WO1989011243A1 - Device improving a per-coelioscopic surgery - Google Patents

Device improving a per-coelioscopic surgery Download PDF

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Publication number
WO1989011243A1
WO1989011243A1 PCT/FR1989/000244 FR8900244W WO8911243A1 WO 1989011243 A1 WO1989011243 A1 WO 1989011243A1 FR 8900244 W FR8900244 W FR 8900244W WO 8911243 A1 WO8911243 A1 WO 8911243A1
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WIPO (PCT)
Prior art keywords
instruments
operator
coupled
rigid
sliding
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PCT/FR1989/000244
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French (fr)
Inventor
Claude Suissa
Original Assignee
Claude Suissa
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Claude Suissa filed Critical Claude Suissa
Publication of WO1989011243A1 publication Critical patent/WO1989011243A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms

Definitions

  • the invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firmly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or of said instruments (25 or 27) by mobilizing the instruments on each other, balls or other retractable stop Systems (33, 36) located in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in operation and actuatable by meahs of the manipulation forceps (45, 46).
  • the invention describes three devices allowing improvement and facilitation of per-laparoscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then flexible (4) avoiding to hold the laparoscope ( 5) manually; a system for securing the lioscope (5) to the operator's head and eye (13) by reusable "adhesives” (9, 11); interchangeable coupled operating instruments (27), sliding in a rigid insulating sheath (24), bent or not, acting alternately one to the other of the operator being able to activate or deactivate said instruments (25 or 27) by mobilizing them one on the other, balls or other stop systems (33, 36) located in housings (32, 35) and retractable, which can block one or the other inst ment (27 or 25).
  • Sliding stops (38, 40) signal the operator on the insulating sheath (24) that the half-inst is in operation and can be actuated by the handling clamps (45, 46).
  • Fibroscopy is a known technique that has been used for decades. For a long time, it was thought to use this way to practice surgical interventions.
  • the big advantage of this method is to avoid any major incision (for example laparotomy for abdomino-pelvic surgery), therefore to shorten the duration of hospitalization and to simplify the operative suites.
  • the disadvantage is due to the methodology: problem of anesthesia, for example in the event of pressurization of gas from the abdominal cavity associated with a positioning of trendelenbourg; problem of multiple and distant approaches to facilitate operational tactics; problem of the operator's experience and fatigue due to the discomfort of the working position and the concentration to be maintained to ensure the simplest and least traumatic intervention possible.
  • the purpose of all of the inventions described below is to provide an improvement in this sense, from the point of view of the operator's working comfort, and to avoid as much as possible the continuous changes of instruments through the trocards. , this causing discomfort for the intervention and prolonging it unnecessarily and dangerously.
  • Figure 1 shows a device for supporting the laparoscope (5) which allows, once the placement of the instruments done, to keep the laparoscope (5) fixed while being relatively mobile for the intervention which is envisaged.
  • This sterilizable device comprises a rigid support (2) fixed to the operating table itself by a mobile fixator (1).
  • This rigid support (2) is extended by a flexible support (3) allowing the mobilization of the laparoscope (5) in the different planes of the space.
  • Itself (3) has at its end a flexible support (4) in which is housed the laparoscope (5).
  • FIG. 2 shows the example of a device allowing the operator to free himself from the constraint of mobilizing the laparoscope (5) manually, this device allowing him to have both hands free for the other technical gestures.
  • the laparotomy hole (17) is introduced the trocar (47), then the laparoscope (5), if necessary bent (6,16,7), as we will see later.
  • the eyepiece (8) of the laparoscope (5) are fixed hollow devices (10) at the bottom of which are fixed magnets (9) or another fastening system (for example velcro ).
  • the operator himself is “dressed” with an elastic or rigid headband (14) (which could also have the shape of a helmet) on which is fixed a monocle (13), possibly adjustable to the vision of the operator, and on both sides of which are positioned projecting devices (12) surmounted by counter-magnets (11) or other fastening systems as defined above.
  • These devices (12) will fit like keys in locks in the recesses (10) which face them when the operator wishes to look into the laparoscope (5) via the eyelet (8) placing facing the monocle (13).
  • the fastening systems, magnet or other (9,11) will secure the assembly and thus allow the operator to mobilize the laparoscope at will without having to use his hands, available for other gestures.
  • FIG. 3 represents, seen from above, an operating situation where the practitioner, for example sitting on the patient's left on an operating saddle, installed his equipment in the following manner: a peri-umbilical hole (17) having been made after swelling of the abdominal cavity, the operator introduces the trocar (47) of the laparoscope (5), then the latter (5), possibly bent (6,7), the vision then being provided by reflection on an optical system ( 6) or glass fibers towards the eyecup (8).
  • This eyelet (8) comprises two or more attachment systems (9,10) as described in Figure 2.
  • a right iliac counter-incision (18) is introduced a trocard (20) whose diameter will depend on the size of the instrument (22) described in Figures 4 and 5, itself divided into two sub-units (25,27) located in an insulating sheath (24) and manipulated by suitable sleeves (45,46).
  • This straight instrument (22) will be (or not) bent according to the wishes of the operator, this only to facilitate the gripping of the sleeves (45,46) by the right hand of the operator acting under control of the view provided by the eyepiece of the coelioscope (5).
  • FIG. 4 shows in section the new coupled tool proposed for per-laparoscopic interventions.
  • the said instrument (22 or 23) is introduced, comprising at its periphery an insulating sheath (24) allowing, however, the sliding of the one on the other of the two coupled half-instruments (25,27).
  • Each of the half-instruments (25,27) has the shape of a cylinder cut in its center in the longitudinal direction so that the two coupled half-instruments form a straight cylinder or having an angulation according to the models (as described in Figure 3).
  • FIG. 5 illustrates a possibility of coupled instruments, with, from outside inside, an insulating sheath (24) within which the two coupled instruments (25,27) slide freely, can even be removed individually to be replaced by another half-instrument, necessary during intervention .
  • the insulating sheath (24) is rigid and closed entirely at the bottom, but has at its upper part two diametrically opposite orifices (37, 39), in the form of more or less wide slots, in which two stops will slide, retractable stops (38.40) each belonging to an instrument (25.27) and preventing untimely mobilization of said instruments.
  • Each of the instruments (25,27) has the shape of a half-cylinder cut in the longitudinal direction so that the two parts coupled by their rectilinear sectional section together form a cylinder sliding perfectly in the insulating sheath (24) in the direction longitudinal, not in the circular direction since the instruments (25,27) are integral with the sheath (24) by the stops (38,40) located in the sliding zones (37,39) arranged at the top of the insulating sheath (24). From their distal part to their proximal part, the following parts can be described for each of the instruments (25,27): below the instrumental jaws (29,30) (in general it will be useful to couple an operating tip: gripper , coagulating forceps ...
  • FIG. 6 shows in section the upper end of the rigid insulating sheath (24), in which the slots (37, 39) are hollowed out where the stops (38, 40) slide, respectively belonging to the instruments I, operational, and II, out of function in the example described.
  • the proximal part of the instruments I and II is optionally bent (41,42) at a variable distance from the start of the rigid insulating sheath (24), and the proximal ends of the two instruments I and II form a variable angle between them allowing to have in front of the operator's hand with a single clamp (45 or 46), without discomfort therefore to maneuver the cables (26 or 28) sliding on the pulleys (43,44) before mobilizing the jaws (29) of instrument I (not blocked in the example taken) or those (30) of instrument II (here in an out-of-service situation).
  • the invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firrnly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or off said instruments (25 or 27) by mobilizing the instruments on each other, balls or other retractable stop Systems (33, 36) located in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in operation and actuatable by means of the manipulation forceps (45, 46).
  • the invention describes three devices allowing improvement and facilitation of per-laparoscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then flexible (4) avoiding to hold the laparoscope ( 5) manually; a system for securing the lioscope (5) to the head and the operator's eye (13) by reusable "adhesives” (9, 11); interchangeable coupled operating instruments (27), sliding in a rigid insulating sheath (24), bent or not, acting alternately, one at the operator's g being able to activate or deactivate said instruments (25 or 27) by mobilizing them one on the other, d balls or other stop systems (33, 36) located in housings (32, 35) and retractable, which can block one or the other inst ment (27 or 25).
  • Sliding stops (38, 40) signal the operator on the insulating sheath (24) that the half-inst is in operation and can be actuated by the handling clamps (45, 46).

Abstract

The invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firmly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or off said instruments (25 or 27) by mobilizing the instruments on each other, balls or other retractable stop systems (33, 36) situated in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in operation and actuatable by means of the manipulation forceps (45, 46).

Description

P-TT ORGANISATION MONDIALE DE LA PROPRIETE INTELLECTUELLE _> X Bureau internationalP-TT WORLD INTELLECTUAL PROPERTY ORGANIZATION _> X International Bureau
DEMANDE INTERNATIONALE PUBLIEE EN VERTU DU TRAITE DE COOPERATION EN MATIERE DE BREVETS (INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (
(51) Classification internationale des brevets4 : (11) Numéro de publication internationale: WO 89/1(51) International Patent Classification 4 : (11) International Publication Number: WO 89/1
A61B 1/00, 17/32, 17/34 Al A61B 19/00 (43) Date de publication internationale: 30 novembre 1989 (30.A61B 1/00, 17/32, 17/34 Al A61B 19/00 (43) Date of international publication: November 30, 1989 (30.
(21) Numéro de la demande internationale : PCT/FR89/00244 SN (brevet OAPI), SU, TD (brevet OAPI), TG (brevet O US.(21) International application number: PCT / FR89 / 00244 SN (OAPI patent), SU, TD (OAPI patent), TG (O US patent.
(22) Date de dépôt international : 22 mai 1989 (22.05.89)(22) International filing date: May 22, 1989 (22.05.89)
PubliéePublished
(30) Données relatives à la priorité: Avec rapport de recherche internationale.(30) Data relating to priority: With international search report.
88/06863 24 mai 1988 (24.05.88) FR Avant l'expiration du délai prévu pour la modificatio revendications, sera republiée si de telles modification reçues.88/06863 24 May 1988 (24.05.88) FR Before the expiry of the period provided for the modification of claims, will be republished if such modification received.
(71X72) Déposant et inventeur: SUISSA, Claude [FR/FR]; 59, avenue Foch, F-94100 S.-Maur-des-Fosses (FR).(71X72) Applicant and inventor: SUISSA, Claude [FR / FR]; 59, avenue Foch, F-94100 S.-Maur-des-Fosses (FR).
(81) Etats désignés: AT, AT (brevet européen), AU, BB, BE (brevet européen), BF (brevet OAPI), BG, BJ (brevet OAPI), BR, CF (brevet OAPI), CG (brevet OAPI), CH, CH (brevet européen), CM (brevet OAPI), DE, DE (brevet européen), DK, FI, FR (brevet européen), G A (brevet OAPI), GB, GB (brevet européen), HU, IT (brevet européen), JP, KP, KR, LK, LU, LU (brevet européen), MC, MG, ML (brevet OAPI), MR (brevet OAPI), MW, NL, NL (brevet européen), NO, RO, SD, SE, SE (brevet européen),(81) Designated States: AT, AT (European patent), AU, BB, BE (European patent), BF (OAPI patent), BG, BJ (OAPI patent), BR, CF (OAPI patent), CG (OAPI patent) ), CH, CH (European patent), CM (OAPI patent), DE, DE (European patent), DK, FI, FR (European patent), GA (OAPI patent), GB, GB (European patent), HU, IT (European patent), JP, KP, KR, LK, LU, LU (European patent), MC, MG, ML (OAPI patent), MR (OAPI patent), MW, NL, NL (European patent), NO, RO, SD, SE, SE (European patent),
(54) Title: DEVICE IMPROVING A PER-COELIOSCOPIC SURGERY(54) Title: DEVICE IMPROVING A PER-COELIOSCOPIC SURGERY
(54) Titre: DISPOSITIFS PERMETTANT UNE AMELIORATION DE LA CHIRURGIE PER-COELIOSCOPIQUE(54) Title: DEVICES FOR IMPROVING PERCOELIOSCOPIC SURGERY
(57) Abstract(57) Abstract
The invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5) ; a system for firmly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or of said instruments (25 or 27) by mobilizing the instruments on each other, balls or other rétractable stop Systems (33, 36) situated in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in opération and actuatable by meahs of the manipulation forceps (45, 46).The invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firmly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or of said instruments (25 or 27) by mobilizing the instruments on each other, balls or other retractable stop Systems (33, 36) located in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in operation and actuatable by meahs of the manipulation forceps (45, 46).
(57) Abrégé(57) Abstract
L'invention décrit trois dispositifs permettant une amélioration et une facilitation de la chirurgie per-coelioscopique: un système d'attache flexible avec un support rigide (2), puis flexible (3), puis souple (4) évitant de tenir le coelioscope (5) manuellement; un système de solidarisation du lioscope (5) à la tête et l'oeil de l'opérateur (13) par des "adhésifs" réutilisables (9, 11); des instruments opératoires couplés ( 27) interchangeables, coulissant dans une gaine isolante rigide (24), coudés ou non, agissant alternativement l'un, l'autre, au de l'opérateur pouvant mettre en fonction ou hors service Iesdits instruments (25 ou 27) en les mobilisant l'un sur l'autre, billes ou autres systèmes d'arrêt (33, 36) situés dans des logements (32, 35) et rétractables, pouvant bloquer l'un ou l'autre inst ment (27 ou 25). Des butées d'arrêt de coulissage (38, 40) signalent en haut sur la gaine isolante (24) à l'opérateur, le demi-inst ment en fonction et actionnable par les pinces de manipulation (45, 46). The invention describes three devices allowing improvement and facilitation of per-laparoscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then flexible (4) avoiding to hold the laparoscope ( 5) manually; a system for securing the lioscope (5) to the operator's head and eye (13) by reusable "adhesives" (9, 11); interchangeable coupled operating instruments (27), sliding in a rigid insulating sheath (24), bent or not, acting alternately one to the other of the operator being able to activate or deactivate said instruments (25 or 27) by mobilizing them one on the other, balls or other stop systems (33, 36) located in housings (32, 35) and retractable, which can block one or the other inst ment (27 or 25). Sliding stops (38, 40) signal the operator on the insulating sheath (24) that the half-inst is in operation and can be actuated by the handling clamps (45, 46).
UNIQUEMENT A TITRE D'INFORMATIONONLY FOR INFORMATION
Codes utilisés pour identifier les Etats parties au PCT, sur les pages de couverture des brochures publiant des demandes internationales en vertu du PCT.Codes used to identify States Parties to the PCT, on the cover pages of brochures publishing international applications under the PCT.
'AT Autriche Fl Finlande ML Mafi'AT Austria Fl Finland ML Mafi
AU Australie FR France MR MauritanieAU Australia FR France MR Mauritania
BB Barbade GA Gabon MW MalawiBB Barbados GA Gabon MW Malawi
BE Belgique GB Royaume-Uni NL Pays-BasBE Belgium GB United Kingdom NL Netherlands
BF Burkina Fasso HU Hongrie NO NorvègeBF Burkina Fasso HU Hungary NO Norway
BG Bulgarie rr Italie RO RoumanieBG Bulgaria rr Italy RO Romania
BJ Bénin JP Japon SD SoudanBJ Benin JP Japan SD Sudan
BR Brésil KP République populaire démocratique SE SuèdeBR Brazil KP Democratic People's Republic SE Sweden
CF République Centra ficauie de Corée SN SénégalCF Central Republic of Korea SN Senegal
CG Congo KR République de Corée SU Union soviétiqueCG Congo KR Republic of Korea SU Soviet Union
CH Suisse u Liechtenstein TD TchadCH Switzerland u Liechtenstein TD Chad
CM Cameroun LK Sri Lanka TG TogoCM Cameroon LK Sri Lanka TG Togo
DE Allemagne. République fédérale d' U Luxembourg US Etats-Unis d'AmériqueFROM Germany. Federal Republic of U Luxembourg US United States of America
DK Danemark MC MonacoDK Denmark MC Monaco
ES Espagne MG Madagascar ES Spain MG Madagascar
Dispositifs permettant une amélioration de la chirurgie per coelioscopique.Devices for improving laparoscopic surgery.
La fibroscopie est une technique connue et utilisée depuis des décennies. Depuis longtemps, on a pensé utiliser cette voie pour pratiquer des interventions chirurgicales. Le gros avantage de cette méthode est d'éviter toute incision importante (par exemple laparotomie pour la chirurgie abdomino-pelvienne), donc d'écourter la durée d'hospitalisation et de simplifier les suites opératoires.Fibroscopy is a known technique that has been used for decades. For a long time, it was thought to use this way to practice surgical interventions. The big advantage of this method is to avoid any major incision (for example laparotomy for abdomino-pelvic surgery), therefore to shorten the duration of hospitalization and to simplify the operative suites.
L'inconvénient tient à la méthodologie : problème d' anesthésie, par exemple en cas de mise sous pression de gaz de la cavité abdominale associée à une mise en position de trendelenbourg ; problème des voies d'abord, multiple et éloignées pour faciliter la tactigue opératoire ; problème de l'expérience de l'opérateur et de sa fatigue du fait de l' inconfort de la position de travail et de la concentration à maintenir pour assurer une intervention la plus simple et la moins traumatisante possible. Le but de l'ensemble des inventions ci-après décrites est d'apporter une amélioration dans ce sens, du point de vue du confort de travail de l'opérateur, et pour éviter au maximum les changements continuels d'instruments au travers des trocards, ceci entraînant une gêne pour l'intervention et la prolongeant inutilement et dangereusement.The disadvantage is due to the methodology: problem of anesthesia, for example in the event of pressurization of gas from the abdominal cavity associated with a positioning of trendelenbourg; problem of multiple and distant approaches to facilitate operational tactics; problem of the operator's experience and fatigue due to the discomfort of the working position and the concentration to be maintained to ensure the simplest and least traumatic intervention possible. The purpose of all of the inventions described below is to provide an improvement in this sense, from the point of view of the operator's working comfort, and to avoid as much as possible the continuous changes of instruments through the trocards. , this causing discomfort for the intervention and prolonging it unnecessarily and dangerously.
A cet effet nous envisagerons d'abord l'installation des instruments et de l'opérateur, puis un nouveau type d'instruments couplés permettant d'améliorer la tactique opératoire. Dans l'exposé qui suit, pour simplifier, nous prendrons comme exemple la chirurgie gynécologique pelvienne per-coelioscopique.For this purpose we will first consider the installation of instruments and the operator, then a new type of coupled instruments allowing to improve the operational tactics. In the following description, for simplicity, we will take as an example pelvic per-laparoscopic gynecological surgery.
Les figures ci-après, données uniquement à titre d'exemples, permettront d'avoir un aperçu de la nouvelle tactique proposée: La figure 1 montre un dispositif de sustentation du coelioscope (5) qui permet, une fois la mise en place des instruments faite, de maintenir le coelioscope (5) fixé tout en étant relativement mobile pour l'intervention qui est envisagée. Ce dispositif, stérilisable, comporte un support rigide (2) fixé sur la table d'opération elle-même par un fixateur mobile (1). Ce support rigide (2) est prolongé par un support flexible (3) permettant la mobilisation du coelioscope (5) dans les différents plans de l'espace. Lui-même (3) comporte à son extrémité un support souple (4) dans lequel vient se loger le coelioscope (5). La figure 2 montre l'exemple d'un dispositif permettant à l'opérateur de se libérer de la contrainte de mobiliser le coelioscope (5) manuellement, cet artifice lui permettant dravoir les deux mains libres pour les autres gestes techniques. A travers le trou de laparotomie (17) est introduit le trocard (47), puis le coelioscope (5), au besoin coudé (6,16,7), comme nous le verrons plus loin. Des deux côtés de l'oeilleton (8) du coelioscope (5) sont fixés des dispositifs creux (10) au fond desquels sont fixés des aimants (9) ou un autre système d'attache (par exemple velcro...). L'opérateur lui-même s'est "habillé" d'un bandeau élastique ou rigide (14) (qui pourrait aussi avoir la forme d'un casque) sur lequel est fixé un monocle (13), éventuellement ajustable à la vision de l' opérateur, et des deux côtés duquel sont positionnés des dispositifs en saillie (12 ) surmontés de contre-aimants (11) ou autres systèmes d'attaches tels que définis plus haut. Ces dispositifs (12) vont s'emboiter tels des clés dans des serrures dans les creux (10) qui leur font face quand 301' opérateur souhaitera regarder dans le coelioscope (5) par l'intermédiaire de l'oeilletton (8) se plaçant face au monocle (13). Les systèmes d'attaches, aimant ou autre (9,11), solidariseront l'ensemble et permettront ainsi à l'opérateur de mobiliser le coelioscope à sa guise sans avoir à utiliser ses mains, disponibles pour les autres gestes.The figures below, given only as examples, will give an overview of the new tactic proposed: Figure 1 shows a device for supporting the laparoscope (5) which allows, once the placement of the instruments done, to keep the laparoscope (5) fixed while being relatively mobile for the intervention which is envisaged. This sterilizable device comprises a rigid support (2) fixed to the operating table itself by a mobile fixator (1). This rigid support (2) is extended by a flexible support (3) allowing the mobilization of the laparoscope (5) in the different planes of the space. Itself (3) has at its end a flexible support (4) in which is housed the laparoscope (5). FIG. 2 shows the example of a device allowing the operator to free himself from the constraint of mobilizing the laparoscope (5) manually, this device allowing him to have both hands free for the other technical gestures. Through the laparotomy hole (17) is introduced the trocar (47), then the laparoscope (5), if necessary bent (6,16,7), as we will see later. On both sides of the eyepiece (8) of the laparoscope (5) are fixed hollow devices (10) at the bottom of which are fixed magnets (9) or another fastening system (for example velcro ...). The operator himself is "dressed" with an elastic or rigid headband (14) (which could also have the shape of a helmet) on which is fixed a monocle (13), possibly adjustable to the vision of the operator, and on both sides of which are positioned projecting devices (12) surmounted by counter-magnets (11) or other fastening systems as defined above. These devices (12) will fit like keys in locks in the recesses (10) which face them when the operator wishes to look into the laparoscope (5) via the eyelet (8) placing facing the monocle (13). The fastening systems, magnet or other (9,11), will secure the assembly and thus allow the operator to mobilize the laparoscope at will without having to use his hands, available for other gestures.
La désolidarisation du coelioscope (5,8) et du monocle de vision (13) nécessitera cependant, selon la force qui sera donnée aux éléments de solidarisation (9,11), de tenir le coelioscope (5) avec une main pour retirer la tête (et le monocle) et ainsi découpler les attaches.The separation of the laparoscope (5,8) and the vision monocle (13) will however require, depending on the force which will be given to the securing elements (9,11), to hold the laparoscope (5) with one hand to remove the head (and the monocle) and thus decouple the fasteners.
La figure 3 représente, vue de haut, une situation opératoire où le praticien,, par exemple assis à gauche de la patiente sur une selle opératoire, a installé son matériel de la manière suivante : un trou péri ombilical (17) ayant été fait après gonflement de la cavité abdominale, l'opérateur introduit le trocard (47) du coelioscope (5), puis celui-ci (5), éventuellement coudé (6,7), la vision étant alors assurée par une réflexion sur un système optique (6) ou des fibres de verre vers l'oeilleton (8). Cet oeilleton (8) comporte deux ou plusieurs systèmes d'attache (9,10) tels que décrits à la figure 2. Par une contre-incision iliaque droite (18) est introduit un trocard (20) dont le diamètre sera fonction de la taille de l'instrument (22) décrit sur les figures 4 et 5, divisé lui-même en deux sous unités (25,27) situées dans une gaine isolante (24) et manipulées par des manches adaptés (45,46). Cet instrument droit (22) sera (ou non) coudé selon les souhaits de l'opérateur, ceci uniquement pour faciliter la préhension des manches (45,46) par la main droite de l'opérateur en train d'agir sous controle de la vue procurée par l'oeilleton du coelioscope (5).FIG. 3 represents, seen from above, an operating situation where the practitioner, for example sitting on the patient's left on an operating saddle, installed his equipment in the following manner: a peri-umbilical hole (17) having been made after swelling of the abdominal cavity, the operator introduces the trocar (47) of the laparoscope (5), then the latter (5), possibly bent (6,7), the vision then being provided by reflection on an optical system ( 6) or glass fibers towards the eyecup (8). This eyelet (8) comprises two or more attachment systems (9,10) as described in Figure 2. By a right iliac counter-incision (18) is introduced a trocard (20) whose diameter will depend on the size of the instrument (22) described in Figures 4 and 5, itself divided into two sub-units (25,27) located in an insulating sheath (24) and manipulated by suitable sleeves (45,46). This straight instrument (22) will be (or not) bent according to the wishes of the operator, this only to facilitate the gripping of the sleeves (45,46) by the right hand of the operator acting under control of the view provided by the eyepiece of the coelioscope (5).
Cet oeilleton (8) lui-même solidarisé au monocle (13) que l'opérateur s'est fixé sur l'oeil opérant avant l'intervention par le bandeau de fixation ou casque (14), ceci par l'intermédiaire d'aimants (9,11) situés des deux côtés de l'oeilleton (8) du coelioscope (5) et du monocle (13). Par une contre-incision gauche (19) est introduit un trocard (21) lui-aussi de taille variable en fonction de l'instrument (23) choisi pour opérer par cette voie. Cet instrument sera soit à prise unique, soit à prise double, comme décrit plus loin au niveau des figures 4 et 5. La figure 4 montre en coupe le nouvel outil couplé proposé pour les interventions per-coelioscopiques. Au travers d'un trocard (20) de taille adaptée à celle de l'instrument (22 ou 23), on introduit le dit instrument (22 ou 23) comportant à sa périphérie une gaine isolante (24) permettant toutefois le coulissage l'un sur l'autre des deux demi-instruments couplés (25,27). Chacun des demi-instruments (25,27) a la forme d'un cylindre coupé en son milieu dans le sens longitudinal de telle sorte que les deux demi-instruments accouplés forment un cylindre rectiligne ou présentant une angulation selon les modèles (comme décrit à la figure 3). Ce double demi-cylindre coulisse longitudinalement dans la gaine (24) et bien sûr dans le trocard (20), ainsi qu'il peut tourner sur lui-même, en bloc, permettant ainsi de l'utiliser comme une pièce instrumentale unique pour les interventions percoelioscopiques. Chaque demi-instrument (25,27) est muni d'un dispositif de commande (26,28) de ses machoires terminales (29,30). La figure 5 illustre une possibilité d'instruments couplés, avec, de dehors en dedans, une gaine isolante (24) au sein de laquelle les deux instruments couplés (25,27) coulissent librement, pouvant même être retirés individuellement pour être remplacés par un autre demi-instrument, nécessaire en cours d'intervention. La gaine isolante (24) est rigide et fermée entièrement en bas, mais présente à sa partie supérieure deux orifices (37,39) diamétralement opposés, en forme de fentes plus ou moins larges, dans laquelle vont coulisser deux butées, d'arrêt rétractables (38,40) appartenant chacune à un instrument (25,27) et empêchant une mobilisation intempestive des dits instruments. Chacun des instruments (25,27) a une forme de demi-cylindre coupé dans le sens longitudinal de telle sorte que les deux pièces couplées par leur partie rectiligne de section forment ensemble un cylindre coulissant parfaitement dans la gaine isolante (24) dans le sens longitudinal, pas dans le sens circulaire puisque les instruments (25,27) sont solidaires de la gaine (24) par les butées d'arrêt (38,40) situées dans les zones de coulissage (37,39) aménagées au sommet de la gaine isolante (24). De leur partie distale à leur partie proximale, on peut décrire pour chacun des instruments (25,27) les parties suivantes : en bas les machoires instrumentales (29,30) (en général il sera utile de coupler un embout opératoire : pince à saisir, pince coagulante ... avec une paire de ciseaux) manoeuvrées par un cable de liaison (26,28) relié aux zones de préhension de l'instrument (45,46) ; un peu plus haut, sur la face interne, rectiligne, de chaque instrument (25,27) est aménagée une cupule (31,34) dans laquelle viendra se loger au gré de l'opérateur soit la bille (33) dans la cupule (34) (s'il veut utiliser l'instrument I), soit la bille (36) dans la cupule (31) (s'il veut choisir l'instrument II) ; ces deux billes (33) et (36) étant rétractables vers l'intérieur de l'instrument les portant, leur rétraction s'accompagne d'un blocage mécanique du cable (26 ou 28) permettant la mobilisation des machoires instrumentales correspondantes (29 ou 30) ; plus haut, à égal distance sur chaque instrument I ou II, on retrouve la billeThis eyepiece (8) itself secured to the monocle (13) that the operator has fixed on the operating eye before the intervention by the fixing strip or helmet (14), this by means of magnets (9,11) located on both sides of the eyepiece (8) of the laparoscope (5) and the monocle (13). Through a left counter-incision (19) is introduced a trocar (21) also of variable size depending on the instrument (23) chosen to operate by this route. This instrument will either be a single tap or a double tap, as described below in FIGS. 4 and 5. FIG. 4 shows in section the new coupled tool proposed for per-laparoscopic interventions. Through a trocar (20) of a size adapted to that of the instrument (22 or 23), the said instrument (22 or 23) is introduced, comprising at its periphery an insulating sheath (24) allowing, however, the sliding of the one on the other of the two coupled half-instruments (25,27). Each of the half-instruments (25,27) has the shape of a cylinder cut in its center in the longitudinal direction so that the two coupled half-instruments form a straight cylinder or having an angulation according to the models (as described in Figure 3). This double half-cylinder slides longitudinally in the sheath (24) and of course in the trocar (20), so that it can turn on itself, in block, thus allowing to use it as a single instrumental piece for percoelioscopic interventions. Each half-instrument (25,27) is provided with a control device (26,28) for its terminal jaws (29,30). FIG. 5 illustrates a possibility of coupled instruments, with, from outside inside, an insulating sheath (24) within which the two coupled instruments (25,27) slide freely, can even be removed individually to be replaced by another half-instrument, necessary during intervention . The insulating sheath (24) is rigid and closed entirely at the bottom, but has at its upper part two diametrically opposite orifices (37, 39), in the form of more or less wide slots, in which two stops will slide, retractable stops (38.40) each belonging to an instrument (25.27) and preventing untimely mobilization of said instruments. Each of the instruments (25,27) has the shape of a half-cylinder cut in the longitudinal direction so that the two parts coupled by their rectilinear sectional section together form a cylinder sliding perfectly in the insulating sheath (24) in the direction longitudinal, not in the circular direction since the instruments (25,27) are integral with the sheath (24) by the stops (38,40) located in the sliding zones (37,39) arranged at the top of the insulating sheath (24). From their distal part to their proximal part, the following parts can be described for each of the instruments (25,27): below the instrumental jaws (29,30) (in general it will be useful to couple an operating tip: gripper , coagulating forceps ... with a pair of scissors) operated by a connecting cable (26,28) connected to the gripping zones of the instrument (45,46); a little higher, on the internal rectilinear face of each instrument (25,27) is arranged a cup (31,34) in which will be lodged at the option of the operator is the ball (33) in the cup ( 34) (if he wants to use instrument I), or the ball (36) in the cup (31) (if he wants to choose instrument II); these two balls (33) and (36) being retractable towards the interior of the instrument carrying them, their retraction is accompanied by a mechanical blocking of the cable (26 or 28) allowing the mobilization of the corresponding instrumental jaws (29 or 30) ; higher, at equal distance on each instrument I or II, we find the ball
(33) sortant de son logement (32) pour se loger dans la cupule(33) leaving its housing (32) to be housed in the cup
(34) qui lui fait face ; ceci a libéré le cable de l'instrument I (26) et permet de se servir des machoires (29) du dit instrument ; plus haut encore, on trouve la bille d'arrêt (36) de l'instrument II dans son logement (35) qui, ayant en face d'elle la surface rectiligne de l'instrument I, se situe en position "rétractée" et bloque ainsi le cable (28) de l'instrument II, ce qui évite une mobilisation intempestive des machoires (30) du-dit instrument ; beaucoup plus haut encore, à l'extrémité supérieure de la gaine isolante, on retrouve sur l'instrument I une butée d'arrêt (38) rétractable (par exemple sur un ressort) située en position basse dans l'exemple pris sur la figure 5 où c'est l'instrument I qui est en fonction ; cette butée coulisse dans une fente (37) dont la longueur est égale à la distance milieu de la cupule (31) /milieu du logement de la bille d'arrêt (35), elle-même identique à la longueur milieu de la cupule (34) /milieu du logement de la bille d'arrêt (32) lorsque l'instrument I est retiré et l'instrument II poussé pour mettre celui-ci en action et inactiver le premier ; en face de la fente (37), diamétralement opposée à elle sur la gaine isolante rigide (24), se trouve une autre fente (39), de taille identique à la première, où coulisse une butée d'arrêt (40) rétractable appartenant à l'instrument II et située dans l'exemple pris à la partie supérieure de la fente (39).(34) facing him; this freed the cable of the instrument I (26) and makes it possible to use the jaws (29) of said instrument; higher still, there is the stop ball (36) of the instrument II in its housing (35) which, facing from it the rectilinear surface of the instrument I, is in the "retracted" position and thus blocks the cable (28) of the instrument II, which avoids untimely mobilization of the jaws (30) of said instrument; much higher still, at the upper end of the insulating sheath, there is on the instrument I a retractable stop (38) (for example on a spring) situated in the low position in the example taken in the figure 5 where it is instrument I which is in operation; this stop slides in a slot (37) whose length is equal to the distance from the center of the cup (31) / center of the housing of the stop ball (35), itself identical to the middle length of the cup ( 34) / middle of the housing of the stop ball (32) when the instrument I is removed and the instrument II pushed to put the latter in action and inactivate the first; opposite the slot (37), diametrically opposite to it on the rigid insulating sheath (24), is another slot (39), of identical size to the first, where slides a retractable stopper (40) belonging to instrument II and located in the example taken from the upper part of the slot (39).
La figure 6 reprend en coupe l'extrémité supérieure de la gaine isolante (24) rigide, dans laquelle sont creusées les fentes (37,39) où coulissent les butées d'arrêt (38,40) appartenant respectivement aux instruments I, opérationnel, et II, hors fonction dans l'exemple décrit. La partie proximale des instruments I et II est éventuellement coudée (41,42) à une distance variable du début de la gaine isolante rigide (24), et les embouts proximaux des deux instruments I et II forment entre eux un angle variable permettant de disposer en face de la main de l'opérateur d'une seule pince (45 ou 46), sans gêne donc pour manoeuvrer les cables (26 ou 28) coulissant sur les poulies (43,44) avant de mobiliser les mâchoires (29) de l'instrument I (non bloqué dans l'exemple pris) ou celles (30) de l'instrument II (ici en situation d'hors-service). FIG. 6 shows in section the upper end of the rigid insulating sheath (24), in which the slots (37, 39) are hollowed out where the stops (38, 40) slide, respectively belonging to the instruments I, operational, and II, out of function in the example described. The proximal part of the instruments I and II is optionally bent (41,42) at a variable distance from the start of the rigid insulating sheath (24), and the proximal ends of the two instruments I and II form a variable angle between them allowing to have in front of the operator's hand with a single clamp (45 or 46), without discomfort therefore to maneuver the cables (26 or 28) sliding on the pulleys (43,44) before mobilizing the jaws (29) of instrument I (not blocked in the example taken) or those (30) of instrument II (here in an out-of-service situation).
PCT ORGANISATION MONDIALE DE LA PROPRIETE INTELLECTUELLE Bureau international PCT WORLD INTELLECTUAL PROPERTY ORGANIZATION International Bureau
DEMANDE INTERNATIONALE PUBLIEE EN VERTU DU TRAITE DE COOPERATION EN MATIERE DE BREVETS (PCINTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PC
(51) Classification internationale des brevets-* (11) Numéro de publication internationale: WO 89/112(51) International Patent Classification- * (11) International publication number: WO 89/112
A61B 1/00, 17/32, 17/34 Al A61B 19/00 (43) Date de publication internationale: 30 novembre 1989 (30.11.A61B 1/00, 17/32, 17/34 Al A61B 19/00 (43) Date of international publication: November 30, 1989 (30.11.
(21) Numéro de la demande internationale : PCT/FR89/00244 SN (brevet OAPI), SU, TD (brevet OAPI), TG (brevet OA US.(21) International application number: PCT / FR89 / 00244 SN (OAPI patent), SU, TD (OAPI patent), TG (OA US patent.
(22) Date de dépôt international: 22 mai 1989 (22.05.89)(22) International filing date: May 22, 1989 (22.05.89)
PubliéePublished
(30) Données relatives à la priorité: Avec rapport de recherche internationale.(30) Data relating to priority: With international search report.
88/06863 24 mai 1988 (24.05.88) FR Avec revendications modifiées et déclaration88/06863 24 May 1988 (24.05.88) FR With amended claims and declaration
Date de publication des revendications modifiées et déclaratiDate of publication of the amended and declared claims
(71X72) Déposant et inventeur: SUISSA, Claude [FR/FR]; 59, 25 janvier 1990 (25.01.90 avenue Foch, F-94100 S.-Maur-des-Fosses (FR).(71X72) Applicant and inventor: SUISSA, Claude [FR / FR]; 59, January 25, 1990 (25.01.90 avenue Foch, F-94100 S.-Maur-des-Fosses (FR).
(81) Etats désignés: AT, AT (brevet européen), AU, BB, BE (brevet européen), BF (brevet OAPI), BG, BJ (brevet OAPI), BR, CF (brevet OAPI), CG (brevet OAPI), CH, CH (brevet européen), CM (brevet OAPI), DE, DE (brevet européen), DK, FI, FR (brevet européen), GA (brevet OAPI), GB, GB (brevet européen), HU, IT (brevet européen), JP, KP, KR, LK, LU, LU (brevet européen), MC, MG, ML (brevet OAPI), MR (brevet OAPI), MW, NL, NL (brevet européen), NO, RO, SD, SE, SE (brevet européen),(81) Designated States: AT, AT (European patent), AU, BB, BE (European patent), BF (OAPI patent), BG, BJ (OAPI patent), BR, CF (OAPI patent), CG (OAPI patent) ), CH, CH (European patent), CM (OAPI patent), DE, DE (European patent), DK, FI, FR (European patent), GA (OAPI patent), GB, GB (European patent), HU, IT (European patent), JP, KP, KR, LK, LU, LU (European patent), MC, MG, ML (OAPI patent), MR (OAPI patent), MW, NL, NL (European patent), NO, RO, SD, SE, SE (European patent),
(54)TitIe: DEVICE IMPROVING A PER-COELIOSCOPIC SURGERY(54) Title: DEVICE IMPROVING TO PER-COELIOSCOPIC SURGERY
(54) Titre: DISPOSITIFS PERMETTANT UNE AMELIORATION DE LA CHIRURGIE PER-COELIOSCOPIQUE(54) Title: DEVICES FOR IMPROVING PERCOELIOSCOPIC SURGERY
(57)Abstract(57) Abstract
The invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firrnly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or off said instruments (25 or 27) by mobilizing the instruments on each other, balls or other rétractable stop Systems (33, 36) situated in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in opération and actuatable by means of the manipulation forceps (45, 46).The invention discloses three devices which improve and facilitate a per-coelioscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then appliable (4) which avoids to hold manually the coelioscope (5); a system for firrnly attaching the coelioscope (5) to the head and eye of the operator (13) by means of reusable adhesives (9, 11); interchangeable coupled operative instruments (25, 27) sliding into a rigid isolating sheet (24), which may be bent or not, acting alternatingly, as the operator wishes so as to set on or off said instruments (25 or 27) by mobilizing the instruments on each other, balls or other retractable stop Systems (33, 36) located in housings (32, 35) being provided to block one or the other of the instruments (25 or 27). Sliding stops (38, 40) signal at the top on the isolating sheet (24) to inform the operator which half instruments is in operation and actuatable by means of the manipulation forceps (45, 46).
(57) Abrégé(57) Abstract
L'invention décrit trois dispositifs permettant une amélioration et une facilitation de la chirurgie per-coelioscopique: un système d'attache flexible avec un support rigide (2), puis flexible (3), puis souple (4) évitant de tenir le coelioscope (5) manuellement; un système de solidarisation du c lioscope (5) à la tête et l'oeil de l'opérateur (13) par des "adhésifs" réutilisables (9, 11); des instruments opératoires couplés ( 27) interchangeables, coulissant dans une gaine isolante rigide (24), coudés ou non, agissant alternativement l'un, l'autre, au g de l'opérateur pouvant mettre en fonction ou hors service Iesdits instruments (25 ou 27) en les mobilisant l'un sur l'autre, d billes ou autres systèmes d'arrêt (33, 36) situés dans des logements (32, 35) et rétractables, pouvant bloquer l'un ou l'autre inst ment (27 ou 25). Des butées d'arrêt de coulissage (38, 40) signalent en haut sur la gaine isolante (24) à l'opérateur, le demi-inst ment en fonction et actionnable par les pinces de manipulation (45, 46). The invention describes three devices allowing improvement and facilitation of per-laparoscopic surgery: a flexible attachment system with a rigid support (2), then flexible (3), then flexible (4) avoiding to hold the laparoscope ( 5) manually; a system for securing the lioscope (5) to the head and the operator's eye (13) by reusable "adhesives" (9, 11); interchangeable coupled operating instruments (27), sliding in a rigid insulating sheath (24), bent or not, acting alternately, one at the operator's g being able to activate or deactivate said instruments (25 or 27) by mobilizing them one on the other, d balls or other stop systems (33, 36) located in housings (32, 35) and retractable, which can block one or the other inst ment (27 or 25). Sliding stops (38, 40) signal the operator on the insulating sheath (24) that the half-inst is in operation and can be actuated by the handling clamps (45, 46).
UNIQUEMENT A TITRE D'INFORMATIONONLY FOR INFORMATION
Codes utilisés pour identifier les Etats parties au PCT, sur les pages de couverture des brochures publiant des demandes internationales en vertu du PCT.Codes used to identify States Parties to the PCT, on the cover pages of brochures publishing international applications under the PCT.
AT Autriche FI Finlande ML MaliAT Austria FI Finland ML Mali
AU Australie FR France MR MauritanieAU Australia FR France MR Mauritania
BB Barbadc GA Gabon MW MalawiBB Barbadc GA Gabon MW Malawi
BE Belgique GB Royaume-Uni NL Pays-BasBE Belgium GB United Kingdom NL Netherlands
BF Burkina Fasso HU Hongrie NO NorvègeBF Burkina Fasso HU Hungary NO Norway
BG Bulgarie rr Italie RO RoumanieBG Bulgaria rr Italy RO Romania
BJ Bénin JP Japon SD SoudanBJ Benin JP Japan SD Sudan
BR Brésil KP République populaire démocratique SE SuédeBR Brazil KP Democratic People's Republic SE Sweden
CF République Centraficaine de Corée SN SénégalCF Central African Republic SN Senegal
CG Congo KR République de Corée SU Union soviétiqueCG Congo KR Republic of Korea SU Soviet Union
CH Suisse u Liechtenstein TD TchadCH Switzerland u Liechtenstein TD Chad
CM Cameroun LK Sri Lanka TG TogoCM Cameroon LK Sri Lanka TG Togo
DE Allemagne. République fédérale d' LU Luxembourg US Etats-Unis d'AmériqueFROM Germany. Federal Republic of LU Luxembourg US United States of America
DK Danemark MC MonacoDK Denmark MC Monaco
ES Espagne MG Madagascar ES Spain MG Madagascar

Claims

REVENDICATIONS
1º Dispositifs mécaniques permettant une amélioration de la chirurgie per fibroscopique, caractérisés en ce qu'ils comportent un support de fibroscope/coelioscope, un dispositif de couplage de l'optique avec la tête de l'opérateur, des instruments couplés minimisant les changements d'instruments. 2º Dispositif selon la revendication 1 caractérisé par la présence d'un support souple (4) à l'extrémité des supports rigide (2) et flexible (3) du coelioscope.1º Mechanical devices allowing an improvement of the per fibroscopic surgery, characterized in that they comprise a support of fibroscope / coelioscope, a device of coupling of the optics with the head of the operator, coupled instruments minimizing the changes of instruments. 2. Device according to claim 1 characterized by the presence of a flexible support (4) at the end of the rigid (2) and flexible (3) supports of the laparoscope.
3º Dispositif selon la reventication 1 caractérisé par la présence de deux ou plusieurs dispositifs de couplage (10,11) "arrimant" le coelioscope (5) à un monocle (13 ajustable et réglable à l'oeil de l'opérateur. Ce monocle (13) est lui-même fixé sur un bandeau ou un casque rigide (14).3º Device according to claim 1 characterized by the presence of two or more coupling devices (10,11) "securing" the coelioscope (5) to a monocle (13 adjustable and adjustable to the eye of the operator. 13) is itself fixed on a headband or a rigid helmet (14).
4° Dispositif selon la revendication 1 caractérisé par la présence d'instruments couplés (22, 23) comportant à leur périphérie une gaine isolante rigide (24)) permettant le coulissage des demi-instruments couplés (25, 27) ainsi que leur remplacement au gré de l'utilisateur.4 ° Device according to claim 1 characterized by the presence of coupled instruments (22, 23) comprising at their periphery a rigid insulating sheath (24)) allowing the sliding of the coupled half-instruments (25, 27) as well as their replacement at user's discretion.
5° Dispositif selon les revendications 1 et 4 caractérisé par des instruments couplés (25, 27) soit droits, soit coudés à leur extrémité supérieure, ayant la forme d'un demi-cylindre coupé dans le sens longitudinal coulissant dans une gaine isolante rigide (24), interchangeables indifférement en dehors ou en cours d'intervention chirurgicale.5 ° Device according to claims 1 and 4 characterized by coupled instruments (25, 27) either straight or bent at their upper end, having the shape of a half-cylinder cut in the longitudinal direction sliding in a rigid insulating sheath ( 24), interchangeable either outside or during surgery.
6º Dispositif selon les revendications 1, 4, 5 caractérisé par la présence de butées rétractables (38,40) au sommet des instruments couplés (25, 27), empêchant ceux-ci de sortir de la gaine isolante (24) coulissant dans le trocard (20) ; deux cupules (31, 34) sur chacun des instruments (25,27) reçoivent alternativement des billes (33, 36) qui, logées dans la cupule leur faisant face, mettent alternativement, au gré de l'opérateur, en fonction ou hors fonction les machoires (29, 30) des instruments couplés (25, 27) en bloquant le système de manoeuvre (26, 28) des embouts instrumentaux (29, 30).6º Device according to claims 1, 4, 5 characterized by the presence of retractable stops (38.40) at the top of the coupled instruments (25, 27), preventing them from coming out of the insulating sheath (24) sliding in the trocar (20); two cups (31, 34) on each of the instruments (25, 27) alternately receive balls (33, 36) which, housed in the cup facing them, alternately switch the operator on or off the jaws (29, 30) of the coupled instruments (25, 27) by blocking the operating system (26, 28) of the instrumental tips (29, 30).
7º Dispositif selon les revendications 1, 4, 5, 6 caractérisé par la possibilité de couder la partie proximale des instruments couplés (25, 27) de telle sorte que le manoeuvrage des pinces (45, 46) servant à mobiliser les machoires (29, 30) soit facilité par 51eur éloignement l'une de l'autre. 7. Device according to claims 1, 4, 5, 6 characterized by the possibility of bending the proximal part of the coupled instruments (25, 27) so that the operation of the clamps (45, 46) serving to mobilize the jaws (29, 30) or facilitated by distance from one another.
PCT/FR1989/000244 1988-05-24 1989-05-22 Device improving a per-coelioscopic surgery WO1989011243A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR8806863A FR2631807A1 (en) 1988-05-24 1988-05-24 DEVICES FOR IMPROVING PERCOELIOSCOPIC SURGERY
FR88/06863 1988-05-24

Publications (1)

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WO1989011243A1 true WO1989011243A1 (en) 1989-11-30

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AU (1) AU3682689A (en)
FR (1) FR2631807A1 (en)
WO (1) WO1989011243A1 (en)

Cited By (1)

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Publication number Priority date Publication date Assignee Title
CN116982923A (en) * 2023-09-25 2023-11-03 首都医科大学附属北京同仁医院 Improved generation peritoneoscope device

Citations (6)

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Publication number Priority date Publication date Assignee Title
FR2433331A1 (en) * 1978-08-16 1980-03-14 Wolf Gmbh Richard SUPPORT FOR MEDICAL DEVICES SUCH AS AN ENDOSCOPE
US4461281A (en) * 1977-06-15 1984-07-24 Carson Robert W Arthroscopic surgical apparatus and method
US4573452A (en) * 1984-07-12 1986-03-04 Greenberg I Melvin Surgical holder for a laparoscope or the like
DE3601453A1 (en) * 1985-02-25 1986-09-04 Hans E. Prof. Dr.Med. Sachse Endoscope for the removal of tissue
US4625713A (en) * 1982-12-14 1986-12-02 Olympus Optical Co. Ltd. Instrument incorporated in a resectoscope
US4681413A (en) * 1985-02-05 1987-07-21 Propper Manufacturing Co., Inc. Headband with optical device adjustably coupled thereto

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4461281A (en) * 1977-06-15 1984-07-24 Carson Robert W Arthroscopic surgical apparatus and method
FR2433331A1 (en) * 1978-08-16 1980-03-14 Wolf Gmbh Richard SUPPORT FOR MEDICAL DEVICES SUCH AS AN ENDOSCOPE
US4625713A (en) * 1982-12-14 1986-12-02 Olympus Optical Co. Ltd. Instrument incorporated in a resectoscope
US4573452A (en) * 1984-07-12 1986-03-04 Greenberg I Melvin Surgical holder for a laparoscope or the like
US4681413A (en) * 1985-02-05 1987-07-21 Propper Manufacturing Co., Inc. Headband with optical device adjustably coupled thereto
DE3601453A1 (en) * 1985-02-25 1986-09-04 Hans E. Prof. Dr.Med. Sachse Endoscope for the removal of tissue

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN116982923A (en) * 2023-09-25 2023-11-03 首都医科大学附属北京同仁医院 Improved generation peritoneoscope device
CN116982923B (en) * 2023-09-25 2024-01-19 首都医科大学附属北京同仁医院 Improved generation peritoneoscope device

Also Published As

Publication number Publication date
FR2631807A1 (en) 1989-12-01
AU3682689A (en) 1989-12-12

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