Surgery – Truss – Perineal
Patent
1992-09-17
1994-12-27
Apley, Richard J.
Surgery
Truss
Perineal
604104, 606191, A61B 1702
Patent
active
053755910
DESCRIPTION:
BRIEF SUMMARY
FIELD OF THE INVENTION
The subject of the present invention is an instrument for implementing medical or surgical operations by laparoscopy or coelioscopy.
BACKGROUND OF THE INVENTION
For the purpose of medical investigations, a coelioscopy technique is often employed, which consists in pressurising the volume delimited by the peritoneum, ensuring a raising of the abdominal wall, before introducing into the latter a trocar allowing passage of an optical device allowing visualisation of the state of the organs on which investigation is to be carried out.
It is also known to use this technique for carrying out surgical operations. In such a case it is suitable to make passages for several trocars of which some serve for visualising the organs on which the operation is to be carried out, and of which others serve for passage of the instruments.
The raising of the wall is currently obtained by a sufficient pressure difference between the peritoneal cavity and the outside. However this pressure difference cannot be increased without danger because of circulatory or ventilatory disturbances which this could cause.
Now, the plurality of the passageways causes gas leaks which are sufficiently large to prevent keeping a sufficient pressure inside the peritoneum. In fact, pneumoperitoneal insufflation apparatuses have a flow rate which is limited by construction, in particular for safety reasons. Furthermore, the increase of pressure inside the peritoneal cavity represents some danger during the course of a laparoscopy.
This constraint of relative airtightness requires that all the instruments used must be very specifically adapted so as to obtain as complete an airtightness as possible in the crossing of the wall. This extremely rigorous technical constraint is a very restricting factor in the design and production of coelioscopic surgical instruments.
Moreover, the appearance of operating techniques comprising the ablation of tissue volume or of larger organs requires the creation of extraction orifices of greater size than those normally used in conventional laparoscopy. These extraction orifices generate considerable leaks from the pneumoperitoneum which cause collapse of the wall, which is manifested by an complete disappearance of the operating volume as well as the zone of visibility for the practitioner.
OBJECTS OF THE INVENTION
The present invention aims to alleviate these problems by providing an instrument allowing the raising of the wall of the peritoneum to be held mechanically.
For this purpose, the instrument to which it relates is made from a filiform material and comprises a first part intended to be positioned against the deep surface of the anterior abdominal wall, and a second part which, crossing the abdominal wall, is terminated by a fastening device.
According to a first embodiment, this instrument is made from a fillform material and comprises a first part generally in the shape of an open ring intended to be positioned against the deep surface of the anterior abdominal wall, and a suspension element crossing the abdominal wall and terminated by a fastening device.
In practice, the peritoneal cavity is pressurised and equipped with a flexible trocar which crosses the abdominal wall. By means of this flexible trocar the ring-shaped; part of the instrument is introduced, from the open free end of this part, until that ring-shaped part is positioned against the deep surface of the anterior abdominal wall. The suspension element which terminates in a fastening device, for example in the shape of a hook, is then solidly attached to a support such as a bracket attached to the operating table. It is thus possible to hold the abdominal wall mechanically, so that one no longer depends exclusively on the insufflation of gas inside the peritoneal cavity.
In order to facilitate ring-shaped introduction through the abdominal wall, this ring-shaped part is disposed in a slightly twisted plane, the end zone of the branch forming the open part of the ring being inclined with respect to the plane of th
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Apley Richard J.
Dubno Herbert
Maraglio Donna Y.
Wilford Andrew
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