CN1093894A - 一种腹腔镜下解剖的张力牵开器装置和方法 - Google Patents

一种腹腔镜下解剖的张力牵开器装置和方法 Download PDF

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CN1093894A
CN1093894A CN94101371A CN94101371A CN1093894A CN 1093894 A CN1093894 A CN 1093894A CN 94101371 A CN94101371 A CN 94101371A CN 94101371 A CN94101371 A CN 94101371A CN 1093894 A CN1093894 A CN 1093894A
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tubular support
tissue
dissector
minimally invasive
distal end
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L·菲顿
W·J·戈曼
J·马考弗
A·索迪克森
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Valleylab Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00353Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2906Multiple forceps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • A61B2017/306Surgical pincettes without pivotal connections holding by means of suction
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • A61B2017/3445Cannulas used as instrument channel for multiple instruments

Abstract

本发明公开了一种用于对病人进行体内手术的 最小侵害性牵开器解剖器及其应用方法。

Description

本发明是涉及一种最小侵害性手术器械,它经过一个入口进入病人体内对其中的组织施行手术,更具体地讲,它能利用最小侵害性解剖器和牵开器经入口将组织拉紧并施行手术。
通常,在进行最小侵害性操作时,要把几个套针穿入病人的身体以便进入其体腔。一个套针提供光照和影像,一个用来注入气,还有一个供最小侵害性手术器械使用。
通过插入病人体内(如穿过病人的腹壁组织)的套针进行手术,已经成为一种重要的减低手术侵害的方法。侵害的减轻改进了美容效果,缩短了恢复期并降低了费用。现在,已有最小侵害性体内手术方法和器械,并用于多种医疗手术中,它们包括胆囊、肠和妇科手术。但仍需要一种简便而合适的通过入口进行牵开和解剖的器械。
拉紧组织是所有外科技术的基本原则。当解剖区域被绷紧时,所切开的组织就从切割器上自然分开。这样就能快速安全地辨别下面的组织结构,而且提供了清楚的解剖路径,从而使外科医生能对准更深层的目标。
在现有最小侵害性装置中,不能用少至三个开口或入口让器械进入腹腔切割绷紧的组织。现在所用的两种器械常常被用来把大结构(如胆囊或肠)固定在靠边处。这就迫使外科医生用钳子挟掉或扯掉遮挡的易损的筋膜,从而在显微外科手术部位的旁边留下一团团的组织碎片。经常,由于外科大夫不能让手术部位产生张力而使下面的结构被意外切割或误认。
如果外科医生有一种可靠的方法对切口处的组织施加张力,而不放弃其它器械或不再对腹壁穿刺,就能明显减少胆管和血管损伤的并发症,且更容易完成此项手术。胆管损伤的发生率为0.2-3%,一旦发生就是一种严重的并发症而且有时需要进行开腹手术修复。
目前,可使用的作腹腔镜检查的最小侵害性夹子和解剖器的销售量数以百万计,而且将有迅猛增长。
有很多种普通剪刀或钳子,而且还有一些稍为特殊的工具专门为固定特殊器官(如胆囊和肠)而制做。轻侵害或最小侵害的外科方法的应用日益频繁和复杂。这类方法包括:腹腔镜检查、胸腔镜检查、内窥镜检查等。
本发明的解剖器牵开器在一个或多个相连结的部件的末端具有一个或多个抓或夹持组织的尖端,并且有一个能允许其它器械穿过的通道。这些部件的设计是能使其向远离支撑它们的管的轴向运动,以便使内部的组织形成张力。通道的设计是让其它器械(如刀、夹、剪或带电装置-激光、电烙器、检查镜、锁环和夹子安放器等)从其中通过,以便对准绷紧的组织。这些部件可以设计成分离式、咬合型或沿轴向互相滑动,也可以互相替换使用。本发明的牵开器解剖器使外科医生在切割时能提供直接的组织拉紧和支撑(这在现有的设备中往往是不可能的)。绷紧部件被固定在管形支撑上,而手术器械可以利用管中的通道,这样可以减少手术所需的开口的数目。采用本发明解剖器牵开器可以使切割工具稳定于绷紧的组织,而这在现有的设备中是不可能的。管形支撑作为开口的安全延伸允许快速更换器械,在插入时又无需移动观察镜。管形支撑的远侧端位于有助于经管形支撑快速更换器械的地方。本发明的解剖器牵开器适用于不向腹腔注入气体的方法,并可以在检查镜周围使用。它可以为检查镜解剖出一个通路,并把它稳定于难于到达的部位或移动的部位。
本发明用于内脏外科手术的最小侵害性牵开器解剖器可以有一个用以穿入病人体内的管形支撑。
管形支撑的近端最好被放在能被外科大夫接触到的病人体外,并且可包括一个类似止血阀的气塞。管形支撑的远端最好放在病人的体内以便为大夫提供进入通路。管形支撑上所带的一个能移动的工具可以有一个或多个由关节相连接的组件,它们的位置能够移动且能夹持和牵拉远侧端以远的组织。
管形支撑包括一个通道,在对病人的体内组织进行手术的过程中,通过它能获得沿其轴的通路。一种能独立于所述工具进行移动,并与该工具协同对组织发挥作用的器械,最好同时从近端经通道进入到远端,以使该工具把组织固定在相对于病人和器械的位置。所述器械最好是一种手术器械,而且所述工具在病人体内把组织固定在手术器械的位置。手术器械可以是一种电手术设备。
该工具包括至少一个伸出远端并能相对于远端移动的组件;当器械相对于被组件夹持的组织移动时,该组件则被用于夹持和牵拉病人体内的组织。该工具可包括一对伸出远端的相对于它能移动的交错的臂,这一对组件将组织夹持在中间,而手术器械则能相对于所述组件所夹持的组织移动。每一个组件的末端有一个能夹持组织的结构。每个末端可有至少一个用来接触组织的钩,或每个末端包括一对夹子用来夹持或拉紧相邻的组织,或每个末端有一把剪刀用来夹、拉紧或剪切相邻的组织。
组件可以是伸出末端的钳子,该钳子用于打开、关闭和夹持组织。其中的一个或多个组件可以有一个用于夹持和操纵位于病人体内的远侧端以外的组织的吸管。
近侧端可以装一个用于操纵该工具的控制器,它能相对于该轴夹持和牵拉远侧端以远的组织。控制器能使器械独立于该工具移动,以便在病人体内对被夹持和操纵的远侧端以外的组织做手术。该工具可以通过控制器连接以便使其在病人体内绕轴移动。所述器械也可以由控制器连接以便在病人体内绕轴移动。控制器可以有一个用来操纵该工具的柄和操作器械的把。
在一个实例中,管形支撑是一对U形管道,它们共同构成一个含有连接部件的相互之间能沿轴作相对移动的长管。
一种利用最小侵害性牵开器解剖器给病人进行内脏手术的方法可具有几个步骤。一个步骤可以是为把管形支撑插入病人体内而打开一个入口,接着把管形支撑的近侧端留放在病人的体外以便让外科大夫操作。然后,下一个步骤可以把管形支撑的远侧端固定在病人的体内以便外科大夫操作。另一步骤是移动管形支撑上所携带的工具并把一个或多个由关节相连的组件固定好,使其能夹持和牵拉远侧端以远的组织。
再一个步骤最好可以是夹持和牵拉管形支撑远侧端以远的组织。随后一个步骤可以是利用管形支撑的通道到达沿其轴的位置给病的内脏组织进行手术。希望另外一个步骤可以是在通道中移动一个独立于该工具的器械以便同时协调作用于组织。
图1是本发明的最小侵害性牵开器解剖器的透视图,为了显示控制器对组件的控制画出了它的部分剖视图。
图2是放大的组件的部分透视图和位于其间的器械,其中当组织被拉紧时,器械可以对它进行手术。
图3是一种管形支撑的部分透视图,它具有相连接的互相配合作用的U-形管道,它们能够沿轴相互滑动。
图4是放大的沿图3的线4-4的截面图,以显示U-形管道的连接。
图5A至F显示不同尖端外形的透视图,它们可以互相更换。
图6是侧剖面图,显示本发明最小侵害性牵开器解剖器可以折迭起来以便插入管形支撑。
图1显示一种用于对病人进行内脏手术的最小侵害性牵开器解剖器10的部分透视图。有一个用来通过诸如穿刺孔或插管进入到病人体内的管形支撑11。在用于腹腔镜的一个具体实例中,一个穿过腹壁进入到充气的体腔中的穿刺针或插管是放置管形支撑11的合适的位置。管形支撑11有位于病人体外并固定在外科大夫能接触到的位置的近侧端12;可以应用止血阀形式的气塞。管形支撑的远侧端被安放在病人体内以便到达充气的体腔内的器官。工具14能移动,被安装在管形支撑的远侧端13处。尤其是安装有一个或多个由关节相连能移动的组件15,它能夹持和牵拉远侧端13以远的组织。图1中的管形支撑11有一个腔形通道16,经该通道基本上可获得沿其“A”轴的途径为病人进行体内手术。通道16允许沿其轴自由到达连接组件15之间的区域,以便为附加器械经管形支撑11的通道16进入病人体内提供额外通路。
附加器械能独立于工具14移动,从而提供了同时协调地处理组织的能力。具体地讲,器械从近侧端12穿过通道16进入到远侧端13以远的位置,以便当工具14相对于病人和器械把组织固定时,该器械能够独立移动并发挥功能。在一种方法中,器械是一种手术工具而病人体内的组织则被工具14操纵到相对于手术工具的位置。一种具体的手术工具可以是一把手术刀、一种电手术装置如凝血器或刀具、或者仅仅是一个摄像器或检查镜。工具或器械与工具14协同工作的例子见图2。
工具14包括至少一个组件15,在图1,2,3和6中,显示有两个组件15但并非必需如此。如果要求的通道16比具有两个组件15的通道大,则一个组件15就足够,但是,在有些情况下,需要最大程度的灵活性,这时可以用两个具有不同尖端的组件15,正象图5A至F中所显示的那样。组件15伸到远侧端外并可以相对于远侧端移动。在某些图中,如图1、2、3和6中,组件15被安装在管形支撑11的远侧端13上,而且组件15可以相对于远侧端13的轴向移动而不是转动或摆动,因为其中组件15沿管形支撑11的内壁18相对滑动可能是更直接、更简便的工作方式。图6显示了这一方法。组件15的尖端17能相对于它移动,这样当末端17被安放在相对于管形支撑11的“A”轴的体腔内时,它能够夹持组织。因此,通过管形支撑11上所配备的能相对于它移动的组件15能够很容易地操纵内脏器官或组织。
在图1中,在管形支撑11的近侧端12处有一个控制器19。控制器19操纵着工具14和尖端17。控制器19允许相对于管形支撑11的“A”轴的方向夹持和牵拉超出远侧端13的组织。控制器19允许移动位于通道16内的独立于工具14的器械,以便对所夹持和操纵的远侧端13以远的组织进行体内手术。
组件15最好是以一对臂形的形式,安装在远侧端13以远处,使其在使用时能相对于远侧端13具有最大程度的灵活性。这样一种安排可能会限制管形支撑11的通道16所提供的窗口。图1所示的剖面图是一种用来控制组件15的控制器19,其间的一对相连接的环20被管形支撑11的近侧端12所携带,用以操作组件15的尖端17。环20能够自由地相互转动,因此外科大夫在安放器械时相对于尖端17而转动控制器19,这样就使最小侵害性牵开器解剖器容易使用。内环21通过一根悬索与尖端17相连,以便悬索沿轴向移动蛙能把尖端17关闭在夹持的位置。具体地讲,如果象图5F所示,位于管24中的尖端17是钳子形23,那么沿轴按箭头的方向运动将把钳子23拉进管24中,因此共同在其中夹取组织。索22沿管形支撑11的内壁18从近侧端12延伸至远侧端13以外。索22被沿组件15至尖端17的方向所控制,以便与图5D中的正常情况下开启的夹子25或钳子23相连接,以对其控制。
为操纵索22,有一个外环26包围着内环21上的悬壁27,并与一个向内翻的凸缘28相连接,其上固定有内环21,其内与悬壁27相连接。提升外环26将引起内环21的升高并与其内壁相连的索22沿轴向移动。外环26和内环21允许在其间自由转动,在转动时控制尖端17关闭的状态不受影响。特别是,为提升外环26而把一个钟形曲柄29能转动地装在控制器19上。钟形曲柄29有一个向内伸的点30,它与外环26和促动开关31相连,该开关位于让外科大夫通过控制器19容易操作的位置。打开促动开关31将提起索22和相连接的外环26和内环21,同时允许控制器19相对于管形支撑11转动。如果要应用两套尖端17,就需应用另一套环20。第二套环能象第一套环一样工作,被安装在图1中第一套环的上方。在控制器19的基底部可以装一个有锯齿形的箍带32,以便相对于固定的尖端17进行转动,目的在于容易用手控制尖端17的位置。
一个定向橄榄33被装在管形支撑11的远侧端13处,以使安装在其上的组件15能在不止一个平面上摆动。具体地讲,象图1所示的组件15的正常位置是并列的而且被弹簧固定在那个位置。当希望把组件15分开时,那么就把尖端17的一个尖夹在某一组织上,正象图2所示和此处所解释的那样,以便至少利用一个组件15。然后操纵管形支撑11把组件15分开以便使空着的组件15指向其它地方的组织并夹在其上面。可以通过控制器19上的张开钳34把尖端17分开以便对组织施加张力。尤其,图1中的张开钳34与杆35相连,杆35从张开钳34穿过内壁至位于定向橄榄33附近的组件15。沿轴向运动杆35将牵拉组件15的尖端17张开。由于组件15的正常位置是在一起的,所以杆35需克服弹簧的阻力把它们分开。定向橄榄33允许在组件15转动的同时保持通道16开通;即,橄榄33在中心无妨碍,在相对于远侧端13作转动的同时,又不影响通道16。组件15的弹簧装配可以与组件15是一个整体,以便分别用一种弹性材料制造它们,这种材料被弯曲至有足够的力使它们处在正常合拢的位置。与此相似,在尖端17处的夹25也可以被弹簧控制在正常合拢状态并可以被索22拉开,但这不是一个优选的方法。
在剖视图1中显示了每个促动器开关31的闩36。在柄穴上有齿形边37,它能够使促动开关31分一步或多步启动。要放开这一齿合,就压弹簧38把促动开关向后拉以便使其与齿形边37分离。一个类似的固定器39被用于控制张开钳34,以便把组件15固定在某一位置,即张开。
在图3和4中,互相补充显示了由一对U形管40构成的管形支撑的另一实例,它们共同构成一个伸长的管道41,该管道由相连接的部件构成,这些部件能沿“A”轴的方向相互移动。图4具体显示了连接部件相互关系的一种方式。非常清楚,U形管40的相互移动为组件15相互之间提供了额外的灵活性,以便使其不仅能被摆动分开,而且可以沿轴向作相互移动。图4是放大了的末端截面图,以便显示连接的细节。
用于制造管形支撑11的材料可以是符合其使用性,尤其是医用标准的任何材料,如塑料、金属或陶瓷,但是,原料的选择无疑应同特定结构的功能所决定。尽管细长管41能够很容易地被挤压成U形管道40,除挤压和浇铸以外,也可能需要机械加工才能得到所需的断面图的结构。预料熟练工匠是能够用一块或多块原料加工成管形支撑11,并且提供薄壁和通过其中的尽可能大的通道16,同时具备合适的强度以便携带位于远侧端13的组件15。
图5显示不同的尖端17;每个显示的尖端17都可以用来夹持和/或拉动体内的组织或器官。这些不同的尖端17都位于组件15的末端以便在体内固定位置。具体地讲,图5A有一个牵开钩42能沿箭头方向的轴滑动以便夹取或夹持其间的组织。示出的用于该目的的管24和相配合的钩42,其中双向箭头表明相对于管24钩42的轴移动方向,但优选的方法是钩42处于正常的开启状态且仅仅被牵拉关闭。
图5B显示一个能够用平固定组织的吸管。向吸管24施加的真空可以间歇式启动以便抓取和固定组织。吸管24应当是半刚性材料以便最大限度的控制。图5C显示一对虎钳形的片43,它们能够沿轴相移运动以便夹持其间的组织。图5D显示出一对类似老虎钳的嘴的夹子,它们能够被用来夹组织。夹25正常时分开,合起来用于夹持组织。
图5E是一对钳44,它可以用来固定组织而不象图5D中的夹25那样夹组织。并不局限于所示出的这几种结构。可以根据需要结合组件15和医疗措施使用其它结构的工具。具体地讲,可以安装剪刀来代替图5D所示的夹25。可以安装钳23以便让其是一对弯曲在一起的被固定在管24中的叶片弹簧;根据需要索22可以把它们沿轴拉入或推出管24。位于管24中的钳23的弯曲与组件15相连,它相对于管形支撑11的远侧端13能移动。
图6显示每一个组件15,是如何包含一个尖端17的示意图。管形支撑11包住一对组件15,当组件15沿轴被拉进或推出管形支撑11时,它们能分开或共同平行移动或分别移动。
尤其,当工具14移动时,例如通过摆动或旋转使其离开轴“A”以便最大限度利用管形支撑11所穿过的患者体壁的入口,通道16内的器械可以相对于管形支撑11沿轴进入体腔。如上所述,工具14可以与杆35相连,杆35通过张开夹34和钟形曲柄29与操纵末端17的促动开关31相连,以使组件15在夹持组织的同时能在体内张开。还可以用杆35滑动一对在远侧端固定的组件15,把它沿轴拉进或拉出管形支撑11并使其相对于器械运动,该器械可以单独用手动操作使其从近侧端12穿过通道16到达远侧端13。因此,尽管所有的移动都可能都是沿轴方向,但它们是独立的。
一种应用该最小侵害性牵开器手术器10的方法可以包括各种步骤。为管形支撑11开一个口使其进入到体内,例如进行腹腔镜检查时穿过腹壁把胆囊、子宫或其它类似的器官移开,以上步骤通常是利用一个带肌肉剪切头的穿刺针来完成的,该穿刺针穿过体壁而留下一个直径约10mm的孔。做完开孔以后,可以把管形支撑11插进该孔并把它固定在病人体内,以便使其远侧端13在体腔内并使与其相连的组件15位于其间操纵的组织的位置。另一步骤是把管形支撑的近侧端12放在病人的体外并把其固定在外科大夫能接近的位置以便容易控制体内的工具14。然后,外科大夫可以把管形支撑11上的远侧端13相对于病人的身体固定好,并使外科大夫在手术过程中通过其上的工具14对组织或器官进行操纵。外科大夫是通过控制器19使工具14移动的,以便根据需要进行夹持或牵拉体内的组织,尽管这些组织位于管形支撑11的远侧端13以远。在某种程度上,管形支撑11能被移进移出身体或相对于腹部运动,例如以便使远侧端13靠近感兴趣的组织或器官,以便使体内的工具14能很效地被使用。在对病人体内组织进行手术的过程中,尤其是当把摄像器、手术器械或其它器械经通道16穿入体腔时,穿过管形支撑11的通道16能被用作到达沿其“A”轴的途径。因此,器械能独立于工具14对组织同时协调地发挥作用。器械被插进一个被固定好的套针中,而其远侧端13则在该器械进入的同时由另一个入口用摄像机或检查镜进行观察。外科大夫能通过控制器19转动管形支撑11以便让手位于最理想的位置。然后,可以向要牵开和/或解剖的组织前移该最小侵害性牵开器解剖器10。组件15上有尖端17,尖端17可以有钳23或夹25,它被夹在一块组织上,该组织位于所要解剖的平面的稍偏位置。另一个组件15通过控制器19被固定在所要解剖平面的另一侧;并且其上的尖端17被夹在组织上。当尖端17处于夹持组织的位置以后,组件15被外科大夫利用施加于夹34上的压力而张开,夹34控制着组件15的位置。就这样把解剖点拉紧了,而且能根据外科大夫的需要逐渐施加压力。
然后,第二个手术器械可以穿过通道16或其它任何用于解剖拉紧的组织的入口。在外科大夫解剖组织的时候,可以施加另外的张力把筋膜从解剖点拉走或张开。根据需要,一个或两个位于每个组件15上的尖端17的夹25或钳23可被重新安放,以便在完成合适的拉紧或牵开后在别处进一步解剖。如有必要,外科大夫可以随时象安置时那样容易放松夹持或牵张。如果通道16为手术器械所用,管形支撑11的移动就起到控制手术器械的作用。管形支撑11的远侧端13附近的橄榄33在相对于牵张组件15运动管形支撑11时,起到引导插在其中的器械的作用。

Claims (26)

1、一种用于对病人内脏进行手术的最小侵害性牵开器解剖器,它包括;
一个用于穿入病人体内的管形支撑;
一个位于病人体外、便于外科大夫操作的在管形支撑上的近侧端;
一个位于病人体内便于外科大夫操作的管形支撑上的远侧端;
一个位于管形支撑近侧端的控制器;
一个或多个相连的组件,其位置能相对于管形支撑的远侧端移动,而且允许每个相连的组件相对于远侧端摆动;和
一个转动装置,它与管形支撑的近侧端和病人体内的连接组件相连接,以使其相对于控制器移动。
2、权利要求1的最小侵害性牵开器解剖器10,其中管形支撑11包括通道16,该通道从近侧端穿到远侧端,在对病人体内的组织进行手术时,通过该通道基本上能获得沿其“A”轴的路径。
3、权利要求20的最小侵害性牵开器解剖器10和器械,其中所述通道无妨碍,能够让不依赖于连接组件而独立移动的所述器械通过,并携带器械移动,以便协调作用于组织;安排所述器械由近侧端12同时通过通道16到远侧端13,使连接组件相对于病人的身体和器械可以夹持和固定组织,因此,器械可以对连接组件所夹持的组织进行手术。
4、权利要求20最小侵害性牵开器解剖器10和器械,其中所述的器械是一件手术工具,而所述组织则被位于病人体内的连接组件所操纵,在相对于手术工具的位置被绷紧。
5、权利要求4的最小侵害性牵开器解剖器10和器械,其中所述手术工具是电手术装置。
6、权利要求3的最小侵害性牵开器解剖器10,其中所述的连接组件携带至少一个伸出远侧端13可连接的组件15,该组件能相对于连接点移动;当器械相对于工具所夹持的组织移动时,该组件能夹持和牵拉病人体内的组织。
7、权利要求20的最小侵害性牵开器解剖器10和器械,其中所述的伸出远侧端13的连接组件15能相互独立地移动并夹持其间的组织,而且所述器械能相对于连接组件15之间夹持组织相互独立的移动。
8、权利要求7的最小侵害性牵开器解剖器10和器械,其中,每个组件15有一个构成的并能移动的远侧尖端17以便夹持组织。
9、权利要求8的最小侵害性牵开器解剖器10和器械,其中每个尖端17包括至少一个用于接触组织的钩42。
10、权利要求8的最小侵害性牵开器解剖器10和器械,其中每个尖端17包括一副用于独立地夹或张开相邻的组织的夹子。
11、权利要求8的最小侵害性牵开器解剖器10和器械,其中每个尖端17包括一把剪刀,用于独立地夹、张开或剪切相邻的组织。
12、权利要求1的最小侵害性牵开器解剖器10,其中所述的连接组件15包括伸到远侧端13外的钳子23,它能独立地用于打开、关闭和夹持组织。
13、权利要求1的最小侵害性牵开器解剖器10,其中一个或多个连接的组件15包括一个吸管24,该吸管能独立于其它组件在病人体内夹持和操纵远侧端以外的组织。
14、权利要求1的最小侵害性牵开器解剖器10,其中所述的近侧端12处的控制器19控制着连接组件,因此,控制器19允许相对于“A”轴独立地夹持和牵拉超出远侧端13的组织。
15、权利要求20的最小侵害性牵拉器解剖器10和器械,其中所述的控制器19能使管形支撑移动,因此,在某种程度上能独立于连接的组件而影响穿过通道的器械以便在病人体内对所夹持和操纵的超出远侧端13的组织进行手术。
16、权利要求14的最小侵害性牵开器解剖器10,其中所述的一个或多个连接的组件是由控制器19相连接的,以使组件在病人体内相对于“A”轴独立地移动。
17、权利要求15的最小侵害性牵开器解剖器10和器械,其中所述的器械是独立地移动的,以使其能独立于连接的组件在病人体内相对于“A”轴移动。
18、权利要求15的最小侵害性牵开器解剖器10和器械,其中所述的控制器19有一个夹34,以利于独立地操纵连接的组件,而且该器械是分离的,以利于独立操作。
19、权利要求27的最小侵害性牵开器解剖器10,其中所述的管形支撑11是一对U形管道40,它们互相配合形成一个长形管道41,该管道由相互之间能在“A”轴方向上独立移动的相关联的部件构成。
20、一种由外科医生使用对病人进行体内手术的最小侵害性牵开器解剖器和一种器械,包括:
一个穿入病人体内的管形支撑,它包括一个通道,在对病人的内脏组织进行手术时,通过该通道能得到沿其“A”轴的途径;
一个位于病人体外便于外科大夫使用的在管形支撑上的,近侧端;
一个位于病人体内为外科大夫提供操作的在管形支撑上的远侧端;
一个位于管形支撑的近侧端处的控制器,它允许相对于“A”轴夹持和牵拉超出远侧端的组织;
一个或多个连接的组件,其位置能相对于管形支撑的远侧端移动,而且每一个连接的组件允许相对于远侧端在多于一个平面上摆动;
一个位于每个连接组件上的远侧尖端,每个尖端制成能独立于另一尖端移动并能夹持组织的结构,以利于连接组件对超出管形支撑远侧端的组织进行夹持和牵拉;
一个旋转器,它与管形支撑的近侧端和位于病人体内的连接组件相连接,以利于相对于控制器移动;和
一种器械,它能独立于管形支撑、连接组件和远侧尖端而移动,以便相互合作发挥功能,这样该器械由近侧端同时通过通道到远侧端以外,而连接组件能把组织相对于病人固定好,其中所述的器械是一种手术工具,而组织则被位于病人体内的连接组件操纵在相对于手术工具的位置。
21、权利要求20的最小侵害性牵开器解剖器10和器械,其中的定向橄榄是由控制器19独立连接的,以便在病人体内相对于“A”轴移动,而且其中所述的通道中的器械则受管形支撑的移动的影响,在病人体内相对于“A”轴移动。
22、权利要求21的最小侵害性牵开器解剖器10和器械,其中所述的控制器19有一个夹34,用于独立地操纵连接组件;而且有一个用于独立地操纵该器械的管形支撑。
23、一种由外科医生利用最小侵害性牵开器解剖器10和器械在病人体内进行手术的方法,它包括下列步骤:
开一个口,以便把管形支撑11穿入病人体内;
把管形支撑11的近侧端12留在病人体外,处于便于外科大夫操作的位置;
把管形支撑11的远侧端13放在病人体内适当位置,以使外科大夫能接近到病人体内;
在管形支撑的近侧端装有一个旋转器,以便使远侧端作旋转运动;
移动一个或多个定位的连接组件,它们相互独立地移动并能夹持和牵拉远侧端13以远的组织。
24、应用权利要求23的最小侵害性牵开器解剖器10和器械的方法,该方法还包括夹持、牵拉和转动位于管形支撑11远侧端13以远的组织。
25、应用权利要求23的最小侵害性牵开器解剖器10和器械的方法,该方法还具有外加步骤是:在对病人的体内组织施行手术时,利用穿过管形支撑11的通道16,让所述器械基本上沿其“A”轴通过。
26、应用权利要求23的最小侵害性牵开器解剖器10和器械的方法,该方法还具有的外加步骤是:独立于所述的连接组件而移动通道中的所述器械,以便同时协调地对组织发挥作用。
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CN102065781A (zh) * 2008-03-27 2011-05-18 梅奥医学教育和研究基金会 导航和组织俘获系统及方法
CN104203079A (zh) * 2011-02-10 2014-12-10 丹尼·A·舍温特 腹腔镜牵开器
WO2019114605A1 (zh) * 2017-12-11 2019-06-20 梅达布蒂奇股份有限公司 一种腹腔镜

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KR960700656A (ko) 1996-02-24
JPH08502438A (ja) 1996-03-19
US5683349A (en) 1997-11-04
FI940808A (fi) 1994-08-23
EP0684789A1 (en) 1995-12-06
CA2154172A1 (en) 1994-09-01
WO1994018893A1 (en) 1994-09-01
US5474057A (en) 1995-12-12
AU6236794A (en) 1994-09-14
FI940808A0 (fi) 1994-02-21

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