WO2013182730A1

WO2013182730A1 - Laparoscopic forceps

Info

Publication number: WO2013182730A1
Application number: PCT/ES2013/070373
Authority: WO
Inventors: Jaime Alonso Gómez
Original assignee: Servicio Andaluz De Salud
Priority date: 2012-06-08
Filing date: 2013-06-07
Publication date: 2013-12-12
Also published as: ES2472567B1; ES2472567A1

Abstract

The invention relates to a laparoscopic forceps characterised in that it comprises a longitudinal tube, a main body, a stationary handle that can be gripped with the index, middle, ring and/or little fingers, and a movable eye ring for the thumb that can be used to actuate the forceps. The longitudinal tube and the stationary handle are located in a single plane, and the movable eye ring can be moved in a plane that forms an angle of between 60º and 90º with the plane of the stationary handle.

Description

LAPAROSCOPIC CLAMP

OBJECT OF THE INVENTION The invention is framed within the field of medicine, and more particularly within the field of surgical devices used in laparoscopic surgery.

The object of the invention is a novel laparoscopic forceps specially designed to improve its ergonomics, thus facilitating the surgeon a comfortable use thereof even during operations of several hours duration.

BACKGROUND OF THE INVENTION A laparoscopic forceps is a device that allows the surgeon to access the inside of the patient's body through a very small opening. Fundamentally, a current laparoscopic forceps has a handle similar to that of scissors, an elongated tube through which the movement generated by the surgeon when opening and closing the eyelets of the handle is transmitted, and a tip where the pincer is properly located said, which is the one that acts directly on the tissues of the patient.

Although laparoscopic surgery is increasingly widespread, this widespread use has also evidenced the appearance of specific lesions related to the use of instruments and special techniques developed for these procedures, as described, for example, in the article by R Berguer, DLForkey and WD Smith entitled "Ergonomic problems associated with laparoscopic surgery", Surgical Endoscopy, 13 (1999). The fundamental cause of the injuries is related to the few ergonomic characteristics of these instruments. Surgeons often complain about pressure, as well as pain and fatigue in the hands and the lower limb joints, even causing tendonitis in the wrist The existing general ergonomic guidelines for the design of hand tools are not specific enough, and therefore are insufficient for use in the design of laparoscopic instruments.

DESCRIPTION OF THE INVENTION

A conventional mechanism for actuating a laparoscopic forceps, that is, the handle, consists essentially of a pair of eyelets arranged within the same plane. One of the eyelets is fixed, and is designed for the surgeon to insert one or more of between the index, middle, ring and little fingers. The other eyelet is mobile within the mentioned plane, and is designed for the surgeon to insert the thumb. Broadly speaking, the use of this device requires the surgeon to move the thumb in the anteroposterior direction along an axis essentially parallel to that of the longitudinal tube of the clamp, a movement that is transmitted by means of a semi-rounded cable or rod. rigid along said longitudinal tube of the clamp to finally cause an opening-closing action of the clamp arms, which are located at the distal end or tip of the longitudinal tube.

The inventor of the present application has discovered that a large part of the ergonomic problems presented by the current tweezers are the consequence mainly of two characteristics: both eyelets are within the same plane; and the angle formed by the axis of the fixed eyelet in relation to the longitudinal tube that transmits the movement to the tip is approximately 90 °

In the first place, the fact of placing the two eyelets in the same plane, the mobile eyelet being the one that is located in the back position and that is operated with the thumb, causes the surgeon to be forced to move his thumb to activate the clamp. backwards, approximately in the direction of your own elbow. It is an absolutely ergonomic movement and whose repetition for a long period of time causes the aforementioned discomfort, even reaching tendinitis in the wrist and numbness of the fingers. Secondly, the angle of about 90 ° that forms the main axis of the clamp in relation to the axis of the fixed front eyelet forces the surgeon to remain with the wrist flexed, with the palm facing medial, for the entire duration of the operation. The reason is that, to be able to handle the tip of the clip with precision, the surgeon normally adopts a position in which the forearm that activates it is approximately parallel to the tube that transmits the movement to the tip. This forces the wrist to be forced during the entire time of use of the clamp, which aggravates the above problems. In this document, reference will be made to the following addresses and plans:

- Fixed handle plane (TT _F ) This is the plane that contains the fixed handle and the longitudinal tube that transmits the movement to the tip of the clamp.

- Mobile eyelet plane (TTM): IS the plane within which the mobile eyelet moves.

- Longitudinal tube axis (E-i): This is the axis that passes through the center of the longitudinal tube transmitting the movement.

- Axis of the fixed handle (E ₂ ): This is an axis that runs longitudinally through the fixed handle of the clamp.

- Shaft of the mobile eyelet (E ₃ ): This is an axis that runs longitudinally the mobile eyelet.

- Axis of the surgeon's forearm (E ₄ ): It passes through the surgeon's forearm when holding the clamp.

A conventional laparoscopic clamp basically comprises the following elements: - An elongated longitudinal tube intended to be introduced into the body of a patient and which has, at its distal end, pincer arms that are the ones that effectively grasp, cut, hold, etc. The patient's tissues.

- A fixed eyelet that has adequate dimensions for the surgeon to insert his index fingers, ring heart and / or pinky, as required by each case.

- A mobile eyelet that has adequate dimensions for the surgeon to insert his thumb. This is the eyelet that allows the clamp to be operated, the movement being transmitted along the longitudinal tube to the clamp arms located at its distal end.

- A main body to which the longitudinal tube and the two eyelets are fixed, and inside which the movement transmission mechanism is housed.

As previously mentioned, in the prior art tweezers both eyelets are arranged within the same plane, the movable eyelet being movable within that same plane. Well, the novel clamp of the invention, on the other hand, has as a main advantage the fact that the movable eyelet is movable within a plane that forms between 60 ° and 90 °, more preferably between 80 ° and 90 °, with in relation to the plane of a fixed handle, which replaces the fixed eyelet of the prior art. The fixed handle is designed for the surgeon to hold or grab it with his index, heart, ring and / or pinky fingers, being able to have different shapes, Although in a preferred embodiment of the invention it is a cylindrical handle, it can also have cavities Ergonomic to accommodate the fingers.

As for the orientation of the plane that contains the fixed eyelet in relation to the plane of the fixed handle, it is understood that it can be variable depending on the design of the handle in relation to the position of the hand that grabs it. Thus, figures in this document are shown where the moving eyelet follows a line that is the continuation of the direction of the longitudinal tube of the clamp. But nevertheless, it would also be possible for the mobile buttonhole to be arranged according to other orientations.

The replacement of the fixed eyelet by the mentioned handle, as well as the movement of the mobile eyelet within a plane different from the plane in which the handle is located and the longitudinal transmission tube of the movement, greatly improve the ergonomics of the clamp. Note that, when a laparoscopic forceps is operated, the surgeon's natural gesture is to approximately align the longitudinal tube of the forceps with the direction of his forearm in order to direct the tip of the clamp as precisely as possible. When both eyelets are in the same plane, as is the case with the prior art tweezers, to actuate the tweezers, the thumb does not move following its natural direction, that is, following an approach / distance movement of the inner part of the other fingers of the hand (movement commonly referred to as "pincer"), but it is necessary to move the thumb back in the direction of your own elbow approximately.

In the clamp of the invention, however, the movement performed by the surgeon is much more ergonomic, since it keeps the fist closed around the handle and should only move the thumb from a position corresponding to a closed fist to a corresponding position approximately to the position commonly used to make "auto-stop". This will be clearer later in this document with reference to the figures.

The movement of the mobile eyelet can essentially be of two types: swivel or pivot, and sliding. This movement is transmitted to the proximal end of a semi-rigid, usually metallic, cable that runs along the longitudinal tube to transmit the movement to the tip or distal end of the tube where the clamp arms that open or close to grab are located, cut, press, etc. The patient's tissues. In this document, the The term "semi-rigid" refers to an essentially rigid cable in the sense of allowing adequate transmission of both traction and compression, but which has a certain flexibility that allows the direction of the longitudinal tube not to be perfectly aligned with the direction of movement of the mobile eyelet by which it is operated. Next, two preferred embodiments of the invention relating to the movement transmission mechanism are described.

In a preferred embodiment of the present invention, the movable eyelet is configured to undergo a pivoting or pivoting movement about an axis located within the plane (TT _F ) of the handle when it is operated by the surgeon. This movement can be transferred to the semi-rigid cable in various ways, although preferably a gear is used in solidarity with the rotary movement of the movable eye within the plane (π _Μ ) and which is engaged to notches in the proximal end of the semi-rigid cable. Thus, when the mobile eyelet is operated, the longitudinal displacement of said semi-rigid cable is caused to open / close the clamp arms. That is, when the surgeon operates the movable eyelet, the pivoting movement thereof is transmitted through the gear to the semi-rigid cable to open / close the clamp arms located at the distal end of the tube.

Normally, conventional surgical forceps have means that allow the clamp arms located at the distal end of the tube to be rotated, in order to allow the surgeon to pick up or cut tissues arranged in different orientations without having to move around the operating environment. To do this, they usually have a wheel (not shown in the figures) located on the distal part of the main body of the clamp that is attached to the semi-rigid cable and that the surgeon himself can spin manually with his index finger. To allow this rotation of the semi-rigid cable, preferably the notches of the clamp of the invention cover the entire circumference of the semi-rigid cable, so that the cable can rotate around its axis because the tips of the gear slide along the inside the notches.

Depending on the angle and relative position of the planes in which the fixed handle (TT _F ) and the movable eyelet (π _Μ ) are located, it may be necessary to use an additional intermediate gear arranged between the front gear and the semi-cable. rigid. A bevel gear could also be used, possibly also with an additional bevel gear, instead of plain, simpler gears. In accordance with another preferred embodiment of the present invention, the movable eyelet is movable according to a sliding movement along a line located within the plane (TT _F ) of the handle. This can be achieved simply with a sliding mobile eyelet along a rail disposed in the body of the clamp, said mobile eyelet being connected to a proximal end of the semi-rigid cable to transmit the movement.

To allow the semi-rigid cable to rotate around its axis, in a preferred embodiment the connection between the movable eyelet and the semi-rigid cable is rotatable, that is, it allows the semi-rigid cable to be rotated along its own axis. For example, the cable could have a ball or similar to its proximal end, while the movable eyelet could have a suitable groove for the passage of the cable, but not the ball. Thus, the cable could rotate around its own axis without disconnecting from the mobile eyelet. In another preferred embodiment, however, the clamp comprises means for disconnecting the movable eyelet from the semi-rigid cable, which allows free rotation of the semi-rigid cable around its axis.

On the other hand, as mentioned above, a second main advantage of the surgical clamp of the invention is related to the angle formed by the axis of the fixed handle in relation to the axis of the longitudinal tube of the clamp, which in this example is preferably between 135 ° and 180 °, more preferably from 150 ° to 160 °. This setting allows the position of the The surgeon's wrist during the use of the clip is more relaxed and natural than with the prior art setting, where it was necessary for the wrist to remain forced. This will also be seen in greater detail in the attached figures.

BRIEF DESCRIPTION OF THE FIGURES

Fig. 1 shows a surgeon using a clamp according to the prior art.

Fig. 2 shows an example of a surgical clamp according to the prior art.

Fig. 3 shows a preferred embodiment of the surgical forceps of the present invention.

Fig. 4 shows an example of a surgical clamp with a cut-out part to illustrate an example of a movement transmission mechanism where the movable eyelet is pivoting.

Fig. 5 shows an example of a surgical clip with a clipped part to illustrate an example of a movement transmission mechanism where the moving eyelet is sliding. Figs. 6 and 7 show the use of the surgical clamp of Fig. 3 in its two corresponding positions, respectively open and closed clamp.

PREFERRED EMBODIMENT OF THE INVENTION An exemplary embodiment of a surgical forceps (1) according to the present invention is described below with reference to the attached figures. First, Figs. 1 and 2 show an example of surgical clamp (100) according to the prior art. It can be seen how this clamp (100) is formed by a main body (103) to which a longitudinal tube (102) is connected at whose distal end are the clamp arms designed to hold, grab, hook, cut, etc. the patient's tissue (not shown in the figures). At the opposite end of the main body (103) are the eyelets: a fixed eyelet (104) that is rigidly attached to the body (103); and a mobile eyelet (105) that can be moved from a first retracted position to an extended position where it is furthest from the fixed eyelet (104).

The mobile eyelet (105), shown in Fig. 2, moves from the retracted position parallel to the axis (E3a) to the extended position parallel to the axis (E3b). This movement is always carried out within the plane (TT _F ) in which the fixed eyelet (104) is located, so that, in the position in which the surgeon must hold the clamp (100) during use, the direction The movement that the surgeon's thumb must follow to open / close the clamp (100) is approximately parallel to the direction (E4) of his forearm. This movement is very forced and causes numerous long-term injuries, in addition to the obvious discomfort.

Fig. 3 shows an example of clamp (1) according to the present invention. This clip (1) also has a main body (3) on whose distal side is the longitudinal tube (2) that is inserted into the patient's body. However, unlike the tweezers of the prior art, this novel clip (1) is provided at its opposite end with an approximately cylindrical handle (4) that has adequate dimensions for the surgeon to grasp with his four fingers: index , heart, ring and / or pinky. This handle (4) is arranged inside the plane (TT _F ) in which the body (3) and the longitudinal tube (2) are also located. The mobile eyelet (5), meanwhile, is located in a plane (π _Μ ) that is perpendicular to the plane (TT _F ) above. The movement carried out by the movable eyelet (5) to drive the clamp arms arranged at the distal end of the longitudinal tube (2) (not shown) is develops between a retracted position where the mobile eyelet (5) is parallel to the axis (E3a) and an extended position where the mobile eyelet (5) is parallel to the axis (E3b), always within the plane (π _Μ ). Thus, as seen in Figs. 6 and 7, to operate the clamp (1) the surgeon only has to move the thumb between a closed fist position (Fig. 7) and a position similar to that used to make "auto-stop" (Fig. 6), With the thumb out of the fist. This movement is much more comfortable than that described in relation to Fig. 1.

To transmit the movement generated by the movement of the mobile eyelet (5) to the tip or distal end of the longitudinal tube (2), various mechanisms can be used, of which two examples are explicitly shown. In Fig. 4 a first mechanism is illustrated where the movable eyelet (5) moves according to a rotating or pivoting movement. In this case, when the mobile eyelet (5) is tilted, the effect is to produce in turn the rotation of a gear (7) that is rigidly fixed to said mobile eyelet (5) within the plane (π _Μ ). This gear (7), in turn, is coupled with notches (8) made in the proximal end of the semi-rigid cable (6). Thus, when the surgeon moves the movable eyelet (5), the rotation of the gear (7) is transmitted to the semi-rigid cable (6) through the notches (8) as an effort that "pulls" or "pushes" longitudinally of the cable (6), causing the clamp arms to open / close. In Fig. 5, on the other hand, an example of a clamp (1) is shown where the movable eyelet (5) moves longitudinally by sliding along a rail (9). This sliding movement is transferred to the semi-rigid cable (6) by means of a simple connection between the mobile eyelet (5) and the cable (6), since in this example the direction of the rail (9) coincides with the direction of the longitudinal tube (2). If it does not coincide, it would be possible to transmit the movement using a gear and notch mechanism similar to that shown in Fig. 4, although possibly using a bevel gear. On the other hand, notice also that the direction of the rail (9) could vary according to the designs, Fig. 5 being merely illustrative.

Finally, and going back to Fig. 3, it can also be seen how the angle (Θ) formed by the axis (E2) of the fixed handle (4) in relation to the main axis (E1) of the clamp (1) is of approximately 150 ° (for reasons of clarity, the complementary angle (180- Θ) has been shown in Fig. 3). This allows the surgeon to have a more comfortable posture, since it allows to keep the wrist relaxed while using the forceps.

Indeed, in Figs. 6 and 7 it is observed how the surgeon's wrist during the use of the clip (1) is tilted down, and therefore less forced to remain stretched and aligned with the clip (1) than in the prior art. In other words, the axis (E4) of the surgeon's forearm remains approximately parallel to the axis (E1) of the longitudinal tube (2) of the clip (1), but with a much more comfortable and ergonomic wrist posture. On the contrary, it can be seen in Fig. 1 how, using a clamp (100) of the prior art, to achieve that the axis (E4) of the forearm is parallel to the axis (E1) of the longitudinal tube (2) of the clamp (1), it is necessary to keep the wrist forced.

Claims

one . Laparoscopic forceps (1), characterized in that it comprises a longitudinal tube (2), a main body (3), a fixed handle (4) that can be grasped with the index, heart, ring and / or little fingers, and an eyelet (5 ) mobile for the thumb that allows the clamp (1) to be operated, said longitudinal tube (2) and said fixed handle (4) being located within a plane (TT _F ), and where the movable eyelet (5) is movable within of a plane (π _Μ ) that forms between 60 ° and 90 ° with said plane (TT _F ) of the fixed handle (4).

2. Laparoscopic forceps (1) according to claim 1, wherein the plane (π _Μ ) of the movable eyelet (5) forms between 80 ° and 90 ° with the plane (TT _F ) of the fixed handle (4).

3. Laparoscopic forceps (1) according to any of the preceding claims, wherein the fixed handle (4) has a cylindrical shape.

4. Laparoscopic forceps (1) according to claim 3, wherein the handle (4) further comprises ergonomic cavities for housing the fingers.

5. Laparoscopic forceps (1) according to any of claims 1 -4, wherein the movable eyelet (5) is movable according to a pivot movement around an axis located in the plane (TT _F ).

6. Laparoscopic pitch (1) according to claim 5, comprising a gear (7) integral with the pivoting movement of the eyelet (5) movable within the plane (π _Μ ), said gear (7) being engaged to notches (8) of the proximal end of a semi-rigid cable (6) that passes through the longitudinal tube (2) and has a distal end connected to a pair of clamp arms located at the distal end of said longitudinal tube (2) , so that, when the mobile eyelet (5) is operated, the longitudinal displacement of said semi-rigid cable (6) is caused to open / close the clamp arms.

7. Laparoscopic clamp (1) according to claim 6, wherein the notches (8) cover the entire circumference of the semi-rigid cable (6).

8. Laparoscopic clamp (1) according to any of claims 6-7, which further comprises an additional intermediate gear between the gear (7) and the notches (8) of the semi-rigid cable (6).

9. Laparoscopic forceps (1) according to any of claims 1-4, wherein the movable eyelet (5) is movable according to a sliding movement along a line located within the plane W.

10. Laparoscopic clamp (1) according to claim 9, wherein the movable eyelet (5) is sliding along a rail (9) disposed in the body (3) of the clamp (1), said eyelet being connected (5) movable to a proximal end of the semi-rigid cable (6) to open / close the clamp arms.

11. Laparoscopic clamp (1) according to claim 10, wherein the connection between the movable eyelet (5) and the semi-rigid cable (6) is rotatable.

12. Laparoscopic clamp (1) according to claim 10, comprising means for disconnecting the movable eyelet (5) from the semi-rigid cable (6) to allow free rotation of the semi-rigid cable (6) around its axis .

13. Laparoscopic forceps (1) according to any of the preceding claims, wherein the angle (Θ) forming the axis (E2) of the fixed handle (4) relative to the axis (E1) containing the longitudinal tube (2) it is between 135 ° and 180 ° 14. Laparoscopic forceps (1) according to claim 13, wherein the angle (Θ) is comprised between 150 ° and 160 °.