WO1994021188A1

WO1994021188A1 - A laparoscopic apparatus

Info

Publication number: WO1994021188A1
Application number: PCT/GB1994/000586
Authority: WO
Inventors: Patrick Finlay
Original assignee: Armstrong Projects Limited
Priority date: 1993-03-23
Filing date: 1994-03-22
Publication date: 1994-09-29
Also published as: GB9305965D0

Abstract

A laparascopic apparatus comprises a laparoscope of elongate form, means adapted to support the laparoscope and to move the laparaoscope in a predetermined manner, the support and moving means being such that, with the laparoscope inserted through an incision in the abdominal wall of the patient, the laparoscope may be moved about a virtual pivot point substantially coincident with the incision.

Description

"A LAPAROSCOPIC APPARATUS"

THE PRESENT INVENTION relates to a laparoscopic apparatus.

Laparoscopic apparatus is utilised when carrying out a surgical technique known as laparoscopy. In following this technique a device incorporating a camera, known as a laparoscope, is inserted into a patient through a small hole formed in the abdominal wall. Typically the abdomen is inflated, by injecting a substantially inert gas into the abdomen, enabling the laparoscope to be manipulated to be positioned at a desired location relative to the organs within the abdominal cavity. Typically a laparoscope is of elongate form, with the camera provided at the end of the laparoscope which is to be inserted into the abdominal cavity. The camera may be a small charge coupled device or any other appropriate camera adapted to provide an output signal.

The output from the camera of the laparoscope is fed to an appropriate display. When an operation is to be performed, the appropriate instruments necessary to perform the operation may be inserted into the abdominal cavity through one or more further small apertures formed in the abdominal wall, and the laparoscope can be utilised to observe an organ which is to be operated upon, and the instruments as the surgeon manipulates the instruments to operate on the organ.

Since the surgeon needs to utilise both hands to control the instruments, an assistant, typically a junior doctor, controls the laparoscope. The junior doctor thus moves the laparoscope in and out of the cavity, and also manipulates the position of the laparoscope so that the camera of the laparoscope is directed in an appropriate direction, causing the appropriate organ to be shown upon the display. The laparoscope may, of course, include a light fibre arrangement to direct light into the abdominal cavity so that the region effectively viewed by the camera is also illuminated by the laparoscope.

The present invention seeks to provide an improved laparoscopic apparatus.

According to this invention there is provided a laparascopic apparatus comprising a laparoscope of elongate form, means adapted to support the laparoscope and to move the laparoscope in a predetermined manner, the support and moving means being such that, with the laparoscope inserted through an incision in the abdominal wall of the patient, the laparoscope may be moved about a virtual pivot point substantially coincident with the incision.

Preferably means are provided to move the laparoscope in and out of the abdominal cavity of the patient.

Conveniently the means adapted to move the laparoscope are controlled by a control arrangement, the control arrangement receiving signals from position sensors adapted to sense the position of the head of a surgeon.

Advantageously the apparatus includes a display adapted to display an image derived from a camera forming part of the laparoscope.

Preferably the display forms part of a head-up display to be worn by a surgeon operating the laparoscope.

In a preferred embodiment the laparoscope is mounted on an arcuate support element adapted to be driven along the arc defined by the arcuate support element, the arcuate support element being mounted on a rotatable support disc, means being provided to support the disc and to drive the disc rotationally.

Preferably the laparoscope is releasably connected to the arcuate support member. Advantageously the support means supporting the support disc are adjustable.

In an alternative embodiment the laparoscope is supported by an element having a hemispherical surface, the laparoscope extending through the hemispherical surface, the hemispherical surface being adapted to abut the abdominal wall of a patient, means being provided to drive the element defining the hemispherical surface in two substantially orthogonal directions.

Conveniently means adapted to drive the element with the substantially hemispherical surface comprise drive elements connected to the said element defining the hemispherical surface at orthogonally located positions, each drive element being connected to the element defining the substantially hemispherical surface by means of a mounting block, the mounting block being pivotally connected to the drive element about one axis and being pivotally connected to the element defining the hemispherical surface about another, orthogonal axis.

Advantageously the drive means comprises piston and cylinder arrangements.

Preferably means are provided to move the laparoscope axially into and out of the cavity.

In order that the invention may be more readily understood, and so that further features thereof may be appreciated, the invention will now be described, by way of example, with reference to the accompanying drawings in which

FIGURE 1 is a block diagram of a laparoscope apparatus,

FIGURE 2 is a schemmatic view of an apparatus in accordance with the invention, part of which is schematic, and

FIGURE 3 is a perspective view of an alternative embodiment of the invention.

Referring initially to Figure l of the accompanying drawings, it is to be appreciated that the present invention provides a laparoscopic apparatus in which the laparoscope is positioned by an appropriate drive mechanism, which is controlled by a control arrangement. The control arrangement may be designed to receive signals from sensors adapted to determine the position of the head of a surgeon. Consequently, by moving his head appropriately, a surgeon may control the position of a laparoscope.

Thus, as shown in Figure 1, a plurality of head position sensors 1 are provided. The head position sensors are preferably formed integrally with a head-band or the like. The sensors are adapted to sense a raising or lowering of the head, and a turning of the head to the left and to the right. The sensors are also adapted to sense when the surgeon leans inwardly. Signals from sensors are transmitted to a control arrangement 2 which may be in the form of a computer or appropriately programmed microprocessor. The link between the sensors 1 and the control arrangement 2 may comprise a wire or may comprise a radio link, or an infra-red link.

The control arrangement 2 is adapted to control a laparoscope and drive mechanism 3. The control is such that if the surgeon turns his head the drive of the laparoscope causes the laparoscope to pan, whereas if the surgeon raises or lowers his head the laparoscope is caused to tilt. If the surgeon leans in, the laparoscope effectively zooms, and this may be achieved either by altering the focus of a lens arrangement associated with the camera or, preferably, by physically driving the laparoscope further into or out of the body cavity.

The output from the laparoscope is fed to a display 4. The display may comprise a conventional monitor or cathode ray tube device, or may comprise a liquid crystal monitor. It is envisaged that the display may form a "head up" display and may thus be formed integrally with a helmet or head-gear incorporating the sensors 1, to be worn by the surgeon. The surgeon will thus be able to see, in front of his eyes, a display derived from the laparoscope, and simply by moving his head will be able to control the precise position of the laparoscope within the body cavity.

It is to be appreciated that the use of the laparoscope must be such that the laparoscope causes the minimal amount of pain and/or physical damage to the patient.

Referring to Figure 2 of the accompanying drawings, a patient 5 is illustrated schematically, and the abdomen of the patient is shown as having been inflated. An incision 7 has been formed in the abdominal wall of the patient and an elongate laparoscope 8 is illustrated in position, with the lower end of the laparoscope inserted through the incision 7 in the abdominal wall.

The upper end of the laparoscope is provided with a drive mechanism 9 adapted to drive the laparoscope axially, thus moving the camera provided at the lower end of the laparoscope into or out of the body cavity.

The laparoscope is connected to one end of an arcuate support member 10. Preferably the laparoscope is releasably mounted in position on the arcuate member 10.

The arcuate member 10 is mounted on a support disc 11 so that the arcuate member may move along the arc defined by the arcuate member in response to a drive mechanism 12 which is also mounted on the disc 11. The drive mechanism 12 may incorporate a motor driving a toothed wheel, the toothed wheel co-operating with a toothed rack 13 formed on the exterior of the arcuate member 10. The sides of the arcuate member may be provided with guide channels 14, which engage guide members formed integrally with the support disc 11 on opposed sides of a substantially diametrically extending slot 15 formed in the support disc, the slot 15 having a width slight greater than the width of the arcuate support element 10. The arcuate support element is thus at least partially accommodated in the slot 15. It is to be appreciated that the radius of curvature of the arcuate support member 10 is such that the centre of the arc is located at a point substantially coincident with the incision 7 formed in the abdomen 6 of the patient 5.

Thus, by operating the motor forming part of the drive 12 the arcuate support element 10 may move effectively along its arc, thus tilting the laparoscope 8, the laparoscope 8 being tilted about a virtual pivot point which is coincident with the incision 7.

The support disc 11 is supported in position and is driven by a support and drive arrangement 16. The support maintains the disc 11 at an appropriate position above the patient 5. The drive is adapted to drive the disc rotationally in a substantially horizontal plane as illustrated.

It is to be appreciated that the support is an adjustable support and thus, when the apparatus illustrated in Figure 2 is assembled in position, initially the laparoscope will be inserted in position through an incision 7 formed in the abdomen 6 of a patient 5, and then the adjustable support of the support and drive arrangements 16 will be adjusted so that the support disc and the arcuate support element 10 are brought to the position illustrated, and the arcuate support element 10 is then connected to the laparoscope, whilst the laparoscope is held in the initial vertical position. Subsequently, the drive of the support and drive arrangement 16 and the drive arrangement 12 are operated, by signals from the control arrangement 2 of Figure 1. It is to be appreciated that by driving the support disc 11 rotationally in an appropriate way, and by driving the arcuate support element 10 to have a desired position so that the laparoscope has a desired angle of tilt, it is possible to locate the laparoscope in any predetermined position relative to the patient. By operating the zoom drive 9, the camera can be moved in and out of the abdominal cavity, meaning that the camera can be located in any position that the surgeon requires. As mentioned above, control of the laparoscope can be effected simply by the surgeon moving his head.

Since the laparoscope enters the cavity 7 at the virtual pivot point of the laparoscope, the described movement of the laparoscope effects a minimum of pain and physical damage to the patient.

Referring now to Figure 3, in an alternative embodiment of the invention a laparoscope 19, only part of which is shown, extends through a drive mechanism 20 adapted to move the laparoscope axially, that drive mechanism being mounted on top of a semi-spherical element 21 which has a planar upper surface 22 engaged by the drive 20 and a lower hemispherical surface 23, which actually engages the abdominal wall 24 of a patient in the region of an incision formed in the abdominal wall of the patient, the incision not being visible in Figure 3. The element 21 is provided with two lugs 25,26 which extend orthogonally from the element at positions spaced apart by 90° lying in the plane of the planar upper surface 22. Each lug is identical. Thus the lug 25 consists of two projecting arms 27,28 which extend parallel with each other, there being a pivot pin 29 extending between the arms and engaging apertures formed in the arms. A mounting block 30 is provided which is mounted for pivotal rotation, between the arms 27,28 about the axis of the pivot pin 29. The mounting block 30 defines, in its forward end remote from the pivot pin 29, a recess 31. A vertically extending pivot pin 32 extends vertically across the recess 31, the pivot pin 32 thus being perpendicular to the pivot pin 29. A boss 33 is mounted for pivoting movement about the pivot pin 32, the boss 33 being received within the cavity 31 and being connected to an arm 34 which enters a drive cylinder 35. The arrangement incorporating the mounting block 30 thus resembles a universal joint.

The boss 26 is of the same design as the boss 25, and the various component parts are identified by similar reference numerals, each carrying a prime.

The drive cylinders 35,35' may comprise pneumatic or hydraulic cylinders, or may comprise solenoid devices or other arrangement adapted to provide forces directed axially of the arms 34,34' .

The mounting blocks 30,30' are provided, with the described arrangement of pivot pins, to provide the necessary freedom of movement. It is to be appreciated that the laparoscope of Figure 3 may be moved into and out of the abdominal cavity by means of the drive 20 and may be caused to tilt with any degree of tilt in any direction, by operating the drive cylinders 35,35'. If only one of the drive cylinders 35 or 35' is operated, the mounting block 30 or 30' associated with the other drive element pivots appropriately to enable the element 21 to be moved to the appropriate position.

It is to be understood that in both the embodiment of Figure 2 and the embodiment of Figure 3, the laparoscope is caused to move about a virtual or effective pivot point which is coincident with the incision formed in the abdomen of the patient.

Claims

CLAIMS :

1. A laparascopic apparatus comprising a laparoscope of elongate form, means adapted to support the laparoscope and to move the laparoscope in a predetermined manner, the support and moving means being such that, with the laparoscope inserted through an incision in the abdominal wall of the patient, the laparoscope may be moved about a virtual pivot point substantially coincident with the incision.

2. An apparatus according to Claim 1 wherein means are provided to move the laparoscope in and out of the abdominal cavity of the patient.

3. An apparatus according to Claim 1 or Claim 2 wherein the means adapted to move the laparoscope are controlled by a control arrangement, the control arrangement receiving signals from position sensors adapted to sense the position of the head of a surgeon.

4. An apparatus according to any one of the preceding Claims including a display adapted to display an image derived from a camera forming part of the laparoscope.

5. An apparatus according to Claim 4 wherein the display forms part of a head-up display to be worn by a surgeon operating the laparoscope.

6. An apparatus according to any one of the preceding Claims wherein the laparoscope is mounted on an arcuate support element adapted to be driven along the arc defined by the arcuate support element, the arcuate support element being mounted on a rotatable support disc, means being provided to support the disc and to drive the disc rotationally.

7. An apparatus according to Claim 6 wherein the laparoscope is releasably connected to the arcuate support member.

8. An apparatus according to Claim 6 or 7 wherein the support means supporting the support disc are adjustable.

9. An apparatus according to any one of Claims 1 to 5 wherein the laparoscope is supported by an element having a hemispherical surface, the laparoscope extending through the hemispherical surface, the hemispherical surface being adapted to abut the abdominal wall of a patient, means being provided to drive the element defining the hemispherical surface in two substantially orthogonal directions.

10. An apparatus according to Claim 9 wherein the means adapted to drive the element with the substantially hemispherical surface comprise drive elements connected to the said element defining the hemispherical surface at orthogonally located positions, each drive element being connected to the element defining the substantially hemispherical surface by means of a mounting block, the mounting block being pivotally connected to the drive element about one axis and being pivotally connected to the element defining the hemispherical surface about another, orthogonal axis.

11. An apparatus according to Claim 9 or Claim 10 wherein the drive means comprise piston and cylinder arrangements.

12. An apparatus according to any one of Claims 9 to 11 wherein means are provided to move the laparoscope axially into and out of the cavity.

13. A laparascopic apparatus substantially as herein described with reference to and as shown in Figure 2 of the accompanying drawings.

14. A laparascopic apparatus substantially as herein described with reference to and as shown in Figure 3 of the accompanying drawings.

15. Any novel feature or combination of features disclosed herein.