Surgery – Instruments – Internal pressure applicator
Reexamination Certificate
2003-05-08
2004-10-19
Ho, Tan-Uyen T. (Department: 3731)
Surgery
Instruments
Internal pressure applicator
C606S127000
Reexamination Certificate
active
06805699
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention concerns the construction of a laparoscopic specimen retrieval shoehorn (“LSRS”). An LSRS combines the features and advantages of a laparoscopic specimen extraction port (“LSEP”) with those of an endoscopic specimen retrieval bag device (“ERBD”). More specifically, the present invention concerns the construction of a device that facilitates removal of a specimen extracted from a patient during laparoscopic surgery, among other types of surgery.
2. Description of Related Art
As illustrated in
FIG. 11
, during a typical abdominal laparoscopic surgery, a surgeon makes four or so small (typically about 2 cm) incisions
10
in the abdominal wall
20
of the patient. The surgeon positions a trocar
22
(shown in
FIGS. 15 and 16
) into an axial hole
26
in a laparoscopic port
30
to facilitate insertion of the port
30
into the incision
10
. After inserting the trocar
22
and port
30
through the incision
10
, the surgeon removes the trocar
22
to allow insertion of surgical instruments (e.g., grasping instrument
80
) into the abdominal cavity
40
through the axial hole
26
in the port
30
. The surgeon repeats this procedure for each of the four or so required ports
30
.
To simplify the figures and focus on the functional structures of the laparoscopic port
30
and trocar
22
,
FIGS. 11-14
illustrate simplified views of the conventional laparoscopic port
30
. It is to be understood, however, that in reality, conventional laparoscopic ports
30
and trocars
22
are typically shaped as shown in
FIGS. 15 and 16
. Similar types of simplified views are used to illustrate the present invention. Nonetheless, as would be appreciated by one of ordinary skill in the art, the present invention will, in practice, have a shape similar to the laparoscopic port
30
and trocar
22
illustrated in
FIGS. 15 and 16
.
The surgical instruments that are inserted through the laparoscopic port
30
typically include a video camera that enables the surgeon to visualize the surgical procedure. Variously sized surgical ports
30
are designed to be used with variously sized instruments. Typical instruments require surgical ports
30
with axial holes
26
having 5 mm inside diameters. As is discussed in greater detail below, endoscopic specimen retrieval bags (“endo-bags™”) typically are inserted through ports
30
that have holes
26
with 10 mm inside diameters and 12 mm outside diameters.
During laparoscopic surgery, the abdomen is insufflated with carbon dioxide to distend the abdominal cavity
40
(creating pneumoperitoneum) and allow for better visualization of the surgical operation. Each port
30
includes a flapper valve
45
(see
FIGS. 15 and 16
) that opens to allow the surgeon to insert an instrument therethrough and automatically closes when the instrument is removed so as to prevent the loss of pneumoperitoneum.
During laparoscopic surgery, it is often necessary to extract a specimen
50
such as a gall bladder from the abdominal cavity
40
of the patient. As illustrated sequentially in
FIGS. 11-14
, using a conventional specimen extraction technique, the surgeon inserts an endo-bag
60
through one of the ports
30
and positions the endo-bag
60
using an endo-bag handle/controller
70
. As illustrated in
FIG. 11
, after the specimen
50
has been surgically detached from the patient, the surgeon uses a surgical grasping instrument
80
, which is inserted into the abdominal cavity
40
through a separate port
30
, to place the specimen into the open endo-bag
60
. As illustrated in
FIG. 12
, the surgeon pulls a “purse string”
90
of the endo-bag
60
to synch down the open end of the endo-bag
60
, thereby securely enclosing the specimen
50
within the endo-bag
60
. As illustrated in
FIG. 13
, the surgeon then removes the port
30
through which the endo-bag
60
was inserted, leaving the purse string
90
extending through the incision
10
. This unfortunately often causes loss of pneumoperitoneum, leading to impaired visualization of the specimen
50
during the extraction process. The surgeon thereafter attempts to pull the endo-bag
60
and specimen
50
out of the abdominal cavity
40
through the incision
10
.
Unfortunately, as illustrated in
FIG. 14
, it is frequently difficult for the surgeon to extract the specimen
50
and endo-bag
60
through the relatively small incision
10
. As the surgeon pulls the endo-bag
60
through the incision
10
, most of the plastic endo-bag
60
easily pulls through the incision
10
with the specimen
50
bunching in the bottom of the endo-bag
60
in the abdominal cavity
40
(as shown in FIG.
14
). Such bunching results in a variety of deleterious effects. In one example, the surgeon may resort to exerting a strong pulling force on the endo-bag
60
, causing the endo-bag
60
and/or the surgical specimen
50
to rupture. Such a rupture might spread infectious, bilious, and/or even cancerous material in the abdominal wall
20
and cavity
40
. Alternatively, the surgeon may resort to extending his/her initially relatively small port incision
10
. Expanding the incision
10
deleteriously increases postoperative pain, increases surgical blood loss, increases the risk of future dehiscence (opening) of the incision and/or herniation of the abdominal contents through the expanded incision
10
, and reduces or eliminates the advantages of laparoscopic surgery. Furthermore, the complications that often accompany the specimen
50
extraction procedure add significant operating room and anesthetic time to the surgery, which greatly increases the cost of the procedure to the hospital and the patient.
In summary, while prior art laparoscopic ports
30
and procedures(s) (as outlined above in connection with
FIGS. 11-14
) have proven effective, for the most part, in laparoscopic surgery, the prior art ports
30
available (and, therefore, the procedure(s) used in connection with those ports
30
) may lead unnecessarily to complications. This has resulted in a need for an improved port and/or procedure to lessen the occurrence of such complications.
In addition, as may be apparent from the foregoing discussion, laparoscopic surgery relies upon coordination between several instruments, the port
30
, the endo-bag handle/controller
70
, the endo-bag
60
, and the surgical grasping instrument
80
. This coordination, while performed routinely and successfully during laparoscopic surgery, is complex and calls out for a solution.
SUMMARY OF THE INVENTION
One aspect of the present invention, therefore, provides an improved laparoscopic instrument that reduces surgery time and post-operative recovery time.
An additional aspect of the present invention provides a laparoscopic instrument that substantially prevents a specimen from bunching in an endo-bag during extraction of the specimen from a patient.
A further aspect of the present invention provides a laparoscopic instrument that reduces the risk of rupturing the specimen or endo-bag during extraction of the specimen from a patient.
A further aspect of the present invention provides a laparoscopic instrument that reduces the risk of spreading infectious, bilious, and/or cancerous material into the patient's abdominal cavity and/or incision.
Another aspect of the present invention is to provide an LSRS. The LSRS has a primary shaft, where the primary shaft includes a rearward portion, an intermediate portion, and a forward portion. The forward portion is radially-enlarged relative to the intermediate portion. A secondary shaft is slidably disposed within the primary shaft. The secondary shaft has an endo-bag attached thereto. A sheath, with expanded and contracted positions, is slidably disposed around the primary shaft. The sheath has a holding ring disposed radially-outwardly from the intermediate portion of the primary shaft. The holding ring is adapted to slide relative to the intermediate portion. The holding ring is disposed at a rear end of the sheath. A plurality of circumferentially-spaced
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