Surgery – Specula – Retractor
Reexamination Certificate
1999-03-29
2001-04-24
Smith, Jeffrey A. (Department: 3732)
Surgery
Specula
Retractor
C600S214000
Reexamination Certificate
active
06221008
ABSTRACT:
TECHNICAL FIELD
The present invention relates to a device for lifting the abdominal wall for laparoscopy, whereby this device can be at least partially inserted into the abdomen through an opening in the abdominal wall.
STATE OF THE ART
Generic type devices possess an instrument shaft which is provided at its distal end region with at least one, preferably two parallel limbs disposed parallel to the axis of the instrument shaft. The limbs can be folded open laterally to the axis of the shaft.
Devices of the above class, employed in the field of endoscopic surgery, for laparoscopy respectively laparoscopic treatment, are also known under the term “elevation instruments” Instruments of this type are inserted into the abdominal cavity through a narrow opening and, by folding the holding supports open laterally, provide a wide fan support in order to be able to lift as large as possible an area of the abdominal wall. In this way, the surgical area required inside the abdominal lumen is created for subsequent laparoscopy as well as endoscope-supported surgery.
The elevation instruments used for widening the abdominal cavity, should, on the one hand, have a small as possible cross section so that the opening in the abdominal wall through which the instrument is inserted inside the abdomen can be maintained as small as possible and, on the other hand, however the carrier arms or hereinafter called limbs, which can be folded open laterally to the side of the instrument offer a wide as possible fan support for the abdominal wall.
The following demands are made on the rotating respectively folding mechanism, by which the limbs are folded away from the axis of the instrument:
The folding open and shut procedure should occur inside the abdominal cavity in a reliable and dosed manner. The whole carrier mechanism should be provided with sufficient stability for bearing the weight of the abdominal wall and at the same time require as little space as possible. Furthermore, safety devices should be provided in order to be able to remove the elevation instrument from the abdomen again if the folding mechanism fails.
The article by Albert K. Chin et al., “Gasless Laparoscopy Using a Planar Lifting Technique”, in the Journal of the American College of Surgeons, April 19194, vol. 178, pp. 401-403, describes a generic type device for mechanically lifting the abdominal wall which permits carrying out laparoscopic surgery without continuous gas insufflation into the abdominal cavity. The gas bubble inside the abdominal cavity created by the insufflation of, preferably, carbon dioxide can lead to reducing the breathing capacity and diminished vein return flow due to the artificial maintenance of a relatively high pressure. Generic type elevation instruments are utilized in order to avoid this and other drawbacks for the patient.
The generic type device described in the aforementioned article provides for a handling shaft at the distal end region of which an expanding device, which assumes a closed position for insertion into the abdominal cavity, is attached at a right angle to the axis of the shaft so that the expanding shaft can be brought into the abdominal cavity through very narrow abdominal openings. Due to an operating mechanism attached to the handling shaft, the folding mechanism can be folded open scissorlike inside the abdominal cavity, whereby two limbs provided in a V position lift the abdominal wall intracorporally by appropriate lifting of the instrument.
Removal of the device is not possible until the limbs set in the V position have been returned to a parallel position by the corresponding operating mechanism. However, if pieces of tissue are present between the limbs, these may be bruised or irreversibly damaged when the limbs are closed again. Moreover, in such an event, complete closing of the two limbs is impossible, thereby considerably impeding gentle removal of the instrument through the small opening in the abdomen.
Furthermore, generic type devices are known which provide limbs that can be folded open parallel to the axis of the shaft of the instrument, which following insertion into the abdominal cavity through very narrow abdominal openings fold open inside the abdominal cavity like the mechanism of an umbrella and with appropriate lifting of the instrument lift the abdominal wall intracorporally from below in the direction of the movement of the instrument. With these type of folding mechanisms, which preferably occupy a region of rotation between the parallel position to the axis of the shaft and an orthogonal position to the axis of the shaft, the problem arises that pieces of tissue in the abdominal cavity can considerably impede closing the limbs again. However, incomplete closing of the individual limbs leads to a kind of catching, the removal of which through the small abdominal opening inevitably damages the tissue surrounding the abdominal opening.
DESCRIPTION OF THE INVENTION
The object of the present invention is to improve a device for lifting the abdominal wall for laparoscopy according to the generic part of claim
1
in such a manner that the aforedescribed risk of incomplete closing of the instrument limbs expanded for lifting the abdominal wall due to, for example catching or pinching pieces of tissue, is largely ruled out. For this purpose, a folding mechanism should be used for folding the expanding limbs open with as little use of space as possible in order to avoid intracorporal tissue irritation. Nonetheless, the instrument should be easy to operate without requiring major force.
A solution to the object is set forth. Further features which advantageously improve the concept of the solution are disclosed.
An element of the present invention is to improve a device for lifting the abdominal wall for laparoscopy in such a manner that the limbs are joined with the shaft of the instrument via a folding mechanism which rotates the limbs at an angle range up to 180°.
In this manner, for removal of the instrument out of the abdominal cavity, the limbs folded open for lifting, preferably in an orthogonal position to the shaft of the instrument, can be folded either to the proximal side of the instrument parallel to the axis of the shaft of the instrument or, if the limbs are prevented from fitting completely close to the axis of the instrument by caught pieces of tissue, to fold in the opposite direction, i.e. toward the distal side, until the limbs fit closely parallel to the axis of the shaft of the instrument in order to be able to remove the instrument in this position easily from the abdominal cavity through the abdominal opening.
REFERENCES:
patent: 5195505 (1993-03-01), Josefsen
patent: 5289817 (1994-03-01), Williams et al.
patent: 5381788 (1995-01-01), Matula et al.
patent: 5702352 (1997-12-01), Kimura et al.
patent: 5722935 (1998-03-01), Christian
patent: 640 126 (1936-12-01), None
patent: 9106553 (1991-09-01), None
patent: 0 614 646 (1994-09-01), None
patent: 1532001 (1989-12-01), None
Bacher Uwe
Keckstein Jörg
Lehmann Markus
Karl Storz GmbH & Co. KG
Smith Jeffrey A.
St.Onge Steward Johnston & Reens LLC
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