WO2018127933A2 - Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles - Google Patents

Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles Download PDF

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WO2018127933A2
WO2018127933A2 PCT/IN2017/050628 IN2017050628W WO2018127933A2 WO 2018127933 A2 WO2018127933 A2 WO 2018127933A2 IN 2017050628 W IN2017050628 W IN 2017050628W WO 2018127933 A2 WO2018127933 A2 WO 2018127933A2
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trans
surgery
isn
length
ports
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PCT/IN2017/050628
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WO2018127933A3 (fr
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Sanjiv P HARIBHAKTI
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Haribhakti Sanjiv P
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    • 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
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • 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
    • 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
    • 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
    • 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
    • A61B2017/345—Cannulas for introduction into a natural body opening
    • A61B2017/3452—Cannulas for introduction into a natural body opening for the rectum, e.g. for hemorrhoid surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B2017/3454—Details of tips
    • A61B2017/3456—Details of tips blunt
    • 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
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A61B2017/3466—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals for simultaneous sealing of multiple instruments
    • 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

  • the present invention relates to Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery. It is a divisional patent application to the invention disclosed in the provisional patent application number 201721000186 filed on 3 day of January 2017, providing interchangeable equipments and surgical methods versatile for all types of Gastro-intestinal surgeries including single incision laparoscopic surgery (SILS) and natural orifice trans-luminal surgery (NOTES) platform for trans-umbilical, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans-rectal and trans-gastric access routes.
  • SIMS single incision laparoscopic surgery
  • NOTES natural orifice trans-luminal surgery
  • the Gastrointestinal system is a very important system of the body consisting of many different digestive organs and its various diseases.
  • the several organs involved in digestion start from esophagus, stomach, small intestines, large intestines, rectum and anal canal.
  • the accessory organs involved in digestion are liver, gallbladder, bile ducts and the pancreas.
  • Spleen is a hemopoetic organ in the abdomen.
  • abdominal diseases also involve the surgery for abdominal wall hernias and bariatric or weight loss surgery.
  • Various common diseases of the abdomen which need surgery are Gallstones for which laparoscopic cholecystectomy which is the standard of care today. Appendicitis is another common problem which needs laparoscopic appendectomy.
  • Hernias can be of several types, including inguinal hernias which are the most common. Other varieties are incisional or ventral hernias, femoral, diaphragmatic, parastomal, obturator and spigelian hernias. Majority of these hernias are treated with laparoscopic surgery.
  • UMI upper gastrointestinal
  • HPB hepato-pancreatic-biliary
  • the upper gastrointestinal surgery involves surgery of the esophagus, stomach and the duodenum.
  • Various common operations done are laparoscopic fundoplication for hiatus hernia and GERD, laparoscopic cardiomyotomy for achalasia cardia, thoraco-laparoscopic esophagectomy for cancer of the esophagus and others.
  • the bariatric surgery also involves surgery of the upper gastrointestinal tract but is considered as a separate specialty.
  • Common operations are laparoscopic gastric sleeve, laparoscopic gastric bypass and laparoscopic minigastric bypass for morbid obesity.
  • the Colorectal surgery involves surgery of the colon, rectum and the anal canal.
  • Common operations include laparoscopic hemicolectomies for cancer of the colon, lap. Sigmoid colectomy for diverticulitis, lap. partial or total colectomies for inflammatory bowel disease, laparoscopic rectopexy for rectal prolapse, laparoscopic rectal resection and TME for cancer of rectum.
  • the HPB surgery involves surgery of the liver, pancreas and biliary tract.
  • Common operations include laparoscopic Cholecystectomy for gallstones, laparoscopic CBD exploration for CBD stones, laparoscopic Hydatid cystectomy, laparoscopic Liver resection for liver cancers, necrosectomy for pancreatic necrosis, laparoscopic Cystogastrostomy and laparoscopic Cystojejunostomy for pancreatic pseudocyst, pancreatico-jejunostomy for chronic pancreatitis and Pancreaticoduodenectomy for pancreatic head and periampullary cancers.
  • VARD video assisted retroperitoneal debridement
  • Hybrid SILS was developed, which involved a combination of SILS with multiport laparoscopic surgery. This involves using 2-3 instruments from a single port from the umbilicus in combination with additional 1 -2 instruments from laparoscopic incisions away from the umbilicus.
  • the additional incision utilizes a surgeons active working hand. This approach improves the ergonomics for the surgeon and reduces the instrument clashing, improving the conduct of the operation.
  • the additional incision could be the drain site in advanced surgeries, the stoma site in colorectal surgery or the feeding jejunostomy site in upper gastrointestinal surgery.
  • Single incision Laparoscopic Surgery (SILS) Ports have been developed by several companies. They include X Cone by Karl Storz, SILS Port by Medtronic, Gelport Access, Triport and the quadport by Olympus etc. Many of these are flexible and some of them are rigid ports. They have the main disadvantage that they are made in one specific dimension, and thus do not fit for all surgeries of the GI tract where the requirement of incision and number of ports, length and diameter of the port is variable. They also fail to facilitate natural orifice trans-luminal surgery (NOTES). Thus they do not cater to the wide variety of requirements based on different GI surgical procedures and patient built.
  • NOTES natural orifice trans-luminal surgery
  • Principal object of the present invention is to provide universal and Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery for different SILS and NOTES access which includes umbilical access, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans-gastric and trans-rectal access.
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery is to provide a versatile and an adaptable platform for SILS and NOTES operations from access routes which includes trans-umbilical access, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans-gastric and trans-rectal access.
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery is to provide a rigid platform for performing various natural orifice trans-luminal surgeries (NOTES) from access routes which includes umbilical access, trans-anal, trans- oral, retroperitoneal, trans-vaginal, trans-gastric and trans-rectal access.
  • NOTES natural orifice trans-luminal surgeries
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery is to provide reusable and autoclavable platform for various SILS and NOTES operations from access routes which includes umbilical access, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans- gastric and trans-rectal access.
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery is to provide a trans-anal port(TAP) for performing trans-anal surgery from natural orifice for surgery of the rectum including cancer of the rectum.
  • TAP trans-anal port
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery is to is to provide a special retroperitoneal access port(VARD Port) for debridement of pancreatic necrosis in video assisted retroperitoneal debridement(VARD)
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery is to provide a trans-vaginal port(TVP) for performing intra-abdominal gastrointestinal surgery.
  • TVP trans-vaginal port
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery is to provide a trans-gastric (TGP) and trans-rectal access ports (TRP) for performing NOTES GI Surgery.
  • Yet another object of the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery is to provide specific instruments for use in SILS and NOTES Surgery for several applications,
  • Fig.1E4 Shows top view of silicon washer of Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans luminal surgery for 40mm diameter.
  • Fig.1E5 Shows top view of silicon washer of Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans luminal surgery for 60mm diameter. Shows assembly of Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans luminal surgery for 20mm diameter and 30cm length.
  • VARD gastro-intestinal video assisted retroperitoneal debridement
  • NOTEs Shows Interchangeable equipment and method for gastro-intestinal Trans-oral trans gastric Natural orifice trans luminal endoscopic surgery (NOTES).
  • NOTES Natural orifice trans luminal endoscopic surgery
  • ISN 40 Interchangeable equipment for Single Incision Laparoscopic Surgery and natural orifice transluminal surgery with 40mm diameter.
  • the present invention provides interchangeable equipments and surgical methods versatile for all types of Gastro -intestinal surgeries including single incision laparoscopic surgery(SILS) and natural orifice trans-luminal surgery (NOTES) further provides access routes for trans-umbilical, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans-rectal and trans gastric access routes; termed as trans-umbilical ports, trans-anal ports, trans-oral ports, retroperitoneal ports, transvaginal ports, trans-rectal ports and trans-gastric ports.
  • the present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery(P) mainly comprises of:
  • suction port SP for suction of smoke while using the electrocautery during the surgical procedures.
  • Fig.1A to Fig. IF shows the component parts and assembly of various component parts into ports as present Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P).
  • Fig.1A1 shows Interchangeable equipment for gastro- intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 20mm diameter and 5cm length
  • Fig. lA2 shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans luminal surgery (P) with 20mm diameter and 10cm length.
  • Said equipments (P) are used for abdomen umbilical SILS as shown in Fig.3 A.
  • Fig. lAla to lAld The component parts of said equipments are shown in Fig. lAla to lAld and Fig. lA2a to lA2d respectively wherein Fig. lAla, lAlc. lA2a, lA2c shows the markings on the sheath specifying the lengths of the sheaths (SH 20.5, SH 20.10).
  • Said sheaths has air ports (AP) and suction ports (SP) as shown in Fig. lAlb and lA2b.
  • the blunt introducer (BI) is as shown in Fig.
  • lAld and lA2d which is used to facilitate insertion of sheath (SH) into human body for surgery wherein Said Sheath (SH) is inserted under vision with a blunt introducer (BI) inserted into the sheath (SH) .
  • BI blunt introducer
  • TE 5 mm 0 degree telescope
  • Said sheath (SH) is fitted on the diaphragm and can be changed during surgery depending on the instrument to be used.
  • Said Silicon Washer (SW) is fitted on the diaphragm to enable passage of instruments through its openings for facilitating surgery.
  • Said silicon washers (SW) are selected from:
  • Said component parts assembled to form present equipments named as ISN20.5 and ISN 20.10 as shown in Fig. 1A1 and 1A2.
  • Saidports are mainly used for trans-umbilical single incision laparoscopic surgery for gastrointestinal operations through a 2 cm periumbilical incision which is hidden in the umbilicus and thus practically produces a scar less surgery.
  • sheaths with diameter 20mm having length 30cm and 45 cm are disclosed and described in detail in the complete specification for application number201721000186 disclosing "Novel Equipments And Methods For Trans-oral Endoscopic Surgery Of Upper Gastrointestinal Tract Using Rigid Platform" filed on 2 day of March 2017.
  • IB shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 40mm diameter.
  • Fig. 1B 1 , Fig. lB2 shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans luminal surgery (P) with 40mm diameter and 5cm length, 40mm diameter and 10cm length.
  • Said equipments (P) are used for abdomen SILS as shown in Fig.3A, Trans-anal surgery as shown in Fig.3B, VARD as shown in Fig.3C.
  • the component parts of said equipments are shown in Fig. IB la to lB lc and Fig. lB2a to lB2c respectively wherein Fig.
  • lB la, lB lb. lB2a, lB2b shows the markings on the sheath specifying the lengths of the sheaths (SH 40.5, SH 40.10).
  • Said sheaths has air ports (AP) and suction ports (SP) as shown in Fig. lB lb and lB2b.
  • the blunt introducer (BI) is as shown in Fig. lB lc and lB2c which is used to facilitate insertion of sheath (SH) into human body for surgery wherein Said Sheath (SH) is inserted under vision with a blunt introducer (BI) inserted into the sheath (SH) .
  • Said sheath (SH) is fitted on the diaphragm and can be changed during surgery depending on the instrument to be used.
  • Said Silicon Washer (SW) is fitted on the diaphragm to enable passage of instruments through its openings for facilitating surgery.
  • Said silicon washer (SW) is of 40mm with a 10mm and three 5mm openings. (SW404) .
  • FiglB3 and Fig. 1B4 shows Interchangeable equipment for gastrointestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 40mm diameter and 15cm length, 40mm diameter and 25cm length respectively. Said component parts are used for trans-anal surgery as shown in Fig.3B and trans-vaginal NOTES surgery as shown in Fig.3D. The component parts of said equipments are shown in Fig. lB3a to lB4c, wherein said Fig. lB3a, lB3b, lB4a. lB4b shows the markings on the sheath specifying the lengths of the sheaths (SH 40. 15, SH 40.25) .
  • the blunt introducer (BI) is as shown in Fig. lB3c and lB4c is used to facilitate insertion of sheath (SH) into human body for surgery.
  • Said sheath (SH) is fitted on the diaphragm and can be changed during surgery depending on the instrument to be used.
  • Said Silicon Washer (SW) is fitted on the diaphragm to enable passage of instruments through its openings for facilitating surgery.
  • Fig. lC shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 60mm diameter
  • Fig. lCl shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 60mm diameter and 5cm length
  • Fig. 1C2 shows Interchangeable equipment for gastrointestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 60mm diameter and 10cm length.
  • Fig. lC shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 60mm diameter and 10cm length.
  • Fig. lCla, Fig. lClb, Fig. l C2a, Fig. lC2b shows the markings on the sheath specifying the lengths of the sheaths (SH 60.5, SH 60. 10) .
  • Said component parts of equipment (P) is used for single incision laparoscopic surgery from the trans-umbilical access as shown in Fig.3A and Fig.3E.
  • the blunt introducer (BI) is as shown in Fig. l Clc and lC2c which is used to facilitate insertion of sheath (SH) into human body for surgery wherein Said Sheath (SH) is inserted under vision with a blunt introducer (BI) inserted into the sheath (SH) .
  • Said sheath (SH) is fitted on the diaphragm and can be changed during surgery depending on the instrument to be used.
  • Said Silicon Washer (SW) is fitted on the diaphragm to enable passage of instruments through its openings for facilitating surgery.
  • Said silicon washer (SW) is of 60mm with one 10mm, one 12 mm opening and two 5mm openings, (SW604).
  • Said component parts assembled to form present equipments (P) named as ISN60.5 and ISN60. 10 respectively.
  • Fig. ID shows Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) with 12mm diameter and 45 mm length.
  • Said equipment is used for natural orifice trans-luminal surgeries, which includes trans-rectal NOTES surgery as shown in Fig.3D, Trans-vaginal NOTES as shown in Fig.3D, Trans-oral and Trans-gastric NOTES as shown in Fig.3F.
  • the component parts of said equipments are shown in Fig. ID 1 to 1D3, wherein said Fig. 1D 1 , Fig. 1D 1E, Fig. 1D2 shows the markings on the sheath specifying the lengths of the sheaths (SH 12.45) .
  • the blunt introducer (BI) is as shown in Fig. 1D3 which is used to facilitate insertion of sheath (SH) into human body for surgery.
  • Said sheath (SH) is fitted on the diaphragm and can be changed during surgery depending on the instrument to be used.
  • Said Silicon Washer (SW) is fitted on the diaphragm to enable passage of instruments through its openings for facilitating surgery.
  • Said silicon washer (SW) is of 12mm with two 5mm openings (SW 122).
  • Said component parts assembled to form present equipments (P) named as ISN 12.45.
  • Present Interchangeable equipment for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery further provides with 12mm diameter and 5 cm length, 12mm diameter and 10cm length, 12mm diameter and 15cm length, 12mm diameter and 30cm length ports; wherein said ports are interchanged for various SILS, NOTES surgery applicability of which are shown in Table 4 in said document.
  • the present invention provides interchangeable equipments and surgical methods versatile for all types of Gastro-intestinal surgeries including single incision laparoscopic surgery (SILS) and natural orifice trans luminal surgery (NOTES) platform for trans-umbilical, trans-anal, trans-oral, retroperitoneal, trans-vaginal, trans-rectal and trans-gastric access routes.
  • Said Interchangeable equipments and methods for gastro-intestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery (P) is applicable to all gastro intestinal surgeries including basic surgeries such as cholecystectomy, appendectomy, hernia surgeries and advanced GI surgeries including hepatobiliary, pancreatic surgery and colorectal surgery for benign and malignant diseases.
  • the present invention provides interchangeable equipments for single incision laparoscopic surgery (SILS) and natural orifice transluminal surgery (NOTES) by providing surgical equipment with four fixed diameters of ports with varying lengths.
  • Said Port Diameters include 20 mm, 40 mm, 60 mm and 12 mm.
  • Said ISN 20 mm diameter port is provided with varied length which includes ports with length: 5 cm, 10 cm, 30 cm, 45 cm and is herein after referred as ISN20.5, ISN20.10, ISN20.30 and ISN20.45 respectively.
  • Said ISN20.5 is used as a SILS port for common surgeries which includes but not limits to; laparoscopic cholecystectomy surgery, laparoscopic appendectomy surgery, laparoscopic hernia surgeries, laparoscopic fundoplication and laparoscopic cardiomyotomy surgery.
  • Said ISN20 port requires a 2 cm skin incision within the umbilicus, and is thus hidden in the umbilicus and thereby provides scarless surgery.
  • SILS Cholecystectomy For removing of the gallbladder, 1-2 cm incision is required depending on the wall thickness and the size of the stones in the gallbladder. Thus a SILS port placed at the umbilicus, requires incision which is not more than 2 cm in diameter. Larger the skin incision at the umbilicus, greater is the chance of developing port site hernias. Therefore, said ISN20.5 is inserted in the umbilicus, which causes 2cm skin incision. Said silicon washer SW203 is used to accommodate said 5 mm telescope and two other 5 mm laparoscopic instruments.
  • the fundus of the gallbladder is retracted cranially with the help of suture which is tied to the diaphragm so as to expose the under surface of the liver and open up the calots triangle.
  • the cystic duct is clipped with 5mm clip applicator on SW203 or with a 10 mm clip applicator with SW 202.
  • the gallbladder is easily removed at the end of the procedure from 2 cm incision and the defect is closed with interrupted vicryl sutures.
  • Said ISN 20 mm port is interchangeable with said ISN 40 mm port, in case of difficulty during the surgery.
  • SILS Appendectomy- Using ISN 20 mm port SILS appendectomy is performed using silicon washer SW203 to accommodate said 5 mm telescope and two other 5 mm laparoscopic instruments. In difficult cases to have a vision of a 10 mm telescope, silicon washer is changed to SW202 10.5 on ISN 20 port. Further to treat adherent retrocaecal appendix or perforated appendix, an additional 3/ 5 mm instrument is used in the suprapubic skin crease for vision or retraction, called the Hybrid SILS. Said SILS appendectomy is operated in paediatrics patients using ISN 12 mm port from the umbilicus reducing the size of the incision to 12 mm.
  • ISN 20 port hernia is treated through SILS hernia surgery, as a larger diameter than ISN 20 port is not advisable as there is a higher chance of ventral hernia at the SILS site which is not acceptable in hernia surgery.
  • Said silicon washer SW203 is used to accommodate said 5 mm telescope and two other 5 mm laparoscopic instruments.
  • wound is closed with interrupted vicryl sutures.
  • the SILS port is placed at the umbilicus whereas in ventral hernia of the paramedian location, the SILS port is placed in the flank for performing the surgery.
  • ISN 20 port is replaced with ISN 40 mm port and a 10 mm 45 degree telescope is used to get a better view of the esophageal hiatus and EG junction.
  • Said ISN20. 10 is used for the said surgeries as described above in an obese patient. Obese patients have much higher thickness of the abdominal wall due to excess fat in the subcutaneous tissue and thus require a longer port.
  • Transoral surgery of the esophagus, stomach and GE junction - Said ISN 20.30 and ISN 20.45 ports are used for performing trans-oral surgery of the upper gastrointestinal tract.
  • Said surgeries includes but not limiting to; trans-oral cardiomyotomy(TOEM) for achalasia cardia, Trans-oral Fundoplication(TOF) for Hiatus Hernia, Trans-oral bariatric surgery(TOBS) and Trans-oral esophagectomy(TOO) .
  • SILS Trans- gastric necrosectomy and cystogastrostomy for Acute Pancreatitis -Two major complications of acute pancreatitis require surgical intervention include infected pancreatic necrosis and pancreatic pseudo cysts.
  • Video assisted retroperitoneal debridement (VARD) provides access route to the left retroperitoneum or uncommonly form the right side of the patient.
  • VARD Video assisted retroperitoneal debridement
  • a trans-gastric approach is used with SILS approach to enter the stomach with ISN20.10 through a small 2 cm incision in the epigastrium (upper central abdomen) .
  • the stomach is inflated and under vision the posterior wall of the stomach is incised to enter the pancreatic bed. Under vision, the said ISN20.10 is interchanged to ISN 20.30 to enter the pancreatic bed in the retroperitoneum. Under vision debridement of the pancreatic necrosis is performed, all the fluid is aspirated and thorough lavage is performed. Further said port is withdrawn into the stomach.
  • the cystogastrostomy is constructed with hand suturing or with stapler. The necrosis is placed in the plastic bag and removed from trans-gastric or trans-oral route with flexible endoscopy. Said 2 cm stomach opening is closed.
  • SILS Paediatric surgery Said ISN 20 port is used for most of the paediatric SILS surgery.
  • ISN 20 port is used as a VATS port in thoracoscopic esophagectomy, mediastinal LN biopsy or lung biopsy.
  • ISN 40 mm diameter port is provided with varied length which includes ports with length: 5 cm, 10 cm, 15 cm, 25 cm and is herein after referred as ISN40.5, ISN 40.10, ISN 40.15 and ISN 40.25 respectively.
  • SILS Bariatric Surgery Said ISN 40. 10 or 40. 15 is used for bariatric surgery. Initial dissection for laparoscopic gastric sleeve or gastric bypass is done using a 10 mm telescope and 5 mm energy devices. Later for the stapling, 5 mm telescope is used with stapler inserted from the 12 mm opening in the washer. The suturing is achieved under vision with interrupted vicryl sutures.
  • SILS Colorectal and SILS HPB Surgery -ISN 40.5 is used for major surgeries such as SILS colorectal surgery, SILS HPB surgery including SILS Splenectomy in a normal BMI patient.
  • the 4 cm incision helps to retrieve the specimen of spleen.
  • Benign colorectal resections need a 4 cm incision for specimen removal at the end of the surgery, thus an ISN 40 port provides effective treatment in SILS benign colorectal surgery.
  • Said ISN 40. 10 is used for said surgeries in an obese patient.
  • VARD Video assisted Retroperitoneal necrosectomy
  • ISN 40.5 and ISN 40. 10 is used for Video assisted retroperitoneal debridement (VARD) for debridement of necrosis in acute infected necrotising Pancreatitis.
  • VARD Video assisted retroperitoneal debridement
  • ISN40.5, ISN40.10, ISN40.15, ISN40.25 are used as trans-anal ports for performing trans-anal surgery depending on the location of the tumour.
  • ISN40.5 and ISN40. 10 are useful, whereas for mid and upper rectal tumours, ISN40.15 and ISN40.25 are used.
  • the applications are trans-anal endoscopic full thickness resection for benign adenomas and Tl or selected T2 adenocarcinomas.
  • Said ports are also very useful in performing major rectal surgeries for rectal cancer called trans-anal TME.
  • Silicon washers SW404 is applied in said surgeries.
  • ISN40 port is used for SILS Nephrectomy, partial nephrectomy, pyeloplasty, SILS cystectomy or Prostatectomy in urology surgery.
  • Said ISN 60 mm diameter port is provided with varied length which includes ports with length: 5 cm and 10 cm and is herein after referred as ISN 60.5, ISN 60.10 respectively.
  • SILS Colorectal surgery In SILS colorectal resections for cancers, a 6 cm incision is used at the end of the procedure to extract the specimen. Said incision is to be placed at the beginning of the surgery using ISN 60port for surgery.
  • SILS Splenectomy For SILS Splenectomy for large spleens as in portal hypertension, ISN 60 mm port is used from a 6 cm incision in per umbilical region. A 45 degree angled telescope provides adequate vision on the splenic hilum. After the spelenectomy, the spleen is removed from the 6 cm skin incision.
  • SILS Hepatectomy - SILS Liver resection is performed with ISN60 port. After liver resection, the specimen is removed from the 6 cm skin incision.
  • SILS Pancreatic surgery including SILS Whipples Surgery- Said ISN60.5 and ISN60. 10 are used mainly in advanced laparoscopic surgery. In SILS Whipples pancreaticoduodenectomy (PD), at least 6 cm incision is needed at the end of the procedure. Thus ISN 60 port is ideal for SILS Whipples PD procedure. Said ISN60.5port is used for normal BMI patient whereas ISN60.10 port is used for obese patient undergoing these major surgeries. Said ports is also used in lap bariatric surgery or any other surgery. Said ports uses silicon washers (SW) of diameter 60mm with one 10mm, one 12 mm openings and two 5mm openings(SW604) . Hybrid SILS is used to achieve triangulation by having two others ports in the flanks at the drain site to perform SILS Whipples PD.
  • SW silicon washers
  • Trans-vaginal NOTES- Trans-vaginal cholecystectomy and transvaginal appendectomy have been performed by flexible endoscopy, however this access route is not the standard procedure. Further said route is only used in female patients, who are most concerned about their cosmetic appearance.
  • SaidISN 12.15, ISN 12.30 and ISN 12.45 port is used from the trans-vaginal route for diagnostic laparoscopy and biopsy.
  • Said ISN20.30 port is used to perform the trans-vaginal cholecystectomy and trans-vaginal appendectomy by trans-vaginal approach.
  • An angled telescope of 45 degree and angular instruments are essential to get a good view of peritoneal cavity.
  • a flexible endoscope is used through the ISN ports to get a better view along with a rigid instrument by using the Silicon washer (SW201).
  • Said ISN 12.30 or ISN 12.45port is inserted from ISN 20.30 port to get a better view of the peritoneal cavity and perform biopsy procedures.
  • Flexible endoscope is used from the ISN 12 port to get a better view of the entire peritoneal cavity for diagnostic laparoscopy. Further, the same opening is used for specimen extraction of gallbladder, appendix or lymph node biopsy.
  • ISN 40. 15 and ISN 40.25 are used for trans-vaginal approach to perform hemicolectomies, small bowel resections & anastomosis and performing splenectomy.
  • ISN 40. 15 is used for trans-vaginal natural orifice specimen extraction(NOSE) in colorectal, small bowel, gastric, pancreatic or liver resections.
  • NOSE trans-vaginal natural orifice specimen extraction
  • ISN 60. 10 is used for the specimen extraction.
  • the vaginal opening is closed either from the laparoscopic approach or from trans-vaginal suture closure. Further said ports are applied to treat pelvic floor prolapse, rectal prolapse, pancreatic resections and gastric surgery like gastric cancer resections.
  • Trans-rectal NOTES - Said ISN 12.30 and ISN 12.45 port is used for diagnostic laparoscopy from trans-rectal access.
  • Said ISN 20.30 port is used for trans-rectal appendectomy and trans-rectal cholecystectomy in male patients.
  • the Trans-anal surgery is performed with the ISN 40.10 port.
  • the site of entry from the rectum into the peritoneal cavity is identified in the anterior wall at a level of 15 - 20 cm from the anal verge. A 2 cm opening is created in the rectum with a hook. Through said opening, ISN20.30 port is inserted into the abdomen.
  • Said 5mm telescope is used for the vision, whereas other two 5 mm long angled instruments are used to perform the NOTES procedures in the abdomen which includes cholecystectomy, appendectomy and LN biopsy. Finally the specimen is removed from the 2 cm rectal incision. The rectal opening is closed with interrupted sutures. For larger specimens or major resections, ISN40.25 is used. A new technique of short rectal tunnelling for 3-5 cm is used to enter the peritoneal cavity to create a flap like effect on the mucosa to reduce chances of anastomotic leaks.
  • the specimen is extracted from the 4 cm rectal opening and the rectal opening is closed with ISN40.10 port by using standard suturing techniques with needle holder.
  • ISN40.10 and ISN40.15 is applied to NOTES for cancer of the rectum.
  • ISN40. 15 port is changed to ISN40.25 port, so that intraperitoneal surgery is performed from the trans-anal route.
  • the abdominal part includes steps such as IMA ligation, sigmoid and left colon mobilization and splenic flexure mobilization.
  • the specimen is extracted from the trans-anal route and stapled colorectal anastomosis or handsewn graspal anastomosis is constructed.
  • Trans-oral NOTES- Said ISN 20.30 port is used for trans-oral pure NOTES for placing a small 12 mm incision in the stomach just below the GE junction. Alternatively, the incision can be placed after creating a submucosal tunnel from oesophagus for 5-6 cm and then entering the abdomen through a 12 mm opening in the stomach. Said ISN 12.45 port along with its blunt introducer and under 5 mm telescope is inserted through the gastric opening into the peritoneal cavity. Under vision inspection of the peritoneal cavity is done for diagnostic laparoscopy and biopsy.
  • trans-oral pure NOTES cholecystectomy and appendectomy is operated through ISN 20.45 wherein; a 2 cm incision is placed in the stomach just below the GE junction. ISN20.45 is inserted under vision into the peritoneal cavity from said gastric opening and by using two other 5 mm angled instruments, appendectomy is performed. Finally the specimen is removed from the gastric incision and the trans-oral route. The gastric opening is closed by suturing or using the endostitchTM.
  • Trans-oral surgery of the stomach includes procedures such as
  • Trans-oral NOTES GJ Trans-oral NOTES GJ.
  • TOP-G is inserted into the stomach, the posterior wall of stomach is opened to enter into the lesser sac, which avoids injury to the small bowel while opening anterior wall and directly entering the peritoneal cavity.
  • a flexible endoscopy is further passed into the lesser sac.
  • the peritoneum of the transverse mesocolon is opened close to the proximal jejunum.
  • the endoscope is advanced into the peritoneal cavity. Thorough inspection of the peritoneal cavity is done for diagnostic peritoneoscopy.
  • Said proximal jejunal limb is withdrawn into the stomach opening.
  • a posterior sutured or stapled gastrojejunostomy is constructed.
  • Trans-oral NOTES pancreatic necrosectomy and cyst gastrostomy is performed for large bulging pseudocysts into the stomach.
  • Said TOP-G port is inserted into the stomach and an incision is placed over the posterior gastric wall overlying the cyst.
  • flexible endoscope is inserted into the pancreatic bed and necrosectomy is performed.
  • lavage is done and posterior cystogastrostomy is constructed with sutured or stapled technique.
  • Hybrid SILS- SILS with reduced Port Laparoscopic surgery is termed Hybrid SILS.
  • the ISN 12.5 and ISN 12.10 ports is used as SILS port from the trans-umbilical access for diagnostic peritoneoscopy and biopsy.
  • ISN 12.5, ISN 12. 10 is used to perform Hybrid SILS Cholecystectomy, Appendectomy, Hernia surgeries, Fundoplication, Cardiomyotomy and alike as a combination of SILS and traditional laparoscopic reduced port surgery to achieve triangulation and reduce the difficulties encountered in pure SILS surgery.
  • Interchangeable equipments and methods for gastrointestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery provides Interchangeable equipments for SILS and NOTES (ISN) ports which are applicable in various surgeries which includes Diagnostic Laparoscopy(DL), Cholecystectomy (Chole), Appendectomy (Append), Upper Gastrointestinal surgery (UGI) including Fundoplication, cardiomyotomy and esophageal and gastric surgery, hernia, Colorectal, Bariatric surgeries as shown in table 2.
  • present Interchangeable equipment and methods for gastrointestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery provides Interchangeable equipments for SILS and NOTES (ISN) ports which are applicable in various surgeries.
  • Said ports are interchangeable among varied diameter and length and further applied to various surgeries.
  • Said varied diameter and length of the ports are ISN20.5, ISN20. 10, ISN20.30, ISN20.45, ISN40.5, ISN40.10, ISN40.15, ISN40.25, ISN60.5, ISN60.10,ISN12.5, ISN12.10, ISN12.15, ISN 12.30 and ISN12.45 as shown in table: 3
  • ISN Interchangeable equipments and methods for gastrointestinal single incision laparoscopic surgery and natural orifice trans-luminal surgery
  • P provides Interchangeable equipments for SILS and NOTES (ISN) applicable to various surgeries; wherein said ISN ports are interchanged and are applied to perform various surgeries as shown in table 4:
  • Diag. lap. Diag. lap., trans, transflexible lap. in flexible rectal rectal over rigid, obese, over NOTE and

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Abstract

La présente invention concerne des équipements universels et interchangeables et des procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (SILS) et de chirurgie transluminale par voies naturelles (NOTES) (P). L'invention porte sur une plate-forme polyvalente, adaptable et rigide par différentes voies d'accès pour chirurgies trans-ombilicales, trans-anales, trans-buccales, rétropéritonéales, trans-vaginales, trans-rectales et trans-gastriques ; dénommées voies trans-ombilicales, voies trans-anales, voies trans-buccales, voies rétropéritonéales, voies trans-vaginales, voies trans-rectales et voies trans-gastriques. Lesdites voies sont polyvalentes pour toutes les opérations gastro-intestinales par accès mono-incisionnel aux voies naturelles. Suivant la constitution du patient, son état pathologique, le degré de difficulté rencontré pendant la chirurgie, lesdites voies peuvent passer d'un diamètre à un autre ou d'une longueur à une autre.
PCT/IN2017/050628 2017-01-03 2017-12-29 Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles WO2018127933A2 (fr)

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WO2018127933A3 (fr) * 2017-01-03 2019-08-01 Haribhakti Sanjiv P Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles

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US5586977A (en) * 1990-01-26 1996-12-24 C.R. Bard, Inc. Quick disconnect fitting for coupling interchangeable probe tip to laparoscopic instrument
US8721539B2 (en) * 2010-01-20 2014-05-13 EON Surgical Ltd. Rapid laparoscopy exchange system and method of use thereof
WO2018127931A1 (fr) * 2017-01-03 2018-07-12 Haribhakti Sanjiv P Nouveaux équipements et procédés de chirurgie endoscopique transorale du tractus gastro-intestinal supérieur utilisant une plateforme rigide
WO2018127933A2 (fr) * 2017-01-03 2018-07-12 Haribhakti Sanjiv P Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018127933A3 (fr) * 2017-01-03 2019-08-01 Haribhakti Sanjiv P Équipements interchangeables et procédures de chirurgie gastro-intestinale laparoscopique mono-incisionnelle (sils) et de chirurgie transluminale par voies naturelles

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