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WO2007039036A1 - Dispositif pour maintenir une douille de trocart - Google Patents

Dispositif pour maintenir une douille de trocart Download PDF

Info

Publication number
WO2007039036A1
WO2007039036A1 PCT/EP2006/008716 EP2006008716W WO2007039036A1 WO 2007039036 A1 WO2007039036 A1 WO 2007039036A1 EP 2006008716 W EP2006008716 W EP 2006008716W WO 2007039036 A1 WO2007039036 A1 WO 2007039036A1
Authority
WO
WIPO (PCT)
Prior art keywords
holder
trocar
holding
recess
holding arm
Prior art date
Application number
PCT/EP2006/008716
Other languages
German (de)
English (en)
Inventor
Yu-Mi Ryang
Veit Rohde
Original Assignee
Rheinisch-Westfälische Technische Hochschule Aachen
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Rheinisch-Westfälische Technische Hochschule Aachen filed Critical Rheinisch-Westfälische Technische Hochschule Aachen
Publication of WO2007039036A1 publication Critical patent/WO2007039036A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body
    • 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
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms

Definitions

  • the invention relates to a device for holding a trocar sleeve, comprising a holder in which a trocar sleeve can be fastened, in particular a self-retaining device for use in operations e.g. at the spinal column, especially in microsurgical "minimal access" operations of the dorsal lumbar spine, such as herniated discs, spinal canal stenosis, etc.
  • Hijikata described the first percutaneous nucleotomy technique with partial resection of disc tissue via a posterolateral approach in 1975.
  • percutaneous discectomies using various methods, i.a. e.g. percutaneous intradiscal radiofrequency thermocoagulation followed (Troussier et al 1995).
  • Ascher and Heppner first used an Nd-YAG laser to heat the nucleus pulposus and thermally shrink the disc herniation to achieve decompression of the nerve root.
  • endoscopic procedures have been used since the 1990s.
  • the METRx system consists of a tubular retractor system with concentric dilators of various lengths and diameters. It was developed for microsurgical Minimal Access (“minimal access”) surgery Lumbar disc herniations. It allows a much less invasive access to the spine through a smaller incision and a special gentle muscle-splitting technique, compared to the conventional microsurgical method using the standard Caspar retractor, as the paraspinal ligamentomuscular structures can be left intact and not like usually have to be detached from the spine. While the MED system was still working with the endoscope, the operation is performed via the METRx system as in conventional microsurgery, using the surgical microscope. In 2001, Muramatsu and colleagues reported on their experience with the MED technique, reporting faster postoperative mobilization, less intraoperative blood loss, and lower postoperative painkillers.
  • trocars or trocar sheaths of various lengths and diameters which have their origin in endoscopy, are also screwed into the paraspinal musculature in the minimally invasive muscle splitting technique and the operation continues in microsurgical technique.
  • BSVs can only be treated with a significantly increased risk or not at all via the above-mentioned methods, so that there is a relatively narrow range of indications for operating reasons, with only a small, carefully selected patient population for this method is suitable. Failure to meet certain criteria, e.g. that the BSV should not be too large and not too long, otherwise it could be severely scarred, glued or ossified, there is no concomitant spinal stenosis, etc., these methods are not suitable for surgical treatment. Furthermore, due to the unfamiliar instruments and the unfamiliar visualization of the surgical area, there is a relatively steep learning curve, which discourages many surgeons from using such procedures and requires a degree of operational experience and expertise from the surgeon.
  • the assistant does not have both hands, as usual, but only one hand free to assist the surgeon, eg holding other instruments (suckers etc). Furthermore, the surgeon relies on the assistant, the Keep the holder as quiet as possible, as even slight changes in position can make the view of the trocar, which is only 1-2 cm wide, difficult and hinder the operation itself.
  • the task of the newly developed, especially self-holding trocar holder is essentially the maintenance of a certain required by the surgeon angle of the trocar holder with respect to the surgical area, the setting can be changed quickly and easily by a few simple actions at any time, so that the trocar holder always exactly in the position set by the surgeon remains without having to be held by the assistant or surgeon.
  • the surgeon is thus self-sufficient, so can operate alone, regardless of an assistant.
  • the object is achieved in that the holder comprises at least three support arms, wherein at least one support arm, in particular all support arms with one end in a desired position lockable on the holder is articulated and arranged with another end to a surgical area, in particular on the skin of a Patients is supportable.
  • the trocar holder is self-holding, so that it retains the respective set by the surgeon position, even after the surgeon has released the holder.
  • the trocar holder according to the invention allows an operation in the usual microsurgical technique under the surgical microscope with the usual Instruments, so that there is almost no limitation with regard to suitable patients. Also, usually only a short period of getting used to the smaller access is necessary.
  • At least three respectively hinged and lockable in the desired position retaining arms are arranged on the holder. Then the axis of a trocar sleeve can be adjusted in almost any direction without having to turn the holder for this.
  • three retaining arms are arranged at 90 degrees to each other and form a T-shape. Other angles are possible here.
  • the lockable axes of rotation of all support arms are in a common plane.
  • the self-holding trocar holder eliminates all the disadvantages mentioned at the outset, the trocar and the non-self-retaining trocar holder.
  • the holder makes it possible to maintain the desired position of the trocar. Due to the self-holding construction, an operation by a single surgeon without assistants is possible. A not inconsiderable advantage in the present time is the possibility of saving manpower and thus personnel costs, which has a significant economic and economic advantage.
  • microsurgical instruments if already available with this technique can be used, so that no additional costs incurred by the acquisition of instruments, new surgical sieves etc ..
  • the surgeon is not dependent on the ability of the assistant to always keep the holder exactly in the position desired or required by the surgeon. Even slight changes in the position of the assistant's hand, and thus of the holder and the trocar, result in a significant impairment of the field of vision of the surgeon, which prevents an operation under constant visual control and can significantly impair the smooth operation procedure.
  • the assistant is not only provided with one hand, as in the hitherto available holders, but both hands in order to assist the surgeon, e.g. To relieve by holding other instruments (vacuum cleaner, dissector etc), since he no longer has to lead the holder with one hand.
  • the assistant also no longer has to deal with two tasks, namely keeping the trocar in place for the duration of the operation in the position desired by the surgeon and holding an instrument, but can fully rely on assisting in the operation focus on the true meaning.
  • the assistant can concentrate fully on the task that is actually his, namely the assistance and relieve and support the surgeon by holding certain additional instruments or by performing other minor surgical tasks without even having to do so Keeping the trocar holder in focus. It is also much easier and less cumbersome for the surgeon, instead of instructing his assistants, how to tilt and hold the holder, simply by quick, simple manipulations deliberately kept very simple construction, the holder in the desired position, which then also complies with the set position exactly.
  • a supporting end of a holding arm may be formed to protect the tissue on which it is supported.
  • This can e.g. be achieved in that at the end of a support surface is arranged, which is formed in a particularly preferred embodiment, at least partially rounded and, e.g. may have the shape of a sphere section, e.g. can be designed as a hemisphere or full ball.
  • a support surface may have a skin-friendly and / or optionally non-slip coating.
  • a trocar is sleeve-shaped in a known manner, the sleeve often having a head to handle the trocar can.
  • a head may be polygonal, preferably hexagonal, as in a machine screw.
  • a holder of the device according to the invention has a receptacle to hold such a trocar sleeve.
  • a recess is provided in the holder, which is adapted to receive a trocar, in particular at the head end.
  • a positive and / or non-positive connection can result, for example. can be held in the holder of the edge of the polygonal head.
  • the holder may be frame-shaped, wherein the frame encloses a recess which may serve to receive the head of the trocar.
  • the holder is preferably formed in two parts, wherein one holder part can be pivotable relative to another, e.g. by means of a hinge connection.
  • the frame can be opened by pivoting one part relative to the other to insert the head of the trocar into the recess and then close the holder again, whereby the frame tightly encloses the trocar head.
  • the frame-shaped holder may be formed so that one part is approximately U-shaped and another part is an open U-shape closing bow.
  • This arcuate part can form a tensioning element with which a force directed into the U-shape can be generated in order to press the trocar head into the holder.
  • the movable sheet may for example be provided with a clamping means, for example a screw, by means of which the sheet is drawn onto the U-shape.
  • a groove between them may be provided at least in regions at the inner edge of the recess, wherein the groove width is selected to receive the edge of the head of a trocar therein.
  • the wall / land areas may e.g. be formed as projections of the top and bottom of Trokarhalters invention.
  • two holding arms are arranged on a holder part, in particular the larger U-shaped, which lie opposite each other in particular.
  • a holding arm may be arranged, which may be preferably arranged at 90 degrees to the two aforementioned arms.
  • a holding arm can then extend in the radial direction essentially relative to the center of the holder.
  • a support arm may e.g. additionally have a weight-saving recess.
  • Each of these support arms may have an articulated connection to the holder which is lockable to secure a support arm in a desired position.
  • a screw which forms the hinge axis and by means of which a determination is possible. To achieve good handling, such a screw can be designed as a thumbscrew.
  • a holding arm can be pivoted from a plane parallel to the holder frame enclosing the recess by 90 degrees, at least in one direction towards an operating area, whereby a determination in each arbitrary angular position is possible is.
  • FIG. 1 side view and top view of a metal trocar
  • FIG. 2 shows a dilator to be introduced into a trocar
  • FIG. 3 top view of the trocar holder in the opened state without trocar
  • FIG. 4 a plan view of the trocar holder in the closed state with two angled holding arms and a trocar received
  • FIG. 5 side view of the trocar holder without trocar with non-angled holding arm
  • FIG. 6 side view of the trocar holder without trocar with angled holding arm
  • the figures show a device according to the invention for holding a trocar sleeve in different spatial directions with respect to a patient, not shown here.
  • the trocar sleeve 1 is shown in Figure 1 in two views.
  • trocars 1 are used in minimally invasive surgery, usually in minimally invasive procedures in the abdominal area, the so-called laparoscopy. Trocars find for some years but also in the Spine surgery Use, especially in the microsurgical operation of lumbar disc herniation and lumbar spinal canal narrowing.
  • the trocar serves as an access route to the operating area, via which medical instruments are introduced and the respective spinal column pathology can be operated on.
  • such a trocar sleeve 1 is similar to a hollow machine screw with a central through-hole 2 and a hexagonal screw head 3. On the outside of the sleeve a thread 4 is arranged.
  • a spinal surgery e.g. initially a 1.6 cm long skin incision performed. Thereafter, the fascia of the posterior lumbar musculature is visualized and blunted, e.g. spread with scissors and the trocar 1 with inserted dilator 5, which is shown in Figure 2 and the trocar with its rounded tip 6 surmounted by a certain distance (here, for example, 1 cm), screwed into the back muscles in a clockwise direction until the trocar 1, which is equipped with an external thread 4, the bone window between two vertebral bodies is seated. Then the dilator 5, which is intended to prevent the penetration of soft tissue into the trocar 1 and spread the tissue as gently as possible, is removed.
  • dilator 5 which is intended to prevent the penetration of soft tissue into the trocar 1 and spread the tissue as gently as possible
  • the trocar sleeve 1 aligns with a particular direction dictated by the anatomy of the body and the nature of the tissue layers. Although the trocar sleeve 1 can be tilted by hand in a different direction, but when it is released, always returns to its original position. By means of the holding device according to the invention, as shown in FIGS. 3 to 6, the trocar sleeve 1 can be held in a specific position after the holding device has been pushed onto the trocar 1.
  • the Trokarhülsenhalterung 6 comprises two holding parts 7 and 8, which are movably connected to each other, for example via a hinge 9, wherein the smaller arcuate part 8 can be folded away from the larger 7.
  • a recess 10 is enclosed in the manner of a frame, which serves to receive the trocar head 3.
  • the larger holding part 7 forms a U-shape which, when folded together with the smaller fold-away holding part 8 as an enclosed recess, forms a substantially symmetrical geometric shape.
  • a projection (12, 13) which runs here over the entire U-shaped inner route and serves as a groove-shaped rail for the introduced hexagonal trocar head 3.
  • the edge of the trocar is held and guided between the supernatants 12 and 13.
  • the holding device can be closed by a screw cap 14.
  • a closure of any other kind e.g. via a click closure or clamp closure would also be possible.
  • a respective holding arm 15, 16, 17 is attached to the outer end, so that they are arranged at right angles to each other when the holder is closed.
  • These are each attached to the holder 7, 8 via a joint 18, by means of which each holding arm can be tilted vertically upwards or downwards, e.g. via a screw or worm thread.
  • the arms are e.g. attached via a screw thread, each with a knurled screw 19 in a kind of hinge joint 18.
  • the arms can each be moved out of the plane about 90 ° upwards and downwards by about 90 °, as shown in FIGS. 5 and 6, respectively, in which one arm is slightly angled.
  • the large range of motion thus allows for extreme orientation of the trocar in situ, which is often necessary in the operation on the spine, especially since the area of operation, which is visible at once, is severely restricted due to the small diameter of the metal trocar (here, for example, 13.5 mm), so that the entire operating area can be successively surveyed and, if necessary, processed only by a large number of alignment changes.
  • the holding arms 15, 16, 17 is located as a bearing surface to the operating area in each case a spherical shape 20 or at least directed to the surgical area hemisphere 20 with which the support arms are supported on the skin of the patient, without the skin or the underlying To lazer lying tissue or injured by pressure.
  • the terminations of the support arms may also have a different shape. These must ensure protection of the underlying soft tissue and skin by a relatively large contact surface and should have no peaks or sharp edges.
  • the support arms 15, 16, 17 can be brought in a few simple steps in their position and fixed, if this was not the case.
  • the holder 6 no longer needs to be held with one hand.
  • FIGS 3 and Figures 3 and Figure further show weight-saving recesses 21 in the respective support arms.
  • the holding device is very robust due to its simple construction, easy to clean and sterilize, less susceptible to technical defects, requires little maintenance and above all is easy and fast and with little effort to operate.

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

Abstract

L'invention concerne un dispositif pour maintenir une douille de trocart, ce dispositif comprenant un support dans lequel peut être fixée une douille de trocart. Selon l'invention, ledit support (6) comprend au moins trois bras de support (15, 16, 17), au moins un de ces bras de support, en particulier tous ces bras de support (15, 16, 17) étant disposés de façon articulée sur le support (6) au niveau d'une de leurs extrémités de façon bloquée dans une position voulue et ce ou ces bras de support (15, 16, 17) pouvant s'appuyer au niveau de l'autre extrémité (20) sur une zone d'opération, en particulier sur la peau d'un patient.
PCT/EP2006/008716 2005-10-04 2006-09-07 Dispositif pour maintenir une douille de trocart WO2007039036A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102005047527.2 2005-10-04
DE102005047527A DE102005047527A1 (de) 2005-10-04 2005-10-04 Vorrichtung zum Halten einer Trokarhülse

Publications (1)

Publication Number Publication Date
WO2007039036A1 true WO2007039036A1 (fr) 2007-04-12

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2006/008716 WO2007039036A1 (fr) 2005-10-04 2006-09-07 Dispositif pour maintenir une douille de trocart

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DE (1) DE102005047527A1 (fr)
WO (1) WO2007039036A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20170156751A1 (en) * 2015-12-03 2017-06-08 Amendia, Inc. Handheld instrument assembly
US10117564B2 (en) 2010-04-16 2018-11-06 Hitachi Healthcare Americas Corporation Ultrasound and detachable instrument for procedures

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8206306B2 (en) 2009-05-07 2012-06-26 Hitachi Aloka Medical, Ltd. Ultrasound systems and methods for orthopedic applications
CN102421374B (zh) 2009-05-07 2014-12-17 日立阿洛卡医疗株式会社 用于整形手术应用的超声波系统
US20200205855A1 (en) * 2019-01-02 2020-07-02 Covidien Lp Surgical access device and sleeve stops for use therewith
US11484337B2 (en) 2020-02-06 2022-11-01 Covidien Lp Surgical access device including anchor with rachet mechanism

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5267970A (en) * 1991-11-01 1993-12-07 Origin Medsystems, Inc. Device for anchoring trocar sleeve
US20020042606A1 (en) * 2000-10-11 2002-04-11 Popcab, Llc Through-port heart stabilization system

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4573452A (en) * 1984-07-12 1986-03-04 Greenberg I Melvin Surgical holder for a laparoscope or the like
WO1996036292A1 (fr) * 1995-05-18 1996-11-21 Michael Vogele Procede et dispositif pour fixer la tete humaine
US5993463A (en) * 1997-05-15 1999-11-30 Regents Of The University Of Minnesota Remote actuation of trajectory guide
US6132437A (en) * 1999-07-14 2000-10-17 Omurtag; Ahmet Method and stereotactic apparatus for locating intracranial targets guiding surgical instruments
US7636596B2 (en) * 2002-12-20 2009-12-22 Medtronic, Inc. Organ access device and method

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5267970A (en) * 1991-11-01 1993-12-07 Origin Medsystems, Inc. Device for anchoring trocar sleeve
US20020042606A1 (en) * 2000-10-11 2002-04-11 Popcab, Llc Through-port heart stabilization system

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10117564B2 (en) 2010-04-16 2018-11-06 Hitachi Healthcare Americas Corporation Ultrasound and detachable instrument for procedures
US20170156751A1 (en) * 2015-12-03 2017-06-08 Amendia, Inc. Handheld instrument assembly
US9962211B2 (en) * 2015-12-03 2018-05-08 Amendia, Inc. Handheld instrument assembly

Also Published As

Publication number Publication date
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