Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
  • A61B17/0281—Abdominal wall lifters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/02—Devices for expanding tissue, e.g. skin tissue

Definitions

• the invention relates to an instrument for expanding the pneumoperitoneum for endoscopy (abdominal cavity expander).
• the pneumoperitoneum In endoscopic examinations and operations, especially in the abdominal area, the pneumoperitoneum is generally flooded with carbon dioxide so that the internal organs to be treated are easily accessible to the optics and the surgical instruments. In rare cases, the pneumoperitoneum can collapse, with the risk that the inserted surgical instruments will injure the internal organs when the abdominal wall descends.
• an abdominal cavity expander for endoscopy which has a rod, at the proximal end of which at least one folding element is hinged between a first position aligned with the rod and a second position essentially directed transversely to the rod.
• this rod In the first position, this rod can be inserted into the pneumoperitoneum directly or through a trocar sleeve through the patient's abdominal wall. If the rod is inserted so far that the folding element is completely in the pneu moperitoneum, it is folded out into its second position.
• the abdominal cavity expander in an advantageous further development has an annular sealing plate which can be fixed axially in any position on the rod.
• the sealing plate is formed on the proximal longitudinal end of a sleeve which surrounds the rod without play and which can be fixed to the rod by means of a radial clamping screw.
• the abdominal wall is clamped between the folding element and the sealing plate, which reliably prevents the gas from escaping through the puncture point.
• the exact fit between sleeve and rod is not necessary when using a ring seal.
• the abdominal cavity expander can be designed in the manner of a folding anchor with a plurality of folding elements, for example in the manner of an expansion screen, the folding elements then preferably being arranged rotationally symmetrically around the rod.
• the folding elements can be hinged to the rod at their proximal end.
• an elongated folding element is articulated in the middle of the rod and forms a cylinder with the rod in the first position, which can be inserted through a trocar sleeve without any problems.
• the end of the folding element which is proximal in the first position can taper to ensure that the abdominal wall is traumatized as little as possible during the puncture.
• the longitudinal ends of the folding element are preferably rounded in order to avoid injuries.
• the abdominal cavity expander can be introduced through an already inserted trocar sleeve.
• the expander or elevator is advantageously perforated. This can be achieved, for example, by forming an air duct parallel to the axis of the expander, which connects the pneumoperitoneum to the ambient air.
• a one-sided closing valve could also be arranged in the air duct, which only allows gas to pass in one direction. If this valve is rotatably arranged in the gas channel, it can be set for the expansion or collapse of the pneumoperitoneum are so that in the first case only gas, in particular air, can penetrate into the pneumoperitoneum and in the latter case only gas can escape from the pneumoperitoneum.
• the perforated expander is usually inserted through a trocar sleeve, which can also be pulled when the folding element is inserted or expanded.
• Another advantage of the perforated expander is the self-sucking effect when the abdominal wall is raised, so that air can flow into the intra-abdominal area from the outside. With the help of the expander, it is now relatively easy to inspect difficult topographic sites.
• Figure 1 is a partially sectioned side view of a double-sided insertable abdominal cavity expander with a sealing plate.
• Fig. 6 is a partially sectioned side view of a perforated expander.
• the expander 10 consists of a rod 12, to the distal end 14 of which a hinged element 16 is articulated, which is aligned with the rod 12 in a first position (illustration) and, in a second position (FIGS. 3 to 5), is folded out transversely to the rod .
• a sleeve 18 is slid onto the rod 12 and can be fixed to the rod by means of a radial clamping screw 20.
• the sleeve 18 has at its distal end a sealing plate 22 which, after inserting the expander 10 into the pneumoperitoneum, unfolding the folding element 16 and expanding the pneumoperitoneum, is pressed against the abdominal wall in the proximal direction by pretensioning the expander 10 to avoid gas loss at the puncture site of the abdominal wall.
• the sleeve 18 surrounds the rod 12 with as little play as possible and / or a seal is provided between the sleeve 18 and the rod 12.
• This seal is advantageously designed as a ring seal made of known types of rubber or plastic.
• the flap elements 12 of the two longitudinal ends 14 of the expander can preferably be folded in opposite directions or in the same direction. In contrast to the illustration, the diameters of the longitudinal ends can be different, for example 5 and 10 mm. A longitudinal end can be perforated in the manner described below.
• the double-sided insertable expander can be easily held and replaced.
• the mode of operation of the abdominal cavity expander 10 will be described below with reference to FIGS. 2 to 5. Parts identical to FIG. 1 are provided with identical reference numerals.
• the expander 10 is inserted into the pneumoperitoneum 28 by means of a trocar sleeve 24 through the abdominal wall 26 of a patient (FIG. 2). Subsequently, the elongated folding element 16, which was previously aligned with the rod 12, is folded out into a second position which is transverse to the rod 12. In the present case, this is done with the help of another medical instrument that was introduced through a further trocar sleeve of the pneumoperitoneum.
• a folding element can also be folded in and out by means of an actuating linkage guided in or on the rod or purely in terms of weight or spring preload.
• the trocar sleeve 24 is first pulled out of the pneumoperitoneum in the proximal direction.
• the expander is then also moved in the proximal direction (FIG. 4) until the folding element 16 lies against the inside of the abdominal wall 26 of the patient (FIG. 5). Now the expander is prestressed in the proximal direction, whereby the abdominal wall 26 is raised and the pneumoperitoneum 28 is inflated or expanded accordingly.
• a proximal expander end with a different diameter or a different length of the folding element can also be formed on the expander, so that an expander can have different folding elements at its opposite ends.
• the sealing plate 22 is pressed onto the outside of the abdominal wall 26 and fixed on the rod 12 by means of the clamping screw 20.
• the sealing plate can preferably have a diameter of 50 mm, while a diameter of 5 or 10 mm is provided for the expander, for example.
• 6 shows a perforated expander 30, which can be inserted on both sides, with an elongated rod-shaped body 32.
• Axial channels 36 open into the longitudinal ends 34 of the rod 32, which provide pressure equalization between the pneumoperitoneum and a gas storage space located outside the pneumoperitoneum, for example the operating room Room or the ambient air. The negative pressure that occurs when the abdominal cavity expands is thus compensated for by this channel 36.
• a valve 38 is arranged (screwed on) at the opening of the channel 36, which valve allows gas to pass through in one direction only.
• the valve is rotatably arranged about an axis protruding from the plane of the drawing, so that the direction of passage can be reversed. In this way, it can be specifically controlled that gas can only pass in one direction.
• the outlet of this valve 38 can be open or can be connected to a gas storage container with a defined pressure and / or a certain gas.
• the expander can also be used to set a certain pressure in the pneumoperitoneum.
• the expander or elevator which can be inserted or stretched on both sides, is applied through a trocar sleeve with a diameter of 5 mm or 10 mm. After the intra-abdominal application, the trocar sleeve can be removed.
• the perforated expander sucks the air from the environment into the pneumoperitoneum, which is advantageous for techniques in which a CO pneumoperitoneum is not desired.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Molecular Biology (AREA)
• General Health & Medical Sciences (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Animal Behavior & Ethology (AREA)
• Engineering & Computer Science (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Dermatology (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Pathology (AREA)
• Surgical Instruments (AREA)
• Endoscopes (AREA)

Priority Applications (1)

Applications Claiming Priority (4)

Publications (1)

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Cited By (30)

Families Citing this family (3)

Citations (6)

• 1991
  • 1991-05-28 DE DE9106553U patent/DE9106553U1/de not_active Expired - Lifetime
• 1992
  • 1992-04-09 EP EP92908195A patent/EP0579674A1/de not_active Ceased
  • 1992-04-09 WO PCT/EP1992/000811 patent/WO1992018056A1/de not_active Application Discontinuation
  • 1992-04-09 JP JP4507650A patent/JPH0761331B2/ja not_active Expired - Lifetime

Patent Citations (6)

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