Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/32—Surgical cutting instruments
  • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/0023—Surgical instruments, devices or methods disposable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
  • A61B17/3421—Cannulas
  • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B2217/00—General characteristics of surgical instruments
  • A61B2217/002—Auxiliary appliance
  • A61B2217/005—Auxiliary appliance with suction drainage system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B2217/00—General characteristics of surgical instruments
  • A61B2217/002—Auxiliary appliance
  • A61B2217/007—Auxiliary appliance with irrigation system

Definitions

• the present invention is in the field of surgical apparatus and it relates to a multifunctional instrument used for the interventions of endoscopic surgery, also called laparoscopic.
• a multifunctional instrument used for the interventions of endoscopic surgery also called laparoscopic.
• FR2625428 (SINERGY SA, inv.MAHNES, OGNIER) a multifunctional surgical device comprising a cannula combining a plurality of spaces for circulation of fluids and for guiding surgical instruments, the said cannula being connected at its proximal end to an operating handle and being able to be separated therefrom for its sterilization, the nozzles opening into a connecting part of the cannula, a main conduit for introducing rigid operating instruments is located in its proximal part inside the handle and its distal part inside the cannula, the junction and sealing between the two parts being ensured by a slide valve operable by the practitioner at the time of the introduction of a rigid surgical instrument.
• This device of the prior art has demonstrated its effectiveness; however, its use has identified a number of drawbacks.
• a second drawback is the obligation for the practitioner, when inserting an instrument into the cannula, to abandon any gesture in progress in order to actuate a valve with his first hand. cannula drawer and with his other hand, insert the instrument.
• a third drawback results from the fact that it is increasingly necessary to resort to single-use surgical equipment, the sterilization methods not fully guaranteeing the absence of pathogenic germs; in view of this necessity, the simultaneous use of trocars and cannulas according to the prior art entails a significant cost borne by the community or by patients.
• a first object of the present invention is to provide an apparatus intended for endoscopic surgery, the cannula of which jointly performs the functions of the trocar.
• a second object of the invention is to provide a simplified cannula in its design and construction so that it is less costly to consider replacing it with each intervention rather than reusing it after sterilization.
• a third object of the present invention is to provide said device with a sealed connection device between the proximal and distal parts of the passage passage for rigid surgical instruments, that is to say requiring no specific operation for its setting implemented during the introduction of said instruments into the device.
• a fourth object of the invention resides in instruments of the rigid type and in means of reciprocal adaptation of these with the apparatus, means such that these instruments can be operated by the thumb or by the index finger of the hand. holding the device, and can be introduced or removed from the device by the other hand remained free, all these operations to be performed without modification of grip.
• a surgical device for operative laparoscopy roof known as a multifunctional instrument, of the type made up of a tube, known as a cannula, inside which various instruments can be introduced, said cannula being able to allow the passage of body or irrigation liquids, and comprising in the vicinity from its so-called proximal end a connection assembly to a grip handle, from which it can be separated after use, said handle comprising a connection piece to the cannula, this piece supporting a plurality of means for implementing the various functions of the device, while the cannula comprises at its proximal end a connecting part to the handle, this connecting part comprising nozzles for the passage of liquids, is mainly characterized in that all of the conduits opening out to the distal end of the cannula, such as that allowing the passage of the various instruments and those allowing the functions of irrigation or aspiration, are coaxial.
• the communication between the cannula and the operating handle is controlled by a ball valve device included in the connecting part of the cannula, the ball being movable laterally under the effect of the introduction of 'an instrument to free the passage and resuming its obstruction position under the effect of a spring when removing the instrument.
• the cannula is constituted in its distal part, of two concentric tubes, respectively inside and outside.
• An irrigation pipe is formed by an annular space formed between the two tubes.
• the said inner tube is preferably stamped at its distal end at three equally spaced points on its periphery, this stamping forms three grooves on the outer surface of said tube, and three bosses on its inner surface of dimension such that the cumulation of their sections corresponds to the section of the annular space, and such that the diameter of a fictitious circumference passing through the three apexes of the bosses is slightly greater than the largest external diameter of the instruments.
• the so-called distal end of the outer tube is advantageously constricted, so that the diameter of the orifice of the outer tube cor corresponds to that of the outer diameter of the inner tub: the distal ends of said two inner and outer tubes being in close contact , these are welded on their periphery.
• the outer tub is also constricted at its proximal end so as to be in close contact with the inner tube and to be welded to the latter, a passage being provided in the said outer tub and communicating with a nozzle duct in the section is equivalent to that of said annular space and whose orifice opening to the outside of the cannul is equipped with a valve and a spring-loaded valve.
• the communication is carried out by stamping the outer tube identically to that carried out on the distal end of this same tube
• the communication is carried out by means of grooves made at 1 proximal end of the outer tube and opening onto its orifice
• the communication is made through a perforation arranged near the proximal orifice of the outer tube.
• the ball valve device is located in a cylindrical cavity formed inside the proxima end of the cannula. This advantageously includes the following elements:
• a first element made up of a ball of a diameter greater than the instrument passage, the ball being biased radially by a leaf spring,
• a second element constituting a cylindrical plunger in the shape of a piston provided with axial bore and comprising in its upper part a collar whose upper face is provided with a groove the groove is of a width less than the diameter of the ball and its depth is such that the ball rests only on the two edges of the groove without obstructing the bore;
• the pusher comprises a hollow rod, the internal diameter of which corresponds to that of the instrument passage duct, the external diameter of the flange corresponding to that of the cavity, so that the pusher is guided axially in the cavity,
• a third element constituting a helical compression spring axially urging the plunger in the direction of the ball
• a fourth element formed a valve seat, consisting of a washer provided on its lower flat face with a concave concave bearing surface provided with a central orifice whose diameter corresponds to that of the conduit for passage of the instruments.
• the ball in the absence of instrument in the duct, obstructs the orifice of the seat and prevents any leakage, through the proximal end of the duct of the fluid usually used to dilate the operating cavity; when an instrument is inserted into the leads the ball is retracted following a lateral movement initiated by a leaf spring, and axial to the en ⁇ against the pusher and its helical spring; when removing the instrument, the ball returns to apply against the second valve seat.
• the handle being perpendicular to the axis of the cannula
• the operation of a rigid instrument present in the device results from the operation of an eyelet supported above the handle by a couple of arms and a couple of links, while the transverse operation of the eyelet, on either side of the rest position materialized by the axis of the handle, respectively activates one or the other of two suction and irrigation control microswitches, each of the operations of the eyelet having an effect inde ⁇ hanging from the position of the eyelet resulting from the other operation.
• Fig.l is a perspective view of the apparatus of the invention.
• Fig.2 is a longitudinal section of the distal part of the cannula, with in the extension a mandrel intended to form with it a trocar, Fig.3 is - a section of the distal part of the cannula,
• Fig.4 is a longitudinal section of the device
• Fig. 5 is a partial section of the ball valve device
• Fig. 6 is a top view of the device
• Fig.7 is an axial (or longitudinal) section of adaptation means, integral with the device, of a rigid instrument according to the invention
• Fig.8 is a similar view of the opposing means specific to the instrument
• Fig.9 is a similar view illustrating the cooperation of the means of the two previous figures.
• a chi ⁇ rurgical device intended for operative laparoscopy consists on the one hand of a cannula 1 provided with a connecting piece 01, and on the other hand of an operating handle 2 provided with a connecting piece 02 perpendicular to the axis of said cannula.
• An operating eyelet 24, located in the proximal part of the operating handle 2 allows the practitioner to control the irrigation or aspiration of liquids and to control the operation of surgical instruments introduced inside the device, thanks to movements along two axes of a plane perpendicular to the operating handle.
• the distal part of the cannula 1 consists of two concentric tubes, one inside 5 and the other outside 6, welded to each other at their ends, the outside tube 6 being constricted so that the diameter of its orifice corresponds to that of the outside of the inner tube 5.
• the section of the annular space defined between the two tubes called exterior and interior is substantially equal to 1.7 mm ⁇
• the diameter of the fictitious cir ⁇ conference defined by the three vertices of the bos ⁇ sages is equal to that of the rigid utensils plus 0.2 mm, or 5.2 mm
• the outside diameter of the said outer tube is 8 mm and that of the said inner tube is 7.2 mm.
• a mandrel 90 consisting of a distal end 91 swollen and sharp, a rod 92 and a proximal end shaped like a pommel 93;
• the distal end 91 has an outside diameter which closely follows the inside diameter of the end of the cannula and it has three grooves 94 at 120 ° which also follow the bosses 7 of the internal face of the cannula, so as to completely fill its interior space at its distal end;
• the knob 92 has a shape adapted to the face of the connecting piece 01 of the cannula recalled in dashes; the assembly of the cannula and the mandrel forms a trocar.
• the outer tube 6 is stamped at its ends at three points 7, 7 'and 7 "equally spaced on its periphery, forming on its outer surface three grooves and on its inner surface three bosses.
• the annular space 4 arranged between the two tubes 5 and 6 corresponds to an irrigation conduit, the liquid circulating initially in said annular space 4, and secondly s 'evacuating the cannula through the conduits formed by said grooves 7,7' and 7 ".
• annular space 9 formed between on the one hand the internal surface of the inner tube 5 and on the other hand the external surface of a rigid surgical instrument 8 introduced 1 * inside the cannula and guided axially by the said bosses 7,7 ′ and 7 ′′, corresponds to a suction pipe.
• connection between the connecting piece 01 of the cannula and the connecting piece 02 of the handle is provided by a device of the "bayonet" type.
• This consists of a ring 25 integral with the operating handle 2, which ring penetrates inside a cylindrical cavity 10 formed inside the proximal part of the cannula 1, and is maneuverable therein. by means of a lever 35 (fig. 6).
• the proximal part of the cannula 1 is provided with two conduits arranged transversely to the cannula, one 21 intended for the passage of the irrigation liquid, the other 23 intended for the passage of the aspirated liquid.
• the irrigation conduit 21 communicates with the annular space 4 formed between the two exterior and interior tubes 6 and 5 by means of grooves 29 stamped on the proximal end of the exterior tube 6, and its orifice opening out of the cannula is fitted with a valve 22.
• the suction duct 23 opens onto the duct 9 formed by the internal space of the inner tube 5.
• the cylindrical cavity 10 contains an automatic ball valve device.
• This consists of a ball 11 obstructing a conduit 12 for the passage of rigid instruments, the latter resting on a cylindrical pusher 13 provided with a transverse groove 15 on its upper surface, itself resting on a spring 17 compression whose base is supported by the bottom of said cylindrical cavity 10.
• a washer 18, the lower flat face of which comprises a conical concave ramp 19 is supported on the upper surface of the ball 11.
• a leaf spring 20 is fixed close to the periphery of the washer 18.
• the invention proposes in its fourth object, shown in figs. 7-9, a provision to facilitate the exchange of specific instruments by the practitioner alone; in this arrangement, as in the previous one, the operation of a specific rigid instrument introduced into the device results from the operation or axial of the eyelet 24 disposed above the handle 2 (fig.l); each of the operations of the leton eye having an independent effect.
• the instrument (fig. 7) is held on the apparatus, and is maneuvered there, by means of, on the one hand, a first assembly, called the reception assembly, included in the apparatus, and on the other hand d '' a second assembly, known as the coupling head of the instrument (fig. 8), which can be made functionally integral with the first assembly by a double clutch device with balls which can be operated with one hand, the receiving assembly supporting the 'oeil ⁇ leton via the pair of arms 27 and the pair of links 30 (fig.l) articulated on it.
• a first assembly called the reception assembly, included in the apparatus
• a second assembly known as the coupling head of the instrument (fig. 8)
• the receiving assembly supporting the 'oeil ⁇ leton via the pair of arms 27 and the pair of links 30 (fig.l) articulated on it.
• the reception assembly mainly consists of three hollow coaxial parts, namely:
• the coupling head mainly consists of four coaxial hollow parts, namely:
• first part 54 provided with a pair of oblong slots 56 and, at its distal extremi, with an external conical bearing 58, called the first proximal end being shaped as a pusher 59,
• a second part 60 provided with a pair of oblong lights 62 and a plurality of housings 64 of balls, said second part is connected to the fixed part 41 of the instrument, while q the balls complete with the first conical bearing the first groove, the first dog clutch,
• a fourth part 72 provided with a plurality of housings 74 of balls, said fourth part being traversed by a pin 76 passing freely in the oblong slots 56,62 and being integral with one end of the movable part 43 of the instrument, while the balls complete with the second conical bearing 70 and the second groove 50 the second clutching member and that compression springs 78,80 urge the ball housings distantly, conical bearings so as to push the balls back into the circumferential gorges.
• the parts 41 and 60 are integral with the parts 48 and 29, that is to say with the handle 2, therefore fixed in translation, while the part 43 is integral in translation by means of the pin 76, parts 72 and 48, that is to say biel ⁇ lettes and the eyelet which can thus by its axial movement cause the displacement of the movable part 43 of the instrument.
• the uncoupling of the head and the receiving assembly is carried out by an identical manipulation of the parts 54 and 66 followed by the withdrawal of the instrument.

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ID=9401424

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Citations (2)

• 1990
  • 1990-10-15 FR FR9013011A patent/FR2667780A1/fr active Granted
• 1991
  • 1991-10-14 WO PCT/FR1991/000795 patent/WO1992006640A1/fr active Application Filing
  • 1991-10-14 AU AU88788/91A patent/AU8878891A/en not_active Abandoned

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