WO2013160742A1

WO2013160742A1 - Device for closing working incisions in endoscopic surgery

Info

Publication number: WO2013160742A1
Application number: PCT/IB2013/000748
Authority: WO
Inventors: David LASKY-MARCOVICH
Original assignee: Internacional Farmacéutica, S.A. De C.V.
Priority date: 2012-04-24
Filing date: 2013-04-19
Publication date: 2013-10-31

Abstract

The invention relates to a device for closing working incisions in endoscopic surgery, of the type that comprises: a totally hollow female element that is open at one end; and a male element that can be coupled to, and can slide in a reciprocating manner inside, the female element. The male element is formed by at least two detachable portions, namely a first upper portion and a second lower portion, and said upper and lower portions can be coupled to one another, such that one of said portions is fitted inside the other.

Description

"DEVICE FOR CLOSURE OF WORK PORTS

IN ENDOSCOPIC SURGERIES "

FIELD OF THE INVENTION

The present invention is related to the techniques employed in the design and manufacture of surgical instruments, and more particularly it is related to a device for closing work ports in endoscopic surgeries.

BACKGROUND OF THE INVENTION

• Even when endoscopic or laparoscopic surgery is not something new in the history of medicine, if it has been perfected such that it allows complex surgeries with the lowest risk and minimal aggressiveness and invasion for the patient, allowing a better and faster recovery , since large incisions are avoided, but above all, injuries to organs and muscles of the body are avoided.

Endoscopy is defined as the direct observation of an organ or cavity by an optical or endoscopic system, where the latter refers to a tube connected to a video camera and television monitor, which is introduced through natural holes, or, through the abdominal wall.

Endoscopic surgery is a consequence of the long-sought need, as already mentioned, by surgeons to minimize surgical trauma but without reducing the quality of abdominal exploration. In all patients who undergo surgery, it has always been a concern of surgeons to reduce aggressiveness in the treatment of surgeries.

With endoscopic surgery this objective has been achieved, having a panoramic view of the entire abdominal cavity that can be accessed through the use of an optician. Endoscopic surgery is done through small wounds or incisions. known as "ports" and with the help of a video camera that allows the medical team to see with precision the affected area and its contour, in addition to using the instruments required for this purpose.

To perform endoscopic surgery, it is necessary to practice said wounds known as ports in the patient's body, through which instruments commonly known in surgery such as trocars are introduced, which allow work material to be introduced to the patient's body to carry out said Endoscopic surgery procedures.

The specialist surgeons who perform endoscopic procedures in the abdominal cavity and in the retroperitoneum, immediately after finishing the endoscopic surgery proceed to close the mentioned ports using the traditional technique used in open surgery, being in many cases an imperfect closure, in addition to that said surgeons spend more time and make a greater effort to carry out said closure with said traditional techniques.

In order to close the aforementioned ports at the end of an endoscopic surgery, there are several devices for this purpose, such as the "Gore Suture Pin", which consists of a device that resembles a syringe, which when pushing the plunger causes the tip to separate into two parts that imprison the suture material of the ports, however, said device has the great disadvantage that the needle used is too thick and always exposed, since it does not have protective elements for it, representing a very large risk of causing injuries to the underlying viscera at the time of closing the ports, in addition to requiring an additional instrument that allows you to manipulate the suture material.

Also, there is the device known as "Endo-closure" that is quite useful for closing ports, consisting of a needle-shaped device elongated that includes a hole in the tip to receive the suture material. However, like the device described above, it has the disadvantage that it uses a thick needle that is always exposed or unprotected, increasing the risk of causing damage to the underlying viscera with the same instrument, in addition to requiring of a first trocar for laparoscopic vision and of a second trocar to use endoscopic instruments that allow collecting the thread for the second capture thereof.

Other devices used to close ports after endoscopic surgery are the "Dr. Jorge Cueto Hook" and the "Dr. Paul Li Hook", practically the same with respect to each other and with the same technical application, and consist of a cylindrical-shaped handle that includes at one of its ends an elongated hook-shaped needle that has a hole in the tip to accept the suture material. Both devices are used at the end of endoscopic surgery, and like the devices described above, they have the great disadvantage that the needle is always exposed or unprotected.

Similarly, there is the "Inlet CloseSure Procedure" case, which consists of an elongated needle with a hole in the tip to receive the suture material. Despite being a widely used device for closing ports, it has disadvantages in its use, since it also uses a needle that is too thick and is always exposed, with the usual risk of damaging the underlying viscera, in addition to requiring a first trocar for laparoscopic vision and a second trocar to use endoscopic instruments that allow the thread to be collected for its second capture.

There is also the Berci suture instrument, which consists of a scissor-shaped handle and provided with an elongate element perpendicular to said handle, whose tips can be separated for the purpose of holding the suture thread. With this instrument is achieved the application of stitches with preservation of the pneumoperitoneum and with endoscopic visual control. However, it has the disadvantage of requiring a third port to insert another trocar for the passage of the endoscopic instrument that serves as a support to rescue the suture thread, in addition to the fact that it is again a thick needle and without any protection.

On the other hand, in the state of the art there is also the device for surgical suturing described in US Patent No. 5468251, which refers to an improved method and device for suturing incisions and penetrations through tissue in a cavity of the body. The device finds a particular use in laparoscopy and other types of minimally invasive procedures. Said device includes a handle and an inverted needle attached to the handle. Two ends of the length of a suture material are held at or near a sharp proximal tip over the needle. The device may include a movable protector that is slidable to alternatively cover or expose the sharp point of the needle. Said protector may include a blunt distal end and an inclined proximal surface to assist the surgeon in the orientation of the hook in and out of the body cavity. The device may be provided with a tactile and visual indicator on one side of said device to help the user skewer and remove the suture material in and out of a selected side of the hook.

Likewise, the device described in US Patent No. 5632752 is found, which refers to an improved method and device for suturing incisions and penetrations through tissue in a cavity of the human body. The device finds a particular use in laparoscopy and other types of minimally invasive procedures. Said device includes a handle and an inverted needle attached to the handle. Two ends of the length of a suture material are held at or near a sharp proximal tip over the needle. The device may include a movable protector that is slidable for alternatively cover or expose the sharp point of the needle. Said protector may include a blunt distal end and an inclined proximal surface to assist the surgeon in the orientation of the hook in and out of the body cavity. The device may be provided with a tactile and visual indicator on one side of said device to help the user skewer and remove the suture material in and out of a selected side of the hook. _/

As can be seen from the devices for closing ports in endoscopic surgery found in the prior art and described above, they all have the great disadvantage that when used to close ports after endoscopic surgery, they carry the inherent risk of accidentally causing lesions to the underlying viscera.

On the other hand, it is important to mention that at the time of inserting the working trocars for endoscopic surgery, injuries to vascular structures of the abdominal wall, more frequently epigastric vessels and intercostal vessels, can result accidentally resulting in bleeding, which can lead to bleeding. become so important that the extension of the wound is required for vascular control and, occasionally, in conversion to an open surgery procedure.

Another disadvantage of the devices for closing ports found in the state of the art is related to the fact that all of them are manufactured in metallic material that must be sterilized or disinfected to be reused, since otherwise there is a risk of infect the patient with some type of disease especially contagious, such as hepatitis, HIV virus, among others.

Sterilization or disinfection processes are carried out daily, not only in the laboratory, where they are essential to prevent contamination of media, crops, plates, etc., but also in other areas such as hospitals, where failures in these procedures increase patient morbidity.

It is critical to think about what would happen if materials such as catheters, needles, syringes and surgical material in general, used in daily medical maneuvers (blood draws, venous lines, lumbar punctures, surgeries, etc.) were used even with minimal levels of contamination .

It is assumed that even with sterilization the death of all microbial life forms, including bacteria and their highly resistant sporulated forms, fungi and their spores, and viruses, is always the risk that such sterilization has not been carried away from full form, and consequently, there is a risk of infecting the patient with a disease, especially contagious.

As a result of the above, it has been sought to eliminate the inconveniences that presently present surgical devices have for the closure of ports in endoscopic surgeries, developing a device for closing working ports in endoscopic surgeries, which, in addition to allowing the application of points for the closure of these ports in a practical and simple way, eliminate the risk of infection of the patient with some disease contagious disease.

OBJECTS OF THE INVENTION

Taking into account the defects of the prior art, it is an object of the present invention to provide a device for closing work ports in endoscopic surgeries, of extremely practical, simple and economical construction and, however, highly effective and safe for application. of stitches to close the wounds that must be performed in endoscopic surgeries, avoiding damage to underlying viscera during use.

Another object of the present invention is to provide a device for closing of work ports in endoscopic surgeries, which, thanks to its construction and design, allows the use of a needle for thin suture and that is always protected, thereby avoiding injury to underlying viscera and, occasionally, an injury to the surgeon user at the time of carrying out said port closure.

A further object of the present invention is to provide a device for closing work ports in endoscopic surgeries that can be manufactured in a reusable material, or in a disposable material.

It is yet another object of the present invention to provide a device for closing work ports in endoscopic surgeries, whose design and manufacture allows its male element to be formed by at least two portions, wherein said portions assemble with respect to the other .

It is still a further object of the present invention to provide a device for closing work ports in endoscopic surgeries that allows to exchange and discard at least one of the portions that make up the male element and prevent infections of the patient _. diseases, especially contagious.

A further object of the present invention is to provide a device for closing work ports in endoscopic surgeries, whose design and construction allows a better vision to the surgeon when said device is being used.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel aspects that are considered characteristic of the present invention will be established with particularity in the appended claims. However, the invention itself, both by its organization and by its method of operation, together with other objects and advantages thereof, will be better understood in the following detailed description of certain modalities, when read in relation to accompanying drawings, in which:

Figure 1 is a perspective view of a device for closing work ports in endoscopic surgeries, constructed in accordance with the principles of a particularly specific embodiment of the present invention, showing the device in a position such that the suture needle is exposed.

Figure 2 is a perspective view of the female element that is part of the device for closing work ports shown in Figure 1.

Figure 3 is a perspective view of the male element that is part of the device for closing work ports shown in Figure 1.

Figure 4 is a front view of the male element shown in Figure 3, where it is illustrated that the portions that make up said male element are partially assembled with respect to each other.

Fig. 5 is an exploded front view of the male element shown in Fig. 3.

Figures 6 is a front view of the upper portion that conforms to the male element shown in Figure 3.

Figure 7 is a front view of the lower portion or cartridge that conforms to the male element shown in Figure 3.

Figure 8 is a side view of the lower portion or cartridge shown in the o

figure 7.

Figure 9 is a perspective view of a device for closing work ports in endoscopic surgeries, constructed in accordance with the principles of a first additional embodiment of the present invention, showing the device in a position such that the suture needle is hidden or protected.

Figures 10 to 12 are schematic sectional views in which shows a sequence of the closure of a working port in an endoscopic procedure, using the device constructed in accordance with the principles of the specific embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

Referring in particular to the accompanying drawings, and more specifically to figure 1 thereof, there is shown a device 100 for closing work ports in endoscopic surgeries, constructed in accordance with a particularly preferred embodiment of the present invention. , which should be considered only as illustrative, but not limited thereto, and which comprises in general terms: a first component 10 or female element 10 that is completely hollow inside and is open at one of its ends, which includes a side window 11; and a second component 20 or male element that engages and slides with a reciprocating movement inside the first component 10, wherein said second component 20 fixedly includes at one of its ends a suture needle 21 having a hole 22 located at its opposite end to the end where said needle is fixed to the male element 20, and said hole 22 is pierced by the suture material. Said suture needle 21 is protected within the inner part of the female element 10 and is only exposed when it coincides with the side window 11 by sliding the male element 20, as shown in said figure 1.

With more particular reference now to figure 2 of the accompanying drawings, it shows the first component 10 or female element, which is formed by a cylindrical main body 12 and includes at its upper end a perimeter flange 13 preferably circularly extending horizontally outward and serves as a support for manipulating the device 100. Additionally, said body 12 is provided with a blunt tip 14 at its lower end that serves to prevent injury to the patient's organs when it is in use in surgery. Also, between said blunt tip 14 and the lower end of the side window 1 1 an inner protection chamber 15 is formed which serves to hide and protect the suture needle 12 of the male element 20.

- Making particular reference to figures 3 to 8, of the accompanying drawings, they show the second component 20 or male element, as well as the portions that comprise it, wherein said male element 20 is formed by at least two separable portions, of which the first is an upper portion 23 and the second is a lower portion 24 or cartridge, wherein said upper portions 23 and lower 24 are attachable with each other, such that preferably said lower portion 24 splices fit in said upper portion 23.

Referring now more particularly to Figure 6 of the accompanying drawings, the upper portion 23 of the male element 20 is shown therein, which has a solid body 25 preferably cylindrical and includes at its upper end a support support 26 preferably rhomboidal, wherein said upper portion 23 has a length such that it coincides with the upper edge of the window 1 1 of the female element 10 when the male element 20 is fully inserted in said female element 10.

Also, the upper portion 23 includes a diametral groove (not shown in the figures) located towards its lower end, which serves as a housing for a plastic package 27 commercially known as "o-ring". Said plastic packaging 27, in addition to serving to prevent the male element 20 from leaving the female element 10 on its own, provides a resistance that allows smooth sliding and control of the reciprocating movement of the male element 20 inside the female element 10 . Additionally, the upper portion 23 includes a hole (not shown in the figures) centrally located on the face of its lower end, which includes a plurality of helical projections or "female" type thread.

With more specific reference now to figures 7 and 8 of the accompanying drawings, the lower portion 24 or cartridge of the male element 20 is shown, which is made up of three sections, of which: a first section or section central 28 preferably of half-round shape with a length that extends approximately to the total length of said lower portion 23; a second section or upper section 29 preferably cylindrical in shape, whose diameter is preferably equal to the diameter of the upper portion 23 of the male element 20; and, a third section or lower section 30 preferably cylindrical in shape, whose diameter is equal to the diameter of the upper portion 23 of the male element 20, wherein said third section 30 includes centrally and fixedly attached to the suture needle 21 extending upwards keeping an alignment in parallel with the central section 28. Additionally, said lower portion 24 includes centrally located on the upper face of the second section 29 a shoulder 31 that extends upward and that includes a plurality of helical projections or type thread "male" 32 which coincides with the plurality of helical projections present at the lower end of the upper portion 23 to allow said upper portion 23 to be fixedly assembled with the lower portion 24 and to form the male element 20 of the device for closing work ports 100 of the present invention.

The lower portion 24 or cartridge has a blunt tip 33 at its lower end, such that said lower portion 24 can reach the bottom of the protection chamber 15 formed inside the female element 10.

The lower portion 24 or cartridge has the particular characteristic of being interchangeable and disposable, this in order to avoid possible contagion to the patient, I smiled all of contagious diseases that could cause him even to death.

With more specific reference now to Figure 9 of the accompanying drawings, there is shown a device for closing work ports 100 ', constructed in accordance with an additional embodiment of the present invention, wherein said device for closing ports 100 'has a curvature along its length with a radius of between 1 and 5 ^th, and more preferably within 3 ^or. Said device 00 'comprises a first component 10' or female element that is completely hollow inside and is open at one of its ends, which includes a side window 11 '; and a second component 20 'or male element that engages and slides with a reciprocating motion inside the first component 10', wherein said second component 20 'fixedly includes at one of its ends a suture needle 21' having a hole 22 'located at its end opposite the end where said needle is fixed to the male element 20', and said hole 22 'is pierced by the suture material. Said suture needle 21 'is protected within the inner part of the female element 10' and is only exposed when it coincides with the side window 11 'by sliding the male element 20', as shown in said figure 9.

It is important to note that the first step to perform a laparoscopic surgery is the induction of the pneumoperitoneum that allows to create a space in the abdomen, so that all surgical procedures can be performed in a safe way and with minimal risks for the patient, where said Pneumoperitoneum induction is through insufflation of the abdomen using a gas, and more particularly C0 ₂ . In this context, when the port is penetrated with the device for closing ports of the present invention, after having removed the trocar, it is sometimes necessary to give some inclination to the device for closing ports for prevent gas leakage, in addition to that this inclination allows the surgeon a better vision and thus can avoid injuring the subcutaneous cellular tissue and the patient's skin. With the curvature of the device 100 'it is not necessary to give that inclination.

In accordance with the above description, the characteristics of the device 100 of the present invention allow the needle 21 to be pushed into the inner protection chamber 15, pushing the male element 20 to the bottom of the female element 10, such that the to carry out the controlled upward movement of the male element 20 with the aid of the plastic gasket 27, the lower portion 24 of said male element 20 coincides with the plane of the window 1 thus leaving the water 21 exposed, as can be seen in the figure 1 of the accompanying drawings.

It is important to note that the external walls of the device for closing work ports 100 described in the specific modality of the present invention are completely smooth to allow said device for closing portslOO to enter and exit the port (s) without No restrictions Likewise, all the edges of the aforementioned device for closing ports 100 lack "live" edges and the lower ends of the elements that comprise it include blunt tips, as indicated when describing said elements, in such a way that any risk of damage that said device for closing work ports 100 could cause both the patient and the surgeon when it is being used in endoscopic surgery.

On the other hand, all the elements, which make up the device 100 of the present invention, except the suture needle 21, are manufactured in both metallic and non-metallic material, where the metallic material can be reusable by a sterilization process and the nonmetallic material being a plastic material that can be disposable once said device 100 has been used.

In the specific embodiment described in the present invention, the device for closing work ports 100 is reusable, with the exception of the lower portion 24 of the male element 20, wherein said lower portion 24 and the suture needle 21 are disposable. In view of the foregoing, said device 100, including the suture needle 21, is preferably manufactured in a metallic material, and more preferably in stainless steel material; while the lower portion 24 of the male element 20 is made of hypoallergenic plastic material.

On the other hand, in order to explain the way in which the device 100 of the present invention is used to close a working port in an endoscopic surgery, reference is now made to Figures 9 to 1 of the drawings that are they accompany, in which schematic views of the use of said device 100 are shown. Once the trocar has been removed and under endoscopic vision it is introduced inwards through the working port 34, keeping in this step the hidden suture needle in the protection chamber.15 of the female element 10, as can be seen in Figure 9 of the accompanying drawings.

Once the device for closing ports 100 is located within the working port 34, it is placed in such a way that the step formed in the window 1 1 of the female element 10 at its bottom is made to coincide with the edge of said work port 34 and the male element 20 moves upward, whereby the suture needle 21 pierces said work port 34 from inside the cavity involving all planes except the subcutaneous cellular tissue 35 and skin 36, such as seen in figure 10 of the accompanying drawings.

Subsequently, the suture thread 37 is passed through the distal hole 22 of the suture needle 21, as can be seen in Figure 1 1.

^" The next step is to move the male element 20 down, whereby the suture needle 21 is hidden in the protection chamber 15 and the suture thread 37 is taken into the port 34. Then, the device for closing of portsOO is rotated 180 ° and the step of the window 11 is tied again with the end of the port 34 to pull the male element 20 again, getting the needle of Suture 21 exit the protection chamber 15 and again pierce the anatomical planes, taking the suture thread 37 to the opposite edge of the port 34.

Subsequently, the suture thread 37 is released from the suture needle 21 and the male element 20 is pressed, bringing said suture needle 21 to the protection chamber 5. Immediately, the device 100 is removed from the port 34, leaving the thread of suture 37 in position to be knotted to close said port 37.

In accordance with the above, it can be seen that the device for closing work ports 100 in endoscopic surgeries of the present invention is distinguished by being of a highly practical, simple and economical design and construction, and yet the closure of ports are performed in a very safe and efficient way, since the suture needle inside the cavity is always hidden, avoiding the risk of puncturing the underlying viscera and at all times maintaining a direct endoscopic vision, not making necessary the use of another instrument to manipulate the suture inside the cavity. Additionally, the risk of infection by any type of contagious disease is reduced by disposing of the lower portion 24 of the male element 20 which is the one that includes the suture needle 21.

Even when a specific embodiment of the invention has been illustrated and described, it should be emphasized that numerous modifications to it are possible, such as the shape and structure of the device, the separable and disposable parts, among others. Therefore, the present invention should not be considered as restricted, except as required by the prior art and by the spirit of the appended claims.

Claims

NOVELTY OF THE INVENTION REIVINDICATIONS

1. A device for closing work ports in endoscopic surgeries of the type comprising a female element that is completely hollow inside and open at one end; and a male element that is attachable and slidable with a reciprocating movement inside said female element; said device for closing work ports being characterized in that said male element is formed by at least two separable portions, of which the first is an upper portion and the second is a lower portion or cartridge, wherein said upper and lower portions are attachable to each other, such that one of said portions fits spliced into the other.

2. A device for closing work ports in endoscopic surgeries according to claim 1, further characterized in that the upper portion has a solid cylindrical body and includes at its upper end a rhomboid-shaped support support, wherein said upper portion has a length such that it coincides with the upper edge of a window included in the female element when the male element is fully inserted in said female element.

3. A device for closing work ports in endoscopic surgeries according to claim 1, further characterized in that the upper portion includes a centrally located hole in the face of its lower end, which includes a plurality of helical projections or type thread "female".

4. A device for closing work ports in endoscopic surgeries according to claim 1, further characterized in that the lower portion or cartridge is formed by three sections, which are: a first section or central section preferably of half-round shape with a length that extends approximately to the total length of said lower portion; a second section or section upper cylindrical, whose diameter is preferably equal to the diameter of the upper portion of the male element; and, a third section or lower section of cylindrical shape, the diameter of which is equal to the diameter of the upper portion of the male element, wherein said third section centrally and fixedly includes the suture needle extending upwards keeping a parallel alignment with the central section; additionally, the lower end of said lower portion has a blunt tip, such that said lower portion can reach the bottom of a protection chamber formed inside the female element.

5. A device for closing work ports in endoscopic surgeries according to claim 4, further characterized in that the lower portion includes centrally located on the upper face of the second section a shoulder that extends upward and that includes a plurality of helical projections or "male" type thread that coincides with the plurality of helical projections present at the lower end of the upper portion to allow said upper portion to be fixedly assembled with the lower portion and to form the male element.

A device for closing work ports in endoscopic surgeries according to claim 1, further characterized in that the lower portion of the male element is interchangeable and disposable.

7. - A device for closing work ports in endoscopic surgeries according to claim 1, characterized in that the device has a curvature in its length with a radius ranging from 1 ^or up to 5 ^o .

8. - A device for closing work ports in endoscopic surgeries according to claim 7, further characterized in that the device has a curvature in its length with a radius of 3 ^o .