Patent Application
20180132838
The present invention relates to a specimen retrieval bag, specimen retrieval device, a specimen retrieval device including a side-activation mechanism, a method of use, a method of surgical treatment, and a kit containing such device.
In general, laparoscopic surgery is a minimally invasive surgical technique, in which surgery is performed through several small incisions rather than the traditional larger incision. This technique relies on the use of endoscopes and long-handled instruments that are introduced into the body through an insertion port, or trocar. As endoscope and instrument technology has improved, the technique has become more and more prevalent and has been adapted to virtually every imaginable procedure. Today, laparoscopic surgery is one of the most common surgical techniques in the United States.
The initial opening in the body tissue to allow passage of surgical instruments to the interior of the body may be a natural passageway of the body, or it can be created by a tissue piercing instrument such as a trocar, or created by a small incision into which a cannula is inserted. Because the tubes, instrumentation, and any required punctures or incisions are relatively small, the surgery is less invasive as compared to conventional surgical procedures in which the surgeon is required to cut open large areas of body tissue. Therefore, minimally invasive surgery minimizes trauma to the patient and reduces patient recovery time and hospital costs. In addition, in certain surgeries abdominal walls and abdominal organs are minimally damaged during a surgical operation, so that complications, recovery time of a patient and pain during the recovery of the patient can all be reduced.
Minimally invasive procedures may be used for partial or total removal of body tissue or organs from the interior of the body, e.g. nephrectomy, cholecystectomy, lobectomy, myomectomy, hysterectomy and other procedures including thoracic, laparoscopic and endoscopic procedures. During such procedures, it is common that a cyst, tumor, or other affected tissue or organ needs to be removed via the access opening in the skin, or through a cannula. Various types of entrapment devices have been disclosed to facilitate this procedure. In many procedures where cancerous tumors are removed, removal of the specimen in an enclosed environment is highly desirable to prevent seeding of cancer cells. Further, in certain types of surgery such as cholecystectomy, an infected or inflamed gallbladder is removed and bile must be contained so as not to contaminate the surgical area. In a hysterectomy the whole or part of the uterus must be removed through the vaginal opening.
Many types of laparoscopic surgery involve removal of tissue, and virtually all of these surgeries require the use of a specimen pouch, also called an endoscopic specimen bag or an “endo bag” or a laparoscopic bag or “lap-bag”. The bag is inserted into the body via a cannula and trocar, in an incision location where another device has been removed or for example through the belly button or umbilicus, and the bag is deployed within the body cavity to receive the tissue, closed, and then removed through one of the incisions, typically the umbilicus, or in females the vagina if a gynecological surgery such as without limitation a hysterectomy.
During the abdominal surgery using an endoscope as described above, when an operator or surgeon performs an operation of removing tumors or suturing internal organs and the like, the operator inserts various medical instruments into an abdomen, together with the endoscope and surgical instruments, to take pieces of tumors or internal organs, which are removed during the abdominal procedure or surgery, out of the abdomen by receiving the pieces of tumors or internal organs in a vinyl or polyurethane bag using a medical instrument referred to as a lap-bag.
Conventional lap-bag mechanisms employed in an abdominal surgery using the trocar as described above are well known and comprise a tube or cannula, a wire spring and a folded vinyl bag. In action the wire spring is deployed from the housing, engaged and the bag moves over the specimen and a pull string is engaged by a second instrument via a different incision or trocar and the string seals and cinches the bag holding the specimen, otherwise graspers or other instruments may position a sealing mechanism such as a ring around the opening of the bag to contain the specimen.
In certain surgical operations such as abdominal surgery, an incision is made in the abdomen sufficient for insertion of a 10 mm trocar which forms pneumoperitoneum by putting gas (e.g. CO2 gas) into the abdomen during endoscopic surgery so as to create the space and visibility for the endoscopic surgery, and allows an endoscope, a surgical instrument and a medical instrument, such as an endoloop, or lap-bag, to be inserted into the abdomen. The trocar and cannula are used for inserting surgical instruments into the abdomen. Given the diameter of the trocar and the various instruments passing therethrough, the incision must be at least 15-20 mm.
Conventional minimally invasive surgeries for cholecystectomy involve the use of four trocars (access devices). In general, one trocar is inserted in the umbilicus, through which an endoscope is inserted, with two trocars being inserted on the right side of the abdomen for retraction and mobilizing the gallbladder, in order to identify the important structures. The fourth trocar is typically inserted in the midline above the umbilicus.
The aforementioned method has become the standard approach and has withstood twenty years of changes in surgical skill sets, in various groups of surgeons. However, even using a 5 mm trocar still leaves a scar and thus there is a need to reduce scarring and need for even small trocars such as a 5 mm version. Relatively recently, even newer and advantageous techniques for cholecystectomy have been developed that involve either two 5 mm trocars or even only a single trocar or “port”, called SILS (single incision laparoscopic surgery). As most conventional specimen retrieval bag devices are 10 mm they in turn require a 10 mm trocar opening and thus the less invasive two 5 mm trocar method of surgery cannot be used. Further, the prediction is that nearly twenty to forty percent of all gallbladder surgeries will be performed using SILS as the opening and incision is larger than the two trocar method, but the number of openings or incisions is reduced. This technology involves inserting a single port inserted through the umbilicus, with all the instruments going into the abdominal cavity through the single port. Retrieving the gallbladder is challenging with this technology, especially if the gallbladder is distended due to inflammation.
In conventional cholecystectomy an endoscope or other surgical instruments cannot be inserted through the trocar into which the lap-bag is inserted such that the number of trocars through which an endoscope or surgical instruments can be inserted are increased. This may cause unnecessary surgical damage of the abdomen, increase of the total operation time required for the abdominal surgery and increase possible complications. Other surgeries are also impeded by this approach in that not all instruments may reside within a single trocar, no matter how large the trocar size. Even a 5 mm trocar leaves a scar and may increase complications, pain and recovery time. Thus, a need exists to reduce the size of the main incision during a laparoscopic surgery, typically the incision in which the majority of the instruments will pass through the body wall into the body cavity during the surgery.
In minimally invasive thoracic surgery, access to the thoracic cavity is limited as well as maneuverability within the cavity as the access port is placed between the confined space between a patient's ribs. Such procedures, commonly referred to as video assisted thorascopic surgery (VATS), aim to reduce patient recovery time by accessing the thoracic cavity through the natural intercostal space without spreading the ribs as in open procedures. This restricted access can sometimes cause problems when removing large specimens. Moreover, in such procedures, e.g. thorascopic wedge resection and lobectomy, it is often necessary to remove a portion of the lung and retrieve it relatively intact for pathology. It is also desirable that the specimen be sufficiently contained to prevent seeding of cancer cells during manipulation and removal.
Further, a need exists to reduce the number of incisions during surgery and therefore reduce the potential areas for complications, infection and scarring. Specifically a need exists for a specimen retrieval device which does not need a trocar. One less trocar is thus required. A need exists for a self-inserting specimen retrieval device including a specimen retrieval bag.
This and other needs are met by the inventive specimen removal device. The number of incisions, namely larger incisions needed for a 10 mm or 20 mm trocar, are reduced. Further, the total number of incisions are reduced and total number of trocars needed are reduced, even smaller diameter trocars. In addition, an operation process for removing the specimen can be simplified by using the inventive specimen retrieval device and the time and cost for the surgery can be reduced. Likewise the potential for complications and pain to the patient post-surgery may be reduced by the inventive device.
In conventional cholecystectomy endoscope or other surgical instruments (such as graspers, scissors, needles, scalpels, coagulators and other known surgical instruments) cannot be inserted through the trocar into which the lap-bag is inserted such that the number of trocars through which an endoscope or surgical instruments can be inserted are increased. This may cause unnecessary surgical damage of the abdomen, increase of the total operation time required for the abdominal surgery and increase possible complications. Other surgeries are also impeded by this approach in that not all instruments may reside within a single trocar, no matter how large the trocar size. Even a 5 mm trocar leaves a sear and may increase complications, pain and recovery time. Thus, a further need exists to reduce the size of the main incision during a laparoscopic surgery, typically the incision in which the majority of the instruments will pass through the body wall into the body cavity during the surgery.
Further, a need exists to reduce the force needed to activate a surgical instrument during a surgical procedure. Another need exists to reduce the use of two hands to one hand by the surgeon during such activation. Still another need exists to reduce the space in which the surgical instrument takes within the surgical area during its activation stage, and a retraction stage if needed during the surgical procedure depending on the end effectors associated with such surgical instrument.
Yet another need exists to reduce the cost and packaging for a surgical instrument in the unactuated state which includes a rod extending out of the distal end of such surgical instrument. A further need exists to reduce the cost of transporting such surgical instrument and reduction of storage space for such instruments.
This and other needs are met by the inventive surgical instrument including a side activation mechanism. In addition, a manufacturing, transportation and operation process can be simplified while reducing costs by using the inventive surgical instrument and the time and cost for the surgery can be reduced.
In designing specimen retrieval bags for surgical procedures a balance must be struck between the need to provide a strong enough containment bag to prevent tearing or rupture while providing sufficient rigidity to enable manipulation and removal of the bag from a device. Another balance which needs to be achieved is to provide sufficient maneuverability while reducing tissue trauma, e.g., damaging healthy tissue or organ, during manipulation and removal. Additionally, the instrumentation on one hand should be able to be inserted through a small access incision or port while on the other hand able to accommodate a wide range of patient sizes and be able to easily remove large specimens and minimize risk of cancer seeding.
Further, a need exists to reduce the costs associated with such retrieval bags. A bag is needed which has the rigidity and strength for the containment of the specimen while being easily separated from a device so as to facilitate the retrieval of the contained specimen. This and other needs are met by the inventive specimen retrieval bag and assembly.
Accordingly, there remains a need in the art for the inventive specimen retrieval bag, inventive specimen retrieval device, its method of use, a method of treatment, and a kit containing the inventive bag and device. The present invention provides a solution for these needs and other needs.
The present invention has been made to solve the above problems occurring in the prior art and other needs in regard to surgical instruments and methods of treatment.
In one aspect, a surgical instrument and assembly for laparoscopic procedures is provided, which is adapted and configured to be self-inserted and retrieve a specimen via an endoscopic bag such as a specimen retrieval bag.
In another aspect, a specimen retrieval bag and assembly for surgical procedures is provided, which bag is adapted and configured to be comprised of two or more different materials.
In yet another aspect, a surgical instrument for laparoscopic procedures is provided which is adapted and configured to be activated via a side activation mechanism.
In yet another aspect, a method for laparoscopic procedures is provided including use of a surgical instrument for laparoscopic procedures, which is adapted and configured to be self-inserted and retrieve a specimen via an endoscopic bag which is activated via a side activation mechanism.
In yet another aspect, a kit for laparoscopic procedures is provided including a device which is adapted and configured to be self-inserted and retrieve a specimen via an endoscopic bag which is activated via a side activation mechanism.
The above and other advantages of the present invention will become readily apparent with reference to the following detailed description when considered in conjunction with the accompanying drawings which are incorporated in and constitute part of this specification, are included to illustrate and provide a further understanding of the surgical instruments, devices, mechanisms, specimen retrieval bags, kit, and related methods of the invention. Together with the description, the drawings serve to explain the principles of the invention, wherein:
Reference will now be made in detail to the present invention, examples of which are illustrated in the accompanying drawings. In an object, the term “proximal” refers to the end of the instrument, device, component or object that is closer to the user and the term “distal” refers to the end of the instrument, device, component or object that is further from the user.
In accordance with one aspect of the invention, a surgical instrument assembly is provided having the capacity to be self-inserted within the body, deploy a specimen retrieval bag and retrieve the specimen. In accordance with one aspect, the inventive assembly has a distal end which is capable of being self-inserted without the need for as trocar. The assembly includes a specimen retrieval bag within a housing. Once the assembly is inserted into the patient and the target tissue or organ to be removed from the body cavity is in a position relative to the still retracted bag, the specimen retrieval bag is deployed out of the housing. The deployed specimen retrieval bag is moved to encompass the specimen of tissue or an organ, or the target tissue or organ placed within the deployed and opened bag, and then the specimen retrieval bag is detached, cinched, and separated from the specimen removal device. The specimen retrieval device is removed and the specimen retrieval bag including the specimen is removed through the initial incision or through a larger incision elsewhere in the body. The device may include a loop grip mechanism, thumb grip mechanism, pistol grip mechanism or other mechanism for the surgeon to deploy and detach the specimen retrieval bag.
It should be noted that although the devices of the present invention is advantageous for surgical procedures such as cholecystectomy procedures, it can advantageously be applied to retrieve and/or extract filled specimen retrieval bags in other procedures containing other organs, such as the uterus or fibroidsurinary bladder, for example, and to retrieve tissue such as tumors.
A surgical instrument, device or assembly in accordance with the invention advantageously helps by reducing the need for a series of trocars used during surgery. Notably, the need for a larger trocar, such as a 10 mm, 15 mm or 20 mm trocar for insertion of all instruments during surgery, is reduced as typically a conventional known specimen retrieval device requires a larger trocar. The inventive device is self-inserting so no trocar is needed. Further, advantageously, the small diameter size of the inventive device minimizes or eliminates scarring, complications and pain to the patient.
For the purposes of explanation and illustration, and not limitation, in accordance with the invention, an exemplary embodiment of a specimen retrieval assembly in an unactuated position is illustrated in
Housing 20 may be comprised of any material compatible to the human body as the distal end of the housing 20 will be placed within the body cavity for deployment of the bag 100. Such materials include plastics or metals. If a metal, the housing 20 may be comprised of stainless steel and may further be coated with a shrink wrap plastic such as shrinkable polyethylene fiberglass, or polyvinyl chloride of a grade suitable for use in surgical procedures. The housing 20 may be comprised of many known polymers such as polycarbonates or ABS. For cost effectiveness, the housing 20 may be comprised of any plastic capable of sterilization according to regulatory agencies for medical devices.
The housing 10 may be hollow and thus includes a channel which houses the folded non-deployed specimen retrieval bag 100 which bag 100 is connected to the deployment mechanism. The deployment mechanism may be a rod 40 and a support means 70. In an unactuated position, the support means 70 is housed within the housing as it is connected to the specimen retrieval bag 100 such that it supports the mouth of the bag 100 when the bag 100 is deployed and open. The rod 40 is partially housed within the housing 20 at the distal end of the rod 40 and proximal end of the housing 20 in the inventive device's 10 unactuated position while the proximal end of the rod 40 extends beyond and out of the proximal end of the housing 20 in the unactuated position. To deploy the specimen retrieval bag 100 the rod 40 is pushed in a downward direction toward the self-inserting distal end tip 30 such that the rod 40 resides fully within the housing 20 with just a portion of the proximal end of the rod 40 extending out of the housing 20. In the actuated position the specimen retrieval bag 100 is moved from a stowed position within the distal end of the housing 20 to a deployed position by sliding the distal end 45 of the rod 40 from a retracted position within the housing 20 to an extended position at least partially projecting out of the housing 20. The rod 40 may be connected to a rod grip 50 which the surgeon may use in actuating the inventive device 10, such as a ring grip, finger grip, thumb grip, pistol grip, or other known grips. In
Each of the grips (50, 60) may be comprised of any material, preferably compatible to the human body though neither will reside within the body cavity. Preferred materials are plastics or metals. If a metal, either grip (50, 60) may be comprised of stainless steel and may further be coated with a shrink wrap plastic such as shrinkable polyethylene fiberglass, or polyvinyl chloride of a grade suitable for use in surgical procedures. Either or both of the grips (50, 60) may be comprised of many known polymers such as polycarbonates or ABS. For cost effectiveness, the grips (50, 60) may be comprised of any plastic capable of sterilization according to regulatory agencies for medical devices.
The deployment mechanism includes a rod 40 and further includes a support means 70 connected to the specimen retrieval bag 100. The support means may be a spring, a circular metal or polymer piece, a non-circular metal or polymer piece, one arm, two arms, or other known means to support the mouth of a specimen retrieval bag 100 when open. In one embodiment of the invention the support means is two arms 70a, 70b, which when deployed in an actuated or open position form a circle to support the mouth of a specimen retrieval bag 100 when open. The arms 70a, 70b comprising the support means 70 may be comprised of any flexible materials which is capable of compression when housed within the housing 20 and capable of forming an open position for the mouth of a specimen retrieval bag 100 when open, once deployed and actuated outside of the distal end of the housing 20. The support means 70 may be a spring resilient material to give it a tendency to form a circle, oval or other substantially round shape in a fully deployed position. When retracting, the circle or oval collapses under manual force against spring bias to fit within the housing 20. For instance, the arms 70a, 70b may be comprised of a flexible metal such as stainless steel, may be a high strength stainless steel alloy, titanium, nitinol, steel spring alloys, metal alloys, plastics, combinations thereof. In general, the support means 70 (such as arms 70a, 70b) may be comprised of any material that can be stored in a deformed shape, is resilient, and can be returned via compression or other force to an initial or near initial shape.
As shown in detail in
The specimen retrieval bag 100 is detachably connected to the support means 70. Typically, a specimen retrieval bag 100 has an unsealed mouth portion located at the top end of the specimen retrieval bag 100 and a sealed portion located at the bottom end of the specimen retrieval bag 100. The specimen retrieval bag 100 may be capable of cinching or closing via a cinching means 90 such as a cinch cord or a string connected to the outer diameter of the specimen retrieval bag 100 at a position below the mouth of the specimen retrieval bag 100. In some specimen retrieval bags 100, the string 90 is connected to the specimen retrieval bag 100 via a channel located on the outer circumference of the specimen retrieval bag 100. Further, the specimen retrieval bag 100 may be capable of detachment from the support means 70 via, for instance, perforations 95 located near mouth and the top of the specimen retrieval bag 100. Other means to detach the specimen retrieval bag 100 may be employed. Further, other means for cinching, closing or sealing the specimen retrieval bag 100 once the specimen is within it may be employed.
The specimen retrieval bag 100 is not shown in
The specimen retrieval bag 100 in one embodiment of the present invention includes an unsealed mouth and a sealed bottom and may be tapered inward, tapered outward or of a square, rectangle, triangle, oval or circular shape overall. The shape of the specimen retrieval bag 100 may be dependent on the target specimen. In another embodiment of the invention, the specimen retrieval bag 100 may not be capable of cinching and instead remains open throughout the procedure and only partially closes upon force by the body wall when the filled specimen retrieval bag 100 is being pulled out of the body cavity and through the body wall and fascia. In another embodiment of the present invention, the specimen retrieval bag 100, may not be capable of cinching but may instead be capable of sealing the open mouth after the specimen is placed within the open and deployed specimen retrieval bag 100.
The specimen retrieval bag 100 has a closed lower end and an open upper end forming a mouth. The mouth is detachably connected to the distal ends of the rod such as by a series of perforations 95. Just below the perforations 95 the specimen retrieval bag 100 includes a cinching or sealing means such as a string 90 which string 90 is sealed within a pouch or channel or sleeve miming along the upper end of the specimen retrieval bag 100 configured to cinch or seal the specimen retrieval bag 100 upon detachment. The string 90 is connected at one end to a pull ring 80 (shown in
An inventive specimen retrieval bag and assembly in accordance with the invention advantageously helps by providing for at least two different materials, having at least one different physical or chemical property, joined via a joining means, but easily separated under typical force during a surgical procedure. The cost for such a bag is reduced as the second material may have lesser physical and/or chemical properties as it may be connected to the assembly and remains on the assembly after the surgical procedure is completed and the assembly retracted or removed from the patient's body cavity.
For the purposes of explanation and illustration, and not limitation, in accordance with the invention, an exemplary embodiment of a specimen retrieval bag is illustrated in
The inventive specimen retrieval bag 100 is comprised of at least two portions, a lower portion 110 having one set of physical and chemical properties, and an upper portion 120 have at least one different physical or chemical property compared to the lower portion 110 material. The materials may include any biocompatible material. The materials include without limitation elastomeric or polymeric materials such as polyurethane, polyethylene, polypropylene, silicone, vinyl, or Teflon. Further, the materials may flexible metal meshes, thermoformed plastic meshes, fabrics, or Kevlar for reinforcement.
The materials will have certain physical and/or chemical properties. For instance, one material, for example used in the lower portion 110 may have a certain tensile strength. For example, one material used in the lower portion 110 may have a higher tensile strength than the second material used in the upper portion 120. In one embodiment, the polymeric material used in the lower portion 110 is a polyurethane sheet having a thickness that ranges from about 0.001 to about 0.005. In such an embodiment the physical property difference between the lower portion 110 and the upper portion 120 of the inventive specimen retrieval bag 100 may be the thickness of the materials used, with the same material being used and only the thickness being different. In other embodiments, Nylon material can be utilized. Other materials and/or other dimensions are also contemplated.
In another embodiment of the present invention, the lower portion 110 may be comprised of a material which has a textured portion on the inner side of the inventive specimen retrieval bag 110. In contrast, the upper portion 120 of the inventive specimen retrieval bag 100 may be smooth. Other physical properties may be different between the lower portion 110 and the upper portion 120 of the inventive specimen retrieval bag 100. Only one property need be different between the two materials used for the lower portion 110 and the upper portion 120 of the inventive specimen retrieval bag 100, though more than one property may be different, or all properties different.
In another embodiment of the present invention, the lower portion 110 may be comprised of a material which has certain chemical properties. The chemical properties may be a reactive material being included in the inner side of the lower portion 110 of the inventive specimen retrieval bag 100. Other chemical properties may be contemplated as well.
For instance, the inventive specimen retrieval bag 100 may include a coating, such as a polyurethane coating, on the lower portion 110 on the inside and/or outside to provide on impermeable barrier. A lubricant can also be placed on select portions of the exterior of the inventive specimen retrieval bag 100 to facilitate its loading into the housing of the assembly during manufacture and facilitate its deployment from the housing from a folded, rolled or collapsed condition. It is also contemplated that a lubricant can be placed on the exterior surface of the bag, on either portions or on the entire surface, to facilitate its removal from the incision point on the patient's fascia and/or access port extending through the incision.
In another embodiment of the present invention the specimen retrieval bag 100 may be comprised of three materials joined together, each material having at least one property different from the two other materials. For instance, in a specimen retrieval bag used for morcellation of the target specimen as shown in
The specimen retrieval bag 100 in one embodiment of the present invention includes an unsealed mouth located at the upper portion 120 and a sealed bottom located at the lower portion 110, and may be tapered inward, tapered outward or of a square, rectangle, triangle, oval or circular shape overall. The sealed bottom 410 in another embodiment may also be tapered inward, tapered outward or of a square, rectangle, triangle, oval or circular shape overall. The inventive specimen retrieval bag 100 also includes a separating means 140. The separating means 140 is used so that the tissue or organ within the inventive specimen retrieval bag 100 may be separated from another embodiment of the inventive specimen retrieval device 200. The separating means 140 as shown in
Further, the inventive specimen retrieval bag may be connected to the assembly 200 via a connecting means 150. The connecting means 150 may be a channel located in the upper portion 120 of the inventive specimen retrieval bag 100, 400 for insertion of a support means 270, such as a pair of arms 270a, 270b as shown in
The inventive specimen retrieval device 10 further includes a self-inserting distal end tip 30. The distal end tip 30 is which tip is configured to be self-inserting and generally has a non-blunt shape. The distal end tip 30 in
In use, as shown in
The distal end tip 30 is connected to the support means via any known connecting means. In one embodiment of the present invention, as shown in
In a further embodiment of the present invention, the distal end tip 30 is connected to the support means via a hinge such the distal end tip 30 may move in a downward direction once within the body cavity. This embodiment may be employed within a body cavity where space is tight so as to reduce any unintentional nicks of non-target tissue or organs by the distal end tip 30. For instance, the specimen retrieval device 10 may be employed in a pediatric patient or in a body location of an adult patient which even when insufflated, has many non-target tissue and organs within close proximity to the distal end tip 30 when the device 10 is placed within the body cavity. In that instance, the distal end tip 30 may be moved in a downward position once it has been inserted within the body wall and either prior to or after deployment of the specimen retrieval bag. In such an embodiment of the present invention, as shown in
A method of use of the inventive specimen retrieval device 10 as shown in
Once the target tissue or organ is identified within the body cavity, the surgeon will place the distal end of the housing 20 in the vicinity therein and deploy the specimen retrieval bag 100. Deployment occurs when the rod 40 is advanced longitudinally distally through the housing 20 by the operator's force, such as pushing, of the rod grip 50, while maintaining the distal end of the housing 20 within the body cavity by gripping the housing grip 60 to stabilize the housing's 20 location. This movement of the rod 40 pushes the support means 70 and the specimen retrieval bag 100 beyond the distal end and out of housing 20 and, therefore, the support means 70 resiliently pops open to its substantially round configuration to thereby open the mouth of the specimen retrieval bag 100. The specimen retrieval device 10 is thus actuated and the specimen retrieval bag 100 unfolds as the specimen retrieval bag 100 is moved from a stowed position to a deployed position by sliding the rod 40 from a retracted position, partially within the housing on its distal end and partially outside the housing at the proximal end of the rod 40, to an extended position of the distal end of the rod 40 at least partially projecting out of the housing 20. Further manipulation of the deployed specimen retrieval bag 100 may occur via surgical instruments such as graspers inserted through the same or a separate incision, cannula or trocar.
The specimen retrieval bag 100 is moved so as to encompass the target tissue or organ within the specimen retrieval bag 100 or the target tissue or organ is placed via graspers or other surgical instruments within the open and deployed specimen retrieval bag 100. At this point the filled specimen retrieval bag 100 is detached from the main body of the specimen retrieval device 10 and cinched.
A pull ring 80, which is connected to the string 90 of the specimen retrieval bag 100, may be grasped and pulled thereby causing the specimen retrieval bag 100 to cinch via the proximal movement of the string and in turn detach from the support means 70 due to the movement of the string and force on the perforations 95 thereby detaching while cinching. At this point the specimen retrieval bag 100, including the target specimen, has a dosed mouth and is detached from the support means 70 but still connected to the device 10 solely via the string 90.
In one embodiment of the inventive specimen retrieval device 10, the string 90 proximately located and connected to the pull ring 80 is severed via a razor (not shown) connected and located within an aperture on a lower portion of the rod grip 50. The string 90 is inserted into the aperture and cut by the razor to allow for complete detachment of the specimen retrieval bag 100 from the specimen retrieval device 10. The fully detached specimen retrieval bag 100 is thus capable of removal separate from the specimen retrieval device 10. Other known detachment means are available such as scissors, knives, razors, non-blunt surfaces and may be used to sever the string (or any other cinching or sealing means).
After the specimen retrieval bag 100 has been detached from the support means 70, the support means 70 is retracted, or pulled, so as to compress and withdraw back into housing 20, whereupon support means 70 refolds back into its pre-deployed relatively straight configuration to permit removal of the specimen retrieval device 10 from the patient's body. The detached string 90 remains partially outside of the patient's body upon removal of the specimen retrieval device 10. The string 90 is used to remove the specimen retrieval bag 100 via force applied, such as pulling, and thus the specimen retrieval bag 100 including the target specimen is removed via the incision formed by the distal end tip 30. In another embodiment of the inventive method, the portion of the string located outside the patient's body may not be used to remove the specimen retrieval bag 100 and instead the portion of the string 90 located within the patient's body may be used to remove the specimen retrieval bag 40 via a trocar or other incision located on the patient's body such as through the umbilicus. In such an embodiment the portion of the string 90 located within the patient's body is manipulated via another surgical instrument such as a grasper or vacuum instrument.
In accordance with one aspect of the invention, a surgical instrument is provided having a side activation mechanism including an activation means, such as a thumb slide and rod, within a hollow housing. The activation means is employed to move the rod within the hollow housing from the distal end of the hollow housing toward the proximal end of the hollow housing, which in turn moves an end effector from an inactivated state, either fully within the hollow housing or its proximal end out of the proximal end of the hollow housing, into an activated state either fully outside of the hollow housing or partial outside of the hollow housing at its proximal end. The activation means may further be retracted or moved back to the inactivated position by moving it toward the distal end of the hollow housing. In accordance with one aspect of the invention, a surgical instrument is provided having a side activation mechanism including an activation means, such as a thumb slide and rod, within a hollow housing. The activation means is employed to move the rod within the hollow housing from the distal end of the hollow housing toward the proximal end of the hollow housing, which in turn moves an end effector from an inactivated state, either fully within the hollow housing or its proximal end out of the proximal end of the hollow housing, into an activated state either fully outside of the hollow housing or partial outside of the hollow housing at its proximal end. The activation means may further be retracted or moved back to the inactivated position by moving it toward the distal end of the hollow housing.
For the purposes of explanation and illustration, and not limitation, in accordance with the invention, an exemplary embodiment of a specimen retrieval assembly in an unactuated position is illustrated in
The dimensions of housing 210 may be a diameter in the range of about 1 mm to about 50 mm, preferably between about 3 mm to about 20 mm. The dimensions of the housing 210 may also be such that the diameter is slightly larger than the maximum diameter of an open specimen retrieval bag 100, 400 in such an embodiment including a specimen retrieval bag 100, 400, either empty or filled and preferably when filled with the target specimen, such as for example without limitation, if the open diameter of the specimen retrieval bag 100, 400 is 5 mm then the diameter of the housing 210 would be between about 7 mm to about 8 mm.
The housing 210 may be hollow and thus includes a channel which houses the activation mechanism. The hollow housing 210 includes an aperture 220 in which the activation means may be moved from a distal end of the housing 210 to a proximal end of the housing 210. The activation means may include any means to activate the end effectors 300 or specimen retrieval bag 100, 400. In one embodiment of the present invention the activation means is a thumb slide 230 connected to a rod 240. In one embodiment of the present invention, the rod 240 is visible through the aperture 220. The rod 240 may be connected to a wire 270 (70a, 70b as shown in
In an embodiment of the present invention including a specimen retrieval bag 100 or 400, the folded non-deployed specimen retrieval bag 100, 400 is housed within the hollow housing 210 at the distal end of the hollow housing 210. The specimen retrieval bag 100, 400 is connected to a support means 270 such as a pair of wires or arms. In an unactuated position, the support means 270 is housed within the housing 210 as it is connected to the specimen retrieval bag 100, 400 such that it supports the mouth of the bag 100, 400 when the bag 100, 400 is deployed and open. The rod 240 is housed within the housing 210 at the proximal end of the housing 210 in the inventive device's 200 unactuated position while the distal end of the rod 240 extends beyond and out of the distal end of the housing 210 in the unactuated position. To deploy the specimen retrieval bag 100, 400, the rod 240 is pushed in a downward direction via the thumb slide 230 toward the self-inserting distal end tip 280 such that the rod 240 resides fully within the housing 210 with just a portion of the distal end of the rod 240 extending out of the housing 210. In the actuated position the specimen retrieval bag 100, 400 is moved from a stowed position within the distal end of the housing 210 to a deployed position by sliding the thumb slide 230 from an unactuated position to an extended position by pushing it toward the distal end of the hollow housing 210 such that the distal end of the rod 240 at least partially projects out of the housing 210.
The activation means 230 may be a thumb slide as described above or any known conventional slide, grip, handle or the like. The surgeon may use the activation means in actuating the inventive device 200, such as a thumb slide, slide guide, push slide, pull slide, ring grip, finger grip, thumb grip, pistol grip, or other known slides and grips. In
A further grip 260 is also shown which assists the surgeon in use in that the grip 260 is connected to the outer diameter of the housing 210, on a proximal end of the housing 210, such that the surgeon can grip the housing grip 260 with a palm or fingers with using his or her thumb to slide the thumb slide 230 within the aperture 220 in a direction toward the distal end of the hollow housing 210. In another alternative method where the surgeon uses two hands to activate the inventive surgical instrument, the surgeon may use one hand to activate the activation means 230 while his or her second hand rests or grips the housing grip 260 with the other hand. The housing grip 260 is shown in one embodiment to include a portion on the top 260a of the housing 210 with a further portion on the bottom 260b of the housing 210. In yet another embodiment the housing grip 260 completely surrounds the proximal end of the housing 210.
The activation means 230 and the housing grip 260 may be comprised of any material, preferably compatible to the human body though neither will reside within the body cavity. Preferred materials are plastics or metals. If a metal, the activation means 230 and/or the housing grip 260 may be comprised of stainless steel and may further be coated with a shrink wrap plastic such as shrinkable polyethylene fiberglass, or polyvinyl chloride of a grade suitable for use in surgical procedures. Either or both of the activation means 230 and the housing grip 260 may be comprised of many known polymers such as polycarbonates or ABS. For cost effectiveness, the activation means 230 and the housing grip 260 may be comprised of any plastic capable of sterilization according to regulatory agencies for medical devices. The housing grip 260 may be a rubber or plastic which provides textural contrast to the smoothness of the outer housing 210.
In an embodiment of the present invention including a specimen retrieval bag 100, 400, the rod 240 may be connected to a support means 270 connected to the specimen retrieval bag 100, 400. The support means 270 may be a spring, a circular metal or polymer piece, a non-circular metal or polymer piece, one arm, two arms, or other known means to support the mouth of a specimen retrieval bag 100, 400 when open. In one embodiment of the invention the support means is two arms 270a, 270b, which when deployed in an actuated or open position form a circle to support the mouth of a specimen retrieval bag 100, 400 when open. The arms 270a, 270b comprising the support means 270 may be comprised of any flexible materials which is capable of compression when housed within the housing 210 and capable of aiming an open position for the mouth of a specimen retrieval bag 100, 400 when open, once deployed and actuated outside of the proximal end of the housing 210 (as shown in
As shown in detail in
The inventive surgical instrument 200 may further include a self-inserting distal end tip 280. The distal end tip 280 is a tip which is configured to be self-inserting and generally has a non-blunt shape. The distal end tip 280 in
A further embodiment of the present invention includes end effectors 300 such as a pair of graspers 300a, 300b as shown in
In use, the embodiment of the inventive surgical instrument 200 including a distal end tip 280 employs the surgical instrument 200 being positioned outside of the body directly over or in the vicinity of the tissue or organ to be retrieved. Force is applied such that the distal, end tip 280 penetrates the fascia of the patient. No trocar or port access is needed to insert the surgical instrument 200. In some instances the surgical instrument 200 may be inserted into a defect or prior incision area. In other instances a trocar may be removed, for instance having a diameter or 5 mm, and the inventive surgical instrument 200 inserted which has an outer diameter of 7.5 mm so that the surgical instrument 200 is self-inserting without need for a trocar. Other diameters of the surgical instrument 200 may be employed with other defect widths or other trocar diameter sizes. Once the target tissue or organ is identified within the body cavity, the surgeon will place the distal end of the housing 210 in the vicinity therein and deploy the specimen retrieval bag 100, 400. Deployment occurs when the thumb slide 230 and connected rod 240 are advanced longitudinally distally through the housing 210 by the operator's force (the thumb slide 230 remains outside the body cavity), while maintaining the distal end of the housing 210 within the body cavity by gripping the housing grip 260 (outside of the body cavity) to stabilize the housing's 200 location. This movement of thumb slide 230 and connected rod 240 pushes the support means 270 and the specimen retrieval bag 100, 400 beyond the distal end and out of housing 210 and, therefore, the support means 270 resiliently pops open to its substantially round configuration to thereby open the mouth of the specimen retrieval bag 100, 400. The surgical instrument 200 is thus actuated and the specimen retrieval bag 100, 400 unfolds as the specimen retrieval bag 100, 400 is moved from a stowed position to a deployed position by sliding the rod 240 from a retracted position within the housing to an extended position of the distal end of the rod 240 at least partially projecting out of the housing 210. Further manipulation of the deployed specimen retrieval bag 100, 400 may occur via surgical instruments such as graspers inserted through the same or a separate incision, cannula or trocar.
The specimen retrieval bag 100, 400 is moved so as to encompass the target tissue or organ within the specimen retrieval bag 100, 400 or the target tissue or organ is placed via graspers or other surgical instruments within the open and deployed specimen retrieval bag 100, 400. At this point the filled specimen retrieval bag 100, 400 is detached from the main body of the surgical instrument 200 and cinched. A pull ring 290, which is connected to the string 250 of the specimen retrieval bag 100,400, may be grasped and pulled thereby causing the specimen retrieval bag 100, 400 to cinch via the proximal movement of the string and in turn detach from the support means 270 due to the movement of the string and force on the perforations thereby detaching while cinching. At this point the specimen retrieval bag 100, 400, including the target specimen, has a closed mouth and is detached from the support means 270 but still connected to the surgical instrument 200 solely via the string 250. The arms 270a, 270b are retracted back within the hollowing housing 210 by retraction of the rod 240 via reverse direction of the thumb slide 230 moving back toward the proximal end of the housing 210 nearer the housing grip 260. The inventive surgical instrument may be retracted and removed from the body cavity through the incision and thereafter or at the same time the filled specimen retrieval bag 100, 400 may be removed from the incision point or through a trocar at the incision point or another location within the patient's fascia depending on the surgical procedure.
Advantages of the inventive surgical instrument 200 having the side activation mechanism include the configuration such that it is smaller in size in an unactuated state, reduces the cost of the inventive surgical instrument, reduces the operating space for the inventive surgical instrument, reduces the cost of packaging and transportation and storage for the inventive surgical instrument and reduces the storage space of the inventive surgical instrument.
Other advantages of the inventive surgical instrument, device and assembly including a distal end tip are that it is self-inserting, which reduces the need for a trocar. Accordingly the incision location is smaller and may cause less surgical damage to the fascia, reduce the total operation time required for the procedure and reduce possible complications. Further, the surgical process for removing a specimen can be simplified by using the inventive surgical instrument 10, 200 and the time and cost for the surgery can be reduced.
Thus, the inventive surgical instrument 10, 200 may reduce complications, surgical processes, time and cost.
Many possible combinations could be within the specimen retrieval device, the methods of use, the method of treatment and the kit or system of the present invention.
Although the exemplary embodiments of the present invention have been described, it is understood that the present invention should not be limited to these exemplary embodiments but various changes and modifications can be made by one ordinary skilled in the art within the spirit and scope of the present invention as hereinafter claimed.
The invention has been described in terms of embodiments thereof, but is more broadly applicable as will be understood by those skilled in the art. The scope of the invention is only limited by the following claims.
This application claims priority from provisional application Ser. No. 61/949,806 filed Mar. 7, 2014 and PCT Application No. PCT/US2015/019,218 filed Mar. 6, 2015, provisional application Ser. No. 62/158,383 filed May 7, 2015, provisional application Ser. No. 62/160,056 filed May 12, 2015, and PCT Application No. PCT/US2016/031,494 filed May 9, 2016.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US16/31494 | 5/9/2016 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62158383 | May 2015 | US | |
| 62160056 | May 2015 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15111595 | Jul 2016 | US |
| Child | 15572335 | US |
