Surgery – Specula – Retractor
Patent
1998-10-24
1999-11-02
Smith, Jeffrey A.
Surgery
Specula
Retractor
600206, 600235, A61B 1700
Patent
active
059760796
DESCRIPTION:
BRIEF SUMMARY
BACKGROUND AND SUMMARY OF THE INVENTION
The present invention relates to a device for lifting the abdominal wall for conducting endoscopic examinations, such as surgery within the abdominal cavity. The device has a spiral-shaped section provided with at least one pitched winding and the one end of which is the distal end and which develops on the proximal side into a handling section.
Today, endoscopic instruments meeting ever greater demands for as minimal as possible trauma during surgery are increasingly employed in diagnosis and therapy within the human abdominal cavity. Within the framework of laparoscopy, in order to obtain the freedom of movement necessary for conducting examination and surgical procedures inside an abdominal cavity, the abdominal cavity is filled with gas. The intermediate space, the pneumoperitonium, forming between the internal organs and the abdominal wall due to the selective introduction of gas, has to be maintained over several hours depending on the difficulty and complexity of the surgery to be carried out.
Intra abdominal pressure maintained for an extensive period of time during surgery can lead to diminishment of breathing capacity and, furthermore, to the reduction of venous blood return flow. Moreover, the continuous introduction of gas into the human abdominal cavity, so-called insufflation, leads to slow hypothermia in the patient unless suited tempering of the insufflation gas is attended to during insufflation. In the event of continuous insufflation, hypoxia can set in due to hypoventilation as well as heart rhythm or expectoration disorders connected with the above-mentioned decreased venous return blood flow reduction. Further, intra abdominal pressure conditions can lead to increased vagus irritation due to extension of the peritoneum which, as the lung-stomach nerve, may impair the vegetative nervous system considerably.
Therefore, the question arises whether laparoscopic surgery is possible with reduced pneumoperitonium and whether reduction of intraabdominal pressure, generated and maintained by the insufflation procedure, possesses positive effects on the blood pressure dynamics and the respiratory cycle.
Within the scope of these examinations a number of instruments, with the aid of which the abdominal wall can be lifted manually, have become known as alternative to the aforementioned insufflation technique.
The article "Gasless Laparoscopy and Conventional Instruments" by R. S. Smith et, al., Journal Arch Surg. Vol. 128, Oct. 1993, pp. 1102 to 1107, describes a socalled laparolift system comprising a scissor-shaped mechanism which can be introduced into the abdominal cavity through the abdominal wall in a closed state. Inside the abdominal cavity the two scissor-like limbs can be expanded by means of an expansion mechanism. The two scissor-like limbs lift the abdominal wall from the internal organs by means of external drawing. The fillet like shape of the two scissor-like limbs puts much local strain on the abdominal wall due to the small surface of the support area of the limbs, which may damage the abdominal wall tissue. Furthermore, with lifting the scissor-like limbs, the scissor-like instrument offers only a small tent-like internal space in which endoscopic manipulations and examinations can be carried out only under difficult spatial conditions.
Although, in this manner the disadvantages connected with insufflation are avoided, the method does not ensure a large voluminous inflation of the abdominal cavity in which surgical measures can be conducted without hindering the surgeon.
In order to avoid the disadvantage of only a little expansion of the abdominal cavity achievable with the afore described scissor-like instrument, a spiral-like shaped stainless steel wire construction has been developed. The spiral-shaped state-of-the-art arrangement depicted in FIG. 1 is provided at its distal end E with an essentially centered and parallel to the spiral axis S shaped distal section which is designed on the distal side with a tapering material diameter
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Klicker Mike
Meyer Joerg-Uwe
Paul Volker
Schuck Herbert
Volz Joachim
Fraunhofer Gesellschaft zur Foerderung der angewandten Forschung
Smith Jeffrey A.
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