WO2009021297A1 - Plateforme à conducteur pour chirurgie par les orifices naturels - Google Patents

Plateforme à conducteur pour chirurgie par les orifices naturels Download PDF

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Publication number
WO2009021297A1
WO2009021297A1 PCT/BR2007/000210 BR2007000210W WO2009021297A1 WO 2009021297 A1 WO2009021297 A1 WO 2009021297A1 BR 2007000210 W BR2007000210 W BR 2007000210W WO 2009021297 A1 WO2009021297 A1 WO 2009021297A1
Authority
WO
WIPO (PCT)
Prior art keywords
conductor
instruments
natural orifice
surgical
surgery
Prior art date
Application number
PCT/BR2007/000210
Other languages
English (en)
Inventor
Ricardo Paiva Araujo Dos Scheiba-Zorron
Original Assignee
Paiva Araujo Dos Scheiba-Zorro
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 Paiva Araujo Dos Scheiba-Zorro filed Critical Paiva Araujo Dos Scheiba-Zorro
Priority to PCT/BR2007/000210 priority Critical patent/WO2009021297A1/fr
Priority to EP07784939A priority patent/EP2187831A1/fr
Publication of WO2009021297A1 publication Critical patent/WO2009021297A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • 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
    • A61B17/320016—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, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2906—Multiple forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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

Definitions

  • the invention relates to a conductor platform comprised by multiple flexible instruments to perform surgical techniques of digestive system (gallbladder, liver, intestines, stomach, etc), urinary system (kidneys, urethers, etc), gynecologic applications (utherus, ovars, etc), and many other surgical applications, by means of the so-called "natural orifice surgery".
  • digestive system gallbladder, liver, intestines, stomach, etc
  • urinary system kidneys, urethers, etc
  • gynecologic applications utherus, ovars, etc
  • many other surgical applications by means of the so-called "natural orifice surgery.
  • Surgical subspecialties are represented by many branches, as general surgery, oncology, urology, coloproctology, gynecology, among many others, which usually perform operations using available conventional surgical instruments (scissors, graspers) since more than 100 years of surgical history.
  • Laparoscopy made possible these operations, previously done by longer incisions of conventional surgery, to be carried out by small orifices, reducing the trauma and lowering complications for the patients, with less pain and hospital stay.
  • New endoscopic suture devices could allow to break the intestinal barrier with more safety for patients, allowing clinical applications.
  • Available suture devices are insufficient for safe full-thickness closure of gastric wall for example, because these devices were idealized for small mucosal sutures.
  • the present invention consists, basically, in a conductor platform and multiple instruments and accessories, allowing the introduction of a flexi- ble endoscope (gastroscope or colonoscope), through human natural orifices, penetrating into the abdominal cavity and allowing the insertion and use of the specific flexible instruments through the device to perform surgical procedures.
  • the group of instruments is composed by a perforated conductor tube, that could be fixed to the operating table by its table fixer, that allows the insertion of any flexible endoscope commercially available ant that allows the insufflation of gas into the cavity, in addition to allow the insertion of special flexible instruments designed for this purpose, and other accessories.
  • the objective of the present invention is to provide a perforated conductor tube for insertion of a flexible endoscope, for insufflating gas into the cavity, and to be fixed to the operating table by means of its table fixer, to perform natural orifice surgery.
  • Another objective of the invention is to allow new flexible surgical instruments designed for execution of natural orifice surgery.
  • Figure 1 represents the perforated conductor tube for natural orifice surgery, as seen from its axial view
  • Figure 2 depicts the extremity of the perforated conductor tube for natural orifice surgery, as seen from its side view, showing the emergence of the flexible instruments;
  • Figure 3 depicts the perforated conductor tube for natural orifice surgery, as seen from its side view
  • Figure 4 represents the table holder for perforated conductor tu- be for natural orifice surgery, as seen from its side view;
  • Figure 5A depicts the knot pusher, as seen from its side view, with details of its distal extremity
  • Figure 5B depicts different possible forms of the extremity of the knot pusher.
  • Figure 6A depicts the hook, as seen from its side view, with details of its distal extremity;
  • Figure 6B depicts different possible forms of the extremity of the hook
  • Figure 7A depicts the grasper, as seen from its side view, with details of its distal extremity.
  • Figure 7B depicts different possible forms of the extremity of the grasper
  • Figure 8A depicts the clipator, as seen from its side view, with details of its distal extremity
  • Figure 8B depicts different possible forms of the extremity of the clipator
  • Figure 9A depicts the shears, as seen from its side view, with details of its distal extremity
  • Figure 9B depicts different possible forms of the extremity of the shears
  • Figure 1OA depicts the dissector, as seen from its side view, with details of its distal extremity
  • Figure 1OB depicts different possible forms of the extremity of the dissector
  • Figure 11 depicts the instruments disposed into the conductor tube
  • Figure 12 depicts an example of use of the conductor platform for natural orifice surgery, in an operation for transvaginal gallbladder extraction as seen from its side view, with details of insertion in the natural human orifice (vagina) and the procedure inside the abdomen;
  • Figure 13 depicts the external view of an example of use of the conductor platform for natural orifice surgery, in an operation for transvaginal gallbladder extraction as seen from its side view, with details of insertion of the invention in the natural human orifice (vagina);
  • Figure 14 depicts an internal view of an example of use of the conductor platform for natural orifice surgery, in an operation for transvaginal gallbladder extraction with details of intraoperative video image after insertion of the invention in the natural human orifice (vagina).
  • the present invention consists of a conductor platform system comprised by a perforated conductor tube and a group of flexible instruments to perform variable surgical techniques of digestive system (gallbladder, liver, intestines, stomach, etc), urinary system (kidneys, urethers, etc), gynecologic applications (utherus, ovars, etc), and many other surgical applications, by means of the so-called "natural orifice surgery", specially by the transvaginal access.
  • the present invention has the intent to afford devices and instruments designed for these new surgical procedures, consisting of a conductor tube and multiple flexible instruments, allowing the execution of natural orifice surgery.
  • Natural Orifice Transluminal Endoscopic Surgery is emerging as an experimental alternative to standard approaches for the abdominal cavity, as open surgery (conventional laparotomy) and laparoscopy. With advances in technology and videosurgery, the morbidity related to incisions is low. Trying to minimize the trauma of minimally invasive surgery, research groups recently started the evaluation of possible no scar abdominal surgeries. Pioneer researchers, restricted to animal studies, gained abdominal access t- hrough natural orifices as mouth, anus, urethra and vagina.
  • the present invention provides a device capable of introduce a flexible endoscope (gastroscope or colonoscope) through a natural orifice of the human or animal body, penetrating into the abdominal cavity and allowing the crossing over and use of special flexible instruments inside the device for performing surgical procedures.
  • the body of the invention consists of a perforated conductor tube fixed to the operating table by its table holder, the conductor tube allowing the insertion of a generic flexible endoscope, and the specially designed flexible surgical instruments for this purpose, the special channel that allows gas insufflation to the cavity and other accessories.
  • the patient is submitted to general anesthesia, and installed in a Lloyd-Davies position.
  • Disinfection of the vagina is achieved by topic iodopovidone, and an urinary catheter is installed.
  • Incision of vaginal posterior sac is done after traction of the cervix with a conventional instrument.
  • Operator is positioned between the legs of the patient, and first assistant behind and holding the controls of the colonoscope.
  • a second assistant takes position on the left side of the patient to retract the gallbladder.
  • the perforated conductor tube 1 is inserted through the posterior vaginal wound created and inserted into the abdominal cavity. Gas insufflation of abdominal cavity is performed through the adequate channel of the tube.
  • a generic 2-channel flexible videocolonoscope 5 is inserted into the conductor tube 1 through one of its channels 2, and insufflation of the cavity with CO 2 begins through the device.
  • the perforated conductor tube comprises at least two distinct passing channels 2,3, with at least one principal channel 2 and at least one accessory channel 3, inside of which flexible instruments are passed to perform surgical techniques through the human natural orifice.
  • the conductor tube 1 is inserted into the natural orifice (mouth, anus, vagina, and urethra), fastened to the operating table in the desired position by means of the table holder 6, as seen in Figure 4.
  • the table holder is externally connected to the perforated conductor tube 1 by means of, for example, pressure loopes 7.
  • the table holder 6 can be of any shape, preferably a C-clamp shape, capable of rotating on its longitudinal axis, so being adjustable for the surgery and natural orifice used.
  • an endoscope or colonoscope 5 of any type is introduced, passing through the principal channel 2 during the procedure and providing the image camera for the operation.
  • These flexible gastroscopes and colonoscopes 5 are commercially available, and are not the purpose of the invention.
  • a knot pusher 9 is one of the specially designed flexible instruments 4.
  • This knot pusher 9 is comprised by a flexible stem 8, with a length longer than the total length of the conductor tube 1 by which it passes, and with a substantially smaller caliber than the diameter of the accessory channel 3.
  • the knot pusher also comprises, on the other end, a perforated knot pusher extremity 9 with different conventional shapes, as illustrated on Figure 5B, allowing the conduction and tightening of the knot in the organ or internal structure of the body of the patient.
  • the specially designed flexible hook instrument 10, as illustrated on Figure 6A, the graspers 11 , as illustrated on Figure 7A, the clipators 12, as illustrated on Figure 8A, the scissors, as illustrated on Figure 9A, and dissectors, as illustrated on Figure 10A and 14, are also comprised by a flexible stem 8, with a length longer than the total length of the conductor tube 1 and with a caliber substantially smaller than the accessory channel 3 diameter.
  • their ends corresponds to their respective functions and uses, as illustrated on Figures 6B, 7B, 8B, 9B e 10B respectively, in their different shapes.
  • These instruments 4 are introduced into the perforated conductor tube through the accessory channels 3 specially designed for this purpose, as illustrated on Figure 11 , by this way allowing, for example, the dissection of the gallbladder after insertion of the invention into a natural orifice, for e- xample the vagina.
  • Dissection of the cystic duct and artery is obtained by conjoined action using the flexible instruments 4, and the coagulated artery with monopolar energy.
  • Cystic duct ligation is performed by generic commercially available endoclips, using the specially designed flexible clipator 12, or ligating the duct with external wire endoloop, using the specially designed flexible knot pusher 9.
  • the gallbladder is dissected from its liver bed u- sing the other special instruments above mentioned.
  • the gallbladder is extracted by the natural orifice (for example, the vagina), using the specially designed flexible graspers 11 to hold it. These procedures can be observed on Figures 12 e 13.
  • All the specially designed flexible instruments 4 and the perforated conductor tube 1 can also be used for surgical techniques through other natural orifices of the human or animal body, as the vagina, mouth, anus and urethra, and also be used through skin incisions, performing the procedures with the same instruments.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne une plateforme à conducteur utilisée dans de nombreuses techniques opératoires en chirurgie par les orifices naturels du système digestif (vésicule biliaire, foie, estomac, etc.), du système urinaire (reins, urètres, etc.), dans des applications gynécologiques (utérus, ovaires, etc.), et de nombreuses autres applications chirurgicales. La plate-forme comprend un tube conducteur perforé (1), contenant au moins un canal principal (2) et au moins un canal accessoire (3), un porte-table (6) pour stabiliser le tube (1) sur la table chirurgicale, et de multiples instruments souples (4) constitués par une tige de connexion (8) offrant différentes possibilités d'instruments chirurgicaux à son extrémité, tels que des boutons-poussoir (9), un crochet (10), des pinces à préhension (11), des clips chirurgicaux (12), des ciseaux (13), des dissecteurs (14) entre autres.
PCT/BR2007/000210 2007-08-16 2007-08-16 Plateforme à conducteur pour chirurgie par les orifices naturels WO2009021297A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
PCT/BR2007/000210 WO2009021297A1 (fr) 2007-08-16 2007-08-16 Plateforme à conducteur pour chirurgie par les orifices naturels
EP07784939A EP2187831A1 (fr) 2007-08-16 2007-08-16 Plateforme à conducteur pour chirurgie par les orifices naturels

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/BR2007/000210 WO2009021297A1 (fr) 2007-08-16 2007-08-16 Plateforme à conducteur pour chirurgie par les orifices naturels

Publications (1)

Publication Number Publication Date
WO2009021297A1 true WO2009021297A1 (fr) 2009-02-19

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/BR2007/000210 WO2009021297A1 (fr) 2007-08-16 2007-08-16 Plateforme à conducteur pour chirurgie par les orifices naturels

Country Status (2)

Country Link
EP (1) EP2187831A1 (fr)
WO (1) WO2009021297A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012005819A1 (fr) * 2010-05-24 2012-01-12 Surgiquest, Incorporated Dispositifs pour chirurgie automatisée

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3319049A1 (de) * 1982-11-26 1984-05-30 Richard Wolf Gmbh, 7134 Knittlingen Rektoskop
US4867404A (en) * 1988-05-16 1989-09-19 The United States Of America As Represented By The Department Of Health And Human Services Flexible holder for a cystoscope or the like
US20030018237A1 (en) * 2001-06-29 2003-01-23 Olympus Optical Co., Ltd. Endoscope
US20060135971A1 (en) * 2004-05-07 2006-06-22 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US20060237022A1 (en) * 2005-04-26 2006-10-26 Usgi Medical Inc. Transgastric abdominal access
US20060259018A1 (en) * 2005-04-28 2006-11-16 Alexander Shilkrut Device for holding a medical instrument
WO2007038715A1 (fr) * 2005-09-27 2007-04-05 Synecor, Llc Interventions et dispositifs chirurgicaux transgastriques

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3319049A1 (de) * 1982-11-26 1984-05-30 Richard Wolf Gmbh, 7134 Knittlingen Rektoskop
US4867404A (en) * 1988-05-16 1989-09-19 The United States Of America As Represented By The Department Of Health And Human Services Flexible holder for a cystoscope or the like
US20030018237A1 (en) * 2001-06-29 2003-01-23 Olympus Optical Co., Ltd. Endoscope
US20060135971A1 (en) * 2004-05-07 2006-06-22 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US20060237022A1 (en) * 2005-04-26 2006-10-26 Usgi Medical Inc. Transgastric abdominal access
US20060259018A1 (en) * 2005-04-28 2006-11-16 Alexander Shilkrut Device for holding a medical instrument
WO2007038715A1 (fr) * 2005-09-27 2007-04-05 Synecor, Llc Interventions et dispositifs chirurgicaux transgastriques

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012005819A1 (fr) * 2010-05-24 2012-01-12 Surgiquest, Incorporated Dispositifs pour chirurgie automatisée

Also Published As

Publication number Publication date
EP2187831A1 (fr) 2010-05-26

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