Surgery – Specula – Retractor
Reexamination Certificate
2001-03-13
2003-09-23
Dvorak, Linda C. M. (Department: 3739)
Surgery
Specula
Retractor
C600S206000, C600S208000, C604S513000, C604S539000, C606S108000
Reexamination Certificate
active
06623426
ABSTRACT:
The invention relates to a surgical/medical device for laparoscopic surgery to provide surgical access to the abdomen and maintain a gas-tight seal around the arm or an instrument during surgery. Surgery of this type is referred to as hand-assisted laparoscopic surgery or hand-access surgery.
Conventional abdominal surgery requires the creation of an incision in the abdominal wall to allow access to, and visualisation of the internal organs and other anatomical structures. These incisions must be large enough to accommodate the surgeons hands and any instruments to be utilised by the surgeon during the surgery. Traditionally the size of these incisions has been dictated by the need to see, retract and palpate internal bodily structures. While a large incision will provide access to the interior of the abdomen they are associated with longer healing times, are more susceptible to infection and result in unsightly scars.
Alternatives to open surgery exist in the form of endoscopic or laparoscopic surgery. In this method of surgery, the surgeon operates through small incisions using remotely actuated instruments. The instruments pass through the abdominal wall using devices called trocars. These working channels typically have a diameter ranging from 5 to 25 millimeters. Vision is provided using a laparoscope which is typically 20 to 25 centimeters long and uses fibre-optic technology or a CCD camera to provide the operator with a picture of the interior of the abdomen. The abdomen must be insufflated with a gas such as carbon dioxide or nitrogen to maintain a bubble effect and provide a viable working space for the operator to perform the surgery unhindered by the lack of space. This insufflation creates a working space known as the pneumoperitoneum. Trocars through which instruments are inserted are constructed to prevent loss of the gas through them resulting in collapse of the pneumoperitoneum.
The benefits of laparoscopic surgery are numerous. Recovery times have been shown to be reduced due to the absence of a large incision. This has benefits for the patient, the health care organisation and society. The benefits to the patient are reduced stay in hospital, faster mobilisation and return to normal activity. The benefits to the health care organisation is also due to the reduced stay in hospital which is often the most expensive aspect of health care provision. Society benefits in faster return to work and normal activity of the patient.
However, not all surgical procedures can be performed laparoscopically. Surgery requiring the removal of large organ specimens, such as surgery for removal of the colon, has traditionally been hampered by the small incisions used for the introduction of laparoscopic instruments in the surgery.
The other major disadvantages of laparoscopic surgery are due to the complex nature of the technique. Surgeons who wish to practise laparoscopic surgery must spend much time training to master the technique. The success of laparoscopic surgery depends on the skill of the surgeon to manipulate organs and carry out delicate tasks using remotely actuated instruments. Unfortunately in laparoscopic surgery the surgeon is insulated from the material that they are working on. This deprives the surgeon of tactile feedback and the ability to palpate delicate structures. The surgeon's most effective instrument, the hand, is reduced to a device that must simply actuate instruments that are inherently lacking in dexterity and operability due to the constraints on their design placed by the nature of the narrow channels in trocars through which they must pass. Another disadvantage of laparoscopy is that the image viewed by the surgeon is a two dimensional image on a video screen. The surgeon loses three dimensional perspective of depth and distance and awareness of the proximity of other structures during video laparoscopy.
These disadvantages have led to long learning curves for the practitioners of laparoscopic surgery, required highly skilled and coordinated surgical teams and has limited the application of laparoscopic surgery to relatively simple surgical procedures.
Recently, new surgical techniques have been developed that combine the advantages of both open surgery and laparoscopic surgery. In these new techniques surgery is carried out using a laparoscopic approach with the addition of a slightly larger incision to allow the surgeon to insert a hand into the insufflated abdomen. This is often referred to as hand-assisted laparoscopic surgery or HALS.
HALS allows surgeons to regain the tactile feedback and three-dimensional perspective lost in the conversion from open to laparoscopic procedures. It also permits rapid finger dissection, enhanced retraction capabilities and simplified haemostasis. There are several publications in the literature describing procedures carried out using a hand-assisted approach. These include total and sub-total colectomy, rectopexy, Nissen's fundoplication, gastrectomy, splenectomy, nephrectomy, pancreatectomy and others. Some of these procedures were previously performed using an open technique only. Over the past few years several centres have been investigating HALS with surgical device companies and increasing the literature on the subject. With the advent of surgical devices for facilitating HALS it is expected that more open surgical procedures will be converted to HALS procedures.
The key to the success of hand-assisted laproscopic surgery is to provide that seals to the wound edge and to a surgeons arm to maintain the pneumoperitoneum required. The device should provide freedom of movement including rotational, lateral and translational; In addition it should be possible to use laparoscopic instruments with the device.
Various hand access devices have been proposed however, to date, no hand access device is available that adequately addresses these key issues.
U.S. Pat. No. 5,366,478 (Brinkerhoff et al) describes a device which is said to be for use during endoscopic surgery, the device having two inflatable toroidal sections connected by a transitional section. The transitional section is said to function to allow the passage of air from one toroid to the other toroid on inflation of the device. Each toroidal section contains a flexible stiffening ring. The stiffening ring in the outer toroid is illustrated in a position floating above the abdominal wall after inflation. It is unclear how this stiffening ring maintains this configuration. It is therefore unlikely that this device will operate as described. Also it is difficult to pass an object such as a surgeon's forearm through a lumen in the transitional section, because of frictional resistance to the movement of the object relative to the transitional section.
A medical device for forming an external extension of the pneumoperitoneum is described in U.S. Pat. No. 5,480,410 (Cuschieri et al). The device includes an enclosure sealed into a trocar puncture site in an abdominal wall. Insufflation gas passes from the body cavity into the enclosure inflating it. A number of valved openings are provided on the device to enable access to the enclosure interior.
In U.S. Pat. No. 5,514,133 (Golub et al) describes an endoscopic surgical apparatus, which enables a surgeon to access a surgical site through an opening. The apparatus includes two plates, which engage the outer and inner surfaces of the abdominal wall, and a sealing member, which inhibits the flow of gas through the opening. The seal in this apparatus does not maintain complete insufflation of the body cavity, gas can gradually leak out through the flapvalves and seal. The valve configuration also makes it impossible to extracorporealise an organ, which is preferred in hand assisted surgery devices. The device also has a complicated construction.
A surgical glove suitable for endoscopic surgical procedures is disclosed in U.S. Pat. No. 5,526,536 (Cartmill). The glove has an inflatable wrist section, which when inflated, provides a seal between the surgeon's hand and the body wall. The surge
Bonadio Frank
McManus Ronan Bernard
Reid Alan
Young Derek William
Atropos Limited
Dvorak Linda C. M.
Finnegan Henderson Farabow Garrett & Dunner LLP
Ram Jocelyn
LandOfFree
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