WO2016108704A1

WO2016108704A1 - Retractor for laparoscopic surgery

Info

Publication number: WO2016108704A1
Application number: PCT/PL2015/000204
Authority: WO
Inventors: Maciej SKÓRSKI; Michał SKÓRSKI
Original assignee: Skórski Maciej; Skórski Michał
Priority date: 2014-12-29
Filing date: 2015-12-22
Publication date: 2016-07-07
Also published as: PL410790A1

Abstract

The retractor for laparoscopic surgery performed in the peritoneal cavity is given the form of a balloon (1) fitted with an insufflation/desufflation conduit (2), where upon insufflation the balloon (1) has the shape of a hollow cylinder, ring-shaped in cross-section, and before insufflation it is accordion-folded towards the balloon (1) axis and the fold is curled around the balloon (1) axis. The balloon (1) is made of a thin-wall plastic polymer material, preferably modified nylon or duraline. Preferably, the retractor is disposable.

Description

Retractor for laparoscopic surgery

The invention concerns a retractor for laparoscopic surgery performed in the peritoneal cavity.

Minimally invasive surgery has been observed to develop rapidly over the past 20 years. Laparoscopics on the organs in the abdominal cavity rank among most frequently performed procedures. Initially, laparoscopy was employed in gynaecological surgeries and in cholecystectomy. In those procedures, to expose the operating field it was sufficient to create the pneumoperitoneum (by intraoperative insufflation of carbon dioxide into the abdominal cavity). Today, laparoscopy is used on ever larger operating fields, where it is a true challenge to expose and secure the operating field. Those procedures include: adrenalectomy, colectomy, or bariatric surgeries. In those procedures an operative retractor is guided through a trocar into the peritoneal cavity, where it unfolds. During the surgery, however, the operating field is unstable which makes procedure last longer and creates technical problems.

Known prom patent document US 5,349,476 is a device which can be used instead of the laparoscopy retractor to retract individual organs in the abdominal cavity. Once the retractor is guided through the operating opening its operating section slides out, whereupon the pear-shaped balloon is insufflated; thanks to its smooth external walls the balloon is atraumatic in use. From the inside, the balloon is reinforced with a mesh, thanks to which it does not indent when the tissues are being retracted. The device can only be used to retract individual organs, e.g. small intestine or greater omentum, which intrude in the operating field, however it is impossible to ensure a stable operating field, especially during long surgeries. Keeping the retractor in a stable position requires engagement of an extra surgical assistant.

Known from patent document US 5,947,895 is a retractor which is used to lift the walls of the abdominal cavity during a laparoscopy procedure. The device is composed of two metal retractors given the half-crescent shape, on which there is a balloon overlay matching in shape. When being fitted, the device takes the shape of a single retractor which unfolds its half-circle shaped sections only when it has been introduced into the peritoneal cavity and insufflated. Walls of the abdominal cavity are lifted using a system of external levers which are fixed to the edges of the operating table. The permanent external part of the device is reusable and must be sterilised. In order to place the system inside the abdominal cavity it is necessary to perform an additional operating opening. Therefore, the camera must be introduced through a separate point of access. The device improves exposure of the operating field to view, but retracting the tissues from around the organ operated on requires using additional retracting tools, as in standard

laparoscopic procedures.

Known from document WO 2014/096370 A2 is a retractor used to clear the operating field, the operating section of which has a flexible tip fitted with a number of air cushions. The retractor size and the number of balloons are selected according to the expanse of the surgical procedure. The flexible section of the retractor can be controlled by various pre-existing systems used to manipulate the laparoscopic tools. The retractor enables better exposure of the operating field to view inside the abdominal cavity and minimises the risk of traumatising the organs in the abdominal cavity, which would happen during the laparoscopic procedures involving traditional rigid retractors or graspers.

The purpose of the invention is to design such structure of a retractor which would enable its easy introduction into the peritoneal cavity and ensure stable operating field without the need to engage an extra surgical assistant.

A retractor for laparoscopic surgery according to the invention is characterised in that it is given the form of a balloon fitted with an insufflation/desufflation conduit, where upon insufflation the balloon has the shape of a hollow cylinder, ring-shaped in cross-section, and before

insufflation it is accordion-folded towards the balloon axis and the fold is curled around the axis.

Preferably, the balloon ranges from 100 to 200mm in height, and its inner diameter after insufflation ranges from 100 to 450mm.

Preferably, the thickness of the ring-shaped cross-section of the insufflated balloon ranges from 20 to 50mm.

Preferably, the outer diameter of the accordion-folded balloon when curled around its axis ranges from 10 to 15mm.

The balloon is made of a thin- walled plastic polymer material, particularly of modified nylon or duraline, which are commonly used in the production of balloons fitted at the ends of the catheters used in vascular angioplasty, where the material must endure high pressure so as to ensure good fixation upon inflation.

Preferably, the external convex surface of the cylindrical balloon wall is coarse so as to minimise the risk of retractor's dislocation upon fixing, caused by the peristaltic wave of the intestines and the slipperiness of the organs in the abdominal cavity.

Preferably, the balloon insufflation/ desufflation conduit is fitted in its upper section, preferably in the top ring-shaped balloon wall.

Preferably, the outer diameter of the balloon insufflation/ desufflation conduit ranges from 6 to 8Ch, where Ch is an abbreviation of the French unit used to measure the outer diameter of catheters according to the Charriere scale, also denoted with the following symbols: CH; Fr; Fg; Ga; FR; F.

Preferably, the balloon insufflation/ desufflation conduit is made of a flexible, pressure-resistant material.

Preferably, the retractor is disposable. The advantage of the retractor according to this invention is the possibility to create a stable operating field by retracting all instead of just one organ in the peritoneal cavity, neighbouring on the operated area. The operating field remains stable and clear throughout the surgery. Thanks to its structure, the reactor is easy to introduce into the peritoneal cavity without the need to perform an extra operating opening. It can be implanted through the opening which is subsequently used for the insertion of the visual track. The retractor's accordion folding and curling around its own axis allows to minimise the retractor's cross- wise dimensions when folded, and even unfolding of the balloon when insufflated. As a disposable device, the retractor ensures reducing the costs related to tool sterilisation and preparation for the surgery. The retractor is simple to produce and use and ensures excellent exposition of the operating field to view, while being absolutely atraumatic. During the surgery the retractor does not require any

manipulation, or operation by an extra surgical assistant.

Further benefits and advantages of the present invention will become apparent after a careful reading of the detailed description with appropriate reference to the accompanying drawings.

In the drawings:

Fig. 1 shows the bird's eye view of the retractor before insufflation,

accordion-folded and not curled around its axis.

Fig.2 shows front view of the retractor before insufflation, accordion-folded and curled around its axis.

Fig.3 shows the bird's eye view of the retractor partially insufflated.

Fig.4 shows a spatial view of the retractor upon insufflation.

Fig.5 presents the bird's eye view of the retractor upon insufflation.

Fig.6 sketches the general idea of using of the retractor in the peritoneal cavity. An exemplary retractor for laparoscopic surgery is given the form of a balloon 1, made of a thin- wall modified nylon so as to ensure good fixation upon inflation. The balloon 1 upon insufflation takes the shape of a hollow cylinder, ring-shaped in cross-section, as shown on Figures 4 and 5, while before insufflation it is accordion-folded towards its axis and curled around the axis, as shown on Fig. 2. The height H of the balloon 1 upon insufflation is 150mm, its inner diameter Dl is 250mm, and the thickness D2 of the ring- shaped cross-section of the balloon 1 is 30mm, while before insufflation the inner diameter D3 of the balloon, accordion-folded and curled around its axis, is 12mm. The balloon 1 is fitted with a conduit 2 for insufflation/

desufflation, 7Ch in diameter, made of a flexible and pressure-resistant material, fitted in the top ring-shaped wall of the balloon 1, as shown on Fig.2 and Fig.4.

The dimensions of the retractor as described above may be different, falling in the following ranges: inner diameter Dl of the retractor upon insufflation: from 100 to 450 mm; thickness D2 of the ring-shaped cross-section of the retractor: from 20 to 50mm; inner diameter D3 of the retractor when folded: from 10 do 15mm; height H of the retractor: from 100 to 200mm; diameter of the insufflation/ desufflation conduit: from 6 to 8Ch. The dimensions may vary depending on individual needs.

In another exemplary embodiment of the invention, the external convex surface of the cylindrical wall of the balloon 1, as described in the above example, is coarse so as to minimise the risk of retractor's dislocation upon fixing, caused by the peristaltic wave of the intestines and the slipperiness of the organs in the abdominal cavity, where the coarseness must be such as to prevent the risk of traumatising the organs in the abdominal cavity.

In other exemplary embodiments of the invention, the balloon 1 described in the examples above can be made of duraline or another thin-wall plastic polymer material, which is commonly used in the production of balloons fitted at the ends of the catheters used in vascular angioplasty, where the material must endure high pressure so as to ensure good fixation upon inflation.

The general idea of using the retractor laparoscopic surgery is sketched on Fig.6. Upon making an opening and introducing a camera with a visual track A, operating ports B, C, and D are introduced through trocars under visual monitoring, whereupon the pneumoperitoneum is created by

insufflating carbon dioxide until the intra-abdominal pressure reaches ca. 10 mm Hg, thus making space for introducing the retractor according to the invention. Then, the camera is withdrawn and while keeping the opening left after its removal secure, the non-insufflated retractor, as shown on Fig. 2, is introduced so as to maintain the pneumoperitoneum, and the visual track is inserted next to the conduit 2 for the retractor insufflation/ desufflation. After the retractor has been inserted and correctly positioned in the peritoneal cavity using operating tools introduced through operating ports B, C, D, the balloon 1 is insufflated under visual monitoring and left there for the time of the surgery. When the operating field is clear, the surgery can proceed.

Generally, the canal formed by the operating trocar can be used for

introducing other instruments. When the surgery is over, the retractor is disufflated using a suction unit commonly used in surgeries and removed through the opening created by the widest of trocars. Should there be any problem with its removal, an extra perforation is made in the balloon 1. The use of a soft balloon allows to minimise traumatisation of the organs neighbouring on the operating field, such as the intestines, greater omentum, liver, spleen, uterus, or the ovaries.

Claims

1. A retractor for laparoscopic surgery, characterised in that it is given the form of a balloon (1) fitted with an insufflation/ desufflation conduit (2), where upon insufflation the balloon (1) has the shape of a hollow cylinder, ring-shaped in cross-section, and before insufflation it is accordion-folded towards the balloon (1) axis and the fold is curled around the balloon (1) axis.

2. The retractor according to Claim 1, characterised in that the balloon (1) ranges from 100 to 200mm in height (H), and the inner diameter (Dl) of the balloon (1) after insufflation ranges from 100 to 450mm.

3. The retractor according to Claim 2, characterised in that the thickness (D2) of the ring-shaped cross-section of the insufflated balloon (1) ranges from 20 to 50mm.

4. The retractor according to Claim 1, characterised in that the outer diameter (D3) of the accordion- folded balloon (1) when curled around its axis ranges from 10 to 15mm.

5. The retractor according to Claims 1 to 4, characterised in that the balloon (1) is made of a thin- walled plastic polymer material.

6. Retractor according to Claim 5, characterised in that the balloon (1) is made of modified nylon.

7. The retractor according to Claim 5, characterised in that the balloon (1) is made of duraline.

8. The retractor according to Claims 1 to 7, characterised in that the external convex surface of the cylindrical balloon (1) wall is coarse.

9. The retractor according to Claim 1, characterised in that the balloon (1) insufflation/desufflation conduit (2) is fitted in its upper section.

10. The retractor according to Claim 9, characterised in that the balloon (1) insufflation/desufflation conduit (2) is fitted in the ring-shaped balloon (1) wall.

11. The retractor according to Claims 1 or 9 or 10, characterised in that the diameter of the insufflation/desufflation conduit (2) ranges from 6 to 8Ch.

12. The retractor according to Claims 1 or 9 or 10 or 11, characterised in that the insufflation/desufflation conduit (2) is made of a flexible, pressure- resistant material.

13. The retractor according to Claims 1 to 12, characterised in that it is disposable.