WO2014052809A1

WO2014052809A1 - Surgical dissector device

Info

Publication number: WO2014052809A1
Application number: PCT/US2013/062270
Authority: WO
Inventors: Avraham COOPER; Vamsidhar CHAVAKULA; Chi Wan KO
Original assignee: Beth Israel Deaconess Medical Center
Priority date: 2012-09-28
Filing date: 2013-09-27
Publication date: 2014-04-03

Abstract

The present invention relates to a surgical device that performs a plurality of different operating modes in response to the selection by the user such as a surgeon during a surgical procedure. Preferred embodiments utilize a handle with actuating elements that operate the device and switch between different operating modes. A hook can be mounted to at least one jaw element of the device that can be selectively deployed by the surgeon. The device can further comprise a cautery element.

Description

TITLE OF THE INVENTION

SURGICAL DISSECTOR DEVICE

RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 61/707565, filed September 28, 2012, the entire teachings of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

Present surgical techniques commonly use numerous tools to perform a variety of different functions during a procedure. Laparascopic surgery, for example, can employ tools such as dissectors, hooks and cautery instruments to address a variety of conditions that arise during such procedures. These procedures commonly utilize one or more ports of an endoscope that has been inserted through an incision in the patient's skin to access the surgical site. Such minimally invasive surgical procedures utilize tools adapted for insertion through the ports of such

endoscopes. The surgeon is frequently called upon to remove one tool and insert another into the surgical site to manipulate tissue. This exchange and insertion of different tools complicate the process and can increase the costs and risks associated with surgery. Further improvements are needed to improve the efficiency and safety of surgical procedures.

SUMMARY OF THE INVENTION

The present invention relates to a surgical instrument that is convertible between a plurality of different tissue-manipulating functions. Preferred embodiments of the invention provide for the deployment of various laparoscopic surgical tools from a single instrument. The instrument can include three primary sections: a handle apparatus, a shaft, and the head of the instrument, which contains moveable grasping elements or jaws.

A preferred embodiment of the invention combines functions that include a straight dissecting jaw and a hook, described below, into a single instrument with a switching mechanism that reduces the number of exchanges between different tools that a surgeon makes in any given operation. There are difficulties with existing designs that limit their use in surgical practice. First, the surgeon must load the hook onto the instrument which is time consuming and labor intensive. Second, the hook projects around in the plane of the closed jaws, which can create difficulties for the surgeon in visualizing the hook during dissection, depending on the angle of the laparoscopic camera in the abdomen, for example. Third, because of the way in which the user grasps the device, it does not replicate the real-time user interface of using an actual hook on its own, but rather requires the user to hold the device in a foreign way when using the hook function. In surgical practice, these are all impediments to implementation.

A preferred embodiment of the invention circumvents these limitations in the context of a method to deploy the hook from the jaw, and while doing so, allowing the user to replicate the native user interface of both the jaw and the hook with an integrated handle.

The handle casing can be constructed with a plastic polymer that can be sterilized or from a reusable metallic material that can be sterilized. The handle includes a first actuator that operates the moveable jaws of the device and a second actuator that moves the hook between an operating position and a storage position. The tool elements can be detachable from the handle and replaced.

The straight dissector jaw is opened and/or closed by a handle-grip mechanism. In a preferred embodiment, the operator inserts two fingers into two finger holes set on one side of the handle. One finger hole is fixed and the other is movable to actuate the opening and closing of the jaws. The movable finger hole is attached to a filament that rotates around an axis. This filament is attached to a spring which is itself attached to a metal rod or tube that passes through the shaft. When the operator opens their hand, this rotates the filament about its axis, which shortens the spring attached to the rod. This operates to retract the rod towards the handle in the shaft, which allows for opening of the jaw elements.

In a preferred embodiment, two jaw elements or blades that can be utilized together to grasp, dissect, and mobilize tissues and organs. The two blades are connected to a common rotational axis to distal end of the shaft of the instrument. The jaw heads can be rotated about an axis that is orthogonal to the plane of the shaft by rotation of a flange situated at the base of the shaft. On extension of the central rod, the jaws open, while on retraction of the central rod, the blades close. The jaw blades can be locked in a closed position by a sliding filament that is coupled to the handle mechanism. Once the jaws are locked, an "L" type hook can then be deployed converting the instrument into a small, more precise tissue dissector.

The above described "L" hook is deployed as follows: One of the standard jaw elements is attached at the tip of the device to a platform section, or 'L" hook, via a pivot joint at the tip of the jaw element. This hook can be embedded in an opening or aperture of the top of the jaw element that is sized to receive the hook. When not deployed, the hook sits within the opening on the jaw element, and remain flush against its outer surface. The hook can be a solid section of material with an attachment point for an actuator cable. The actuator cable runs from the handle, where the amount of tension in the wire is regulated, through the shaft, and then runs within the jaw element, or alternatively along the under-surface of the jaw element, until it attaches to the platform. When tension is placed on the actuator cable, the hook rotates from its resting state about the pivot joint, and can be maneuvered to extend from the element at a variable angle between zero to ninety degrees, or even to 180 degrees, if desired. The platform itself can be utilized as an interface along which various tools can be attached.

A preferred embodiment includes an electrical cable running adjacent with or inside the actuator cable. The user can selectively actuate the hook to function as an electrocautery device. Hence the instrument can function as both a grasping device as well as performing electrocautery as needed without the need for placement of a second cautery tool. This device enables the quick changing from a jaw-dissection function to a hook-dissection function with the simple rotation of an embedded hook. Other options to place on the extendible platform can include the placement of surgical clips, staples, and ligation sutures. When not deployed, the platform preferably is positioned flush within the jaw element outer surface.

The embedded hook can be deployed by rotating a second ratcheted wheel in the handle. There is a safety lock that, when engaged, prevents the wheel from turning. This wheel is attached to a wire that is wound around the thin rod on which the wheel turns. When the operator turns the wheel, tension is placed on the actuator cable, the hook rotates from its resting state about the pivot joint, and can be maneuvered to extend from the jaw element at a variable angle between zero to ninety degrees, or even to 180 degrees if desired, as previously described.

Three modalities to achieve and maintain closure of the hook in an embedded position can be utilized, for example. In the first modality, the hook itself and the jaw element are lined by magnetic strips so that when tension in the actuator cable is released, the platform shuts and is held shut by magnetic force. A second modality involves the placement of a spring around the pivot joint that exists between the jaw element and the hook. One end of the spring is attached to the hook, while the other end is attached to the jaw element. The natural position of the spring ensures that the platform is maintained closed within the jaw element unless tension is placed on the actuator cable so that the hook is forced to be extended. A third modality involves placement of a second actuator cable, which when pulled taut, causes the hook to rotate to the closed state.

The handle is connected to the shaft by a hinge. This allows for retraction of the handle into a parallel plane with the shaft, which is convenient for the operator while using the hook function (essentially turning the device into a rod). In current surgical practice the surgeon holds the shaft of the hook between the thumb and the index and middle fingers. Retracting the handle into a straight plane with the shaft allows for emulation of the normal interface with a hook dissector. This also allows for rapid switching from the hook to the jaw function with a simple rotation of the platform from its embedded position, while at the same time utilizing the native user interface of each separate instrument. The motion of the handle can be prevented by a locking mechanism, ensuring that the handle only retracts when desired by the operator. Similarly, the handle can be locked into position in the storage position. In this embodiment, the switch or button for deployment of the hook can be situated near the hinge-point, allowing for entrance of the wire into the shaft, as described above.

The shaft can range in length from 20 cm to 50 cm and 5 mm to 15 mm in diameter and is designed to fit through standard surgical ports for entry into the abdomen. It contains a movable metal rod by which the jaw is opened and closed. The rod is contained within a hollow metal tube, which itself is coated with non-conductive rubber tubing to protect the operator from electric shock. For the purpose of passage of the wire that opens and closes the platform embedded in the jaw, the rod in the shaft can be hollow or can include a channel for a wire that can extend inside the rubber tubing but outside the metal rod.

BRIEF DESCRIPTION OF THE DRAWINGS

Figs. 1A-1E illustrate a surgical tool for use with preferred embodiments of the invention.

Fig. 2 illustrates a hook deployed from a jaw element in accordance with preferred embodiments of the invention.

Fig. 3 illustrates a hook in the storage position being rotated into an operating position in accordance with preferred embodiments of the invention.

Fig. 4 illustrates an open dissector tool with an electrocautery feature of the hook in a storage position in accordance with preferred embodiments of the invention.

Fig. 5 illustrates a deployed hook being used to cauterize a bleeding capillary.

Fig. 6A shows jaw elements closed to grasp a blood vessel during an appendectomy in accordance with preferred embodiments of the inventions.

Fig. 7 illustrates a preferred embodiment utilizing the jaws to dissect tissue in a laternal direction.

Fig. 8 illustrates a perspective view of the hook deployed within the surgical field during a gall bladder operation in accordance with preferred embodiments of the invention.

Fig. 9 illustrates a further view of a deployed hooks used in conjunction with gall bladder surgery.

Fig. 10 illustrates a process sequence for using a multifunction surgical tool during a surgical procedure. DETAILED DESCRIPTION OF THE INVENTION

Preferred embodiments of the invention utilize a multi-functional surgical instrument that comprises a jaw tissue dissector modality with a hook tissue dissector modality. One of the jaw elements can contain a moveable arm or hook inserted in an aperture position on the outer surface of at least one jaw.

A surgical tool 10 in accordance with the invention is shown in Fig. 1A. The tool 10 includes a handle 18, a tubular shaft 12 and distally mounted jaw elements 22, 24. One or both jaw elements can have a hook 40 that is deployed typically at an oblique or orthogonal angle relative to the jaw element. In Fig. IB, the hook element 40 has been rotated into a storage position so that the distal surface is flush with the contiguous outer surface of the jaw element(s) 22, 24. The handle elements 26, 28 have respective openings 25, 27 for the fingers of the user to rotate elements relative to each other around axis 52. This rotational movement of handle elements actuates a linear movement of rod 80 within tube 12 to either open or close the jaw elements.

The device 18 can be used with a cannula 15 as shown in Fig. 1C during a surgical procedure such as endoscopic abdominal surgery. The endoscope 17 is used to visualize the distal end 20 of the device 18 during the procedure.

As seen in the view of Fig. ID, the two sides of the handle enclose an anchor 72 for the end of the cable or wire 80 use to actuate the hook. The cable extends around element 74 which moves within opening 50 and can lock in place. The two handle elements pivot around first connector 76 that attaches to second connector 78. A thumb or finger actuated element 75 can be used to lock the handle members in place and hold the hook in position. As shown in Fig. IE, the device can be oriented in a pistol grip configuration.

As shown in Fig. 2, the hook 40 is connected to the jaw element 22 at a pin 46 such that the hook can rotate to extend in a plane orthogonal to the shaft 12 axis. In the perspective view of Fig. 3, pulling cable 80 in the proximal direction will rotate 82 the hook from the storage position. A spring can be incorporated into the mechanism that operates to move the hook to the storage position upon release of tension in the cable 80. Alternatively, the hook and jaw element can also be lined with a magnetically attractive material to facilitate retraction of the hook into its embedded position. The wire can pass through the jaw element and move within the shaft. The metal rod that can be centrally hollow. The wire passes into the hollow portion of the rod.

The hook can be deployed by moving a switch or button situated on the handle, which puts tension on the wire passing to the distal end and thereby operative to extend the hook from its embedded position in a cavity or recess 45 of the outer face on the jaw blade. The outer face of the hook can be contoured to be flush with the outer face of the jaw element while in the storage position. For different embodiments, this knob can be situated at different locations on the handle.

The hook can also be deployed by retracting the rear handle-grip section of the device, which can put tension on the wire passing to the head to extend the hook from its embedded position in the jaw blade. After deploying the hook, the handle-grips can be retracted from an orthogonal axis with respect to the shaft to a parallel axis. This allows for easier manipulation of the hook in the surgical abdomen. The opening 50 allows the hook can be prevented from deploying by a locking mechanism in the handle, so that the operator only deploys the hook when specifically desired.

Shown in the perspective view of Fig. 4 are the jaws 22 and 24 separated for dissection using the outer faces, for example, and for grasping using the inner faces of the jaw elements. The inner face 42 of each element 22, 24 can be serrated 44 and can be optionally coated with an electrically conductive heating element 41. The heating element or elements can be connected to a switch 56 on the handle. The handle 18 can be connected to a power source such as a generator 90 with a cable 51. A first connector 55 attaches the cable to the handle and a second connector 57 attaches the cable 51 to the generator to supply electrical power to the heating element. A second switch 54 enables the user to select between a plurality of heating elements at the distal end 20. The user actuates one or more heating elements with switch or button 56.

Thus, the present invention relates to surgical instrument that combines at least two different tissue-dissecting modalities. Preferred embodiment can be used for laparoscopic surgeons for general surgery as well as specialty practitioners such as gynecologic surgeons, as either a single-use device or, alternatively, can be sterilized for further use.

In current laparoscopic surgical practice, surgeons traditionally use many distinct methods of separating planes of tissue from each other: one is a pivoting jaw mounted at the end of a rod that is inserted into the body through holes, or ports, created in the abdominal wall. This apparatus is connected to a source of electric current. The jaws can be opened and closed and used to grasp tissue. With activation of current, holes can be created in tissue and the jaw can then be used to spread planes of tissue apart. Another method comprises a rigid L-shaped hook attached to the end of a rod that also is inserted through ports or holes in the abdominal wall. This apparatus can also be connected to a source of electric current and can be used to push or pull on tissue planes and, when the electric current is activated, can cut through tissue planes or divide one from another.

Currently, surgeons use these two devices to separate planes of tissue from each other during an operation. When swapping from one tool to the another tool, as often happens in surgical practice, they must withdraw one instrument and insert the other. This process is both time- consuming and potentially dangerous. For situations requiring electrosurgical tools, the surgeon must withdraw the device being employed, disconnect it from the electric current source, pass it to the surgical technician who then hands the other type of desired device to the surgeon. The surgeon then connects the second device to the electric current source and inserts it into the abdomen.

5 Laparoscopic surgeries require the use of a camera that is also inserted into the abdomen so that the surgeon can view the surgical field. When the second device is inserted into the abdomen, the camera must be pulled backward so that the device can be more safely brought towards the area of operation. Only then can the operation resume. This process is time consuming and it requires the cessation of the act of operating while the transition is occurring. Each time the transition occurs o and the new instrument is brought into the abdomen, this raises the risk of puncturing of intraabdominal structures by the device being inserted. This exchange can occur numerous times in any given procedure.

As described herein, the present invention enables faster and more convenient transition between different surgical tools for the surgeon, as they are able to switch between tissue dissecting 5 modalities, for example, almost instantaneously, without the need to engage in the cumbersome process described above every time a new dissecting modality is desired. The present invention achieves this goal while allowing the surgeon to replicate the user interface of each separate device. As a result, this device can shorten operating room times while maximizing convenience for the surgeon.

o Shown in Fig. 5 is an enlarged view of a preferred embodiment of a dissector and grasping tool with jaw elements 22, 24 with an integrated hook 40. The hook 40 can be deployed and an electric current can be delivered to a conductive element or layer 41 that can be used to cauterize a bleeding capillary or vessel 60. The handle is shaped to minimize the space occupied during use to provide a lightweight, low profile system.

5 An electrical safety mechanism can be integrated with the electrocautery generator unit 90.

In order to prevent short circuiting and potentially serious abberant current routes, the generator continuously monitors the resistance of the circuit. If it detects a precipitous decline in the resistance across the device, it immediately shuts off the current to the device, thereby preventing unintended cauterization. Another electrical safety mechanism can include a fuse system in the 0 device, which protects against generator failure. If too much energy is delivered by the generator to the device, the fuse breaks and any current above a safety limit current level is not delivered to the patient.

A preferred embodiment of a tool in accordance with the invention is depicted in Fig. 6 in which an appendectomy 100 is being performed. In an appendectomy procedure, upward traction can be applied to the appendix 64 using a second grasping tool 102 to gain clearance from the colon 62. In the presently illustrated step, tool 12 is used to grasp and occlude blood vessels 66. As shown in Fig. 7 jaws 12, 24 can be used to separate planes 120, 140 of tissue to gain access to a site.

In a gall bladder procedure 200 shown in Fig. 8, both the hook element and jaws can be used to move the small intestine 80 to access the gall bladder 82 and bile ducts 84. Clamps 402 can then be used, as shown in Fig. 9, to secure the gall bladder while the hook is deployed to clear tissue away from the gall bladder. The device enables rapid switching between tissue spreading, grasping and hook electrocautery modes frequently used in this procedure.

Shown in Fig. 10 is a process sequence 500 illustrating steps that can be used during such surgical procedures where an endoscope or other surgical access port or cannula is inserted 502 into a surgical site. The multifunction tool is then inserted 504. A first tool element is used under visualization 506 by endoscope camera 17 to manipulate or grasp tissue. The surgeon can then actuate the handle to deploy the hook 508. The hook can be used to manipulate tissue 510 or can be electrically actuated 512 to cauterize or cut tissue. The hook can then be retracted and other functions employed 516 to complete the procedure. The tool can then be removed 518 and sterilized for further use.

While the present invention has been described herein in conjunction with certain preferred embodiments, a person with ordinary skill in the art, after reading the present application, can effect changes, substitutions of equivalents and other alterations to the devices and methods set forth herein. Each embodiment described herein can also have included therein such variations as disclosed with other embodiments.

Claims

What is claimed is:

5 1. A surgical tool comprising:

a handle having a first actuator that operates relative movement of jaw elements of the surgical tool, the handle having a second actuator to actuate a hook attached to one of the jaw elements;

a tubular shaft having a proximal end attached to the handle and a distal end, the jaws o extending from the distal end of the tubular shaft; and

an actuating element connected to the second actuator, the actuating element operable to move the hook between an operating position and a storage position.

2. The surgical tool of claim 1 wherein the jaw further comprise a first jaw element and a 5 second jaw element that undergo relative displacement in response to operation of the first actuator.

3. The surgical tool of claim 1 further comprising an electrically actuated cautery element at the distal end of the surgical tool. 0

4. The surgical tool of claim 1 wherein the hook is rotatably mounted to a first jaw element.

5. The surgical tool of claim 1 wherein the actuating element comprises a cable.

6. The surgical tool of claim 1 further comprising a locking mechanism to retain the hook at a 5 fixed deployment angle.

7. The surgical tool of claim 1 wherein the handle comprises a first handle element that rotates relative to a second handle element. 0

8. The surgical tool of claim 1 wherein the hook is mounted with a spring.

9. The surgical tool of claim 1 wherein the hook comprises a conductive heating element.

10. The surgical tool of claim 1 wherein each jaw element has a serated surface.

11. The surgical tool of claim 1 wherein the hook is positioned in a recess of a jaw element.

12. The surgical tool of claim 1 further comprising a heating element on at least one jaw element.

13. The surgical tool of claim 12 further comprising a switch on the handle to actuate the heating element.

14. The surgical tool of claim 12 further comprising a cable to connect the handle to a power source.

15. The surgical tool of claim 12 further comprising a plurality of heating elements.

16. The surgical tool of claim 1 wherein jaw elements comprises a first jaw movable about a pivot relative to a second jaw.

17. The surgical tool of claim 1 further comprising a cannula for receiving the tubular shaft.

18. The surgical tool of claim 1 further comprising a cable connecting the hook to the handle to actuate hook movement and an opening in a handle element to receive a locking element.

19. The surgical tool of claim 1 wherein the surgical tool is operable to perform a surgical procedure at a surgical site within a body, the surgical tool including the handle and movable jaw elements and the hook wherein the hook moves into the operating position from the storage position.

20. The surgical tool of claim 19 wherein the jaw elements move between a closed position and an open position in a movement plane.

21. The surgical tool of claim 20 wherein the hook moves within the movement plane of the jaw elements.

22. The surgical tool of claim 20 wherein the hook out of the movement plane of the jaw elements.

23. The surgical tool of claim wherein the tool is inserted through an endoscope port.

5

24. The surgical tool of claim wherein the handle attaches to a generator with a cable to actuate a heating element on the hook to cauterize tissue.

25. The surgical tool of claim 10 further comprising a heating element on at least one of the jaw o elements to cauterize tissue.

26. The surgical tool of claim 15 further comprising operating the generator with a safety shut off for the generator. 5

27. The surgical tool of claim 10 further comprising an endoscope to view movement of a first jaw element and a second element to grasp or dissect tissue.

28. The surgical tool of claim 10 further comprising a cannula having a channel to receive the tool to access a surgical site.

0

29. The surgical tool of claim 10 further comprising an endoscope camera to visualize the surgical procedure.

30. A method for performing a surgical procedure comprising:

5 inserting a surgical tool into a surgical site within a body, the surgical tool including a handle and movable jaw elements and a hook that is movable between a storage position and an operating position;

actuating the hook with an actuator on the handle to move the hook into the operating position from the storage position; and

0 using the hook to perform a surgical procedure.

31. The method of claim 30 further comprising moving the jaw elements between a closed position and an open position in a movement plane.

32. The method of claim 31 further comprising moving the hook within the movement plane of the jaw elements.

33. The method of claim 31 further comprising moving the hook out of the movement plane of 5 the j aw elements .

34. The method of claim 30 further comprising inserting the tool through an endoscope port.

35. The method of claim 30 further comprising attaching the handle to a generator with a cable o and actuating a heating element on the hook to cauterize tissue.

36. The method of claim 30 further comprising cauterizing tissue with a heating element on at least one of the jaw elements. 5

37. The method of claim 35 further comprising operating the generator with a safety shut off.

38. The method of claim 30 further comprising moving a first jaw element and a second element to grasp or dissect tissue. o

39. The method of claim 30 further comprising inserting the tool through a cannula to access a surgical site.

40. The method of claim 30 further comprising visualizing the surgical procedure with an endoscope.

5

41. The method of claim 30 further comprising performing a laparascopic procedure with the surgical tool.

42. The method of claim 30 further comprising storing the hook in a recess on an outer face of 0 the j aw element.

43. The method of claim 30 wherein a second jaw element has a second hook.

44. The method of claim 30 further comprising actuating a heating element with a switch on the handle.

45. The method of claim 30 further comprising rotating a first handle element relative to a second handle element to provide relative movement of the jaw elements and locking the first handle element to the second handle element to hold the hook in a fixed position relative to the jaw element.