WO1994021179A2 - Double action adjustable self-retaining retractor for video-monitored endoscopic surgery - Google Patents

Double action adjustable self-retaining retractor for video-monitored endoscopic surgery Download PDF

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Publication number
WO1994021179A2
WO1994021179A2 PCT/EP1994/000865 EP9400865W WO9421179A2 WO 1994021179 A2 WO1994021179 A2 WO 1994021179A2 EP 9400865 W EP9400865 W EP 9400865W WO 9421179 A2 WO9421179 A2 WO 9421179A2
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WO
WIPO (PCT)
Prior art keywords
instrument
retractor
pallets
distal
retractor according
Prior art date
Application number
PCT/EP1994/000865
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French (fr)
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WO1994021179A3 (en
Inventor
Pierre Hourlay
Johan Ceuppens
Original Assignee
Pierre Hourlay
Johan Ceuppens
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Publication date
Application filed by Pierre Hourlay, Johan Ceuppens filed Critical Pierre Hourlay
Publication of WO1994021179A2 publication Critical patent/WO1994021179A2/en
Publication of WO1994021179A3 publication Critical patent/WO1994021179A3/en

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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
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30092—Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A61F2210/0019—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at only one temperature whilst inside or touching the human body, e.g. constrained in a non-operative shape during surgery, another temperature only occurring before the operation

Definitions

  • the autostatic retractor makes it possible to separate two anatomical structures from each other and to stabilize this spacing by a locking system. All the retractors currently on the market in this type of surgery make it possible to spread a structure, but not to exert on each of the two structures a traction aiming to draw them apart from one another.
  • the space between the two arms of the retractor is completely free and allows work with other instruments.
  • the arms of the retractor have a certain degree of flexibility aimed at protecting the anatomical structures from too brutal and excessive traction.
  • these arms allow great force to be applied to the distal end.
  • Distal palettes that are applied to structures anatomical are movable in a plane perpendicular to the plane of separation of the arms and atraumatic. Their shape has been studied in order to avoid lateral sliding of the structures they contain. The sliding of the anatomical structures at the end of each pallet is avoided by a slight curvature on the longitudinal axis by digging the pallet and by longitudinal grooves which are produced on the external face of the pallet.
  • the pallets may have a hollowed out shape on their longitudinal side wall (s).
  • the plates of the autostatic orientable spacer according to the invention are machined on their outer face.
  • the movement of the distal arms and the platelets is linked. Indeed, the same axis controls the two movements, the mobilization of the pads being done only from a certain "stroke" of the single transmission axis.
  • the controls of the distal "arms" and of the spacers are completely independent. on the other and can be done separately, regardless of the respective positions of the arms or pads.
  • any modification of the position of the distal arms implies a modification of the length of the part of the instrument externalized from the main sheath of the instrument.
  • the total length of the autostatic retractor remains stable whatever the position of the arms.
  • the movement of the arms is only induced by the force linked to the elasticity of the metal of the arms which come out of their sheath.
  • the transmission makes it possible to apply to the distal end of the retractor a force directly dependent on that applied by the operator to the control handle.
  • instruments of different structure and for different use have a flexible main axis part have been described.
  • Fig. 1 Side view of the instrument (arms apart).
  • Fig. 2 Top view of the instrument (closed position).
  • Fig. 3 Side and upper view of the closed instrument during its introduction into the body through an introduction trocar.
  • Fig. 4 3/4 view of the instrument constructed with a semi-flexible intermediate segment (in the spacing position with 90 ° pads).
  • Fig. 5 a, b, c Views of the instrument in different planes when it is constructed with different plates.
  • the space between the two arms of the retractor (2) is completely free and allows work with other instruments.
  • the arms of the retractor (2) have a certain degree of flexibility aimed at protecting the anatomical structures from too brutal and excessive traction. These arms (2), however, allow great force to be applied to the distal end.
  • the distal pallets (1) which are applied to the anatomical structures are mobile (in a plane perpendicular (14) to the spacing plane (13) of the arms) and atraumatic. Their shape has been studied in order to avoid lateral sliding of the structures they contain (concave curvature (3) on the transverse axis and longitudinal grooves (4)). The sliding of the anatomical structures at the end of each pallet (1) is avoided by a slight curvature (3) on the longitudinal axis by digging the pallet (1).
  • These longitudinal ridges (4) and the curvature (3) are produced on the external face of the pallet (1).
  • the pallets can have a hollowed out shape on their lateral longitudinal wall.
  • These different curvatures (3) are made by digging into the mass of thick pallets (1) (+ 2mm.) So that their ends and edges can be foam and atraumatic.
  • These pallets can be interchangeable by latching system (in order to be able to use the retractor to keep open an extraperitoneal space without the aid of insufflation during endoscopic extraperitoneal surgery).
  • a transverse axis (5) (at the proximal end of the pallet) fixes the pallet (1) to the arm of the spreader (2).
  • This mobility (14) is actively controlled from outside the body by a semi-rigid cable (6) fixed to the base (7) of the pallet (1) and which runs along the arms (2) of the retractor , then in the axis of the device (8) to the control system (9) which is the external handle.
  • This control system (9) (located outside the body) is accessible by the finger of the hand which actuates the main handle of the instrument (10).
  • This spacing (13) can be maintained by blocking the external handle by a rack system (12) for example, or any other blocking system.
  • Other control systems are of course imaginable. This is in fact an incidental detail in the operation and interest of the instrument.
  • the device described can be made of stainless steel in whole or in part. Indeed a metallic instrument (washable and sterilizable) could also give rise to a production of a functionally identical instrument composed of non-metallic material. This instrument would then be part of the disposable equipment.

Abstract

A self-retaining retractor for spacing apart two anatomical structures and stabilising the resulting spacing by means of a locking system with two distal tabs (1) which are movable in two different planes relative to the main axis of the instrument, one of the planes being the spacing plane (13) of the arms of the retractor (2) while the other plane (14) perpendicular to the first is the moving plane of said distal tabs (1).

Description

Ecarteur autostatique orientable à effet double pour chirurgie sous videoscopie et endoscopique.Autostatic double effect retractable retractor for videoscopic and endoscopic surgery.
Il s'agit d'un ecarteur autostatique utilisé en chirurgie endoscopique abdominale et thoracique, c'est à dire en chirurgie à ventre fermé et à thorax fermé sous contrôle video scopique. il peut être aussi utilisé lors de toute chirurgie abdominale ou thoracique avec abord minimum (ouverture) entrant dans le concept de "Minimal Invasive Surgery" ou en chirurgie orthopédique.It is an autostatic retractor used in endoscopic abdominal and thoracic surgery, that is to say in closed belly and closed chest surgery under scopic video control. it can also be used during any abdominal or thoracic surgery with a minimum approach (opening) falling within the concept of "Minimal Invasive Surgery" or in orthopedic surgery.
L'écarteur autostatique permet d'écarter deux structures anatomiques l'une de l'autre et de stabiliser cet écartement par un système de blocage. Tous les écarteurs actuellement sur le marché dans ce type de chirurgie, permettent d'écarter une structure, mais pas d'excercer sur chacune des deux structures une traction visant à les écarter l'une de 1'autre.The autostatic retractor makes it possible to separate two anatomical structures from each other and to stabilize this spacing by a locking system. All the retractors currently on the market in this type of surgery make it possible to spread a structure, but not to exert on each of the two structures a traction aiming to draw them apart from one another.
II s'agit d'un ecarteur autostatique permettant d'écarter deux structures l'une de l'autre au moyen de deux palettes distales mobiles par rapport à l'axe principal de l'instrument dans deux plans différents: d'une part le plan d'écartement des bras de l'écarteur et d'autre part, un plan perpendiculaire à celui-ci dans lequel sont mobilisées les palettes distales.It is an autostatic retractor making it possible to separate two structures from one another by means of two distal pallets movable relative to the main axis of the instrument in two different planes: on the one hand the spacing plane of the arms of the retractor and on the other hand, a plane perpendicular thereto in which the distal pallets are mobilized.
De plus, l'espace situé entre les deux bras de l'écarteur est totalement libre et y autorise un travail au moyen d'autres instruments. Les bras de l'écarteur présentent un certain degré de flexibilité visant a protéger les structures anatomiques d'une traction trop brutale et excessive. Ces bras permettent cependant d'appliquer une grande force à l'extrémité distale. Les palettes distales qui sont appliquées sur les structures anatomiques sont mobiles dans un plan perpendiculaire au plan d'écartement des bras et atraumatiques. Leur forme à été étudiée afin d'éviter le glissement latéral des structures qu'elles contiennent. Le glissement des structures anatomiques à l'extrémité de chaque palette est évité par une légère courbure sur l'axe longitudinal par creusement de la palette et par des stries longitudinales qui sont réalisées sur la face externe de la palette. Les palettes peuvent présenter une forme creusée sur leur(s) paroi(s) longitudinale(s) latérale(s).In addition, the space between the two arms of the retractor is completely free and allows work with other instruments. The arms of the retractor have a certain degree of flexibility aimed at protecting the anatomical structures from too brutal and excessive traction. However, these arms allow great force to be applied to the distal end. Distal palettes that are applied to structures anatomical are movable in a plane perpendicular to the plane of separation of the arms and atraumatic. Their shape has been studied in order to avoid lateral sliding of the structures they contain. The sliding of the anatomical structures at the end of each pallet is avoided by a slight curvature on the longitudinal axis by digging the pallet and by longitudinal grooves which are produced on the external face of the pallet. The pallets may have a hollowed out shape on their longitudinal side wall (s).
Dans 1'état actuel de la technique est connu un instrument (European Patent 0531710 A2) destiné à récliner (à repousser) une seule structure. En aucun cas, cet instrument ne provoque 1'écartement par distraction simultanée sur deux structures différentes. Ses "lames" distales ne présentent pas des moyens d'écartement dans un plan situé à 90° du plan dans lesquelles elles sont construites. De plus, en aucune manière, on ne peut travailler dans un espace situé entre ces lames d'écartement. Il n'y a pas d'espace libre à ce niveau. Un autre instrument décrit dans le United States Patent number 4,944,741 présente des extrémités distales mobiles. En fait, il s'agit d'une pince et nullement d'un ecarteur. Cet instrument est utilisé afin de serrer une structure entre ses lames distales. La situation - à l'intérieur des bras distaux - des petites plaquettes mobiles montre bien que cet instrument n'est pas du tout conçu pour obtenir un effet d'écartement. Les plaquettes de l'écarteur autostatique orientable selon l'invention sont quant à elles usinées sur leur face extérieure. En plus dans la pince décrite, le mouvement des bras distaux et des plaquettes est lié. En effet, le même axe commande les deux mouvements, la mobilisation des plaquettes ne se faisant qu'à partir d'une certaine "course" de l'axe de transmission unique. Dans l'écarteur autostatique orientable à effet double selon l'invention, les commandes des "bras" distaux et des plaquettes d'écartement sont tout à fait indépendantes l'une de l'autre et peuvent se faire séparément, quelles soient les positions respectives des bras ou des plaquettes. Dans la pince, selon l'état de la technique toute modification de la position des bras distaux implique une modification de la longueur de la partie de 1'instrument extériorisée de la gaine principale de l'instrument. Par contre, la longueur totale de 1'ecarteur autostatique reste stable quelle que soit la position des bras. Dans la pince décrite dans le brevet U.S., le mouvement des bras n'est induit que par la force liée à l'élasticité du métal des bras qui sortent de leur gaine. Dans l'écarteur autostatique présenté, la transmission permet d'appliquer à l'extrémité distale de 1'ecarteur une frorce directement dépendante de celle qui est appliquée par l'opérateur à la poignée de commande. Par ailleurs, en chirurgie laparoscopique, des instruments de structure différente et à usage différent comportent une partie d'axe principal flexible ont été décrits.In the current state of the art, an instrument (European Patent 0531710 A2) intended to remove (repel) a single structure is known. In no case does this instrument cause separation by simultaneous distraction on two different structures. Its distal "blades" do not have means of spacing in a plane located at 90 ° from the plane in which they are built. In addition, in no way can one work in a space between these spacer blades. There is no free space at this level. Another instrument described in United States Patent number 4,944,741 has movable distal ends. In fact, it is a clamp and in no way a retractor. This instrument is used to clamp a structure between its distal blades. The situation - inside the distal arms - of small mobile plates clearly shows that this instrument is not at all designed to obtain a spreading effect. The plates of the autostatic orientable spacer according to the invention are machined on their outer face. In addition in the forceps described, the movement of the distal arms and the platelets is linked. Indeed, the same axis controls the two movements, the mobilization of the pads being done only from a certain "stroke" of the single transmission axis. In the double-acting, autostatic orientable retractor according to the invention, the controls of the distal "arms" and of the spacers are completely independent. on the other and can be done separately, regardless of the respective positions of the arms or pads. In the clamp, according to the state of the art, any modification of the position of the distal arms implies a modification of the length of the part of the instrument externalized from the main sheath of the instrument. On the other hand, the total length of the autostatic retractor remains stable whatever the position of the arms. In the clamp described in the US patent, the movement of the arms is only induced by the force linked to the elasticity of the metal of the arms which come out of their sheath. In the autostatic retractor presented, the transmission makes it possible to apply to the distal end of the retractor a force directly dependent on that applied by the operator to the control handle. Furthermore, in laparoscopic surgery, instruments of different structure and for different use have a flexible main axis part have been described.
Commentaire général des figures: Fig. 1 : Vue latérale de l'instrument (bras écartés).General comment on the figures: Fig. 1: Side view of the instrument (arms apart).
Fig. 2 : Vue d'en haut de l'instrument (position fermée). Fig. 3 : Vue latérale et supérieure de l'instrument fermé lors de son introduction dans le corps au travers d'un trocart d'introduction. Fig. 4 : Vue de 3/4 de l'instrument construit avec un segment intermédiaire semi-flexible (en position d'écartement avec plaquettes à 90°). Fig. 5 a, b, c : Vues de l'instrument dans différents plans lorsqu'il est construit avec des plaquettes différentes.Fig. 2: Top view of the instrument (closed position). Fig. 3: Side and upper view of the closed instrument during its introduction into the body through an introduction trocar. Fig. 4: 3/4 view of the instrument constructed with a semi-flexible intermediate segment (in the spacing position with 90 ° pads). Fig. 5 a, b, c: Views of the instrument in different planes when it is constructed with different plates.
Le fonctionnement de l'écarteur sera décrit en faisant référence aux différents éléments qui le constituent (chiffres entre parenthèses faisant référence aux différents composants de l'appareil).The operation of the retractor will be described with reference to the various elements that constitute it (figures in brackets referring to the various components of the device).
Il s'agit donc d'un ecarteur autostatique permettant d'écarter deux structures l'une de l'autre au moyen de deux palettes distales mobiles (1) par rapport à l'axe principal de l'instrument dans deux plans différents: d'une part, le plan d'écartement (13) des bras de l'écarteur (2) et d'autre part un plan perpendiculaire (14) à celui-ci dans lequel sont mobilisées les palettes distales (1).It is therefore an autostatic retractor allowing two structures to be separated from one another by means of two distal pallets movable (1) relative to the main axis of the instrument in two different planes: on the one hand, the spacing plane (13) of the arms of the retractor (2) and on the other hand a plane perpendicular (14) thereto in which the distal pallets (1) are mobilized.
De plus, l'espace situé entre les deux bras de l'écarteur (2) est totalement libre et y autorise un travail au moyen d'autres instruments. Les bras de l'écarteur (2) présentent un certain degré de flexibilité visant à protéger les structures anatomiques d'une traction trop brutale et excessive. Ces bras (2) permettent cependant d'appliquer une grande force à l'extrémité distale. Les palettes distales (1) qui sont appliquées sur les structures anatomiques sont mobiles (dans un plan perpendiculaire (14) au plan d'écartement (13) des bras) et atraumatiques. Leur forme à été étudiée afin d'éviter le glissement latéral des structures qu'elles contiennent (courbure concave (3) sur l'axe transversal et stries longitudinales (4)). Le glissement des structures anatomiques à l'extrémité de chaque palette (1) est évité par une légère courbure (3) sur l'axe longitudinal par creusement de la palette (1). Ces stries longitudinales (4) et la courbure (3) sont réalisées sur la face externe de la palette (1). Les palettes peuvent présenter une forme creusée sur leur paroi longitudinale latérale. Ces différentes courbures (3) sont réalisées en creusant dans la masse des palettes (1) épaisses (+ 2mm.) afin que leur extrémité et leurs bords puissent être mousses et atraumatiques. Ces palettes peuvent être interchangeables par système d'encliquettage (afin de pouvoir utiliser 1'ecarteur pour maintenir ouvert un espace extrapéritoneal sans l'aide d'insufflation lors de la chirurgie endoscopique extrapéritoneale) . Un axe transversal (5) (à l'extrémité proximale de la palette) fixe la palette (1) au bras de l'écarteur (2). Il permet la mobilité (14) de ces palettes (1) par rapport à l'axe longitudinal de l'appareil (axe + 0° — _^- axe + 90°). Cette mobilité (14) est commandée activement depuis l'extérieur du corps par un cable semi-rigide (6) fixé à la base (7) de la palette (1) et qui court le long des bras (2) de l'écarteur, puis dans l'axe de l'appareil (8) jusqu'au système de commande (9) qui est la poignée extérieure. Ce système de commande (9) (situé à l'extérieur du corps) est accessible au doigt de la main qui actionne la poignée principale de l'instrument (10). Ces cables (6), au niveau des bras de écartement (2), courent dans de fins canaux soudés à ces bras (2) ou sont englobés dans des bras (2) creux. Ils sont fixés du côté intra-corporel de l'appareil aux plaquettes distales (1) à une distance de 3 à 4mm. (7) par rapport à l'axe de rotation des plaquettes (5)(1). La mobilisation (13) (écartement rapprochement) des bras (2) est assurée par la poignée externe (10) dont le mouvement est transmis par un axe métallique rigide (11) qui court dans le corps de l'appareil (8) (diam. = 5, 8, 10, 11, 12, 12,5, 15mm. ... ) . Il s'agit donc pour 1'écartement d'un système de transmission selon l'état de la technologie connue pour les pinces et les ciseaux endoscopiques mais dont l'action s'effectue en sens inverse. En effet, ici une fermeture de la poignée (10) entraînera 1'écartement (13) des bras (2) distaux alors que dans le cas des pinces ou des ciseaux une fermeture de la poignée se traduit par une fermeture des mords ou des lames situées au bout de l'instrument.In addition, the space between the two arms of the retractor (2) is completely free and allows work with other instruments. The arms of the retractor (2) have a certain degree of flexibility aimed at protecting the anatomical structures from too brutal and excessive traction. These arms (2), however, allow great force to be applied to the distal end. The distal pallets (1) which are applied to the anatomical structures are mobile (in a plane perpendicular (14) to the spacing plane (13) of the arms) and atraumatic. Their shape has been studied in order to avoid lateral sliding of the structures they contain (concave curvature (3) on the transverse axis and longitudinal grooves (4)). The sliding of the anatomical structures at the end of each pallet (1) is avoided by a slight curvature (3) on the longitudinal axis by digging the pallet (1). These longitudinal ridges (4) and the curvature (3) are produced on the external face of the pallet (1). The pallets can have a hollowed out shape on their lateral longitudinal wall. These different curvatures (3) are made by digging into the mass of thick pallets (1) (+ 2mm.) So that their ends and edges can be foam and atraumatic. These pallets can be interchangeable by latching system (in order to be able to use the retractor to keep open an extraperitoneal space without the aid of insufflation during endoscopic extraperitoneal surgery). A transverse axis (5) (at the proximal end of the pallet) fixes the pallet (1) to the arm of the spreader (2). It allows the mobility (14) of these pallets (1) relative to the longitudinal axis of the device (axis + 0 ° - _ ^ - axis + 90 °). This mobility (14) is actively controlled from outside the body by a semi-rigid cable (6) fixed to the base (7) of the pallet (1) and which runs along the arms (2) of the retractor , then in the axis of the device (8) to the control system (9) which is the external handle. This control system (9) (located outside the body) is accessible by the finger of the hand which actuates the main handle of the instrument (10). These cables (6), at the level of the spacer arms (2), run in fine channels welded to these arms (2) or are included in hollow arms (2). They are fixed on the intra-corporeal side of the device to the distal plates (1) at a distance of 3 to 4mm. (7) relative to the axis of rotation of the plates (5) (1). The mobilization (13) (approximation spacing) of the arms (2) is ensured by the external handle (10) whose movement is transmitted by a rigid metallic axis (11) which runs in the body of the device (8) (diam . = 5, 8, 10, 11, 12, 12.5, 15mm. ...). It is therefore for the separation of a transmission system according to the state of the art known for forceps and endoscopic scissors but whose action is carried out in the opposite direction. Indeed, here a closing of the handle (10) will cause the spacing (13) of the distal arms (2) whereas in the case of pliers or scissors a closing of the handle results in a closing of the jaws or blades located at the end of the instrument.
Cet écartement (13) peut être maintenu en bloquant la poignée externe par un système de crémaillère (12) par exemple, ou tout autre système de blocage. D'autres systèmes de commande sont bien sûr imaginables. Ceci est en fait un détail accessoire dans le fonctionnement et 1'intérêt de 1'instrument.This spacing (13) can be maintained by blocking the external handle by a rack system (12) for example, or any other blocking system. Other control systems are of course imaginable. This is in fact an incidental detail in the operation and interest of the instrument.
L'appareil décrit peut être en acier inox entièrement ou en partie. En effet un instrument métallique (lavable et stérilisable) pourrait également donner lieu à une production d'un instrument fonctionnellement identique composé de matière non-métallique. Cet instrument entrerait alors dans le cadre de l'équipement à usage unique. The device described can be made of stainless steel in whole or in part. Indeed a metallic instrument (washable and sterilizable) could also give rise to a production of a functionally identical instrument composed of non-metallic material. This instrument would then be part of the disposable equipment.

Claims

Revendications claims
1. Ecarteur autostatique orientable à effet double et à longueur constante pour chirurgie sous videoscopie et/ou endoscopique et/ou orthopédique caractérisé par le fait qu'il comporte: d'une part deux bras mobiles (2) pouvant s'écarter l'un de l'autre, commandés activement par une poignée extérieure (10), présentant une possibilité de blocage par un système de crémaillère (12) attenant à la poignée, et d'autre part deux palettes (1) orientables (14) (de axe de l'instrument + 0°—**> axe de l'instrument + 90° et plan d'écartement des bras (2) + 0° —>- plan d'écartement des bras (2) + 90°), chacune d'elles fixée sur un bras d'écartement (2); la mobilisation (14) de ces palettes distales (1) se faisant depuis une commande extérieure (9) accessible à la main tenant la poignée extérieure (10) de l'instrument; la transmission se faisant par deux cables semi-rigides (6) reliant les palettes (1) au système de commande extérieure (9) ou tout autre système de transmission attenant à la poignée (10) qui permet le blocage de 1'écarte¬ ment; la transmission poignée-bras d'écartement s 'effectuant par un axe métallique rigide (11) ou tout autre système de transmission. 1. Autostatic orientable retractor with double effect and at constant length for videoscopic and / or endoscopic and / or orthopedic surgery, characterized in that it comprises: on the one hand two movable arms (2) which can move apart one on the other, actively controlled by an external handle (10), presenting a possibility of blocking by a rack system (12) attached to the handle, and on the other hand two orientable pallets (1) (14) (of axis of the instrument + 0 ° - * * > axis of the instrument + 90 ° and arm spacing plane (2) + 0 ° -> - arm spacing plane (2) + 90 °), each of them fixed on a spacer arm (2); the mobilization (14) of these distal pallets (1) taking place from an external control (9) accessible by hand holding the external handle (10) of the instrument; the transmission being made by two semi-rigid cables (6) connecting the pallets (1) to the external control system (9) or any other transmission system attached to the handle (10) which allows the 1'écarte¬ ment to be blocked ; the handle-to-arm spacer transmission being effected by a rigid metallic pin (11) or any other transmission system.
2. Ecarteur selon la revendication 1 caractérisé par des palettes d'écartement (1) dont la partie extérieure comprend des stries longitudinales (4) et est usinée dans la masse afin d'éviter un glissement des structures anatomiques dans l'axe longitudinal et transversal; ces palettes (1) étant à bords et extrémités mousses et atraumatiques.2. Retractor according to claim 1 characterized by spacing pallets (1), the outer part of which comprises longitudinal grooves (4) and is machined in the mass in order to avoid sliding of the anatomical structures in the longitudinal and transverse axis ; these pallets (1) being with foam and atraumatic edges and ends.
3. Ecarteur selon l'une des revendications 1 à 2, caractérisé par le fait que les plaquettes distales (1) tout en restant mobiles peuvent présenter une longueur plus importante jusqu'à dépasser d'un côté ou des deux côtés de l'axe de rotation (5) .3. Retractor according to one of claims 1 to 2, characterized in that the distal plates (1) while remaining mobile can have a greater length until protruding from one side or both sides of the axis of rotation (5).
4. Ecarteur selon l'une des revendications 1 à 3, caractérisé par le fait que les plaquettes distales (1) ont une forme creusée sur leur paroi longitudinale latérale afin de maintenir en place une structure anatomique qui serait en même temps soulevée et écartée.4. Retractor according to one of claims 1 to 3, characterized in that the distal plates (1) have a shape hollowed out on their longitudinal side wall in order to hold in place an anatomical structure which would be at the same time lifted and spread.
5. Ecarteur selon l'une des revendications 1 à 4, caractérisé par l'interposition entre l'axe principal de l'appareil (8) et l'articulation des bras d'écartement (2) d'un système d'articulation complémentaire mécanique ou par matière semi- flexible à mémoire permettant de modifier la direction du plan d'écartement; Cet instrument, entré rectiligne dans le trocart d'introduction (15) prenant activement ou passivement une orientation différente une fois entré à 1'intérieur du corps.5. Retractor according to one of claims 1 to 4, characterized by the interposition between the main axis of the device (8) and the articulation of the spacer arms (2) of a complementary articulation system mechanical or by semi-flexible memory material allowing the direction of the spacing plane to be modified; This instrument, entered rectilinear into the introductory trocar (15) actively or passively taking a different orientation once entered inside the body.
6. Ecarteur selon l'une des revendications 1 à 5, caractérisé par le fait que la gaine externe de l'appareil peut être mise en communication avec 1'intérieure de 1'appareil au moyen d'un orifice (obturable) afin de permettre le lavage et le séchage de l'intérieur du corps de l'instrument.6. Retractor according to one of claims 1 to 5, characterized in that the external sheath of the device can be placed in communication with the interior of the device by means of an orifice (closable) in order to allow washing and drying the interior of the instrument body.
7. Ecarteur selon l'une des revendications 1 à 6, caractérisé par la possibilité de rotation (16) du plan d'écartement (2) sur l'axe longitudinal de l'appareil à l'intérieur du corps sans modifier le plan principal du système de préhension extérieur; la commande active se faisant de l'extérieur par un système de manipulation rotative (16) accessible à la main tenant la poignée de l'appareil (10). 7. Retractor according to one of claims 1 to 6, characterized by the possibility of rotation (16) of the spacing plane (2) on the longitudinal axis of the device inside the body without modifying the main plane the external gripping system; the active control being carried out from the outside by a rotary manipulation system (16) accessible by hand holding the handle of the device (10).
8. Ecarteur selon l'une des revendications 1 à 7, caractérisé par un système permettant 1'interchangeabilité des plaquettes distales (1) composé d'un jeu de plaquettes de forme et de dimension différentes; un système d'encliquettage permet cette interchangeabilité. 8. Retractor according to one of claims 1 to 7, characterized by a system allowing the interchangeability of the distal pads (1) composed of a set of pads of different shape and size; a snap-in system allows this interchangeability.
9. Ecarteur selon l'une des revendications 1 à 9, caractérisé par une transmission entre le système de préhension et les bras d'écartement par un système à vis et/ou un piston conique et/ou hydraulique et/ou pneumatique. 9. Retractor according to one of claims 1 to 9, characterized by a transmission between the gripping system and the spacer arms by a screw system and / or a conical and / or hydraulic and / or pneumatic piston.
10. Ecarteur selon les revendications 1 à 9 caractérisé par le fait qu'il peut être fabriqué en métal inoxydable lavable et restérilisable ou en tout ou en partie par combinaison de matières plastiques ou synthétiques faisant entrer cet instrument dans le domaine du matériel à usage unique. L'écarteur autostatique permet d'écarter deux structures anatomiques l'une de l'autre et de stabiliser cet écartement par un système de blocage et il permet d'écarter les structures l'une de l'autre au moyen de deux palettes distales mobiles (1) par rapport à l'axe principal de l'instrument dans deux plans différents: d'une part le plan d'écartement (13) des bras de l'écarteur (2) et d'autre part un plan perpendiculaire (14) à celui-ci dans lequel sont mobilisées les palettes distales (1). 10. Retractor according to claims 1 to 9 characterized in that it can be made of washable and re-sterilizable stainless metal or in whole or in part by combination of plastic or synthetic materials making this instrument enter the field of single-use equipment . The autostatic retractor allows to separate two anatomical structures from each other and to stabilize this spacing by a locking system and it allows to separate the structures from each other by means of two movable distal pallets (1) relative to the main axis of the instrument in two different planes: on the one hand the spacing plane (13) of the arms of the retractor (2) and on the other hand a perpendicular plane (14 ) to the latter in which the distal pallets (1) are mobilized.
PCT/EP1994/000865 1993-03-23 1994-03-21 Double action adjustable self-retaining retractor for video-monitored endoscopic surgery WO1994021179A2 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
BE9300278A BE1006889A3 (en) 1993-03-23 1993-03-23 SELF-RETAINING RETRACTOR ADJUSTABLE DOUBLE EFFECT FOR SURGERY AND UNDER ENDOSCOPIC videoscopy.
BE09300278 1993-03-23

Publications (2)

Publication Number Publication Date
WO1994021179A2 true WO1994021179A2 (en) 1994-09-29
WO1994021179A3 WO1994021179A3 (en) 1994-11-24

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US5749892A (en) * 1994-08-31 1998-05-12 Heartport, Inc. Device for isolating a surgical site
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US5951465A (en) * 1995-11-22 1999-09-14 Karl Storz Gmbh & Co. Device for carrying out manipulations in the human body
US6027518A (en) * 1995-05-30 2000-02-22 Gaber; Benny Seizing instrument
EP1011462A1 (en) * 1997-02-03 2000-06-28 Applied Medical Resources Corporation Surgical instruments with improved traction
WO2001028431A1 (en) * 1999-10-18 2001-04-26 Coroneo, Inc. Adjustable surgical retractor
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US6592573B2 (en) 2000-10-11 2003-07-15 Popcab, Llc Through-port heart stabilization system
EP1547528A1 (en) * 1997-02-03 2005-06-29 Applied Medical Resources Corporation Surgical instruments with improved traction
DE102004052204A1 (en) * 2004-10-19 2006-05-04 Karl Storz Gmbh & Co. Kg Deflectible endoscopic instrument
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WO2007099175A1 (en) * 2006-03-03 2007-09-07 Corporacion Sanitaria Parc Tauli Surgical instrument for endoscopic surgery
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WO2014197498A1 (en) * 2013-06-04 2014-12-11 Boston Scientific Scimed, Inc. Tissue spreader for accessing papilla, and related methods of use
CN108143449A (en) * 2017-12-06 2018-06-12 浙江省肿瘤医院 A kind of novel armpit approach cavity mirror thyroid operation retractor
US10299874B2 (en) 2006-12-01 2019-05-28 Boston Scientific Scimed, Inc. Guide tube systems and methods
US10617848B2 (en) 2007-05-18 2020-04-14 Boston Scientific Scimed, Inc. Drive systems and methods of use

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Cited By (38)

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Publication number Priority date Publication date Assignee Title
US5749892A (en) * 1994-08-31 1998-05-12 Heartport, Inc. Device for isolating a surgical site
WO1996038197A1 (en) * 1995-05-30 1996-12-05 Helfgott & Karas, P.C. Seizing instrument
US6027518A (en) * 1995-05-30 2000-02-22 Gaber; Benny Seizing instrument
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EP1011462A1 (en) * 1997-02-03 2000-06-28 Applied Medical Resources Corporation Surgical instruments with improved traction
EP1547528A1 (en) * 1997-02-03 2005-06-29 Applied Medical Resources Corporation Surgical instruments with improved traction
EP1011462A4 (en) * 1997-02-03 2001-06-13 Applied Med Resources Surgical instruments with improved traction
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US6592573B2 (en) 2000-10-11 2003-07-15 Popcab, Llc Through-port heart stabilization system
US7481766B2 (en) 2003-08-14 2009-01-27 Synthes (U.S.A.) Multiple-blade retractor
US7182729B2 (en) 2003-09-18 2007-02-27 Stryker Spine Surgical retractor with removable scissor arms
US7988625B2 (en) 2003-09-18 2011-08-02 Stryker Spine Surgical retractor with removable scissor arms
US7666189B2 (en) 2004-09-29 2010-02-23 Synthes Usa, Llc Less invasive surgical system and methods
DE102004052204A1 (en) * 2004-10-19 2006-05-04 Karl Storz Gmbh & Co. Kg Deflectible endoscopic instrument
US8114017B2 (en) 2004-10-19 2012-02-14 Karl Storz Gmbh & Co. Kg Articulating endoscopic instrument
US7618367B2 (en) 2005-01-07 2009-11-17 Stryker Spine Three-prong retractor with elastomeric sheath
US7618413B2 (en) 2005-06-22 2009-11-17 Boston Scientific Scimed, Inc. Medical device control system
US9089356B2 (en) 2005-06-22 2015-07-28 Boston Scientific Scimed, Inc. Medical device control system
US9763650B2 (en) 2005-06-22 2017-09-19 Boston Scientific Scimed, Inc. Medical device control system
US8057462B2 (en) 2005-06-22 2011-11-15 Boston Scientific Scimed, Inc. Medical device control system
WO2007002545A1 (en) * 2005-06-22 2007-01-04 Boston Scientific Limited Steerable medical device control system
US9549716B2 (en) 2005-06-22 2017-01-24 Boston Scientific Scimed, Inc. Medical device control system
US8317811B2 (en) 2006-03-03 2012-11-27 Corporacio Sanitaria Parc Tauli Surgical instrument for endoscopic surgery
WO2007099175A1 (en) * 2006-03-03 2007-09-07 Corporacion Sanitaria Parc Tauli Surgical instrument for endoscopic surgery
ES2291112A1 (en) * 2006-03-03 2008-02-16 Corporacion Sanitaria Parc Tauli Surgical instrument for endoscopic surgery
US10993606B2 (en) 2006-12-01 2021-05-04 Boston Scientific Scimed, Inc. Medical systems comprising optical devices
US10299874B2 (en) 2006-12-01 2019-05-28 Boston Scientific Scimed, Inc. Guide tube systems and methods
US10588707B2 (en) 2006-12-01 2020-03-17 Boston Scientific Scimed, Inc. Medical systems comprising tool members
US10939807B2 (en) 2006-12-01 2021-03-09 Boston Scientific Scimed, Inc. Medical systems comprising articulating devices
US11344185B2 (en) 2006-12-01 2022-05-31 Boston Scientific Scimed, Inc. Guide tube systems and methods
US11712150B2 (en) 2006-12-01 2023-08-01 Boston Scientific Scimed, Inc. Medical systems comprising tool members
US10617848B2 (en) 2007-05-18 2020-04-14 Boston Scientific Scimed, Inc. Drive systems and methods of use
US11696998B2 (en) 2007-05-18 2023-07-11 Boston Scientific Scimed, Inc. Drive systems and methods of use
WO2014197498A1 (en) * 2013-06-04 2014-12-11 Boston Scientific Scimed, Inc. Tissue spreader for accessing papilla, and related methods of use
CN108143449A (en) * 2017-12-06 2018-06-12 浙江省肿瘤医院 A kind of novel armpit approach cavity mirror thyroid operation retractor
CN108143449B (en) * 2017-12-06 2020-02-07 浙江省肿瘤医院 Novel axillary cavity endoscope thyroid surgery retractor

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