WO2017007442A1

WO2017007442A1 - A cutter

Info

Publication number: WO2017007442A1
Application number: PCT/TR2016/050218
Authority: WO
Inventors: Ali Dogan Bozdag; Erdal AKTAN; Eyup Murat YILMAZ; Cumhur ESIN; Aykut SOYDER; Cemal KARA
Original assignee: Gaziantep Universitesi Vakfi
Priority date: 2015-07-06
Filing date: 2016-07-01
Publication date: 2017-01-12

Abstract

The invention relates to a cutter improved for use in laparoscopic surgery, which shortens the duration of anesthesia of the patient by accelerating and facilitating the removal of the large body tissues outside the body and that eliminates the risk of tearing away of the bag during the operation and to the method of working of this cutter.

Description

DESCRIPTION

A CUTTER

Subject of the Invention

This invention relates to an instrument that is used in laparoscopic surgery operations and that makes it possible to cut and remove the mass which has to be taken out from the patient's body, and to how this instrument works.

State of the Art

Laparoscopy is the manner of application of endoscopic surgery that is applied in abdominal operations. As laparoscopic surgery is being used more and more especially in recent years and as experienced surgeons applying this technique have been trained, currently almost all operations can be made using this technique. The said operation is carried out under general anesthesia.

Laparoscopic surgery has advantages such that there is less post-operation pain and that healing is rapid.

Laparoscopic surgery is being used in many operations. One of these operations is laparoscopic splenectomy, where the patient is under general anesthesia. The abdomen is entered by laparoscope and the connection of the spleen of the patient is cut off. After laparoscopic splenectomy is completed, the spleen is placed inside a bag within the body. In order to take out the spleen in the bag from the trocar hole, the spleen has to be cut. In the current state of the art, grasper forceps or similar instruments are used to cut the spleen. After cutting the spleen with such instruments, an aspirator tip is inserted at the side of the instrument to remove the pieces out. The pieces thus cut off from the spleen are taken out with the aspirator or grasper forceps. After repeating this procedure many times, the spleen gets smaller and it becomes possible to take the spleen out of the trocar hole within the bag. It may take a long time to cut the spleen in pieces and to remove the pieces. During this time, the patient may be exposed to anesthesia excessively. In addition, it becomes necessary to insert the instruments into the bag and take them out many times and during this procedure the bag may tear away. When the bag is torn, the spleen pieces will fall into the abdomen. It becomes necessary to enlarge the hole on the abdominal wall to clean away the pieces fallen into the abdomen and take the spleen off. Thus, the operation is no longer a laparoscopic splenectomy and the patient cannot benefit the advantages of the laparoscopy.

Patent No. 2013/06211 can be given as an example of the state of the art inventions. This application discloses an apparatus that is used to remove stones or foreign objects out from the organs in the abdomen in many surgical operations, primarily laparoscopic cholecystectomy. It is stated that the device contains forceps, an oval shaped ring attached at the end of the forceps, a bag at the ring into which the stones are to be put and a cover that exactly fits to the other end of the forceps. When using the mentioned apparatus, it is not possible to remove the larger pieces out. Thus, it becomes necessary that the larger pieces are cut into smaller pieces and then are removed one by one. Since this procedure takes a long time, the patient remains under anesthesia for a long time. Additionally, there is the risk of tearing the bag away since the body is entered in many times. If the bag is torn, it becomes necessary that a large cut is established and the patient is operated. Thus, the patient cannot benefit the advantages of the laparoscopy operation.

In other examples, in patent applications No. WO 2009036875 Al and US 2002035372 A, cutting systems for cutting large tissues in the body into smaller pieces are disclosed. However, there is no system in these inventions to remove the small particles out of the body. Thus, it becomes necessary that the surgeon making the operation takes out the small particles one by one, as in the state of the art. This causes the patient remain under anesthesia for a long time.

Another example of the current technique is Patent No. US 5972012. Its object is establishing channels in the tissue during the operation and it contains a cutting apparatus with a cutting head designed for points difficult to access that makes this possible. This mentioned hand instrument is used together with a single-use cable. In the interior of the cable, there is a vacuum pump and the mechanism of the cutting head. The cutting head operates together with the vacuum pump to discharge the pieces cut during the operation. In the mentioned system, the tissues cut by the cutter head into smaller pieces are removed by vacuum. However, to be able to use this system the cutter must be connected to the engine. That the cutter head of the said instrument and the vacuum system have to be connected to each other causes the vacuum system to have a narrower structure. Thus, the vacuum system may get clogged during use.

Background of the Invention and Its Brief Description

Of the examples given above, document No. WO2009036875 was assessed as the closest to the present application. Document No. WO2009036875 relates to the use of the "morcellator" part used to take out large sized pieces. The mentioned instrument is in a cutter tube that can rotate using a motor. The cutter blade can lock at three positions on the same axis. In the invention of document No. US2002035372, a cutting unit to be used in cutting biological or human tissue in endoscopy operations is disclosed. The mechanism contains a cylindrical cutting tube through the central axis and a blade attached to the tip. Through an activating button in the system, the blade comes out of the tube and performs the cutting. The WO2009036875 and US2002035372 documents do not contain any solution for the discharge of the wastes in the site. In addition, the WO2009036875 and US2002035372 documents do not contain any structure providing irrigation at the site or matter transmission. However, in the system of the present application, there are integrated structures to perform these procedures. In virtue of these integrated structures, procedures will be possible through an independent system that can be attached later.

In document No. US5972012, there is a discharge system. However, the cutting apparatus and the discharge system in the present document are a single mechanism dependent on each other. The piece cut is discharged at the same time. Furthermore, the instrument has been developed not for laparoscopic surgery but for opening channels in tissues and organs. It has been developed to open channels on the heart to accelerate the blood flow to the heart and to open clogs in trans-myocardial re-vascularization (TMR) operations. Therefore, it is suitable for cutting and discharging smaller pieces. In addition, no structure which provides irrigation at the cutting site or matter transmission is disclosed in the document. However, in the invention of the present application, there is an integrated system that allow for performing these procedures using an independent instrument. Assessing documents No. WO2009036875, US2002035372 and US5972012 altogether, in all of them there is a motor to drive the blade and this system does not allow manual movement of the blades in case of any adversity or for situations requiring sensitivity. In the system of the present application, contrary to the above documents, it is possible to rotate the blade both manually and electrically.

In order to be able to overcome the above mentioned technical problems, a laparoscopy instrument that allows for the removal of large masses out of the body after the laparoscopy operation, that reduces large pieces at a single entry, and that performs aspiration and irrigation.

Detailed Description of the Invention

The invention of the present application is a cutter as can be seen in Figure- 1. The cutter contains a rod (1), the cutting means (2), connection head (3), handle (4), a main tubular body (5) with a large diameter, which is composed of a shaft (6), internal tube (7), external tube (8), cover (12) and a motion means.

In further detail, the present invention is a cutter used in laparoscopic surgery and it contains a main tubular body (5), a rod (1) in this tubular body (5) that extends from one end to the other and that goes out the tubular body (5), and at least one cutting means (2) which cuts and reduces tissues at the end of the said rod (1). In addition, this cutter contains a motion means attached to one end of the rod (1) to provide rotation motion to the cutting means (2) and a connection head (3) on the rod (1) for the connection of the said motion means. In addition, this cutter contains one or more internal tubes (7) for aspiration and/or irrigation of the tissues cut with the cutting means (2), which internal tubes (7) extend within the same tubular body (5) and opens out from one section of the tubular body (5) allow for discharge matter from and/or transmission of matter to the site.

According to a preferred embodiment of the present invention, there is a rod (1) and internal tubes (7) in the tubular body (5). The internal tubes (7), preferably two, are on both sides of the rod (1). The rod (1) and the internal tubes (7) are positioned so that they do not protrude out from the tubular body (5). At the part of the rod (1) which is at one end of the tubular body (5), there is the cutting means (2). In an embodiment of the invention, the cutting means (2) may be a fan-like structure that surrounds the rod (1) so that it has two or four blades like a multi-arm blender. The cutting means (2) has a structure that rotates around the axis of the rod (1). In other words, the cutting means (2) at one end of the rod (1) may be a blade system with an arm, preferably a multi-arm blade system, which has a center that is overlapping the rod's (1) axis and rotates around the axis of the rod (1) in circular motion. The embodiment example is shown in Figure-2. The rod (1) goes through a shaft (6) so that the cutting means (2) does not sway around. The shaft (6) is immediately behind the cutting means (2), and is rod (1 Reentered. Hence, the control of the cutting means (2) in the body is facilitated and crashing on the inner walls of the tubular body (5) and damaging the instrument is prevented.

The internal tubes (7) on both sides of the rod (1) help to discharge the tissues cut by the cutting means (2) out of the body. The rear ends of the mentioned internal tubes (7) are attached to the tubular body (5) and open outside, where the external tubes (8) start. The internal tube (7) and the external tube (8) are connected to each other without any interruption. Attaching a hose to the open end of the external tube (8), the aspiration and irrigation processes can be carried out.

More generally speaking, the mentioned cutter contains one or more external tubes (8) which establishes an entrance/exit channel protruding from the outlet end of each internal tube (7) and which allows for the connection of an external apparatus for aspiration and/or irrigation.

An embodiment of the invention contains integrated to the same tubular body (5) at least one internal tube (7) and external tube (8) for aspiration and a secondary internal tube (7) and a secondary external tube (8) for irrigation. In the said embodiment, the tubular body (5) is a tube of large diameter and the internal tubes (7) and external tubes (8) are tubes having a smaller diameter than the tubular body (5) within this structure.

The rod (1) may protrude for some length from one end of the tubular body (5). The end of the rod (1) that remains outside passes through the hole on the cover (12) and joins to the connection head (3). This cover (12) is demountable when desired, and allows demounting and cleaning the rod (1) and the cutting means (2). The cover (12) may be a screw cap. A motion means is connected to the connection head (3) that is outside the cover (12) to make the rotation motion. As can be seen in Figure-4, the motion means can be a handle (4) or an electrical apparatus such as a motor (11) if desired. In both cases, the rod (1) and hence, the cutting means (2) attached to the rod (1) performs the rotary motion around the axis of the rod (1). With this rotary motion, the cutting means (2) cuts the tissue into small pieces. When the handle (4) is connected to the connection head (3), the rotary motion is performed rotating the handle (4) manually. On the handle (4), there is a seat (10) to which the connection head (3) can be mounted for connecting the handle (4) to the connection head (3). When the handle (4) is rotated, the rotary motion is transmitted to the rod (1) and hence, to the cutting means (2), through the connection head (3). In the structure of the motor (11), there is a connection end (9) which allows for the transmission of the rotary motion to the rod (1) and hence, to the cutting means (2) by helping to connect the motor (11) to the connection head (3).

The operation method of the cutter that is the subject of the present application is as follows: The motion means is connected to the connection head (3) at one end of the rod

(1) . The rod (1), gaining rotary motion through the motion means, transmits the motion to the cutting means (2). With this rotary motion, the cutting means (2) cuts the tissue in front of it into small pieces. These small pieces are aspirated by a hose or another apparatus connected to the open end of the external tubes (8) and are discharged out of the body through the internal tubes (7). Subsequently, irrigation can be performed optionally through the external tubes (8) and the internal tubes (7). During all these procedures, the shaft (6) on the rod (1) prevents the swaying of the cutting means (2). Thus, cutter that is the subject of the present application can be used under control.

The operation method of a cutter, which allows cutting tissues especially in laparoscopic surgery and removing them outside the body and which contains in its structure a tubular body (5), internal tubes (7) and external tubes (8) integrated to this tubular body (5) and a cutting means (2), and the operation method of the cutter is characterized by connecting a motion means to a connection head (3) on a rod (1) that will rotate a cutting means (2) to give the said cutting means (2) a rotary motion; transmitting the rotary motion from the motion means to the rod (1) and hence, to the cutting means (2) through the connection head (3); with this transmitted rotary motion, cutting the tissue in front of the cutting means

(2) into small pieces by making a circular motion around the axis of the rod (1); discharging the small pieces cut out of the body by the help of an aspirating apparatus connected to the primary external tube (8), through a primary internal tube (7) extending within the tubular body (5); and optionally, transmitting matter (agent) to the site by the help of an irrigation apparatus connected to the a secondary external tube (8), through a secondary internal tube (7).

In summary, the present invention is a cutter for use in laparoscopic surgery, wherein the cutter contains a tubular body (5) constructing the main line of the cutter, internal tube (7) in this tubular body (5) for helping the aspiration and irrigation processes, a cutting means (2) at the end of the rod (1) for cutting and reducing the tissues, a shaft (6) that prevents swaying of the cutting means (2) during its motion, external tubes (8) that extend from the point where the internal tubes (7) open outside and that allow for mounting external apparatus for aspiration of the small tissues and for irrigation, a motion means to give rotary motion to the cutting means(2), and a connection head (3) for the connection of this means to the rod (1).

Figures

Figure 1: Upper view of the cutter.

Figure 2: Front view of the cutter.

Figure 3: Across view of the cutter.

Figure 4: Rear view of the cutter.

Figure 5: Front cross-section of the cutter.

Figure 6: Cross-section of the cutter. References

1. Rod

2. Cutting means

3. Connection head

4. Handle

5. Tubular body

6. Shaft

7. Internal tube

8. External tube 9. Connection end

10. Seat

11. Motor

12. Cover

Claims

1. A cutter for cutting tissues and removing the cut tissues outside the body, especially for use in laparoscopic surgery, characterized in comprising:

a main tubular body (5), a rod (1) extending along this tubular body (5) from one end to the other and opening outside at one end of the tubular body (5) and at least one cutting means (2) at one end of the said rod (1) for cutting the tissues into smaller pieces; a motion means connected to one end of the rod (1) for driving the cutting means (2) and a connection head (3) on the rod (1) for connection of the said motion means to the cutter; and

for the aspiration of cut tissues and/or irrigation; one or more internal tube(s) (7) which extend along the same tubular body (5), which has an end that opens outside from one section of the tubular body (5) and which allows discharge of matter from the site and/or transmission of matter to the site.

2. The cutter according to Claim 1, characterized by comprising; one or more external tube(s) (8) protruding out from the open end of each internal tube (7) to establish an entrance/exit channel, and which allows the connection of an external apparatus for aspiration and/or irrigation.

3. The cutter according to Claim 2, wherein it comprises at least one internal tube (7) and at least one external tube (8) for aspiration and a secondary internal tube (7) and a secondary external tube (8) for irrigation integrated within the same tubular body (5).

4. The cutter according to Claim 1 or 2, wherein it comprises a shaft (6) through which the rod (1) passes and which prevents the swaying of the cutting means (2) during its motion.

5. The cutter according to Claim 1 or 2, wherein the cutting means (2) is a blade system comprising one or several arms whose centers are overlapping the axis of the rod (1) and rotate around the axis of the rod (1) in circular motion.

6. The cutter according to Claim 1 or 2, wherein the rod (1) comprises at least one part which is protruding out at one end of the tubular body (5) and the connection head (3) that is at this protruding end of the rod (1).

7. The cutter according to Claim 1 or 2, wherein the motion means comprises;

a handle (4) that allows rotating the rod (1) manually or

a motor (11) that automatically transmits the rotary motion to the rod (1), which is connected to the connection head (3).

8. The cutter according to Claim 7, wherein the handle (4) in comprises a seat (10) for placing the connection head (3) at the end of the rod (1).

9. The cutter according to Claim 8, wherein the motor (11) comprises a connection end (9) for the connection of the motor (11) to the connection head (3) and the transmittance of the rotary motion of the motor (11).

10. The cutter according to Claim 1 or 2, wherein it comprises a cover (12) passing through the hole on the rod (1) for connecting the connection part, such that the cover (12) is demountable for demounting and cleaning the rod (1) and the cutting means (2).

11. The cutter according to Claim 10 wherein the cover (12) is a screw cap.

12. A working method of a cutter for cutting tissues especially in laparoscopic surgery and removing them outside the body, and which contains a tubular body (5), internal tubes (7) and external tubes (8) integrated to this tubular body (5) and a cutting means (2), characterized by;

connecting a motion means to a connection head (3) on a rod (1) for rotating the cutting means (2) to give the said cutting means (2) a rotary motion; transmitting the rotary motion from the motion means to the rod (1) and hence, to the cutting means (2) through the connection head (3); cutting the tissue in front of the cutting means (2) into smaller pieces by making a circular motion around the axis of the rod (1); discharging the cut pieces out of the body with an aspirating apparatus connected to the primary external tube (8), through a primary internal tube (7) extending within the tubular body (5); and

optionally transmitting an agent/matter to the site with an irrigation apparatus connected to a secondary external tube (8), through a secondary internal tube

(7).