Patent Application
20090182292
a) Field of the Invention
The invention relates to a medical instrument with an endosurgical extraction bag for the extraction during an endoscopic surgical procedure of material to be removed from a body on which surgery is to be performed.
b) Description of Related Prior Art
Medical instruments for the extraction of material, for example the gall bladder, to be removed during endoscopic surgery are known in various versions. In a known version a bag (=“endosurgical extraction bag”) is held by means of a hoop of a spring-elastic material at the distal end of a shaft of the instrument. In the state in which the instrument is delivered, the bag is rolled up and is located, together with the pressed-together hoop, in an enveloping tube encompassing the shaft. The shaft is introduced in this state through a trocar. When the enveloping tube on the shaft is withdrawn in the direction toward the proximal end of the shaft, the hoop and the bag appended thereon are released at the distal end of the enveloping tube, such that the bag can become unrolled and the hoop can unfold forming a fill opening of the bag. After the bag has been filled with the material to be extracted, it can be closed, for example by sliding the enveloping tube distally again on the shaft and the distal end of the enveloping tube pushes the bag together on the hoop, with the hoop being gradually pressed together again. A further feasible closure of the bag can be attained by means of a so-called drawstring closure. Herein a loop guided in a conduit of the bag, which encompasses its fill opening in this region, is drawn together whereby the bag is also torn off the spring-elastic hoop.
One disadvantage of these known extraction instruments comprises that, in general, the material to be extracted is of too great a size for it to be pulled out through the trocar through which the instrument has been inserted. Pulling the instrument together with the trocar through the opening in the body wall through which the trocar has been introduced is frequently also only possible by enlarging the opening in the body wall. Another feasibility consists in partially opening the bag again and inserting a morcellator (=size reducer) to reduce the material located in the bag to pieces and subsequently to extract the reduced material by means of an aspiration device. This procedure is highly complex and labor intensive.
A surgical extraction instrument with an extraction bag appended on a shaft is disclosed, for example, in U.S. Pat. No. 6,409,733 B1. Further, U.S. Pat. No. 5,769,794 A describes a separate extraction bag which is not secured in position on a shaft. A further extraction bag secured on a shaft is disclosed in U.S. Pat. No. 5,853,374 A, wherein this extraction bag comprises an opening directed toward the distal end of the instrument, which opening is closable.
The invention addresses the problem of providing a medical instrument through which the extraction is facilitated of material, in particular organic material, to be removed from a human or animal body during a surgical procedure, in particular an endoscopic surgical procedure. According to the invention, this is attained through a medical instrument comprising an endosurgical extraction bag for the extraction of material to be removed during a surgical procedure from a body on which surgery is to be performed, and a net disposed within the extraction bag. The net can be pulled through the material for the purpose of reducing the material to pieces.
In the case of the medical instrument of the invention a net is disposed in the extraction bag which serves for reducing the material to be extracted. For this purpose the net is pulled through the material, in the process of which the filaments of the net cut through the material and herein cut the material in accordance with the mesh size of the net. The net can thus also be referred to as a cutting net. The material thus reduced can subsequently be removed from the body, for example by means of an aspiration line integrated into the medical instrument.
The net is preferably formed in the shape of a bag or it forms a portion of a bag, i.e. at least a segment of the wall of the bag is formed by a net. The bag formed by the net or including the net is initially disposed in the extraction bag when the material to be extracted is placed into the extraction bag. The material to be extracted, consequently, is placed into the bag formed by the net or including the net. The material to be extracted is held in this bag formed by the net or including the net until the net has been pulled through the material whereby the material is reduced to pieces.
In an advantageous embodiment of the invention the extraction bag is held by a shaft of the medical instrument, preferably by means of a hoop comprised of a spring-elastic material, which, without the action of an external force, unfolds annularly (for example approximately in the shape of a circular ring or an oval) such that a fill opening of the extraction bag is opened. The extraction bag is herein held over a large portion of its circumference on the hoop in the proximity of its fill opening. The bag formed by the net or including the net is located within the extraction bag and has an opening directed into the same direction as the fill opening of the extraction bag. The bag formed by the net or including the net is preferably substantially in contact on the wall of the extraction bag, at least in the region of the fill opening, in order to form as large an overall fill opening as is possible.
To close the extraction bag, preferably at least one draw element engages on the extraction bag, which draw element can be pulled in the direction toward the proximal end of the medical instrument by means of an actuation part. The draw element can herein extend through a conduit of the extraction bag in the proximity of its fill opening. When the draw element is pulled in the direction of the proximal end of the medical instrument, the extraction bag is gradually torn off the hoop and progressively closed. It can herein advantageously be pulled over a distal end section of the shaft, wherein at this distal end section a channel opens out which forms an inner hollow volume of the shaft. In the closed state of the bag, consequently, the distal end section of the shaft projects into the extraction bag through a residual opening of the constricted fill opening of the extraction bag. By means of a further draw element the bag formed by the net or including the net can be pulled into the hollow volume preferably opening out at the end side at the distal end section of the shaft, wherein the net is pulled through material initially disposed in the net while reducing it to pieces.
In the present document the specifications “proximal” and “distal” refer to the position with respect to the user (=surgeon). Consequently, a distal end is remote and facing away from the user and a proximal end is facing toward the user.
Further advantages and details of the invention will be explained in the following in conjunction with the attached drawings.
In the drawings:
The Figures are drawn to different scales.
An embodiment of a medical instrument according to the invention is depicted in
A grip 32 can be disposed proximally on shaft 1.
In the extraction bag 2 is disposed a net 7 which has the form of a bag (=it forms a bag). Thus, the bag formed by the net 7 is located within the extraction bag 2, the bag formed by the net 7 having a closed end 8, which is located on the same side as the closed end 3 of the extraction bag 2, and an open end, which is located on the same side as the fill opening 4 of the extraction bag 2. When the medical instrument is in the state in which it can be filled (cf.
In the delivery state of the medical instrument (cf.
When the enveloping tube 9 is slid on shaft 1 in the direction toward the proximal end 31 of the instrument, it gradually releases the hoop 5 with the extraction bag 2 held by it. After the enveloping tube 9 has been completely slid off the hoop 5 (cf.
For the displacement of the enveloping tube 9, an outwardly projecting projection 10 can be disposed thereon, which, when the instrument is inserted into the trocar, comes to rest on the edge of the trocar whereby the enveloping tube 9 is displaced proximally during the continuing displacement.
In the filling state depicted in
The material 11 can in particular be organic material. Such material to be removed from the body within the scope of endoscopic surgery is also referred to as resected tissue or specimen.
The fill opening 4 of extraction bag 2 can be drawn together. For this purpose a longitudinally extended draw element 12, for example a string or a cord or a band, is guided through a conduit 13 encircling the extraction bag 2 in the proximity of its fill opening 4. After their passage through the conduit 13, the two ends of the draw element 12 are inserted into a channel 14 in shaft 1 and extend through it and, by means of an actuation part 15, can be displaced with respect to shaft 1. Hereby the loop formed by the draw element 12 and extending through the conduit 13 is tightened whereby the extraction bag 2, starting from a distal section of hoop 5 opposite the shaft 1, is progressively torn off the hoop 5. During this tearing-off conduit 6 is torn open. To make possible or to facilitate this tearing-open, a weakened line-shaped zone or tear seam 16 is preferably formed in the material of the extraction bag 2 which delimits the conduit 6. This tear seam 16 extends preferably in the region of the outside of hoop 5.
In the present state of the extraction bag 2 in which it is closed, the fill opening 4 of the extraction bag 2 is constricted and pulled over an end section 17 of shaft 1. The end section 17 of shaft 1 consequently projects into the extraction bag 2 through its constricted fill opening and the remaining fill opening 4 (residual opening) is filled out by the end section 17 of shaft 1 projecting into it and is thus closed.
A channel opens out at the front end of the distal end side of end section 17 of shaft 1, which channel forms an inner hollow volume 18 of shaft 1 as is most clearly evident in
After the net 7 has been drawn so far into the hollow volume 18 that the material 11 in the bag formed by net 7 cannot be drawn further in the direction toward the distal end of the end section 17 and, due to its dimensions, can also not be drawn into the hollow volume 18, the filaments of net 7, when the net 7 is further drawn into the hollow volume 18, start cutting through the material 11 whereby the cut up parts of material 11 are pressed through the mesh of the net. After the net 7 has been completely drawn into the hollow volume 18, cf.
In its final position the net 7, which in its initial position was located in the extraction bag 2, is completely pulled out of the extraction bag 2. Instead of drawing the net into a hollow volume 18 in shaft 1 or into a part connected with it, it would also be conceivable and feasible, for example, to pull the net through the opening of a ring connected with the shaft 1, wherein it is pulled out of the extraction bag 2.
In the depicted embodiment the end section 17 adjoins via a step the portion of the shaft located further proximally, which portion has a greater diameter compared to the end section 17. Into the step opens out the channel 14 for the draw element 12. Other formations are also conceivable and feasible.
The reduced parts of the material 11 can subsequently be aspirated by means of an aspiration line 22. The aspiration line 22 is initially located in a further channel 23 in shaft 1, which channel opens out at the distal end side of the distal end section 17 of shaft 1. The channel 23 and the channel forming the hollow volume 18 can be delimited against one another by a wall 24 (cf.
The aspiration line 22 can be slid out of the channel 23 as is depicted in
To make possible the irrigation of the closed extraction bag 2 with liquid or also gas, at least one irrigation channel, in addition to the at least one aspiration channel, can preferably be integrated into the aspiration line 22. Connection fittings 26, 27 for the at least one aspiration channel and the at least one irrigation channel are shown schematically.
The extraction bag 2 can thus be completely or at least partially emptied by alternating aspiration and irrigation. The extraction bag 2, completely or at least partially emptied in such a manner, can be pulled through the trocar without any problem or be removed from the body together with the trocar.
The filaments of net 7 are formed of a thin (such that it is possible to cut easily through the material 11) and adequately tear-resistant flexible material. The net is, for example, comprised of metal or nylon filaments or of carbon fibers.
The mesh size of net 7 is preferably less than 1 cm.
The extraction bag 2 is comprised of a suitable flexible material, for example of polyurethane, such as is known of conventional extraction bags.
It would also be conceivable and feasible that the net 7 forms only a portion of the bag disposed within the extraction bag 2, for example only the bottom in the region of the closed end 8 of this bag.
Net 7 could also be drawn into several hollow volumes 18 in the shaft or into a part connected with it (while undoing the net) or through several rings connected with the shaft.
A separate device for closing the bag formed by net 7 or including this net could also be provided. For example, a draw element which extends through a conduit of this bag encompassing the bag in the proximity of its fill opening could be provided.
The aspiration line 22 (or aspiration-irrigation line 22) integrated into the medical instrument could also be omitted and the reduced material 11 could be aspirated from the extraction bag 2 by means of a separate aspiration instrument.
In a further feasible embodiment of the invention the extraction bag 2 could also be provided in the proximity of its closed end 3 with an extension having a decreased diameter. The material reduced by means of net 7 could fall into this “worm-like” extension. This worm-like extension could herein have so small a diameter that the medical instrument with the reduced material fallen into this extension can be drawn out through the trocar or be withdrawn from the body together with the trocar.
The actuation parts 15, 21 for the extraction bag 2 and the net 7 are shown in the depicted embodiment example in the form of rings. In their initial position they are held on a proximal ring 28 disposed on tube section 25, for example snapped into it by means of pins 29, 30. These actuation parts 15, 21 can also be formed differently in another manner, for example in the form of actuation levers or rotary grips. Formations different for the actuation part 15 and for the actuation part 21 are also feasible, for example in order to be able to exert a greater force for drawing back the net 7. The actuation parts 15, 21 can be disposed on shaft 1 or on a part rigidly connected with it or—as in the depicted embodiment example—displaceably connected with.
It would also be conceivable and feasible that the at least one draw element 19 for drawing the bag, formed by net 7 or including such, out of the extraction bag 2 does not extend through the fill opening 4 of the extraction bag 2. The extraction bag 2 could have a separate lateral opening through which this at least one draw element 19 extends and through which the bag formed by net 7 or including such is drawn out.
It is further conceivable and feasible not to close the extraction bag 2 using a draw element 12 but rather by sliding the enveloping tube 9 again in the distal direction, wherein the extraction bag 2 is pushed together on the hoop 5 and the fill opening 4 is closed, as is known in the case of extraction bags of prior art.
The medical instrument according to the invention can be utilized in different types of endoscopic surgical procedures for the extraction of material from the human or animal body (=removal of material from the body such that, if possible, it does not come into contact with other body parts). These types of endoscopic procedures include, for example, laparoscopic surgery or intraluminal endoscopic surgery, which are also known by the term N.O.T.E.S. When used in such flexible endoscopic operations, the shaft as well as the parts distally disposed thereon can be formed such that they are flexible. The net 7 is suitable in the various types of endoscopic procedures for reducing material, in particular body material, of adequate softness.
In an instrument according to the invention with a net 7 disposed within the extraction bag for dividing material 11 collected in the extraction bag 2, the extraction bag 2 could also be formed in a manner other than described in the depicted embodiment example. The extraction bag 2, as is known in prior art, could for example also have a closable fill opening directed into a distal direction. The bag formed by net 7 or including net 7 disposed within the extraction bag could in this case also have a closable opening directed distally and be drawable from its proximal end into a hollow volume of the shaft.
As is evident in the above description, the scope of the invention is not limited to the depicted embodiment example but rather should be determined with reference to the attached claims together with its full range of feasible equivalents. While the preceding description and the drawing represent the invention, it is obvious to a person of skill in the art that various modifications can be carried out therein without leaving the true spirit and scope of the invention. Furthermore, the entire content of priority Austrian application A34/2008 is incorporated herein by reference.
| Number | Date | Country | Kind |
|---|---|---|---|
| A 34/2008 | Jan 2008 | AT | national |
