WO2001035831A1

WO2001035831A1 - Extraction device

Info

Publication number: WO2001035831A1
Application number: PCT/SE2000/002285
Authority: WO
Inventors: Staffan TERNSTRÖM
Original assignee: Safe Conduct Ab
Priority date: 1999-11-19
Filing date: 2000-11-20
Publication date: 2001-05-25
Also published as: AU1566901A; SE9904223D0

Abstract

A device for use in endoscopic operations, such as laparoscopic surgery, to encompass and extract specimens, comprising an inserting means (1) which comprises a tubular sleeve (10), an actuating means (2) which is displaceably arranged in the inserting means (1), and a pouch (3) formed with an opening and arranged at the distal end, intended for insertion of the actuating means (2). the actuating means (2) further comprises arms (21) which are movable towards and away from each other, and the pouch (3) comprises fastening means (31) for releasable fastening to the arms (21) of the actuating means, the pouch being an exchangeable unit of the device.

Description

EXTRACTION DEVICE

Field of the Invention

The present invention relates to a device for use in endoscopic operations, such as laparoscopic surgery, to encompass and extract specimens.

Background Art

Laparoscopic surgery, or so-called keyhole surgery, is becoming more and more important m general surgery and gynaecologic surgery. The advantages over conven- tional surgery are considerable for the patient as well as for society. In laparoscopic surgical procedures small entrance openings are made m the abdominal wall, through which trocars (tubular sleeves) are inserted, and through these the laparoscopic instrument and one or more working instruments are inserted. Moreover the abdomen is filled with gas, thereby increasing its volume significantly, which causes overview and accessibility. The image of the operation area is transmitted to a monitor and the sick organ is freed and severed from surrounding tissues by means of the working instruments. The specimen (the organ, the severed tissue) is then to be removed from the abdomen. If it is small, it can be extracted directly through a trocar, but if it is larger, either the abdomen must be opened with an incision (thereby reduc- mg the advantages of the laparoscopic incision) , or the specimen must be divided (morcellated) . Instruments for such division of specimens are previously known, for instance from WO 97/35522 by the same applicant, which is herewith m its entirety incorporated by reference. However, it is desirable for both extraction and optional division of specimens to be carried out by means of a protective device, comprising some kind of protective pouch since waste from the specimen may cause contamination m the abdomen or abdomen wall, particularly when the specimen is infected, contains cancer cells etc. Several such extraction devices are already known, e.g. from US 5,465,731, US 5,368,597 and EP 0 930 047. A common feature of these is that they comprise an inserting means, which comprises a tubular sleeve with a distal end intended, when in use, to be inserted through a body opening and a second, proximal end adapted to remain outside the body opening. Moreover, they comprise an actuating means which is displaceably arranged in the insert - ing means, and a pouch provided with an opening and arranged at the distal end, intended for insertion, of the actuating means, the actuating means being adapted to enable, from the proximal end of the inserting means, actuation of the opening of the pouch to open and close the same. These prior-art solutions, however, suffer from a large number of practical problems, viz. that the solutions for opening and closing the pouch are either complicated or unsatisfactory, which makes them either expensive or difficult to handle. • that it is difficult to handle and control, by means of these devices, the pouch in the desired fashion in the body cavity, which results in the operation taking longer to carry out. This causes increased operation costs and greater restraints. . that the specimens must in many cases be passed a long way round when being inserted into the pouch. This, too, results in increased costs and restricted use. • that the outside of the pouch, especially at the edge of the opening, is easily contaminated when inserting the specimen. This means, in turn, that also the trocar or the incision to the body cavity is contaminated. This is most serious since normally there are open blood vessels at the body opening, which are very sensitive to contamination. These and other problems complicate the laparoscopic surgery and increase the costs of the operations as well as the risks to the patients. That mentioned above is also applicable, under equivalent conditions, to other types of endoscopic surgery, such as operative thorascopy (keyhole surgery in the thoracic cavity) .

Object of the Invention

The object of the present invention is to provide aids for use in endoscopic operations, to encompass and extract specimens, said aids wholly or partially elimi^¬ nating the above problems of prior-art technique. This object is achieved by a device, a pouch and an actuating means according to the appended claims.

Summary of the Invention

The invention relates to a device for encompassing and extracting specimens in endoscopic surgery, comprising an inserting means, which comprises a tubular sleeve with a distal end adapted to be inserted, when in use, through a body opening and a second, proximal end adapted to remain outside the body opening, an actuating means which is displaceably arranged in the inserting means, and a pouch formed with an opening and arranged at the distal end, intended for insertion, of the actuating means. The actuating means is adapted to enable, from the proximal end of the inserting means, actuation of the opening of the pouch to open and close the same. A characteristic feature of the invention is further that the pouch comprises fastening means for releasable fastening to the arms of the actuating means, the pouch being an exchangeable unit of the device. Owing to the fact that the pouch is fastened in a releasable and exchangeable fashion, the actuating rod and the inserting means can be designed for multiple use and be sterilised between the occasions of use, while the pouch can be designed for one-time use and easily be replaced before each occasion of use. This radically reduces the costs of the device while at the same time the actuating means can be improved and be made more user-friendly, without significantly increasing the costs of each operation.

Preferably, the actuating means comprises arms which are movable towards and away from each other, the fasten- ing means of the pouch being adapted to be engaged with the arms by being moved in the longitudinal direction of the arms. In this way, easy but safe mounting of the pouch to the actuating means is permitted. At the same time also the actuation of the pouch will be easy since the pouch can easily be opened by moving the arms apart, and sealed by moving the arms towards each other.

It is particularly preferred for the fastening means to comprise inlets for each arm, and preferably these inlets are ducts which are extended in the longitudinal direction and arranged at the opening of the pouch. As a result, the adaptation of the pouch to the actuating means will be very easy while at the same time the arms of the actuating rod can be made relatively uncomplicated. It also makes the pouch easy and inexpensive to manu- facture, which is important since it is intended for onetime use. It is sufficient to make a number of apertures in the pouch in the vicinity of the opening, or to turn down the edge and weld a hem along part of the edge of the opening. It is also preferred for the pouch at the opening to comprise a cut-out portion which gives the opening an extension downwards along the pouch, said cut-out portion being arranged so as to face away from the inserting means when the pouch is fastened to the actuating means. This facilitates insertion of a specimen into the pouch since the opening will be larger in relation to the size of the pouch. The opening will also face the specimen, which further facilitates the insertion. It is particularly preferred that the edge at the opening of the pouch, at least at the cut-out portion, be provided with a stiffening, which stretches and stabilises the opening, since this further facilitates the insertion of a speci- men. Such stiffening also increases the strength of the pouch and reduces the risk of its breaking.

The above type of pouch with a cut-out portion and optionally also a stiffening can also be used together with other actuating means than the one discussed above, and gives advantages also in cases where the pouch is not exchangeable etc .

It is also convenient that the pouch is at least partly rollable onto the actuating means and that the pouch in its rolled-up state is retractable together with the actuating means into the inserting means. This is desirable in connection with the insertion since the insertion will consequently be facilitated. However, this is still more important in connection with extrac- tion since the opening of the pouch can thus be rolled in and covered by the rest of the pouch material , which decreases the risk of contamination. This functions even if the rolled-up opening of the pouch is not retracted into the sleeve but is directly extracted through the body opening after the sleeve has been extracted.

It is also very preferred that the device further comprises a working means, which is insertable through the inserting means, said working means comprising an active end which is adapted, when in use, to be moved past the pouch and an actuating end, which is adapted, when in use, to remain outside the proximal end of the inserting means. The working means can be many different types of instruments for working of specimens, such as a gripping means, a pair of scissors etc. In the case of a gripping means, for instance the entire extraction procedure can take place through a single body opening. By using the same insertion sleeve as the actuating means, the insertion of the specimen into the pouch will besides be very easy. The specimen is quite simply grasped with the aid of the gripping means, which is pulled inwards to the insertion sleeve. In this position, the specimen is automatically positioned straight above the pouch, which means that it need only be released to land correctly in the pouch. The surgeon's work of inserting the specimen into the pouch is thus facilitated to a considerable extent . The above-described combination of actuating means and working means can also be used in other kinds of system than the one discussed above, i.e. in systems with non-replaceable pouches etc.

The invention also relates to a pouch and an actuat- ing means for use together with a device as described above .

Brief Description of the Drawings

The invention will now be described in more detail by way of embodiments and with reference to the accompanying drawings, in which

Fig. 1 is a perspective side view of a device according to an embodiment of the invention, in a position prepared for insertion through a body opening; Fig. 2 is a perspective side view of the device in Fig. 1 in a position of use;

Fig. 3 is a perspective side view of the distal end of the device in Fig. 2, the device being inserted through a body opening; Fig. 4 is a top plan view of the device in Fig. 3 ; and

Fig. 5 is a side view of a pouch according to an embodiment of the invention.

Descrivtion of Preferred Embodiments

The device for encompassing and extracting specimens in endoscopic surgery according to the invention comprises, as shown in Figs 1-5, an inserting means 1, an actuating means 2, a pouch 3 and optionally a gripp- ing means 4.

The inserting means 1 comprises a tubular sleeve 10, with two ducts 11, 12, with a distal end adapted, when in use, to be inserted through a body opening and a second, proximal end adapted to remain outside the body opening. The inserting means can, when necessary, comprise a valve or the like which prevents gas from escaping through the body opening. The insertion sleeve can be made of plastic for multiple use, but is preferably made of a metal material, such as stainless steel.

The actuating means 2 is displaceably arranged in the inserting means, in the first duct 11, and has also a distal end 21 adapted, when in use, to be inserted through a body opening and a second, proximal end 22 which is adapted to remain outside the body opening, and a shank part 20 joining these ends. At the distal end, the pouch is releasably and exchangeably arranged in such manner that the user can, via the proximal end of the inserting means, actuate the opening of the pouch to open and close the same. The distal end of the actuating means preferably comprises arms which are movable towards and away from each other and act as the jaws of a forceps. The arms can be operated from the proximal end by the arrangement of a plurality of parallel rods in the shank part, by the arrangement of one or more threads extending along the shank part or the like.

The pouch comprises a pouch portion 3 with an open- ing. At the opening, or at least in the vicinity thereof, there are also arranged fastening means 31, which are adapted to be engaged with the arms by being moved in the longitudinal direction of the arms. This can be carried out, for example, by arranging grooves in the arms of the actuating means, in which grooves thickened edges of the pouch can be inserted. However, it is preferred that the fastening means instead comprise at least one inlet 31 for each arm, in which case the pouch can be fastened to the actuating means by passing the arms into the respective inlets. Such inlets can be provided by arranging a number of apertures in the vicinity of the opening of the pouch. However, it is preferred that the fastening means comprise ducts 31 which are extended in the longitudinal direction and arranged at the opening of the pouch. Such ducts can be formed by the edge at the opening being turned down and fixed, for example, by means of welding.

Moreover, the pouch can advantageously have a downwardly tapering shape, which results in an advantageous reshaping of the specimen, as shown in Fig. 5. In this way, it is ensured that the shape of the specimen is reshaped into a shape which is advantageous for extraction.

The actuating means thus is intended for multiple use and the pouch for one-time use. This makes it possible to manufacture the actuating means with high qua- lity and at a higher cost, but keeping a low price per operation. The pouch has a simple but expedient construction and can be manufactured at a low price. Different sizes of the pouch, such as pouches with openings of different size, can be used for the same actuating means. The pouch is easily adapted to the actuating means by the user before each occasion of use .

It is also preferred that the pouch at the opening comprises a cut-out portion which gives the opening an extension downwards along the pouch, said cut-out por- tion being arranged so as to face away from the inserting means when the pouch is fastened to the actuating means. This increases the size of the opening and results in a shape which facilitates the insertion of specimens into the pouch. The pouch can further, at the opening and at least at the cut-out portion, comprise a stiffening 32. Moreover the pouch is made of such a flexible material as to allow rolling up of at least parts thereof onto the actuating means. It is also convenient that the pouch in its rolled-up state is retractable together with the actuating means into the inserting means.

Moreover the device advantageously comprises a gripping means 4 which is insertable through the inserting means, together with the actuating means, said gripping means comprising a gripping end 41, which is adapted, when in use, to be moved past the pouch, and an actuating end, which is adapted, when in use, to remain outside the proximal end of the inserting means. The gripping end comprises preferably two relatively stiff gripping arms which act as the jaws of a forceps, and which from the actuating end can be moved towards and away from each other. Other variants of gripping means, such as nooses or the like, are also feasible. It is also advantageous to provide guiding between the actuating rod and the gripping means so that they extend in the same direction. This can be carried out, for example, by the gripping means being inserted through the actuating means if the shank of the actuating means is a tube.

For insertion, the pouch 3 can advantageously be rolled up onto the arms 21 of the actuating rod or be folded and gripped between the arms, whereupon it is pulled into the insertion sleeve 1, as shown in Fig. 1. Subsequently the insertion sleeve is inserted into the body cavity and the actuating rod 2 is then moved forwards, whereby the pouch will be inserted further into the body opening, past the distal end 11 of the inserting means. The pouch is then unrolled (unfolded) to the posi- tion shown in Fig. 2. If the pouch is folded between the arms, it is sufficient for the arms to open for the pouch to be released, but if it is rolled up, the actuating rod must be rotated to unroll the pouch. Then the pouch can be opened by the arms being opened. The pouch and the opening of the pouch are now easily actuated from the outside with the aid of the actuating means.

Through the actuating means, or preferably beside the actuating means but through the insertion sleeve, the gripping means 4 is then inserted (i.e. through the same inlet) . This occurs preferably in a separate duct 12 in the insertion sleeve. The insertion sleeve, along with the actuating means, is now directed directly towards the specimen and the gripping means is advanced and grasps the specimen. Subsequently the gripping means along with the specimen is pulled back so that the specimen is located above the opening of the pouch as shown in Figs 3 and 4, after which the specimen is released and falls down in the pouch.

For extraction, the actuating means is rotated so that the opening of the pouch is rolled up onto the arms. Optionally, the point of the cut-out portion can be grasped by the gripping means or using a different forceps and can then be pulled/inserted into the opening before this is rolled up. Any contamination along the opening of the pouch is then encompassed by pouch por- tions located below the opening.

The device according to the invention is well suited for laparoscopic surgery in abdominal wall and abdomen, but can in applicable parts also be used for thoracic wall and thoracic cavity and each body cavity which can be involved in endoscopic surgery with the corresponding problems in extraction of specimens. Moreover the device is particularly suited for extraction of small specimens. It may, however, also be used for larger specimens, in which case a division of the specimen into smaller parts can be take place above the opening of the pouch or inside the pouch by means of a dividing instrument .

Several variants of the invention, of which some have already been mentioned, are of course feasible. For example, the pouch can be designed in various ways, and in particular e.g. different types of fastening means can be used. Further the arms of the actuating means can be designed in a manner other than described above, the gripping means can alternatively be inserted sideways etc. Such obvious variants must be considered to be comprised by the invention as defined by the appended claims .

Claims

1. A device for encompassing and extracting speci- mens m endoscopic surgery, comprising an inserting means (1), which comprises a tubular sleeve (10) with a distal end adapted to be inserted, when m use, through a body opening and a second, proximal end adapted to remain outside the body opening, an actuating means (2) which is displaceably arranged m the inserting means (1) , and a pouch (3) formed with an opening and arranged at the distal end, intended for insertion, of the actuating means (2), the actuating means being adapted to enable, from the proximal end of the inserting means, actuation of the opening of the pouch to open and close the same, c h a r a c t e r i s e d m that the actuating means (2) comprises arms (21) which are movable towards and away from each other, and that the pouch (3) comprises fastening means (31) for releasable fastening to the arms of the actuating means (21) , the pouch being an exchangeable unit of the device.

2. A device as claimed m claim 1, c h a r a c t e r i s e d m that the fastening means (31) of the pouch are adapted to be engaged with the arms (21) of the actuating means by being moved m the longitudinal direction of the arms.

3. A device as claimed m claim 2, c h a r a c t e r i s e d m that the fastening means (31) comprise at least one inlet for each arm, the pouch being capable of being fastened to the actuating means by passing the arms into the respective inlets.

4. A device as claimed m claim 3, c h a r a c t e r i s e d m that the fastening means of the pouch comprise ducts (31) extended m the longitudinal direc- tion and arranged at the opening of the pouch.

5. A device as claimed m claim 2, c h a r a c t e r i s e d m that the arms (21) of the actuating means comprise grooves, and that the fastening means (31) of the pouch comprise areas which are arranged at the opening of the pouch and have an increased thickness and which are adapted to be inserted into said grooves.

6. A device as claimed in any one of the preceding claims, c h a r a c t e r i s e d in that the pouch (3) at its opening comprises a cut-out portion which gives the opening an extension downwards along the pouch, which cut-out portion is arranged to face away from the insert- ing means (1) when the pouch is fastened to the actuating means (2 ) .

7. A device as claimed in claim 6, c h a r a c t e r i s e d in that the edge of the pouch opening, at least at the cut-out portion, is provided with a stiffen- ing (32) .

8. A device as claimed in any one of the preceding claims, c h a r a c t e r i s e d in that the pouch (3) further is at least partly contractible by being rollable onto the arms (21) of the actuating means.

9. A device as claimed in any one of claims 1-7, c h a r a c t e r i s e d in that the pouch (3) further is at least partly contractible between the arms (21) of the actuating means.

10. A device as claimed in claim 8 or 9, c h a r - a c t e r i s e d in that the pouch (3) in the contracted state is retractable together with the actuating means (2) into the inserting means (1) .

11. A device as claimed in any one of the preceding claims, c h a r a c t e r i s e d in that it further com- prises a working means (4) , which is insertable through the inserting means, said working means comprising an active end (41) which is adapted, when in use, to be moved past the pouch (3) and an actuating end (42), which is adapted, when in use, to remain outside the proximal end of the inserting means (1) .

12. A device as claimed in claim 11, c h a r a c t e r i s e d in that the active end comprises two pre- ferably relatively stiff gripping arms (41) which from the actuating end (42) can be moved towards and away from each other.

13. A pouch for use in endoscopic surgery to encom- pass and extract specimens, sa d pouch (3) comprising an opening, c h a r a c t e r i s e d in that the pouch comprises fastening means (31) for releasable fastening to an actuating means (2) , the pouch being an exchange¬

14. A pouch as claimed claim 13, c h a r a c t e r i s e d in that the fastening means (31) of the pouch are adapted to be engaged with the arms (21) of the actuating means by being moved the longitudinal direction of the arms.

15. A pouch as claimed in claim 14, c h a r a c t e r i s e d in that the fastening means (31) comprise at least one inlet into which arms (21) of the actuating means are sertable, the pouch being capable of being fastened to the actuating means by passing the arms into the respective inlets.

16. A pouch as claimed m claim 15, c h a r a c t e r i s e d that the fastening means (31) of the pouch comprise ducts extended m the longitudinal direction and arranged at the opening of the pouch.

17. A pouch as claimed m any one of claims 13-16, c h a r a c t e r i s e d in that the pouch (3) at the opening comprises a cut-out portion which gives the opening an extension downwards along the pouch, said cut-out portion being arranged so as to face away from the inserting means when the pouch is fastened to the actuating means.

18. A pouch as claimed claim 17, c h a r a c t e r i s e d in that the edge at the opening of the pouch, at least at the cut-out portion, is provided with a stiffening (32) .

19. An actuating means (2) for use endoscopic surgery, with a distal end (21) adapted to be inserted, when in use, through a body opening and a second, proximal end (22) which is adapted to remain outside the body opening, said actuating means being adapted to enable, from the proximal end, actuation of the opening of a pouch arranged on the actuating means, to open and close the pouch, c h a r a c t e r i s e d in that the actuating means comprises at the distal end arms (21) which are movable towards and away from each other and act as a forceps, and on which the pouch can be releasably fasten- ed with the aid of fastening means.

20. An actuating means as claimed in claim 19, c h a r a c t e r i s e d in that that arms (21) comprise longitudinal grooves for fastening the pouch.