WO1992018056A1 - Abdominal-cavity expander - Google Patents

Abdominal-cavity expander Download PDF

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Publication number
WO1992018056A1
WO1992018056A1 PCT/EP1992/000811 EP9200811W WO9218056A1 WO 1992018056 A1 WO1992018056 A1 WO 1992018056A1 EP 9200811 W EP9200811 W EP 9200811W WO 9218056 A1 WO9218056 A1 WO 9218056A1
Authority
WO
WIPO (PCT)
Prior art keywords
rod
abdominal cavity
expander according
expander
cavity expander
Prior art date
Application number
PCT/EP1992/000811
Other languages
German (de)
French (fr)
Inventor
Kurt Semm
Original Assignee
Wisap Gesellschaft für wissenschaftlichen Apparatebau mbH
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
Priority claimed from DE9104383U external-priority patent/DE9104383U1/de
Application filed by Wisap Gesellschaft für wissenschaftlichen Apparatebau mbH filed Critical Wisap Gesellschaft für wissenschaftlichen Apparatebau mbH
Priority to JP4507650A priority Critical patent/JPH0761331B2/en
Publication of WO1992018056A1 publication Critical patent/WO1992018056A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0281—Abdominal wall lifters
    • 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
    • A61B90/02—Devices for expanding tissue, e.g. skin tissue

Definitions

  • the invention relates to an instrument for expanding the pneumoperitoneum for endoscopy (abdominal cavity expander).
  • the pneumoperitoneum In endoscopic examinations and operations, especially in the abdominal area, the pneumoperitoneum is generally flooded with carbon dioxide so that the internal organs to be treated are easily accessible to the optics and the surgical instruments. In rare cases, the pneumoperitoneum can collapse, with the risk that the inserted surgical instruments will injure the internal organs when the abdominal wall descends.
  • an abdominal cavity expander for endoscopy which has a rod, at the proximal end of which at least one folding element is hinged between a first position aligned with the rod and a second position essentially directed transversely to the rod.
  • this rod In the first position, this rod can be inserted into the pneumoperitoneum directly or through a trocar sleeve through the patient's abdominal wall. If the rod is inserted so far that the folding element is completely in the pneu moperitoneum, it is folded out into its second position.
  • the abdominal cavity expander in an advantageous further development has an annular sealing plate which can be fixed axially in any position on the rod.
  • the sealing plate is formed on the proximal longitudinal end of a sleeve which surrounds the rod without play and which can be fixed to the rod by means of a radial clamping screw.
  • the abdominal wall is clamped between the folding element and the sealing plate, which reliably prevents the gas from escaping through the puncture point.
  • the exact fit between sleeve and rod is not necessary when using a ring seal.
  • the abdominal cavity expander can be designed in the manner of a folding anchor with a plurality of folding elements, for example in the manner of an expansion screen, the folding elements then preferably being arranged rotationally symmetrically around the rod.
  • the folding elements can be hinged to the rod at their proximal end.
  • an elongated folding element is articulated in the middle of the rod and forms a cylinder with the rod in the first position, which can be inserted through a trocar sleeve without any problems.
  • the end of the folding element which is proximal in the first position can taper to ensure that the abdominal wall is traumatized as little as possible during the puncture.
  • the longitudinal ends of the folding element are preferably rounded in order to avoid injuries.
  • the abdominal cavity expander can be introduced through an already inserted trocar sleeve.
  • the expander or elevator is advantageously perforated. This can be achieved, for example, by forming an air duct parallel to the axis of the expander, which connects the pneumoperitoneum to the ambient air.
  • a one-sided closing valve could also be arranged in the air duct, which only allows gas to pass in one direction. If this valve is rotatably arranged in the gas channel, it can be set for the expansion or collapse of the pneumoperitoneum are so that in the first case only gas, in particular air, can penetrate into the pneumoperitoneum and in the latter case only gas can escape from the pneumoperitoneum.
  • the perforated expander is usually inserted through a trocar sleeve, which can also be pulled when the folding element is inserted or expanded.
  • Another advantage of the perforated expander is the self-sucking effect when the abdominal wall is raised, so that air can flow into the intra-abdominal area from the outside. With the help of the expander, it is now relatively easy to inspect difficult topographic sites.
  • Figure 1 is a partially sectioned side view of a double-sided insertable abdominal cavity expander with a sealing plate.
  • Fig. 6 is a partially sectioned side view of a perforated expander.
  • the expander 10 consists of a rod 12, to the distal end 14 of which a hinged element 16 is articulated, which is aligned with the rod 12 in a first position (illustration) and, in a second position (FIGS. 3 to 5), is folded out transversely to the rod .
  • a sleeve 18 is slid onto the rod 12 and can be fixed to the rod by means of a radial clamping screw 20.
  • the sleeve 18 has at its distal end a sealing plate 22 which, after inserting the expander 10 into the pneumoperitoneum, unfolding the folding element 16 and expanding the pneumoperitoneum, is pressed against the abdominal wall in the proximal direction by pretensioning the expander 10 to avoid gas loss at the puncture site of the abdominal wall.
  • the sleeve 18 surrounds the rod 12 with as little play as possible and / or a seal is provided between the sleeve 18 and the rod 12.
  • This seal is advantageously designed as a ring seal made of known types of rubber or plastic.
  • the flap elements 12 of the two longitudinal ends 14 of the expander can preferably be folded in opposite directions or in the same direction. In contrast to the illustration, the diameters of the longitudinal ends can be different, for example 5 and 10 mm. A longitudinal end can be perforated in the manner described below.
  • the double-sided insertable expander can be easily held and replaced.
  • the mode of operation of the abdominal cavity expander 10 will be described below with reference to FIGS. 2 to 5. Parts identical to FIG. 1 are provided with identical reference numerals.
  • the expander 10 is inserted into the pneumoperitoneum 28 by means of a trocar sleeve 24 through the abdominal wall 26 of a patient (FIG. 2). Subsequently, the elongated folding element 16, which was previously aligned with the rod 12, is folded out into a second position which is transverse to the rod 12. In the present case, this is done with the help of another medical instrument that was introduced through a further trocar sleeve of the pneumoperitoneum.
  • a folding element can also be folded in and out by means of an actuating linkage guided in or on the rod or purely in terms of weight or spring preload.
  • the trocar sleeve 24 is first pulled out of the pneumoperitoneum in the proximal direction.
  • the expander is then also moved in the proximal direction (FIG. 4) until the folding element 16 lies against the inside of the abdominal wall 26 of the patient (FIG. 5). Now the expander is prestressed in the proximal direction, whereby the abdominal wall 26 is raised and the pneumoperitoneum 28 is inflated or expanded accordingly.
  • a proximal expander end with a different diameter or a different length of the folding element can also be formed on the expander, so that an expander can have different folding elements at its opposite ends.
  • the sealing plate 22 is pressed onto the outside of the abdominal wall 26 and fixed on the rod 12 by means of the clamping screw 20.
  • the sealing plate can preferably have a diameter of 50 mm, while a diameter of 5 or 10 mm is provided for the expander, for example.
  • 6 shows a perforated expander 30, which can be inserted on both sides, with an elongated rod-shaped body 32.
  • Axial channels 36 open into the longitudinal ends 34 of the rod 32, which provide pressure equalization between the pneumoperitoneum and a gas storage space located outside the pneumoperitoneum, for example the operating room Room or the ambient air. The negative pressure that occurs when the abdominal cavity expands is thus compensated for by this channel 36.
  • a valve 38 is arranged (screwed on) at the opening of the channel 36, which valve allows gas to pass through in one direction only.
  • the valve is rotatably arranged about an axis protruding from the plane of the drawing, so that the direction of passage can be reversed. In this way, it can be specifically controlled that gas can only pass in one direction.
  • the outlet of this valve 38 can be open or can be connected to a gas storage container with a defined pressure and / or a certain gas.
  • the expander can also be used to set a certain pressure in the pneumoperitoneum.
  • the expander or elevator which can be inserted or stretched on both sides, is applied through a trocar sleeve with a diameter of 5 mm or 10 mm. After the intra-abdominal application, the trocar sleeve can be removed.
  • the perforated expander sucks the air from the environment into the pneumoperitoneum, which is advantageous for techniques in which a CO pneumoperitoneum is not desired.

Abstract

The abdominal cavity expander for use in endoscopy comprises a rod (12) at the distal end (14) of which at least one pivoting unit (16) is fixed in such a way that its position can be varied from flush alignment with the rod (initial position) to being essentially perpendicular to it (second position). It is further proposed that the pivoting unit and the rod together should form a cylinder corresponding to the internal diameter of a trocar sheath; that the pivoting unit should be spring-loaded; that it should be possible to lock the sealing collar, which forms a ring around the rod, in place; that the expander should have a pivoting unit at each extremity; and that it should have an axial channel (36) for the introduction of a pneumoperitoneum.

Description

ABDOMINALHÖHLENEXPANDER ABDOMINAL CAVE EXPANDER
Die Erfindung betrifft ein Instrument zum Aufweiten des Pneumoperitoneums für die Endoskopie (Abdominalhöhlenexpan¬ der).The invention relates to an instrument for expanding the pneumoperitoneum for endoscopy (abdominal cavity expander).
Bei endoskopisehen Untersuchungen und Operationen, insbe¬ sondere im Abdominalbereich wird das Pneumoperitoneum in der Regel mit Kohlendioxid geflutet, damit die zu behan¬ delnden inneren Organe für die Optik und die chirurgischen Instrumente gut erreichbar sind. In seltenen Fällen kann das Pneumoperitoneum kollabieren, was die Gefahr mit sich bringt, daß die eingeführten chirurgischen Instrumente beim Herabsinken der Bauchdecke die inneren Organe verletzen.In endoscopic examinations and operations, especially in the abdominal area, the pneumoperitoneum is generally flooded with carbon dioxide so that the internal organs to be treated are easily accessible to the optics and the surgical instruments. In rare cases, the pneumoperitoneum can collapse, with the risk that the inserted surgical instruments will injure the internal organs when the abdominal wall descends.
In wenigen Fällen kommt es auch vor, daß ein Kohlendioxid- Pneumoperitoneum nicht eingestellt werden darf oder kann. Auch in diesem Fall wäre es zweckmäßig, in der Bauchhöhle endoskopische Untersuchungen oder Applikationen sicher durchführen zu können.In a few cases it also happens that a carbon dioxide pneumoperitoneum cannot or cannot be stopped. In this case too, it would be expedient to be able to carry out endoscopic examinations or applications safely in the abdominal cavity.
Es ist daher A u f g a b e der Erfindung, ein Gerät zu schaffen, das ein Kollabieren des Pneumoperitoneums während einer endoskopischen Untersuchung oder Operation verhindert.It is therefore an object of the invention to provide a device which prevents the pneumoperitoneum from collapsing during an endoscopic examination or operation.
Diese Aufgabe wird durch einen Abdominalhöhlenexpander für die Endoskopie gelöst, der einen Stab aufweist, an dessen proximalem Ende mindestens ein Klappelement zwischen einer mit dem Stab fluchtenden ersten Stellung und einer im we¬ sentlichen quer zum Stab gerichteten zweiten Stellung klappbar angelenkt ist. Dieser Stab kann in der ersten Stellung direkt oder durch eine Trokarhülse durch die Bauchdecke des Patienten in das Pneumoperitoneum eingeführt werden. Ist der Stab soweit eingeführt, daß das Klappelement sich vollständig im Pneu¬ moperitoneum befindet, wird es in seine zweite Stellung ausgeklappt. Dies kann entweder durch ein in dem Stab oder an dem Stab angeordnetes Betätigungsgestänge geschehen, das an dem Klappelement in einem Abstand von dessen Schwenkach¬ se angreift, oder mittels eines durch eine andere Tro¬ karhülse eingeführten chirurgischen Instruments. Im ausge- klappen Zustand wird der Stab in proximale Richtung gezo¬ gen, wodurch das Pneumoperitoneum expandiert wird. Damit durch die Einstichstelle in der Bauchdecke kein Gas ent¬ weicht, hat der Abdominalhöhlenexpander in einer vorteil¬ haften Weiterbildung eine ringförmige Abdichtplatte, die axial in beliebiger Lage an dem Stab festlegbar ist.This object is achieved by an abdominal cavity expander for endoscopy, which has a rod, at the proximal end of which at least one folding element is hinged between a first position aligned with the rod and a second position essentially directed transversely to the rod. In the first position, this rod can be inserted into the pneumoperitoneum directly or through a trocar sleeve through the patient's abdominal wall. If the rod is inserted so far that the folding element is completely in the pneu moperitoneum, it is folded out into its second position. This can be done either by means of an actuating linkage arranged in the rod or on the rod, which acts on the folding element at a distance from its pivot axis, or by means of a surgical instrument inserted through another trocar sleeve. When extended, the rod is pulled in the proximal direction, whereby the pneumoperitoneum is expanded. In order that no gas escapes through the puncture site in the abdominal wall, the abdominal cavity expander in an advantageous further development has an annular sealing plate which can be fixed axially in any position on the rod.
Hierfür ist die Abdichtplatte an dem proximalen Längsende einer Hülse ausgebildet, die den Stab spielfrei umgibt und die mittels einer radialen Spannschraube an dem Stab fest¬ legbar ist. Die Bauchdecke wird in diesem Fall zwischen dem Klappelement und der Abdichtplatte eingespannt, wodurch ein Entweichen des Gases durch die Einstichstelle zuverlässig vermieden wird. Die genaue Passung zwischen Hülse und Stab ist bei Verwendung einer Ringdichtung nicht notwendig.For this purpose, the sealing plate is formed on the proximal longitudinal end of a sleeve which surrounds the rod without play and which can be fixed to the rod by means of a radial clamping screw. In this case, the abdominal wall is clamped between the folding element and the sealing plate, which reliably prevents the gas from escaping through the puncture point. The exact fit between sleeve and rod is not necessary when using a ring seal.
Der Abdominalhöhlenexpander kann in der Art eines Klappan¬ kers mit mehreren Klappelementen, z.B. in Art eines Spreiz¬ schirmes, ausgebildet sein, wobei die Klappelemente dann vorzugsweise rotationssymmetrisch um dem Stab angeordnet sind. Die Klappelemente können hierfür beispielsweise an ihrem proximalen Ende klappbar an dem Stab angelenkt sein. In einer vorteilhaften Weiterbildung ist ein längliches Klappelement in seiner Mitte an dem Stab angelenkt und bildet mit dem Stab in der ersten Stellung einen Zylinder, der problemlos durch eine Trokarhülse eingeführt werden kann.The abdominal cavity expander can be designed in the manner of a folding anchor with a plurality of folding elements, for example in the manner of an expansion screen, the folding elements then preferably being arranged rotationally symmetrically around the rod. For this purpose, the folding elements can be hinged to the rod at their proximal end. In an advantageous development, an elongated folding element is articulated in the middle of the rod and forms a cylinder with the rod in the first position, which can be inserted through a trocar sleeve without any problems.
Ist der Expander für eine Verwendung ohne Trokarhülse vor¬ gesehen, kann das in der ersten Stellung proximale Ende des Klappelements spitz zulaufen, um eine möglichst geringe Traumatisierung der Bauchdecke beim Einstich zu gewährlei¬ sten.If the expander is intended for use without a trocar sleeve, the end of the folding element which is proximal in the first position can taper to ensure that the abdominal wall is traumatized as little as possible during the puncture.
Soll der Expander nur mit einer Trokarhülse verwendet werden, so sind die Längsenden des Klappelements vorzugs¬ weise abgerundet, um Verletzungen zu vermeiden.If the expander is only to be used with a trocar sleeve, the longitudinal ends of the folding element are preferably rounded in order to avoid injuries.
Der Abdominalhöhlenexpander kann bei einem akuten Druckab¬ fall im Pneumoperitoneum durch eine bereits eingeführte Trokarhülse eingebracht werden. Es kann jedoch auch ange¬ zeigt sein, ein oder zwei Abdominalhöhlenexpander prophy¬ laktisch zu verwenden, wenn eine Aufblähung des Pneumoperi¬ toneums mit einer höheren Gasdurchflußrate kontraindiziert ist, z.B. bei hoher Thrombose-Anfälligkeit.In the event of an acute drop in pressure in the pneumoperitoneum, the abdominal cavity expander can be introduced through an already inserted trocar sleeve. However, it may also be indicated to use one or two abdominal cavity expanders prophylactically if an inflation of the pneumoperitoneum is contraindicated with a higher gas flow rate, e.g. with high susceptibility to thrombosis.
Bei Kontraindikation eines Kohlendioxid-Pneumoperitoneums ist der Expander oder Elevator vorteilhafterweise perfo¬ riert. Dies kann zum Beispiel dadurch realisiert werden, daß parallel zur Achse des Expander ein Luftkanal ausgebil¬ det ist, der das Pneumoperitoneum mit der Umgebungsluft verbindet. In dem Luftkanal könnte weiterhin ein einsei¬ tig schließendes Ventil angeordnet sein, das Gas nur in ei¬ ne Richtung durchläßt. Wenn dieses Ventil drehbar in dem Gaskanal angeordnet ist, kann es für das Expandieren bezie¬ hungsweise Kollabieren des Pneumoperitoneums eingestellt werden, so daß es im ersten Fall nur Gas, insbesondere Luft, in das Pneumoperitoneum eindringen läßt und im letz¬ teren Fall nur Gas aus dem Pneumoperitoneum entweichen läßt.If a carbon dioxide pneumoperitoneum is contraindicated, the expander or elevator is advantageously perforated. This can be achieved, for example, by forming an air duct parallel to the axis of the expander, which connects the pneumoperitoneum to the ambient air. A one-sided closing valve could also be arranged in the air duct, which only allows gas to pass in one direction. If this valve is rotatably arranged in the gas channel, it can be set for the expansion or collapse of the pneumoperitoneum are so that in the first case only gas, in particular air, can penetrate into the pneumoperitoneum and in the latter case only gas can escape from the pneumoperitoneum.
Der perforierte Expander wird üblicherweise durch eine Trokarhülse eingeführt, die auch gezogen werden kann, wenn das Klappelement eingeführt bzw. ausgeklappt ist. Ein wei¬ terer Vorteil des perforierten Expanders ist der selbstan¬ saugende Effekt beim Anheben der Bauchdecke, so daß Luft von außen in den Intraabdominalbereich fließen kann. Auch ist mit Hilfe des Expanders nunmehr die Inspizierung schwieriger topographischer Siten relativ einfach möglich.The perforated expander is usually inserted through a trocar sleeve, which can also be pulled when the folding element is inserted or expanded. Another advantage of the perforated expander is the self-sucking effect when the abdominal wall is raised, so that air can flow into the intra-abdominal area from the outside. With the help of the expander, it is now relatively easy to inspect difficult topographic sites.
Die Erfindung wird nachfolgend beispielsweise anhand sche- matischer Zeichnungen zum perforierten oder nicht-perfo- rierten Abdominalhöhlenexpander noch näher beschrieben. In diesen zeigen:The invention is described in more detail below, for example, using schematic drawings of the perforated or non-perforated abdominal cavity expander. In these show:
Fig. 1 eine teilgeschnittene Seitenansicht eines doppelseitig einführbaren Abdominalhöhlen¬ expanders mit Abdichtplatte;Figure 1 is a partially sectioned side view of a double-sided insertable abdominal cavity expander with a sealing plate.
Fig. 2 bis 5 den Abdominalhöhlenexpander aus Fig. 1 beim Ein¬ führen in das Pneumoperitoneum durch die Bauch¬ decke mittels einer Trokarhülse und beim Expan¬ dieren des Pneumoperitoneums, und2 to 5 the abdominal cavity expander from FIG. 1 when inserted into the pneumoperitoneum through the abdominal wall by means of a trocar sleeve and when expanding the pneumoperitoneum, and
Fig. 6 eine teilgeschnittene Seitenansicht eines perforierten Expanders.Fig. 6 is a partially sectioned side view of a perforated expander.
Fig. 1 zeigt einen doppelseitig eiriführbaren, gestreckten Abdominalhöhlenexpander 10. Zur Veranschaulichung wird nur ein Längsende des Expanders beschrieben, wobei klarge¬ stellt sein soll, daß das andere Längsende in gleicher bzw. analoger Weise ausgebildet ist. Der Expander 10 besteht aus einem Stab 12, an dessen distalem Ende 14 ein Klappelement 16 angelenkt ist, das in einer ersten Stellung (Abbildung) mit dem Stab 12 fluchtet und in einer zweiten Stellung (Fig. 3 bis 5) quer zum Stab ausgeklappt ist. Auf den Stab 12 ist eine Hülse 18 aufgeschoben, die mittels einer radia¬ len Spannschraube 20 an dem Stab festlegbar ist. Die Hülse 18 weist an ihrem distalen Ende eine Abdichtplatte 22 auf, die nach dem Einführen des Expanders 10 in das Pneumoperi¬ toneum, dem Ausklappen des Klappelements 16 und dem Auswei¬ ten des Pneumoperitoneums durch Vorspannung des Expanders 10 in proximaler Richtung an die Bauchdecke angepreßt wird, um einen Gasverlust an der Einstichstelle der Bauchdecke zu vermeiden. Hierfür ist es vorteilhaft, wenn die Hülse 18 den Stab 12 möglichst spielfrei umgibt und/oder eine Dich¬ tung zwischen der Hülse 18 und dem Stab 12 vorgesehen ist. Diese Dichtung ist vorteilhaft als Ringdichtung aus bekann¬ ten Gummi- oder KunststoffSorten ausgebildet. Die Klappele¬ mente 12 der beiden Längsenden 14 des Expanders können vor¬ zugsweise gegensinnig oder gleichsinnig klappbar sein. Die Durchmesser der Längsenden können im Gegensatz zur Abbil¬ dung unterschiedlich sein, z.B. 5 und 10 mm. Ein Längsende kann in nachfolgend beschriebener Weise perforiert sein. Der doppelseitig einführbare Expander läßt sich problemlos halten und auswechseln.1 shows a double-sided, expandable abdominal cavity expander 10 only one longitudinal end of the expander is described, it being clear that the other longitudinal end is designed in the same or analogous manner. The expander 10 consists of a rod 12, to the distal end 14 of which a hinged element 16 is articulated, which is aligned with the rod 12 in a first position (illustration) and, in a second position (FIGS. 3 to 5), is folded out transversely to the rod . A sleeve 18 is slid onto the rod 12 and can be fixed to the rod by means of a radial clamping screw 20. The sleeve 18 has at its distal end a sealing plate 22 which, after inserting the expander 10 into the pneumoperitoneum, unfolding the folding element 16 and expanding the pneumoperitoneum, is pressed against the abdominal wall in the proximal direction by pretensioning the expander 10 to avoid gas loss at the puncture site of the abdominal wall. For this purpose it is advantageous if the sleeve 18 surrounds the rod 12 with as little play as possible and / or a seal is provided between the sleeve 18 and the rod 12. This seal is advantageously designed as a ring seal made of known types of rubber or plastic. The flap elements 12 of the two longitudinal ends 14 of the expander can preferably be folded in opposite directions or in the same direction. In contrast to the illustration, the diameters of the longitudinal ends can be different, for example 5 and 10 mm. A longitudinal end can be perforated in the manner described below. The double-sided insertable expander can be easily held and replaced.
Die Wirkungsweise des Abdominalhöhlenexpanders 10 soll nachfolgend anhand der Fig. 2 bis 5 beschrieben werden. Zu Fig. 1 identische Teile sind hierbei mit identischen Be¬ zugszeichen versehen. Der Expander 10 wird mittels einer Trokarhülse 24 durch die Bauchdecke 26 eines Patienten in das Pneumoperitoneum 28 eingeführt (Fig. 2). Anschließend wird das längliche Klapp¬ element 16, das vorher mit dem Stab 12 fluchtete, in eine quer zum Stab 12 befindliche zweite Stellung ausgeklappt. Dies geschieht im vorliegenden Fall unter Zuhilfenahme ei¬ nes anderen ärztlichen Instruments, das durch eine weitere Trokarhülse des Pneumoperitoneums eingeführt wurde. Das Ein- und Ausklappen eines Klappelements kann jedoch auch durch ein in oder an dem Stab geführtes Betätigungsgestänge oder rein gewichtsmäßig oder federvorgespannt erfolgen. Nach dem Ausklappen des Klappelements 16 wird zuerst die Trokarhülse 24 in proximaler Richtung aus dem Pneumoperito¬ neum herausgezogen. Anschließend wird der Expander eben¬ falls in proximaler Richtung bewegt (Fig. 4), bis das Klappelement 16 an der Innenseite der Bauchdecke 26 des Pa¬ tienten anliegt (Fig. 5). Nun wird der Expander in proxima¬ ler Richtung vorgespannt, wodurch die Bauchdecke 26 angeho¬ ben und das Pneumoperitoneum 28 entsprechend aufgebläht bzw. expandiert wird.The mode of operation of the abdominal cavity expander 10 will be described below with reference to FIGS. 2 to 5. Parts identical to FIG. 1 are provided with identical reference numerals. The expander 10 is inserted into the pneumoperitoneum 28 by means of a trocar sleeve 24 through the abdominal wall 26 of a patient (FIG. 2). Subsequently, the elongated folding element 16, which was previously aligned with the rod 12, is folded out into a second position which is transverse to the rod 12. In the present case, this is done with the help of another medical instrument that was introduced through a further trocar sleeve of the pneumoperitoneum. However, a folding element can also be folded in and out by means of an actuating linkage guided in or on the rod or purely in terms of weight or spring preload. After the folding element 16 has been unfolded, the trocar sleeve 24 is first pulled out of the pneumoperitoneum in the proximal direction. The expander is then also moved in the proximal direction (FIG. 4) until the folding element 16 lies against the inside of the abdominal wall 26 of the patient (FIG. 5). Now the expander is prestressed in the proximal direction, whereby the abdominal wall 26 is raised and the pneumoperitoneum 28 is inflated or expanded accordingly.
Am Expander kann auch ein proximales Expanderende mit einem anderen Durchmesser oder einer unterschiedlichen Länge des Klappelementes ausgebildet sein, so daß ein Expander unter¬ schiedliche Klappelemente an seinen entgegengesetzten Enden aufweisen kann.A proximal expander end with a different diameter or a different length of the folding element can also be formed on the expander, so that an expander can have different folding elements at its opposite ends.
Die Abdichtplatte 22 wird in der in Fig. 5 gezeigten Stel¬ lung des Expanders 10 auf die Außenseite der Bauchdecke 26 aufgedrückt und mittels der Spannschraube 20 an dem Stab 12 festgelegt.In the position of the expander 10 shown in FIG. 5, the sealing plate 22 is pressed onto the outside of the abdominal wall 26 and fixed on the rod 12 by means of the clamping screw 20.
Die Abdichtplatte kann vorzugsweise einen Durchmesser von 50 mm haben, während z.B. für den Expander ein Durchmesser von 5 oder 10 mm vorgesehen ist. Fig. 6 zeigt einen perforierten, doppelseitig einführbaren Expander 30 mit einem länglichen stabförmigen Körper 32. In die Längsenden 34 des Stabes 32 münden axiale Kanäle 36, die einen Druckausgleich zwischen dem Pneumoperitoneum und einem außerhalb des Pneumoperitoneums gelegenen Gasvorrats¬ raum, zum Beispiel dem OP-Raum bzw. der Umgebungsluft, si¬ cherstellen sollen. Der beim Expandieren der Bauchhöhle auftretende Unterdruck wird somit durch diesen Kanal 36 ausgeglichen. An einer Seite des doppelseitig einführbaren Expanders 30 ist an der Öffnung des Kanals 36 ein Ventil 38 angeordnet (angeschraubt), das einen Gasdurchtritt nur in einer Richtung ermöglicht. Das Ventil ist um eine aus der Zeichenebene herausstehende Achse drehbar angeordnet, so daß die Durchlaßrichtung umgekehrt werden kann. Auf diese Weise kann gezielt gesteuert werden, daß ein Gasdurchtritt nur in einer Richtung erfolgt. Der Ausgang dieses Ventils 38 kann offen sein oder an einen Gasvorratsbehälter mit ei¬ nem definierten Druck und/oder einem bestimmten Gas ange¬ schlossen sein. Der Expander kann somit unter anderem auch zur Einstellung eines bestimmten Drucks im Pneumoperitoneum verwendet werden.The sealing plate can preferably have a diameter of 50 mm, while a diameter of 5 or 10 mm is provided for the expander, for example. 6 shows a perforated expander 30, which can be inserted on both sides, with an elongated rod-shaped body 32. Axial channels 36 open into the longitudinal ends 34 of the rod 32, which provide pressure equalization between the pneumoperitoneum and a gas storage space located outside the pneumoperitoneum, for example the operating room Room or the ambient air. The negative pressure that occurs when the abdominal cavity expands is thus compensated for by this channel 36. On one side of the expander 30, which can be inserted on both sides, a valve 38 is arranged (screwed on) at the opening of the channel 36, which valve allows gas to pass through in one direction only. The valve is rotatably arranged about an axis protruding from the plane of the drawing, so that the direction of passage can be reversed. In this way, it can be specifically controlled that gas can only pass in one direction. The outlet of this valve 38 can be open or can be connected to a gas storage container with a defined pressure and / or a certain gas. The expander can also be used to set a certain pressure in the pneumoperitoneum.
In der Regel wird der doppelseitig einführbare oder ge¬ streckte Expander oder Elevator durch eine Trokarhülse mit 5 mm Durchmesser oder 10 mm Durchmesser appliziert. Nach der intraabdominellen Applikation kann die Trokarhülse ent¬ fernt werden. Der perforierte Expander saugt die Luft aus der Umgebung in das Pneumoperitoneum, was für Techniken vorteilhaft ist, bei denen ein CO -Pneumoperitoneum nicht gewünscht ist. As a rule, the expander or elevator, which can be inserted or stretched on both sides, is applied through a trocar sleeve with a diameter of 5 mm or 10 mm. After the intra-abdominal application, the trocar sleeve can be removed. The perforated expander sucks the air from the environment into the pneumoperitoneum, which is advantageous for techniques in which a CO pneumoperitoneum is not desired.

Claims

PATENTANSPRÜCHE PATENT CLAIMS
1. Abdominalhöhlenexpander für die Endoskopie mit einem Stab (12), an dessen distalem Ende (14) mindestens ein Klappelement (16) zwischen einer mit dem Stab (12) fluchtenden ersten Stellung und einer im wesent¬ lichen quer zum Stab (12) gerichteten zweiten Stel¬ lung klappbar angelenkt ist.1. Abdominal cavity expander for endoscopy with a rod (12), at the distal end (14) of which there is at least one folding element (16) between a first position aligned with the rod (12) and an essentially transverse to the rod (12) second position is hinged hinged.
2. Abdominalhöhlenexpander nach Anspruch 1, dadurch g e k e n n z e i c h n e t, daß der Stab (12) und das Klappelement (16) in der ersten Stellung einen Zylinder bilden.2. Abdominal cavity expander according to claim 1, characterized in that the rod (12) and the folding element (16) form a cylinder in the first position.
3. Abdominalhöhlenexpander nach Anspruch 2, dadurch g e k e n n z e i c h n e t, daß der Außendurchmesser des Zylinders dem Innen¬ durchmesser einer Trokarhülse entspricht.3. Abdominal cavity expander according to claim 2, characterized in that the outer diameter of the cylinder corresponds to the inner diameter of a trocar sleeve.
4. Abdominalhöhlenexpander nach einem der vorhergehen¬ den Ansprüche, dadurch g e k e n n z e i c h n e t, daß das Klappelement (16) länglich ausgebildet und in seiner Mitte an dem Stab (12) angelenkt ist.4. Abdominal cave expander according to one of the preceding claims, characterized in that the folding element (16) is elongated and is articulated in its center on the rod (12).
5. Abdominalhöhlenexpander nach einem der vorhergehen¬ den Ansprüche, dadurch g e k e n n z e i c h n e t, daß das in der ersten Stellung distale Längsende des Klappelements spitz zuläuft. 5. Abdominal cavity expander according to one of the preceding claims, characterized in that the distal longitudinal end of the folding element tapers to a point in the first position.
6. Abdominalhöhlenexpander nach einem der vorhergehen¬ den Ansprüche, dadurch g e k e n n z e i c h n e t, daß der Stab mit einem Betätigungsgestänge für das6. Abdominal cave expander according to one of the preceding claims, characterized in that the rod with an actuating linkage for the
Klappelement versehen ist.Folding element is provided.
7. Abdominalhöhlenexpander nach Anspruch 6, dadurch g e k e n n z e i c h n e t, daß der Angriffspunkt des Betätigungsgestänges an dem Klappelement von dessen Anlenkungspunkt beabstandet ist.7. abdominal cavity expander according to claim 6, characterized in that the point of application of the actuating linkage on the folding element is spaced from its articulation point.
8. Abdominalhöhlenexpander nach einem der vorhergehenden Ansprüche, dadurch g e k e n n z e i c h n e , daß das Klappelement auch durch eine Feder in eine8. abdominal cavity expander according to any one of the preceding claims, characterized in that the folding element is also connected by a spring into a
Stellung vorgespannt sein kann.Position can be biased.
9. Abdominalhöhlenexpander nach einem der vorhergehenden Ansprüche, dadurch g e k e n n z e i c h n e t, daß an dem Stab (12) eine diesen ringförmig umgebende9. abdominal cavity expander according to any one of the preceding claims, characterized in that the rod (12) has a ring surrounding it
Abdichtplatte (22) festlegbar ist.Sealing plate (22) can be fixed.
10. Abdominalhöhlenexpander nach Anspruch 9, dadurch g e k e n n z e i c h n e t, daß die Abdichtplatte (22) an einem distalen Längs¬ ende einer den Stab (12) im wesentlichen spielfrei umgebenden Hülse (18) ausgebildet ist, die mittels einer radialen Spannschraube (20) an dem Stab (12) festlegbar ist.10. Abdominal cavity expander according to claim 9, characterized in that the sealing plate (22) is formed at a distal longitudinal end of the rod (12) substantially free of play surrounding sleeve (18) by means of a radial clamping screw (20) on the rod (12) can be determined.
11. Abdominalhöhlenexpander nach Anspruch 10, dadurch g e k e n n z e i c h n e t, daß zwischen der Hülse (18) und dem Stab (12) eine Ringdichtung angeordnet ist.11. Abdominal cavity expander according to claim 10, characterized in that an annular seal is arranged between the sleeve (18) and the rod (12).
12. Abdominalhöhlenexpander nach einem der vorhergehenden Ansprüche, dadurch g e k e n n z e i c h n e t, daß der Expander (10) zur doppelseitigen Einführbar- keit an seinen beiden Längsenden (14) je ein Klapp¬ element (16) aufweist.12. Abdominal cavity expander according to one of the preceding claims, characterized in that the expander (10) has a folding element (16) on its two longitudinal ends (14) for double-sided insertion.
13. Abdominalhöhlenexpander nach Anspruch 12, dadurch g e k e n n z e i c h n e t, daß beide Klappelemente (16) gleich- oder gegensinnig klappbar an dem Stab (12) angelenkt sind.13. Abdominal cavity expander according to claim 12, characterized in that both folding elements (16) are hinged in the same or opposite directions to the rod (12).
14. Abdominalhöhlenexpander nach Anspruch 12 oder 13, dadurch g e k e n n z e i c h n e t, daß die Längsenden (14) des Expanders (10) verschie¬ dene Durchmesser haben.14. Abdominal cavity expander according to claim 12 or 13, characterized in that the longitudinal ends (14) of the expander (10) have different diameters.
15. Abdominalhöhlenexpander nach einem der vorhergehenden Ansprüche, dadurch g e k e n n z e i c h n e t, daß der Expander als perforierter Expander (30) einen axialen Kanal (36) zum Anlegen eines Pneumoperito¬ neums aus einem Gasvorrat oder insbesondere mit Umge¬ bungsluft aufweist.15. Abdominal cavity expander according to one of the preceding claims, characterized in that the expander as a perforated expander (30) has an axial channel (36) for applying a pneumoperito¬ neum from a gas supply or in particular with ambient air.
16. Abdominalhöhlenexpander nach Anspruch 15, dadurch g e k e n n z e i c h n e t, daß in dem Kanal (36) ein einseitig sperrendes Ventil (38) angeordnet ist.16. Abdominal cavity expander according to claim 15, characterized in that a unilaterally blocking valve (38) is arranged in the channel (36).
17. Abdominalhöhlenexpander nach Anspruch 16, dadurch g e k e n n z e i c h n e t, daß die Sperrichtung des Ventils (38) umkehrbar ist. 17. Abdominal cavity expander according to claim 16, characterized in that the locking direction of the valve (38) is reversible.
PCT/EP1992/000811 1991-04-10 1992-04-09 Abdominal-cavity expander WO1992018056A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP4507650A JPH0761331B2 (en) 1991-04-10 1992-04-09 Abdominal dilator

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
DEG9104383.2U 1991-04-10
DE9104383U DE9104383U1 (en) 1991-04-10 1991-04-10
DE9106553U DE9106553U1 (en) 1991-04-10 1991-05-28
DEG9106553.4U 1991-05-28

Publications (1)

Publication Number Publication Date
WO1992018056A1 true WO1992018056A1 (en) 1992-10-29

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Country Status (4)

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EP (1) EP0579674A1 (en)
JP (1) JPH0761331B2 (en)
DE (1) DE9106553U1 (en)
WO (1) WO1992018056A1 (en)

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US5289817A (en) * 1991-08-20 1994-03-01 Linvatec Corporation Endoscopic surgical retractor
EP0614646A1 (en) * 1993-03-08 1994-09-14 Dobrivoje Dr. Tomic Surgical trocar sleeve
US5353785A (en) * 1991-07-15 1994-10-11 Wilk Peter J Method for lifting abdominal wall during laparoscopic surgery
AU666855B2 (en) * 1991-05-29 1996-02-29 Covidien Ag Apparatus and method for peritoneal retraction
US5505689A (en) * 1991-05-29 1996-04-09 Origin Medsystems, Inc. Propertioneal mechanical retraction apparatus
US5676636A (en) * 1994-07-22 1997-10-14 Origin Medsystems, Inc. Method for creating a mediastinal working space
US5755661A (en) * 1993-06-17 1998-05-26 Schwartzman; Alexander Planar abdominal wall retractor for laparoscopic surgery
US5836871A (en) * 1991-05-29 1998-11-17 Origin Medsystems, Inc. Method for lifting a body wall using an inflatable lifting apparatus
US10070853B2 (en) 2013-08-14 2018-09-11 Covidien Lp Expandable balloon desufflation assembly
US10166376B2 (en) 2013-06-11 2019-01-01 Covidien Lp Restricted expansion dissector
US11369400B2 (en) 2019-03-20 2022-06-28 Covidien Lp Balloon dissector
US11376037B2 (en) 2020-05-08 2022-07-05 Covidien Lp Surgical access device including dual lumen cannula for anchor inflation and deflation
US11432846B2 (en) 2020-05-05 2022-09-06 Covidien Lp Surgical access device including alternating cutout fluid flow pathway for anchor inflation and deflation
US11439430B2 (en) 2020-05-11 2022-09-13 Covidien Lp Surgical access device with air release mechanism
US11471189B2 (en) 2020-10-29 2022-10-18 Covidien Lp Surgical access device with fixation mechanism and illumination mechanism
US11484337B2 (en) 2020-02-06 2022-11-01 Covidien Lp Surgical access device including anchor with rachet mechanism
US11547441B2 (en) 2020-02-20 2023-01-10 Covidien Lp Retention anchor for surgical access devices
US11564708B2 (en) 2020-06-15 2023-01-31 Covidien Lp Cannula assembly including an adjustable elongate shaft assembly
US11583315B2 (en) 2020-11-09 2023-02-21 Covidien Lp Surgical access device including variable length cannula
US11672563B2 (en) 2020-02-07 2023-06-13 Covidien Lp Surgical access device with rotatably actuated fixation mechanism
US11717322B2 (en) 2020-08-17 2023-08-08 Covidien Lp Flexible cannula having selective rigidity
US11751906B2 (en) 2020-10-29 2023-09-12 Covidien Lp Adapter for use with surgical access device for evacuation of smoke
US11751907B2 (en) 2021-04-13 2023-09-12 Covidien Lp Surgical access device with self-inflating balloon
US11786233B2 (en) 2020-03-27 2023-10-17 Covidien Lp Retention anchor with suture tie down for surgical access devices
US11839404B2 (en) 2020-07-28 2023-12-12 Covidien Lp Surgical access assembly having pre-filled air chamber
US11844549B2 (en) 2020-10-15 2023-12-19 Covidien Lp Surgical access device including a universal fluid flow valve
US11849969B2 (en) 2020-12-04 2023-12-26 Covidien Lp Cannula with smoke evacuation housing
US11864761B2 (en) 2021-09-14 2024-01-09 Covidien Lp Surgical instrument with illumination mechanism
US11896263B2 (en) 2020-05-11 2024-02-13 Covidien Lp Surgical access device with fixation mechanism
US11944348B2 (en) 2021-04-07 2024-04-02 Covidien Lp Surgical access device including an anchor having a suture retention mechanism

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Cited By (34)

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Publication number Priority date Publication date Assignee Title
US5836871A (en) * 1991-05-29 1998-11-17 Origin Medsystems, Inc. Method for lifting a body wall using an inflatable lifting apparatus
US5941819A (en) * 1991-05-29 1999-08-24 Origin Medsystems, Inc. Apparatus for creating a mediastinal working space
AU666855B2 (en) * 1991-05-29 1996-02-29 Covidien Ag Apparatus and method for peritoneal retraction
US5505689A (en) * 1991-05-29 1996-04-09 Origin Medsystems, Inc. Propertioneal mechanical retraction apparatus
EP1287786A1 (en) 1991-05-29 2003-03-05 Sherwood Services AG Apparatus for peritoneal retraction
US5353785A (en) * 1991-07-15 1994-10-11 Wilk Peter J Method for lifting abdominal wall during laparoscopic surgery
US5289817A (en) * 1991-08-20 1994-03-01 Linvatec Corporation Endoscopic surgical retractor
EP0614646A1 (en) * 1993-03-08 1994-09-14 Dobrivoje Dr. Tomic Surgical trocar sleeve
US5755661A (en) * 1993-06-17 1998-05-26 Schwartzman; Alexander Planar abdominal wall retractor for laparoscopic surgery
US5676636A (en) * 1994-07-22 1997-10-14 Origin Medsystems, Inc. Method for creating a mediastinal working space
US5823946A (en) * 1994-07-22 1998-10-20 Origin Medsystems, Inc. Method for creating a mediastinal working space
US10166376B2 (en) 2013-06-11 2019-01-01 Covidien Lp Restricted expansion dissector
US10835229B2 (en) 2013-08-14 2020-11-17 Covidien Lp Expandable balloon desufflation assembly
US10070853B2 (en) 2013-08-14 2018-09-11 Covidien Lp Expandable balloon desufflation assembly
US11369400B2 (en) 2019-03-20 2022-06-28 Covidien Lp Balloon dissector
US11484337B2 (en) 2020-02-06 2022-11-01 Covidien Lp Surgical access device including anchor with rachet mechanism
US11672563B2 (en) 2020-02-07 2023-06-13 Covidien Lp Surgical access device with rotatably actuated fixation mechanism
US11547441B2 (en) 2020-02-20 2023-01-10 Covidien Lp Retention anchor for surgical access devices
US11786233B2 (en) 2020-03-27 2023-10-17 Covidien Lp Retention anchor with suture tie down for surgical access devices
US11432846B2 (en) 2020-05-05 2022-09-06 Covidien Lp Surgical access device including alternating cutout fluid flow pathway for anchor inflation and deflation
US11376037B2 (en) 2020-05-08 2022-07-05 Covidien Lp Surgical access device including dual lumen cannula for anchor inflation and deflation
US11896263B2 (en) 2020-05-11 2024-02-13 Covidien Lp Surgical access device with fixation mechanism
US11439430B2 (en) 2020-05-11 2022-09-13 Covidien Lp Surgical access device with air release mechanism
US11564708B2 (en) 2020-06-15 2023-01-31 Covidien Lp Cannula assembly including an adjustable elongate shaft assembly
US11839404B2 (en) 2020-07-28 2023-12-12 Covidien Lp Surgical access assembly having pre-filled air chamber
US11717322B2 (en) 2020-08-17 2023-08-08 Covidien Lp Flexible cannula having selective rigidity
US11844549B2 (en) 2020-10-15 2023-12-19 Covidien Lp Surgical access device including a universal fluid flow valve
US11751906B2 (en) 2020-10-29 2023-09-12 Covidien Lp Adapter for use with surgical access device for evacuation of smoke
US11471189B2 (en) 2020-10-29 2022-10-18 Covidien Lp Surgical access device with fixation mechanism and illumination mechanism
US11583315B2 (en) 2020-11-09 2023-02-21 Covidien Lp Surgical access device including variable length cannula
US11849969B2 (en) 2020-12-04 2023-12-26 Covidien Lp Cannula with smoke evacuation housing
US11944348B2 (en) 2021-04-07 2024-04-02 Covidien Lp Surgical access device including an anchor having a suture retention mechanism
US11751907B2 (en) 2021-04-13 2023-09-12 Covidien Lp Surgical access device with self-inflating balloon
US11864761B2 (en) 2021-09-14 2024-01-09 Covidien Lp Surgical instrument with illumination mechanism

Also Published As

Publication number Publication date
DE9106553U1 (en) 1991-08-08
EP0579674A1 (en) 1994-01-26
JPH0761331B2 (en) 1995-07-05
JPH06503024A (en) 1994-04-07

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