WO2020058635A1

WO2020058635A1 - Portable device for the circulation of gas between trocars and accessory for endoscope

Info

Publication number: WO2020058635A1
Application number: PCT/FR2019/052183
Authority: WO
Inventors: Clément LABICHE
Original assignee: Smices
Priority date: 2018-09-18
Filing date: 2019-09-18
Publication date: 2020-03-26
Also published as: FR3085830A1

Abstract

The portable device (50) for the circulation of gas between trocars for a surgical operation, comprises: - at least one feed tube (53) provided with a suction connection (52) configured to be connected to a valve of a trocar, - a motor (51) for sucking the gas originating from at least one suction connection and discharging this gas into at least one outlet connection (61), - a self-contained power source for powering the motor, - a manual switch for controlling the supply to the motor by the self-contained power source, - at least one discharge tube (55, 58, 60) provided with an outlet connection (61) configured to be connected to a trocar valve and/or to an inlet of an accessory for injecting gas onto the optical window at the distal end of an endoscope and - at least one filter (54, 56) positioned in the path of the gas flowing in the device.

Description

PORTABLE GAS CIRCULATION DEVICE BETWEEN TROCARS AND ACCESSORY FOR

ENDOSCOPE

TECHNICAL FIELD OF THE INVENTION

The present invention relates to a portable device for circulating gas between trocars and an accessory for an endoscope.

It is particularly applicable to the field of minimally invasive surgery performed under endoscopy, for example laparoscopy, thoracoscopy, arthroscopy and otolaryngology.

STATE OF THE ART

Laparoscopy, also called laparoscopy, is a medical endoscopy technique used for diagnosis (laparoscopy proper) or surgical intervention (laparoscopy) on the abdominal cavity. The instrument used, called an endoscope, is made up of an optical tube fitted with a lighting system and a video camera transmitting the image on a screen.

Comparable techniques have been developed in thoracic surgery (thoracoscopy), orthopedics (arthroscopy), visceral surgery, gynecology and urology.

The notion of endoscope also covers fibroscopes, endoscopes in which the image is formed by a bundle of optical fibers.

Laparoscopy involves accessing the abdominal cavity without opening the abdominal wall. It is possible thanks to several devices:

an endoscope is introduced into the abdominal cavity through a trocar crossing a scar that the surgeon practices in the umbilicus. The endoscope is connected to a screen that the surgeon looks at while operating,

carbon dioxide (CO2) is then introduced into the abdominal cavity. The positive pressure exerted by this gas lifts the abdominal wall, thus creating a space between the wall and the viscera where the surgeon can look and where he can introduce his instruments to operate and

trocars are finally introduced through the wall thus raised, through which the surgeon will pass instruments 5 to 12 mm in diameter to operate (forceps, scissors, coagulation and suturing instruments, etc.).

The choice of carbon dioxide is justified by its presence in the human body, by the fact that the tissues are capable of absorbing it and that the respiratory system can evacuate it. It is also not flammable, which is important because electrosurgical instruments are used frequently.

Thus, during a laparoscopic operation, carbon dioxide gas is put inside the patient's abdomen. The end of the endoscope optical tube is inserted into an incision formed in the patient's skin and observes the operating field. Surgical instruments are inserted through other incisions and are manipulated in the optical field of the endoscope, which allows the surgeon to view the operating field on a video screen. However, the atmosphere being at around 37 ° C and saturated with humidity while the endoscope forms a thermal bridge with the external atmosphere, at around 20 ° C, mist forms on the front lens of the endoscope. In addition, liquids or pieces of fat or organ may be splashed onto this front lens during the operation. In both cases, the quality of the visualization is reduced and the surgical team is forced to take out the endoscope to clean the front lens in physiological saline.

In addition to the waste of time, and the need to prolong the patient's anesthesia, each additional insertion of the endoscope head into the abdomen increases the patient's risk of contamination.

In addition, during electrical cauterization of organ tissues, smoke is released in the cavity and impairs the vision of the surgeon. Faced with this problem, some surgeons open the exhaust valve of one of the trocars to evacuate the smoke. However, this carcinogenic smoke, by escaping into the operating room, can cause illness or even harm the health of the medical staff present there and, to a lesser extent, the patient.

OBJECT OF THE INVENTION

The present invention aims to remedy all or part of these drawbacks.

To this end, the present invention relates to a portable and autonomous device for the circulation of gas between trocars during a surgical operation, which comprises:

- at least one supply tube provided with a suction connection configured to connect to a valve of a trocar positioned on a cavity of the body of a patient,

- a motor for sucking the gas coming from at least one suction connection and delivering this gas in at least one outlet connection,

- an autonomous energy source to power the engine,

- a manual switch to control the supply of the motor by the autonomous energy source,

- at least one delivery tube fitted with an outlet connection configured to connect to a trocar valve positioned on the patient's body cavity and / or to a gas injection accessory inlet on the optical window by distal end of an endoscope inserted into a trocar positioned over the patient's body cavity and

- at least one filter placed on the path of the gas circulating in the device.

Thanks to these provisions, by connecting the connections of the device to at least one trocar, on the one hand, and to a trocar or an endoscope accessory, on the other hand, and by putting the switch in the closed position, the motor causes the aspiration of the atmosphere from the abdominal cavity, its filtering by the filter, and its reinjection into the abdominal cavity.

The surgeon can therefore, at any time, cause the evacuation of the fumes in the abdominal cavity, without consuming gas from a reservoir, by simply pressing the switch, or even cleaning the optical window of an endoscope. The fumes are captured by the filter, which prevents their dispersion in the operating room and endangers the health of the people who are there. In embodiments, the device comprises a motor housing comprising the motor, the autonomous power source, the manual switch, connections for the supply and discharge tubes and, optionally, at least one filter, the housing comprising:

- a first part comprising at least the motor,

a second part comprising at least connections for the supply and delivery tubes and a rotary pump wheel or propeller positioned between the supply and delivery tubes and

- attachment means, detachable without tools, from the first part to the second part, said attachment means comprising a coupler connecting a motor shaft to a shaft of the wheel or propeller.

Thanks to these provisions, the autonomous energy source, for example cells or a battery, can be recovered for reprocessing and the motor can be reconditioned to be placed in a box intended for future surgical operations. The pollution induced by the surgical operation is thus greatly reduced.

In embodiments:

the coupler is a mechanical coupler comprising a gear,

- the coupler is a magnetic coupler,

- the autonomous energy source is integrated into the first part,

- the autonomous energy source is in mechanical contact with the first and with the second part,

- the first part also includes a switch which controls the operation of the engine,

- the second part includes a housing for the first part,

- the second part takes the form of a waterproof case provided with a cover mounted on a base, case whose sealing is obtained by interlocking,

- the second part comprises a flexible membrane for transmitting a manual pressure exerted by a user, to an engine control switch,

- the device also comprises a charger for recharging the autonomous energy source and / or

- the charger comprises a housing for the first part and electrical studs on which two electrical contacts of the first part are supported in electrical connection with the autonomous energy source, when the first part is inserted in the housing of the charger.

In embodiments, the autonomous power source and the motor are configured to provide a constant flow throughout an operation lasting 10 hours.

In embodiments, the device further comprises at least one manual gas speed acceleration pump on at least one gas delivery tube.

Thanks to these provisions, if necessary, for example in delicate or extreme cauterization cases and in narrow intervention zones, the use of the manual pump makes it possible to accelerate the circulation of gas in the zone considered. In embodiments, at least one filter is configured to capture fumes from the cauterization of organ tissues.

In embodiments, at least one filter is configured to capture at least part of the humidity of the gas circulating in the device.

Thanks to each of these arrangements, not only is the smoke removed from the abdominal cavity but the humidity is reduced there, which reduces the risk of condensation on or near the optical window at the distal end of the endoscope.

In embodiments, the device includes a filter configured to capture the particles emitted by the moving engine, downstream of the engine.

Thanks to these provisions, the particles emitted by the effect of friction in the engine are captured before risking entering the abdominal cavity.

In embodiments, the device comprises a liquid supply, a rigid endoscope tube provided with a gas inlet, an endpiece configured to surround the distal end of an endoscope, the endpiece comprising a means for distributing liquid on an optical window at the distal end of the endoscope, the gas and the liquid flowing in the form of multiphase fluid through the rigid endoscope tube to the optical window at the distal end of the endoscope.

Thanks to these provisions, whether the gas inlet comes from a gas reservoir or from the delivery of the gas sucked into the abdominal cavity, the surgeon can clean the optical window at the distal end of the endoscope during surgical operation without extract the endoscope from the trocar which introduces it into the abdominal cavity.

The surgeon can thus clean the optical window, for example the front lens of the endoscope, by covering it with liquid, for example physiological saline. It therefore becomes unnecessary, or rarely necessary, to remove the head of the endoscope from the patient's body when dirt has settled on the optical window. The duration of a surgical intervention and the risk of contamination are therefore reduced. The liquid is projected onto the optical window at the distal end of the endoscope by the transport gas.

In embodiments, the liquid supply includes a syringe connection.

In embodiments, the liquid supply comprises a reservoir provided with a rotary piston.

Thanks to each of these provisions, a light device allows the injection of liquid, typically physiological saline.

BRIEF DESCRIPTION OF THE FIGURES

Other advantages, aims and characteristics of the present invention will emerge from the description which follows, given for explanatory purposes and in no way limiting with regard to the appended drawing, in which:

FIG. 1 represents a perspective view, a particular embodiment of the device which is the subject of the invention,

FIG. 2 represents a sectional view of the installation of the device illustrated in FIG. 1, FIG. 3 represents a sectional view of the implanted device illustrated in FIG. 2, during the regular circulation of gas,

FIG. 4 represents a sectional view of the implanted device illustrated in FIG. 2, during the accelerated circulation of gas,

FIGS. 5 to 7 represent three perspective views of a first embodiment of an engine housing usable in a device illustrated in FIGS. 1 to 4,

Figures 8 and 9 show two sections of the housing illustrated in Figures 5 to 7, Figure 10 shows, in perspective, an exploded view of the housing illustrated in Figures 5 to 9, Figure 1 1 shows, in section, a fixing means removable from an engine in an engine housing,

FIG. 12 represents, in perspective, an exploded view of a filter housing, FIG. 13 represents, in section, a filter housing,

FIG. 14 illustrates, in the form of a flow diagram, the operating steps of the device illustrated in FIGS. 1 to 13,

FIG. 15 represents, in perspective, a second embodiment of the device which is the subject of the invention,

FIG. 16 represents, in perspective, an endoscope tube being assembled around an endoscope,

FIG. 17 represents a gas circulation in the embodiment illustrated in FIGS. 15 and 16,

FIG. 18 represents, in section, the circulation of multiphasic fluid in an endoscope tube,

FIGS. 19 to 24 represent, in perspective or in section, end caps of the endoscope tube,

FIG. 25 represents, in the form of a flow diagram, steps for setting up and using the embodiment of the accessory object of the invention illustrated in FIGS. 18 to 24 and the endoscope supporting it,

Figures 26 to 32 show two sections, three perspective views, a side view, a top view of a second embodiment of a motor housing usable in a device illustrated in Figures 1 to 4 and

FIGS. 33 and 34 represent, in perspective, a charger for the reusable part of the box illustrated in FIGS. 26 to 32.

DESCRIPTION OF EXAMPLES OF EMBODIMENT OF THE INVENTION

This description is given without limitation, each characteristic of an embodiment can be combined with any other characteristic of any other embodiment in an advantageous manner. We note, as of now, that the figures are not to scale.

FIG. 1 shows a portable device 50 for circulating gas between the trocars which is the subject of the invention, which comprises, following the direction of displacement of the carbon dioxide:

a connector (suction) for trocar 52, a smoke filter and humidity sensor 54 mounted on a flexible tube 53, an autonomous module 51 for circulating carbon dioxide gas by engine, a flexible tube 55,

a particle filter 56 which can come from the module motor 51 (particles coming from the stator rotor connection and / or glue from 0.5 micron to one micron in diameter),

a non-return valve 57, mounted on a tube 58,

a manual pump 59 making it possible to quickly blow out and blow in carbon dioxide,

a flexible tube 60 is terminated by a connector (outlet) for trocar 61.

The various elements of the device are described in more detail with reference to the following figures.

As illustrated in FIG. 2, during laparoscopic operations, a minimum of three trocars 62, 63 and 64 are present in the cavity 66 of the patient, in triangulation. The trocars 62 and 63 allow the circuit to be sealed and the passage of instruments such as bipolar, monopolar, and other clamps. The trocar 64 receives an endoscope 65. In the example of use illustrated in FIG. 2, the device is connected to the trocars 62 and 63 and the carbon dioxide insufflator (not shown) is connected to the trocar 64. The insufflation of carbon dioxide from the insufflator maintains a pressure between 12 and 15 mm of mercury in the cavity 66.

Trocars (here, trocars 62 and 63) not connected to the insufflation pipe have their valve closed.

The endoscope 65, rigid or flexible, has a camera. The cameras used have an angle of 0 ° and 30 ° and a diameter of 5mm and 10mm. They are used depending on the area of intervention and its complexity.

The device 50 keeps the cavity 66, a pneumoperitoneum, stable while avoiding the formation of condensation on the optics of the endoscope 65, and by evacuating and filtering the fumes during laparoscopic operations.

Figure 3, which shows the elements illustrated in Figure 2 shows the circulation of carbon dioxide. From the insufflation trocar 64, into the patient's cavity 66 and into the device 50.

FIG. 4, which repeats the elements of FIGS. 2 and 3, shows the effect of a pressure on the manual pump 59: an increase in carbon dioxide is blown into the cavity 66 of the patient, by means of the trocar 63.

Figures 5 to 7 show the autonomous module 51 for circulating carbon dioxide. This module 51 has a gas inlet 67 and a gas outlet 68 between which an arrow 69 indicates the direction of gas flow.

The module 51 is provided with a cover with opening button 77 allowing the recovery of the battery pack (or rechargeable batteries) and the engine, with a view to recycling the batteries and reconditioning the engine. The parts of the module 51 are assembled by gluing and fitting for the cover in order to recover the engine and the battery pack at the end of the intervention. The module 51 includes removable fixtures without tools for the motor and the autonomous energy source (the batteries). A manual switch 70 makes it possible to initiate and stop the operation of the module 51 and the circulation of carbon dioxide in the device 50.

The sections of the module 51 shown in Figures 8 (switch 70 in the closed position) and 9 (switch 70 in the open position) show the components of a particular embodiment. The module housing 51 comprises the upper cover, an intermediate part, or chassis 76 and a lower part 75 for connection with the tubes.

The motor 71, for example of the brushless or “brushless” direct current type (for example of the Maxon brand, registered trademark, and of reference DCX1 DL EB), is mounted, by means of a thread allowing its disassembly, through a vibration and noise reduction silent block, on a fixing nut 78. Thus, by simple rotation, the motor 71 is dismantled and extracted from the module 51. The shaft 73 of the motor 71 ends with a wheel or a propeller 74 depending on whether the pump is centrifugal rotary or axial rotary, respectively.

The removable battery pack 72 is, for example, of the lithium type with motor contact by lug and unwelded wires. Their voltage is, for example, 3.6 volts allowing a circulation of carbon dioxide with a flow of 0.3 to 0.9 m ³ / h for a period of ten hours. For example, the capacity of the removable battery pack 72 is between six and nine Ah.

We find these different elements in exploded figure 10, to which are added the strips 79 and 80 of the switch 70.

We observe, in Figure 1 1, another embodiment of the autonomous module 81 for circulating carbon dioxide. This module 81 aims to obtain a perfect seal between the carbon dioxide circuit, in the lower part 85 and the casing 86 of an engine 82. To this end, this engine 82 drives a magnetic coupler 89, which drives a shaft 83 bearing a wheel or a propeller 84, between a gas inlet 87 and a gas outlet 88.

The engine 82 is mounted on a silent block. The motor or the silent block has a thread allowing the extraction of the motor 82 by simple rotation. Maintaining the shaft 83 avoids bending and deflection of the wheel or propeller 84, thanks to the presence of a ball bearing or any other type of bearing.

The magnetic coupler is, for example, an asynchronous discoid magnetic coupler which makes it possible to transmit mechanical power (speed and torque) without contact. Torque transmission takes place by interaction of magnetic fields in an air gap. The air gap is defined as being a space between two magnetic parts in which the magnetic field is not deformed, the air gap material can be air or a non-magnetic material and if possible not electrically conductive (plastic). Thus, one can place a waterproof plastic wall in the air gap of a magnetic coupler and achieve a perfect seal between the motor area and the wheel or propeller area. Preferably, a discoid architecture is implemented, more compact than a cylindrical architecture having regard to the dimensions available for this portable system.

For synchronous magnetic couplers with permanent magnets and asynchronous magnetic couplers, a metal washer is sufficient on the wheel or propeller side and for the simplicity of the parts (no magnets or adhesives liable to be degassed in the CO ² environment) and ease of starting (open loop). Asynchronous technology does not require any particular soft start procedure, while for synchronous technology this is the case.

In the exploded view of FIG. 12 and in the sectional view of FIG. 13, the components of a filter 54 of smoke and humidity are observed. From a gas inlet 90 to a gas outlet 96, there is successively a flange 91, a flat gasket 92, a double filter 93 HEPA (High Efficiency Particulate Air for high efficiency particulate air) and ULPA (Ultra Low Air penetration for ultra low penetration air) or 0.5 microns with adequate filtering surface to stop particles of 0.2 microns. Humidity sensors are inserted between the flange 91 and the filters 93, these filters 93 preventing pieces of the sensors from circulating in the gas circuit. A flat seal 94 and a flange 95 carrying the gas outlet 96 complete the filter 54. The humidity sensors can be composed of silica gel, calcium chloride, activated carbon, or cotton with high absorption.

The use of the device exposed with reference to FIGS. 1 to 13 comprises, first of all, step 101 known to those skilled in the art of placing the trocars and the endoscope, for example as illustrated in FIGS. 2 to 4. During a step 102, an insufflator is connected and it is put into operation to inflate the patient's cavity. During a step 103, the device is positioned and the surgical operation is started. During a step 104, the gas circulation module of the device is put into operation. This start-up can be permanent, for the entire duration of the operation, or temporary, for example each time smoke is released or moisture causes condensation on the optical window at the distal end of the endoscope.

After the end of operation 105, the circulation module is stopped. During a step 106, the endoscope and the trocars as well as the device object of the invention are removed. During a step 107, the engine and the battery pack are removed from the circulation module.

FIG. 15 shows an accessory and a particular use of the device which is the subject of the invention. We observe, in Figure 15, in the direction of gas flow, a tube 1 13, the module 51, a tube 1 14 emerging on the base of a rigid endoscope tube 1 10 ending with an injection nozzle straight 1 1 1 or inclined 1 12. A metering device 1 16 allows the injection of a dose of liquid, typically physiological saline into the rigid tube 1 10. A tube 1 15 connects an insufflator (not shown) to an inlet of gas from the base of the rigid tube 1 10. In the gas circulation, the module 51 is preceded by a filter 54 (not shown). Preferably, a filter 56, a non-return valve 57 and a manual pump 59 are positioned between the module 51 and the base of the rigid endoscope tube 1 10.

Figure 16 illustrates the insertion of an endoscope 1 17, known to those skilled in the art, in the rigid tube 1 10 of endoscope. The endoscope has, at its proximal end, a camera head ensuring the electronic connection with a display screen, a light source connection, perpendicular to the general axis of the endoscope and, at its distal end, a window optical with light output. The endoscope tube has an internal diameter leaving play around the endoscope 1 17 so that a circulation of biphasic fluid (gas and liquid) can occur there. This circulation of biphasic fluid brings the liquid to the front optical window of the endoscope 1 17. We observe, in FIG. 16, on the base 126 of the endoscope tube 1 10, a connector 123 for the tube 1 14 (see FIG. 15), a connector for a resuscitator and a connector 124 for insertion of liquid by a syringe . These different inputs lead to the multiphasic conduit formed between the endoscope tube 1 10 and the endoscope 117. The tight fixing 125 ensures the endoscope tube 1 10 is held on the endoscope 1 17 by rotation of a knob which crushes a tight seal.

FIG. 17 shows, with arrows, the circulation of gas in the device illustrated in FIGS. 15 and 16.

Due to the entry of gas, a multiphase fluid travels the tube 1 10 of the endoscope around the endoscope 1 17, as illustrated in Figure 18, to the nozzle 1 1 1 (Figures 19, 20 and 24 ) or 1 12 (Figures 21 to 23).

The endoscope tube 110 illustrated in FIG. 18 is produced by extrusion of plastic material. CO ^{2 as} well as physiological saline circulate all around the endoscope 1 17 inside the endoscope tube 1 10. The passage section of CO ² and physiological saline allows, for example, a maximum flow of 14 L / min.

The ends illustrated in FIGS. 19 to 24 exist in two references. Tip 1 1 for endoscopes at 0 °, Figures 19, 20 and 24, and tip 1 12 for endoscopes at 30 °, Figures 21 to 23. These tips 1 1 1 and 1 12 have micro-channels 130 allowing the passage of CO ² and physiological saline. The channels 130 are dimensioned so as to allow a minimum flow rate, for example 6 L / min. They end with leaves 131 to reduce pressure losses and project carbon dioxide and physiological saline onto the optical window at the distal end of the endoscope 1 17.

As illustrated in FIG. 25, to implement the endoscope accessory illustrated in FIGS. 18 to 24, during a step 280, the distal end of the endoscope is inserted into the endoscope tube 110. During a step 281, the accessory is positioned, by pulling on the tube 1 10 of the endoscope and pushing on the tube until the tip is in abutment on the optical window.

In step 282, pressurized gas is injected into the abdominal wall and the endoscope is inserted into a prepositioned trocar on a patient and a vial or syringe without a needle in the holder. The gas inlet of the sleeve then permanently receives carbon dioxide under pressure

In the event of soiling or fogging on the front face of the optical window, during a step 283, physiological liquid is injected with the vial or the syringe.

During a step 284, the liquid cleans the optical window, as explained above.

Steps 283 and 284 are repeated as often as necessary during the surgical procedure, possibly by changing the vial or syringe.

At the end of the surgical procedure, during a step 285, the accessory is removed from the endoscope.

During a step 286, the accessory is cleaned or discarded and the endoscope is cleaned. In the second embodiment, the accessory which is the subject of the invention makes it possible to aspirate, with the venturi effect, with the CO2, the physiological saline present in a stored volume to clean the optical window at the distal end of the endoscope and maintain it clean. However for thoracoscopy, arthroscopy, and otolaryngology, we do not use CO2 but the accessory allows to clean the optical window at the distal end of the endoscope by closing the CO2 circuit and using only the access for physiological saline or the first embodiment of the accessory.

In FIGS. 26 in the closed configuration and in FIG. 27 in the open configuration, there are two sections of a second embodiment of a motor housing 301. This motor housing 301 comprises a first part 31 1, 321 in one piece comprising at least one drive motor 302. Preferably, the first part 31 1, 321 also includes a switch 310 which controls the operation of the motor, as illustrated in FIGS. 26 and 27. In the variant shown in FIGS. 26, 28 to 32 and 34, this first part 31 1 also includes an autonomous energy source 305, preferably an electric accumulator. In the variant illustrated in FIG. 27, the autonomous energy source 325 is outside the first part 321. In both variants, the housing 301 has a second part 314 in which the first part 31 1, 321 is housed. The second part comprises at least connections 306, 307 for the delivery and delivery tubes, respectively, and a wheel or propeller 303 of rotary pump positioned between the delivery and delivery tubes. In the second embodiment, to house the first part 31 1, 321, the second part 314 takes the form of a sealed housing provided with a cover 313 mounted on a hinge 304, housing whose sealing is obtained by locking a lock 308. A flexible membrane 312 transmits a manual pressure exerted by a user to the switch 310.

Attachment means, detachable without tools, from the first part 31 1, 321 to the second part 314 comprises a coupler 309, 309a, 309b connecting a motor shaft 302 to a wheel or propeller shaft 303 These attachment means also comprise the cover 313, the hinge 304 and the lock 308 in the embodiment illustrated in FIGS. 26 to 32. In variants (not shown), the attachment means do not comprise a hinge , the cover 313 fitting into the base 314, the lock being formed by the attachment of complementary shapes, by clip or depression.

In this embodiment, the coupler 309 consists of a mechanical gear comprising a male part 309a secured to the motor shaft and a part 309b secured to the shaft of the wheel or propeller 303. The male part 309a has a screwdriver head shape, for example cruciform, and the female part 309b has the shape of a corresponding screw head.

Alternatively (not shown), the male part is secured to the shaft of the wheel or propeller and the female part is secured to the motor shaft. In another variant, the coupler takes the form of a universal joint, with two parts provided with teeth. In another variant (not shown), the coupler is magnetic, as explained above. In non-preferred variants (not shown), the first part is not enclosed in the second part. These variants impose additional sterilization constraints on the first part. In variants, such as the variant in FIG. 27, the autonomous energy source 325 is maintained in position and in electrical contact with the first part by the closure of the attachment means securing the first and second parts.

As illustrated in FIGS. 28, to use the engine housing 301, the user opens the cover 313 of the second part 314. It is recognized, in FIG. 28, the filter 56, a gas delivery tube 317, a tube 316 gas supply from outlet 306 to filter 56 and a gas supply tube 315 to gas inlet 307. Then, as illustrated in Figure 29, the operator assembles the first and second part and, optionally the autonomous energy source 325. In the embodiment illustrated in FIG. 26, the operator inserts the first part 31 1 into the second part 314, by vertical translation. Once the first part has been inserted as a stop in the second part (Figure 30), the operator closes the cover 313 and locks the closure (Figure 31 in side view and 32 in top view). Optionally, a seal runs through the connection between the cover 313 and the base of the second part 314. Once the surgical operation is completed, the operator performs the reverse steps and separates the first, reusable part and the second part, for single use.

A charger 323, illustrated in FIGS. 33 and 34, makes it possible to recharge the autonomous energy source 315. This charger 323 is connected to the network by an electric cable 321 and a plug 322. This charger comprises a housing for the first part 31 1 and two electrical pads which have a difference in low voltage potential (for example 5 or 15 Volts), on which two electrical contacts (not shown) of the first part 31 1 are supported in electrical connection with the autonomous energy source 315 when the first part 31 1 is inserted into the charger 323 (Figure 34).

In the embodiments shown in FIGS. 26 to 32, the first part 31 1, 321 constitutes a non-sterile reusable capsule and the second part 314 constitutes a sterile module for single use. As will be understood, the most expensive and potentially the most polluting or complex elements to be recycled are not incorporated into the second part 314, which reduces the costs of use and recycling of the motor housing 301. Between two operations, the first part is cleaned, disinfected and recharged.

Although the above description more specifically sets out the accessory object of the invention, the invention also relates to an endoscope comprising a tip configured to surround a distal optical window of the optical tube of the endoscope, said tip comprising means liquid distribution on this optical window and a liquid supply channel to the distribution means. Preferably, the channel is integrated into the wall of the optical tube of the endoscope, like the lighting fibers of the observed scene.

Claims

1. Portable and autonomous device (50) for circulating gas between trocars during a surgical operation, characterized in that it comprises:

- at least one supply tube (53) provided with a suction connection (52) configured to connect to a valve of a trocar (62) positioned on a cavity (66) of the body of a patient,

- a motor (71, 82) for sucking the gas coming from at least one suction connection and discharging this gas in at least one outlet connection (61),

- an autonomous energy source (72) to power the engine,

- a manual switch (70) for controlling the supply of the motor by the autonomous energy source,

- at least one delivery tube (55, 58, 60) provided with an outlet connection (61) configured to connect to a trocar valve (63) positioned on the cavity of the patient's body and / or to an inlet (123) gas injection accessory on the optical window at the distal end of an endoscope (1 17) inserted in a trocar (63) positioned on the cavity of the patient's body and

- at least one filter (54, 56) placed on the path of the gas circulating in the device.

2. Device (50) according to claim 1, which comprises a motor housing (51, 81, 301) comprising the motor (71, 82, 302), the autonomous energy source (72, 305, 325), l '' manual switch (70, 310), connections (67, 68, 87, 88, 306, 307) for the supply (53) and discharge (55) tubes and, optionally, at least one filter, the housing comprising:

- a first part (31 1, 321) comprising at least the motor (71, 82, 302),

- a second part (314) comprising at least connections (67, 68, 87, 88, 306, 307) for the supply (53) and discharge (55) tubes and a wheel or propeller (74, 84, 306) rotary pump positioned between the supply and discharge tubes and

- attachment means (313, 304, 308, 309), detachable without tools, from the first part to the second part, said attachment means comprising a coupler (309) connecting a motor shaft to a the wheel or propeller.

3. Device according to claim 2, in which the coupler (309) is a mechanical coupler comprising a gear.

4. Device according to claim 3, wherein the coupler is a magnetic coupler.

5. Device according to one of claims 2 to 4, wherein the autonomous energy source (305) is integrated into the first part.

6. Device according to one of claims 2 to 4, wherein the autonomous energy source (325) is in mechanical contact with the first and with the second part.

7. Device according to one of claims 2 to 6, in which the first part further comprises a switch (310) which controls the operation of the engine.

8. Device according to one of claims 2 to 7, in which the second part (314) comprises a housing for the first part (31 1, 321).

9. Device according to claim 8, wherein the second part (314) takes the form of a sealed housing provided with a cover (313), housing whose sealing is obtained by fitting the cover on a base.

10. Device according to one of claims 8 or 9, wherein the second part comprises a flexible membrane (312) for transmitting a manual pressure exerted by a user, to a switch (310) for controlling the engine.

1 1. Device according to one of claims 2 to 10, which further comprises a charger (323) for recharging the autonomous energy source (315).

12. Device according to claim 1 1, in which the charger (323) comprises a housing for the first part (31 1) and electrical pads on which two electrical contacts of the first part bear in electrical connection with the energy source autonomous (315), when the first part is inserted in the charger housing.

13. Device (50) according to one of claims 1 or 12, wherein the autonomous power source (72) and the motor (71, 82) are configured to ensure a constant flow throughout an operation d '' duration of 10 hours.

14. Device (50) according to one of claims 1 to 13, which further comprises at least one manual pump (59) for accelerating gas speed on at least one gas delivery tube (60).

15. Device (50) according to one of claims 1 to 14, wherein at least one filter (54) is configured to capture the fumes from the cauterization of organ tissues.

16. Device (50) according to one of claims 1 to 15, wherein at least one filter (54) is configured to capture at least part of the humidity of the gas circulating in the device.

17. Device (50) according to one of claims 1 to 16, which comprises a filter (56) configured to capture the particles emitted by the engine (71, 82) in movement, downstream of the engine.

18. Device (50) according to one of claims 1 to 17, which comprises a liquid inlet (1 16), a rigid tube (1 10) for endoscope (1 17) provided with a gas inlet (123) , a nozzle (1 1 1, 1 12) configured to surround the distal end of an endoscope (1 17), the nozzle comprising means (130, 131) for distributing liquid on an optical window at the distal end of the endoscope, the gas and the liquid passing under multiphase fluid forms the rigid endoscope tube to the optical window at the distal end of the endoscope.

19. Device (50) according to claim 18, wherein the liquid supply comprises a connection (124) for syringe.

20. Device (50) according to one of claims 18 or 19, wherein the liquid supply (1 16) comprises a reservoir provided with a rotary piston.