• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    LAPAROSCOPIC INSTRUMENT WITH FIXABLE END ACTUATOR. The present invention relates to a laparoscopic surgical device that comprises an elongated nail that defines a longitudinal axis, the nail comprising a distal end and a proximal end. A plurality of arms extending distally from the distal end of the elongated rod, each of the arms comprising a side notch. The elongated pin is slidable axially in relation to the arms between a locked position preventing the medial deflection of the arms and an unlocked position allowing the medial deflection of the arms. A surgical end actuator is fixable in vivo and separable in vivo selectively to the corresponding feature of the arms, with the surgical end actuator comprising jaws that open and close in response to the axial movement of the two arms when attached to the end actuator surgical.
    公开号:BR112012010813B1
    申请号:R112012010813-1
    申请日:2010-10-07
    公开日:2021-03-02
    发明作者:Rudolph H. Nobis；James T. Spivey；Kevin M. Huey；Sean P. Conlon；Christopher J. Hess
    申请人:Ethicon Endo-Surgery, Inc.；
    IPC主号:
    专利说明:

    BACKGROUND OF THE INVENTION
    [001] The present invention relates in general to surgical devices and procedures, and more particularly to minimally invasive surgery.
    [002] Surgical procedures are often used to treat and cure a wide range of diseases, conditions and injuries. Surgery often requires access to the internal tissue through open surgical procedures or endoscopic surgical procedures. The term "endoscopic" refers to all types of minimally invasive surgical procedures including laparoscopic, arthroscopic, intraluminal natural orifice and transluminal natural orifice procedures. Endoscopic surgery has numerous advantages over traditional open surgical procedures, including reduced trauma, faster recovery, reduced risk of infection and reduced scarring. Endoscopic surgery is often performed with an insufflating fluid present within the body cavity, such as carbon dioxide or saline, to provide adequate space to perform the intended surgical procedures. The inflated cavity is usually under pressure and is sometimes referred to as being in a pneumoperitoneum state. Surgical access devices are often used to facilitate surgical manipulation of the internal tissue, while maintaining pneumoperitoneum. For example, trocars are often used to provide a port through which endoscopic surgical instruments are passed. In general, trocars have an instrument seal, which prevents the inflation fluid from escaping at the same time that the instrument is positioned in the trocar.
    [003] Although surgical access devices are known, surgical devices and methods according to the present invention have not been produced or used previously. BRIEF DESCRIPTION OF THE DRAWINGS
    [004] Although the specification ends with claims that specifically indicate and distinctly claim the present invention, it is believed that the invention will be better understood from the description below considered in conjunction with the accompanying drawings that illustrate some non-limiting examples of invention. Except where otherwise noted, figures are not necessarily represented to scale, but rather to illustrate the principles of the invention.
    [005] Figure 1 represents the surgical procedure with an instrument and loader containing an end actuator;
    [006] Figure 2 represents an enlarged view of the distal ends of the instrument and charger in figure 1;
    [007] Figure 3 represents an instrument being inserted in an end actuator;
    [008] Figure 4 represents an instrument attached to an end actuator being removed from a charger;
    [009] Figure 4A represents a loader with a removable distal end;
    [010] Figure 5 represents an enlarged isometric view of the distal end of an instrument in a locked position;
    [011] Figure 6 represents an enlarged isometric view of the distal end of an instrument in an unlocked position;
    [012] Figure 7 represents an isometric cross-sectional view of the distal end of an instrument attached to an end actuator;
    [013] Figure 8 represents an isometric cross-sectional view of the distal end of an instrument attached to an end actuator in a separate configuration;
    [014] Figure 9 represents an instrument cable;
    [015] Figure 10 represents a bipolar end actuator with claws;
    [016] Figure 11 represents an end actuator with cutting shears;
    [017] Figure 12 represents a Maryland dissector end actuator; and
    [018] Figure 13 represents an end actuator with ultrasonic scissors; DETAILED DESCRIPTION
    [019] As shown in figure 1, the instrument (20) comprises an elongated rod (22) that passes through an incision (8) of a tissue wall (6). A carrier (10) comprises an elongated rod (12) which passes through an incision (4) of a fabric wall (2). The surgical end actuator (30) is selectively fixable in vivo and removable in vivo to the fixation mechanism (40) located at the distal end (23) of the instrument (20). In this example, the end actuator is a clamp for fabric with claws, but a variety of other end actuators could also be used. The end actuator (30) can be loaded ex vivo at the distal end (13) of the stem (12) and then introduced into the surgical field through the incision (4). The magazine (10) retains the end actuator (30) during in vivo fixation and in vivo separation to / from the instrument (20). The charger (10) and the instrument (20) individually include ex vivo cables (11, 21) attached to the proximal ends of the rods (12, 22) that enable surgeons to use the devices.
    [020] The anatomies of the tissue wall (2, 6) will vary based on the surgical procedure, but some non-limiting examples include percutaneous incisions in the abdomen, chest or pelvis. The incisions (4, 8) can be created with a cutting or piercing instrument and, typically, will be spaced in relation to each other. The tissue walls (2, 6) can have the same or different anatomies. For example, the tissue walls (2, 6) can both be the abdominal wall. In another example, the tissue wall (2) may be an organ (for example, stomach, colon, esophagus, etc.) accessed through a natural orifice, while the incision (8) in the tissue wall (6) it can be percutaneous. In yet another example, the incision (4) can provide access to the abdomen, while the incision (8) can provide access to the pelvis. If pneumoperitoneum is desired, the incisions may include instrument seals, such as those commonly found in trocars. In this example, the instrument seal (5) is shown schematically in the incision (4) with the magazine (10) passing through the seal (5), while the rod (22) directly seals the fabric wall (6) due resilience of the fabric without the aid of a sealing device.
    [021] The loader rod (12) in this modality is rigid and straight, but the rod (12) can be curved or flexible, which would be beneficial for the transluminal introduction through a natural orifice of the distal end (13) in the surgical field. The magazine (10) may include a hinged distal end (13) controlled by the gripper (14). Typically, the distal end (13) will be inserted and removed through the incision (4) in line with the stem (12) and then articulated in vivo to facilitate alignment between the end actuator (30) and the stem (22 ). The arm (15) is rigidly connected to the cable (11) to facilitate the grip of the cable and the rotational orientation of the distal end (13) articulated around the axis of the rod (12). In this embodiment, the distal end (13) of the magazine (10) comprises a tube opening at the distal end (17). The tube is dimensioned to receive the end actuator (30). The tube (30) includes an engaging feature (16) for retaining the end actuator (30). Although the latching feature (16) may vary, in this embodiment a plurality of leaf springs provides an interference fit to the end actuator (30) to friction the end actuator in the tube. In this embodiment, when the end actuator (30) is loaded on the tube, the distal end (32) is positioned on the tube and the proximal end (31) extends from the tube opening (17). This arrangement prevents the end actuator claws from opening. After the distal end (23) of the instrument (20) is attached to the proximal end (31) of the end actuator (30), the end actuator (3) can be pulled from the distal end (13) of the magazine (10 ).
    [022] Figure 4A represents an alternative embodiment of a magazine (10) in which the distal end (13) is selectively fixable and removable from that of the stem (12). As shown in this example, this feature is enabled by a bayonet connection (18), but other connections are also contemplated, including snap connections, threaded connections, and the like. An advantage of this alternative embodiment is that different distal end configurations (13) can be used to retain the end actuators that cannot be accommodated by a single dimension tube.
    [023] Figures 5 and 6 represent a detailed view of an embodiment of a fixation mechanism (40) located at the distal end (23) of the rod (22). The fixing mechanism (40) comprises a corresponding feature on the rod (22), which in this modality is a circumferential groove (45) positioned on the lateral surface of the rod (22). The fixing mechanism (40) also comprises arms (42A, 42B) that project in the distal position from the distal end (44) of the rod (22). The arms are axially slidable in relation to the rod (22) and are resiliently deflectable in the middle (46). Each arm comprises a corresponding feature, which in this mode comprises a lateral notch in steps (43A, 43B). An elongated pin (41) is positioned moderately in relation to the arms (42) and is axially slidable in relation to the arms (42) between a locked position that avoids the medial deflection of the arms (an example of which is shown in figure 5) and an unlocked position that allows the medial deflection of the arms (an example of which is shown in figure 6). The pin (41) and the arms (42) can individually slide independently from the rod (22).
    [024] As shown in the embodiment of figure 5, the elongated pin (41) may include a pointed obturator tip. In this configuration, the distal end (23) can be used to perforate the tissue wall (6). The distal ends of the arms (42) and the distal end (44) of the nail (22) include tapered surfaces to facilitate passage through the incision (8).
    [025] Figure 7 shows the clamping mechanism (40) attached to the end actuator (30). The groove (45) of the stem (22) corresponds to the rib (32) of the end actuator (30), preventing relative axial movement. The lateral grooves (43) of the arms (42) correspond to the ring (33) of the end actuator (30), preventing relative axial movement. The rib (32) is rigidly connected to the outer housing (37) of the end actuator (30), and the ring (33) is rigidly connected to the claw actuator (34) via the coupling (35). Accordingly, the axial movement of the arms (42) in relation to the stem (22) will cause the axial movement of the actuator with claws (34) in relation to the housing (37), thereby causing the claws to open and close.
    [026] The following describes a method for attaching the end actuator (30) to the stem (22). The distal end (23) is inserted into the proximal end (31) of the end actuator (30) with the pin (41) in the unlocked position. When the arms (42) are advanced axially in the end actuator (30), the beveled guide (36) of the ring (33) deflects the arms (42) mediumly until the ring (33) is sealed in the side notches (43) . Simultaneously, the stem (22) advances axially to the end actuator (30), and the chamfered end (44) aligns the rib (32) with the seat in the groove (45). In both cases, the surgeon will feel a tactile "click" that indicates the appropriate engagement. Once fully seated on the end actuator (30), the pin (41) can be slid into the locked position, thereby securing the end actuator (30) to the instrument (20). Once attached, the surgeon can pull the end actuator from the magazine (10), and the magazine (10) can then be removed from the surgical field. The surgeon can then manipulate the tissue with the end actuator (30) as required by the surgical procedure.
    [027] Figure 9 shows an example of the cable (21) of the instrument (20). The cable (21) includes a base (50). A button (51) rotates the clamping mechanism (40) around the shaft of the stem (22), which will also rotate a fixed end actuator (30). The driver (54) rotates in relation to the base (50) causing the axial movement of the arms (42) and the pin (41) in relation to the rod (22). Operating the actuator (54) will operate the grips on a fixed end actuator (30). The latch (55) rotates in relation to the base (50) between a locked position (as shown in the figure) to prevent the operation of the driver (54) and a lowered unlocked position on the base (50). During seating with the end actuator (30), the latch (55) can be locked to maintain the same relative axial spacing of the correspondence between the corresponding features (43, 45) and the corresponding features (33, 32), resulting in a unique "snap" feedback. The actuator lock (56) can lock / unlock the actuator in / from the pressed position. An actuator (53), which in this modality is a sliding element, controls the axial movement of the pin (51) in relation to the arms (42). The most distal position of the actuator (53) in relation to the base (as shown in the figure) places the pin (51) in its locked position, and the most proximal position places the pin (51) in its unlocked position. The pin lock (52) includes a pin (52A) that has been inserted into the hole (53A) and holds the pin (41) and arms (42) in the locked and extended positions as shown in figure 5.
    [028] Figures 10-13 illustrate some non-limiting examples of alternative end actuators (30A-D) that can be attached to the distal end (23) of the instrument (20). In addition to the charger (10) and the instrument (20), all or a portion of the end actuators (30, 30A, 30B, 30C, 30D) can be part of a kit so that the surgeon can change the fixed end actuator according to the need for a surgical procedure. All examples of end actuators shown in the present invention had cooperating claws; however, claw-free end actuators could also be employed as cutting blades, loops, and the like. In the case of end actuators requiring energy, suitable energy transmission mechanisms known in the art should be added to the cable (21) and the rod (22). For example, appropriate electrical connections can be added to the end actuator (30A) with bipolar forceps. Similarly, an ultrasonic transducer and waveguide can be added to the end actuator (30D) of ultrasonic scissors.
    [029] The following describes a method for using the devices during a laparoscopic surgical procedure. An instrument (20) is obtained and passed through the incision (8). The incision (8) can be a percutaneous incision formed at least partially by a perforation formed with the plug on the pin (41) in the configuration shown in figure 5. The lock (52) and the pin latch (55) can be attached to the sliding element (53) and the driver (54), respectively. After drilling, the pin lock (52) can be removed.
    [030] A charger (10) and an end actuator (30) are obtained. The end actuator (30) can be selected from a plurality of end actuators provided in a kit. The end actuator (30) is loaded ex vivo at the distal end (13) of the magazine (10). The distal end (13) of the loader (10) with the loaded end actuator (30) is passed through the incision (4). The second incision (4) can also be a percutaneous incision spaced from the first incision (8), and can include the passage of the distal end (13) with the loaded end actuator (30) through a trocar. The distal end (13) can be pivoted to facilitate orientation between the proximal end (31) of the end actuator (30) and the clamping mechanism (40). The actuator (53) is slid proximally to move the pin (41) to its unlocked position. The distal end (23) of the instrument (20) is advanced to the proximal end (31) of the end actuator (30) until the corresponding corresponding features of the instrument (20) and the end actuator (30) are engaged. The actuator (53) can then be slidable distally, thus advancing the pin (41) to its locked position. The end actuator (30) is now attached in vivo to the instrument (20). The end actuator (30) can then be pulled from the magazine (10) and the latch (55) disengaged from the actuator (54). The fabric is then manipulated by activating the cable actuator (54) (21) to operate the end actuator claws (30).
    [031] After completing the surgical procedure, the end actuator (30) can be separated from the rod (22). If previously removed, the magazine (10) can be reintroduced through the incision (4) in the surgical field. The distal end (32) of the end actuator (30) is seated on the distal end (13) of the magazine (10), and the pin (41) is moved to its unlocked position. The arms (42) are then removed proximally from the ring (33) and the pin (41) returns to the locked position. Consequently, the device will be in the configuration shown in figure 8. The distal advance of the arms (42) will push the ring (33) distally until the rib (32) comes out of the groove (45). This withdrawal can be facilitated by the claws of the end actuator (30) being held in a closed position by the tube at the distal end of the loader (13). The distal end (23) can then be removed from the end actuator (30), thereby separating the end actuator (30) from the instrument (20). The end actuator will be retained in the loader (10) due to the coupling feature (16). Removing the charger (10) from the surgical field will remove the end actuator (30). A different end actuator can then be attached to the instrument (20), or the instrument (20) can be removed from the surgical field.
    [032] Without limitation, the following describes some of the benefits and advantages of the devices and methods mentioned above in relation to the prior art. The end actuator (30) can have a much larger diameter than the rod (22); consequently, the incision (8) may be smaller compared to traditional laparoscopic instruments, resulting in less pain and scarring, in addition to faster recovery. This also facilitates a nail with a smaller diameter (22) (even less than 3 mm), potentially eliminating, therefore, a trocar in the incision (8). The clamping mechanism (40) provides quick exchanges of the end actuator (30) with the instrument (20), thus shortening the time of surgery. The charger (10) also facilitates quick changes of the end actuator (30). A kit of multiple end actuators can reduce instrument costs by consolidating a single rod (22) and cable (21) for all instruments. Many other benefits will be evident to those skilled in the art.
    [033] Having shown and described various modalities and examples of the present invention, further adaptations of the methods and devices described herein can be made by means of suitable modifications by the element skilled in the art without departing from the scope of the present invention. Several of these possible modifications have been mentioned, and others will be evident to the elements versed in the technique. For example, the specific materials, dimensions and scale of the drawings will be understood as non-limiting examples. Consequently, the scope of the present invention should be considered in terms of the following claims and is understood to be not limited to the details of structure, materials or acts presented and described in the specification and drawings.
    权利要求:
    Claims (11)
    [0001]
    1. Surgical device, characterized by the fact that it comprises: an instrument (20) and a surgical end actuator (30) selectively fixable and separable from the instrument (20), the instrument (20) comprising: a) an elongated stem ( 22) which defines a longitudinal axis, the stem (22) comprising a distal end, a proximal end and a corresponding first feature (45) adapted to correspond with a first feature (32) on the surgical end actuator (30); b) an arm (42) comprising a second corresponding feature (43) adapted to correspond with the second feature (33) on the surgical end actuator (30), the arm (42) being adapted to be axially slidable with respect to to the elongated rod (22) and to be moderately deflectable; and c) an elongated pin (41) positioned in relation to the arm (42), the elongated pin (41) being axially slidable in relation to the arm (42) between a locked position that prevents the medial deflection of the arm (42) and an unlocked position that allows the medial deflection of the arm (42), the surgical end actuator (30) being adapted to be selectively fixable in vivo and separable in vivo from the second corresponding feature (43) of the arm (42) by medial deflection of the arm (42).
    [0002]
    2. Surgical device according to claim 1, characterized by the fact that the second corresponding feature (43) is a lateral notch (43) at the distal end of the elongated nail (22).
    [0003]
    3. Surgical device according to claim 2, characterized by the fact that the second feature (33) of the surgical end actuator (30) comprises a ring (33) dimensioned to correspond with the side notch (43).
    [0004]
    4. Surgical device according to claim 1, characterized by the fact that it comprises two or more arms (42) involving the elongated pin (41).
    [0005]
    5. Surgical device according to claim 1, characterized by the fact that the distal end of the elongated pin (41) comprises a obturator tip.
    [0006]
    6. Surgical device according to claim 1, characterized by the fact that it still comprises a cable (21) operationally connected to the proximal end of the elongated rod (22), the cable (21) comprising a driver (54 ) controlling the axial movement of the arm (42) and an actuator (53) controlling the axial movement of the elongated pin (41).
    [0007]
    7. Surgical device according to claim 6, characterized by the fact that the actuator (53) can be locked.
    [0008]
    8. Surgical device according to claim 1, characterized by the fact that the end actuator (30) has cooperating claws that move between the open and closed positions in response to the axial movement of the arm (42).
    [0009]
    9. Surgical device according to claim 1, characterized by the fact that the arm (42) protrudes distally from the distal end of the elongated nail (22).
    [0010]
    10. Laparoscopic surgical device, characterized by the fact that it comprises: a plurality of arms (42) that project distally from the distal end of the elongated rod (22), the arms (42) each comprising a lateral notch (43) as a corresponding feature, the arms (42) being axially slidable in relation to the elongated rod (22) and being medially deflectable; the elongated pin (41) being positioned medially in relation to the arms (42), the elongated pin (41) being adapted to be axially slidable in relation to the arms (42) between a locked position preventing the medial deflection of the arms (42 ) and an unlocked position allowing the medial deflection of the arms (42); and since the surgical end actuator (30) is adapted to be selectively fixable in vivo and separable in vivo from the corresponding feature (43) of the arms (42), the surgical end actuator (30) comprises jaws that open and close in response to axial movement of the arms (42) when attached to the surgical end actuator (30).
    [0011]
    11. Laparoscopic surgical device, according to claim 10, characterized by the fact that it still comprises a obturator tip at the distal end of the elongated pin (41).
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    法律状态:
    2020-09-15| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-12-22| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-03-02| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 10 (DEZ) ANOS CONTADOS A PARTIR DE 02/03/2021, OBSERVADAS AS CONDICOES LEGAIS. |
    2021-06-22| B16C| Correction of notification of the grant|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 07/10/2010, OBSERVADAS AS CONDICOES LEGAIS. PATENTE CONCEDIDA CONFORME ADI 5.529/DF, QUE DETERMINA A ALTERACAO DO PRAZO DE CONCESSAO |
    优先权:
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    US12/576,578|2009-10-09|
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    US12/576,546|US20110087265A1|2009-10-09|2009-10-09|Laparoscopic instrument with attachable end effector|
    US12/576,578|US9186203B2|2009-10-09|2009-10-09|Method for exchanging end effectors In Vivo|
    US12/576,546|2009-10-09|
    US12/576,565|2009-10-09|
    PCT/US2010/051812|WO2011044353A1|2009-10-09|2010-10-07|Laparoscopic instrument with attachable end effector|
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