Device & method for the positioning of tissue during laparoscopic or endoscopic surgery
A surgical device and method for the retracting, maneuvering, and re-positioning of tissue and/or a body organ during endoscopic and laparoscopic procedures. The surgical apparatus comprises a separable grasping device with a detachable head, an exteriorly-operated handle mechanism, surgical needles, and lengths of suture. The disclosed device enables a physician, using a plurality of lengths of sutures simultaneously connected to (a) the exteriorly exposed handle mechanism and (b) the detachable head, positioned at clasping points on the organ, to rearrange the orientation of tissue or the organ for better accessibility, analysis, and/or exposure to accompanying surgical instruments in situ. The method presented minimizes the number of bodily incisions required to perform surgery by means of endoscope or laparoscopic equipment.
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This application claims the benefit of priority of U.S. Provisional Application Ser. No. 61/271,842, filed on Jul. 27, 2009 and said provisional application is incorporated herein by reference.
FEDERALLY-SPONSORED RESEARCH & DEVELOPMENTThere is no federally sponsored research or development in connection with this inventive concept.
NAMES OF THE PARTIES TO A JOINT RESEARCH AGREEMENTThere is no joint research agreement applicable to this inventive concept.
BACKGROUND OF THE INVENTION(1) Field of the Invention
The present inventive concept, among other uses and applications, primarily relates to an improved surgical instrument and a method which will enable a physician to perform laparoscopic or endoscopic surgery with a minimum amount of bodily incisions to a patient's body. The device under consideration is an improvement on what is known in the medical profession as a grasper.
Graspers come in a wide of variety of functional designs, which are intended for specific purposes. Various types of graspers include tissue, claw, sharp tooth, endo-clinch, alligator, aggressive, cobra tooth, spoon, cup, babcock, DeBakey, and Allis graspers.
(2) Description of the Related Art
Graspers are used to clasp bodily tissue or an internal organ and, often to reposition the tissue or organ for better utilization of other instruments which may be required during a laparoscopic surgical process. The grasper is typically inserted into the abdominal cavity by means of insertion through the inner channel of a trocar, said trocar having been initially used to pierce the abdominal wall in the vicinity of the subject organ or tissue. Usually, a second trocar is also required as a means of inserting other surgical instruments to perform operations on the organ or tissue being held by the grasper.
Over the years, various surgical instruments and complex trocar designs have been devised to perform separate multiple functions during laparoscopic surgery. A recent patent, U.S. Pat. No. 7,318,802 (Suzuki, 2008), discloses a combination of an endoscope and a grasping device which, when used together, are suited for operationally treating gastro esophageal reflux disease. The grasping device is specially designed for holding tissue formed at the junction the stomach and esophagus.
U.S. patent application publication #2005/0149066 (Stafford, 2005) presents a device for laparoscopically suturing tissue, comprising an elongated shaft which, upon being inserted through the abdominal wall, deploys two mechanical arms, each arm having a means of receiving a needle and its respective suture.
U.S. patent application publication #2009/0062816 (Weber, 2009), discloses an apparatus comprising a manually operated handle attached to the proximal end of a lengthy shaft. The handle further comprises two separate mechanical operating devices, one being attached to a pair of grasping jaws at the distal end of the shaft and the other device serving to advance suture to two needles, also at the distal end of the shaft. The handle may mechanically advance the suture.
U.S. patent application publication #2007/0123914 (Lizardi et al, 2007) presents a needle passer instrument which has a needle engaging cartridge in the upper jaw and a surgical needle with attached suture mounted in the lower jaw. A needle actuation rod engages the surgical needle and pushes the needle through tissue contained between the jaws of the device.
BRIEF SUMMARY OF THE INVENTIONThe present inventive concept, among other uses and applications, relates to an apparatus and method by which a physician may perform laparoscopic or endoscopic surgery with improved ability to reposition a body organ or tissue during the surgical procedure. An important object of the apparatus and method disclosed is to minimize the number of incisions and/or trocar placements into the abdominal wall during the course of a surgical procedure, while providing enhanced retraction capability to the physician.
The primary components of the apparatus include a detachable grasping device comprising a detachable head, a grasper handle removably fixed to the detachable head, at least two needles on suture, which needles may be removably attached to the detachable head, and a puppet/storage handle maintained exteriorly to the abdominal wall.
Initiation of the surgical process is begun with the placement of a trocar through the abdominal wall of the patient. The grasping device is inserted through the channel of the trocar and positioned proximate the organ or tissue to be operated upon. Once the organ is grasped by the detachable head of the grasping device, the grasper handle is removed from the detachable head. A secondary grasper is then inserted through the trocar for the purpose of removing the first of the two needles on suture from its retention means on the detachable head. The respective suture remains within its retention mechanism on the detachable head. The secondary grasper is then manipulated to a desired location or exit point on the interior of the abdominal wall, at which exit point the first needle and suture is impelled outwardly through the abdominal wall.
The foregoing procedure is repeated with the second needle and suture. Once outside the abdominal wall, the two needles and sutures are inserted into opposite ends of the storage handle. The storage handle then becomes the means by which the operator may retract or reposition the organ as required for better vision and assessment during the surgical procedure. The puppet/storage handle may move either of the two stored needles/sutures, thereby directly re-positioning the organ at the point where the detachable head is grasping the organ.
The reader is advised that, for the sake of convenience and clarity, the operation of this device has been described primarily with respect to the human body. However, the inventive concept is also suitable for use by veterinarians and other professionals where anatomical procedures internal to a vertebrate body are necessary. Therefore, the descriptions rendered herein are not considered to be restrictive or limiting of the operation of the device.
A more thorough understanding of the present invention and fabrication system may be had by reference to the drawings herein, of which a brief summation of each drawing follows:
FIGS. 10A through 10DC present a different embodiment of the separable grasper device wherein the internal operating mechanism is two interconnecting drive shafts.
The description of this inventive concept will begin with reference to
The surgical procedure is initiated by the placement of an initial trocar device 30 through the abdominal wall 28, 27. The penetration point of the initial trocar 30 becomes the working port 35 for the surgery. Utilizing the initial trocar 30, an endoscope 4 is inserted into the channel of the trocar 30 and maneuvered to position the instrument proximate the body organ 29 which is the subject of the surgical procedure. The trocar 30 may need to be gradually pressed to a greater depth, since immediately afterwards, the separable grasping device 1 is inserted, parallel to the tube of the endoscope 4, through the channel of the initial trocar 30.
By turning the attention to
Generally, the detachable grasper head 5 can be separated from its grasping handle 2 by a head detaching mechanism 9a which transmits control inputs through linkage to a head detaching means 9. At the time of separation, the needle one retainer 40 and needle two retainer 41 are also activated so as to release needle one 14 and needle two 15. Suture-harnessing means 18, 19 hold the respective sutures for needle one 14 and needle two 15. The two needles remain close to the grasper head 5 for the ensuing capture by a needle driver which is used to execute a piercing-type exit of each needle 14, 15 and its respective suture through the abdominal wall 28.
As we turn our attention to a different embodiment,
At the proximal end of the separable grasping device 1, as shown in
At the grasping handle proximal end 3(a) the head detaching means 9 is activated to disengage the spring-loaded balls 61(a) from their respective recessed seats 61(b), thereby separating the detachable head 5 from the grasping handle 2. The grasping handle 2 is then removed from the initial trocar 30 and placed in temporary storage within the puppet handle connector means 23. Suture one 16 and suture two 17, being previously attached to needle one 14 and needle two 15, are now prepared for being drawn through suture one harnessing means 18 and suture two harnessing means 19, respectively. To accomplish this, a specialized grasper or needle driver 36 is inserted into the channel of the initial trocar 30 and maneuvered into position to grasp each needle 14, 15, in sequence. Each needle is then positioned upward toward desired respective abdominal exit point one 24 and exit point two 25, as illustrated in
Again referring to
In
Also connected at the proximal end of the handle 2 is a gripping handle 58 which, by longitudinal connection means, operates to release the spring-loaded balls 54 from the circumferential groove 53, thereby disengaging the detachable head 5.
Variations of Equipment and MethodsBy the nature of the surgical procedures presented herein, it is evident that other variations of the devices and the methods may be utilized, according to the medical requirements of a particular surgical procedure. The following alternative structures or embodiments of devices may be readily applied: a triple-stem puppet handle 21 as illustrated in
All embodiments of the puppet handles presented thus far may be constructed with a variety of means for retention of the abdominally exiting needles, 14, 15, said means including, but not limited to, latching, clamping, grasping, hooking, constricting, and clutching. In other words, the compressible material 37 is not the sole means of securely retaining the abdominally exiting needles 14, 15 in, or proximate to, the stem of a particular puppet handle.
It is recognized that one knowledgeable in the medical industry and skilled in the art, has the capability to design or produce similar, or other embodiments of this inventive concept. However all such variations, alterations, or modifications are entirely conceivable as being within the intent and scope of the present inventive concept. In particular, the essence of the inventive concept is a surgical grasper comprising a detachable grasper head containing at least one length of suture, combined with the method of performing surgical manipulations with sutures attached to said grasper head and controlled exteriorly of the abdominal wall. Any number of connections, disconnecting methods, operational linkages, functions, and combinations thereof may be used to effectuate the engagement and disengagement of the detachable grasper head from its handle component.
Claims
1. A surgical apparatus for retracting, re-positioning, and re-orienting tissue or a bodily organ during endoscopic or laparoscopic procedures, comprising
- a) a separable grasping device, said grasping device selected from the group of graspers consisting of tissue, claw, sharp tooth, endo-clinch, alligator, aggressive, cobra tooth, spoon, cup, babcock, DeBakey, and Allis graspers, and said grasper further comprising a means for operating said grasper, a means for locking said grasper, a means for retaining at least one surgical needle, a means for harnessing at least one suture, and a means for complete detaching of said grasper; and
- b) a puppet handle having (i) a means for exteriorly retaining said separable grasping device, and (ii) a means for retaining at least two surgical needles.
2. A surgical apparatus for retracting, re-positioning, and re-orienting tissue or a bodily organ during endoscopic or laparoscopic procedures, comprising
- a) a separable grasping device further comprising a detachable grasping head having an upper jaw and a lower jaw, a jaws control means, a jaws locking means, a head detaching means, a jaws operator, at least one needle retainer, at least one suture harnessing means; and
- b) a puppet handle having (i) a means for exteriorly retaining said separable grasping device, and (ii) a means for retaining at least two surgical needles.
3. A surgical apparatus for retracting, re-positioning, and re-orienting tissue or a bodily organ during endoscopic or laparoscopic procedures, comprising
- a) a detachable grasping head comprising an upper jaw and a lower jaw, said jaws being attached to a grasper shell wherein a tensioned locking ring is attached to the perimeter of said grasper shell, with a driven shaft attached to and concentric with the center of said grasper shell; and
- b) a grasping handle having a proximal end (proximate a user) and a distal end (proximate said grasper shell), and further comprising a hollow longitudinal sleeve, said longitudinal sleeve housing a drive shaft, which drive shaft connects, at the proximal end of the longitudinal sleeve, to a control wheel, and further, said drive shaft having at its distal end an expanded u-joint interiorly containing a plurality of spring-loaded balls, wherein said control wheel, when activated by a user, turns a driven shaft, said driven shaft being attached by a square fitting to said grasper shell; and
- c) a puppet handle comprising (i) a primarily cylindrical structure having a hollow left end and a hollow right end, wherein a compressible material is firmly compacted within the interior of said left end and of said right end, said compressible material of such frictional coefficient as to enable the retention of at least one surgical needle inserted into said compressible material; and (ii) two exteriorly-attached, co-axial, flexible c-ring clips, each clip of an inner diameter equal to the outer diameter of said grasping handle.
4. A surgical apparatus according to claim 2 wherein said puppet handle further comprises
- a) a primarily cylindrical structure having a hollow left end and a hollow right end, wherein a compressible material is firmly compacted within the interior of said left end and of said right end, said compressible material of such frictional coefficient as to enable the retention of said surgical needles inserted into said compressible material; and
- b) said means for exteriorly retaining said separable grasping device comprises two exteriorly-attached, co-axial, flexible c-ring clips, each clip of an inner diameter equal to the outer diameter of said grasping handle.
5. A surgical apparatus according to claim 2 wherein said puppet handle further comprises
- a) a structure comprising a plurality of conjoined, primarily cylindrical stems, each said stem having a hollow opening wherein a compressible material is firmly compacted within the interior of said stems, said material of such frictional coefficient as to enable the retention of a surgical needle inserted into said compressible material; and
- b) at least one paired, co-axial, flexible c-ring clips attached to the outer surface of said structure.
6. A surgical apparatus according to claim 2 wherein said puppet handle further comprises (i) a means for storing and dispensing suture material, (ii) a means for exteriorly retaining said grasper when said grasper is detached from said locking head, and (iii) a means of interiorly retaining at least two surgical needles.
7. A method for the retracting, re-positioning, and re-orienting tissue or a bodily organ during endoscopic or laparoscopic surgery, comprising the steps of
- a) providing a surgical apparatus comprising (i) a separable grasping device having a detachable grasping head comprising an upper jaw and a lower jaw, a jaws control means, a jaws locking means, a head detaching means, a jaws operator, at least one needle retainer containing at least one surgical needle and suture, at least one suture harnessing means; and (ii) a puppet handle comprising a means for exteriorly retaining said separable grasping device, and a means for exteriorly retaining at least two surgical needles.
- b) inserting a trocar, or other suitable medical instrument, having a first integral shaft and a second integral shaft, into the abdominal wall of a patient;
- c) inserting, through said first integral shaft, said separable grasping device;
- d) inserting, through said second integral shaft, an endoscope;
- e) utilizing said endoscope, and thereby clasping, by utilizing said detachable grasper, tissue or an organ involved with said surgery;
- f) removing, by means of a device inserted through said second integral shaft, said needles from the at least one needle retainer on said detachable locking head;
- g) passing each said needle through the interior of said abdominal wall so as to expose each said needle exteriorly to the patient's body;
- h) affixing each said needle and its accompanying suture separately into said compressible material within said left end and said right end, respectively, of said puppet handle;
- i) utilizing said puppet handle to retract and/or position said tissue or said organ to an orientation as required by the nature of said surgery.
Type: Application
Filed: Jul 26, 2010
Publication Date: Feb 17, 2011
Applicant: (LaGrange, GA)
Inventor: C. Paul Major (LaGrange, GA)
Application Number: 12/804,685
International Classification: A61B 17/00 (20060101);