WO2016203089A1

WO2016203089A1 - Laparoscopic extractor

Info

Publication number: WO2016203089A1
Application number: PCT/ES2016/070460
Authority: WO
Inventors: Manuela TORRES LORITE; Francisco Andrés López De La Fuente
Original assignee: Servicio Andaluz De Salud
Priority date: 2015-06-19
Filing date: 2016-06-17
Publication date: 2016-12-22
Also published as: ES2597654A1; ES2597654B1

Abstract

The invention relates to a laparoscopic extractor for the extraction of anatomical parts, comprising: forceps (3) having multiple arms configured for alternating between a closed position in which it is accommodated inside the tube (2), and an open position in which it projects via the distal end of the tube (2); and a bag (4) configured for alternating between a folded position in which it is accommodated inside the tube (2), and an unfolded position in which it projects via the distal end of the tube (2).

Description

LAPAROSCOPIC EXTRACTOR DESCRIPTION OBJECT OF THE INVENTION

The present invention belongs in general to the field of medicine, and more particularly to the devices used for the extraction of anatomical pieces by laparoscopy.

The object of the present invention is an improved laparoscopic extractor.

BACKGROUND OF THE INVENTION Laparoscopy consists primarily of a minimally invasive surgical technique consisting of performing the intervention with the help of specific instruments through a very small incision. This technique allows to reduce recovery times and the risks associated with a conventional surgical intervention.

Sometimes, during a laparoscopic intervention, it is necessary to remove an anatomical piece of a certain size through the small incision made. This operation is not always simple, and many extractors specifically designed for this purpose have been developed.

Most of the current extractors are formed by a bag that is inserted into the patient's cavity in a folded state inside a tube, and which are subsequently deployed inside with the purpose of "trapping" the anatomical piece in question. Once the anatomical piece is housed in the bag, it is pulled until the anatomical piece leaves the cavity through the incision. An example of this type of extractors is described in US patent application 2011/0184435.

Another known option is the use of a laparoscopic clamp formed by two arms that pivot around a common axis arranged at the end of a tube. The tweezers hold the anatomical part in question and pull it until it is removed. Through the incision. An example of this type of clamp is described in international patent application WO2013182730.

DESCRIPTION OF THE INVENTION

The present invention describes a new laparoscopic extractor for anatomical pieces that essentially comprises a multi-arm clip equipped with a bag emerging from its interior. This extractor allows a smooth extraction of the anatomical part thanks to the fact that the clamp has a gradually increasing section when it is holding an anatomical part. In addition, the internal bag allows to avoid the danger that the anatomical part can detach from the multi-arm clamp during the extraction maneuver.

The present invention is directed to a laparoscopic extractor for the extraction of anatomical pieces comprising a tube provided with a distal end and a proximal end, and also comprising: a) Clamp This is a multi-arm clamp configured to alternate between a closed position in which it is housed inside the tube and an open position in which it protrudes through the distal end of the tube.

In a preferred embodiment of the invention, the clamp comprises a plurality of arms arranged so that, when they are in the open position, they create a cavity therein, said cavity closing as the arms are introduced into the tube to pass The closed position. In this way, the user can reduce the volume of the internal cavity of the clamp by partially inserting the arms into the tube, so that the anatomical piece is compressed and its passage through the incision is facilitated. In addition, the plurality of arms that generate the cavity prevents the anatomical part to be removed from being detached or out of the clamp during the extraction process. The number of arms can be variable, although preferably the clamp comprises between 8 and 14 arms. As for the shape of the clamp when it is in its open position, it preferably has a first section of gradually increasing cross-section from the distal end of the tube and an optionally a second section of decreasing cross-section. In essence, it is about facilitating the exit of the clamp, with the anatomical part housed inside, through the incision. For this, it is enough that the cross section of the first section is gradually increased from the distal end of the tube, which facilitates the gradual elongation of the tissues of the incision and minimizes the risk of tears. For example, said first section may have an essentially conical shape with the vertex at the distal end of the tube.

Optionally, the clamp may have a second section of decreasing cross-section, although in this case it is not important if it decreases gradually or more sharply. In another preferred embodiment of the invention, the free end of the arms of the clamp is curved inwardly essentially in the direction of the axis of the tube to prevent the anatomical part from leaving the cavity. It can be a claw-like curvature or the like directed inwardly essentially in the direction of the axis of the tube with an angle of curvature of approximately 90 ° in relation to the direction of the arm in question.

In addition, the free end of the caliper arms is "blunt" to avoid puncturing the bag during operations.

According to yet another preferred embodiment, the extractor comprises a first clamp drive mechanism configured to pass it between the open position and the gradually closed position. In principle, this first drive mechanism can be configured in any way as long as it allows the clamp to be gradually closed in order to catch and compress the anatomical part to be removed in a controlled manner, although preferably the first drive mechanism is of the type hydraulic. The use of a first hydraulic drive mechanism instead of a mechanical one, such as those commonly used in this area, improves the haptic perception and control of the force exerted by the user. In other words, it allows the user to have a greater "touch" when carrying out the opening and closing of the clamp. Preferably, the first drive mechanism comprises a hydraulic circuit in communication with the base of the arms and driven by a movable piston with the aid of a first trigger located at the proximal end of the tube. When the user activates the trigger, the fluid pressure is transmitted to the base of the arms causing it to enter or exit the tube, which causes the clamp to close or open respectively. The fluid used in the circuit can be distilled water, which is harmless to the patient in the event of a spill. A particular example of the first drive mechanism according to the invention will be described in detail later in this document.

Bag

It is a bag configured to alternate between a retracted position in which it is housed inside the tube and an unfolded position in which it protrudes through the distal end of the tube. Furthermore, according to a preferred embodiment of the invention, when the bag is in the unfolded position it protrudes from the distal end of the tube beyond the free end of the arms of the clamp when it is in the open position.

The bag can be configured fundamentally in two ways.

In a first mode, when the bag returns to the stowed position from the unfolded position, it is housed inside the caliper cavity. In this embodiment, therefore, the bag is first used to trap the anatomical piece, then the bag is retracted to drag the anatomical piece inside the clip, and finally the clip is closed to accommodate and compress both elements inside during the extraction maneuver.

In a second mode, when the bag returns to the stowed position from the deployed position, it houses the clamp inside. In this embodiment, therefore, the clip is first used to trap the anatomical piece, then the clip is retracted to drag the anatomical piece to an area near the distal end of the tube and compress it, and finally the bag is folded to accommodate both elements inside during the extraction maneuver. In this second mode, preferably the inner face of an intermediate section of the caliper arms comprises protrusions configured to engage the anatomical part and prevent it from moving. These are projections configured as "harpoons" or the like directed towards the inside of the cavity.

In a preferred embodiment of the invention, the extractor comprises a second bag drive mechanism configured to pass it between the deployed position and the retracted position. This second drive mechanism comprises a second trigger located at the proximal end of the tube.

In another preferred embodiment of the invention, the extractor of the invention further comprises means for closing the bag. The closure of the bag is intended to prevent its fluids from coming into contact with the abdominal wall during the extraction maneuver. In principle, these means can be implemented in different ways, although they preferably comprise a thread that has a loop that runs along the edge of a bag sack and that has a proximal end located in a proximal portion of the extractor. When the user pulls said proximal end of the thread, the loop is closed by dragging the edges of the bag.

Note that the actuation mechanisms of the clamp and the bag are independent of each other, so that the user can operate one or the other individually depending on the needs of the extraction process. Thus, in an extraction process the tube is first introduced, with the clamp in the closed position and the bag in the folded position, into the patient's cavity through the incision. Next, the first trigger is used to open the clamp and the second trigger to deploy the bag. Once the clamp and bag are respectively open and deployed inside the patient's cavity, the procedure is slightly different depending on whether the bag is configured according to the first mode or the second mode.

In the first mode of the invention, where the bag is housed inside the clamp when it is folded, the tube is then handled to orient the extractor towards the place where the anatomical part in question and the second trigger are located for unfold or fold the bag as necessary for the purpose of housing the anatomical part in question inside the bag. Once the anatomical part is inside the bag, it is retracted by pulling the second trigger, so that the bag with the anatomical part is located at the distal end of the tube, inside the caliper cavity, which is still in the state open. Then, the means for closing the bag are activated, which in this way waterproofs the anatomical piece so that contact between its fluids and the abdominal wall cannot occur during the extraction maneuver. The user then triggers the first trigger to bring the clamp to its closed state. The caliper cavity gradually closes, the free ends curved into the caliper arms prevent the anatomical part from coming out. The anatomical piece is compressed inside the caliper cavity. The user can now pull the extractor to remove the anatomical piece. The gradually increasing shape of the cross section of the first section of the clamp, which is only partially closed, makes it easier for large pieces to exit through relatively smaller incisions. During this process, the curvature into the free end of the caliper arms, and, above all, the bag, prevents the anatomical part from leaving the inside of the caliper cavity.

In the second mode of the invention, where the bag houses the clamp when it is retracted, the procedure is similar although in this case the tube and the first trigger are first handled to catch the anatomical part with the clamp. Once this is done, the user activates the first trigger to bring the clamp to a partially closed state. The clamp catches the anatomical piece, which is firmly attached thanks to the curved free ends of the clamp arms and the projections as harpoons of the clamp arms. The second trigger is then activated to fold the bag, which thereby catches the clamp with the anatomical part inside. The closing means of the bag are then activated to prevent the escape of fluids from the anatomical part. The result is that the clamp with the anatomical piece firmly trapped inside it is housed inside the closed bag. Finally, the extraction maneuver is carried out in a manner similar to that described above.

In another preferred embodiment of the invention, the tube is divided longitudinally into two compartments configured to respectively accommodate the clamp and the bag. Normally, the clamp compartment has a cross section substantially larger than the bag compartment, the bag being housed in a more restricted space. Indeed, the clamp is formed by a plurality of arms that take up more space than the bag. The bag may be formed, for example, by a rod that ends in a folding or flexible ring to which the edges of a bag made of a plastic material such as polyvinyl or the like are fixed. The rod with the ring can be made, for example, of a shape memory material so that they adopt the described form automatically upon exiting the tube when they enter the deployed state from the retracted state. BRIEF DESCRIPTION OF THE FIGURES

Figs. 1 a and 1 b show respectively a schematic and detailed view of the extractor of the present invention with the clamp in the closed position and the bag in the folded position.

Figs. 2a-2c respectively show a schematic view of an example of an extractor according to the first mode of the present invention with the clamp in the open position and the bag in the deployed position, a detail view of the same extractor, and a schematic view of the bag housed inside the clamp.

Figs. 3a-3d respectively show a schematic view of an example of an extractor according to the first mode of the present invention with the clamp in the open position and the bag in the deployed position, a detail view of the same extractor, a schematic view of the bag housing the clamp inside, and a detail of an arm of the clamp.

Figs. 4a-4b show a detail of the closure means of the bag respectively in an open and closed state. Fig. 5 shows a cross section of the extractor tube of the present invention.

PREFERRED EMBODIMENTS OF THE INVENTION Figs. 1 a and 1 b show the extractor (1) of the present invention with the bag (4) folded and the clamp (3) closed. The clamp (3) is formed by a plurality of individual arms which, in closed position, are arranged together and in parallel housed in a distal section of the tube (2), which preferably has a length between 25 cm and 30 cm. The arms of the clamp (3) are fixed to a common base equipped with a piston (21) that slides along the tube (2) thanks to the first drive mechanism (7). This first drive mechanism (7) is formed by a hydraulic circuit (8) that covers the inside of the tube (2) and a wider duct located in the handle area (20) of the extractor (1) located at the proximal end of the tube (2). A sliding trigger (10) has a toothed surface that meshes with an intermediate toothed wheel (22), which in turn is engaged to a toothed rod (23) fixed plunger (9).

When the user activates the trigger (10) distally, it moves and rotates the intermediate gear wheel (22), which in turn moves the toothed rod (23) and therefore the piston (9) also in the direction distal When the piston (9) travels distally, it compresses the hydraulic circuit (8) and the pressure communicates towards the distal portion of the tube (2) where the plunger (21) is located, which consequently slides towards the distal end of the tube (2). The arms of the clamp (3) tend to exit through the distal end of the tube (2). The arms of the clamp (3) made of a material with shape memory, so that when they are released outside the tube (2) they automatically take the form corresponding to their open state. Conversely, when the user activates the trigger (10) in the proximal direction, the plunger (9) also moves in the proximal direction, which generates a depression that pulls the plunger (21) and forces the caliper (3) to return to enter the tube (2). The stroke of the piston (9) can be made equal to the stroke of the trigger (10), which allows the user to precisely control the opening and closing of the caliper (3) during the extraction maneuver.

Figs. 2a-2c show an example of an extractor (1) where the bag (4) is configured according to the first mode described above. In this first mode, when the bag (4) is retracted from its deployed state, it is housed inside the clamp (3). This is clearly seen in Fig. 2c.

Figs. 2a and 2b show the shape that the clamp (3) adopts when it is in its open position. It is a conical clamp (3) with its end located at the distal end of the tube (2). Therefore, in this example the clamp (3) is formed only for a first section (3a). This conical shape facilitates the extraction of the anatomical part in question, since when it is time to pull the extractor (1) it allows a progressive elongation of the tissues of the incision. Optionally, the clamp (3) could also have a second section (3b) of decreasing section, and therefore does not significantly affect the extraction maneuver. In Fig. 2b, the second section (3b) of the clamp (3) is marked for illustrative reasons only.

The arms of the clamp (3) have their free end (5) curved inwards essentially in the direction of the axis of the tube (2). This prevents the bag (4) with the anatomical piece from leaving the clamp (3) during extraction, as shown in Fig. 2c.

The bag (4) is formed by a rod (24) at the end of which is a folding ring (25) that provides consistency to a polyvinyl bag (26) or a similar material. The bag (4), when in its folded position, is housed inside the tube (2) with the rod (24) and the ring (25) folded.

A second drive mechanism (11) is designed to carry out the deployment and folding of the bag (4). This mechanism (11) is essentially formed by a sliding trigger (12) connected to the rod (24), so that when the trigger (12) is retracted proximally, the bag (4) is retracted, while when the trigger (12) is pushed distally the bag (4) tends to exit the distal end of the tube (2). As can be seen in Fig. 2b, the length of the rod (24) of this example is greater than the length of the arms of the clamp (3), so that the bag (4) in its most deployed position corresponding to the end The trigger stroke (1 1) distally is beyond the clamp (3) when it is open. This facilitates the maneuver of the extractor (1) to catch the anatomical part in question.

Figs. 3a-3b show similar figures to Figs. 2a-2b, although in this case corresponding to an example of the second mode of the extractor (1) of the invention. A detailed description of these two figures is omitted because the elements that appear therein are equivalent to those in Figs. 2a-2b. Fig. 3c shows a view of the bag (4) with the clip (3) housed inside. Fig. 3d shows an arm of the clamp (3) of this second mode that has projections (6) as harpoons directed inwards and located in an intermediate position. These projections (6) will be hooked to the anatomical piece to make it even more difficult for it to leave the clamp (3) during the extraction maneuver.

Figs. 4a-4b show an example of the bag closure means (4). As can be seen in Fig. 4a, it is a thread (27) that has a proximal end (28) that protrudes next to the second trigger (12), runs along the entire length of the tube (2) until it exits its distal end , surrounds the ring (25) attached to the bag (26) of the bag (4), and returns to the tube (2) for the other end at a fixed point. Fixing to the bag (26) of the bag (4) can be carried out simply by having the thread (27) run inside a hem of the bag (26). To close the bag (4), the user only has to pull the proximal end (28) of the thread (27), so that the loop is closed in the direction of the distal end of the tube (2) by dragging the edge of the sack ( 26).

Finally, Fig. 5 shows a cross section of the tube (2). As can be seen, the inner volume of the tube (2) is divided into two longitudinal compartments (2a, 2b). The compartment (2a) is intended to accommodate the clamp (3), as well as part of the hydraulic circuit (8) for actuating the clamp (3). This compartment (2a) covers most of the cross section of the tube (2), normally cylindrical. The other, smaller, longitudinal compartment (2b) is intended to accommodate the bag (4). As can be seen, this compartment (2b) is located in a peripheral area of the circumference of the cross section of the tube (2) and has an arched shape as a crescent. The rod (24) and the folding ring (25) that make up the bag (4) therefore have a flat cross section that allows them to be accommodated in this compartment (2b). Also the thread (27) of the closure means of the bag travels inside the compartment (2b) of the tube (2).

Claims

1. Laparoscopic extractor (1) for the extraction of anatomical pieces, comprising a tube (2) provided with a distal end and a proximal end, characterized in that it also comprises:

- a multi-arm clamp (3) configured to alternate between a closed position in which it is housed inside the tube (2) and an open position in which it protrudes through the distal end of the tube (2); Y

- a bag (4) configured to alternate between a retracted position in which it is housed inside the tube (2) and an unfolded position in which it protrudes through the distal end of the tube (2).

2. Laparoscopic extractor (1) according to claim 1 wherein, when the bag (4) is in the deployed position, it protrudes from the distal end of the tube (2) beyond the free end (5) of the arms of the clamp (3) when said clamp (3) is in the open position.

3. Laparoscopic extractor (1) according to any of the preceding claims, wherein the clamp (3) comprises a plurality of arms arranged so that, when they are in the open position, they create a cavity inside, said cavity being closed to as the arms are introduced into the tube (2) to move to the closed position.

4. Laparoscopic extractor (1) according to any of the preceding claims, wherein the clamp (3), when in the open position, has a first section (3a) of gradually increasing cross-section from the distal end of the tube (2 ) and optionally a second section (3b) of decreasing cross section.

5. Laparoscopic extractor (1) according to claim 4, wherein the first section (3a) of the clamp (3), when in the open position, has an essentially conical shape with the vertex at the distal end of the tube ( 2).

6. Laparoscopic extractor (1) according to any one of the preceding claims, wherein the free end (5) of the clamp arms (3) is curved inward essentially in the direction of the tube axis (2) to prevent the piece Anatomical can leave the cavity.

7. Laparoscopic extractor (1) according to any of the preceding claims, wherein the clamp (3) comprises 8-14 arms.

8. Extractor (1) according to any of the preceding claims, wherein bag (4) is configured to, when returning to the stowed position from the deployed position, stay inside the clamp (3).

9. Laparoscopic extractor (1) according to any of claims 1-7, wherein the bag (4) is configured to, when returning to the stowed position from the deployed position, accommodate the clamp (3) inside.

10. Laparoscopic extractor (1) according to claim 9, wherein the internal surface of an intermediate section of the clamp arms (3) comprises projections (6) configured to engage the anatomical part.

1 1. Laparoscopic extractor (1) according to any one of the preceding claims, further comprising a first clamp drive mechanism (7) configured to pass it between the open position and the closed position gradually.

12. Laparoscopic extractor (1) according to claim 11, wherein said first drive mechanism (7) comprises a hydraulic circuit (8) in communication with the base (21) of the arms and driven by a movable piston (9) with the help of a trigger (10) located at the proximal end of the tube (2).

13. Laparoscopic extractor (1) according to any of the preceding claims, further comprising a second mechanism (11) for actuating the bag (4) configured to pass it between the deployed position and the retracted position comprising a second trigger (12) located at the proximal end of the tube (2).

14. Laparoscopic extractor (1) according to any of the preceding claims, further comprising means for closing the bag.

15. Laparoscopic extractor (1) according to claim 14, wherein the means for closing the bag comprise a thread (27) having a proximal end (28) located in a proximal portion of the extractor (1) and a loop that runs the edges of a bag (26) of the bag (4) and, so that by pulling said proximal end (28) of the thread (27) the loop is closed by dragging the edges of the bag (26).

16. Laparoscopic extractor (1) according to any of the preceding claims, wherein the tube (2) is divided longitudinally into two compartments

(2a, 2b) configured to accommodate respectively the clamp (3) and the bag (4).