Surgery – Instruments – Electrical application
Reexamination Certificate
1999-01-29
2001-01-23
Dvorak, Linda C. M. (Department: 3739)
Surgery
Instruments
Electrical application
C606S045000, C606S048000, C606S113000
Reexamination Certificate
active
06176858
ABSTRACT:
FIELD OF THE INVENTION
This invention relates to surgical instruments, and more particularly to electrosurgical instruments for laparoscopic surgery.
The invention further relates to a laparoscopic method for performing a section of an organ using an electrosurgical instrument.
STATE OF HTE ART
Supracervical or subtotal hysterectomy is a procedure in which there is renewed interest, and it is currently being evaluated in patients presenting with benign uterine disease and a healthy cervix. The technique of Laparoscopic Supracervical Hysterectomy (LSH) has only been introduced recently (Semm, K. Hysterectomy via laparotomy or pelviscopy. A new CASH method without colpotomy,
Geburtshilfe und Frauenheilkunde,
1991; 51: 996-1003; Pelosi, M. A., Pelosi, M. A. III. Laparoscopic supracervical hysterectomy using a single-umbilical puncture (mini-laparoscopy),
Journal of Reproductive Medicine,
1992; 37: 777-784; Donnez J., Nisolle M. LASH, Laparoscopic supracervical (subtotal) hysterectomy,
Journal of Gynaecologic Surgery,
1993; 9: 92-94.)
Some of the potential advantages of this procedure include a shorter operation time, fewer complications and an earlier return to normal activity including sexual function.
A difficult part of the laparoscopic procedure is the sectioning of the uterine cervix. Conditions are often far from optimal due to the angle of approach with the cutting electrode or scissors and the proximity of neighbouring important structures such that are sometimes difficult to keep at a distance. Safety has always been an important consideration when choosing a supracervical procedure rather than a total hysterectomy. By avoiding the risk of cervical dissection with possible ureteral lesions, the complication rate may be reduced with a supracervical technique. However, when cutting the cervix with any monopolar instrument, there is an associated risk of damaging adjacent structures.
AIMS OF THE INVENTION
A first aim of the present invention is to provide a new surgical instrument for performing laparoscopic section of an organ.
A further aim of the present invention is to provide a new surgical instrument that reduces operation time when performing a laparoscopic supracervical hysterectomy or a total laparoscopic hysterectomy.
Another aim of the present invention is to provide a new method for performing a laparoscopic section of an organ, a laparoscopic supracervical hysterectomy or a total laparoscopic hysterectomy.
SUMMARY OF THE INVENTION
The present invention relates to an electrosurgical cutting apparatus for performing laparoscopic section of an organ, comprising an electrical current transporter, said transporter comprising:
A conducting wire
electrical insulation portions around said conducting wire at the first end and at the second end, forming respectively a first and a second insulated end and defining a non-insulated cutting portion between said first insulated end and said second insulated end, and
a first fastening device located at said first end of said conducting wire and a second fastening device located at said second end of said conducting wire, said second fastening device being in electrical contact with said conducting wire.
Preferably, the electrical insulation portions comprise Teflon® and/or medical grade thermoretractable polyolefine.
The conducting wire preferably comprises a metal, said metal being advantageously selected from the group consisting of tungsten and stainless steel.
The conducting wire preferably has a length between 10 and 20 cm.
In a first embodiment of the present invention , the first fastening device and the second fastening device are clips adapted to be held by a standard laparoscopic forceps. In this case, the electrosurgical cutting apparatus of the embodiment described hereabove further comprises an insulating tube of at least the same length as the conducting wire, and which is broad enough to fit a standard laparoscopic forceps.
In a second embodiment of the present invention, the first fastening device is a screw or the like and the second fastening device is a conducting sphere or the like. Preferably, the screw or the like is insulated. Preferably, the electrosurgical cutting apparatus of the second embodiment described hereabove further comprises:
an introducer device comprising a rod having a proximal end and a distal end, said rod having at its distal end a screwhole adapted to retain said screw or the like and a groove adapted to fit and electrically contact said conducting sphere or the like, said rod having at its proximal end an insulated handle, a contact and an insulated spring therebetween, said contact being in electrical contact with said groove, and
an insulated sheath having a length that is greater than the length of the wire and lesser than the length of said introducer device and comprising a tube and a handle, both adapted to fit the introducer, said handle comprising a plug and a contactor mechanism being in electrical contact with each other, said contactor mechanism not being in contact with the contact of the introducer when the introducer is inserted in the sheath and the distal end extends beyond the sheath, and being in contact with the contact of the introducer when the introducer is in a retracted position such that the distal end is inside the sheath, so that the wire and the plug are electrically connected. Preferably, the electrosurgical cutting apparatus as in this second embodiment further comprises a pin located on the handle of the introducer and a second groove located inside the handle of the sheath, said second groove being adapted to fit said pin and to prohibit translational movement of the introducer with respect to the sheath by trapping said pin when introducer and sheath are rotated with respect to each other.
A third embodiment of the present invention is an electrosurgical cutting apparatus as described hereabove as the second embodiment, further comprising:
an introducer device comprising a rod having a proximal end and a distal end, said rod having at its distal end a screwhole adapted to retain said screw or the like and a groove adapted to fit and electrically contact said conducting sphere or the like, said rod having at its proximal end an insulated handle, an electrical plug and an insulated spring, said electrical plug being in electrical contact with said groove, and
an insulated sheath having a length that is greater than the length of the wire and lesser than the length of said introducer device and comprising a tube and a handle, both adapted to fit the introducer.
Preferably, the electrosurgical cutting apparatus as described in the third embodiment hereabove further comprises a pin located inside the handle of the sheath and a second groove located on the handle of the introducer, said second groove being adapted to fit said pin and to prohibit translational movement of the introducer with respect to the sheath by trapping said pin when introducer and sheath are rotated with respect to each other.
Another aspect of the present invention is a method for performing a laparoscopic section of an organ using an electrosurgical cutting apparatus as described in the first embodiment of the present invention, comprising the following steps:
grasping one clip of the apparatus with a first standard laparoscopic forceps,
introducing said forceps and apparatus into a patient's body through a trocar,
grasping the second clip of the apparatus with a second standard forceps and placing the conducting wire around the organ to be sectioned,
grasping the second clip with the first standard forceps, and
applying high frequency monopolar current to said conducting wire while performing a lateral traction on the apparatus with the first standard forceps.
Prior to the introduction of forceps and apparatus into a patient's body through a trocar, the apparatus is preferably inserted in an insulating tube to insulate the apparatus from the trocar. The organ to be sectioned is preferably an uterus, the operation being a Laparoscopic Assisted Supracervical Hysterect
Constant Camille
Dequesne Jacques
Moreels Xavier
Dvorak Linda C. M.
Knobbe Martens Olson & Bear LLP
Medsys S.A.
Ruddy David M.
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