, adapted to receive at least one intervention tool.

2. An instrument according to claim 1, characterized by the fact that the suction cup includes a flexible annular lip.

3. An instrument according to claim 1 or 2, characterized by the fact that the cannula has a central tube surrounded at its distal end by a sheath.

4. An instrument according to claim 3, characterized by the fact that the proximal end of the sheath is connected in sealed manner to the outside surface of the central tube.

5. An instrument according to claim 3 or 4, characterized by the fact that the proximal end of the sheath is provided with two orifices each receiving a respective rieedle that is free to move in translation.

6. An instrument according to any one of claims 3 to 5, characterized by the fact that the needles are placed in the annular chamber formed between the central tube and the sheath.

7. An instrument according to any one of claims 1 to 6, characterized by the fact that the distal end of the central tube is set back from the distal end of the sheath.

8. An instrument according to any one of claims 1 to 7, character^ that the suction cup is permanently secured to the distal end of the the fact , N T 2 7 MPS 1997 15 27 5 13 0

9. An instrument according to any one of claims 1 to 7, characterized by the fact that the suction cup is independent from the cannula and is adapted to be fixed to the distal end thereof at the site of use, inside the human body.

10. An instrument according to claim 9, characterized by the fact that the suction cup includes a frustoconical skirt provided with a flexible lip, which skirt is extended by a sleeve provided with a radial tongue for handling purposes.

11. An instrument according to any one of claims 1 to 10, characterized by the fact that the suction cup includes annular bellows.

12. An instrument according to any one of claims 1 to 11, characterized by the fact that it includes removable closure means for the proximal ends of the cannula and of each needle.

13. An instrument according to any one of claims 1 to 12, characterized by the fact that the cannula is made from optically transparent material.

14. An instrument according to any one of claims 1 to 13, characterized by the fact that it includes means for indexing each needle relative to the cannula, each in respective retracted and extended positions.

15. An instrument according to any one of claims 1 to 14, characterized by the fact that it comprises a cannula outer tubular body that receives a cannula element free to move in translation which defines a central duct and adapted to receive at least one hollow puncture needle.

16. An instrument according to claim 15, characterized by the fact that the outer tubular body is separable from the cannula element.

17. An instrument according to claim 15 or 16, characterized by the fact that the suction cup is permanently secured to the distal end of the outer tubular body.

18. An instrument according to claim 15 or 16, characterized by the fact that the suction cup is adapted to be removably fixed to the distal end of the outer tubular body.

19. An instrument according to any one of claims 1 to 18, characterjZ8#Bbysthe fact jf\ t11 r c that the suction cup is folded up prior to use within the distal end of tjne^cannula adapted to be deployed therefrom after insertion into the human boc 16 27 5 13 0

20. An instrument according to any one of claims 1 to 19, characterized by the fact that the suction cup has a flexible lip that is radially folded towards the inside of the suction cup.

21. An instrument according to any one of claims 1 to 20, characterized by the fact that the section of the cannula is substantially constant along its entire length.

22. An instrument according to any one of claims 1 to 21, characterized by the fact that the length of the cannula is about 16cm.

23. An instrument according to any one of claims 1 to 22, characterized by the fact that the diameter of the suction cup is about 3cm to 9cm.

24. An instrument according to any one of claims 1 to 23, characterized by the fact that suction cups of different sizes are provided to enable the surgeon to adapt the suction cup to the intervention, as a function of the gathering to be treated and as a function of the patient.

25. An instrument according to any one of claims 1 to 24, characterized by the fact that it further includes a piece of absorbent material with an opening adapted to be engaged on the suction cup.

26. An instrument according to any one of claims 1 to 25, characterized by the fact that the suction cup is associated with stiffening ribs that facilitate deployment thereof.

27. An instrument according to claim 26, characterized by the fact that the ribs are integrally molded with the cannula.

28. An instrument according to claim 26 or 27, characterized by the fact that the cannula is slidably mounted in an outer body, and that the suction cup secured to the cannula is adapted to be retracted into the outer body.

29. A surgical instrument according to claim 1, substantially as herein described with reference to any one of the figures. END OF CLAIMS