surgical device and accessories

专利摘要:
Surgical Device and Accessories The present invention relates to a device designed for surgical interventions comprising (i) an operable / orientable inner end (1), (ii) a user-operated outer end (3) and (iii) ) a middle part (2) that connects both ends (1, 3). According to the principal concept of the present invention, it further comprises power transmission units extending between the outer (3) and inner (1) ends, and said power transmission units, the outer and inner ends and the middle part (2) being designed to transfer the movements from the outer end (3) to the inner end (1) identically, as if the inner end (1) were the direct continuation of the outer part (3).
公开号:BR112012004792B1
申请号:R112012004792-2
申请日:2010-09-02
公开日:2019-11-12
发明作者:Csiky László
申请人:Laszlo Csiky；
IPC主号:

专利说明:

SURGICAL DEVICE AND ACCESSORIES
The present invention is a surgical device system developed for the new types of surgical procedures, which is - advantageously similar to the laparoscopic technique - capable of performing all stages (access, surgical intervention and closure) of NOTES procedures (“Natural Orifice Transluminal Endoscopic Surgery ”- Transluminal Endoscopic Surgery by Natural Orifices), SPLS (“ Single Port Laparoscopic Surgery ”- Laparoscopic Surgery by Single Portal) and IE (“ Interventional Endoscopy ”- Interventional Endoscopy), and the said device system - according to an advantageous realization - comprises laparoendoscopic instrument, trocars gloves, an endoscopic tube or device, and additional connectable accessories.
In recent years, the association of the so-called minimal invasive surgery (that is, laparoscopic surgery, typically using thin, rigid straight instruments) and endoscopy (that is, interventions inside hollow organs through the natural orifices characteristically with flexible instruments) resulted in the appearance of the NOTES technique (Transluminal Endoscopic Surgery for Natural Orifices), which was recently applied mainly in experimental surgery. The desired advantage of NOTES compared to laparoscopic surgery (surgery through small abdominal incisions) includes the additional minimization of surgical intervention and the operative risk in the treatment of certain diseases. However, in order to carry out NOTES intra-abdominal interventions (for example, removal of the gallbladder, appendix, connection of the ovarian tubes, etc.) it is necessary (i) to insert a flexible endoscopic system, for example, through the mouth, vagina or the rectum, in the abdominal cavity through the wall of the hollow organ, (ii) perform the surgical intervention with the device in the abdominal cavity, (iii) remove the necessary tissues or organs from the body, (iv) safely close the opening created artificially on the hollow organ wall at the end of the procedure, and (v) remove the system from the device through the natural orifice.
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According to current research there is no device system available that is capable of performing all the steps of the interventions mentioned above on its own (ie, the complete NOTES or SPLS). It should be noted that the devices currently available, which can perform only a single part of the entire procedure, are not yet sufficiently reliable, and in most cases their uses are difficult and uncomfortable. It is still a challenging problem to have these instruments fixed inside the abdominal cavity, to have them arranged in a triangular pattern (the so-called triangulation) in order to obtain their best coordination and cooperation, and in order to safely close the opening created artificially on the hollow organ wall, respectively. The difficulties mentioned above can lead to severe complications, occasionally life-threatening, for example, damage to vital organs, hemorrhage or peritonitis.
There are many of several devices developed for NOTES interventions. Its properties are usually the result of various combinations of laparoscopic and endoscopic characteristics.
One of the most promising recent solutions is described in patent application US / 2007/086079. According to this description, flexible instruments are inserted into the abdominal cavity through working channels of a device similar to an endoscopic tube. The inner end of this endoscopic dap is controlled by its outer end, using traditional technical solutions. The internal ends of the instruments inserted in the endoscopic tube-like device are also controllable by a bulky device, which is coupled to the outer end of the endoscopic tube-like device. However, the disadvantage of this solution is that the coupling of the internal ends of the instruments and the device similar to an endoscopic tube, and the appropriate triangulation of the instruments remain unsolved. Another disadvantage is that the device that controls the internal ends of the instruments is relatively bulky, and in cases of insertion of a new instrument, it requires additional assembly, and, in addition, in view of its relatively large size, it requires more space when more than two instruments are inserted. Additionally, this
3/59 solution does not follow well-prepared and reliable laparoscopic maneuvers, but requires new types of maneuvers. Its main problem is not related to the need to learn a new technique, but to the fact that when any complication occurs during a procedure, it is advantageous to solve the laparoscopic technique. The different techniques can antagonize each other when they are used simultaneously.
Another innovative idea is described in patent application W0 / 2008/131046. This instrument is a simple modification of traditional laparoscopic instruments: both the instrument head and cable are foldable simultaneously. The cable folding controls the synchronous folding of the head by wires. In fact, this instrument was developed primarily for SPLS (Single Port Laparoscopic Surgery), where the central part is usually used to enter the abdominal cavity. This new SPLS method is considered to be an alternative to the NOTES technique. In fact, SPLS is a variation of laparoscopy. An important disadvantage of this solution is that the movements of the internal and external extremities of the mentioned instrument are in the opposite direction when compared to the conventional laparoscopic instrument, and this is really difficult to do. The relative accumulation of instruments in the ideas mentioned above is another disadvantage, which can endanger the effectiveness and safety of these procedures.
It is clear from the above that there is a need to develop such a laparo-endoscopic system, with which all stages of the NOTES, SPLS or IE procedures can be reliably completed through natural orifices, similar to the well-known and developed laparoscopic technique. .
The objective of the present invention is to develop a device system to reduce the possibility of complications due to immature solutions or unsolved problems of NOTES, SPLS or IE, which allows the easier, faster and safer performance of all the steps of the procedures NOTES, SPLS or IE through natural holes similar to the reliable and well-developed laparoscopic technique.
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The present invention is based on the recognition that (i) the complex internal and external ends of the device system - acting as a continuation of each other - are considered as a unit presenting laparoscopic characteristics, while the middle part - which connects the internal ends and external - it is seen as a unit with flexible endoscopic characteristics, and that (ii) the movements of the internal and external extremities of the device introduced with the aid of an endoscope-like device through natural holes - are synchronized to move with it time and same degree as the internal and external parts of a traditional laparoscopic instrument, and that (iii) an appropriately modified endoscopic stapler is used with the aid of accessory devices coupled to the device system, they will make it possible to perform all the steps of NOTES, SPLS or IE procedures is easier, faster and safer.
Based on the above recognition, the problem mentioned above will be solved by the application of devices designed for surgical interventions, which comprise internal ends orientable to the field of operation, external ends operated by the user and parts of the medium connecting the inner ends and the outer ends. The main idea of the invention is that it contains units of transmission force that extend between the internal and external ends, and the units of transmission force, the internal and external ends and the middle part are constructed in such a way that any movements of the the driven outer end is transferred in an equivalent degree to the inner end, as if the inner end were a direct continuation of the outer end.
Advantageously, a channel is found inside the device, and the power transmission unit comprises a first first power transmission unit that allows the inner and outer ends to be bent simultaneously at the same angle of rotation and in the same direction of rotation with respect to the middle part, and a second transmission unit that transfers the longitudinal / axial movements of the outer and inner ends together simultaneously with the same degree, but in the opposite direction, respectively.
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The outer end and inner end and the middle part of the device are advantageously components of an instrument or trocar sleeve. Advantageously, the outer and inner ends are connected to the middle part by joints. Advantageously, both the outer and inner ends are telescopic. The first and second force transmission units can be integrated into a device, that is, either the surgical instrument or the trocar sleeve, however, according to another possible embodiment one of the two transmission force units is incorporated in the surgical instrument and the other force transmission unit in the trocar sleeve that contains the surgical instrument inside.
In addition, the object of the present invention is an endoscopic tube or device capable of receiving one or more surgical instruments and / or trocars gloves, and the endoscopic tube or device being designed to be able to place the inner ends of the instruments and / or the trocars gloves in the field of operation, and also the inner end of the tube or endoscopic device is in a shape that allows proper fixation and triangulation of the surgical instruments and / or trocars gloves.
In addition, the objective of the present invention is a wound closure device system, which, according to its main concept, contains an implant tube attachable to other devices and an implant wrapper, there are locking elements and a nail implant - this implant stem is operable through its outer end and serves to release these locking elements from the wrapper - inside the implant wrapper, and wires are found connecting to each locking element, and the wires are placed through the longitudinal split of the envelope and the outer end of the tube, and advantageously the implant tube, the envelope and the implant stem are flexible.
In addition, another object of the present invention is an endoscopic stapler, which has a body part and a head part that are advantageously connected together, and also has opposite stapling surfaces on the head part with a control wire - this allows tension
6/59 or relaxation - extending between its free ends, and said thread is advantageously placed inside a longitudinal channel formed inside the head and body of the stapler.
In addition, another object of the present invention is a protective wrapper attachable to the outer surface of one or more surgical instruments or one or more trocars gloves or to the outer surface of a tube or endoscopic device containing one or more surgical instruments or gloves trocars.
In addition, another objective of the present invention is an endoscopic balloon tube, which features two inflatable balloon rings located at an appropriate distance from each other, and also features at least one gas tube that allows the balloons to inflate, and said endoscopic balloon tube can be disposed in the inner region of one or more surgical instruments or one or more trocars gloves or in the inner region of an endoscopic tube or device that contains one or more surgical instruments or trocars gloves.
In addition, another objective of the present invention is a catheter that can be inserted into the working channel of a trocar sleeve, tube or endoscopic device, and said catheter has an electrical unit - which is capable of cutting or joining tissues mounted on the inner end advantageously at the tip of the catheter, said electrical unit has an electrical wiring extending along the catheter, and said electrical wiring being connectable to a source of electrical energy.
According to an advantageous embodiment, the surgical instrument is inserted into the trocar sleeve, and the trocar gloves are inserted into the tube or endoscopic device partially or completely flexible. Advantageously, the connections between the tube or endoscopic device and the trocars gloves and surgical instruments allow both axial and rotational movements with each other. If required, additional accessory devices (for example, protective wrapping, wound closure device, endoscopic stapler, etc.) can be attached to their internal and external surfaces. Advantageously, all connections allow movement or longitudinal sliding along the longitudinal axis and rotation around the longitudinal axis, respectively.
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According to an advantageous embodiment of the surgical instruments, the surgical instrument advantageously consists of three parts: the part of the perpendicularly flexible middle and the two rigid inner and outer ends extending telescopically, and said inner and outer ends are connected to the middle part via of joint-like joints. Advantageously, the segments of the middle part adjacent to the joints are also rigid. The cross section of the instrument is advantageously circular.
Advantageously, the outer and inner ends of the instrument are simultaneously foldable at the joints with respect to the middle part at the same angle of rotation and in the same direction of rotation (when the middle part is in the straight position, the axis of rotation of the end outer and inner ends in the joints are parallel to each other), as if the outer and inner ends were the components of a traditional laparoscopic instrument. The folding of the inner and outer ends is advantageously performed only in a common plane (in the case that the middle part is in the straight position) and advantageously through a pair of opposite wires, and said wires extending from the inner end through all the joints and from the middle to the opposite outer end. Certainly, other realizations make it possible for the joints to be foldable in more than one common plane using more than one pair of opposite wires. It is obvious that any recent technical solution is also acceptable for obtaining the folding mechanism described above. Such a solution can be a flexible or rigid drive rod that is placed inside the middle part and is connected to both the outer and inner ends.
In fact, any recent solutions regarding joint construction can offer the benefits mentioned above. The joints connecting the outer end and the inner end with the middle part can have more than one component.
There is a releasable locking rack located on the joint that connects the middle part and the outer part to each other. The racking mechanism with the lock can establish the desired angle between the middle part and the end
8/59 outer and the inner end transiently or permanently. The locking function is activated or deactivated when desired.
The telescopic ends consist of rigid straight tubes, which are insertable into each other. The head of the surgical instrument is located on the inner telescopic end, and is advantageously constructed similarly to the head of any recently used laparoscopic instrument, including also the camera. The cable is located on the outer telescopic end of the surgical instrument, and advantageously is also constructed similarly to the cable of any recently used laparoscopic instrument, including the camera. The opening and closing movements of the instrument handle control the function of the head with the help of a wire that extends from the outer end through the middle part to the inner end. The functions of the instrument, according to the present invention, also offer the same functions as any current instruments designed for any type of energy transmission (for example, electric, ultrasonic, etc.) in the surgical field.
Despite the fact that the inner and outer telescopic ends are separated from each other by the middle part, they move together simultaneously, as if they were a direct continuation of each other, similar to the movements of the inner and outer ends of a straight traditional laparoscopic instrument. When, for example, the outer telescopic end is pushed to some extent, that is, its length is reduced, the length of the inner telescopic end simultaneously becomes elongated to the same extent, and this works, of course, vice versa. This movement is triggered by the force transmission unit located inside the surgical instrument.
According to an advantageous embodiment, this force transmission unit is located inside the instrument channel and advantageously consists of ball-shaped force transmission particles. The channel extends from the inner telescopic end through the middle part to the outer telescopic end. The total length of the channel is filled with balls. The diameter of the ball is somewhat smaller than the inner diameter of the channel. Advantageously, holes are found in the middle
9/59 of the balls, and the driving wire moves through these holes from the cable to the head. Advantageously, the channel is provided with anti-friction material. Advantageously, the ball-shaped transmission particles are able to pass easily through the channels in the joints. When the instrument cable is pressed forward, the cable pushes the last ball into the channel of the outer telescopic end. The adjacent balls transfer this buoyant force to each other, and at least the first ball in the inner end channel pushes the instrument head forward, resulting in the elongation of the inner telescopic end. In order to execute the movement in the opposite direction, which is to reduce the length of the inner telescopic end, it is advantageous to use a wire that connects the two telescopic ends, and for this purpose the driving wire is also acceptable. When the cable is pulled from the instrument, the outer telescopic end becomes elongated and the wire - attached to the cable - simultaneously pulls the inner telescopic end. If free transmission is guaranteed, any form other than the ball shape is suitable. The collapsible connections between the force transmission particles, which are connected by the driving wire, are designed to resist compression along the longitudinal axis and to resist torsion around the longitudinal axis.
According to another advantageous embodiment, the power transmission unit is advantageously a hydraulic unit with an elastic cap, and said hydraulic unit is located inside the channel described above. According to an advantageous embodiment, the hydraulic unit has three parts: the inner end and the outer end and the middle part. The three parts of the hydraulic unit communicate with each other and together form a common cavity. This hydraulic unit is a closed system and the hydraulic fluid does not communicate with the external environment, it only flows through the three parts of the common cavity. The middle part of the hydraulic unit is advantageously located in the channel of the middle part of the instrument, and its lengths are the same, and said middle part of the hydraulic unit is fixed in the channel in order to avoid displacement. The inner and outer ends of the hydraulic unit are located inside the channels of the inner and outer telescopic ends of the instrument. The edge
10/59 inner and outer end of the hydraulic unit are advantageously designed to allow only longitudinal expansion or reduction along its longitudinal axes without any change in their diameters. The capsules at the ends of the hydraulic unit are advantageously capable of moving within the channels of the ends of the instrument along its longitudinal axis. A possible advantageous solution with regard to the ends of the hydraulic unit would be the accordion-shaped folding of the walls at both ends. When the outer telescopic end is compressed longitudinally because the cable is pressed, the outer end of the accordion-shaped hydraulic unit is simultaneously compressed along its longitudinal axis. In this way, the high pressure inside the external end of the hydraulic unit is transferred through the part of the hydraulic medium fixed to the internal end resulting in the longitudinal expansion of the accordion-folded hydraulic end, which also leads to elongation of the telescopic inner end. Advantageously, the length of the elongation and the length of the shortening are the same. Along with the accordion-folded design, a similar result can be obtained if the wall of the hydraulic unit is made of an appropriately elastic material. In order to carry out the movement in the opposite direction in order to reduce the length of the internal telescopic end, it is advantageous to use a wire that connects the two telescopic ends, and for this purpose the driving wire is also acceptable. When the instrument cable is pulled, the outer telescopic end becomes elongated and the wire attached to the cable - simultaneously pulls the inner telescopic end.
Yet another possible design of the power transmission unit is a flexible housing placed within the instrument channel, which, according to an advantageous solution, is a spiral spring or a plastic tube. The drive wire is inside the flexible housing. Advantageously, the flexible housing has insulating properties. Advantageously, the flexible housing resists compression along the longitudinal axis and also resists torsion around the longitudinal axis.
The head located at the inner end of the instrument can be rotated around the longitudinal axis. The rotation of the head is controlled by the rotation of the
11/59 outer end of the instrument, advantageously without the need to rotate the cable. The rotation of the cable advantageously is independent of the rotation of the head. Advantageously, the head located at the inner and outer ends rotates to the same degree. The rotation of the head and the inner end by the outer end is performed by means of the connected force transmission particles - said connections between the particles resist the effects of torsion around the longitudinal axis as previously described, or are performed through the flexible housing that also resists the effects of torsion around the longitudinal axis. In fact, any other known solutions are acceptable with regard to head rotation.
In the middle part of the instrument at least one connection ring connection ring is advantageously placed for the connection between the tube and the instrument. The instrument is easily rotatable inside the ring. There is a connection groove formed on the outer surface of the ring. According to another advantageous solution, a needle filament is connected to the ring which assists in fixing the middle part of the instrument to any part of the abdominal wall.
According to another advantageous embodiment, the instrument can be attached to the tube using a simple trocar sleeve. There is a sliding connection between the tube and the trocar sleeve, and the middle part of the instrument is located in the trocar sleeve. The middle part of the instrument is advantageously longer than the trocar sleeve. The instrument can be rotated back and forth in a sliding way inside the trocar sleeve. Advantageously, there is a valve and an airtight ring at the outer end of the trocar sleeve.
According to another advantageous embodiment, the instrument has three main components: the partially flexible middle part and the rigid telescopically extendable inner and outer ends which are connected to the middle part by joint-like joints. The power transmission system is the same as that described above. The instrument does not have a wire to perform the folding of the telescopic ends. According to this solution, the instrument is connected to the tube with a trocar sleeve that has a middle part
12/59 partially or totally flexible, and the outer end and inner end rigid which are connected to the middle part through joints. The folding of the outer and inner ends is carried out by the opposite wires located inside the trocar sleeve. Advantageously, the rack mechanism is mounted on the outer hinge. Advantageously, there is a valve and an airtight ring located at the outer end of the trocar sleeve.
The length of the middle part of the trocar sleeve is advantageously longer than the length of the tube. There is a sliding connection between the trocar sleeve and the tube. The length of the middle part of the instrument is advantageously longer than the length of the middle part of the trocar sleeve. The instrument inside the trocar sleeve is easily movable along the longitudinal axis and also rotatable around the longitudinal axis.
According to another advantageous embodiment, the instrument consists of three main parts: the flexible medium part and the rigid non-telescopic outer and inner ends. The driving wire is located inside the instrument. There is no additional force transmission unit inside the instrument, as this transmission function is performed by the middle part and the two rigid ends.
An instrument constructed in this way is advantageously connected to the tube through a trocar sleeve that has a part of the middle partially or totally flexible and with joints connected to the outer and inner ends of the telescopic rigid. Simultaneous folding of the joints, as described above, is carried out by the opposite wires located inside the trocar sleeve wall. Similarly, the rack mechanism can be formed on the external joint. The simultaneous elongation and shortening of the telescopic ends of the trocar sleeve is the result of the instrument's forward or backward movements within the trocar sleeve. Advantageously, there is a sliding connection between the trocar sleeve and the tube, which allows free movement along the longitudinal axis. Advantageously, the sliding connection is obtained by at least one connection ring located in the middle part of the trocar sleeve, and said ring is freely
13/59 rotatable around the middle. Advantageously, the ring has a connection groove that is connected to the rail mounted on the inner surface of the tube. There is an airtight valve and a ring at the outer end of the trocar sleeve.
According to an advantageous embodiment, the trocar sleeves are connected to each other via sliding connections mounted longitudinally on their outer surfaces, and each trocar sleeve is connected with the two adjacent trocar sleeves to form a cylindrical arrangement. Advantageously, four connected trocar gloves are sufficient to perform most surgical interventions. In this case, the cross section of each connected trocar sleeve is advantageously a quarter of a sector, and together they form a complete circle, in this way, the common external cylindrical shape produces the smoothest possible intervention (for example, when it penetrates through the gastric wall). The sliding connections (a groove or a rail that interlock with each other) are located on the flat surface of the trocar sleeves, and said sliding connections allow the longitudinal movements of the trocar sleeves relatively to each other. This type of trocar sleeve has two flat surfaces, one of which contains the groove and the other contains the rail that matches the groove. The cross sections of the working channels of the trocar gloves are advantageously rounded. This type of trocart gloves can be partially or totally flexible or rigid. The inner end of the trocar sleeves can be an oblique plane that allows easier penetration through the stomach wall.
According to this possible solution, the trocars gloves with sector cross sections, rigid internal and external telescopic ends are advantageously coupled by means of joints. Advantageously, the cross sections of the telescopic ends are round, and the said ends are rotatable with respect to the middle part around the longitudinal axis. In this case, there is no power transmission unit to drive the telescopic ends. This telescopic function is performed by the surgical instrument located inside the working channel of the telescopic trocar sleeve, and said instrument has a flexible medium part and the rigid outer and inner ends, and is capable of moving longitudinally forward and back in the working channel. The folding
14/59 simultaneous of the telescopic ends in their joints are advantageously directed by a pair of opposite wires located inside the trocar sleeve. At the outer end of the trocar sleeve is an airtight valve and a sealing ring.
There are several other possible solutions for connecting the trocar gloves to each other. According to an advantageous embodiment, the additional trocar sleeves are connected to the outer surface of a double trocar sleeve by means of sliding connections. Advantageously, the trocar sleeves are coupled to the joint portion of the double trocar sleeve. In addition, more grooves or connecting rails can be formed on the outer surfaces of the double trocar sleeve or in additionally attached trocar gloves to connect them, for example, with a wire, rod or rod in order to ensure their attachment to the abdominal wall .
According to another advantageous embodiment, the trocar sleeves are connected to the outer surface of a trocar guide via sliding connections. The connection slots or rails are mounted on the outer surface of the trocar guide. Within the trocar guide a smaller diameter working channel can be located, which can be used to insert, for example, a balloon access catheter. The inner end of the trocar guide is advantageously pointed. In accordance with yet another advantageous embodiment, the additional trocar sleeves are attached to a central trocar sleeve by means of sliding connections. Advantageously, the external cross section of the central trocar sleeve is optional, while the cross section of the working channel inside the central trocar sleeve is round. Advantageously, there may be more channels located inside the central trocar sleeve, for example, gas or aspiration-irrigation channels. The connection slots or rails are mounted on the outer surface of the central trocar sleeve.
It is not necessary to have a tube to insert the trocars gloves, if they are coupled together. The trocars gloves can be fixed to the abdominal wall transiently or permanently with a ring located advantageously close to the inner end of the middle part. The fixation is possible with a filament with a needle, or with a rigid rod or with a control rod. The gloves of
15/59 trocars connected within the ring are free to move and to rotate around the longitudinal axis, respectively. In this case, no tubes are used, advantageously there may be connection grooves or rails formed on the outer surfaces of the trocar sleeves to allow the connection of other endoscopic devices.
The trocars gloves connected to each other by sliding connections are also capable of being inserted into the abdominal cavity or attached to the abdominal wall with the aid of a simple tube partially or totally flexible. In this case, there is no groove or rail formed inside the tube, they are formed only on the outer surface of the tube. The inner end of the tube can have a normal (ie, flat), oblique or step shape. There may be a filament, rod or rod connected to the outer surface of the inner end of the tube, each of which allows the tube to be attached to the abdominal wall. The rod may have a connection base that fits in the connection groove advantageously longitudinally on the outer surface of the tube, and said connection base is sliding inside the groove. In this case, the inner end of the tube, which is attached to the abdominal wall with the rod, is slid back and forth with the aid of the connection base, thus allowing the proper adjustment of the inner end in the designated operating field. At the same time, with the aid of the rigid rod or rod, the inner end of the tube is easily maneuverable to any desired part of the intra-abdominal cavity, or is flexible in any location or position, respectively. Certainly, several other external endoscopic devices (for example, wound closure device, camera, forceps, etc.) can be connected to the groove located on the outer surface of the tube.
In the following section, tubes and endoscopic devices containing surgical instruments and / or trocars gloves will be discussed in their possible advantageous realizations.
The tube refers to a solution, which has a long cylindrical body advantageously with a single internal lumen, in which surgical instruments, trocars or other accessory devices can be inserted in this lumen.
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According to the simplest advantageous solution, both ends of the tube are normal (ie straight). Advantageously, the outer and inner ends of the tube can be rigid and the middle part can be flexible. The inner diameter of the tube makes it possible to insert more than one - advantageously four trocars. The inner surface of the tube may be completely smooth, or according to an advantageous embodiment, it may have connection grooves or longitudinal rails on the inner surface. Advantageously, connection grooves or longitudinal tracks may also exist on the outer surface of the pipe. A filament, a rod or a rod can be coupled to the outer surface of the tube, advantageously in the region of the inner end. Advantageously, there is a joint similar to the joint between the inner end and the middle part of the tube. The inner end is foldable at the joint in relation to the middle part with the aid of a pair of wires that extends longitudinally across the entire tube, and a hinge device mounted at the outer end of the tube. The opening of the inner end of the tube can be normal (that is, straight), oblique or in the form of a step. The internal opening is straight if the plane of the internal opening is perpendicular to the longitudinal axis of the tube. The internal opening is oblique if the plane of the internal opening is not perpendicular to the longitudinal axis of the tube. The internal opening is in the form of a step if the straight or oblique opening is combined with an opening located on the side of the inner end of the tube (the plane of the lateral opening is advantageously parallel to that of the longitudinal axis). The step-shaped opening has a greater advantage since it significantly increases the size of the intervention area and ensures easier maneuvers. The larger the opening of the inner end facing the operating field, the greater the freedom of movement of the instruments. This opening area can be easily increased to the desired size by further increasing the size of the component's side opening.
The increased diameter of the internal opening makes it possible to arbitrarily increase the distance between the internal joints of the instruments by pressing the instruments in relation to each other along their longitudinal axis. The possible extent of displacement of the instruments is advantageously determined by the
17/59 larger diameter of the internal opening. According to an advantageous solution, the direction of the largest diameter of the inner opening tends towards the direction of the longitudinal axis of the device. During laparoscopic surgery, the intervention can be performed optimally only in the case of the operative field and the two operative instruments form a triangle with an appropriate wide base (this is the so-called triangulation), and the said base of the triangle is determined by the distance between the two instruments inserted in the abdominal cavity. In the case of laparoscopic surgery, the size of the base of the triangle - that is, the distance between the two surgical instruments - is changeable only if one of the instruments is removed and then re-inserted through another location - that is, a new wound - in the abdominal cavity through the abdominal wall.
According to the present invention, the size of the triangulation base can be changed (increased or reduced) without the need to create additional injuries through the abdominal wall. In the case of an oblique opening or a step-shaped opening, the size of the base of the triangle is determined by the larger diameter of the inner opening. The distance between the internal joints of the instruments (that is, the size of the base of the triangle) is optionally changeable (increase or decrease) by the relative changes of the instruments along its longitudinal axis, depending on the larger diameter of the internal opening. In the case of a tube or endoscopic device with a normal (straight) end, the size of the base of the triangle is unfortunately small, in contrast, the oblique or stepped shape of the open inner end provides a significantly larger size. In addition, the step-shaped opening is more advantageous than the oblique opening in order to ensure reliable connections - said connections allow movements along the longitudinal axis and rotation around the longitudinal axis - of at least two instruments or trocars gloves to the tube or the endoscopic device within the entire length of the internal opening. The reliable connection between the instruments or the trocar sleeve and the inner end of the tube or endoscopic device ensures proper stability for the inner end of the instrument or the trocar sleeve in order to perform the surgical intervention with safe maneuvers. It is a considerable advantage of the present invention that
18/59 allow the optional and stable change of the size of the triangle base without creating additional injuries, and in addition, allow the optional change in the position of the inner end of the tube or endoscopic device (for example, with a control rod) and fixing the inner end in the new position to ensure optimal access to any operating field. For all these reasons, adjustable telescopic ends are also necessary.
The ability to arbitrarily change the size and / or position of the triangulation base without the need to create additional injuries is considered to be a significant advantage over the recently used modern laparoscopic technique.
An independent opening can also be located in the middle wall of the tube. Advantageously, there is an articulation device, a gas connection, and an airtight lid arbitrarily detachable or attachable, closing the external opening, mounted on the outer end of the tube. The cover is attached to the outer end by means of threaded screws or any other known hermetic connection. There are valve openings in the cover.
In the case of SPLS procedures, advantageously the entire tube is rigid.
In the case of any of the solutions mentioned above, an optional external fixation device can be attached to the external end of any instrument, trocar sleeve, tube or endoscopic device, and said external fixation device is capable of securely fixing the external end. transient or permanent in a desired position.
In the case of any of the above solutions, the inner end of any instrument, trocar sleeve, tube or endoscopic device, can be fixed by means of a filament, or a rod or a control rod, being attached to the inner end, to the wall abdominal and / or an external fixation device.
The endoscopic device refers to a solution, which has a long cylindrical body advantageously with more than one internal working channel. Advantageously, there may be connection grooves or rails formed on the outer surface of any type of endoscopic device in order to establish connections
19/59 additional external (for example, with a filament, rod, control rod, stomach closure device, etc.). According to an advantageous embodiment, there may be a joint formed at the inner end of any type of endoscopic device, and said joint is bent by a pair of wires and a hinge device. This pair of wires extends through the entire endoscopic device and is connected to the hinge device located at the outer end of the endoscopic device. The inner and outer ends of any type of endoscopic device are advantageously rigid and the middle part can be flexible or rigid. Any endoscopic device can optionally contain a gas channel and a suction-irrigation channel.
According to a possible advantageous solution, the endoscopic device is divided. In this case, the endoscopic device is partially or totally divided into two parts (top and bottom) by a plane that is advantageously parallel to the longitudinal axis. The two parts are connected to each other by a sliding connection, and are optionally movable back and forth along their longitudinal axis in relation to each other. The dividing plane can divide the working channel within the endoscopic device into two complementary divided working channels. When the two divided parts of the endoscopic device are interchanged longitudinally in relation to each other, the divided working channels become free at their internal ends. The instruments fold into their internal joints and are easily movable back and forth within the free part of the divided working channels with or without the trocars gloves. The free part of the divided working channel is advantageous in that it allows the telescopic inner end and the instrument head - that is, the part that is distal to the inner joint - to leave the divided working channel along the entire length its free part in order to reach the intervention area. The length of the free parts of the divided work channels can be optionally changed (increase or decrease) by changing the two endoscopic parts divided longitudinally in relation to each other. According to an advantageous arrangement of the four working channels, the dividing plane of the endoscopic device into two longitudinal parts also longitudinally divides two channels
20/59 opposing work. The other two working channels - advantageously the upper and lower channels - remain intact. The normal or oblique internal ends of the divided endoscopic device can be transformed into a step-shaped internal end by the longitudinal exchange of the two parts 5 (advantageously only the upper part or only the internal part) in relation to each other.
According to a possible advantageous embodiment, an outer end of the divided endoscopic device is rigid. The rigid end of the upper part of the device is completed for a complete cylinder, such that the rigid end of the sliding lower part is also inside the cylinder. The complete outer end 10 for a complete cylinder is airtight and advantageously has four openings with airtight valves, and said openings are the opening openings of the intact or divided working channels located within the endoscopic device. The hermetic closure of the common cylindrical end can also be obtained by an optionally protectable cover with inlet openings and 15 hermetic valves.
Advantageously, the trocar axis - that is, the continuation similar to a rigid tube at the bottom - leaves the common cylindrical end through the lower external opening. The trocar axis - provided with a valve - is the external continuation of the intact working channel located inside the lower endoscopic part, 20 and the said trocar axis, which extends through the lower external opening, presents a cable similar to an ear on the outer end that aids in the movement of the lower endoscopic part longitudinally backwards and forwards. Advantageously, the trocar axis is moved in and out through the lower outer opening of the common cylindrical end with the aid of an ear-like handle, which consequently means longitudinal movement back and forth from the inner end of the part lower endoscopic view. In this way, the size of the internal opening in the form of a step - and consequently the size of the intervention area - is optionally adjustable.
According to another possible solution, the plane that divides the endoscopic device 30 parallel to the longitudinal axis does not divide any of the channels of
21/59 work. Advantageously, both the upper and lower endoscopic part contain two intact working channels. In this case, the shape of the outer end of the endoscopic device can be a common cylinder similar to the previous solution, except that now two axes of rigid trocars, which are the external continuation of the two working channels of the lower endoscopic part, exit through the two openings lower external edges of the common cylindrical end.
According to another possible solution, the outer ends of the divided endoscopic device are similarly divided as the inner ends, and both outer ends are hermetically sealed. The lower and upper outer ends have external openings with airtight valves. In this case, any endoscopic part - the upper and lower endoscopic parts are connected to each other by a sliding connection - can be removed from the patient and can be replaced with a larger instrument (for example, an endoscopic stapler), or through the space of the part endoscopic removed also tissue or organ samples can be removed.
According to another advantageous embodiment, the endoscopic device is solid and not divided. The opening of the inner end of the device can be normal, or oblique or in the form of a step. In the event that the inner end has a step-shaped opening, there may be one or more working channels partially divided advantageously only in the inner end region, in order to obtain the advantages detailed above. Advantageously, the upper and lower working channels are intact (that is, not divided) while the other working channels on both sides are divided at their inner ends. Of course, it is also possible to have a pair of intact (i.e., undivided) upper working channels and a pair of intact lower working channels. The outer end of the undivided endoscopic device is hermetically sealed and there are external openings with hermetic valves, and said external openings are the entrances of the working channels.
Inside the divided working channels of any type of endoscopic device there are sliding connections (for example, sliding ring,
22/59 connection or rail) allowing proper coupling and fixation, and longitudinal movement back and forth of the trocar sleeve or inserted instrument. These connection components (for example, sliding ring, connection groove or rail) are connected to the connection components of instruments or trocars.
The outer end of any type of tube or endoscopic device may have a cone shape. This is advantageous because it allows easier manipulation of the instrument's outer edges.
Any type of instruments, trocars gloves, tubes or endoscopic devices mentioned above can be combined to perform the NOTES / SPLS procedures properly.
Advantageously, any type of tube or endoscopic device can have a protective casing. The protective casing is advantageously in the form of a cone and is made of a material similar to a resistant adhesive film, which at the outer end has a connection ring or tube - capable of hermetically connecting to the outer end of a tube or an endoscopic device - and on the inner end it has an expandable ring. The protective shell covers the tube or endoscopic device. The protective shell is inserted through a natural hole in the abdominal cavity through the wound in the wall of a hollow organ, advantageously in a rolled-up position on the tube or endoscopic device. When the protective shell enters the abdominal cavity, the expandable cone-shaped inner end with the expandable ring and the contraction wound around the protective shell prevents gas from escaping from the inflated abdominal cavity. In addition, the protective casing protects the hollow organ wall and the surrounding area from injury from moving instruments, and prevents contact with contaminated secretions, or with diseased tissues or organs. The cone-shaped inner end (that is, the inner end has a larger circumference) allows the removal of tissues or organs more easily. Of course, any other shape of the protective wrapper can be among the possible solutions.
According to another solution, an independently inflatable endoscopic balloon tube can be advantageously placed in the end region
23/59 internal tube or endoscopic device. This device is placed on the wound in the wall of a hollow organ, in order to prevent gas leakage. When the endoscopic balloon tube is already inserted in the air ducts, the balloons extend over the natural orifice.
In any previously described instrument - trocar sleeve - tube system or endoscopic device, or instrument - trocar sleeve system, or instrument - tube system or endoscopic device, the inserted instruments are capable of safely reproducing all three-dimensional laparoscopic maneuvers with the aid of folds, rotations and telescopic movements.
Any type of instruments, trocars gloves, tubes or endoscopic devices previously described have a disposable or reusable design.
Any type of instruments, trocars gloves, tubes or endoscopic devices previously described can have a design that allows their disassembly, cleaning and reassembly.
From now on, there is a description of the accessory devices.
One such accessory instrument is an access catheter, which makes it possible to create an opening in the wall of a hollow organ (for example, the stomach) during the access phase. The catheter can be inserted into any of the appropriate working channels. There is an electrical unit - which is capable of cutting or connecting tissues - mounted on the inner end advantageously at the tip of the catheter, said electrical unit contains an electrical wiring extending along the catheter, and said electrical wiring is connectable to a source of electricity. The electrical unit is slightly recessed inside the tip of the catheter in order to avoid direct contact with tissue areas. There are two consecutive balloons in the catheter. The one closest to the inner edge advantageously presents an umbrella-like shape characteristically with a diameter - which is perpendicular to the longitudinal axis - greater than that of the tube or endoscopic device. The next is the expansion balloon, which advantageously has a cylinder-like shape and its diameter is smaller than that of the tube or endoscopic device. Balloons are inflatable or deflatable, and
24/59 its air ducts extend over the outer end of the tube or endoscopic device.
Another such accessory device is the wound closure device that allows for the closure of a wound created in the wall of a hollow organ. According to an advantageous embodiment, the wound closure device consists of an implant tube, an implant casing, locking elements, filaments and an implant stem. The groove or rail on the outer surface of the implant tube can be connected with a sliding connection to the rail or groove on the outer surface of the trocar sleeve, tube or endoscopic device. There are locking elements at the inner end of each filament and there is a fastening button at its outer ends. The locking elements are located inside the implant housing, and the housing with the filaments are located inside the implant tube. The inner end of the implant casing is sharp and there is a longitudinal split on the side of the casing, and there is an implant stem located above the locking elements. The locking elements, the implant stem, the implant casing, the filaments and the implant tube are mobile with each other or in relation to the trocar sleeve, tube or endoscopic device, respectively. The implant stem, the implant casing and the implant tube are advantageously flexible.
The third device is advantageously assembled by rigid components, and allows the optimum fixation of the outer and inner ends of a trocar sleeve, tube or endoscopic device. One end of this fixation device is fixed independently of the patient, for example, on the operating table. One type of external fixation device may be suitable for fixing the filament, or rod or rod connected to the external surface of the internal ends, while another type of device is suitable for fixing the external ends. The shape, angle and position of the fixture are optionally fixed or changeable.
The fourth accessory device can be a modified endoscopic stapler. Advantageously, the stapler head is rigid and the body is partially or completely flexible. The head and the body are advantageously connected to each other by
25/59 a joint. The clamping surface of the head is advantageously perpendicular or parallel to the longitudinal axis of the device, however any other angle of inclination is possible. There is a control filament located between the free ends of the stapling surfaces, and said control filament can be optionally tensioned or released. The filament is located within the channel that extends throughout the head and body of the device. The end of the filament extends over the outer end of the stapler. When the control filament is tensioned, the desired part of the fabric is directed between the stapling surfaces. Under full tension the filament supports the parallel closing of the mobile jaw of the stapler head. Advantageously, there may be an internal working channel, or a groove or rail on the external surface of the stapler body and said groove or rail allows the connection of an accessory device (for example, a trocar sleeve, a camera, a forceps, etc.). Stapling surfaces can be flat, curved, wavy or any other recently known shape. The diameter of the stapler is preferably smaller than the inner diameter of the tube.
Any additional advantageous achievements are detailed in the dependent claims.
In the following section, the invention will be described in detail with reference to the accompanying drawings showing the advantageous embodiments of the instrument.
In the drawings:
Figure 1 / A shows the possible joint-like joint solution and its folding system according to the present invention.
Figure 1 / B shows the possible solution of the telescopic instrument with the ball-shaped force transmission particles according to the present invention.
Figure 1 / C shows the possible solution of the telescopic instrument with the hydraulic power transmission unit according to the present invention.
Figure 1 / D shows the possible solution of the advantageously closed hydraulic unit.
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Figure 1 / E shows a possible solution for the rack mechanism located in the region of the external joint.
Figure 1 / F shows the cross section of the instrument with ball-shaped force transmission particles according to the present invention.
Figure 1 / G shows the cross section of the instrument with the hydraulic unit according to the present invention.
Figure 1 / H shows the connection ring attachable to the instrument according to the present invention.
Figure 1/1 (on page 2/29 of the drawings) shows the longitudinal section of the instrument with a flexible housing according to the present invention.
Figure 2 / A shows a possible advantageous solution of the trocar sleeve according to the present invention.
Figure 2 / B shows an advantageous solution for the telescopic instrument according to the present invention.
Figures 2 / C and D show the ring with a connection groove, filament and needle that is attachable to a telescopic instrument according to the present invention.
Figure 2 / E shows the rack mechanism located on the external joint.
Figures 3 / A and B show a possible advantageous solution for the telescopic trocar sleeve according to the present invention.
Figure 3 / C shows a possible solution of the instrument with the flexible medium part according to the present invention.
Figure 3 / D shows the ring attachable to the telescopic trocar sleeve according to the present invention.
Figure 3 / E shows the rack mechanism mounted on the outer hinge.
Figure 4 / A shows an advantageous solution of the tube with a straight inner end according to the present invention.
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Figure 4 / B shows an advantageous solution for trocart sleeves with sector-like cross sections that are connected together by means of sliding connections according to the present invention.
Figures 4 / C, D and E show an advantageous solution of the inner ends of the telescopic trocar sleeves - with sector-like cross sections - which are connected to each other by means of sliding connections according to the present invention.
Figure 4 / F shows, according to the present invention, the cross section of the trocart sleeves (showing sector-like cross sections) inside the tube.
Figure 4 / G shows, according to the present invention, the cross section of the trocart sleeves (showing sector-like cross sections) that are connected to each other by means of sliding connections.
Figure 5 shows the possible dimensions of the instrument's movements and its similarity to the laparoscopic movements according to the present invention, by illustrating the virtual inner edge (dashed line) as a direct continuation of the outer edge in the drawing.
Figures 6 / A, B, C, D, E and F show, one by one, the possible dimensions of the movements of the instrument according to the present invention.
Figure 7 shows a possible position of the laparo-endoscopic system inserted in a patient according to the present invention.
Figure 8 shows, according to the present invention, a possible position of the laparo-endoscopic system to perform the removal of the gallbladder.
Figure 9 / A shows, according to the present invention, an advantageous solution of the tube with an open internal end in the form of a step.
Figure 9 / B shows, according to the present invention, the oblique open inner end of the tube.
Figure 9 / C shows, according to the present invention, a possible solution of the tube or with an internal open end that is oblique or in the form of a step.
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Figure 9 / D shows, according to the present invention, a possible solution of the endoscopic balloon tube that can be pulled over the tube.
Figure 9 / E shows, according to the present invention, a possible solution of the cup which is able to hermetically seal the outer end of the tube.
According to the present invention, Figure 9 / F shows two possible cross sections of the tube.
Figure 10 shows in accordance with the present invention an advantageous solution of the stepped open inner end of the tube.
Figure 11 shows in accordance with the present invention the suggested position of the laparo-endoscopic system with an open, step-shaped internal end during gallbladder surgery, and the advantageous use of the control rod, respectively.
Figure 12 / A shows according to the present invention an advantageous solution of the divided endoscopic device with normal (straight) internal ends and the protective housing.
Figure 12 / B shows the longitudinal sliding of the parts of the anterior endoscopic device and the trocar axis and the protective shell.
Figures 12 / C and D show, according to the present invention, the advantageously oblique internal ends of the endoscopic device divided into the normal and switched positions, respectively.
Figure 12 / E shows, according to the present invention, the possible elliptical cross section of the endoscopic device.
Figures 13 / A and B show, according to the present invention, the longitudinal sections of the divided endoscopic device advantageously with oblique internal ends in the normal and changed positions, respectively.
Figures 13 / C and D show according to the present invention the advantageous cross sections of the divided endoscopic device.
Figure 13 / E shows, according to the present invention, the cross sections of the instrument with a trocar sleeve or a connected ring that are capable of being inserted into the working channel of an endoscopic device.
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Figures 14 / A and B show, according to the present invention, the normal and switched positions of the normal internal (straight) ends of the upper and lower endoscopic parts, each containing two internal working channels.
Figure 14 / C shows the common cylindrical end of the anterior endoscopic device with two trocar axes and the articulation device.
Figure 15 shows, according to the present invention, the upper and lower parts already exchanged of the divided endoscopic device with oblique internal ends, each endoscopic part containing two intact (undivided) working channels that are hermetically sealed at their outer ends, and the two independent parts are connected to each other by a longitudinal sliding connection.
Figures 16 / A, B and C show additional advantageous variations in the trocar sleeve connections.
Figure 17 / A shows the non-divided endoscopic device with an open, stepped or oblique internal end.
Figure 17 / B shows the cross section of the anterior device.
Figure 17 / C shows the internal oblique end of the undivided endoscopic device.
Figures 18 / A and C show the device capable of closing the wound in a hollow organ wall.
Figure 19 / A shows the instrument inside an open step-shaped tube that penetrates the stomach.
Figure 19 / B shows the camera inserted through the small wound.
Figures 20 / A, B and C show another advantageous method with the access catheter for penetrating through the wall of a hollow organ.
Figure 21 shows a gallbladder operation using a laparoendoscopic system with a stepped open inner end, the possibilities for fixing the inner and outer ends of the system, and anatomical landmarks.
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Figure 22 shows a SPLS (Laparoscopic Surgery for Single Portal) of gallbladder operation through an abdominal port by surgical instruments with rigid ends and middle parts.
Figure 23 shows a SPLS (Laparoscopic Surgery for Single Portal) gallbladder operation performed with a laparo-endoscopic system containing a rigid tube with an open end in the form of a step.
Figure 24 / A shows the laparo-endoscopic system with an open, oblique, step-shaped inner tip and a protective casing that is introduced into the patient through a natural orifice.
Figure 24 / B shows the removal of a gallbladder with the aid of the laparo-endoscopic system through the protective envelope.
Figure 25 shows an appendectomy operation using a laparoendoscopic system with a stepped open inner end, the possibilities for fixing the inner and outer ends of the system, and anatomical landmarks.
Figures 26 / A and B show an appendectomy performed with a laparo-endoscopic system with an open, oblique, step-shaped inner end and an endoscopic stapler, and the removal of the appendix through the protective wrap.
Figure 27 shows the procedure for closing the wound on the wall of a hollow organ with the aid of a tube showing an open internal end in the form of a step and a camera, and with the aid of the wound closure device attached to the tube.
Figure 28 shows the wound closure device with a camera attached to the tube that is rotated inside the wound of a hollow organ during the closure process.
Figure 29 / A shows the filaments with locking elements that are inserted circumferentially at the wound edges of the hollow organ, and the implant tube.
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Figure 29 / B shows the filaments with locking elements that are inserted around a pathological lesion of a hollow organ, and the implant tube.
Figure 29 / C shows the contracted wound edges tensioned upwards into the tube by the filaments, and the raised wound edges.
Figure 30 / A shows a straight endoscopic stapler opened laterally, advantageously with a control filament and a camera that is inserted through the mouth together with the implant tube.
Figure 30 / B shows the raised and contracted wound edges or the elevated pathological lesion of the intestinal wall that are placed between the stapling surfaces by the filaments and the implant tube, as well as the tensioned control filament.
Figure 30 / C shows the closed wound of the hollow organ by a stapler, as well as the implant tube and the tissue removed.
Figure 30 / D shows, according to another possible solution of the endoscopic stapler with a control filament and the connection slot,
Figures 31 / A, B and C show a wound closure process with an endoscopic stapler with a laterally curved opening.
Figure 32 / A shows an endoscopic stapler with a straight front opening folded at the joint showing a control filament and a connection slot.
Figure 32 / B shows the contracted and raised wound edges or the elevated pathological lesion of the intestinal wall that are tensioned by the filaments and the implant tube between the stapling surfaces of an endoscopic stapler with a frontal opening, which is folded at its joint, and also a control filament and a camera coupled by a sliding connection.
Figures 33 / A and B show the cut of the fabric pulled into the stapler and also the clamping of the hollow organ wall.
And finally, Figures 34 / A and B show the complete cut of the pathological lesion located on the wall of a hollow organ and also the closure of the wound with sutures with the aid of a laparo-endoscopic system.
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According to an advantageous embodiment, the surgical instrument (6) (for example, Fig. 1 / B) is inserted into the trocar sleeve (7), and the trocar gloves (7) (for example, Fig. 3 / A and B) are inserted in the tube (28) partially or totally flexible (Fig. 9 / A) or endoscopic device (66, 103) (Fig. 15, 17). Advantageously, the connections between the tube (28) or endoscopic device (66, 103) and trocars gloves (7) and surgical instruments (6) allow for both longitudinal and rotational movements (for example, Fig. 11). If additional accessory devices (for example, protective wrapping (71) - for example, Fig. 15, wound closure device - Fig. 18, endoscopic stapler (88) - for example, Fig. 30) can be attached to the its internal and external surfaces. Advantageously, all connections allow longitudinal movement or sliding along the longitudinal axis and rotation around the longitudinal axis, respectively.
As figures 1 / B and C show, according to an advantageous embodiment of the surgical instruments (6), the surgical instrument (6) advantageously consists of three parts: the middle part (2) partially flexible and the two internal ends ( 1) and external (3) rigid telescopically extendable, and said internal (1) and external (3) ends are connected to the middle part (2) through joint-like joints (4). Advantageously, the segments of the middle part (2) adjacent to the joints (4) are also rigid. The cross section of the instrument (6) is advantageously circular.
Advantageously, the outer (3) and inner (1) ends of the instrument (6) are simultaneously foldable at the joints (4) in relation to the middle part (2) with the same angle of rotation and in the same direction of rotation (when the part of the middle (2) is in a straight position the axes of rotation of the outer (3) and inner (1) ends in the joints (4) are parallel to each other, as if the outer (3) and inner (1) ends were components of a traditional laparoscopic instrument. The bending of the inner (1) and outer (3) ends is advantageously performed only in a common plane (in the case that the middle part (2) is in the straight position) and advantageously by means of a pair of opposite wires (5), and said wires extend opposite each other from the inner end (1) by the joints (4) and part of the middle (2) to the end
33/59 external (3). Certainly, according to another embodiment, the joints (4) can be foldable in more than one common plane using more than one pair of opposite wires (5). It is obvious that any currently known technical solutions are also acceptable for obtaining the folding mechanism described above. Such a possible solution can be a flexible or rigid push rod which is placed inside the middle part (2) and is connected to both the outer (3) and inner (1) ends. In fact, the instrument (6) (Fig. 3 / C) inside a trocar sleeve (7) can have a function similar to that of the impeller rod, if the instrument (6) is resistant to compression.
There is a removable rack mechanism (18) (Fig. 1 / E) located on the joint (4) that connects the middle part (2) and the outer end (3). The rack mechanism (18) with the lock (19) allows the fixation of the desired angle between the middle part (2) and the outer (3) and inner (1) ends in a transient or permanent way.
The telescopic ends (1,3) consist of rigid straight tubes, and said tubes can be inserted into each other. The head (8) of the surgical instrument (6) is located on the inner telescopic end (1), and is advantageously constructed similarly to the head of any recently used laparoscopic instrument (also including the camera). The cable (9) is located on the outer telescopic end (3) of the surgical instrument (6), and advantageously is also constructed similarly to the cable of any recently used laparoscopic instrument (also including the camera). The opening and closing movements of the cable (9) of the instrument (6) control the functions of the head (8) with the help of a driving wire (13) that extends from the outer end (3) through the middle part (2) to the inner end (1).
The head (8) located on the inner end (1) of the instrument (6) is rotatable around the longitudinal axis (Figs. 5 and 6 / E). the rotation of the head (8) is controlled by the rotation of the external end (3) of the instrument (6), advantageously without the need to rotate the cable (9). The rotation of the cable (9) is advantageously independent of the rotation of the head (8). Advantageously, the head (8) located at the inner end (1) and the outer end (3) rotates to the same degree. Head rotation
34/59 (8) and the inner end (1) by the outer end (3) is carried out by means of the force transmission particles (12) connected - said connections between the particles [articles (12) resist the effects of torsion around the longitudinal axis as previously described, or is carried out by means of the flexible housing (108) which also resists the torsional effects around the longitudinal axis. Certainly, any other known solutions are acceptable that allow rotation of the head (8).
Despite the fact that the outer (3) and inner (1) telescopic ends are separated from each other by the middle part (2), they move together simultaneously, as if they were a direct continuation of each other, similar to the movements of the inner ends (1) and external (3) of a traditional straight laparoscopic instrument. When, for example, the outer telescopic end (3) is pressed to some extent, that is, its length is reduced, the length of the inner telescopic end (1) is simultaneously stretched to the same extent, and this works vice versa, sure. This movement is directed by the force transmission unit located inside the surgical instrument (6).
According to an advantageous embodiment, this force transmission unit is located inside the instrument channel (6) and advantageously consists of force transmission particles (12) in the form of a ball (Fig. 1 / B). The channel extends from the inner telescopic end (1) through the middle part (2) to the outer telescopic end (3). The total length of the channel is filled with balls (12). The diameter of the ball is somewhat smaller than the inner diameter of the channel. Advantageously, there are holes in the middle of the balls (12), and the driving wire (13) moves through these holes from the cable (9) to the head (8). Advantageously, the channel is provided with an anti-friction method. Advantageously, the force transmitting particles (12) in the form of a ball are able to pass easily through the channels in the joints (4). When the cable (9) of the instrument (6) is pushed forward, the cable (9) pushes the last ball (12) into the channel of the outer telescopic end (3). The adjacent balls (12) transfer this buoyant force between themselves, and at least the first ball in the inner end channel (1) pushes the head (8) of the instrument forward (6), resulting in the elongation of the inner telescopic end ( 3). In order to
35/59 perform the movement in the opposite direction which is to reduce the length of the inner telescopic end (1), it is advantageous to use a wire that connects the two telescopic ends (1, 3) with each other, and for this purpose the driving wire (13) is also acceptable. When the cable (9) of the instrument (6) is pulled, the outer telescopic end (3) becomes elongated and the wire (13) - attached to the cable (9) simultaneously pulls the inner telescopic end (1). If free transmission is guaranteed, any form other than the ball shape is suitable. The foldable connections between the force transmitting particles (12), which are connected by the driving wire (13), are designed to resist compression along the longitudinal axis and to resist torsion around the longitudinal axis.
According to another advantageous embodiment, the power transmission unit is a hydraulic unit (14) advantageously with an elastic capsule, and said hydraulic unit (14) is located inside the channel described above (Fig. 1 / D) . According to an advantageous embodiment, the hydraulic unit (14) contains three parts: the inner (16) and outer (17) ends and the middle part (15). The three parts of the hydraulic unit (14) communicate with each other and together form a common cavity. This hydraulic unit (14) is a closed system and the hydraulic fluid does not communicate with the external environment, it flows only through the three parts of the common cavity. The middle part (15) of the hydraulic unit is advantageously located in the channel of the middle part (2) of the instrument (6), and its lengths are the same, and said middle part (15) of the hydraulic unit (14) is fixed in the channel in order to avoid deviations. The inner (16) and outer (17) ends of the hydraulic unit (14) are located inside the channels of the inner (1) and outer (3) telescopic ends of the instrument (6). The inner (16) and outer (17) ends of the hydraulic unit (14) are advantageously designed to allow only longitudinal expansion or reduction along their longitudinal axes without any change in their diameters. The end caps (16, 17) of the hydraulic unit (14) are advantageously capable of moving within the end channels (1, 3) of the instrument (6) along its longitudinal axis. A possible advantageous solution for the ends (16, 17) of the hydraulic unit (14) would be
36/59 accordion shape of the walls at both ends (16, 17). When the outer telescopic end (3) is compressed longitudinally by pressing the cable (9) of the instrument (6), the accordion-shaped outer end (17) of the hydraulic unit (14) simultaneously becomes compressed along its longitudinal axis. In this way, the high pressure inside the outer end (17) of the hydraulic unit (14) is transferred through the fixed hydraulic middle part (15) to the inner hydraulic end (16) resulting in the longitudinal expansion of the inner hydraulic end (16 ) folded into an accordion, which also leads to elongation of the telescopic inner end (1). Advantageously, the length of the elongation and the length of the shortening are the same. Along with the folded accordion design, a similar result can be achieved if the wall of the hydraulic unit (14) is made of an appropriately elastic material. In order to execute the movement in the opposite direction in order to reduce the length of the internal telescopic end (1), it is advantageous to use a wire that connects the two telescopic ends (1, 3), and for this purpose the driving wire (13) is also acceptable. When the cable (9) of the instrument is pulled, the outer telescopic end (3) becomes elongated and the wire (13) - attached to the cable (9) - simultaneously pulls the inner telescopic end (1).
Yet another possible design of the power transmission unit is a flexible housing (108) placed inside the instrument channel (6), which, according to an advantageous solution, is a spiral spring or a plastic tube (Fig. 1/1 on page 2/29 of the drawings). Advantageously, the flexible housing (108) resists compression along the longitudinal axis and also resists torsion around the longitudinal axis. Advantageously, the flexible housing (108) has insulating properties. The flexible housing (108) is slid back and forth inside the instrument channel (6), thus, the telescopic movements of the outer (3) and inner (1) ends can be performed simultaneously, and in view of the flexibility of the housing (108), also move easily through the joints (4). The driving wire (13) is internal to the flexible housing (108).
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In the middle part (2) of the instrument at least one connection ring (10) is advantageously placed to connect between the tube (28) and the instrument (6) (Fig. 1 / H and 2 / C). The instrument (6) is easily rotatable inside the ring (10). There is a connection groove (11) formed on the outer surface of the ring (10). According to another advantageous solution, a filament (23) with a needle (24) is connected to the ring (10) which assists in fixing the middle part (2) of the instrument (6) to any part of the abdominal wall (41 ) (Fig. 2 / D and 8).
According to another advantageous embodiment, the instrument (6) can be connected to the tube (28) by means of a simple trocar sleeve (7) (Fig. 4 / A and 4 / F). There is a sliding connection (29) between the tube (28) and the trocar sleeve (7), and the middle part (2) of the instrument (6) is located in the trocar sleeve (7). The middle part (2) of the instrument (6) is advantageously longer than the trocar sleeve (7). The instrument (6) is rotating and sliding back and forth inside the trocar sleeve (7). Advantageously, there is a valve (22) and an airtight ring (21) at the outer end 15 (3) of the trocar sleeve (7) (Fig. 4 / E). The cross section of the trocar sleeve (7) may have a sector shape. The trocar sleeve (7) can be rigid or flexible.
According to another advantageous embodiment, the instrument (6) has three main components: the middle part (2) partially flexible and the outer ends (3) and inner (1) rigid telescopically extendable which are connected to the middle part 20 (2) through joints similar to joints (4) (Fig. 2 / B). The power transmission system is the same as that described above. The instrument does not contain wires to perform the folding of the telescopic ends (1, 3). According to this solution, the instrument (6) is connected to the tube (28) with a trocar sleeve (7) such that it presents a part of the middle (2) partially or totally flexible, and ends 25 external (3) and internal (1) rigid which are connected to the middle part (2) by means of joints (4) (Fig. 2 / A). The folds of the outer (3) and inner (1) ends are carried out by the opposite wires (5) located inside the trocar sleeve. Advantageously, the rack mechanism (18) is mounted on the outer hinge (4). Advantageously, there is a valve (22) and an airtight ring (21) located at the outer end (3) of the trocar sleeve (7).
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The length of the middle part (2) of the trocar sleeve (7) is advantageously longer than the length of the tube (28). There is a sliding connection (29) between the trocar sleeve (7) and the tube (28). The length of the middle part (2) of the instrument (6) is advantageously longer than the length of the middle part (2) of the trocar sleeve (7).
The instrument (6) inside the trocar sleeve (7) is easily movable along the longitudinal axis and also rotatable around the longitudinal axis.
According to another advantageous embodiment, the instrument (6) consists of three main parts: the flexible middle part (2) and the rigid non-telescopic outer (26) and inner (25) ends (Fig. 3 / C). The driving wire (13) is located inside 10 of the instrument (6). There is no additional force transmission unit inside the instrument (6), as this transmission function is performed by the middle part (2) and the two rigid ends (25, 26).
An instrument (6) constructed in this way is connected to the tube (28) advantageously by means of a trocar sleeve (7) which presents a part of the medium 15 (2) partially or totally flexible and with joints (4) connected to the outer ends (3) and internal (1) rigid telescopes (Fig. 3 / A and 3 / B). Simultaneous folding of the joints (4) as described above are carried out by the opposite wires (5) located within the wall of the trocar sleeve (7). Similarly, the rack mechanism (18) can be formed on the external joint 20 (4) (Fig. 3 / E). The simultaneous elongation and shortening of the telescopic ends (1, 3) of the trocar sleeve (7) are the result of the forward and backward movements of the instrument (6) inside the trocar sleeve (7). Advantageously, there is a sliding connection (29) between the trocar sleeve (7) and the tube (28), which allows free movement along the longitudinal axis. Advantageously, the sliding connection 25 (29) is obtained by at least one connection ring (10) located in the middle part (2) of the trocar sleeve (7), and said ring (10) is rotatable freely around the middle part (2) (Fig. 3 / D). Advantageously, the ring (10) has a connection groove (11) which is connected with the rail (50) mounted on the inner surface of the tube (28) (for example, Fig. 10). There is an airtight valve (22) and a ring (21) at the outer end (3) of the trocar sleeve (7) (Figs. 3 / A and 3 / B).
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According to an advantageous embodiment, the trocar sleeves (7) are connected to each other by means of sliding connections (29) mounted longitudinally on their outer surfaces, and each trocar sleeve (7) is connected with the two trocar sleeves (7) adjacent to form a cylindrical arrangement (Fig. 4 / B). Advantageously, four trocar gloves (7) connected are sufficient to perform most surgical interventions. In this case, the cross section of each trocar sleeve (7) connected is advantageously a sector of a quarter, and these together form a complete circle (Fig. 4 / G), thus the common external cylindrical shape makes possible a smoother intervention (for example, when penetrating through the gastric wall (39)). The sliding connections (29) (a groove (11) or a rail (50) that fit together) are located on the flat surface of the trocar sleeves (7), and said sliding connections (29) allow longitudinal movements of the sleeves of trocars (7) relative to each other. This type of trocar sleeve (7) has two flat surfaces, one of them has a groove (11) and the other has the track (50) that fits the groove (11). The cross sections of the working channels (27) of the trocar sleeves (7) are advantageously rounded. This type of trocart gloves (7) can be partially or totally flexible or rigid. The inner end (3) of the trocars gloves (7) may have an oblique plane which makes penetration through the stomach wall (39) easier (for example, in a case similar to that of Fig. 19 / A).
According to this possible solution, the trocar sleeves (7) with cross sections in sectors, and with rigid telescopic ends external (3) and internal (1) are advantageously coupled by means of joints (4) (Fig. 4 / C and 4 / D). Advantageously, the cross sections of the telescopic ends (1, 3) are round, and said ends (1,3) are rotatable with respect to the middle part (2) around the longitudinal axis. In this case, there is no power transmission unit to drive the telescopic ends (1, 3). This telescopic function is performed by the surgical instrument (6) located inside the working channel (27) of the telescopic trocar sleeve (7), and Said instrument (6) has a flexible middle part (6) and rigid external ends ( 26) and internal (25) (Fig. 3 / C), and is capable of
40/59 move longitudinally back and forth inside the working channel (27). The simultaneous folding of the telescopic ends (1, 3) in their joints (4) is advantageously directed by a pair of opposite wires (5) located inside the trocar sleeve (7). At the outer end (3) of the trocar sleeve (7) there is an airtight valve (22) and a sealing ring (21).
There are several other possible solutions for connecting the trocars gloves (7) to each other.
According to an advantageous embodiment, the additional trocar sleeves (7) are connected to the outer surface of a double trocar sleeve (99) by means of sliding connections (29) (Fig. 16 / A). Advantageously, the trocar sleeves (7) are coupled to the joint portion of the double trocar sleeve (99). In addition, more connection grooves (11) or rails (50) can be formed on the outer surfaces of the double trocar sleeve (99) or on the trocar sleeve (7) additionally coupled in order to connect them, for example, with a filament (23), rod (51) or rod (61) to ensure its fixation to the abdominal wall (41) (similar to Figs. 8 and 11).
According to another advantageous embodiment, the trocar sleeves (7) are connected to the outer surface of a trocar guide (98) by means of sliding connections (29) (Fig. 16 / B). The connection slots (11) or rails (50) are mounted on the outer surface of the trocar guide (98). Within the trocar guide (98), a working channel (27) of smaller diameter can be located, which can be used to insert, for example, a balloon access catheter (104) (Figs. 20 / A, 20 / B and 20 / C). The inner end of the trocar guide (98) is advantageously sharp.
According to a further advantageous embodiment, the additional trocar sleeves (7) are attached to a central trocar sleeve (7) by means of sliding connections (29) (Fig. 16 / C). Advantageously, the external cross section of the central trocar sleeve (7) is optional, while the cross section of the working channel (27) inside the central trocar sleeve (7) is round. Advantageously, there may be additional channels located within the central trocar sleeve (7), for example, gas channels (64) or suction-irrigation channels (65). The connection slots (11) or rails (50) are mounted on the outer surface of the central trocar sleeve (7).
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A tube (28) is not necessary to introduce the connected trocar sleeves (7). The trocars gloves (7) can be fixed to the abdominal wall (41) transiently or permanently with a ring (10) located advantageously close to the inner end (1) of the middle part (2) (for example, similar to Fig . 8). Fixation is possible with a filament (23) with a needle (24), or with a rigid rod (51) or with a control rod (61) (for example, Figs. 2 / D or 11). The trocars gloves (7) connected inside the ring (10) are free to move along and rotate around the longitudinal axis, respectively. In the event that no tube (28) is used, advantageously there may be connection grooves (11) or rails (50) formed on the outer surfaces of the trocar sleeves (7) to allow the connection of other endoscopic devices (30).
The trocar sleeves (7) connected to each other by sliding connections (29) (Figs. 4 / B, C, D and G) are also capable of being inserted into the abdominal cavity or being fixed to the abdominal wall (41) with the aid of a tube (28) partially or totally flexible (Fig. 4 / A). In this case, there are no grooves (11) or rail (50) formed inside the tube (28), they are formed only on the outer surface of the tube (28) (Fig. 4 / F). The opening of the inner end (31) of the tube (28) can have a normal shape (102) (that is, flat), oblique (101) or in the form of a step (100) (Figs. 4 / A and 9 / A , B and C). There may be a filament (23) (Figs. 2 / D), rod (51) (Fig. 4 / A) or rod (61) (Fig. 11) connected to the outer surface of the inner end (52) of the tube, each one of these allowing the fixation of the tube (28) to the abdominal wall (41). The rod (51) can contain a connection base (58) which fits the connection groove (11) advantageously longitudinally located on the outer surface of the tube (28), and said connection base (58) is sliding inside the groove (11) (Fig. 10). In this case, the inner end (52) of the tube (28), which is fixed to the abdominal wall (41) with the rod (51), is slid back and forth with the aid of the connection base (58), allowing thus the proper adjustment of the inner end (52) in the designated operating field. At the same time with the aid of the rigid rod (51) or the rod (61), the inner end (52) of the tube (28) is easily maneuverable to any desired part of the intra-abdominal cavity, or is fixable in any
42/59 desired location and position, respectively (Fig. 11). In fact, several other external endoscopic devices (30) (for example, wound closure device, camera (44), forceps, etc.) can be connected to the groove (11) located on the outer surface of the tube (28) (for example, Fig. 27).
In the following section, the tubes (28) and endoscopic devices (66, 103) that house surgical instruments (6) and / or trocars gloves (7) will be discussed with their possible advantageous achievements.
The tube (28) refers to a solution, which has a long cylindrical body advantageously with a single internal lumen, and in this lumen of the surgical instruments 10 (6), trocars gloves (7) or other accessory devices can be inserted ( Fig. 4 / A and 9 / A).
According to the simplest advantageous solution, both ends (52, 53) of the tube (28) are normal (ie straight) (102), and their cross section is round or elliptical (Fig. 4 / A). Advantageously, the outer (53) and inner (52) ends of the tube 15 (28) can be rigid and the middle part (2) can be flexible or can be rigid (similar to Fig. 23) if required. The inner diameter of the tube (28) makes it possible to insert more than one - advantageously four - trocars gloves (7). The inner surface of the tube (28) can be completely smooth or, according to an advantageous embodiment, it can contain connection grooves (11) or longitudinal tracks (50) on the inner surface (Fig. 9 / F).
Advantageously, there may be connection grooves (11) or longitudinal tracks (50) also on the outer surface of the tube (28). A filament (23) (Fig. 2 / D), a rod (51) (Fig. 4 / A) or a rod (61) (Fig. 11) can be coupled to the outer surface of the tube (28) advantageously in the region the inner end (52). Advantageously, there is a joint-like joint (4) between the inner end (52) and the middle part (2) of the tube (28) (Fig. 9 / A). The inner end (52) is foldable at the hinge (4) in relation to the middle part (2) with the aid of a pair of wires (5) that extend longitudinally through the tube (28), and a hinge device ( 54) mounted on the outer end (53) of the tube (28). The opening (31) of the inner end (52) of the tube (28) can be normal (102) (that is, straight) Fig. 4 / A, oblique (101) (Fig. 9 / B) or in 30 shape step (100) (Fig. 9 / A and C). The internal opening (31) is straight (102) if the plane of the
43/59 internal opening (31) is perpendicular to the longitudinal axis of the tube (28). The internal opening (31) is oblique (101) if the plane of the internal opening (31) is not perpendicular to the longitudinal axis of the tube (28). The internal opening (31) is in the form of a step (100), if the straight (102) or oblique (101) opening is combined with an opening located on the side of the inner end (52) of the tube (28) (the plane of the lateral opening is advantageously parallel to the longitudinal axis). The step-shaped opening (100) has a greater advantage since it significantly expands the size of the intervention area and ensures easier maneuvers.
The larger the opening size (31) of the inner end (52) facing the operating field, the greater the freedom of movement / maneuvering of the instruments (6). This area of the opening (31) can be easily enlarged to the desired size by further increasing the size of the side opening. An independent opening can also be located in the wall of the middle part (2) of the tube (28). Advantageously, there is an articulation device (54), a gas connection (55), and an optional removable or attachable hermetic cap (47), which closes the outer opening (32), mounted on the outer end (53) of the tube ( 28) (Fig. 9 / A and E). The cover (47) is attached to the outer end (53) by means of threaded screws or by means of any other hermetic connections. There are openings (48) with valves (22) in the cover (47).
In the case of SPLS procedures, advantageously, the entire tube (28) is rigid (Fig. 23).
In the case of any of the solutions mentioned above, an optional external fixation device (42) can be attached (for example, Figs. 21, 23 or 25) to the external end of any instrument (6), trocar sleeve (7) , tube (28) (for example, Figs. 4 / A and 9 / A) or endoscopic device (66, 103) (for example, Figs. 15 or 17 / A), and said external fixation device (42) is able to fix the outer end transiently or permanently in a desired position.
In the case of any of the above solutions, the inner end of any instrument (6), trocar sleeve (7), tube (28) or endoscopic device (66, 103) can be attached via a filament (23) ( Fig. 2 / D), or a stick (51) (Fig.
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4 / A) or a control rod (61) (Fig. 11), being attached to the inner end, the abdominal wall and / or and an external fixation device (42).
The endoscopic device (66, 103) refers to a solution, which has a long cylindrical body advantageously with a round or elliptical cross section and with more than one working channel (27) inside (Fig. 12, 13, 14 , 15 and 17). The elliptical cross section is advantageous, since the distance between the two lateral working channels (27) can be greater (Fig. 12 / E), which allows easier maneuvering of the instruments (6) within these two channels. work (27). Advantageously, there may be connection grooves (11) or rails (50) formed on the external surface of any type of endoscopic device (66, 103) in order to establish additional external connections (for example, with a filament (23), rod (51), control rod (61), stomach closing device, etc.). According to an advantageous embodiment, there can be a joint (4) formed at the inner end of any type of endoscopic device (66, 103), and said joint (4) is bent by a pair of wires (5) and a device articulation (54). This pair of wires (5) extends through the entire endoscopic device (66, 103) and is connected to the hinge device (54) located at the outer end of the endoscopic device (66, 103). The inner and outer ends of any type of endoscopic device (66, 103) are advantageously rigid and the middle part can be flexible or rigid. Any endoscopic device (66, 103) can optionally have a gas channel (64) and an aspiration-irrigation channel (65).
According to a possible advantageous solution, the endoscopic device (66) is divided (Figs. 12 and 15). In this case, the endoscopic device (66) is partially or totally divided into two parts (upper and lower part) by a plane which is advantageously parallel to the longitudinal axis. The two parts are connected to each other by a sliding connection (29), and are optionally movable back and forth along their longitudinal axis in relation to each other. The dividing plane can divide the work (27) inside the endoscopic device (66) into two complementary divided working channels (70) (Fig. 12). When the two parts of the divided endoscopic device (66) are interchanged longitudinally, the working channels
45/59 divided (70) become free at their internal ends. The instruments (6) folded into their internal joints (4) are easily movable back and forth within the free part of the divided work channels (70) with or without the trocar sleeves (7). The free part of the divided working channel (70) is advantageous in view 5 that allows the inner telescopic end (1) and the head (8) of the instrument (6)
- that is, the part that is distal to the internal articulation (4) - leave the free part of the working channel (70) divided along the entire length in order to reach the intervention area. The length of the free parts of the divided working channels (70) can be optionally changed (increase or decrease) by changing the two endoscopic parts 10 divided longitudinally in relation to each other (Fig. 12). According to an advantageous arrangement of the four working channels (27), the plane that divides the endoscopic device (66) into two longitudinal parts also longitudinally divides two opposing working channels (70). The other two working channels (27) - advantageously the upper and lower channels - remain intact. The normal (102) (Fig. 12 / A) or oblique (101) (Fig 12 / C) inner ends of the divided endoscopic device (66) can be transformed into a step-shaped inner end (100) (Figs. 12 / B and D) by the longitudinal exchange of the two parts (advantageously only the upper part or only the internal part) with each other, in order to obtain the advantages discussed above.
₂₀ According to an advantageous possible embodiment, the outer end of the divided endoscopic device (66) is rigid. The rigid end of the upper part of the device (66) is completed for a complete cylinder, such that the rigid end of the sliding lower part is also inside the cylinder (Fig. 12 / A). The completed outer end for a complete cylinder is airtight and 25 advantageously has four airtight openings (48) with valves (22), and said openings (48) are the opening openings of the working channels intact (27) or divided (70) ) located within the endoscopic device (66). The hermetic closure of the common cylindrical end (67) can also be obtained by a cover (47) optionally attachable with inlet openings (48) and hermetic valves (22) (for example, similar to Fig. 9 / E).
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Advantageously, the trocar shaft (68) - that is, the rigid continuation in the form of a tube at the bottom - leaves the common cylindrical end (67) through the lower external openings (48) (Figs. 13 / A and B). The trocar shaft (68) - provided with a valve (22) - is the external continuation of the intact working channel (27) located within the lower endoscopic part, and said trocar shaft (68), which extends through the lower external opening (48), has an ear-shaped cable (69) on the external end that assists the movement of the lower endoscopic part longitudinally forwards and backwards. Advantageously, the trocar shaft (68) is moved in and out through the lower external opening (48) of the common cylindrical end (67) with the aid of the ear-shaped handle (69), which consequently means the movement towards back and forth from the inner end of the lower endoscopic part. In this way, the size of the internal step-shaped opening (100) - and consequently the size of the intervention area - is optionally adjustable.
According to another possible solution, the plane that divides the endoscopic device (66) parallel to the longitudinal axis does not divide any of the working channels (27). Advantageously, both the upper endoscopic part and the lower endoscopic part contain two intact working channels (27) (Fig. 14). In this case, the shape of the outer end of the endoscopic device may be a common cylinder (67) similar to the previous solution, except that now two rigid trocars (68), which are the external continuation of the two working channels (27) of the lower endoscopic part, exit through the two lower external openings (48) of the common cylindrical end (67).
According to another possible solution, the outer ends of the divided endoscopic device (66) are similarly divided as the inner ends, and both outer ends are hermetically sealed (Fig. 15). The upper outer end and the lower outer end have airtight openings with valves (22). In this case, the endoscopic part - the upper endoscopic part and the lower endoscopic part are connected by the sliding connection (29) - can be removed from the patient and can be replaced by a
47/59 larger endoscopic tool (for example, an endoscopic stapler (88) similar to Fig. 26 / A), or through the space of the removed endoscopic part, tissue or organ samples can also be removed.
According to another advantageous embodiment, the endoscopic device (103) is solid and not divided (Fig. 17). The opening of the internal end of the device can be normal (102), or oblique (101) or in the form of a step (100). In the event that the inner end has a step-shaped opening 100, there may be one or more partially divided working channels (70) advantageously only in the region of the inner end region, in order to achieve the advantages detailed above. Advantageously, the lower and upper working channels (27) are intact (i.e., not divided) while other working channels (70) on both sides are divided at their inner ends. Of course, an arrangement with a pair of upper working channels (27) intact (i.e., not divided) and a pair of lower working channels is also possible. The outer end of the undivided endoscopic device (103) is hermetically sealed and there are hermetic openings with valves (22), and the outer openings are the inlets of the working channels (27, 70).
Inside the divided working channels (70) of any type of endoscopic device (66, 103) there are sliding connections (29) (for example, sliding shoulder (74), connection slot (11) or rail (50)) allowing the appropriate coupling and fixation, and the longitudinal movement back and forth of the inserted trocar sleeve (7) or instrument (6) (for example, Fig. 13 / C, D and 17 / B). These connection components (for example, sliding shoulder (74), connection groove (11) or rail (50)) are connected to the connection components (for example, groove (75) in Fig. 13 / E) of the instruments ( 6) or the trocars gloves (7).
The outer end of any type of tube (28) or endoscopic device (66, 103) can have a cone shape (105) (Figs 21 and 25). This is advantageous in view of the fact that it allows easier manipulation of the external ends (3) of the instruments (6).
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Any type of instruments (6), trocars gloves (7), tubes (28) or endoscopic devices (66, 103) mentioned previously can contain light sources (106), for example, LEDs advantageously at their internal ends (Fig. 9 /THE). More light sources (106) result in better illumination of the operating field.
Any type of combination of the laparo-endoscopic system mentioned previously may be able to perform surgical interventions inside the lumen of hollow organs (for example, excision of pathological lesions, wound closure, insertion of a feeding tube). In this case, an inflatable balloon (45) assists in fixing the device (for example, instrument (6), trocar sleeve (7), tube (28) or endoscopic device (66, 103)), which is placed in the region the inner edge of the device (Fig. 34). Advantageously, the balloon is slid in the device, and its outer diameter is greater than the diameter of the esophagus (38) or other hollow organ (39), respectively.
In any of the instrument systems (6) - trocar sleeve (7) - tube (28) or endoscopic device (66, 103) or instrument system (6) - trocar sleeve (7), or instrument system (6) - tube (28) or endoscopic device (66, 103), the instruments (6) inserted are capable of reliably reproducing all three-dimensional laparoscopic maneuvers with the aid of banding, rotating and telescopic movements.
Any type of instruments (6), trocars gloves (7), tubes (28) or endoscopic devices (66, 103) previously described can have a disposable or reusable design.
Any type of instruments (6), trocars gloves (7), tubes (28) or endoscopic devices (66, 103) described previously can have a design allowing their disassembly, cleaning and re-assembly.
The descriptions of the accessory devices are given below.
The first of such accessory devices may be a protective casing (71) attachable to the outside of the trocar sleeves (7), tube (28) or endoscopic device (66, 103) connected (Fig. 12 / A and Β). The protective housing (71) is advantageously in the
49/59 cone-shaped and made of a material similar to resistant cling film, which at the outer end has a connection ring (73) or tube (97) - capable of being hermetically connected to the outer end (53) of a tube (28) or an endoscopic device (66, 103) - and at the inner end it has a self-expanding ring (72). The protective housing (71) covers the tube (28) or the endoscopic device (66, 103). The protective shell (71) is inserted through a natural hole in the abdominal cavity through the wound (40) in the wall of a hollow organ (39) advantageously in a rolled-up position on the tube (28) or endoscopic device (66, 103 ). When the protective casing (71) enters the abdominal cavity, the expanding cone-shaped inner end with the self-expanding ring (72) and the contraction wound (40) around the protective casing (71) prevents the escape of gas from the inflated abdominal cavity (for example, Fig. 24 / A). In addition, the protective casing (71) protects the wall of the hollow organs (39) and the surrounding area against injuries caused by the moving instruments (6), and prevents contact with contaminated secretions, or with diseased tissues or organs. The cone-shaped inner end (that is, the inner end has a larger circumference) allows the removal of tissues and organs more easily. Of course, any other shape of the protective housing (71) can be among the possible solutions.
The second of such accessory devices can be an endoscopic balloon tube (56) with independently inflatable balloons (45), which can be advantageously placed in the region of the inner end of the trocar sleeves (7), tube (28) or endoscopic device ( 66, 103) connected (Fig. 9 and 19 / A). This device (56) is placed on the wound (40) in the wall of a hollow organ (39) (similar to Fig. 22), in order to prevent gas leakage. When the endoscopic balloon tube (56) is already inserted, the air ducts (57) of the balloons (45) extend over the natural orifice.
The third of such accessory devices can be an access catheter (104), which allows the creation of a wound opening (40) in the wall of a hollow organ (39) (for example, the stomach) during the access phase ( Fig. 20 / A, B and C). The catheter (104) can be inserted into any of the suitable working channels (27, 70). There is
50/59 an electrical unit (76) - which is capable of cutting or coagulating tissues - mounted on the inner end advantageously at the tip of the catheter (104), said electrical unit (76) has an electrical wiring that extends along the catheter (104), and said electrical wiring is connectable to an electrical power source. The electrical unit (76) is in a slight recess within the tip of the catheter (104) in order to avoid direct contact with the extended areas of the tissue. There are two consecutive balloons (77, 78) in the catheter (104). The one (77) closest to the inner end advantageously presents an umbrella shape characteristically with a diameter - which is perpendicular to the longitudinal axis - greater than that of the tube (28) or endoscopic device (66, 103). The next is an expansion balloon (78) which advantageously has a cylinder shape and its diameter is smaller than that of the tube (28) or endoscopic device (66,103). The balloons (77, 78) are independently inflatable or deflatable, and their air ducts extend over the outer end of the tube (28) or endoscopic device (66,
103).
The fourth of such accessory devices may be a wound closure device that allows a wound (40) created in the wall of a hollow organ (39) to be closed (Fig. 18). According to an advantageous embodiment, the wound closure device consists of an implant tube (85), an implant casing (82), locking elements (84), filaments (23) and an implant stem (83) . The groove (11) or rail (50) on the external surface of the implant tube (85) can be connected with a sliding connection (29) to the rail (50) or groove (11) on the external surface of the trocar sleeve (7), tube (28) or endoscopic device (66, 103). There are locking elements (84) at the inner end of each filament (23) and there is a fixing button at its outer ends. The locking elements (84) are located inside the implant housing (82), and the housing (82) with the filaments (23) inside the implant tube (85). The inner end of the implant casing (82) is sharp and there is a longitudinal split (86) on the side of the casing (82), and there is an implant stem (83) located above the locking elements (84). The locking elements (84), the implant stem (83), the implant casing (82), the filaments (23) and the implant tube (85) are mobile with each other or in relation to a trocar sleeve ( 7), tube (28)
51/59 or endoscopic device (66, 103), respectively. The implant stem (83), the implant casing (82) and the implant tube (85) are advantageously flexible.
The fifth of such accessory devices can advantageously be assembled by rigid components, and allows the ideal fixation of the outer and inner ends of a trocar sleeve (7), tube (28) or endoscopic device (66, 103) (for example , Fig. 21, 23 and 25). One end of this fixation device (42) is fixed independently of the patient, for example, on the operating table. One type of external fixation device (42) may be suitable for fixing the filament (23), or rod (51) or rod (61) connected to the external surface of the inner ends, while another type of device (42) it is suitable for fixing the outer ends. The shape, angle and position of the clamping device (42) can be maintained or changed optionally. Fixing the inner extremity makes it possible to simultaneously raise the abdominal wall (41). In addition, the fixation of the inner end to the abdominal wall (41) can be performed with the aid of a magnetic device (107) (Fig. 23).
The sixth of such accessory devices can be a modified endoscopic stapler (88) (Fig. 30-32). Advantageously, the head (89) of the stapler (88) is rigid and the body (90) partially or totally flexible. The head (89) and the body (90) are advantageously connected to each other by means of a joint (4). The clamping surface (93) of the head (89) is advantageously perpendicular or parallel to the longitudinal axis of the device (88), however any other angle of inclination is possible. There is a control filament (91) located between the free ends of the stapling surfaces (93), and said control filament (91) can be optionally tensioned or relaxed. The filament (91) is located within the channel (92) which extends throughout the head (89) and the body (90) of the device (88). The end of the filament (91) extends over the outer end of the stapler (88). When the control filament (91) is tensioned, the desired part of the fabric is directed between the stapling surfaces (93). Under full tension. The filament (91) supports the parallel closing of the adjustable jaw (95) of the stapler head (89). Advantageously there may be an internal working channel (27), or a groove (11) or
52/59 rail (50) on the outer surface of the body (90) of the stapler (88) and said groove (11) or rail (50) allows the connection of an accessory device (30) (for example, the trocar sleeve (7), a camera (44), a forceps, etc.). The stapling surfaces (93) can have a straight, curved, wavy shape or any other recently known shape. The diameter of the stapler (88) is preferably smaller than the inner diameter of the tube (28) (for example, Fig. 26 / A).
The functions of the laparo-endoscopic system that, according to the present invention, is developed to perform all stages of the new surgical interventions (access, surgical intervention, and closure) of NOTES (Endoscopic Transluminal Surgery for Natural Orifices), SPLS ( Laparoscopic Surgery for Single Portal) and IE (Interventional Endoscopy) are as follows:
1. Access
Before starting the operation, the laparo-endoscopic device is assembled.
According to an advantageous solution, the protective casing (71) is placed on the tube (28) and first fixed on the outer surface of the tube (28) (for example, Fig. 9 / A), then it is rolled over the body of the tube (28), finally a part of the expandable ring (72) is pulled into the inner opening (31) of the tube (28) with the aid of an inserted instrument (6). The trocar sleeves (7) are inserted into the tube (28) with the aid of sliding connections (29). A camera (44) is placed inside the working channel (27) of the lower trocar sleeve (7) (fig. 19 and 20), and the access catheter (104) inside the upper trocar sleeve (7). Thereafter the properly assembled flexible device system is introduced through the patient's natural orifice, actually through the mouth and esophagus (38) in the stomach (39). It is advantageous to create the opening (40) in the anterior wall of the stomach (39). For this reason, it is advantageous to use a tube (28) with an inner end (52) rigid in the form of an open step (100), and said inner end (52) can be bent at the joint (4) perpendicularly in the direction of stomach wall (39) with the aid of an articulation device (54) and wires (5). The tip of the inner end (52) is pushed against the stomach wall (39), and then the access catheter (104) is pushed forward into the upper trocar sleeve (7) (fig. 20). With the activation of the electrical unit (76) inside the
53/59 tip of the access catheter (104), the catheter (104) moving forward passes through the stomach wall (39) at the desired point due to the developing thermal effect. Then the catheter (104) is propelled forward until the umbrella-shaped protective balloon (77) enters the abdominal cavity. At this point, the protective balloon (77) is inflated, and is pulled against the outer surface of the stomach wall (39) by pulling the entire catheter (104) out. In this position, the dilation balloon (78) is on the stomach wall (39). Now the expansion balloon (78) is inflated to reach a diameter that is smaller than the diameter of the tube (28), then the balloon (78) is deflated, then the inner end (52) in the form of an open step (100) the tube (28) with a gradually increasing diameter is propelled through the enlarged wound (40) into the abdominal cavity until the expandable ring (72) of the wound wrap (71) enters the abdominal cavity. Then the expandable ring (72) is expelled from the inner end (52) of the tube (28) into the abdominal cavity with an instrument (6), and thus the inner opening of the protective housing (71) advantageously expands in the shape of a cone , and the protective casing (71) is pressed against the tube (28) by the wound (fig. 24 / A). These two effects prevent gas leakage through the opening of the wound (40). The expandable ring (72) prevents inadvertent removal of the protective casing (71). The hermetic connection ring (73) or tube (97) located at the outer end of the protective housing (71) prevents gas leakage at the outer end of the device system. The outer ends of the trocar sleeves (7), tubes (28) or endoscopic devices (66, 103) are hermetically sealed.
After the internal end of the device system is inserted into the abdominal cavity, the protective balloon (77) is also deflated, and the access catheter (104) is removed from the trocar sleeve (7). The deflated protective balloon (77) that is pulled towards the inner end (52) of the tube (28) during the access procedure protects the surrounding organs and tissues against casual injuries.
According to another version of the access procedure, the head (8) of an instrument (6) is first passed through the stomach wall (39). Through the small opening (40) created, a camera (44) is inserted to check the
54/59 abdominal cavity (fig. 19). Once the wound area (40) is controlled, the oblique open end (52) and step-shaped (100) inner end is gently passed through the stomach wall (39) following the camera (44), in this way , the wound (40) is gradually dilated.
The access procedure is the same if an endoscopic device (66, 103) is used (for example, Fig. 12, 15 and 17).
When connected trocars gloves (7) are introduced into the stomach (39), the system is directed to the anterior stomach wall (39). Only one telescopic inner end (1) is passed through the stomach wall (39) with the aid of an access catheter (104) or a camera (44), and then the procedure follows the steps previously described.
An endoscopic balloon tube (56) can be attached to the system instead of a protective shell (71) (Fig. 19 / A). As soon as the inner end enters the abdominal cavity, the outer balloon (45) is inflated through the air duct (57) and then the system is propelled inward until the outer balloon (45) reaches inside the stomach wall . At this point, the inner balloon (45) is also inflated through an additional air duct (57). The two balloons (45) secure the stomach wall (39) to the wound opening (40). The endoscopic balloon tube (56) is slidable.
In the case of an SPLS intervention, the access procedure is performed through the navel, advantageously similar to the laparoscopic technique. A small umbilical incision is made and under direct visual control a laparo-endoscopic system is inserted into the abdominal cavity. This system advantageously consists of rigid trocar gloves (7), rigid tube (28) or endoscopic device (66, 103), and is also provided with a protective shell (71) or an abdominal port (81) (Fig. 22 and 23). It is sufficient to fix the outer end of the rigid system to an external fixator (42).
2. Operation
This is the most important part of any intervention: removing or curing sick organs or tissues. The procedure performed with the laparoendoscopic system is similar to the well-developed laparoscopic technique. The internal end (52) of the device system is fixed above the operating field through the wall
55/59 abdominal (41) to an external fixator (42) (Fig. 21 and 25) with the aid of a filament (23) (Fig. 2 / D), a rod (51) (Fig. 4 / A and B) or a control rod (61) (Fig. 11). The abdominal wall (41) can be raised with the internal end (52) fixed, thus preventing the collapse of the abdominal cavity on the operative field in the event of a gas leak, and this makes the intervention very safe. The outer end (53) of the system is attached to another outer fixator (42). It is advantageous that the suitably flexible middle part (2) of the system is only slightly bent. The positions of the instruments (6), which are inserted through the working channels (27), are adjusted with the aid of the joints (4), the telescopic ends (1, 3), the sliding connections (29) or the control (61). The internal (1) and external (3) ends of the instrument (6) inside the tube (28) move similarly to the internal and external components of a traditional laparoscopic instrument (with the only difference being separated by the middle part (2) )), in this way, the intervention can be performed in a similar way to the laparoscopic technique, where a single instrument (6) is controlled by only one hand (for example, gallbladder operation (34) or appendectomy (80) - Fig. 21 and 25). If the size of the operative field is changed during the procedure, the position of the inner end (52) can also be adjusted, depending on the type of fixation. In the case of a filament (23) or a rod (51) the position can be changed by sewing through the abdominal wall (41) at another point. It is easier to use a control rod (61) (Fig. 11), since it is resistant and rigid enough to simplify the movement of the inner end (52) of the device system from an anterior position to a more new. The advantage of the control rod (61) can be increased if it is inserted into the abdominal cavity through the navel (60) (advantageously by the visual control of the camera (44) of the device system) and is fixed on the inner end (52) of the tube (28). With this method it is possible to place the inner end (52) of the system in any area of the abdominal cavity and fix it in the new position, in this way, even extensive operations can be carried out without creating additional injuries. This technique makes it possible to perform any type of intervention within body cavities.
56/59
In the case of appendectomy, the appendix (80) can be removed with the aid of an endoscopic stapler (88) (Fig. 26 / A). The endoscopic stapler (88) can be inserted through the empty space in the tube (28) created by the previous removal of two adjacent trocar sleeves (7). The stapler head (89) is opened and the appendix (80) is pulled between the stapling surfaces (93) and the control filament (91) still released with the aid of forceps (6). Subsequently, the control filament (91) is tensioned together with the closing of the adjustable jaw (95) and the stapler (88) is closed at the origin of the appendix (80). After activating the stapler (88) the appendix (80) is removed.
The gallbladder (34) or appendix (80) is advantageously removed from the abdominal cavity through the tube (28), and if the tube has a cap (47) on the outer end (53), the cap (47) must be removed (for example, Fig. 9 / E). If the tissue or organ is larger than the inner diameter of the tube (28), they are removed through the protective shell (71) by pulling them into the shell (71) with an instrument (6) inside the tube (28) ( Fig. 24 / B and 26 / B). The protective casing (71) makes it possible to easily insert the laparo-endoscopic system previously broken back into the abdominal cavity.
In the case of an undivided endoscopic device (103) (Fig. 17 / A) the steps of the procedure are similar to the previously described methods, except that the endoscopic stapler (88) is inserted into the abdominal cavity outside the laparo-endoscopic system.
If a portion of the divided endoscopic device (66) (for example, Fig. 15) is removed, the endoscopic stapler (88) can be inserted through the emptied space. The size of the open step-shaped inner end (100) of the divided device (66) can be adjusted to various operating fields by longitudinal exchange back and forth of the divided parts in relation to each other without creating additional injuries.
When performing SPLS interventions, rigid instruments (6), trocars gloves (7), tube (28) or endoscopic device (66, 103) are inserted through the navel (60), and their internal ends are directed towards the operative field
57/59 (Fig. 22 and 23). The external end of the device system can be fixed in the right position by an external fixator (42). The additional steps of the intervention are similar to the laparoscopic technique. In the case of a rigid device system there is no need to fix the inner end, however, if required it can be performed with a filament (23), a rod (51) or a control rod (61), as discussed previously.
In the case of a procedure performed inside a hollow organ (39) (for example, the excision of a pathological lesion (87) in the wall), the fixation of the inner end of the laparo-endoscopic device is achieved by a balloon (45) which is sliding along the device (Fig. 34 / A and B). If the balloon (45) is inflated to an appropriate size, it becomes trapped inside the hollow organ, in such a way that the laparoendoscopic system is able to tilt over the balloon (45), and in addition the inner end moves away from the stomach wall (39) for an appropriate distance. Fixation advantageously under multiple vacuum can have similar effectiveness.
3. Closing
The closure means primarily the reliable closing of a wound opening (40) in the wall of a hollow organ (39). As soon as the surgical intervention is over, and the injured organ or tissue is removed, and the operative field is checked again, the protective casing (71) or the endoscopic balloon tube (56) is removed through the mouth, while the ends internal of the trocar trocars (7) connected, or the inner end of the tube (28) or endoscopic device (66, 103) remains inside the abdominal cavity. Within the opening of the inner end, advantageously there is a single camera (44) in a curved position, which makes visual control possible in the adjacent region of the wound (40). A wound closure system is coupled with the sliding connection (29) (advantageously via a connection groove (11) or rail (50)) to the outer surface of the connected trocar sleeves (7), or the tube (28 ) or the endoscopic device (66, 103). The implant tube (85) with the implant casing (82), locking elements (84), filaments (23) and camera (44) inside are pushed against the stomach wall (39). The appropriate distance between the laparo-endoscopic system and the
58/59 connected implant (85) allows the locking elements (84) and the filaments (23) to reliably maintain the raised edges of the wound (40). Controlled by the camera (44) of the implant tube (85), the tip-shaped inner end of the implant casing (82) is propelled through the wall of the hollow organ (39), and by the impulsion of the implant stem (83) a locking element (84) with filament (23) is discharged (Fig. 18 / C). The movement of the implant casing (82) through the stomach wall (39) and the correct position of the locking elements (84) are controlled by a curved (retroflected) camera (44) within the abdominal cavity. This implantation maneuver must be repeated - following the complete rotation of the laparo-endoscopic system within the wound (40) - to implant the locking elements (84) at the edges of the wound (40) around the entire circumference (Fig . 28). Then the laparo-endoscopic system is pulled back and removed from the patient, while the implant tube (85) is dislodged from the laparo-endoscopic system with the aid of the sliding connection (29) and remains in place. As a consequence, the locking elements (84) within the edges of the wound (40), the filaments (23) and the tube (85) containing the filaments (23) remain inside the stomach (39). By simultaneously lifting the filaments upward and pushing the implant tube (85) down, the wound edges (40) are pulled up into the inner end of the implant tube (Fig. 29 / C). The outer end of the implant tube (85) is inserted between the stapling surfaces (93) and the control filament (91) of the stapler (88), and then the stapler (88) is pushed downward along the implant (85) to the wound (40) through the mouth (Fig. 30). Advantageously, the stapler (88) contains a camera (44).
In order to achieve better control over the process, the endoscopic stapler (88) is bent at the joint (4). After the control filament (91) has been slightly tensioned, the wound (4) of the stomach (39) is pulled between the open stapling surfaces (93) and the control filament (91). After which the adjustable jaw (95) is closed while the control filament (91) is continuously tensioned, the situation is checked again with the camera (44). Then the stapler (88) is triggered and the wound (40) is closed and the wound stapled
59/59 (94) is checked with the camera (44). This procedure can be performed with different types of staplers (Fig. 31, 32 and 33).
The closure process after the SPLS intervention is the traditional closure of abdominal (41) or umbilical incisions (61).
The wound closure (40) inside the hollow organ can be performed with the wound closure system (discussed above) and with the stapler (88), or with the laparo-endoscopic system fixed with a balloon (45) (Fig 34 / B). In the latter case, the wound (40) is closed from the inside with sutures (96) similarly to the laparoscopic suture technique.
The most important advantages of the solutions according to this invention are that they ensure the reliable performance of all stages (access, surgical intervention, closure) of NOTES procedures (Endoscopic Transluminal Surgery by Natural Orifices), SPLS (Laparoscopic Surgery by Single Portal ) and IE (Interventional Endoscopy) through natural orifices, similar to the techniques and 15 reliable and well developed laparoscopic maneuvers.

权利要求:
Claims (5)
[1]
1. Device for surgical interventions, comprising (i) a guiding / orientable inner end (1) for the surgical field, (ii) an end
5 external (3) operated by the user and (iii) a middle part (2) that connects both ends (1,3) to each other, comprises units of transmission force extending between the outer end (3) and the inner end (1), and said transmission force units, the outer and inner ends and the middle part (2) are designed to transfer the movements from the outer end (3) to the inner end (1) 10 in the same way, as if the inner end (1) was a direct continuation of the outer end (3), characterized by the fact that it comprises (i) a first force transmission unit that is capable of transferring the flexing movements from the outer end (3) to the inner end (1) in relation to the median part (2) at the same angle of rotation and in the same direction of rotation, and (ii) a second force transmission unit 15 which is capable of transferring the axial telescopic movements of the outer end ( 3 ) to the inner end (1) with the same extension, but in the opposite direction.
[2]
2/5
2. Surgical device according to claim 1, characterized by the fact that it has joints (4) between the outer end (3) and the median part (2)
20 and between the inner end (1) and the middle part (2), and the first force transmission unit (12) is designed to transfer the movements of the first joint (4) to the second joint (4) and the movements from the second joint (4) to the first joint (4).
[3]
3/5 of said instrument (6) has an outer end (3), an inner end (1) and a flexible middle (2).
Surgical device according to claim 8, characterized in that the first force transmission unit (12) is located inside the trocar sleeve (7) that contains the surgical instrument (6), and the second transmission unit force is located inside the instrument channel (6).
10. Surgical device according to claim 9, characterized in that the outer end (3) and the inner end (1) of the surgical instrument (6) are telescopic, and the second force transmission unit comprises force transmitting particles ( 12) - advantageously jugs - connected together, and said particles (12) fill the entire length of the channel or the second force transmission unit is a sealed hydraulic unit (14) located inside the channel of the surgical instrument (6) which has an outer part (17) inside the outer end (3) and an inner part (16) inside the inner end (1) advantageously with folding structures similar to an accordion, designed to be stretched or compressed along its longitudinal axis or the second force transmission unit is a flexible sliding case (108) inside the channel of a surgical instrument (6), which is designed designed to resist compression along the longitudinal axis and to resist torsion around the longitudinal axis.
11. Surgical device according to claim 9 or 10, characterized in that the first force transmission unit (12) is located in the trocar sleeve (6) containing the surgical instrument (6), and the instrument (6) - functioning as a second force transmission unit - being designed to resist compression along the longitudinal axis and to resist torsion around the longitudinal axis.
Surgical device according to claim 11, characterized in that it comprises more than one trocar sleeve (7) with internal ends (1), and at least two trocar gloves (7) are arranged to determine a structure of the type in steps at its internal ends (1).
Surgical device according to claim 1 or 2, characterized
25 in that the first power transmission unit (12) comprises at least one pair of antagonistic wires (5) that extend from the inner end (1) through the joints (4) and from the middle (2) to the outer end (3) opposite or the first power transmission unit (12) comprises at least one flexible or rigid drive rod extending from the inner end (1) through the hinges 30 (4) and the middle part (2) to the outer end (3 ).
[4]
4/5
Surgical device according to claim 12, characterized in that at least one trocar sleeve (7) comprising at least one working channel (27) within it is connected by a sliding connection (29) to one or more gloves trocar (7).
5
Surgical device according to claim 13, characterized in that it contains a partially or totally flexible or rigid tube (28) comprising (i) a cylindrical body with a circular or elliptical cross section, (ii) an inner end (52) and an outer end (53), and advantageously (iii) to a gas (55) and / or a suction-to-discharge connection (63), and said tube (28) being feasible to house one or more instruments inside (6) and / or trocar gloves (7), and be fixed by the inner (1) and outer (3) ends to the abdominal wall (41) and / or to external fixation devices (42) and preferably on the surface outer end of the inner end (52) the tube (28) has (i) a thread (23) with a needle (24) and / or a rod (51) that can be passed through the abdominal wall (41) and can be 15 attached to an external fixture (42), or (ii) a connection point advantageously formed as a groove (11) or a rail (50) - designed to be connected to a control rod (61) that makes fixing to the abdominal wall (41) possible.
Surgical device according to any one of claims 6 to
20 13, characterized by the fact that it contains an endoscopic device partially or totally flexible or rigid (66, 103) comprising (i) a cylindrical body with circular or elliptical cross section, (ii) more than one working channel (27), and advantageously (iii) a gas (55) and / or a suction-irrigation connection (63), and at least one working channel (27) is designed to house one or more 25 surgical instruments (6) and / or trocar gloves (7) and preferably, on the outer surface of the inner end (52) the endoscopic device (66, 103) has (i) a thread (23) with a needle (24) and / or a rod (51) that it can be passed through the abdominal wall (41) and can be attached to an external fixation device (42), or (ii) a connection point - advantageously formed as a groove (11) or a rail 30 (50) - designed to be connected to a control rod (61) that takes the attachment to the
Surgical device according to any one of claims 1 to 3, characterized in that the outer end (3) and the inner end (1) are telescopic, and the second force transmission unit is designed to lengthen the inner end ( 1) telescopic when the outer end (3) is compressed, and to come into contact with the inner end (1) telescopic when the outer end (3) telescopic is elongated.
5. Surgical device according to claim 4, characterized by the fact that it has a channel inside, and that the second force transmission unit comprises force transmitting particles (12) - advantageously balloons - connected together, and said particles ( 12) fill the entire length of the channel, each of which has a hole, and through these holes the particles (12) move the mobile wire (13), or the second power transmission unit is a sealed hydraulic unit (14) located inside the channel, which has an outer part (17) inside the outer end (3) and an inner part (16) inside the inner end (1) advantageously with accordion-like folding structures, designed to be elongated or compressed along its longitudinal axis or the second force transmission unit being a sliding flexible case (108) that is designed to resist compression when along the longitudinal axis and to resist torsion around the longitudinal axis.
6. Surgical device according to claim 5, characterized in that the outer end (3), the inner end (1) and the middle part (2) are the components of a surgical instrument (6), and said instrument ( 6) be located inside a rigid or flexible trocar sleeve (7).
7. Surgical device according to claim 5, characterized in that the outer end (3), the inner end (1) and the middle part (2) are the components of a trocar sleeve (7), and said glove trocar (7) has an air-tight valve (22) located at the outer end (3).
8. Surgical device according to claim 7, characterized by the fact that it contains a surgical instrument (6) located inside the trocar sleeve (7), and
[5]
5/5 abdominal wall (41) possible and, preferably, the endoscopic device (66) be designed to be partially or totally divided into at least two parts by a plane parallel to the longitudinal axis, and said divided parts being connected by sliding connections (29), and being interchangeable with each other or the endoscopic device 5 (103) being undivided, and at the inner end (52) there is an opening (31) oblique (101) or drawn in the form of a step (100).

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同族专利:

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公开号 | 公开日

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HU0900538D0|2009-10-28|

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US20120232339A1|2012-09-13|

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HU0900538A2|2011-04-28|

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WO2011027183A3|2011-06-03|

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CA2772954A1|2011-03-10|

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US10702254B2|2020-07-07|

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BR112012004792A2|2018-03-13|

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EP2473119A2|2012-07-11|

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US20180092635A1|2018-04-05|

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EP2473119B1|2015-04-01|

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CN102665577B|2015-11-25|

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CN102665577A|2012-09-12|

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WO2011027183A2|2011-03-10|

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US9877794B2|2018-01-30|

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AU2010290955A1|2012-04-19|

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IN2012DN02773A|2015-09-18|

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法律状态:
2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-07-09| B06T| Formal requirements before examination [chapter 6.20 patent gazette]|

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2019-10-08| B15K| Others concerning applications: alteration of classification|Free format text: AS CLASSIFICACOES ANTERIORES ERAM: A61B 17/29 , A61B 17/00 , A61B 17/34 , A61B 19/00 , A61B 17/02 , A61B 17/30 Ipc: A61B 17/062 (1995.01), A61B 17/072 (1990.01), A61B |

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2019-10-22| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2019-11-12| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 02/09/2010, OBSERVADAS AS CONDICOES LEGAIS. (CO) 20 (VINTE) ANOS CONTADOS A PARTIR DE 02/09/2010, OBSERVADAS AS CONDICOES LEGAIS |

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