US3834392A - Laparoscopy system - Google Patents

Laparoscopy system Download PDF

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Publication number
US3834392A
US3834392A US32851373A US3834392A US 3834392 A US3834392 A US 3834392A US 32851373 A US32851373 A US 32851373A US 3834392 A US3834392 A US 3834392A
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Prior art keywords
forceps
means
body cavity
passage
gas
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Expired - Lifetime
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Inventor
R Lampman
W Knepshield
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CABOT MEDICAL Corp A NJ CORP
WINIASZ MICHAEL EDWARD 4009 WASHINGTON AVE LORAIN
Cooper Medical Devices Corp
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KLI Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206Generators therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42Gynaecological or obstetrical instruments or methods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/0066Sensing and controlling the application of energy without feedback, i.e. open loop control
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body

Abstract

A laparoscopy system for female sterilization whereby a single unit contains the power source to provide illumination, oscillatory electrical power and CO2 for a laparoscopy. CO2 gas, under pressure, is first passed into the body through a needle into the peritoneal cavity. The fallopian tubes are identified and then the laparoscope, which contains a telescope connected to a source of illumination, is inserted into the body cavity. A flexible forceps is, thereafter, inserted through the laparoscope into the body cavity. The forceps is manipulated to successively close the passage through each fallopian tube, either by means of sending electrical oscillations through the forceps to simultaneously cut, seal and cauterize each tube in turn, or by means of a specific clamp which clamps the passage shut.

Description

United States Patent [191 Lampman et al.

[5 LAPAROSCOPY SYSTEM [75] Inventors: Russell A. Lampman, Yardley;

William R. Knepshield, Malvern, both of Pa.

[73] Assignee: KLI, Inc., Ivyland, Pa.

[22] Filed: Feb. 1, 1973 [2]] Appl. No.: 328,513

[52] US. Cl. 128/303.13, 128/4 [51] Int. Cl A61b 17/36 [58] Field of Search..... 128/303.13, 303.14, 303.15,

[56] References Cited UNITED STATES PATENTS 2,382,109 8/1945 Sheiffele 128/4 2,828,748 4/1958 August 128/303.14 3,299,883 l/1967 Rubens 128/4 OTHER PUBLICATIONS Fiber Optic Laparoscope-American Cystoscope Makers, Inc., D-l83, Feb. 1972.

The Lancet Vol. 11 of 1959, No. 7104, pages Fur-rues FLOW VOLUME PPESSUPE FILI- FLOW SELECT INSUFFL. 4 719 EL EC rtoconaucn 710A! 28 Flue": er-um rep n in 34 ILLUMINITOR 36 4 1 R L 3 4 A 50 3 o 1 46 i smna renunnnr MIML) ca,

[451 Sept. 10, 1974 Primary ExaminerLucie l-l. Laudenslager Attorney, Agent, or Firm-Arthur A. Jacobs ABSTRACT A laparoscopy system for female sterilization whereby a single unit contains the power source to provide illumination, oscillatory electrical power and CO for a laparoscopy. CO gas, under pressure, is first passed into the body through a needle into the peritoneal cavity. The fallopian tubes are identified and then the lap- V aroscope, which contains a telescope connected to a source of illumination, is inserted into the body cavity. A flexible forceps is, thereafter, inserted through the laparoscope into the body cavity. The forceps is manipulated to successively close the passage through each fallopian tube, either by means of sending electrical oscillations through the forceps to simultaneously cut, seal and cauterize each tube in turn, or by means of a specific clamp which clamps the passage 5 shut.

4 Claims, 3 Drawi ng Figures smousm PATENTEU saw an 2 3 884 392 LAPAROSCOPY SYSTEM This invention relates to a laparoscopy system for female sterilization, and it particularly relates to a system of this type which is embodied in a single unitary assembly.

A laparoscopy system is used for female sterilization by minor surgical means wherein the fallopian tubes are separated, cut and sealed.

Heretofore, in laparoscopy, it was necessary for the operator to use a variety of different surgical instruments as well as separate heat sealing means or clamps in order to complete the process. The assembling of the various instruments and their separate use was not only time-consuming, but their proper use depended largely on the skill and experience of the operator. It was also often necessary to use a variety of make-shift instruments and apparatus which were never designed for this specific task so that much time and effort were wasted and much skill was needed to obtain the exact correlation of steps and the exact results desired.

It is one object of the present invention to overcome the aforesaid disadvantages by providing a unitary laparoscopy assembly wherein all the elements are correlated and coactive with each other for the specific purpose required and wherein the proper metering and indicating devices co-act with each other to obtain a rapid, highly coordinated and effective result with a minimum of skill and experience.

Another object of the present invention is to provide an assembly of the aforesaid type that is relatively simple and inexpensive in construction and which requires a minimum of maintenance.

Another object of the present invention is to provide an assembly of the aforesaid type which is compact and relatively portable.

Other objects and many of the attendant advantages of this invention will be readily appreciated as the same becomes better understood by reference to the following description when read in conjunction with the accompanying drawings wherein:

FIG. 1 is a view, partly in elevation and partly in perspective of the various components constituting a laparoscopy device embodying the present invention.

FIG. 2 is an enlarged end view taken on line 22 of FIG. 1, in the present invention.

FIG. 3 is a schematic view of the electronic circuit utilized in the present invention.

Referring now in greater detail to the various figures of the drawings wherein similar reference characters refer to similar parts, there is shown a housing having a pair of fluidic indicators, 12 and 14, each of which consists of a small spring-pressed piston. These indicators are of the type manufactured by the Micro Switch Company, Freeport, 11]., a division of Honeywell. These indicators are operatively connected between an internal tank and the patient output. The indicator 12 shows red when the pressure is below a predetermined level and the indicator 14 shows red when there is no flow of CO gas.

Below the indicators 12 and 14 is a lamp 16 which indicates the CO input, being adapted to glow when the pressure in the supply (external tank) is below a predetermined level.

Below the lamp 16 are two dials, the dial 1 8 indicating the CO volume in the internal tank, and the dial indicating the CO pressure-in the. body cavity of the patient being treated.

Below the dials 18 and 20 are three mechanical switch means indicated at 22, 24 and 26 respectively. The switch 22 is a push-button device which mechanically activates a fill valve for the CO flowing from the primary (external) supply to the internal tank when it is pushed in; the toggle switch 24 mechanically activates or deactivates an on-off valve to allow flow of CO from the internal tank to the patient; the toggle switch 26 is a high-low pressure selector which selects flow from either a high or low pressure second stage regulator of standard construction.

The electrocoagulation activator system comprises a push-button, on-off electrical switch 28 to activate or deactivate the electronic network, a push-button, on-of electrical switch 30 for the illuminator system, and a glow lamp 32 to indicate activation of the electrocoagulation means, this lamp being adapted to glow when the foot-pedal, hereinafter described, is depressed. The push-buttons 28 and 30 also contain glow lamps which will be hereinafter described.

Below the aforementioned switches is a selector switch 34 which is used to regulate the high frequency oscillator to set the range of electrocoagulation, and a fitting or adaptor 36 which is provided for the purpose of providing illumination to the telescope through a fiberoptic cable hereinafter described. Behind the fitting 36 is contained a projection bulb, hereinafter described, which is electrically connected to the pushbutton 30 which turns it on and off.

A groundplate 38 is adapted to be strapped to the patient by a rubber band or the like, indicated at 39, and this groundplate is connected at 40 to the electronic network. A cable-type forceps 42 is provided with a jack 44 that is connected by a cable to a connector 46 connected into the oscillator circuit of the electronic network. A footpedal 48 is connected by a cable to the plug 50 connected to the oscillator circuit. A CO outlet 52 is connected to a valve 54 which has an outlet 56 that is selectively connected to either the housing 58 of a Verees needle 60 or a trocar sleeve 62. The sleeve 62 is adapted to hold a trocar 64 which is insertable through the sleeve and held in place by a spring-pressed plunger 66. The sleeve 62 is also provided with an inlet tube 68 which is adapted to receive the outlet 56 of the valve housing 54.

The laparoscope is indicated generally at 70, and comprises a tubular housing 72 having a neck portion 74 and a connector portion 76 which is connected through an optionally provided knurled focusing knob 78 to an eyepiece 80. A tubular inlet 82 extendsoutwardly from the interior of neck portion 74 and is adapted to receive the forceps 42. The inlet 84 is provided with a shut-off valve 85 similar to the valve 54. A tubular extension 84 projects outwardly from the interior of connector portion 76. This extension-8400mprises a bundle of fiberoptic strands and is adapted to be connected to a light-transmitting cable 86 which is also a bundle of fiberoptic strands encased in aflexible sheathing. This cable 86 is connected to the adaptor 36.

The housing 72, as best seen in FIG. 2, contains an elongated tube 88, adapted'to receive a telescope 89 (shown in FIG. 1), and an elongated tube 90 integral and continuous with the inlet-82" and adapted to receive the forceps 42 which is inserted through inlet 82. The

interior of the housing 72 is filled with fiberoptic material 92 around the two tubes 88 and 90. The cable86 is adapted to transmit light from the projection bulb behind the adaptor 36 through the extension 84 into the housing 72 to provide light for the telescope.

In operation, the valve 54 is attached to the housing 58 of the Verees needle 60 and the valve 54 is connected by a flexible tube to the CO supply outlet 52. The supply outlet 52 is connected to an internal tank in the housing by a low pressure hose. The internal tank is filled with CO from an external supply tank (not shown) by means of the push-button switch 22 which mechanically operates a valve in the connection between the external and internal tank after going through a primary stage regulator of standard construction.

The needle 60 is then injected into the peritoneal cavity of the patient and the select switch 26 is set to high, which is about 30 mm. of mercury as set by the factory. The switch 24 is then activated to cause a flow of CO into the patients peritoneal cavity at the area selected by the operator. The needle 60 is adapted to pass through the tissue into the desired cavity where the fallopian tubes should be situated. If the pressure reading is then maintained, at 9-12 mm. Hg pressure, as shown by dial 20, the gas flow is within the correct cavity. If it is not the correct cavity, the gas pressure rapidly increases and flow is slowed. In this case, the needle is then reinjected and the gas flow repeated until the correct cavity is found. The selector valve, operated by the select switch 26, is then set to low (about 10 mm. of mercury) after approximately 2 liters of CO is passed into the peritoneal cavity.

When the pressure reading indicates that the gas is flowing into the correct cavity, the gas flow is halted and the needle is withdrawn. A slight incision is then made with a scalpel just below the umbilicus, and through this incision is inserted the trocar 64 which is telescopically positioned within the sleeve 62. The valve device 54, which has been disassembled from the needle housing 58, is then coupled to the inlet 68 and the CO pressure is maintained at a constant 10 mm. of mercury. The trocar is manipulated to push between the tissue and into the peritoneal cavity.

The trocar is then pulled out and the laparoscope 70 is inserted in its place. With the vlaparoscope in position, the fiberoptic cable 86 is connected between the extension 84 and the adaptor 36 behind which is contained the light source. The ground plate 38 is also attached to the patient at this time.

With the laparoscope in position, the valve 85, which is normally closed to prevent escape of the gas, is opened and the forceps 42 is inserted through the inlet 82 and the tube 90 into the body cavity. The forceps itself then substantially prevents escape of the gas. The pushbutton 30 is pushed in to turn on the lamp behind adaptor 36. At this time the CO is maintained at a constant 10 mm. mercury pressure which equalizes the pressure of the gas in the cavity, so that there is effectively no flow. The operator then peers through the eyepiece 80 and, while doing so, uses the forceps to grip a fallopian tube. With the forceps in the proper position around the fallopian tube, the operator steps on the footpedal 48 which activates the oscillator circuit, the power output of the oscillator having been set by adjustment of the selector switch 34 to a predetermined value. The oscillator sends its pulses through the cable 94, leading from connector 46, through the forceps 42. This results in a simultaneous cutting, sealing and cauterizing of the fallopian tube by electrocoagulation. The same procedure is then repeated with the other fallopian tube.

Although an electrocoagulation process has been described above, it is also possible to substitute a clip means which can'be inserted by a special forceps and manipulated thereby to clamp the fallopian tube, closing the passage therethrough.

The electronic control and actuating network is shown in FIG. 3. The AC input is comprised of power input lines 102 and 104 and a ground line 106. The ground line 106 is tied to the housing to prevent shock hazard. The lines 102 and 104 are placed into and out of the circuit with the primary winding 108 of a transformer 110 by means of a double pole double throw maintained contact illuminated pushbutton switch 112 operated by button 28. A fuse 114 is provided in the power line 102 to prevent undesirable power surges.

The primary 108 coacts with three secondary windings designated 116, 1 l8 and respectively. The secondary 116 is in circuit with a lamp 122 inside button 28 and a lamp 124 inside button 30. A double throw double pole maintained contact illuminated pushbutton switch is operated by button 30, one of the switch blade contacts being shown at 126 and the other at 128. When the button 30 is pushed in, it simultaneously closes both contacts 126 and 128 to cause both the lamp 124 and a projection lamp 130 to glow. The projection lamp 130 is positioned within the unit and provides the illumination for the telescope in the laparoscope at its output connector 36.

The light circuit also includes a pressure-operated switch 132, single pole double throw momentary contact press to test switch 134 and lamp 16. The switch 134 is normally held in engagement with a contact 136 but may be passed into engagement with contact 138 for a purpose to be hereinafter described.

When the button 28 is pushed in to close switch 112, it activates a blower 140 to keep the equipment cool and activates the transformer 110. This also causes the lamp 122 to glow. When the button 30 is pushed in, it closes switch contacts 126 and 128 causing lamps 124 and 130 to glow. Normally, the switch 132 is open and the lamp 16 does not glow. However, when the primary (external) pressure falls below a predetermined minimum value, the switch 132 closes and the lamp l6 glows indicating low primary gas pressure. if it is desired to test the circuit to determine if the lamp 16 is operative, the switch 134 is moved from contact 136 by pressing pushbutton 32 to contact 138, thereby bypassing the switch 132 and causing lamp 16 to glow.

The secondary winding 1 18 is in circuit with a rectitier bridge 142 for changing AC to DC current. The bridge 142 is in circuit with a relay solenoid 146 which is operated by a foot-pedal switch 148. When the footpedal switch 148 is closed, it causes the relay solenoid 146 to energize which, thereupon, acts to close the solenoid switch 150. This energizes the primary winding 152 of a transformer 154 thereby actuating the electrocoagulatory oscillator.

The transformer 154 has two secondary windings 156 and 158. Energization of secondary 156 causes lamp 32 to glow, indicating activationof the electrocoagulator oscillator. Energization of secondary 158 sends current through the high voltage rectifier bridge 160 to actuate the high frequency oscillator partially comprised of pentodes 162 and 164, whose filaments are in circuit with secondary 120 of transformer 110. The resultant high frequency oscillations pass through transformer 166 and through the pre-set range selector switch 34 to the forceps connector 46 and in turn to the forceps 42.

The circuit from transformer 166 is completed through the shield connector 40. The shield 38 is attached to the patient and by means of the shield cable is connected to shield connector 40.

When the operator releases the foot-pedal 48, it opens the switch 148 and this inactivates the oscillator circuit. Generally only a momentary or very short activation time is required.

The invention claimed is:

1. In a laparoscopy system comprising a housing, a gas tank in said housing, conduit means connecting said tank to a source of gas under pressure, penetrating means constructed and arranged to penetrate into a body cavity through the abdominal wall, said penetrating means being in selective gaseous fluid connection with said tank and being constructed and arranged to project said gas into said body cavity, and a piercing means constructed and arranged to pierce the abdominal wall and pass between muscle layers under the skin to form a passage into a body cavity, said piercing means being in selective gaseous fluid connection with said tank, the improvement comprising a laparoscope selectively insertable through said passage into said body cavity, said laparoscope comprising an elongated casing containing a telescope and a forceps guide tube, said telescope and forceps guide tube extending longitudinally of said elongated casing in substantial parallelism with each other, said telescope being in selective operative connection with a source of illumination in said housing, an elongated flexible forceps adapted to grasp a fallopian tube, said forceps being selectively positioned in said forceps guide tube and extending therefrom in a position to grasp said fallopian tube while said telescope is illuminated by connection with said source of illumination, whereby said forceps may be manipulated while said telescope provides an illuminated view to the operator through the same passage into said body cavity, means connected to said forceps for closing the passage of said fallopian tube, said laparoscope having means to substantially prevent escape of gas from said body cavity when said forceps is not positioned in said forceps guide tube, and said forceps being constructed and arranged to substantially prevent escape of said gas from said body cavity when it is positioned in said forceps guide tube.

2. The system of claim 1 wherein said means for closing the passage of the fallopian tube is an oscillatory electrical current, said current being supplied by an electrical oscillation circuit in said housing, a source of electrical energy operatively and selectively connected to said oscillation circuit, said forceps being constructed and arranged to receive and transmit said oscillatory current from said oscillation circuit to said fallopian tube, said forceps being in selective operative connection with said oscillation circuit, and means to selectively actuate said oscillation circuit.

3. The system of claim 2 wherein adjusting means are provided in said oscillation circuit to vary the power output thereof.

4. The system of claim 1 wherein said means for closing the passage of the fallopian tube is a clip means.

Claims (4)

1. In a laparoscopy system comprising a housing, a gas tank in said housing, conduit means connecting said tank to a source of gas under pressure, penetrating means constructed and arranged to penetrate into a body cavity through the abdominal wall, said penetrating means being in selective gaseous fluid connection with said tank and being constructed and arranged to project said gas into said body cavity, and a piercing means constructed and arranged to pierce the abdominal wall and pass between muscle layers under the skin to form a passage into a body cavity, said piercing means being in selective gaseous fluid connection with said tank, the improvement comprising a laparoscope selectively insertable through said passage into said body cavity, said laparoscope comprising an elongated casing containing a telescope and a forceps guide tube, said telescope and forceps guide tube extending longitudinally of said elongated casing in substantial parallelism with each other, said telescope being in selective operative connection with a source of illumination in said housing, an elongated flexible forceps adapted to grasp a fallopian tube, said forceps being selectively positioned in said forceps guide tube and extending therefrom in a position to grasp said fallopian tube while said telescope is illuminated by connection with said source of illumination, whereby said forceps may be manipulated while said telescope provides an illuminated view to the operator through the same passage into said body cavity, means connected to said forceps for closing the passage of said fallopian tube, said laparoscope having means to substantially prevent escape of gas from said body cavity when said forceps is not positioned in said forceps guide tube, and said forceps being constructed and arranged to substantially prevent escape of said gas from said body cavity when it is positioned in said forceps guide tube.
2. The system of claim 1 wherein said means for closing the passage of the fallopian tube is an oscillatory electrical current, said current being supplied by an electrical oscillation circuit in said housing, a source of electrical energy operatively and selectively connected to said oscillation circuit, said forceps being constructed and arranged to receive and transmit said oscillatory current from said oscillation circuit to said fallopian tube, said forceps being in selective operative connection with said oscillation circuit, and means to selectively actuate said oscillation circuit.
3. The system of claim 2 wherein adjusting means are provided in said oscillation circuit to vary the power output thereof.
4. The system of claim 1 wherein said means for closing the passage of the fallopian tube is a clip means.
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