WO1993024062A1 - Scalpel electrochirurgical a fil - Google Patents

Scalpel electrochirurgical a fil Download PDF

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Publication number
WO1993024062A1
WO1993024062A1 PCT/US1993/002124 US9302124W WO9324062A1 WO 1993024062 A1 WO1993024062 A1 WO 1993024062A1 US 9302124 W US9302124 W US 9302124W WO 9324062 A1 WO9324062 A1 WO 9324062A1
Authority
WO
WIPO (PCT)
Prior art keywords
wire
shaft
aperture
tissue cutter
lateral surface
Prior art date
Application number
PCT/US1993/002124
Other languages
English (en)
Inventor
Terry Buelna
Original Assignee
Laparomed Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Laparomed Corporation filed Critical Laparomed Corporation
Publication of WO1993024062A1 publication Critical patent/WO1993024062A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop

Definitions

  • the present invention relates generally to the structure and use of surgical instruments, and more particularly, to a device and method for enlarging abdominal penetrations by the controlled cutting of the fascia transversalis.
  • Least invasive surgical (LIS) techniques such as laparoscopic, endoscopic, and arthroscopic surgery, are generally performed through small incisions using specialized instruments to perform desired surgical procr ures.
  • the instruments are introduced through a tube, such as a cannula, while the physician observes manipulation of the instruments through spec -lized imaging equipment, such as laparoscopes, endoscopes, and arthroscopes.
  • LIS techniques offer significant advantages over conventional "open" surgical procedures. In particular, LIS techniques are usually less traumatic, require a shorter recovery time, and are less costly than the corresponding conventional surgical techniques.
  • laparoscopic cholecystectomy procedures where the gallbladder is surgically severed and withdrawn through a small cannula, typically having a diameter of about 10 mm. While such procedures have been very successful and have become increasingly common, complications sometimes arise when the gallbladder is especially enlarged or contains gallstones which are too large to be withdrawn through the cannula. In such cases, it is often necessary to remove the cannula and to enlarge the abdominal penetration, typically by making one or more incisions at the border of the penetration using a scalpel or other conventional cutting blade. The ability to surgically enlarge the penetration during a laparoscopic procedure is, however, problematic.
  • fascia transversalis which is a sheet of tough, fibrous material that envelops the abdominal region of the body beneath the skin. It is the fascia transversalis which provides the primary barrier or resistance when making any abdominal incision or penetration.
  • the resistance is not a particular problem when an initial penetration is made using a needle, trocar, or other instrument.
  • the fascia transversalis makes enlargement of an initial hole problematic.
  • the fascia transversalis is covered by the skin, a superficial fascial layer, and the rectus muscle, thus making access to the transversalis fascia is quite limited.
  • the laparoscope At the stage of a laparoscopic procedure that a penetration of the transversalis fascia will need to be enlarged the laparoscope has already been removed, and the laparoscope would be unable to adequately visualize the fascia transversalis were it still in place.
  • Such devices and methods should permit easy location of the fascial layer, even when the layer cannot be seen by the surgeon.
  • the devices and methods should further provide for controlled cutting so that a penetration can be enlarged by a known amount, as well as for operation by a single hand so that the surgeon can manipulate other surgical instruments simultaneously.
  • U. S. Patent No. 3,815,604 describes a device for intraocular surgery comprising an outer tube having an aperture and an inner tubular blade which can be advanced to sever material penetrating the aperture.
  • U. S. Patent Nos. 1,978,495; 1,881,250; 1,798,902; and 1,683,708, describe electrosurgical instruments comprising a blade which reciprocates in an enclosed ring. The instruments are intended for removing tonsils, where the tonsils are captured by the ring, and the blade advanced within the ring to sever the tonsils.
  • U. S. Patent No. 749,689 describes a surgical instrument with an actuable blade.
  • U. S. Patent Nos. 1,741,461 and 1,731,069 describe surgical instruments having actuable components at their distal ends.
  • the present invention comprises a novel device and method for cutting and enlarging tissue penetrations, most particularly fascial penetrations during surgical procedures such as laparoscopic cholecystecto y.
  • the device and method permit the surgeon to locate the fascial layer "by feel" as the device is introduced through a previously formed narrow diameter abdominal penetration. Once the fascial layer has been located, the device can be readily positioned to make a cut. Positioning of the device is facilitated by an axially extending elongate aperture on the lateral surface near the distal end of the device. Cutting occurs due to the passage of electrical current through a wire positioned within the elongate aperture, while the wire contacts tissue.
  • the device of the present invention comprises an elongate shaft having a proximal end, a distal end, a lateral surface, and an elongate aperture in the lateral surface located near the distal end of the shaft.
  • An axially extending wire is exposed within the elongate aperture.
  • a means is provided at the proximal end of the device for connecting the wire to an electrosurgical generator. When electrical current is applied to the wire, and the wire has come into contact with body tissue, cutting and cauterization will occur according to known electrosurgical principles, as described in the medical and patent literature. See, e.g., Sebben (1988) J. Dermatol. Surg. Oncol. 14:1, the disclosure of which is incorporated herein by reference.
  • the tissue cutter may further comprise a means at the proximal end of the device shaft to manually move the wire between a retracted position and an exposed configuration.
  • a means at the proximal end of the device shaft to manually move the wire between a retracted position and an exposed configuration.
  • the dimensions of the device are preferably selected to permit controlled cutting of body tissues, such as the border of a penetration through the abdominal fascia transversalis.
  • the device will preferably be selected to fit within an abdominal penetration that was made to receive a 5 mm or 10 mm cannula.
  • the width of the shaft (along the distal end which will be inserted into the abdominal penetration) will be less than 15 mm, preferably being 7 mm or less, and more preferably being about 5 mm or less, at least over the distal 5 cm of its length.
  • the depth of the elongate aperture will be selected to provide the desired depth of cut. Typically the aperture will have a depth in the range from 0.3 mm to 15 mm, usually from about 1 mm to 6 mm. Additionally, it will be preferable to space the longitudinally extending wire maximally apart from the back lateral surface of the elongate aperture. Maximized spacing between the wire and the back lateral surface facilitates increased depth of individual incremental cuts.
  • the shaft is inserted into a previously formed abdominal penetration until the surgeon can feel the distal tip of the shaft reach the layer of t e transversalis fascia (hereinafter the fascial layer) .
  • the distal end of the shaft is positioned through a hole in the fascial layer so that the wire extending axially within the lateral shaft aperture is t jacent an edge of the hole.
  • the surgeon will then c -age the wire against the fascial layer, and an elec * .
  • cal current is applied to the wire, usually be depress:, g a footswitch connected to the electrosurgical generator.
  • the surgeon will effect severing and cauterization of a portion of the fascial layer.
  • the surgeon may engage the border of the fascial layer by moving the wire relative to the shaft, so that the wire extends radially outward from the shaft itself.
  • the surgeon will make a series of incremental cuts in a single direction from a preexisting hole, thus yielding an enlarged penetration.
  • the enlarged penetration will be used to remove an enlarged gall bladder, or a gall bladder containing oversized stones, as a step in a laparoscopic cholecystectomy procedure.
  • a series of radially spaced incisions can be formed around the periphery of the hole through the fascial layer. Accordingly, a penetration of the fascia transversalis, the primary barrier to intra-abdominal access, can be enlarged with minimal risk of injury to surrounding tissues and structures.
  • FIG. 1 is a side elevational, cross sectional view of a tissue cutter device constructed in accordance with the principles of the present invention, where the wire is movable between a retracted and an exposed configuration.
  • Figs. 2A-2B illustrate the distal end of the device of Fig. 1, where the wire is retracted in Fig. 2A, and the wire is exposed in Fig. 2B.
  • Fig. 3 is a perspective view of the distal end of the tissue cutter of Fig.l.
  • Fig. 4 is a cross sectional, side elevational view of an alternate embodiment of a tissue cutter constructed in accordance with the principles of the present invention, where the guide wire is substantially non-moveable.
  • Fig. 5 is a side elevational, cross sectional view of the distal end of a further alternate embodiment of a tissue cutter constructed in accordance with the principles of the present invention, where the cutting wire is substantially non-moveable.
  • Fig. 6 is a cross sectional side elevational view of an alternate embodiment constructed in accordance with the principles of the present invention, where the cutting wire is moveable from a retracted to an exposed position.
  • Figs. 7A - 7C illustrate use of the tissue cutter device of the present invention for enlarging a penetration through a patient's facial layer.
  • the tissue cutter of the present invention comprises an elongate shaft having proximal and distal ends, a lateral surface, and an elongate aperture in the lateral surface near the distal end of the shaft.
  • a wire will be disposed axially within the elongate aperture.
  • the wire will extend or be coupled to the proximal end of the shaft where it can be connected to an external electrical source. Accordingly, when the wire within the elongate aperture is engaged against a layer of tissue, and as an electrical current is applied to the wire, cutting and cauterization of a portion of tissue will occur.
  • a means for manually moving the wire mounted within the recess is provided at the proximal end of the shaft.
  • the means for reciprocating can be a ring actuator or a lever grip assembly, however, the reciprocating means may comprise any suitable structure for causing the wire to be moved within the elongate recess. As will be known to those skilled in the art, based on the specific procedure for which the device is being utilized, it may be preferable to use an embodiment where the wire is movable within the elongate aperture.
  • the shaft of the tissue cutter will be substantially rigid, usually formed from a metal or rigid plastic. Conveniently, the shaft may be formed from surgical stainless steel.
  • the shaft will typically be tubular but could have other cross-sectional geometries, such as rectangular, polygonal, irregular, or the like.
  • the distal portion of the shaft must have a maximal dimension (in any relevant direction) which permits easy introduction of the shaft into a previously formed abdominal penetration.
  • the relevant maximal dimension i.e., the diameter in the context of tubular shafts
  • the relevant maximal dimension i.e., the diameter in the context of tubular shafts
  • the narrow width of the shaft will generally be maintained along its entire length, however there is no reason why a proximal portion of the shaft cannot be enlarged. It is only necessary that the narrow dimension of the shaft be maintained over a distal portion of the shaft for a length sufficient to permit introduction of tne shaft to a desired depth.
  • the desired depth of introduction will be at least 5 cm, preferably being at least 3 cm.
  • a distal narrow portion of the shaft will, preferably, be at least 3 cm to 5 cm in length.
  • the dimensions of the elongate aperture are more critical.
  • the aperture should have a sufficient axial length to permit receiving of the fascial layer, typically the aperture will be from 3 mm to 5 mm in axial length. In some embodiments, however, apertures with an axial length of 10 mm or longer will be appropriate, and such embodiments fall within the scope of the present invention.
  • the depth of the aperture is selected to provide the desired depth of a cut when the wire is connected to an electrosurgical generator to cause cutting and cautery of tissue.
  • the depth of the aperture, the furthest distance between the lateral surface of the shaft and the back lateral surface of the aperture will be between 0.3 mm to 15 mm, preferably being from 1 mm to 6 mm. It will be preferable to space the longitudinally extending wire maximally apart from the back lateral surface of the elongate aperture.
  • the aperture will be located at or near the distal end of the shaft, preferably within 5 mm of the distal tip, more preferably within 2 mm of the distal tip. In some embodiments, however, the device may employ an aperture which is moved proximally from the distal tip of the shaft.
  • Tissue cutter 2 comprises an elongate shaft 4 having a distal end 6, a proximal 8, and a lateral surface 10.
  • FIG. 1 An elongate aperture 12 is formed in lateral surface 10, near distal end 6 of shaft 4.
  • a cutting wire 14 is movably mounted between retracted and exposed positions. As illustrated, wire 14 is movable within aperture 12 and within an axial lumen 16 of shaft 4. The proximal end 22 of wire 14 is connected to a rod assembly 18. As the wire exits rod assembly 18 the wire extends proximally and is arranged about a proximal surface of a guide 24, the wire then extends distally through port 26.
  • Figures 1 and 2A illustrate the wire in a retracted configuration. In the retracted configuration, wire 14 will have a concave shape within aperture 12.
  • wire 14 While in the retracted configuration wire 14 will lie within a recess 36 that exists around the periphery of aperture 12. In the retracted, concave configuration wire 14 conforms to back lateral surface 28 of aperture 12. The distal end 38 of wire 14 is securely attached to mount mechanism 30 near distal shaft end 6.
  • Rod assembly 18 passes through a flange 20 formed through proximal end 8 of shaft 4. By pressing the rod assembly 18 distally, in the direction of the arrow in Fig. 1, tension is placed on cutting wire 14. When tension is placed on wire 14 the wire will move from the retracted configuration in the elongate aperture 12, and move into the exposed configuration depicted in Fig. 2B.
  • rod assembly 18 will comprise a ring 32 and radially opposed grasping structures 34.
  • Radially opposed grasping structures 34 are mounted to the lateral surface 10 of shaft 4, whereas ring 32 is secured at the proximal end of rod assembly 18. Accordingly, the surgeon can hold the device in one hand with a pair of fingers inserted about grasping structures 34, and a thumb inserted through ring 32. The surgeon can then manually actuate the wire 14 simply by manually pushing ring 32.
  • Fig. 3 depicts a perspective view of the device of Fig. 1, wherein the cutting wire is in the retracted position illustrated by Figs, l and 2A. Accordingly, cutting wire 14 will extend through port 26 and will reside in a recess 36 which extends along the borders of elongate aperture 12. Near a proximal end 22 of cutting wire 14 an electrical connector 40 is coupled to the cutting wire. An electrical wire 42 will couple connector 40 with wire 14. Thereby, a conductive path is provided between the connector 40 and wire 14. Electrical connector 40 is suitable for coupling tissue cutter 2 to a conventional electrosurgical power supply. Such power supplies are available from commercial suppliers, such as Valley Lab, Inc. (a Pfizer Company) , Boulder, Colorado; Aspen Labs, Inc.
  • FIGs. 4 and 5 depict alternate embodiments of the present invention wherein wire 14 is substantially non-moveable. Specifically referring to Fig. 4, electrical connector 44 ' is mounted at the proximal end 8 of shaft 4. Cutting wire 14 is attached to connector 44• , and the wire extends distally through axial lumen 16. As depicted in Fig. 4, the wire will preferably be positioned so that it is maximally spaced apart from back lateral surface 28 of elongate aperture 12.
  • cutting wire 14 is secured in a substantially non-movable position at elongate aperture 12 by means of securing mechanism 46.
  • wire 14 will be maximally spaced apart from back lateral surface of aperture 12 to allow for maximal cutting depth.
  • Electrical wire 42 will connect cutting wire 14 to an electrical connector 40 in a conventional manner.
  • FIG. 6 an alternate embodiment of tissue cutter 2 is illustrated.
  • the embodiment depicted in Fig. 6 has a movable cutting wire.
  • rod assembly 18 comprises ring 32 at its proximal end.
  • grasping structures 34 are provided on the lateral surface of elongate shaft 4. The surgeon can hold the embodiment illustrated in Fig.
  • electrical wire 42 is coupled to electrical connector 40 by electrical wire 42.
  • electrical wire 42 extends through an aperture 48 in grasping structure 34. It is also within the scope of the present invention that electrical wire 42 could couple electrical connector 40 with wire 14 by directly entering rod assembly 18 (not illustrated) .
  • distal end 6 of shaft 4 is blunt (non-tapered) and elongate aperture 12 is located very near the distal end of the shaft.
  • elongate aperture 12 is located very near the distal end of the shaft.
  • the distal end 6 may be tapered, as illustrated in Fig. 6. The tapered embodiment may be preferable as it would facilitate introduction of the tissue cutter into small holes in tissue layers.
  • a cannula 50 will have been previously placed through an abdominal penetration.
  • the cannula extends through the skin S (dermis) , superficial fascia SF, rectus muscle RM, fascia transversalis FT, and peritoneum P.
  • Preferred methods of the present invention will enlarge a penetration which has already been formed through the fascia transversalis FT.
  • cannula 50 will have a diameter of about 10 mm to 15 mm, and it will be desired to enlarge an abdominal penetration (particularly a hole through the fascia transversalis) to a size in the range from about 12 mm to 20 mm.
  • shaft 4 of device 2 is inserted through the skin S, superficial fascia SF, and rectus muscle RM, until the distal end of the shaft engages the fascia transversalis FT.
  • the fascia transversalis is significantly more resistant to penetration than the other abdominal tissue layers, and the surgeon will be able to feel when the tip of the shaft initially encounters the fascia transversalis.
  • shaft 4 will be in the position illustrated in Fig. 7B.
  • Fig. 7C depicts the step of the penetration enlarging method where the edge of the fascia transversalis has been engaged by elongate aperture 12.
  • the wire will then be activated by means of its connection to a conventional electrosurgical power supply. Additionally, for those embodiments where the wire is movable within aperture 12, the wire may be moved from a retracted to an activated position while the wire is connected to the electrosurgical power supply.
  • the incision will be lengthened by making a series of successive (incremental) cuts.
  • the electrosurgical power supply can be applied for limited time periods, usually between 2 to 3 seconds.
  • the edge of the tissue will abut back lateral surface 28 of elongate aperture 12.
  • the surgeon will, therefore, be able to feel that a segment of the fascia transversalis has been cut, the depth of the cut will correspond to the distance between the wire and back lateral surface of the elongate aperture.
  • the electrosurgical power supply may be applied in a continuous manner, and cutting will occur over a continuous distance that the surgeon pushes the device. After enlarging an abdominal penetration shaft
  • the enlarged penetration can facilitate removal of relatively large body parts or organs, for example, removal of an enlarged gall bladder.
  • shaft 4 of device 2 may be introduced after the gall bladder has been partially withdrawn through an abdominal penetration.
  • the gallbladder is withdrawn by using forceps after the cannula has been removed.
  • Shaft 4 can be introduced alongside the partially withdrawn gall bladder, typically after removal of the gall bladder has proven difficult.
  • a penetration through the fascial layer can be enlarged during the course of a laparoscopic cholecystectomy.
  • a penetration can be enlarged without the necessity of pushing the severed gallbladder back into the abdominal cavity.
  • gallbladder contents will be spilled into the peritoneal cavity is lessened.

Abstract

L'invention concerne un scalpel (2) constitué d'une tige (10) dont la surface latérale à proximité de son extrémité distale (6) présente une ouverture oblongue (36). Un fil (14) est disposé axialement dans ladite ouverture de façon qu'il puisse être mû entre une position de retrait et une position de sortie. Un moyen (18) permettant de déplacer le fil est prévu sur l'extrémité proximale de la tige. Un moyen (40) permettant de raccorder l'extrémité proximale du fil à un générateur électrochirurgical est également prévu. Ce dernier est conçu de manière à permettre d'élargir l'incision du tissu lorsqu'un courant électrique est appliqué sur le fil (14). Le scalpel (2) est utile pour élargir des incisions abdominales déjà formées. Pour ce faire, on insère la tige dans l'incision, l'ouverture est mise en contact avec le bord du fascia, du courant électrique est appliqué sur le fil (14), et le fascia est sectionné radialement.
PCT/US1993/002124 1992-05-22 1993-03-08 Scalpel electrochirurgical a fil WO1993024062A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US88857092A 1992-05-22 1992-05-22
US07/888,570 1992-05-22

Publications (1)

Publication Number Publication Date
WO1993024062A1 true WO1993024062A1 (fr) 1993-12-09

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1993/002124 WO1993024062A1 (fr) 1992-05-22 1993-03-08 Scalpel electrochirurgical a fil

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WO (1) WO1993024062A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2311468A (en) * 1996-03-27 1997-10-01 Valleylab Inc Electrosurgical interstitial resector
EP1004277A1 (fr) * 1998-11-25 2000-05-31 Medsys S.A. Boucle électrochirurgicale et instrument pour la chirurgie laparoscopique

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2002559A (en) * 1932-04-13 1935-05-28 Wappler Frederick Charles Means for surgical resection
US2447169A (en) * 1945-01-16 1948-08-17 Sousa Eugenio De Surgical instrument and technique
US3910279A (en) * 1973-06-20 1975-10-07 Olympus Optical Co Electrosurgical instrument
DE2657256A1 (de) * 1976-12-17 1978-06-29 Wolfgang Haag Papillotomieschlinge in form einer als diathermieschlinge oder dergleichen ausgebildeten sonde
SU1235497A1 (ru) * 1984-04-11 1986-06-07 Ташкентский Ордена Трудового Красного Знамени Государственный Медицинский Институт Устройство дл рассечени сужений трубчатых органов
SU1355266A1 (ru) * 1985-12-05 1987-11-30 3. Янгибаев Устройство дл рассечени сужений трубчатых органов

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2002559A (en) * 1932-04-13 1935-05-28 Wappler Frederick Charles Means for surgical resection
US2447169A (en) * 1945-01-16 1948-08-17 Sousa Eugenio De Surgical instrument and technique
US3910279A (en) * 1973-06-20 1975-10-07 Olympus Optical Co Electrosurgical instrument
DE2657256A1 (de) * 1976-12-17 1978-06-29 Wolfgang Haag Papillotomieschlinge in form einer als diathermieschlinge oder dergleichen ausgebildeten sonde
SU1235497A1 (ru) * 1984-04-11 1986-06-07 Ташкентский Ордена Трудового Красного Знамени Государственный Медицинский Институт Устройство дл рассечени сужений трубчатых органов
SU1355266A1 (ru) * 1985-12-05 1987-11-30 3. Янгибаев Устройство дл рассечени сужений трубчатых органов

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB2311468A (en) * 1996-03-27 1997-10-01 Valleylab Inc Electrosurgical interstitial resector
EP1004277A1 (fr) * 1998-11-25 2000-05-31 Medsys S.A. Boucle électrochirurgicale et instrument pour la chirurgie laparoscopique
US6176858B1 (en) 1998-11-25 2001-01-23 Medsys S.A. Electrosurgical loop and instrument for laparoscopic surgery

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