WO2012053993A1 - Procédé d'augmentation du champ visuel en chirurgie mini-invasive - Google Patents

Procédé d'augmentation du champ visuel en chirurgie mini-invasive Download PDF

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Publication number
WO2012053993A1
WO2012053993A1 PCT/TH2010/000039 TH2010000039W WO2012053993A1 WO 2012053993 A1 WO2012053993 A1 WO 2012053993A1 TH 2010000039 W TH2010000039 W TH 2010000039W WO 2012053993 A1 WO2012053993 A1 WO 2012053993A1
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WO
WIPO (PCT)
Prior art keywords
visual field
minimally invasive
enhancing
enhancer
invasive surgery
Prior art date
Application number
PCT/TH2010/000039
Other languages
English (en)
Inventor
Sunton Wongsiri
Original Assignee
Sunton Wongsiri
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 Sunton Wongsiri filed Critical Sunton Wongsiri
Priority to PCT/TH2010/000039 priority Critical patent/WO2012053993A1/fr
Publication of WO2012053993A1 publication Critical patent/WO2012053993A1/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
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/320036—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes adapted for use within the carpal tunnel
    • 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
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00008—Vein tendon strippers
    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0817—Spatulas or spatula like extensions
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

  • Minimally invasive surgery is a surgical technique which aims to minimize extensive exposure wounds.
  • the main limitation of minimally invasive surgery is adequate visualization of the surgical field, which is a major problem in some surgical areas.
  • Surgical visual field enhancing can help to reduce this problem.
  • This invention describes the method of enhancing the visual field in minimally invasive surgery using a surgical visual field enhancer which was devised specifically to reduce the problems encountered in some types of minimally invasive orthopedic surgery.
  • the method consists of at least three steps including tool insertion, creating an enhanced visualization of the operative field and the viewing which may optionally be followed by performing an operation.
  • the method of enhancing the visual field in minimally invasive surgery according to this invention can improve the minimally invasive surgical techniques and reduce the problems in orthopedic surgery.
  • DQV De Quervain's tendonitis
  • DQV De Quervain's tendonitis
  • the surgical release of the fascia covering the tendon is required in some cases that do not respond to conservative treatment.
  • surgical release involves a long incision to provide adequate vision for the surgeon to avoid causing injury to the superficial radial nerve.
  • a shorter incision is good to minimize wound complications. Therefore, the surgical field vision enhancer can provide adequate vision of this restricted area and allow the minimal incision whilst also minimize the danger of radial nerve injury.
  • CTS carpal tunnel syndrome
  • TCL transverse carpal ligament
  • This invention is a tool aimed to improve visualization of operative fields which can be used with minimally invasive techniques in numerous orthopedic problems including De Quervain tendonitis (DQV), carpal tunnel syndrome (CTS), trigger fingers, compartment syndrome, plantar fasciitis, tennis elbow and cubital tunnel syndrome.
  • DQV De Quervain tendonitis
  • CTS carpal tunnel syndrome
  • trigger fingers compartment syndrome
  • plantar fasciitis tennis elbow and cubital tunnel syndrome
  • This invention is related to method to enhance operative field visualization in minimally invasive surgery by using the tool specifically designed for this task.
  • the method according to this invention can be applied to many minimally invasive surgeries, including De Quervain's tendonitis (DQV), carpal tunnel syndrome (CTS), trigger fingers, compartment syndrome, plantar fasciitis, tennis elbow and cubital tunnel syndrome.
  • DQV De Quervain's tendonitis
  • CTS carpal tunnel syndrome
  • trigger fingers compartment syndrome
  • plantar fasciitis tennis elbow and cubital tunnel syndrome.
  • FIG. 1 A perspective view of surgical visual field enhancer 11 which user can see through a enhanced visual field 131.
  • the surgical visual field enhancer 11 are composed of tunnel opening end 12, handle 111, visual enhancer end 13.
  • FIG. 2A The tunnel opening tip 121, which is inserted in the soft tissues 90 above fascia 91 to open the tract from tool insertion. The insertion is halted and controlled at the optimal distance as selected by the surgeon using the tunnel opening guard 122.
  • FIG. 2B A freer elevator 501, which is inserted in the soft tissues 90 above fascia 91 to open the tract from tool insertion.
  • FIG. 2C A tissue dissector 502, which is inserted in the soft tissues 90 above fascia 91 to open the tract from tool insertion.
  • FIG. 3 The visual enhancer end 13 and the visual enhancer tip 132 which is inserted into the soft tissues 90, providing the surgeon a view of the enhanced visual field 131.
  • FIG. 4A A perspective view of the surgical visual field enhancer 11, with the lighting tool 20, composed of a lighting box 204, a power source 201, an electric wire 202 and a lighting source 203 for lighting in the enhanced visual field 131.
  • FIG. 4B A perspective view of the visual enhancer end 13, with headlight 21, for lighting in the enhanced visual field 131.
  • FIG. 4C A perspective view of the visual enhancer end 13, with fiber optic 22, for lighting in the enhanced visual field 131.
  • FIG. 5A A perspective view of endoscope 41 insertion through the enhanced visual field 131.
  • Monitor 46 shows the picture from endoscope 41.
  • FIG. 5B A perspective view of camera 45 insertion through the enhanced visual field 131.
  • Monitor 46 shows the picture from camera 45.
  • FIG. 6 A perspective view of insertion of scissors 42 through the enhanced visual field 131.
  • FIG. 7 A perspective view of insertion of a scalpel 43 inserted through.
  • FIG. 8 A perspective view of insertion of a fascia cutting knife 44 inserted through enhanced visual field 131.
  • FIG. 9 A perspective view of insertion of a visual enhancer end 13 through the skin incision to see the fascia in a case of De Quervain's (DQV) tenosynovitis 911.
  • DQV De Quervain's
  • FIG. 10 A perspective view of insertion of a visual enhancer end 13 through a skin incision to see the fascia in a case of trigger finger tenosynovitis 912.
  • FIG. 11 A perspective view of visual enhancer end 13 insertion through skin incision to see fascia in a case of compartment syndrome 913.
  • FIG. 12 A perspective view of visual enhancer end 13 insertion through skin incision to see fascia in a case of plantar fasciitis disease 914.
  • FIG. 13 A perspective view of visual enhancer end 13 insertion through skin incision to see fascia in a case of tennis elbow 915.
  • FIG. 14 A perspective view of visual enhancer end 13 insertion through skin incision to see fascia covering ulnar nerve 918.
  • FIG. 15 A cross section view of a wrist, showing insertion of a visual enhancer end 13 beneath a palmar aponeurosis 916 and above the transverse carpal ligament (TCL) 917.
  • TCL transverse carpal ligament
  • FIG. 16 A perspective view of insertion of a visual enhancer end 13 through a distal skin incision to see the fascia of a case of compartment syndrome from the distal side.
  • FIG. 17 A perspective view of insertion of a visual enhancer end 13 through a proximal skin incision to see the fascia of a case of compartment syndrome from the proximal side.
  • the method according to this invention employs a surgical visual field enhancer 11 in order to improve the surgical visual field during certain delicate operations, causing a minimally surgical wound, soft tissue dissection and surrounding soft tissue damage.
  • the method of enhancing the visual field in minimally invasive surgery consists of at least three steps. Firstly, tool insertion through the soft tissue in the area of the desired surgery which begins with insertion at least one of a starter-tool such as, but not limited to, the tunnel opening end 12, or scissors 42, freer elevator, tissue dissector or any tool alike. This step allows the enhanced visual field 131 to be formed.
  • the enhanced visual field 131 is, therefore, the interested area of surgical field which is created by starter-tool as shown in FIG. 2.
  • the optimum length of the said the enhanced visual field 131 is established through setting the tunnel opening guard 122 as shown in FIG. 2. Then, the user inserts the visual enhancer end 13 in the said tooling tunnel as shown in FIG.
  • additional tools such as a tool selected from the group of light source or light emitting tools or a group of imaging capturing equipments can be used optionally to further improve visualization.
  • the examples of light source or light emitting tools are the lighting tool 20 (as shown in FIG.4), headlight, illuminator or optic fiber.
  • the examples of imaging capturing equipment are the endoscope 41 (as shown in FIG.5); camera, videoscope, borescope or any tool alike.
  • the above mentioned equipments are not meant to imply the limitation of equipment selection.
  • operative procedures through enhanced visual field 131 with any of the special surgical tools i.e. surgical scissors 42 (as shown in FIG.6), scalpel 43 (as shown in FIG.7) or fascia cutting knife 44 (as shown in FIG.8).
  • surgical scissors 42 as shown in FIG.6
  • scalpel 43 as shown in FIG.7
  • fascia cutting knife 44 as shown in FIG.8
  • These tools can be additionally employed as required, i.e. for additional lighting, cutting, releasing, suturing, removing targeted structure.
  • the operative procedure includes but not limited to cutting, releasing, suturing, or removing targeted structure.
  • the targeted structure can be any part of the body but not limited to soft tissues, ligament, tendon, fascia and bones.
  • De Quervain's tendonitis is a tenosynovitis which causes pain and tenderness at the base of the thumb around the wrist joint area. Inflamed tendons and swollen synovium cause tightening of the tunnel.
  • the standard surgical release involves opening the roof of the tunnel, and the standard decompressing operations leave a large wound and painful scar.
  • minimally invasive surgery has become popular as an alternative technique where possible because of minimally wound size and soft tissue dissection.
  • adequate visualization of the surgical field has been a problem with minimally invasive techniques, and new tools are required to improve the visual surgical field to provide an adequate level of patient safety in minimally invasive surgery.
  • the surgeon can insert the tunnel opening end 12 and see the operative field clearly through the enhanced visual field 131.
  • This enables the performance of surgical decompression with a minimally incision as shown in FIG.9.
  • Other common applications in which the visual field enhancer can readily be applied include the trigger release procedure as shown in FIG.10, decompression of fasciotomy in compartment syndrome as shown in FIG.11, a plantar fascia release procedure as shown in FIG.12, operations for epicondylitis as shown in FIG.13, ulnar nerve decompression procedures as shown in FIG.14, and carpal tunnel
  • the operation can use either a distal approach as shown in FIG.16 or a proximal approach as shown in FIG.17.
  • the tunnel opening end 12 was inserted beneath a palmar aponeurosis 916 and above the transverse carpal ligament (TCL) 917 as shown in FIG.15.
  • the visual enhancer tip 132 is inserted following the tooling tunnel, at which time the surgeon can see the transverse carpal ligament (TCL) 917 and perform a transverse carpal ligament (TCL) release through the enhanced visual field 131.

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

Abstract

La présente invention concerne un procédé pour augmenter la visualisation de champ opératoire en chirurgie mini-invasive en utilisant l'outil spécifiquement conçu pour cette tâche. Le procédé selon cette invention peut être appliqué à de nombreuses chirurgies mini-invasives, comprenant la tendinite de De Quervain (DQV), le syndrome du canal carpien (CTS), les doigts à ressort, le syndrome des loges, l'aponévrosite plantaire, l'épicondylite latérale et le syndrome canalaire du nerf cubital.
PCT/TH2010/000039 2010-10-20 2010-10-20 Procédé d'augmentation du champ visuel en chirurgie mini-invasive WO2012053993A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/TH2010/000039 WO2012053993A1 (fr) 2010-10-20 2010-10-20 Procédé d'augmentation du champ visuel en chirurgie mini-invasive

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/TH2010/000039 WO2012053993A1 (fr) 2010-10-20 2010-10-20 Procédé d'augmentation du champ visuel en chirurgie mini-invasive

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WO2012053993A1 true WO2012053993A1 (fr) 2012-04-26

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109996500A (zh) * 2016-10-31 2019-07-09 高雄医学大学 一种手术用导件
CN112895260A (zh) * 2020-12-11 2021-06-04 北京信息科技大学 一种用于微创外科手术单节软体操作器制作模具

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5431153A (en) * 1993-06-11 1995-07-11 Lee; Hans Surgical apparatus for assisting in the release of the carpal tunnel
US6468206B1 (en) * 1998-05-01 2002-10-22 Genzyme Corporation Illuminated surgical retractor
US20020156348A1 (en) * 1998-06-19 2002-10-24 Joachim Schoellhorn Medical instrument and method for endoscopic removal of the saphenous vein
US20080200758A1 (en) * 2007-02-09 2008-08-21 Skeletal Dynamics, Inc. Endo-surgical Device and Method

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5431153A (en) * 1993-06-11 1995-07-11 Lee; Hans Surgical apparatus for assisting in the release of the carpal tunnel
US6468206B1 (en) * 1998-05-01 2002-10-22 Genzyme Corporation Illuminated surgical retractor
US20020156348A1 (en) * 1998-06-19 2002-10-24 Joachim Schoellhorn Medical instrument and method for endoscopic removal of the saphenous vein
US20080200758A1 (en) * 2007-02-09 2008-08-21 Skeletal Dynamics, Inc. Endo-surgical Device and Method

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109996500A (zh) * 2016-10-31 2019-07-09 高雄医学大学 一种手术用导件
CN112895260A (zh) * 2020-12-11 2021-06-04 北京信息科技大学 一种用于微创外科手术单节软体操作器制作模具

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