WO2010009525A1

WO2010009525A1 - Joint for laparoscopic surgery tools

Info

Publication number: WO2010009525A1
Application number: PCT/BR2009/000220
Authority: WO
Inventors: Marcel Tavares Quintero Milcent Assis
Original assignee: Marcel Tavares Quintero Milcent Assis
Priority date: 2008-07-23
Filing date: 2009-07-23
Publication date: 2010-01-28
Also published as: BRPI0803011A2

Abstract

The invention relates to a joint for laparoscopic surgery instruments. The joint can be coupled to (9) or integrated into (42) the surgical instrument. A circular piece (15) rotates in the circular socket (16) about a rotational axis (11) and conveys a force applied to the handle (4) or articulated handle (42) to the body (1) of the instrument, via internal gears, irrespectively of the rotation thereof (70) when the body (1) of the instrument describes an arcuate motion (50) centred in a fixed point of the abdominal wall (2) of the patient. The handle (4) of the instrument and the surgeon's hand (5) and forearm (7) are kept aligned, avoiding the need for rotation (60) of the surgeon's wrist (6).

Description

"ARTICULATION FOR LAPAROSCOPIC SURGERY INSTRUMENTS"

The purpose of the present invention is to provide an instrument joint used in laparoscopic surgery to replace or complement the usual grip, with advantages in ergonomics, comfort and ease of operation for its end users, laparoscopic surgeons.

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(State of art)

Laparoscopy is a surgical approach in which it operates through small incisions. In one of these

15 incisions a micro camcorder is introduced which transmits the images from inside the patient to a monitor on the outside; the other incisions introduce instruments with which surgery is performed. The advent of laparoscopy in the late twentieth century has generated major advances in the field of surgery minimally.

20 invasive. At the same time, it required very specific instrument development, adapted to the new needs of intraoperative manipulation and exposure of organs and tissues.

The instruments can be of durable material (said permanent) or not (disposable). Are formed

25 by: a handle, holding the operator's hand; a thin body, through which a rod that transmits, the force of the grip to the tip; and by a tip of various possible types, which can be static or open and close according to the movement transmitted by the body. (Problem)

It happens that when crossing the abdominal wall of the patient, it becomes a fixed point ^, support and lever, of important influence on the movements performed by the surgeon. From this point on, the instrument movements describe concentric and variable radius semicircles.

(depending on how much the instrument is introduced into the patient). This point also causes inversion in the pattern of (movements, so that, in order to tip the instrument upwards, the surgeon must move the other end of the instrument downward, and vice versa. In addition, small movements performed on the inside require greater range of motion on the outside, resulting in poorly ergonomic and uncomfortable positions of the surgeon's hands, wrists, and forearms, with excessive forearm muscle strain and fatigue.

With the fixed handle, the wrist joint is overloaded, as it is often found in the lateral (total abduction), medial (total adduction), anterior (total flexion) and posterior (total extension) extremities of position when moving the wrists. fingers of the surgeon's hand. The movement The set of the instrument not articulated with the surgeon's upper limb is uncomfortable and tiring, because when the instrument is projected in any direction (to perform any surgical maneuver), the handle describes a semicircular movement that alters the angle between the instrument and the abdomen of the patient. Since the surgeon's fingers (embedded in the handle) must remain in the same position to hold and operate the instrument (open, close, grasp, cut, dissect), the wrist is often forced to articulate to the extremes of position, with concomitant extension of the forearm. Thereafter, if necessary even greater range of motion, the forearm reach maximum extension and shoulder muscles will be activated to lift the entire upper limb and adding more discomfort to the _ã process.

(Patent Object)

In view of these problems, and in order to overcome them, the Articulation for Laparoscopic Surgery Instruments, object of the present patent, was conceived. Such a joint can be embedded in the handle, or produced separately and coupled between the handle and the handle of the instrument, and allows to maintain the full range of motion required to perform the surgery; what suffers angular movement (rotation) is the articulation of the instrument, not the surgeon's wrist joint, reducing effort and providing comfort and ergonomics.

The joint is formed by: parts that, when fitted, allow rotation movement around its axis. The angle of rotation formed between the body of the instrument and the handle changes dynamically and automatically each time the surgeon moves the instrument from the fixed point on the patient's abdomen.

The articulation mechanism is constructed in such a way that the surgeon's motor commands are transmitted from the handle to the tip of the instrument through the articulation, as in the non-articulated instrument, regardless of the angle of rotation at which the articulation is located. There is no need to perform one step at a time, such as opening the forceps, articulating the instrument, and closing the forceps: the entire process occurs simultaneously. Position locks (closed) as well. can be used, and the pivot will rotate in the same way as long as the lock remains engaged. The presence of the joint also does not affect the grip design (straight, curved, with or without rack, pom or without finger rings) when embedded in it, so it can be used in all laparoscopic instruments (tweezers, dissector, scissors, door needle, vacuum cleaner, gripper, hook, etc.).

With the joint taking the angular movement (rotation) towards you, the operator's hand remains.

elbow joint, and neither the wrist nor the shoulder are overloaded.

The innovative character of the present invention resides in the idealization of the articulation for embedded or coupled laparoscopic surgery instruments, which will give superior ergonomics and comfort to the operator of the instruments, whether used in any medical or veterinary specialty. The propositions (below) of mechanisms that meet the requirements of such articulation do not limit patent rights solely to these mechanisms, as any form of obtaining the expected result - articulation that transmits the force exerted from one end (grip) to another ( when necessary, while allowing rotation about its axis - will achieve the core objective of this patent and is covered by it regardless of the shape, size, design or material employed in its manufacture.

(Proposition - Coupling Mechanism) In the proposed coupling mechanism, the joint is formed by a body and a circular part, which are connected by a circular socket, where the rotation of the joint occurs. Internally, it consists of gears that have two sprockets (proximal and distal) of sprockets, a sprocket that communicates the two sprockets, and two straight sprockets, each attached to one of the shafts and one of the sprockets. free ends, where the handle (proximal end) and the body of the instrument (distal end) will fit. Each wheel axle is formed by two fixedly connected wheels, so that when one rotates, the other must also rotate. The wheels that form an axle do not necessarily have the same radius (same number of teeth). However, both axles have two identical wheels of the same radius (hence the same number of teeth), on which runs the seat belt that communicates the axles. These wheels have the same radius to prevent the force transmitted through the mechanism from being interfered with pivot rotation, otherwise rotation could cause the force to decrease or increase depending on the direction in which it occurred.

When the handle is actuated by the operator, it moves the proximal end sprocket, which therefore moves the proximal shaft sprocket, also moving (through the shaft) the other wheel, connected to the chain; the movement of the chain rotates the distal axis through the identical wheel, also turning its other wheel, it is moving the distal toothed cable and completing the force transfer cycle to the instrument body. Power transfer occurs in one direction (pushing to open the tip of the instrument) and in another direction (pulling to close the tip of the instrument).

The circular part can rotate 360 degrees around the shaft without obstacles. The direction of rotation is not mandatory, it can be clockwise and counterclockwise. The circular piece „

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partially covers the distal wheel axle, and fully the distal toothed shaft. The distal wheel axle attaches inwardly to the right on the wall of the articulation body and to the left in the center of the circular part so that both have the same axis of rotation but with independent movements. The proximal wheel axle attaches internally to the pivot body, rotating about a different axis of rotation from the distal wheel axle and the circular part. Toothed cables, in addition to articulating with their respective wheels, articulate with fixed parts on the walls of the joint body and circular part, which keep them attached to them and allow the cables to slide in linear round-trip movements.

When there is joint rotation (from the

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body on the, circular part), taking the distal axis as fixed, the proximal wheel axle (within the articulation body) describes translational movement around the distal axis. However, the proximal axis remains immobile in relation to its axis, with no rotation. Since the wheels where the toothed belt are fitted have the identical radius, the belt is moving, passively accommodating to the new position. Thus, joint rotation can occur regardless of the force transmission.

Sprockets that do not attach to the belt but to the sprockets, one on each axle, can have their radius ratio manipulated to gain mechanical advantage in the process, compensating for potential energy losses in the system. (Proposition - Built-in Mechanism)

In the proposed mechanism embedded in the handle of the instrument, the joint body is the body of the handle itself, and the gears fit into it. The proximal toothed cable therefore does not require a socket, it is already permanently seated in the cable rod that receives movement from the surgeon's hand.

The rotation movement is the same between the circular part that covers part of the distal wheel axle and the body of the handle by means of the circular engagement.

The transmission of force along the joint occurs in the same way, regardless of the motion i

of joint rotation.

(Proposition - Articulation without Force Transmission)

In cases where the instrument has a static tip, ie it does not need to open and close, such as hooks, vacuum cleaners, retractors, and even the micro-camera itself, the articulation is only by articulated cable, without the presence of internal gears. , and with a specific plug on its end to snap the cable of the instrument. The coupled set will then be used in the same manner. (Explanation of Figures)

Figure 1A shows a usual laparoscopic instrument being used, with its grip (4) held by the operator, and introduced through the hole (fixed point (2) - patient's abdominal wall). The portion of the introduced instrument (3) is lighter in color. Note the position of the operator's hand (5) as well as his wrist (6), forearm, (7) and arm (8). To move the tip of the instrument, its outside - body (1) and handle (4) - must describe an arc (50) whose center is the fixed point (2) in the abdominal wall.

Figure 1B demonstrates the movement, with the body of the instrument (1) describing the arc (50) and its tip (3) moving in the opposite direction. Note that, in order to keep the hand (5) coupled to the handle of the instrument, the handle (6) is articulated, describing an arc (60) between the hand (5) and the forearm (7) in the opposite direction to described by the instrument (50),

Figure 2A shows the moment prior to the same movement as figures 1A and 1B, but with the joint (9) coupled (or embedded) between the body (1) and the handle (4) of the instrument. The arc to be described by the instrument body (1) is the same (50). Note the positions of the operator's hand (5), wrist (6), forearm (7) and arm (8).

Figure 2B demonstrates the movement that has already taken place. The arc (50) described by the instrument body (1) is gives the same way. However, now the compensatory arcuate movement in the opposite direction (70) occurs between the body of the instrument (1) and its handle (4), because what rotates is the joint (9). The position of the operator's hand (5) relative to his forearm (7) remains the same as his fist (6) is not forced to articulate.

Figures 3A, 3B and 3C show the proposed articulation mechanism (9) that can be coupled to laparoscopy instruments in the right lateral, left anterolateral, and right posterolateral views, respectively. In this model the joint (9) fits between the body (1) and the handle (4) of the instrument. Its proximal portion (12) engages the empun ^l hadura (4), while its distal portion (13) engages the tool body (1). The axis of rotation of the joint (1) coincides with the center of the circular part (15). It is in the circular fitting (16) that the coupling and rotation between the circular part (15) and the body of the joint (10) takes place. In the proximal (12) and distal (13) portions there are standard proximal and distal engaging portions (14 and 17 respectively) that engage the other parts of the instrument.

Figures 4A, 4B, 4C, 4D, 4E and 4F show the same joint, alternating between left lateral (4A, 4C and 4E) and left anteroiateral (4B, 4D and 4F) views. However, Figures 4A and 4B show the joint in a 'neutral' position, with the distal end (13) aligned with the body of the joint (10). Figures 4C and 4D show rotation (70) - in this case, counterclockwise - of about 45 ° of the circular part (15), of the distal end (13) and distal housing (17) with respect to the body of the pivot (0), rotation is performed on the circular housing (16) along the axis of rotation (11). Figures 4E and 4F show more pronounced counterclockwise rotation (70), in this case, about 90 ° of the same circular part (15), distal end (13), and distal socket (17), in relation to the body of the joint (10), always made in the circular socket (16), along the axis of rotation (11).

Similarly, with reference still to the joint body (10), Figures 5A, 5B _t 5C and 5D also alternate between the left lateral (5A and 5C) and left anterolateral (5B and 5D) views. articulation. But now the _; Figures 5A and 5B show clockwise rotation (70) about 45 ° of the circular part (15), distal end (13), and distal socket (17) relative to the joint body (10) . Figures 5C and 5D, in turn, show rotation (7θ clockwise about 90 ° of the circular part (15), distal end (13), and distal socket (17) relative to the body gives

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joint (10). As already mentioned, the rotation always takes place in the circular socket (16), and around the axis of rotation (11). For the same reason, it is given the same designation (70), in whatever sense, and having the breadth it has.

Figures 6A, 6B, 6C, 6D and 6E show the joint in left posterolateral view. In figure 6A the joint is in neutral position. The other figures show joint rotation, but now their joint is fixed. proximal part (13) and circular part (15). Thus, it is the pivot body (10) which rotates about the shaft (11) by means of the circular fitting (16). Figure 6B shows rotation (70) of about 45 ° clockwise. In figure 6C it is more pronounced, approximately 90 ° clockwise as well. Fig. 6D indicates rotation (70) about 60 ° counterclockwise, while in Fig. 6E rotation (70) is approximately 30 °, also counterclockwise. The rotation is always the same (70) as it is about the same axis (11), and occurs in the same place, the circular fitting (16), regardless of the direction, amplitude, and which part of the joint. is taken as a fixed reference.

Figure 7A shows the interposition of the joint (9) between the handle * (4) and the body (1) of the laparoscopic instrument. Figure 17B demonstrates the entire set already connected. Both figures have left lateral view.

Figures 8A, 8B, 8C and 8D show the assembly formed by the handle, joint and body of the instrument in left side view. In figure 8A the system is in neutral position. Figures 8B, 8C and 8D denote, in increasing amplitude, arcuate movement (50) of center at the fixed point of the abdominal wall (2), described by the body of the instrument (1), compensated by rotation (70) in the joint between its body (10) and the circular part (15) in the circular fitting (16), keeping the handle (4) in the same position. Figure 9 shows the joint in left posterolateral view, without the circular part (15) and the left wall of the body, and its interior view. Pivot gears, consisting of: proximal toothed cable (18) and proximal socket (14), proximal wheel axle (22), toothed belt (28), distal wheel axle (23), and toothed cable can be seen. distal (19) and distal socket (17). The view favors the wheels on the left, which connect to the toothed cables, the proximal axle (24) and the distal (25). It is noted that the rotation of the distal wheel axle (23) occurs on the same axis (11) as the circular part (15), while the rotation of the proximal wheel axle is along another axis (29). Proximal (20) and distal (21) cylindrical appendages are present on the respective toothed cables to connect to the joint wall by means of complementary parts,

Figure 10 shows the joint in right anterolateral view. The wheels on the right are best viewed, the proximal axle (26) and distal axle (27), which connect to the timing belt (28). Such wheels are identical, with same radius and same number of teeth. It is noticed that the distal wheel axle (23) is longer than the proximal wheel (22), which makes the left wheel i

distal (25), and consequently the distal toothed cable (19) within the circular part (15),

Figure 11 shows the articulation seen from above, without the circular part and the upper cover of its body. Note the difference in length between the proximal (22) and distal (23) axes, with the left wheel (25) of the latter being outside the joint body, in what would be the inside of the circular part (not shown). It is also possible to understand the points of engagement of the shafts on the body walls and the circular part: left distal shaft engagement (30), right distal shaft housing (31), left proximal shaft housing (32) and right shaft housing proximal (33).

Figure 12 shows the interior of the joint under right anterolateral view, without the right walls, i

front and bottom of the body, without the wheel axles, the toothed belt and the toothed cables. Note the position of the fittings for the wheel axles, proximal left (32) and distal left (30), as well as the complementary fittings between the cylindrical parts of the toothed cables, the proximal (35) and the distal (34). }

Figure 13 demonstrates the ^! í Inside the joint, under left posterolateral view, without the wheel axles or timing belt. The notches for the wheel axles, the right proximal (33) and the right distal (31) are noticeable. Note also the cylindrical appendages of the toothed cables, the proximal (20) and distal (21), which fit the complementary parts in the body wall and the circular part.

Figures 14A, 14B, 14C and 14D detail the connection of the cylindrical appendix (21) of the distal toothed cable (19) with its complementary part (34) in the wall of the circular part. Figure 14A does not show the complementary part (34). Figure 14B shows the complementary part (34) with the toothed cable (19) in neutral position. Figure 14C demonstrates linear motion. (36) in front of the distal toothed cable (19), with the proximal cylindrical appendage (21) sliding into its complementary part (34). Figure 14D shows the same movement (36) of the distal toothed cable (19), but in the opposite direction, also with sliding of the proximal cylindrical appendix (21) inside its complementary part (34),

Figures 15A, 15B, 15C and 15D detail the connection of the cylindrical appendix (20) of the proximal toothed cable (18) with its complementary part (35) in the joint body wall. Figure 15A does not show the complementary part (35).

Figure 15B shows the complementary part (35) with the toothed cable (18) in neutral position. Figure 15C shows the linear movement (37) forward of the proximal toothed cable (18) with slip _^ ptoximal cylindrical appendix (20) within the complementary piece (35). Figure 15D shows the same movement (37) of the proximal toothed cable (18), but in the opposite direction, also with sliding of the proximal cylindrical appendix (20) inside its complementary part (35),

Figure 16 details the mechanism of force transmission through the articulation gears. The proximal sprocket (18) undergoes linear movement (37) that drives the left sprocket (24) of the proximal wheel axle (22) along its axis of rotation (29), which necessarily rotates its right wheel (26). ) by driving the toothed belt (28) which, through its movement (38), rotates the distal wheel axle (23) along its axis of rotation (11) through its right wheel (27), the what it must rotate its left wheel (25), pushing Q distal toothed cable (19) to linear motion (36). The same transmission is done in reverse. It is worth noting that, as the position of the toothed cables is different in relation to the wheel with which each one connects - the proximal (18) is positioned inferiorly and the distal (19) is positioned superiorly - the linear movement of one occurs in reverse direction of movement of the other.

Figures 17A, 17B, 17C and 17D have a right posterolateral view of the joint, demonstrating the translational movement of the proximal right wheel (26) relative to the distal right wheel (27) - and hence their respective axes - which occurs when of the rotation (70) of the joint body (10) relative to the circular part (15). Figure 17A shows the system in neutral position. Note one marking (39) of the distal right wheel (27), one tooth (40) of the proximal right wheel (26) and one

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tooth (41) of the timing belt (28) for tracking movement. Figure 17B shows the counter-clockwise rotation system 70 along the pivot axis 11. Figure 17C shows the same Polling (70) counterclockwise, but of greater magnitude.

amplitude. Figure 17D also shows the same system rotation,. with even greater amplitude. It can be seen that as the range of motion increases, both the distal wheel tooth

(39) as the proximal wheel tooth (40) remains. unchanged in relation to its axes, although that of the proximal

(40) move along with it in relative wheel translation distal (27). The belt tooth (41) progressively approaches the distal right wheel (27). This indicates that there is no wheel rotation, but rather belt movement (38) - the greater the range of system rotation (70) - in accommodation to the translation.

Figures 18A and 18B show a ₍ hinge model embedded in the instrument handle (hinged handle), in this particular case a pistol grip. Figure 18A has a left side view, while Figure 18B has a left posterolateral view. Note the similarity ^¾ of the distal portion of the assembly with that of the coupling model with the circular part (15), distal part (13) and distal engagement (17), as well as the circular engagement (16) and the axis of rotation. (11) However, now the body of the joint and the handle are one (42), and note the surgeon's finger rings, one fixed (43) and one movable (44).

Figures 19A and 19B, both in left lateral view, show the relationship of the articulated handle (42) with the body of the instrument (1). In figure 19A they are separated. Figure 19B demonstrates the connected set.

Figures 20A, 20B, 20C and 20D show the assembly in left side view. In figure 20A the system is in neutral position. Figures 20B, 20C and 20D denote, in increasing amplitude, rotational motion (70) of the circular part (15) and the body of the instrument (1) in relation to the hinged handle (42).

Figures 21, 22, 23A and 23B show the joint embedded in the handle internally, Figure 21 in left posterolateral view, Figure 22 in right posterolateral view, Figure 23A in left superolateral view, and Figure 23B in right inferolateral view. It differs from the coupling coupling by the proximal toothed cable (46), already fixed to the rod (45) of the movable ring (44). The proximal toothed cable (46) also has a cylindrical appendix (47) which hinges with its complementary part on the body wall of the joint. All the rest of the articulation is identical to that of the coupling, with: proximal wheel axle (22) and its left (24) and right wheel (26) rotating about its axis (29); toothed belt (28); _^ Pro fmal wheel axle (23) _and; its left (25) and right (27) wheels rotating about its axis (11); distal toothed handle (19), its cylindrical appendix (21), and distal socket (17); circular part (15) which articulates with the handle body (42) through the circular socket (16) and rotates about the same axis (11) as the distal wheel axle (23).

Figures 24A, 24B and 24C, respectively in left side view, left posterolateral view and right anterolateral view, show an articulated grip model for instruments which do not require force transmission to their respective tips. There is a grip cable (48) which pivots with the circular part (15) through the socket (16) by rotating about the same axis of rotation (11). Coupled to the circular part (15) is a socket (49) for the instrument cable.

Claims

1) "JOINT FOR LAPAROSCOPIC SURGERY INSTRUMENTS" couplable, characterized by articulated object, said joint (9), consisting of body (10) and circular part (15), ₍ which connect by means of circular fitting (16), rotating axis of rotation (11), and fits between the handle (4) and the body (1) of the laparoscopic surgery instrument, the handle (4) at its proximal part (12) through a standard proximal socket (14) ), and the body at its distal part (13) through standard distal engaging part (17), and transmits the force of the handle (4) to the body of the instrument (1) by means of internal gears, regardless of its rotation. (70), which undergoes as the body _^ instrument (J describes arcuate movement (50) centered on the fixed point on the abdominal wall of the patient (2), keeping the instrument handle (4), the operator's hand ( 5) and your forearm (7) aligned, no need for rotation (60) of the wrist 2) "LAPAROSCOPIC SURGERY INSTRUMENTS ARTICULATION" recessed, characterized by articulated handle (42), wherein the joint body and the handle are one (42), which connects the circular part (15 ) by means of circular engagement (16), pivoting (11), and fits to the body of the surgical instrument (1) at its distal part (13) by standard distal engaging part (17), and transmits to force of the movable ring (44) to the instrument body (1) by means of internal gears, regardless of its rotation (70), which suffers as the instrument body (1) describes an arched movement (50) with center at the fixed point of the patient's abdominal wall (2), keeping the handle of the instrument (42), the operator's hand (5) and his forearm (7) aligned, requiring no rotation (60) of the operator's wrist (6) .

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3) "ARTICULATION FOR ¹ SURGERY INSTRUMENTS

Laparoscopic "without need for power transmission, characterized by a grip handle (48) which articulates with circular part (15) through the circular insert (16), rotating on the same axis of rotation (1), and _^ it has, coupled to the circular part (15), socket (49) for the instrument cable, and undergoes rotation (70) as the body of the instrument (1) describes arcuate movement (50) centered at the fixed point of the abdominal wall (2) keeping the grip handle (48), the operator's hand (5) and his forearm (7) aligned, and no rotation (60) of the operator's wrist (6).