PH12016000382A1 - Bamboo snare or crumpling crumeng laparoscopic sponge, a useful device for minimally invasive surgery procedures - Google Patents

Abstract

A special kind of laparoscopic sponge for minimally invasive surgery procedures is disclosed. This laparoscopic sponge device is comprised of specially folded medical-grade weaved cotton gauze, a highly absorbent material, capable of being introduced and retrieved through a port or cannula that has been inserted into a body cavity during laparoscopic surgeries. The novel device can be utilized for one or all the following functions: (a) to dry organ and tissue surfaces, (b) to exert pressure on bleeding capillaries and small vessels for hemostasis, (c) to serve as "surgical peanut" to aid in blunt dissection of tissues, (d) to act as filters during suctioning, (e) to aid in the retraction of heavy organs acting as "cushions" to provide better exposure, and (f) to provide built-in "pouches" for inadvertently spilled gallstones, blood clots, necrotic tissues, or foreign materials such as displaced titanium clips and hemolok that needs to be taken out of the abdominal cavity. This enhanced design provides additional features not present in previous laparoscopic sponge designs. The versatility of this new device will be very helpful to laparoscopic surgeons during the course of minimally invasive surgery, especially difficult ones.

Description

RELATED APPLICATIONS

Laparoscopic sponges are essential in the success of minimally invasive surgeries.

The device has been extensively utilized especially in more complex laparoscopic procedures. > 3. BACKGROUND OF THE INVENTION

At the present time, more and more surgeons utilize laparoscopic procedures in the practice of their profession. Minimally invasive surgery is becoming more familiar because of obvious advantages of laparoscopic procedures over the traditional open-type surgeries, namely, less post-operative pain, shorter hospital stay, faster recuperation translating to earlier return to work, and smaller scars resulting to better aesthetic results. These benefits prompted both practicing surgeons and patients to embrace this surgical approach with open arms. In fact, concepts of minimally invasive surgery and its practice have been incorporated into the residency training programs of surgical specialties even in developing countries.

Currently, several types of laparoscopic sponges have been introduced in the market after the first successful laparoscopic cholecystectomy? performed by Erich

Miihe in 1985. The pursuit of uncovering the ideal laparoscopic sponge is wanting.

Many proposed designs have already been presented by different pioneering inventors and innovators in the previous years. However, the quest remains, and the designs and concepts continue to evolve. The transformations of the laparoscopic sponge accompany the rapid advancements and rapid trends in the field of minimally invasive surgery. Although the need for laparoscopic sponge is seldom appreciated in simple laparoscopic procedures such as diagnostic laparoscopies and easy laparoscopic cholecystectomies, the demand for a versatile laparoscopic sponge is vital and can only be better appreciated in times of difficult and challenging advanced laparoscopic surgeries.

Through the years, upon review of literature, here are some of the notable reported laparoscopic sponge designs that were described and published by their proponents and innovators. The table below summarizes the year, the authors, and a short description of their specific designs. a pre-compressed non-absorbable rectangular gauze 1995 | Mascagni et al® sponge used to control minor hemorrhages during laparoscopic procedures. sponge which was shaped like a cigarette, thus the 2001 | Gholamietal* | name “cigarette sponge” (also known as the “Kittner roll gauze”). unrolled 4” x 4” gauze with a suture tied to one corner to 2003 Maccabee and | allow easy retrieval and to serve as marker thus

Sheppard® eliminate the chance of inadvertently leaving the sponge in the abdomen. absorbable version of the cigarette sponge made from a 40 x 5 x 5 mm strip of absorbable gelatin sponge 2005 Brandlietal® | wrapped with a single layer of oxidized regenerated cellulose, and tied at both ends with 2-0 polygalactin sutures.

Inherent to any other laparoscopic procedures, toilette of the abdominal cavity is very important so that the retrieval of body fluids, such as irrigation fluid, blood, bile, exudates, blood clots, necrotic debris, spilled gallstones, and foreign body materials such as titanium clips should always be given emphasis..

The spattering of blood and other body fluids in the operative field and scope lenses may diminish the image quality registering in the television monitor. This may interfere in the conduct of the operation. Thus, gauzes are utilized to wipe the scopes, and laparoscopic sponges are used to clean interfering body fluids of any types. Therefore, the quality of the laparoscopic sponges should be favorable for such procedures. The ease of inserting the sponge through the port or cannula must be excellent. The material must be absorbent, does not fragment easily, and should be free of lint to avoid inadvertent foreign bodies being left accidentally inside the abdominal cavity. sw

The currently proposed device, a uniquely folded laparoscopic sponge that is being presented here, is a novel design that promises an excellent option, and maybe better compared to what is presently available in the market.

Several other added features of the new design will be discussed later.

> : 4. SUMMARY OF THE INVENTION

The currently proposed innovation which deviates from the existing designs of previously presented laparoscopic sponges is aimed towards a novel device that can be routinely and maximally utilized in all minimally invasive/laparoscopic procedures.

The device comprises of an absorbent medical-grade weaved cotton material that can take up or absorb bodily fluids, and can be easily manipulated inside the abdominal cavity for several functions. If large amount of fluids (e.g., irrigating solution and otherwise) is to be drained out of the abdominal cavity, a laparoscopic suction (“Trumpet”) connected to a suction machine may be utilized to facilitate removal of excess fluids faster. In this case, the novel device can act as a “filter” to safeguard organs and tissues from being inadvertently caught into the suction tip.

The present innovation can be introduced into the abdominal cavity through a 10 mm port or cannula. Because of its pre-formed slender longitudinal shape and approximate diameter of 5.0 mm, the device can be effortlessly slipped through the port. Furthermore, the black silk 2-O ties at the middle and near both ends serve as markers to guide the laparoscopic surgeon during his intra-corporeal manipulations.

The concentrated bulbous tips on both ends can act as “surgical peanuts” and can be utilized in performing delicate blunt dissections especially in narrow areas requiring precise movements.

The uniquely folded bivalve lips of the present innovation provide an added feature of a retractable pouch for easy retrieval of blood clots, spilled gallstones, necrotic tissues/debris, displaced titanium clips, and other foreign body materials by simply slipping these into the pouch before the laparoscopic gauze is extracted through the mm port or cannula. The creation of the pouch can be facilitated by partially pulling first the exposed silk 2-O loop in the middle to remove tension before unrolling both the folded sides of the device. Once identified materials for extraction are deposited into the pouch already, these are entrapped or snared inside the pouch when both ends of the laparoscopic sponge are stretched to its original length as demonstrated in FIG.8.

The device can also be converted to a sponge bolus instantly by simply pulling an exposed loop of sik as previously demonstrated in FIG.4. This “tie-pulling” mechanism shortens the time needed to develop a sponge bolus from an elongated laparoscopic sponge, an action that is not demonstrated in the available laparoscopic sponge designs previously patented. Furthermore, the fashioned sponge bolus maintains its crumpied form even if the iengthened silk loop is cut unless it is stretched back to its original length and form with laparoscopic graspers.

This sponge bolus can serve as “cushions” at the tip once clasped with laparoscopic graspers to aid in retracting heavy solid organs like the liver to improve exposure during laparoscopic procedures. When retraction is no longer needed, the sponge bolus can be switched back to its slender longitudinal shape by simply holding the device at its two ends and stretching it out.

This new incorporated concepts have not been defined yet in practice of laparoscopic surgery because it has not been discovered or implemented yet, and is just being introduced only in this current laparoscopic sponge design.

> 5. BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top schematic view of the device, the slender longitudinal form of the

Bamboo Snare (or Crumpling CruMenG) laparoscopic sponge.

FIG. 2 is the magnified details of the middle portion of the device showing the protruding silk 2-0 tie loop which can be pulled to produce the crumpled form.

FIG. 3A is a top schematic view of the device in FIG. 1 that demonstrates the two “pouches” created by unrolling the bivalve folds to open them. FIG. 3B is the side view to show how the pouches look like. : FIG. 4 shows the completely crumpled device when the silk 2-O tie loop in the midiine is pulled out from the shaft of the sponge.

FIC. 5 demonstrates the device of FIG. 1 being inserted through the 10 mim poit (or cannula) utilizing the laparoscopic graspers.

FIG. 6 demonstrates the device of FIG. 1 being introduced into the abdominai cavity through the 10 mm port utilizing the laparoscopic graspers.

FIG. 7 demonstrates the device of FIG. 3 with the “laid open” pouch being filled with spilled galistones to be extracted from the abdominal cavity.

FIG. 8 shows the device that is depicted in FIG. 3 with the pouch containing the collected galistones being closed.

FIG. 9 shows the device containing the spilled gallstones being extracted by simply slipping it out of the orifice of the 10 mm port with the aid of laparoscopic graspers.

FIG. 10 demonstrates the tied end of the laparoscopic sponge being utilized as “surgical peanut” which is versatile aid for blunt dissection in narrow areas. This is achieved by clasping the prongs of the laparoscopic graspers around the tied portion of either ends of the laparoscopic sponge.

> 6. DESCRIPTION OF THE PREFERRED EMBODIMENT

Although the disclosure made here is presented in precise details to allow those skilled in the art to practice the invention, the physical embodiments disclosed herein simply illustrate the invention which may be embodied in other specific assemblies.

Although the preferred embodiment has been thoroughly explained, certain details of the said device may be altered without departing from the concepts stated by the claims of this invention. Likewise, this device may utilize other types of absorbent material and of other shapes, sizes and thickness for certain specific applications or uses.

FiG. 1 is a schematic view of the device called the retractable Bamboo Snare or

Crumpling CruMenG laparoscopic sponge in its slender longitudinal form. This device has a wide variety of new applications in a laparoscopic surgical procedure.

FIG. 3A demonstrates the top view of the partially laid open pouches of the device when the bivalve folded edges are unrolled. FIG. 3B demonstrates the side view of the device to show the pouches clearly. This feature is a new concept that has not been seen nor described in previously invented laparoscopic sponges available in the market and those applied with pending patents.

This device can readily be introduced into the abdominal cavity through at least 10 mm diameter port with the aid of laparoscopic graspers as shown in FIG. 5, and likewise easily extracted through the same diameter ports by simply pulling the device in one of its end with the same laparoscopic graspers as demonstrated in

FIG. 9.

FIG. 7 demonstrates a laid open pouch of the device inside the abdominal cavity. in this picture the pouch is filled with spilled gallstones from an inadvertently perforated gallbladder. This pouch can likewise accommodate other materials such as blood clots, necrotic tissues/debris, displaced titanium clips, hemolok, and other objects that need to be removed from the abdominal cavity. The pouch to be efficient must be filled in with such materials described above, but should not exceed the 10 mm diameter in its compressed form to allow easy extraction through the non- expandable port.

FIG. 8 demonstrates the pouch being closed by simply pulling the two laparoscopic graspers on their opposite directions. This action narrows and closes the pouch bivalve lips. Upon closure of the pouch, the collected stones can then be extracted through the 10 mm port.

The device, being shaped in a narrow longitudinal strip as seen in FIG. 1 is practical because the contour allows maximum maneuverability utilizing two (2) laparoscopic graspers while inside the abdominal cavity. Since the sponge does not occupy a large area of the operative field, the visualization of the surrounding structures and organs during the procedure is optimized.

The device is highly absorbent being fashioned to form a slender, yet thick and compact medical grade weaved cotton gauze. The 2-O silk ties on both ends and at the middle help maintain the durable and lint-free form of the device unlike the other ordinary sponges presently utilized. Likewise, the concentrated bulbous portion on both ends of the device can serve as “surgical peanut” that can be used during blunt dissection.

The device described in FIG. 1 has a slender longitudinal shape appearing like a “halved” bamboo with three nodes corresponding to the silk 2-O ties. Approximate length of the device is 20.32 millimeters, and equal width and thickness of around 5.0 millimeters. However, the device can be fashioned and made of any length, thickness or width.

Referring now to FIGS. 5, the device is shown being inserted into the abdominal cavity through a trocar with at least a diameter of 10 mm. The device is introduced utilizing the laparoscopic graspers. FIG. 6 shows the device halfway through the cannula towards the abdominal cavity. Entry into the abdominal cavity can be assisted by the other laparoscopic graspers held by the opposite hand of the surgeon.

Once in position, the device can be maneuvered to the desired action or position by the laparoscopic surgeon. Several indications and uses of the device are previously mentioned in the previous statements above.

The crumpled device as in FIG. 4 can be utilized as cushion when retracting heavy organs. The device can be activated by simply pulling the exposed loop of silk 2-O in the middle of the device to instantly transform it to a stable crumpled form. This crumpling action of the device is relatively maintained even if the elongated loop of silk is cut using laparoscopic scissors. Once the cushioning effect of the sponge is no longer needed, the device can be simply stretched, and instantly the sponge can assume the original elongated slender form as in FIG. 1..

A Raytec® thread incorporated in the cotton weave of the device provides an extra safety measure. The radiograph detectable thread aids in the pinpointing the exact location of the sponge by simply requesting for a scout film of the abdomen whenever the device is inadvertently lost in the operative field during laparoscopic procedures. Such Raytec® thread is an important safety feature during surgical procedures. It should be understood that the radiograph detectable feature is included in any of the embodiments of the present invention.

The laparoscopic sponge is specially folded and is distinctly unique compared to other previously described laparoscopic sponges patented and those in the market.

The way it is assembled makes it possible to perform the several functions enumerated above. The laparoscopic sponge is lint-free in all its edges and ends since all loose threads of the gauze are hidden inside the compact assembly which is further secured by the silk 2-O strand ties making sure it maintains its form.

The presented modifications in this device provide improvements over prior laparoscopic sponge designs. The foregoing is considered as illustrative only of the principles of the invention. Furthermore, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described. While the preferred embodiment has been described, the details may be changed without departing from the invention, which is defined by the claims.

>

REFERENCES

1) Chalkoo M, Ahangar S, Wani H, et al. Laparoscopic Management of Difficult

Cholecystectomy. Advances in Laparoscopic Surgery. 2012: 13-28. 2) Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? J Minim

Access Surg. 2011 Jul-Sep; 7(3): 165-168. 3) Mascagni P, Gossetti F, Negro P, et al. Pre-compressed gauze swab in minimally invasive surgery. Brit J Surg. 1995; 82:647— 649. 4) Gholami SS, Shekarriz B, Rudnick D, et al. The laparoscopic cigarette sponge. J

Urol. 2001; 166:194. 5) Maccabee D, Sheppard BC. The laparoscopic sponge. Surg Endosc 2003,17: 1320-1321. 6) Brandli DW, Bernie JE, Connor TM, et al. Absorbable laparoscopic cigarette sponge. JSLS 2005; 9:°362-363. 7) Miguel PR, Figueiredo FA, da Rosa AL, et al. Use of gauze cylinders in laparoscopic cholecystectomy: A technical alternative. Surg Laparosc Endosc 1994;4:73-75. 8) Bariol SV, Heng CT, La u HM. Intracorporeal ribbon gauze in laparoscopic surgery. ANZJ Surg 2004; 74:68. ) 9) Beldi G, Glattli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis.

Surg Endosc.2003 Sep;17(9):1437-9. Epub 2003 Jun 13. 10)Nakajima J, Sasaki A, Obuchi T, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today. 2009;

Claims (1)

1. >

   7. CLAIMS We claim: 1) A device that can be used in any laparascopic surgical procedure, comprising of uniquely folded crumpling absorbent sponge that can be inserted into a body cavity through a 10 mm port or cannula. 2) A device according to claim 1, wherein the absorbent sponge is modified from an 8-ply 4” x 4” medical-grade weaved cotton gauze that is opened at its midiine fold to produce a 4-ply 4” x 8” gauze. 3) A device according to claim 1, wherein the 4-ply 4” x 8” gauze is folded thrice from the two longitudinal sides toward the midline to create a narrow strip of gauze that has a width and thickness of 5.0 mm, a length of 20.32 mm. 4) A device according to claim 1, wherein the elongated folded gauze is tied with a 2-0 silk strand in exactly three (3) areas, at midline and at both ends about 4.0 mm from the edges, making the bivalve gauze strip appearing as a “halved” bamboo shaft with three (3) “nodes”. 5) A device according to claim 1, wherein the laparoscopic sponge is provided with a special “retracting mechanism” to crumple the gauze and maintaining it to steadily assume that position so it can be utilized in retracting a heavy solid organ like the liver. 6) A device according to claim 5, wherein the “crumpling” action of the laparoscopic sponge can be initiated by completely pulling to thread’s full extent the protruded loop of silk 2-0 tie strand seen at the site of the tie-secured middie shaft of the sponge. The pulled loop of silk strand can be cut with a laparoscopic scissors so as not to interfere with the maneuvers done during the procedure. 7) A device according to claim 5, wherein the “crumpled” laparoscopic sponge can be stretched and straightened again to its original length by holding to both ends of the gauze and pulling it towards opposite directions. The “stretched”

   laparoscopic sponge can then be extracted easily from the abdominal cavity through the 10 mm port with laparoscopic graspers.

   8) A device according to claim 4, wherein the bivalve laparoscopic sponge can serve as a “pouch” to secure and entrap blood clots, accidentally spilled gallstones, necrotic debris, broken clips, and other materials that are needed to be taken out from the abdominal cavity.

   9) A device according to claim 8, wherein the pouch mechanism can be initiated by partially pulling the exposed loop of silk 2-0 by around one-fourth of its length from and near the tied middle shaft of the gauze to reduce tension when unrolling both folds of the gauze using two laparoscopic graspers.

   10)A device according to claim 1, wherein the absorbent sponge is capable of taking up any body fluids (e.g., blood, bile, abscess, etc.) that maybe encountered within the abdominal cavity.

   11) A device according to claim 1, the absorbent laparoscopic sponge is also provided further with a Raytec®, an x-ray detectable material, to guide surgeons in locating it in the event that the sponge is misplaced or lost within the abdominal cavity by simply requesting for a scout film of the abdomen..

   12)A device according to claim 4, wherein the two (2) bulbous ends can be grabbed

   ~ with the tip laparoscopic graspers and utilized as “surgical peanuts” to facilitate

   - blunt dissections.

   Because of the ideal size of the bulbous tip, it can be used in small spaces for accurate maneuvering.

   13)The device according to the claims expressed above is a versatile armamentarium for laparoscopic surgeons.

   The device can perform the many functions of already published and patented designs, and with added features not present in previous inventions and innovations.

   14)A device according to claim 13, wherein the newly proposed design of laparoscopic sponge may serve the following purposes: (a) absorbing excess body fluids in the operative field; (b) drying organ and tissue surfaces; (c) applying pressure on bleeding capillaries and small vessels for hemostasis; (d)

   facilitating blunt dissection of adherent and edematous tissues; (e) serving as suction tip filters to avoid tissue injuries while drawing excess fluids from the intra-abdominal cavity; (f) cushioning solid organs during retractions for better “exposure” during surgery; and (g) providing a retractable pouch to accommodate blood clots, spilled gallstones, necrotic debris, and other materials that are to be extracted from the abdominal cavity.