WO2010046513A1

WO2010046513A1 - Holder for a distal tool and endoscopic or laparoscopic surgery system

Info

Publication number: WO2010046513A1
Application number: PCT/ES2009/000506
Authority: WO
Inventors: Ramón SANCIBRÍAN HERRERA; José Carlos MANUEL PALAZUELOS
Original assignee: Universidad De Cantabria; Fundación Marqués De Valdecilla
Priority date: 2008-10-22
Filing date: 2009-10-21
Publication date: 2010-04-29
Also published as: ES2319954B2; ES2319954A1

Abstract

Holder for a distal tool (17) for laparoscopic surgery provided with means for actuating said distal tool, said means comprising a handle (1) having two integral levers (3,4) configured to actuate the distal tool disposed one on either side of the handle such that one lever is configured to be actuated by the thumb, the other lever being configured to be actuated by the forefinger, whilst the handle is configured to be gripped by the remaining three fingers together with the palm of the hand. Levers (3,4) comprise an exterior arm (3a;4a) and an interior arm, there being a space between both arms to house a finger such that each lever is configured for the thumb or finger to exercise a closing force on the interior arm and an opening force on the exterior arm.

Description

Handle for a distal tool and endoscopic or laparoscopic surgery system

The present invention relates to a handle for a distal endoscopic or laparoscopic surgery tool, comprising means for manually actuating said distal tool, and also to a system for endoscopic or laparoscopic surgery comprising such a handle.

The handle is a mechanical system located at the proximal end of the tool and allows the surgeon to operate from the outside the distal tool introduced through small incisions inside the patient.

STATE OF THE TECHNIQUE

Since the 80s, laparoscopic surgery has gained enormous importance and interest due to the advantages it provides in the patient. In laparoscopic surgery, the surgeon accesses the patient's abdominal cavity through small incisions using special surgical tools that can be managed from the outside. Among the advantages of this technique, it should be noted that it produces less pain and blood loss, shorter periods of convalescence and even, aesthetically, less scarring. However, in comparison with open surgery, laparoscopic surgery hinders the surgeon's work, since it considerably reduces the tactile sensitivity that the surgeon has on the organ in which he is acting, limits the possibilities of movement of the tool, and generates muscle fatigue due to the bad ergonomic characteristics that these tools generally have. All this further increases the mental and physical stress that surgeons are already subjected to during their interventions, and may have a low performance on their part.

The problem of the lack of ergonomics has been treated since the late 1990s and has resulted in several publications up to recent dates. However, the vast majority of these publications do not address the design of new tools with ergonomic considerations, but rather they limit to analyze and compare several existing tools in the market from the point of view of their ergonomics. An example of these works is that carried out by Marten et al., And Van Veelen et al. The fundamental reason why this problem has not been satisfactorily resolved is because in the design of laparoscopic surgery tools, functional characteristics have prevailed over purely ergonomic aspects. In addition, according to Berguer, these tools are nothing more than a mere adaptation of the tools used by surgeons in open surgery, are not comfortable to touch and have areas of contact with the hand, and especially in certain parts of the fingers, high Pressure.

Another problem of laparoscopic surgery tools that concerns surgeons is the loss of sensation in the palpation of the organs. This loss of palpation is due to the fact that the force exerted on the distal tool when an organ is compressed is not adequately transmitted to the handle, and this causes the surgeon to be unaware of the force he is performing, which can cause damage involuntarily. In other cases, for example in the appearance of metastases in cancer diseases, the sensitivity of the tool is important to detect the changes in texture and hardness that have occurred in certain areas of the patient's organs. The problem of tactile sensitivity has not been satisfactorily resolved to date, and as in the problem of ergonomics, most of the publications that study this problem, such as the work done by Ottermo et al., they limit comparatively to study different tools from the point of view of tactile sensitivity. In the US Pat. No. 6447532, it is considered a tool design that allows to feel to some extent the variations of force in the claw. US Pat. No. 6096058, proposes a system that limits the force that can be exerted manually on the tool. In the US Pat. No. 5476479, the force of the tool is limited by the use of flexible claws. The tactile sensitivity and ergonomics of the tools are two concepts that are faced in most cases. That is, if ergonomics is improved, sensitivity is lost and vice versa. This for example occurs in those tool handles that incorporate springs to facilitate the opening of the claw. These tools allow better contact between the hand and the handle improving ergonomics. But the force that the surgeon must make to overcome the spring and close the claw adds to the resistance exerted by the organ on which it is acting at that time, damaging the tactile sensitivity. In addition, the handles provided with a spring must have a ratchet mechanism in order to fix the opening position of the claw without the need for the surgeon to exert pressure on the handle.

On the other hand, the tactile sensitivity of a tool is also impaired when force must be exerted on the tool. A manual tool designed to do a force job is generally held very differently than when sensitivity is required. Laparoscopic surgery tools often require these two characteristics, which complicates their design.

Various types of mango used in laparoscopic surgery can be found in the literature. For example Matern et al. they present in their publication examples of this diversity, and the US Pat. No. 0187575, shows an example of current ergonomic handle design. However, currently two types of handle are used: the axial handle and the ring handle. The axial handle is formed by a fixed support parallel, or almost parallel, to the main axis of the tool and a lever that folds over it. This handle is generally provided with a spring and therefore has ergonomic advantages in that the support of the fingers on the tool is almost complete, eliminating areas of excessive tension. It also offers greater comfort in certain operations where it is necessary to turn the tool on its axis, such as in sutures. However, the spring and the form of fastening worsen the sensitivity characteristics of the tool. Also, in certain operations the wrist of the surgeon may be excessively forced and this effect can also be transferred to the arm, forearm and shoulder. According to the studies carried out by Matern, it is the tool that requires the most muscular effort. Examples of this type of mango can be found in different patents. For example in US Pat. No. 6540737, the handle can modify the orientation with respect to the axial position to a position of 60 ° with respect to the axis of the tool. In US Pat. No. 5624431, the handle, in addition to the opening and closing of the claw, allows the rotation of the shaft by actuation with the thumb. US Pat. No. 5382254 shows a case for the application of surgical clips.

The ring handle is surely the handle most commonly used in laparoscopic surgery. Examples of this type of mango can be found in U.S. Pat. Pat. No. 5626608, and U.S. Pat. No. D541416. The ring handle consists of a mobile lever that is generally operated with the thumb and a fixed support to the tool where the rest of the fingers are supported. Depending on the type of tool can be found with spring and ratchet or free movement. In any case, the ergonomics of this tool is poor, since a high pressure is generated in the areas of contact with the fingers and the lever is operated only with very specific areas of the thumb, which generates significant muscular fatigue.

DESCRIPTION OF THE INVENTION

The present invention provides a new surgical tool handle for applications in endoscopy and laparoscopic surgery. This handle complies with the general characteristics that are required of such a tool, being light and easy to use, so that its use only requires one hand and can be used interchangeably by the right or left hand of the surgeon. It can be used in the different types of operations of this type of surgery by locating the corresponding distal tool at the end of the extension tube (eg claws, scissors, dissectors, retractors, etc.), and can work with or without an opening spring. It allows cauterization through different techniques, and can be used in both disposable tools and reusable tools, since its disassembly for sterilization and subsequent assembly is simple. It is also possible to use extension tubes of various lengths and conventional diameters of 5 mm 10 mm and 12 mm or other diameters if necessary.

In accordance with one aspect of the invention, the means provided in the handle for manually operating the distal tool comprise a handle and two levers that are configured to actuate the distal tool together and are arranged one on each side of the handle, so that one of the levers is configured to be operated by the thumb and the other lever is configured to be operated by the index finger, while the handle is configured to be grasped by the other three fingers, heart, ring and little finger, together with The palm of the hand.

In one embodiment, the two levers move in solidarity. In one embodiment, the two levers are arranged symmetrically with respect to the handle, so that each lever can be operated interchangeably with the thumb or the index, depending on whether they are from the right hand or from the left.

In one embodiment, at least one of the levers is configured to be operated both by opening and closing the drive fingers.

In one embodiment, at least one of the levers comprises an outer arm and an inner arm, there being a space between both arms to accommodate the finger, so that the lever is configured so that the finger exerts a closing force on the inner arm and an opening force on the outer arm. In one embodiment, at least one of the levers comprises an additional arm for the middle finger, so that it can also actuate the lever together with the index finger.

In one embodiment, the handle comprises an orientation wheel that allows the distal tool to rotate, the surface of said orientation wheel being a surface of revolution and substantially semi-elliptical, which can be operated by the thumb. To facilitate this drive, the surface of the wheel can incorporate a spline.

The orientation wheel allows the support of the finger on a larger surface than other wheels used in the known tools, so that the pressure on the thumb can be less for the same force exerted. Alternatively, the index finger can be used to drive this orientation wheel.

In one embodiment, the handle comprises a spring connected to the levers in order to exert a slight force of opposition to the actuation of the distal tool.

In one embodiment, the handle comprises a mechanism for retaining the position of the levers.

In one embodiment, the handle comprises a mechanism box located on the levers, which houses the drive mechanism of the distal tool.

In one embodiment, the mechanism box comprises an upper cover that is provided with a cauterization connection.

There are several ways to perform cauterization, although only the monopolar electrocautehzation will be described below. In this type of cauterization, the current is generated in an external device and introduced into the tool through the corresponding connection. Electricity travels from the connection of the tool to the distal tool, and from here through the patient, acting as a ground and closing the circuit through another connection in the body (usually in the patient's thigh). Then, it is not necessary to replace the tool or any element thereof; it is only necessary that the current electrical can circulate freely between the connection of the tool and the patient (or the distal tool where contact with the patient occurs). For this, it must be guaranteed that the elements involved in the tool transmit the electric current. This is not a problem since they are all metallic elements. Electrocautery, although very common in these types of operations, is only performed for very short periods of time.

In accordance with another aspect of the invention, a system for endoscopic or laparoscopic surgery comprises a handle with the characteristics described in the preceding paragraphs, an extension tube, and a distal tool located in the distal region of said tube and actuated by said handle to through the extension tube.

In one embodiment, the actuation of the levers is transmitted to the distal tool through a drive shaft, so that the drive shaft moves coaxially through the interior of the extension tube to produce an opening and closing movement of the tool. distal

In one embodiment, the movement of the levers is transformed into a displacement of the drive shaft by means of two connecting rods fixed to the levers by one end, said connecting rods being connected to a slide at its other end by means of two pivots provided in the lower part of said slide, so that the connection between the upper part of the slide and the drive shaft makes possible the relative rotation movement between them but prevents the relative movement of both in the axial direction of the drive shaft.

In one embodiment, the orientation wheel is connected to the drive shaft by means of a connection that allows the relative movement of both in the axial direction of the drive shaft but prevents the relative rotation movement between them. In general, a laparoscopic surgery tool system is formed by the handle, extension tube and distal tool assembly. The handle object of this invention is located at the proximal end of the tool and is composed of a handle, two drive levers, a support that provides rigidity to the handle assembly, a mechanism housing that contains the mechanical drive elements and that provides movement to the drive shaft, an orientation wheel that It allows rotating the distal tool on the main axis of the tool and a support that serves to improve contact with the hand and improve ergonomic characteristics. The extension tube connects the handle with the distal tool and is composed of a hollow outer tube and inside it is the drive shaft, which is a rigid element. The drive shaft is arranged coaxially with the extension tube and also moves axially with respect to it when the drive levers are operated. At the distal end of the extension tube is the distal tool that opens or closes depending on the opening or closing of the operating levers with respect to the handle. The distal tool is composed of the two upper and lower claws, and has a drive mechanism located at the same distal end and that transforms the axial movement of the drive shaft into the opening and closing movement of the operating tool. In one embodiment, the distal tool comprises two claws that rotate both on the same fixed axis to open or close. The drive shaft moves near one of its ends to the claws. Each of the claws connects its end to the nearest end of the drive shaft by means of a small connecting rod and in this way the translational movement of the driving shaft in rotation of the claw is transformed.

An important innovation of this tool lies in the improvement it provides in aspects of ergonomics and tactile sensitivity compared to other existing tools. Therefore, the first objective is to provide a comfortable handle that reduces the muscle fatigue of surgeons during their interventions. The tool object of this invention provides all manual controls easy to reach by the index and thumb fingers of the surgeon's hand. In addition, the grip of the handle by Ia Hand is performed in a posture that provides adequate clamping force along with ergonomic features. The most sensitive fingers of the hand, in addition to providing a certain degree of grip, are mainly used for opening and closing the operating tool, while the rest of the fingers are used in the firm grip of the tool. The tool is held with practically the entire surface of the hand resting on the handle assembly and the two operating levers. The handle has a cross section that allows it to be grasped around it with sufficient firmness and comfort with the middle, ring and little fingers. On this handle, the operating levers one and two are positioned so that they can rotate on the handle allowing the actuation of the tool to open and close the distal tool. Once the actuation levers are fitted on the handle, the arrangement is such that the main axis of the handle is perpendicular, or approximately perpendicular, to the main length of the two actuation levers on which the actuation fingers rest. The actuation of the actuation levers is achieved by pressing with the thumb and index finger, each of them placing on one of the respective actuation levers. Therefore, the operating levers have a surface on which the fingers rest which is smooth and ergonomically adapted to its shape. The actuation levers have relative movement with respect to each other, but in addition this relative movement between them is synchronized so that the relative position of both is always symmetrical with respect to the central plane of symmetry of the tool. This synchronization is achieved through the drive mechanism that coordinates the movement of the two drive levers and has the additional advantage that the tool can be operated only with one of the fingers, index or thumb, if necessary. Then, the surgeon's hand can grasp the fixed part of the handle with the three mentioned fingers, heart, ring and little finger, and the two operating levers with the thumb on one of them and the index on the other. When the drive levers do not have a spring for opening, they will have two finger support surfaces, with the index and thumb fingers confined between the two surfaces on each of the operating levers. One surface allows the closure by pressure with the palmar area of the fingers and the other surface allows the opening of the distal tool by pressure with the dorsal area of the fingers. Both surfaces are ergonomically adapted to the shape of the fingers and pressure will be exerted on them, in one case closing the fingers to achieve the closure of the distal tool and in the other case opening the fingers to obtain the opening. The opening surface of the operating levers will not be necessary when the tool has a spring for opening. Sometimes it may be necessary to exert greater force during the closing of the operating tool, for this purpose the operating levers have an additional support that allows the use of the middle finger, in addition to the index finger on the same operating lever. Each of the two operating levers must be ergonomically adapted to the two operating fingers, index and thumb, since these fingers will change the operating lever when the tool is operated with the right hand or the left hand. In summary, the clamping provides the three main innovative features to the tool: (1) it provides sufficient firmness in the clamping of the tool and allows its handling, (2) it allows the hand to be practically completely supported avoiding areas of greater tension, and (3) allows the thumb and the index finger to be used as actuation fingers of the claw, fingers that from the ergonomic point of view provide greater tactile sensitivity. These characteristics can be fulfilled independently in other tools existing at present, but not all three together as is the case of the tool object of this invention. Another innovation present in this tool is that the internal mechanism for opening and closing the distal tool is not a simple lever, which allows to regulate the movement in function of the opening position of the distal tool and the opening of the manual drive. In this way the mechanical advantage of the tool is improved without increasing the mechanical complexity of the system. The mechanism is simple, the number of parts that compose it is low and they are easy to manufacture and assemble. In addition, the arrangement of these pieces provides great precision in movement.

In other existing tools, the drive mechanism is a simple lever that only provides an amplification of the force exerted, but does not regulate the force depending on the opening position of the tool. The mechanism of this new tool allows the regulation of the force according to the opening of the tool providing an improvement in the tactile sensitivity by modifying the mechanical advantage in the transmission of the movement.

Also presented as innovation in the tool is a drive wheel located at the proximal end of the tool for the orientation of the distal tool. Its purpose is to allow the rotation of the distal tool up to 360 ° with respect to the main axis of the tool during its handling, to allow operating on the desired area in the most appropriate direction. In this way, the awkward rotation of the surgeon's wrist is avoided. This wheel rotates the drive shaft, which in turn rotates the extension tube and the distal tool with its drives. In comparison with other drive wheels in similar tools, this is distinguished by its location at the rear of the tool and by having a larger surface to be operated with the thumb or, alternatively, with the index finger. In this way the surgeon can easily activate the rotation of the claw while holding the tool with one hand.

The surgery tool handle object of this invention can be used with or without a spring for opening and retention mechanism. In the case of using a spring for the opening of the tool, the tactile sensitivity characteristics may be diminished. However, the handle also allows this configuration. In this case the actuation levers do not require a surface to press with the dorsal area of the fingers during the opening, since this operation will perform the opening spring. As an opening spring, a sheet of small thickness can be used on the handle that internally presses the actuation levers to force them to turn outwards and maintain the opening position when no external force is applied. Together with the opening spring, a retention or ratchet mechanism is incorporated that can be operated by the surgeon to retain the position of the distal tool in any position. This retention mechanism is formed by one of the drive levers which is given a shape of saw teeth in its outer part and a ratchet that can be approached or moved away, retaining or not retaining the position of the operating levers. When the retention mechanism is deactivated, the surgeon must exert sufficient pressure with the index and thumb fingers on the respective operating levers to overcome the spring force and close the distal tool. To achieve the opening of the operating tool, it is enough to stop pressing on the levers. When the retention mechanism is activated and no pressure is exerted with the index and thumb fingers, both the operating levers and the distal tool remain in the position in which they were when this mechanism was activated. However, it is possible to continue closing the distal tool by applying a superior force with the index and thumb fingers on the respective operating levers. In this way, the tool is closed step by step, each step corresponding to the rotation of the levers equivalent to the passage of a sawtooth of the retention mechanism and being retained in each of these positions.

BRIEF DESCRIPTION OF THE DRAWINGS Next, an embodiment of the invention will be described, by way of non-limiting example, with reference to the attached drawings, in which:

Figures 1-5 show several perspectives of the tool object of this invention for use in endoscopy and laparoscopic surgery;

Figure 6 shows the actuation of the actuation levers for

Ia opening of the distal tool;

Figure 7 shows the actuation of the actuation levers for closing the distal tool; Figure 8 shows an internal perspective of the drive mechanism together with detail A of this same extended mechanism;

Figure 9 shows a perspective of the tool and the rotation of the distal tool by means of the orientation wheel;

Figure 10 shows a perspective of traditional tool with ring handle held by the surgeon's hand; Figures 11 and 12 show two different perspectives of the tool object of the invention held by the surgeon's hand; Figures 13 and 14 show a profile and plan view of the assembly of the tool held by the surgeon's hand in a closed position; Figure 15 shows a plan view of the tool held by the surgeon's hand, similar to the view presented in Figure 14 but in the open position of the tool;

Figures 16 and 17 show a profile view of the tool held by the surgeon's hand. In Figure 17 increasing the pressure exerted on the distal tool by means of the application of the middle finger together with the index on the actuation lever;

Figure 18 shows a profile view of the tool held by the surgeon's hand and driving the orientation wheel;

Figure 19 shows an exploded perspective representing the assembly of the handle, support, operating levers, mechanism housing and support; Figure 20 shows an exploded profile of the assembly of the mechanism box and the support on the handle and the two actuating levers already assembled;

Figure 21 shows an exploded perspective that represents the assembly of the cranks of the mechanism and the slide that constitutes the central support of the drive shaft;

Figure 22 shows an exploded perspective of the assembly of the orientation wheel, the cover of the mechanism box and the assembly formed by the drive shaft, the extension tube and the distal tool, on the mechanism box;

Figure 23 shows an exploded perspective of the assembly of the orientation wheel on the drive shaft and on the mechanism housing;

Figure 24 shows a section of the tool along its main plane of symmetry showing the internal scheme thereof; Figure 25 shows an exploded perspective of the assembly of a tool variation with two pivots on the handle;

Figure 26 shows an exploded perspective of the assembly of the lower part of the handle of the tool when an opening spring and ratchet retention mechanism is used; Figure 27 shows the perspective of the operating lever containing the saw teeth of the retention mechanism and the recess for the opening spring;

Figure 28 shows an exploded perspective of the assembly of the retention mechanism located on the support; Figures 29 and 30 show two perspectives of the retention mechanism located on the support; Y

Figure 31 shows the position of the surgeon's hand to activate or deactivate the retention mechanism.

DESCRIPTION OF PREFERRED EMBODIMENTS In FIG. 1 to FIG. 5 general perspectives of the tool for laparoscopic or endoscopic surgery object of this invention are shown. The tool in general will be composed of the handle assembly (40), located at the proximal end, the extension tube (14) and the distal tool (17) located at the opposite end of the handle. The handle in turn is composed of a series of parts where the most important from the functional point of view are the handle (1), the two operating levers, (3) and (4), the drive mechanism housing, formed by the box itself (5) and its cover (22), and the orientation wheel (13). In FIG. 1 to 5 the support (6) that allows the surgeon a firm hold of the tool is also appreciated.

FIG. 6 and FIG. 7 show respectively the way of actuating the handle for opening and closing the distal tool (17). This operation is carried out through the manual operation of the levers (3) and (4) of the tool. In this way when the levers are opened by turning around its pivot towards the outside of the tool, as shown by the arrows (6A) on the actuation levers in FIG. 6, the distal tool opens as indicated by the arrows (6B). When the operating levers close, simultaneously approaching the inside of the tool, as shown by the arrows (7A) on the levers in FIG. 7, the distal tool (17) closes as indicated by the arrows (7B). The movement of the operating levers (3) and (4) is not independent but is synchronized and symmetrical with respect to the central plane of symmetry of the tool. This synchronization is guaranteed by the drive mechanism of the tool shown in FIG. 8 and in its detail A. As can be seen, the drive mechanism is located in the mechanism case (5), above the drive levers (3) and (4) and connected to them so that it can transmit its movement. The operation of this mechanism is observed in detail A of FIG. 8. The opening and closing movement of the manually operated actuation levers (3) and (4) is transformed into an axial movement of the actuation axis (15) inside the mechanism housing (5) and (22) . This axis The drive (15) moves coaxially through the interior of the extension tube to become the opening and closing movement of the distal tool (17). In detail A of FIG. 8 the connections that make the rotation of the operating levers (3) and (4) drive the movement of the two connecting rods (9) can be seen. These connecting rods (9) transmit the movement to the slide (12) since they are connected to the latter by means of two pivots in the lower part of said slide (12). The slide (12) is connected in its upper part with the drive shaft (15) by means of a groove, transforming the movement of the connecting rods (9) in an axial displacement movement of the shaft (15). The connecting rods of the drive mechanism (9) are fixed to the drive levers (3) and (4) by means of the screws (10) that allow the relative rotation between these elements. This mechanism, in addition to guaranteeing the symmetrical movement of the operating levers (3) and (4) with respect to the central plane of symmetry of the tool, allows that the opening and closing of the tool can be provided by acting on the two levers at the same time, or only on one of them.

FIG. 9 shows the rotation drive of the distal tool (17) on the axis of the extension tube. This movement allows the distal tool (17) to be rotated up to 360 ° around the axis of the extension tube by actuating the orientation wheel (13). The orientation wheel (13) is located in the proximal area of the tool and is coaxially connected with the drive shaft (15) inside the mechanism housing formed by the elements (5) and (22). The connection between the drive wheel (13) and the drive shaft (15) allows the relative movement of both in the axial direction of the drive shaft. However, the relative rotation movement between them is impeded, and therefore when the orientation wheel (13) rotates, it also does the drive shaft (15) by turning the extension tube (14) and the tool in turn. distal (17). For this, the shaft (15) has a flange at its connecting end with the orientation wheel (13) that prevents the relative movement of rotation between them. FIG. 10 shows an example of a laparoscopic surgery tool with a ring handle that is currently on the market and the way of holding this tool by hand. The way of holding the tool of FIG. 10 is the most common when the tool does not contain a spring to facilitate opening. FIG. 11 and 12 show the way of holding the tool object of this invention by the hand of the surgeon. As can be seen in FIG. 11 and FIG. 12 the contact of the hand with the tool is practically complete and uniform, avoiding that there are localized areas of greater pressure in the hand as occurs in tools such as that represented in FIG. 10. The palm of the hand and the middle, ring and little fingers surround and firmly hold the handle (1), while the thumb rests on the operating lever (3) as seen in FIG. 11, and the index finger rests on the operating lever (4), as seen in FIG. 12. In this way both fingers, thumb and index, are used for opening and closing the tool. This arrangement of the hand provides the characteristics of ergonomics and sensitivity, and the tool is held in a relaxed position of the hand and with a continuous contact on a surface that adapts to the shape of the hand. In addition, the use of the most sensitive fingers, index and thumb, for the opening and closing operation guarantees the improvement of the tactile sensitivity of the tool.

FIG. 13 shows a profile view of the tool and its grip by the hand and in FIG. 14 and FIG. 15 shows a plan view of the tool and its clamping in the closed and open position respectively. If the tool does not have a spring to facilitate opening, it is necessary that the operating levers (3) and (4) have external support for the thumb or index finger. This external supports (3a) and (4a) of the actuation levers can be easily observed in the plan view of FIG. 15 externally surrounding the fingers located in said actuation levers. In this way when the index and thumb fingers open, moving away from the central plane of the tool, they drag the actuation levers (3) and (4) by pressing with the dorsal part of these fingers on said outer supports (3a) and (4a). These outer supports of the operating levers must be smooth and adapt to the outer shape of the fingers to avoid areas of high pressure, and at the same time allow comfortable movement of the fingers for the opening and closing of the tool.

FIG. 16 and FIG. 17 shows how the external actuation lever (the furthest from the surgeon's body) can only be operated with the index finger as indicated in FIG. 16, or additionally using the middle finger as indicated in FIG. 17. This last case represents the position of the hand only if it is necessary to apply a greater force for closing the distal tool (17).

FIG. 18 shows the actuation of the orientation wheel (13) by the thumb. This wheel allows the support of the finger on a surface greater than other wheels used in current tools, so that the pressure on the thumb is less for the same force exerted. Alternatively, the index finger can be used for the movement of this orientation wheel.

In FIG. 19 shows the assembly structure of the lower part of the handle. In the lower part of FIG. 19 the handle (1) is observed. At the upper end of this handle there is a pivot (1a) to allow the positioning of the support (2) and the operating levers (3) and (4). In the upper horizontal surface of the pivot there is a threaded hole (1b) that allows the mechanism case (5) and the support (6) to be fixed with a threaded joint or screw (7). Before placing the operating levers on the handle (1), the support (2) must be placed. The mission of this support is to provide greater rigidity to the handle assembly. This support has an angular shape and has a through hole in one of its ends that allows it to be introduced into the pivot of the handle (1a). The support contains a cylindrical projection (2a) in its lower part that fits into a hole (1c) existing on the intermediate horizontal surface of the handle (1) in order to prevent the relative rotation between said handle and the support (2 ). The other end of the support (2) It contains a vertical support and at its upper end there is a threaded hole (2b) that allows its attachment to the mechanism box (5) by means of a screw (8). Once the support (2) is placed on the pivot of the handle, the operating levers (3) and (4) are placed. With this object, the operating levers contain a through hole at one end that fits with the pivot of the handle (1). The handle (3) contains a recess in its lower part to allow the rotation without colliding with the support (2). The geometric shape of the operating levers is not symmetrical, so they must be placed in strict order, the drive lever (3) is introduced first and then the drive lever (4) is introduced. In this arrangement, the two operating levers (3) and (4) can rotate freely on the pivot of the handle (1a). In turn, as can be seen in FIG. 19, two pivots (3b) and (4b) are located in the upper part of the operating levers in order to subsequently place the connecting rods of the transmission mechanism (9). Finally, as shown in the exploded perspective of FIG. 19 and in the profile view of FIG. 20 the mechanism box (5) is placed supported on two points and fixed by screws. One of these points is the handle (1), on the upper end of its pivot (1a), the other point is the upper end (2b) of the support (2), in this last support is fixed with a screw (8) once the mechanism box (5) is located. Next, the support (6) is fitted on the proximal hole (5a) of the mechanism housing and screwed with the screw (7) leaving a solid joint of the entire lower handle assembly. With this phase, the first part of the assembly ends, going on to the assembly of the transmission mechanism inside the mechanism box (5).

In FIG. 21 shows the perspective of the explosion of the transmission mechanism whose mission is to transmit the movement of the hand, when the operating levers (3) and (4) are operated, up to the drive shaft (15). For greater clarity in the illustration of FIG. 21 the box (5) has been sectioned. The holes (9a) of the connecting rods of the transmission mechanism (9) are introduced in the aforementioned pivots (3b) and (4b) previously and which are located in the upper part of the operating levers (3) and (4). These pivots of the operating levers reach the inside of the mechanism box (5) thanks to the partial opening that this box has in its lower part. This partial opening of the mechanism box (5) must also allow the free movement of rotation of the operating levers without causing any collision in its opening and closing range. Both cranks of the mechanism (9) are fixed to the operating levers (3) and (4) by the placement of the screws (10) and washers (11). These fasteners prevent the connecting rods from moving axially with respect to the pivots of the operating levers, but allow the relative movement of rotation of said connecting rods around the pivots. At its opposite end, the cranks of the mechanism (9) contain two holes (9b), similar to those used for placement in the pivots of the operating levers. In these two holes the slide (12) is introduced, each of the pivots (12a) containing said slide in its lower part fitting into the respective holes (9b) of the connecting rods. In this way the cranks of the mechanism (9) have a relative movement of rotation with respect to the slide (12). In the upper part of the slide (12) there is a notch (12b) in a semicircular shape that allows a groove of the drive shaft (15) to be fitted.

FIG. 22 shows the exploded perspective of the assembly of the extension tube (14), the drive shaft (15), the orientation wheel (13) and the upper cover (22). First, the orientation wheel (13) is inserted in the rear part of the drive shaft (15). For this, the orientation wheel (13) has a circular hole (13a) where the end of the drive shaft (15) can be adjusted. As can be seen more clearly in the detail of FIG. 23, in addition to the circular hole, the orientation wheel contains a groove of the same length as the hole for inserting the drive shaft (15) and its depth reaches the hole itself (13a). This groove is intended to insert the flange (15a) of the end of the drive shaft (15). With this arrangement, once the drive shaft (15) is inserted in the orientation wheel (13), the shaft The drive wheel can move axially with respect to the latter, but when the orientation wheel (13) rotates on the drive shaft, both the orientation wheel and the drive shaft experience the same rotation. The drive shaft (15) joins the distal tool (17) and the extension tube (14) at the opposite end of the orientation wheel (13). This union is made through the mechanism of the distal tool (19) that transforms the axial movement of the drive shaft (15) into the opening and closing movement of the operating tool (17). The orientation wheel assembly (13), drive shaft (15), extension tube (14) and the distal tool (17) and its drive mechanism (19) are inserted in the mechanism housing (5) based on three points . Two of these points are the fixed supports and are located on the opposite sides of the mechanism box (5b) and (5c) respectively. The third point is mobile and is the upper part of the slide (12) belonging to the previously described drive mechanism. As shown in detail in FIG. 23, the drive shaft (15) fits into the slide (12) in the upper groove (12b) which it has in a semicircular shape. In turn, as seen in the same figure, the drive shaft (15) contains a shoulder (15b) at its contact point with the slide (12), which allows the rotation of said shaft with respect to its axis but not the relative displacement in the axial direction with respect to the slide (12). In this way, when the slide (12) moves due to the actuation of the two actuation levers (3) and (4), it is transformed into a movement in the axial direction to the actuation axis (15), the latter activating the system (19) for opening and closing the distal tool (17). When the orientation wheel (13) is driven in its rotational movement, the drive shaft (15) also rotates, but the slider (12) does not move if the drive levers remain static. Therefore, this system guarantees the independence of the two drives of the distal tool, opening-closing and turning orientation. As can be seen in FIG. 23, the fixed supports (5b) and (5c) on which the extension tube (14) and the orientation wheel (13) sit respectively on the mechanism box (5) they have a semicircular shape. For the correct operation the extension tube (14) and the orientation wheel (13) have two recesses, (14a) and (13c) respectively, which allow their adjustment in the mechanism box (5). When the cover of the mechanism housing (22) is adjusted with the screws (25) and the washers (26) the extension tube (14) and the orientation wheel (13) can rotate when the latter is manually operated, but they remain retained in the axial direction of the tool.

FIG. 24 shows a sectional view of the tool by its central plane of symmetry. This figure allows us to observe the arrangement of the different connections between the elements previously described inside the mechanism box. The upper cover (22) contains the connection for cauterization (23) that can be easily connected to the drive shaft by means of a plate (24). The cauterization current is carried to the connection (23) in the usual way to the distal tool for which its description is unnecessary.

FIG. 25 shows an alternative configuration of the surgery tool where each of the actuation levers (3) and (4) is inserted in its respective pivot (1e) and (1d) on the handle (1). In this configuration, the operating levers have a symmetrical geometry with respect to the central plane of symmetry of the tool and allows improving the characteristics of force transmission to the operating tool (17). Also the support (2) and the mechanism box (5) must contain the respective holes to be inserted on the handle (1). Except for the lower part of the handle shown in FIG. 25, the rest of the tool is not practically affected by this alternative modification.

Although the best tactile sensitivity characteristics are achieved without spring for the opening of the operating levers, it can be easily implemented in the handle of the surgery tool object of this invention. As observed in the exploded perspective of FIG. 26, the configuration of the lower part of the handle is altered when this opening spring (30) is introduced. In this case it is observed in said FIG. 26 that the actuation levers do not require a support surface of the fingers for opening, since this operation makes the spring. The opening spring (30) consists of a metallic element of small thickness that contains a circular area (30a) and extends into two straight arms (30b), which will be located on the respective actuation levers. As seen in FIG. 26, the opening spring (30) is mounted just after the support (2) and the operating lever (3), so that the circular area of the spring externally surrounds the pivot (1a) of the handle (1) and internally to the operating lever (3) being located in a recess (3d) made for this purpose. One of the arms of the opening spring (30b) fits into the extension of the recess (3d) of the operating lever (3). Finally, the operating lever (4) is mounted by fitting the other arm (30b) of the opening spring (30) on a recess similar to that of the other operating lever (3). With this assembly it is necessary to apply pressure on the operating levers to bring them closer as the spring (30) applies a torque that tries to separate them.

In this case, the operating lever (3) must contain a sawtooth finish (3c) in its lower part so that the ratchet mechanism acts on it. This sawtooth finish (3c) can be seen both in FIG. 26 as in FIG. 27, in the latter, the operating lever (3) can be seen in detail.

In FIG. 28 it is observed that the support (2) is also modified when the opening spring (30) is introduced. In this case the support (2) contains the ratchet retention mechanism. The exploded perspective of this mechanism can be seen in detail in this FIG. 28 and contains, in addition to the support itself (2): the actuation trigger (31), the ratchet head (32), a compression spring (29), a bending spring (27) and the clamping screw of this last (28). The flexure spring is located on the groove (2c) of the support (2) and is secured with the screw (28). The compression spring (29) and the ratchet head (32) are introduced in this order in the hole of the support (2d) and are retained by the contact between the flange (27a) of the flexure spring (27) and the flange (32a) of Ia ratchet head (32). The ratchet drive trigger (31) rotates around its hole (31a) located on the pivot (2e) in the support (2). The pivot (32b) is inserted into the slot (31b) of the actuation trigger (31). In this way, when the trigger (31) rotates around the support (2), the cam formed by (32b) and (31b) axially displaces the ratchet head (32). FIG. 29 and FIG. 30 show two perspectives of the support and ratchet set. Once the complete assembly of the handle, the ratchet is deactivated in the configuration of FIG. 29 and FIG. 30, since the ratchet head (32) and its saw teeth (32c) do not come into contact with the saw teeth (3c) of the operating lever (3). In this case, the surgeon can freely open and close the operating levers (3) and (4). During this operation the spring (30) will slightly oppose the closing of the tool when the surgeon presses with his index fingers and thumbs the respective actuation levers. On the other hand, the spring will help its opening, avoiding the need for the surgeon to apply pressure with the dorsal part of the fingers in this operation. The ratchet drive is achieved when the surgeon pushes the trigger trigger (31) with the middle finger, or alternatively with another finger of the same hand, towards the distal end of the tool, and with sufficient force to overcome the retention exerted by the flexure spring (27) by means of the flange (27a). When this operation is performed, the sling head (32) is pushed by the compression spring (29) by fitting its saw teeth (32c) into the sawtooth finish (3c) of the actuation lever (3). In this way, the actuation lever (3) is retained by the compression spring pressure (29) and the ratchet head (32), in turn retaining the actuation lever (4) and therefore preventing the opening or closure of the distal tool (17). However, the surgeon can continue to close the tool if he applies sufficient force with his index and thumb fingers on the respective operating levers (3) and (4). If this force is sufficient, the ratchet head (32) can be pushed back by overcoming the pressure exerted by the compression spring (29). In this way the tool can be closed point to point each point corresponding to the angle rotated by the operating levers when a sawtooth of the ratchet mechanism is exceeded. To deactivate the ratchet mechanism, it is only necessary to push the trigger (31) with the middle finger towards the proximal end of the tool as shown in FIG. 31.

Although only particular embodiments of the invention have been represented and described herein, the person skilled in the art will know how to introduce modifications and replace some technical characteristics with equivalent ones, depending on the requirements of each case, without departing from the scope of protection defined by the attached claims.

Claims

1. Handle (40) for a distal endoscopic or laparoscopic surgery tool (17), comprising means for manually operating said distal tool, characterized in that said means comprise a handle (1) and two levers (3,4 ) that are configured to actuate the distal tool together and are arranged one on each side of the handle, so that one of the levers is configured to be operated by the thumb and the other lever is configured to be operated by the index finger , while the handle is configured to be grasped by the other three fingers, heart, ring and little finger, together with the palm of the hand.

2. Handle according to claim 1, characterized in that the two levers (3,4) move in solidarity.

3. Handle according to claim 1 or 2, characterized in that the two levers (3,4) are arranged symmetrically with respect to the handle, so that each lever can be operated interchangeably with the thumb or the index, depending on whether they are from the right hand or from the left.

4. Handle according to any of the preceding claims, characterized in that at least one of the levers (3; 4) is configured to be operated both by opening and closing the actuation fingers.

5. Handle according to claim 4, characterized in that at least one of the levers (3; 4) comprises an outer arm (3a; 4a) and an inner arm, there being a space between both arms to house the finger, so that the lever is configured so that the finger exerts a closing force on the inner arm and an opening force on the outer arm.

6. Handle according to claim 5, characterized in that at least one of the levers (3; 4) comprises an additional arm for the middle finger, so that it can also actuate the lever together with the index finger.

7. Handle according to any of the preceding claims, characterized in that it comprises an orientation wheel (13) which allows the distal tool (17) to be rotated, the surface of said orientation wheel (13) being a surface of revolution and substantially semi-elliptical, which can be operated by the thumb.

8. Handle according to any of the preceding claims, characterized in that it comprises a spring (30) connected to the levers (3; 4) in order to exert a slight force of opposition to the actuation of the distal tool.

9. Handle according to any of the preceding claims, characterized in that it comprises a mechanism for retaining the position of the levers (3, 4).

10. Handle according to any of the preceding claims, characterized in that it comprises a mechanism box (5) located on the levers (3, 4), which houses the drive mechanism of the distal tool (17).

11. Handle according to claim 10, characterized in that the mechanism box (5) comprises an upper cover (22) which is provided with a cauterization connection (23).

12. System for endoscopic or laparoscopic surgery comprising a handle (40) according to any of the preceding claims, an extension tube (14), and a distal tool (17) located in the distal region of said tube (14) and actuated by said handle through the extension tube.

13. System according to claim 12, characterized in that the actuation of the levers (3; 4) is transmitted to the distal tool (17) through a drive shaft (15), so that the axis of The drive coaxially travels inside the extension tube (14) to produce an opening and closing movement of the distal tool.

14. System according to claim 13, characterized in that the movement of the levers (3; 4) is transformed into a displacement of the drive shaft (15) by means of two connecting rods (9) fixed to the levers by a end, said connecting rods being connected to a slide (12) at its other end by two pivots (12a) provided in the lower part of said slide, so that the connection between the upper part of the slide and the drive shaft makes it possible the relative movement of rotation between them but prevents the relative movement of both in the axial direction of the drive shaft.

15. System according to any of claims 13 or 14 characterized in that the orientation wheel (13) is connected to the drive shaft (15) by means of a connection (13a, 13b, 15a) that allows the relative movement of both in the axial direction of the drive shaft but prevents the relative rotation movement between them.