US20060178564A1 - Surgical rotary capture instrument for gastric band closing - Google Patents
Surgical rotary capture instrument for gastric band closing Download PDFInfo
- Publication number
- US20060178564A1 US20060178564A1 US11/316,194 US31619405A US2006178564A1 US 20060178564 A1 US20060178564 A1 US 20060178564A1 US 31619405 A US31619405 A US 31619405A US 2006178564 A1 US2006178564 A1 US 2006178564A1
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- tool
- movable jaw
- endoscopic surgical
- capture
- rotationally movable
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- 210000002784 stomach Anatomy 0.000 claims description 18
- 210000001835 viscera Anatomy 0.000 claims description 18
- 238000007373 indentation Methods 0.000 claims description 13
- 238000002324 minimally invasive surgery Methods 0.000 claims description 10
- 238000000034 method Methods 0.000 claims description 9
- 210000000056 organ Anatomy 0.000 claims description 8
- 210000003813 thumb Anatomy 0.000 claims description 8
- 239000004809 Teflon Substances 0.000 claims description 4
- 229920006362 Teflon® Polymers 0.000 claims description 4
- 229910045601 alloy Inorganic materials 0.000 claims description 3
- 239000000956 alloy Substances 0.000 claims description 3
- 239000000919 ceramic Substances 0.000 claims description 3
- 239000002131 composite material Substances 0.000 claims description 3
- 239000002184 metal Substances 0.000 claims description 3
- 229920000642 polymer Polymers 0.000 claims description 3
- 239000005060 rubber Substances 0.000 claims description 3
- 210000001367 artery Anatomy 0.000 claims description 2
- 210000000988 bone and bone Anatomy 0.000 claims description 2
- 210000002216 heart Anatomy 0.000 claims description 2
- 210000000936 intestine Anatomy 0.000 claims description 2
- 210000003734 kidney Anatomy 0.000 claims description 2
- 210000004185 liver Anatomy 0.000 claims description 2
- 210000004072 lung Anatomy 0.000 claims description 2
- 210000000496 pancreas Anatomy 0.000 claims description 2
- 239000000463 material Substances 0.000 claims 2
- 238000002357 laparoscopic surgery Methods 0.000 abstract description 3
- 230000008901 benefit Effects 0.000 description 3
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
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- 230000037431 insertion Effects 0.000 description 1
- 238000012830 laparoscopic surgical procedure Methods 0.000 description 1
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- 230000036186 satiety Effects 0.000 description 1
- 235000019627 satiety Nutrition 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0013—Implantable devices or invasive measures
- A61F5/005—Gastric bands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0089—Instruments for placement or removal
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B2017/12018—Elastic band ligators
Definitions
- the present invention relates to an endoscopic surgical rotary capture instrument, and more particularly to a surgical rotary capture instrument used in minimally invasive laparoscopic surgery for closing a gastric band.
- One method of controlling the intake of food in an obese person is to place an adjustable restriction band 10 around the upper stomach 20 , shown in FIG. 1 .
- the band also controls the stoma, i.e., stomach outlet, between the upper stomach and the lower stomach 30 .
- the size of the stoma regulates the flow of food from the upper stomach to the lower stomach. When the stoma is small the patient feels full sooner and has a feeling of satiety that lasts longer.
- the gastric band 10 of the LAP-BAND system includes a body portion 11 a head portion 12 and a tail portion 13 .
- the head portion 12 has a buckle 19 with a pull tab 18 and the pull tab 18 has a hole 18 a for receiving a post.
- the tail portion 13 has a tube 14 extending from one end, a triangular shaped member 13 a and a conical shaped barb 13 b .
- Tube 14 is in communication with an inflatable member 16 of the inner surface 15 of the body portion 11 .
- the inflatable member 16 is gradually inflated by injecting a saline solution through the tube 14 .
- the inflated member 16 presses against and constricts the stomach wall underlying the band 10 . This results in decreasing the diameter of the stoma.
- the amount of the injected solution controls the size of the inflated member 16 and accordingly the diameter of the stoma.
- the tube 14 of the gastric band 10 is pushed through a laparoscopic cannula and is inserted in the patient's abdomen.
- the gastric band 10 is then placed around the patient's upper stomach and the tail portion 13 is inserted into the buckle 19 thereby forming a ring structure around the upper stomach.
- the triangular shaped member 13 a of the tail portion 13 interlocks with the buckle 19 and prevents the tube 14 from slipping backwards.
- the process of inserting the tail portion 13 into the buckle 19 requires simultaneously grasping the buckle 19 , inserting the tube 14 through the buckle conduit 19 a and then pushing the tube 14 .
- Minimally invasive tools are used for performing these mechanical manipulations needed for tightening the gastric band around the upper stomach.
- U.S. Pat. No. 5,658,298 A prior art combination tool for grasping the pull tab 18 and pushing the tube 14 is described in U.S. Pat. No. 5,658,298.
- This prior art tool includes two elongated slidably mounted cylindrical members and a handpiece. At the distal end of the first cylindrical member there is a post extending downwards that is dimensioned to engage the hole 18 a of the tab 18 from the top side, shown in FIG. 6 of U.S. Pat. No. 5,658,298.
- the second cylindrical member which is slidably mounted with respect to the first cylindrical member has mounted on its distal end a seat or a fork, shown in FIG. 3A of U.S. Pat. No. 5,658,298.
- This fork is dimensioned to capture protuberances such as the conical barb 13 b at the tube end of the band 10 and push the tube 14 through the buckle conduit 19 a , while the first cylindrical member engages and pulls on the pull tab 18 .
- Surgeons performing this type of laparoscopic surgery have encountered the problems of the post unintentionally slipping out of the hole 18 a and the fork unintentionally releasing the tube end of the band 10 during the band tightening procedure. This requires regrasping the tube end of the band 10 and the tab 18 several times during the procedure which increases both the operation time and the complexity of the operation.
- the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping and tightening a ligature band.
- the ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon.
- the elongated strap is configured to encircle an internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ.
- the capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle.
- the capture end is configured to engage a protuberance of the distal end and push the distal end after it has been threaded through the aperture.
- the capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft.
- Implementations of this aspect of the invention may include one or more of the following features.
- the elongated shaft is dimensioned to enter one end, pass through and extend beyond the other end of the cannula.
- the handle comprises a mechanism for actuating the rotational motion of the inner shaft, thereby actuating the rotationally movable jaw.
- the mechanism comprises squeezing a handle component.
- the handle comprises a cylindrical body having first and second side indentations opposite to each other and a thumb indentation on a top surface of the cylindrical body, the thumb indentation being aligned with the rotationally movable jaw.
- the handle further comprises a latch for keeping the rotationally movable jaw closed.
- the stationary jaw and the rotationally movable jaw form a circle when closed.
- the stationary jaw and the rotationally movable jaw comprise rounded edges.
- the stationary jaw and the rotationally movable jaw comprise a metal, ceramic, polymer, Teflon, alloys, rubber or composites.
- the stationary jaw and the rotationally movable jaw may have inner surfaces that are spherical, slopped, conical, or have one or more steps or grooves.
- the internal organ may be stomach, artery, intestines, heart, lung, pancreas, kidney, liver or bone.
- the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping an organ or another tool having a circular cross-section.
- the capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle.
- the capture end is configured to engage a protuberance of the organs or the other tool.
- the capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft.
- the invention features an endoscopic surgical instrument used in minimally invasive surgery through a cannula for grasping and tightening a ligature band around an internal organ.
- the ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon.
- the elongated strap is configured to encircle the internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ.
- the instrument comprises a hook tool configured to engage the hole and pull the pull tab in a first direction while the distal end is threaded through the aperture and pushed opposite to the first direction and a capture tool configured to engage a protuberance of the distal end and push the distal end.
- the hook tool comprises a hook having a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole.
- the capture tool comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of an elongated shaft. The hook tool and the capture tool apply opposing forces on the ligature band for tightening the ligature band around the internal organ.
- the invention features a method for tightening a ligature band around an internal organ via minimally invasive surgery.
- the method comprises first providing a ligature band comprising an elongated strap having a buckle end and a distal end.
- the buckle end has an aperture and a pull tab having a hole thereon.
- inserting a surgical hook tool through the cannula.
- the hook tool comprises an elongated shaft having a hook end and a handle.
- the hook end comprises a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole.
- engaging the hole with the hook end is inserting a surgical capture tool through the cannula.
- the capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle.
- the capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft.
- engaging a protuberance in the distal end with the capture tool and inserting the distal end through the aperture is pulling the pull tab in a first direction with the hook tool while pushing the distal end with the capture tool opposite to the first direction.
- the rotationally movable jaw provides flexibility in capturing an elongated organ, vessel, or other tool having a variety of circular cross-sectional dimensions.
- the rounded edges of the jaws prevent the jaws from digging and cutting into the organ or tool.
- the angle between the axis of the elongated shaft and the jaw axis may be varied depending upon the geometry of the organ that needs to be grasped.
- the inner surfaces of the jaws may be slopped, conical or have one or more steps. These configurations are useful in grasping organs with various cross-sectional geometries.
- the bend portion of the hook end together with the extension and the flat portion form a C-shaped hook that grasps securely the pull tab.
- the extension helps prevent slippage of the hook out of the hole.
- the inner surface of the bend portion is formed with a radius that matches the inside of the hole in the pull tab. This distributes the pulling force uniformly around the hole and prevents damaging of the pull tab during pulling.
- the flat portion of the hook end allows the hook end to slide easily underneath or above the pull tab.
- the capture tool may also be used in non-endoscopic procedures.
- FIG. 1 is a side view of a stomach with an adjustable gastric band around the upper part of the stomach;
- FIG. 2A is a perspective view of an open LAP-BAND gastric band
- FIG. 2B is the gastric band of FIG. 2A in a closed position forming a ring structure
- FIG. 3 is a perspective view of the endoscopic rotary capture instrument of this invention.
- FIG. 4 - FIG. 8 are perspective views of the pusher end of the instrument of FIG. 3 ;
- FIG. 9 - FIG. 12 are perspective views of the pusher end of the instrument of FIG. 3 engaging and pushing the barb end of the gastric band of FIG. 2A ;
- FIG. 13 is side view of the handle of the instrument of FIG. 3 ;
- FIG. 14 is a top view of the handle of the instrument of FIG. 3 ;
- FIG. 15 - FIG. 16 are perspective views of the pusher end of the instrument of FIG. 3 engaging and pushing the barb end of the gastric band of FIG. 2A through a buckle while a hook instrument is holding the buckle;
- FIG. 17 - FIG. 19 are perspective views of another embodiment of the rotary capture instrument of this invention.
- FIG. 20 is a perspective view of the endoscopic hook instrument of this invention.
- FIG. 21 is a perspective view of the hook end of the instrument of FIG. 20 ;
- FIG. 22 is a side view of the hook of FIG. 21 ;
- FIG. 23 is a top view of the hook of FIG. 21 ;
- FIG. 24 is perspective view of the handle of the instrument of FIG. 20 ;
- FIG. 25 is side view of the hook end of the instrument of FIG. 20 engaging the hole in the tab of the buckle of the gastric band of FIG. 2A ;
- FIG. 26 is a perspective view of the hook end of the instrument of FIG. 20 engaging the hole in the tab of the buckle of the gastric band of FIG. 2A .
- a surgical rotary capture instrument 200 includes a handle 210 , an elongated shaft 220 and a distal end component 230 .
- the handle 210 features a tactile control of the distal end component 230 .
- the handle 210 features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes two side indentations 211 , 212 opposite to each other and a thumb indentation 213 on the top surface.
- the handle 210 also features a squeeze-to-close, spring-loaded-open design.
- a rack actuates a gear, developing a rotary motion that actuates a movable jaw 232 at the end component 230 through a drive shaft 224 .
- the handle 210 also incorporates a latch 216 to keep the instrument in the closed position.
- the handle actuation could be any number of mechanical means that imparts the rotary motion required.
- the elongated shaft 220 has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery.
- the elongated shaft 220 has a length of 45 cm and a diameter of 5 mm, shown in FIG. 19 .
- Shaft 220 includes an outer shaft 222 and an inner shaft 224 .
- the end component 230 includes a stationary jaw 234 and a movable jaw 232 .
- the movable jaw 232 is actuated by rotary motion of the inner shaft 224 .
- jaws 234 , 232 form a circle having an inner diameter 235 of 4.8 mm and an outer diameter 236 of 7.6 mm.
- the front edge of opening 235 is rounded having a radius that matches the corner radius at the rear of barb 13 b and the diameter of the tube 14 .
- the rounded edge prevents the jaws from digging in and cutting into the tube 14 .
- the maximum distance 237 between the movable jaw 232 and the stationary jaw 234 is 10.5 mm.
- the angle 53 between the axis 52 of the elongated shaft 220 and the jaw axis 54 is 75 degrees, as shown in FIG. 11 and FIG. 17 . This angle 53 may be varied depending upon the geometry of the item that needs to be grasped.
- jaw 232 is rotated open and jaws 232 , 234 are positioned around the tube 14 of the gastric band 10 adjacent to an integral conical shaped barb 13 b that is intended to assist in closure.
- the handle 210 is then actuated causing the movable jaw 232 to rotate closed. This motion captures securely the tube 14 .
- the diameter 240 of the barb 13 b is larger than the inner diameter 235 of the closed jaws.
- the surgeon can then push the closed jaws 232 , 234 , against the integral barb 13 b , thereby causing the tube 14 to move forward.
- the surgeon threads the tube 14 through side 19 b of the buckle conduit 19 a , then captures the tube 14 from the other side 19 c of the buckle conduit 19 a with the jaws 232 , 234 and pushes the tube 14 in the direction 50 away from the buckle 19 by pushing the closed jaws 232 , 234 against the barb 13 b .
- a hook instrument 100 is used to pull the pull tab 18 of the buckle 19 .
- the triangular shaped member 13 a of the tail portion 13 interlocks with the buckle conduit 19 a and prevents the tube 14 from slipping backwards.
- the hook instrument 100 and the rotary capture instrument 200 apply opposing forces on the gastric band 10 in order to cinch and lock the band closed.
- the rotary capture instrument 200 of this invention is used to capture a vessel or a component, such as the anvil 250 of FIG. 17 .
- the shape of the jaws is selected so that they do not cause any damage to the component 250 . This is accomplished by adjusting the angle 53 between the axis of the jaws 54 and the shaft axis 52 . In one example the angle 53 is 60 degrees.
- the shape of the inner jaw surfaces 232 a , 234 a may also be varied to conform to the specific geometry of the component. 250
- the inner surfaces 232 a , 234 a may be slopped, conical, have one or more steps or have grooves that assist in grasping the component 250 .
- the opening 235 shown in FIG. 7 , is slightly larger than the diameter of the anvil stem. This allows the anvil stem to float slightly for ease of alignment with the mating stapler (not shown).
- Inner surfaces may also be coated with protective coatings such as Teflon.
- a surgical hook instrument 100 includes a handle 110 , an elongated shaft 120 and a hook end 130 .
- the handle 110 features a tactile control of the hook end.
- the handle 110 features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes two side indentations 111 , 112 opposite to each other and a thumb indentation 113 on the top surface.
- the elongated shaft 120 has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery. In one example, the elongated shaft 120 has a length of 45 cm and a diameter of 5 mm. Referring to FIG. 21 and FIG.
- the hook end 130 includes an angled portion, a flat portion 130 a bend portion 134 and an extension 136 .
- the angled portion 131 has a flat bottom surface 131 a and a downwards slopped top surface 131 b forming an angle 133 with the top surface 124 of the elongated shaft 120 .
- the flat portion 132 has a flat top surface 132 b and a flat bottom surface 132 a that extends continuously from the bottom surface 122 of the elongated shaft 120 and the bottom surface 131 a of the angled portion 131 .
- the top surface 132 b of the flat portion 132 forms an angle 135 with the top surface 131 b of the angled portion 131 .
- Angles 133 and 135 are supplementary to each other, i.e., their sum is 180 degrees. In one example, angle 133 is 20 degrees and angle 135 is 160 degrees.
- the flat portion 132 has a thickness of 1.3 mm, a width of 3.3 mm and a length of 13.4 mm.
- the bend portion 134 extends from the flat portion 132 and is bend upwards and towards the handle 110 .
- the inner surface 134 a of the bend portion 134 forms an angle 137 with the top surface 132 b of the flat portion 132 .
- Inner surface 134 a is formed with a radius that matches the inside of the hole 18 a in the pull tab 18 . This distributes the pulling force uniformly around the hole and prevents damaging of the pull tab 18 during pulling.
- the outer surface 134 b of the bend portion 134 is curved and forms an angle 138 with the top surface 132 b of the flat portion 132 .
- angles 137 and 138 are 40 and 60 degrees, respectively.
- Extension 136 extends from the bend portion 134 , points towards the handle 110 and is parallel to the flat portion 132 . In one example it has a length of 2.0 mm and a thickness of 0.8 mm. Extension 136 helps prevent slippage of the hook out of the hole 18 a .
- the inner surface of 136 forms an angle with the inner surface 134 a , which facilitates pickup of the hole 18 a by the hook 130 .
- the flat portion 132 of the hook end 130 is placed underneath the pull tab 18 of the gastric band buckle and the bend portion is inserted into the hole 18 a thereby engaging the pull tab.
- the bend portion 134 together with the extension 136 and the flat portion 132 form a C-shaped hook that grasps securely the pull tab 18 .
- the risk of unintentional disengagement is very low.
- a rotary capture instrument 200 (shown in FIG. 15 ) is used to capture and push the tube 14 of the gastric band 10 through the buckle conduit 19 a .
- the triangular shaped member 13 a of the tail portion 13 interlocks with the buckle conduit 19 a and prevents the tube 14 from slipping backwards.
- the hook instrument 100 and the rotary capture instrument 200 apply opposing forces on the gastric band 10 in order to cinch and lock the band closed.
Abstract
Description
- This application claims the benefit of U.S. provisional application Ser. No. 60/650,290 filed on Feb. 4, 2005 and entitled SURGICAL ROTARY CAPTURE INSTRUMENT FOR GASTRIC BAND CLOSING which is commonly assigned and the contents of which are expressly incorporated herein by reference.
- This application is also related to U.S. provisional application Ser. No. 60/650,284 filed on Feb. 4, 2005 and entitled SURGICAL HOOK INSTRUMENT FOR GASTRIC BAND CLOSING which is commonly assigned and the contents of which are expressly incorporated herein by reference.
- This application is also related to U.S. provisional application Ser. No. 60/670,111 filed on Apr. 11, 2005 and entitled GASTRIC BAND INSERTION INSTRUMENT which is commonly assigned and the contents of which are expressly incorporated herein by reference.
- The present invention relates to an endoscopic surgical rotary capture instrument, and more particularly to a surgical rotary capture instrument used in minimally invasive laparoscopic surgery for closing a gastric band.
- One method of controlling the intake of food in an obese person is to place an
adjustable restriction band 10 around theupper stomach 20, shown inFIG. 1 . This creates a new small stomach pouch in theupper stomach 20 for holding a small amount of food and leaves the larger part of the stomach below the band so the stomach volume available for holding food is reduced. The band also controls the stoma, i.e., stomach outlet, between the upper stomach and thelower stomach 30. The size of the stoma regulates the flow of food from the upper stomach to the lower stomach. When the stoma is small the patient feels full sooner and has a feeling of satiety that lasts longer. - One specific type of an
adjustable restriction band 10 is the LAP-BAND system manufactured by INAMED Corporation, shown inFIG. 2A andFIG. 2B . The LAP-BAND system is described in U.S. Pat. No. 5,601,604, the contents of which are incorporated herein by reference. Referring toFIG. 2A , thegastric band 10 of the LAP-BAND system includes a body portion 11 ahead portion 12 and atail portion 13. Thehead portion 12 has abuckle 19 with apull tab 18 and thepull tab 18 has ahole 18 a for receiving a post. Thetail portion 13 has atube 14 extending from one end, a triangularshaped member 13 a and a conicalshaped barb 13 b. Tube 14 is in communication with aninflatable member 16 of theinner surface 15 of the body portion 11. Theinflatable member 16 is gradually inflated by injecting a saline solution through thetube 14. The inflatedmember 16 presses against and constricts the stomach wall underlying theband 10. This results in decreasing the diameter of the stoma. The amount of the injected solution controls the size of the inflatedmember 16 and accordingly the diameter of the stoma. - During a minimally invasive laparoscopic surgical procedure, the
tube 14 of thegastric band 10 is pushed through a laparoscopic cannula and is inserted in the patient's abdomen. Thegastric band 10 is then placed around the patient's upper stomach and thetail portion 13 is inserted into thebuckle 19 thereby forming a ring structure around the upper stomach. The triangularshaped member 13 a of thetail portion 13 interlocks with thebuckle 19 and prevents thetube 14 from slipping backwards. The process of inserting thetail portion 13 into thebuckle 19 requires simultaneously grasping thebuckle 19, inserting thetube 14 through thebuckle conduit 19 a and then pushing thetube 14. Minimally invasive tools are used for performing these mechanical manipulations needed for tightening the gastric band around the upper stomach. - A prior art combination tool for grasping the
pull tab 18 and pushing thetube 14 is described in U.S. Pat. No. 5,658,298. This prior art tool includes two elongated slidably mounted cylindrical members and a handpiece. At the distal end of the first cylindrical member there is a post extending downwards that is dimensioned to engage thehole 18 a of thetab 18 from the top side, shown in FIG. 6 of U.S. Pat. No. 5,658,298. The second cylindrical member which is slidably mounted with respect to the first cylindrical member has mounted on its distal end a seat or a fork, shown in FIG. 3A of U.S. Pat. No. 5,658,298. This fork is dimensioned to capture protuberances such as theconical barb 13 b at the tube end of theband 10 and push thetube 14 through thebuckle conduit 19 a, while the first cylindrical member engages and pulls on thepull tab 18. Surgeons performing this type of laparoscopic surgery have encountered the problems of the post unintentionally slipping out of thehole 18 a and the fork unintentionally releasing the tube end of theband 10 during the band tightening procedure. This requires regrasping the tube end of theband 10 and thetab 18 several times during the procedure which increases both the operation time and the complexity of the operation. - Accordingly there is a need for an improved grasping and pushing tool used in tightening a band having a buckle end and a free end that does not disengage unintentionally and provides better stability and control during the tightening procedure.
- In general, in one aspect, the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping and tightening a ligature band. The ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon. The elongated strap is configured to encircle an internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end is configured to engage a protuberance of the distal end and push the distal end after it has been threaded through the aperture. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft.
- Implementations of this aspect of the invention may include one or more of the following features. The elongated shaft is dimensioned to enter one end, pass through and extend beyond the other end of the cannula. The handle comprises a mechanism for actuating the rotational motion of the inner shaft, thereby actuating the rotationally movable jaw. The mechanism comprises squeezing a handle component. The handle comprises a cylindrical body having first and second side indentations opposite to each other and a thumb indentation on a top surface of the cylindrical body, the thumb indentation being aligned with the rotationally movable jaw. The handle further comprises a latch for keeping the rotationally movable jaw closed. The stationary jaw and the rotationally movable jaw form a circle when closed. The stationary jaw and the rotationally movable jaw comprise rounded edges. The stationary jaw and the rotationally movable jaw comprise a metal, ceramic, polymer, Teflon, alloys, rubber or composites. The stationary jaw and the rotationally movable jaw may have inner surfaces that are spherical, slopped, conical, or have one or more steps or grooves. The internal organ may be stomach, artery, intestines, heart, lung, pancreas, kidney, liver or bone.
- In general, in another aspect, the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping an organ or another tool having a circular cross-section. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end is configured to engage a protuberance of the organs or the other tool. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft.
- In general, in another aspect, the invention features an endoscopic surgical instrument used in minimally invasive surgery through a cannula for grasping and tightening a ligature band around an internal organ. The ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon. The elongated strap is configured to encircle the internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ. The instrument comprises a hook tool configured to engage the hole and pull the pull tab in a first direction while the distal end is threaded through the aperture and pushed opposite to the first direction and a capture tool configured to engage a protuberance of the distal end and push the distal end. The hook tool comprises a hook having a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole. The capture tool comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of an elongated shaft. The hook tool and the capture tool apply opposing forces on the ligature band for tightening the ligature band around the internal organ.
- In general, in another aspect, the invention features a method for tightening a ligature band around an internal organ via minimally invasive surgery. The method comprises first providing a ligature band comprising an elongated strap having a buckle end and a distal end. The buckle end has an aperture and a pull tab having a hole thereon. Next, inserting the ligature band into a patient's body through a minimally invasive cannula and encircling the internal organ with the elongated strap. Next, inserting a surgical hook tool through the cannula. The hook tool comprises an elongated shaft having a hook end and a handle. The hook end comprises a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole. Next, engaging the hole with the hook end. Next, inserting a surgical capture tool through the cannula. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft. Next, engaging a protuberance in the distal end with the capture tool and inserting the distal end through the aperture. Finally, pulling the pull tab in a first direction with the hook tool while pushing the distal end with the capture tool opposite to the first direction.
- Among the advantages of this invention may be one or more of the following. The rotationally movable jaw provides flexibility in capturing an elongated organ, vessel, or other tool having a variety of circular cross-sectional dimensions. The rounded edges of the jaws prevent the jaws from digging and cutting into the organ or tool. The angle between the axis of the elongated shaft and the jaw axis may be varied depending upon the geometry of the organ that needs to be grasped. The inner surfaces of the jaws may be slopped, conical or have one or more steps. These configurations are useful in grasping organs with various cross-sectional geometries. The bend portion of the hook end together with the extension and the flat portion form a C-shaped hook that grasps securely the pull tab. The risk of unintentional disengagement is very low. The extension helps prevent slippage of the hook out of the hole. The inner surface of the bend portion is formed with a radius that matches the inside of the hole in the pull tab. This distributes the pulling force uniformly around the hole and prevents damaging of the pull tab during pulling. The flat portion of the hook end allows the hook end to slide easily underneath or above the pull tab. The capture tool may also be used in non-endoscopic procedures.
- The details of one or more embodiments of the invention are set forth in the accompanying drawings and description below. Other features, objects and advantages of the invention will be apparent from the following description of the preferred embodiments, the drawings and from the claims.
- Referring to the figures, wherein like numerals represent like parts throughout the several views:
-
FIG. 1 is a side view of a stomach with an adjustable gastric band around the upper part of the stomach; -
FIG. 2A is a perspective view of an open LAP-BAND gastric band; -
FIG. 2B is the gastric band ofFIG. 2A in a closed position forming a ring structure; -
FIG. 3 is a perspective view of the endoscopic rotary capture instrument of this invention; -
FIG. 4 -FIG. 8 are perspective views of the pusher end of the instrument ofFIG. 3 ; -
FIG. 9 -FIG. 12 are perspective views of the pusher end of the instrument ofFIG. 3 engaging and pushing the barb end of the gastric band ofFIG. 2A ; -
FIG. 13 is side view of the handle of the instrument ofFIG. 3 ; -
FIG. 14 is a top view of the handle of the instrument ofFIG. 3 ; -
FIG. 15 -FIG. 16 are perspective views of the pusher end of the instrument ofFIG. 3 engaging and pushing the barb end of the gastric band ofFIG. 2A through a buckle while a hook instrument is holding the buckle; -
FIG. 17 -FIG. 19 are perspective views of another embodiment of the rotary capture instrument of this invention; -
FIG. 20 is a perspective view of the endoscopic hook instrument of this invention; -
FIG. 21 is a perspective view of the hook end of the instrument ofFIG. 20 ; -
FIG. 22 is a side view of the hook ofFIG. 21 ; -
FIG. 23 is a top view of the hook ofFIG. 21 ; -
FIG. 24 is perspective view of the handle of the instrument ofFIG. 20 ; -
FIG. 25 is side view of the hook end of the instrument ofFIG. 20 engaging the hole in the tab of the buckle of the gastric band ofFIG. 2A ; and -
FIG. 26 is a perspective view of the hook end of the instrument ofFIG. 20 engaging the hole in the tab of the buckle of the gastric band ofFIG. 2A . - Referring to
FIG. 3 , a surgicalrotary capture instrument 200 includes ahandle 210, anelongated shaft 220 and adistal end component 230. Thehandle 210 features a tactile control of thedistal end component 230. Referring toFIG. 13-14 thehandle 210 features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes twoside indentations thumb indentation 213 on the top surface. Thehandle 210 also features a squeeze-to-close, spring-loaded-open design. By squeezing thehandle piece 215, a rack actuates a gear, developing a rotary motion that actuates amovable jaw 232 at theend component 230 through adrive shaft 224. Thehandle 210 also incorporates alatch 216 to keep the instrument in the closed position. The handle actuation could be any number of mechanical means that imparts the rotary motion required. - The
elongated shaft 220 has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery. In one example, theelongated shaft 220 has a length of 45 cm and a diameter of 5 mm, shown inFIG. 19 .Shaft 220 includes anouter shaft 222 and aninner shaft 224. Referring toFIG. 4-12 , andFIG. 17-18 theend component 230 includes astationary jaw 234 and amovable jaw 232. Themovable jaw 232 is actuated by rotary motion of theinner shaft 224. In one example, inclosed position jaws inner diameter 235 of 4.8 mm and anouter diameter 236 of 7.6 mm. The front edge of opening 235 is rounded having a radius that matches the corner radius at the rear ofbarb 13 b and the diameter of thetube 14. The rounded edge prevents the jaws from digging in and cutting into thetube 14. In the open position themaximum distance 237 between themovable jaw 232 and thestationary jaw 234 is 10.5 mm. In this embodiment, theangle 53 between theaxis 52 of theelongated shaft 220 and thejaw axis 54 is 75 degrees, as shown inFIG. 11 andFIG. 17 . Thisangle 53 may be varied depending upon the geometry of the item that needs to be grasped. - Referring to
FIG. 9-12 ,jaw 232 is rotated open andjaws tube 14 of thegastric band 10 adjacent to an integral conical shapedbarb 13 b that is intended to assist in closure. Thehandle 210 is then actuated causing themovable jaw 232 to rotate closed. This motion captures securely thetube 14. The diameter 240 of thebarb 13 b is larger than theinner diameter 235 of the closed jaws. The surgeon can then push theclosed jaws integral barb 13 b, thereby causing thetube 14 to move forward. - Referring to
FIG. 15 andFIG. 16 , the surgeon threads thetube 14 throughside 19 b of thebuckle conduit 19 a, then captures thetube 14 from theother side 19 c of thebuckle conduit 19 a with thejaws tube 14 in the direction 50 away from thebuckle 19 by pushing theclosed jaws barb 13 b. While pushingtube 14 through thebuckle conduit 19 a, ahook instrument 100 is used to pull thepull tab 18 of thebuckle 19. The triangular shapedmember 13 a of thetail portion 13 interlocks with thebuckle conduit 19 a and prevents thetube 14 from slipping backwards. Thehook instrument 100 and therotary capture instrument 200 apply opposing forces on thegastric band 10 in order to cinch and lock the band closed. - In another embodiment, the
rotary capture instrument 200 of this invention is used to capture a vessel or a component, such as theanvil 250 ofFIG. 17 . In this case the shape of the jaws is selected so that they do not cause any damage to thecomponent 250. This is accomplished by adjusting theangle 53 between the axis of thejaws 54 and theshaft axis 52. In one example theangle 53 is 60 degrees. The shape of the inner jaw surfaces 232 a, 234 a may also be varied to conform to the specific geometry of the component. 250 For example, theinner surfaces component 250. Theopening 235, shown inFIG. 7 , is slightly larger than the diameter of the anvil stem. This allows the anvil stem to float slightly for ease of alignment with the mating stapler (not shown). Inner surfaces may also be coated with protective coatings such as Teflon. - Referring to
FIG. 20 , asurgical hook instrument 100 includes ahandle 110, anelongated shaft 120 and ahook end 130. Thehandle 110 features a tactile control of the hook end. Referring toFIG. 24 thehandle 110 features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes twoside indentations thumb indentation 113 on the top surface. Theelongated shaft 120 has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery. In one example, theelongated shaft 120 has a length of 45 cm and a diameter of 5 mm. Referring toFIG. 21 andFIG. 22 , thehook end 130 includes an angled portion, a flat portion 130 abend portion 134 and anextension 136. The angled portion 131 has aflat bottom surface 131 a and a downwards sloppedtop surface 131 b forming anangle 133 with thetop surface 124 of theelongated shaft 120. Theflat portion 132 has a flattop surface 132 b and aflat bottom surface 132 a that extends continuously from thebottom surface 122 of theelongated shaft 120 and thebottom surface 131 a of the angled portion 131. Thetop surface 132 b of theflat portion 132 forms anangle 135 with thetop surface 131 b of the angled portion 131.Angles angle 133 is 20 degrees andangle 135 is 160 degrees. In one example, theflat portion 132 has a thickness of 1.3 mm, a width of 3.3 mm and a length of 13.4 mm. Thebend portion 134 extends from theflat portion 132 and is bend upwards and towards thehandle 110. Theinner surface 134 a of thebend portion 134 forms anangle 137 with thetop surface 132 b of theflat portion 132.Inner surface 134 a is formed with a radius that matches the inside of thehole 18 a in thepull tab 18. This distributes the pulling force uniformly around the hole and prevents damaging of thepull tab 18 during pulling. Theouter surface 134 b of thebend portion 134 is curved and forms anangle 138 with thetop surface 132 b of theflat portion 132. In one example angles 137 and 138 are 40 and 60 degrees, respectively.Extension 136 extends from thebend portion 134, points towards thehandle 110 and is parallel to theflat portion 132. In one example it has a length of 2.0 mm and a thickness of 0.8 mm.Extension 136 helps prevent slippage of the hook out of thehole 18 a. The inner surface of 136 forms an angle with theinner surface 134 a, which facilitates pickup of thehole 18 a by thehook 130. - Referring to
FIG. 25 andFIG. 26 , theflat portion 132 of thehook end 130 is placed underneath thepull tab 18 of the gastric band buckle and the bend portion is inserted into thehole 18 a thereby engaging the pull tab. Thebend portion 134 together with theextension 136 and theflat portion 132 form a C-shaped hook that grasps securely thepull tab 18. The risk of unintentional disengagement is very low. While holding thebuckle end 19 securely with the hook end 130 a rotary capture instrument 200 (shown inFIG. 15 ) is used to capture and push thetube 14 of thegastric band 10 through thebuckle conduit 19 a. The triangular shapedmember 13 a of thetail portion 13 interlocks with thebuckle conduit 19 a and prevents thetube 14 from slipping backwards. Thehook instrument 100 and therotary capture instrument 200 apply opposing forces on thegastric band 10 in order to cinch and lock the band closed. - Several embodiments of the present invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other embodiments are within the scope of the following claims.
Claims (24)
Priority Applications (2)
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US12/370,956 US9308010B2 (en) | 2005-12-22 | 2009-02-13 | Surgical rotary capture instrument for gastric band closing |
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US11/316,194 US20060178564A1 (en) | 2005-02-04 | 2005-12-22 | Surgical rotary capture instrument for gastric band closing |
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US20110144420A1 (en) * | 2009-12-14 | 2011-06-16 | Woodruff Scott A | Apparatus for Completing Implantation of Gastric Band |
US8663255B2 (en) | 2011-08-09 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Gastric band with overmold |
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Also Published As
Publication number | Publication date |
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US20090157104A1 (en) | 2009-06-18 |
US9308010B2 (en) | 2016-04-12 |
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