Devices and kits for assisting in open surgeries

Abstract

Various examples of devices and kits for assisting in and illuminating medical procedures are disclosed. The devices may be attached to handheld medical tools. Also disclosed are various examples of medical procedures that may be carried out using the devices or kits. Also discloses are various examples for mounting auxiliary medical tools to a device mounted on a primary medical tool.

Description

<DP=1>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²1²Devices and kits for assisting in open surgeries ²This application claims benefit of European Patent Application no. ²15382341.4 filed on June 29, 2015.²The present disclosure relates to devices and kits for assisting in a medical ²procedure, particularly open surgeries.²BACKGROUND² Surgeries can generally be grouped in laparoscopic or minimally-invasive²surgeries and open surgeries. In this sense, open surgeries should be ²understood as traditional surgeries which require a relatively long incision ²in ²order for the surgeon to insert instruments and visualize the surgery through ²the incision, whereas minimally-invasive surgeries are much less invasive²and involve much smaller incisions. With an open approach, e.g. the incision²for a typical appendectomy is approximately 10 cm (4 inches) long. While, ²using minimally-invasive techniques, the incisions may range from 0.5 to 1.5 ²cm (1 / 4 to 1 / 2 inch) or for some surgeries even no incisions at all.² The key element in laparoscopic surgery is the use of a laparoscope, i.e. a²long fiber optic cable system which allows viewing of the affected area. ²Laparoscopic surgeries belong to the field of endoscopy, i.e. using an ²endoscope which is an instrument used to examine the interior of a hollow ²organ or cavity of the body. In laparoscopic surgery, the surgeon is actually² performing the surgery from outside the patient's body, removed from the²actual intervention site. Surgical instruments are controlled from a distance ²and reach the intervention site through a tubular body, e.g. a catheter.²Illumination devices for illuminating medical procedures are known. Since² practitioners in the several medical fields of specialization usually need²enhanced visualization of a body tissue and / or body cavities, a variety of ²illumination systems have been designed to address this issue.²There are currently several ways to illuminate a medical procedure, such as² e.g. open surgeries in an operating room. One option is overhead lighting²mounted in a ceiling. Surgical lights may be fixed in the ceiling or be²<DP=2>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²2²suspended from a ceiling with an arm that can be manipulated to reposition ²and reorient the light. However, these kinds of lighting usually provide a ²general and diffuse kind of illumination, which may lack the precision needed ²to point towards and adequately illuminate the desired target depending on²the kind of intervention. The light may encounter obstacles that cast a shadow²over said target, particularly in interventions in bodily cavities or ²openings.²Another option is the use of lighting devices held in a person's hand. In such ²²a case, surgeons or other operating room personnel may employ handheld² lighting devices, such as surgical flashlights. However, during the time that²the surgeon is holding the device, his / her hand that is holding the lamp is ²unable to perform other actions. If instead such a device is held by other ²personnel, the accuracy in lighting the target might not correspond to the ²surgeon's specific demands. As a solution to overcome some of the²aforementioned limitations, surgical headlights may be used. However, ²surgical headlights commonly are heavy, and can be uncomfortable. They ²also need positioning and possibly adjustments during surgery, again ²requiring a free hand to do so. Furthermore, the headlight and all related ²apparatus are unsterile, so that precautions must be taken in order to avoid²contamination of the surgical field.²In a similar manner, during open surgeries practitioners usually need ways to ²indicate instruments, a body tissue and / or body cavities to other ²practitioners ²or personnel involved. Identification of the correct intervention point and ²the²direction of a required movement (e.g., incision, needle advancement) can be²of pivotal importance for completing these procedures. Verbal communication ²sometimes may not adequately provide the guidance. Laser pens are ²sometimes used for such indications.² In the course of an open surgery, many combinations of surgical instruments²may be needed. For example, it is quite often that one or more blood vessels ²need to be severed in the course of an open surgery. In these cases, ²normally after introducing the scalpel the surgeon needs to provide means for ²closing and cauterizing such blood vessels. To do this, various surgical²elements may be needed. Alternatively, it is known to use an electric scalpel²or electric surgical pencil. This way, the blood vessels can be severed and²<DP=3>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²3²cauterized in a single step. However, during cauterization smoke may hinder ²the view of the surgeon. Thus a further surgical instrument may be needed, ²namely a surgical smoke aspirator which will normally be operated by a ²surgical assistant.² Radio-guided surgery is also known, in which a patient is administered a ²radioactive material. The radioactive material concentrates e.g. in cancer ²cells. By using a radioactive probe, a tumour and affected tissue can be ²located and removed with precision. However, when the surgeon is holding²the probe, his / her hands are unable to perform other actions. Thus normally²the radioactive probe will be held / operated by a surgical assistant. Often ²both medical professionals cannot access the opening for the surgery at the ²same time, i.e. one person uses the radioactive probe to locate affected ²tissue and tells the surgeon where to cut.²Currently, many such combinations of surgical instruments, including, but not ²limited to, cutting, suturing, aspiration, clamping, cauterizing, irrigating, ²and ²various forms of tissue manipulation within a patient's body, may be needed ²simultaneously. And in all these and other combinations of surgical²instruments for open surgery, visibility is very important, but often not ²ideal²because more than one person is needed to handle different tools.²It is an object of examples of the present disclosure to provide alternative ²devices and kits for assisting in open surgeries, particularly for assisting ²or² illuminating in open surgeries that at least partially overcome some of the²aforementioned drawbacks.²SUMMARY²According to a first aspect, a device for assisting in an open surgery is² provided. The device comprises: a base configured to be mounted on a²portion of a handheld medical tool, an illumination device mounted on the ²base such that when the base is attached to the handheld medical tool, the ²illumination device is directed towards a distal end of the handheld medical ²tool. The device further comprises an appendage to the base having a²receptacle configured to receive an auxiliary medical device.²<DP=4>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²4²According to this aspect, a device is provided which can be coupled to a ²handheld medical tool (e.g. an electrical scalpel) to improve visualization ²during open surgery, and at the same allow auxiliary devices to be coupled to ²the handheld medical tool. Such an auxiliary device may be e.g. a surgical² aspirator or smoke / liquid evacuator, a laser pointer, a handheld ultrasound²system, an irrigator for electrocoagulation, a further illuminating device, a ²radioactive probe, a camera or a sensor among others.²In general, these devices may particularly be instruments that assist the²surgeon while performing the surgery (e.g. interacting with the tissue) with ²the²(principal) handheld medial tool.²No further medical personnel is needed to hold such an auxiliary device. The ²surgical procedure can thus be more effective, quicker and safer.² The attachment of the base with appendage locally increases the cross-²sectional dimensions of the medical tool. However, in examples of the present ²disclosure, the base with appendage may remain outside the patient's body ²while the medical tool and auxiliary tool reach sufficiently inside the body. ²In²such cases, there is thus no need to increase a surgical incision.²In some examples, the receptacle may be a through-hole. Optionally, the ²appendage may comprise a tubular or annular portion defining the through-²hole. Optionally, the tubular or annular portion may be made of a resilient²material, such that the auxiliary medical device can be received with a ²friction²fit. In more alternatives, the receptacle may be open having e.g. a ²substantially C-shaped or U-shaped portion.²In some examples, the appendage may be made from a rigid material. In²others, they may be made of a resilient material. A resilient material will ²allow²a secure friction fit. Depending on the resiliency, auxiliary devices with ²slightly ²different dimensions can be fitted in the same through-hole. A single ²appendage may thus be suitable for fitting various different auxiliary medical ²²devices, i.e. auxiliary medical devices having different diameters.² In some examples, the device may comprise an appendage that may be²<DP=5>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960² integrally formed with the base. In other examples, the appendage may be ²removably fixed to the base.²In some examples, a single base may comprise a first appendage and a² 5 second appendage, the first appendage having a receptacle configured to²receive a first auxiliary medical device, and the second appendage having a ²receptacle configured to receive a second auxiliary medical device. In some ²surgical methods, two auxiliary devices may be needed simultaneously, e.g. a ²laser pointer and a surgical aspirator.² Depending on circumstances, devices comprising a base and several ²appendages of different types can be used, e.g. having different sizes and / or ²involving rigid and / or resilient materials may be foreseen.² In more examples, an appendage may be or comprise an antiskid strap²attached to the base. Antiskid straps herein can be straps, bands, slings or ²loops that have a friction fit with an auxiliary medical case. In some of ²these ²cases, the straps may be provided with Velcro-type fasteners. In some cases, ²elastic bands may be foreseen as antiskid straps. The elastic bands achieve²a friction fit when stretched due to the tendency to return to the natural²relaxed state. In still further alternatives, combinations of appendages such ²as appendages integrally formed with the base and / or removably fixed to the ²bases and / or straps separated from the base may be foreseen.²In a further aspect, a kit for assisting in an open surgery is provided, the ²kit²comprising a base configured to be mounted on a portion of a handheld ²medical tool, and an appendage configured to be removably fixed to the base ²and having a receptacle configured to receive an auxiliary medical device.² In some examples according to any of these aspects, the problems of²illuminating may be addressed by a device attached to the medical tool or ²instrument, namely the base with an illumination device. The medical tool or ²instrument may in a direct manner and in proximity of the medical procedure ²provide the illumination needed to properly operate during the medical²intervention or surgery.²<DP=6>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²6²The light source may enhance visualization of e.g. a surgical field ¨ which is ²a ²key issue in surgery - while being lightweight and comfortable to use. The ²fact ²that the device or the kit can be mounted in a variety of medical instruments ²results in a versatile tool which may be added to a tool or instrument and² used whenever convenient. Moreover, this permits to supplement the tools²already at disposal and may highly improve the equipment performance at a ²reduced cost.²The device (and / or appendages) may be disposable and used only once. In² other examples, the device or the kit may be used multiple times and may be²configured to be sterilized after each use. Either way, contamination of the ²surgical field can effectively be avoided.²In some examples, the illumination device may be a LED. LEDs offer a cost-² effective solution while keeping a high illumination standard. They require²little maintenance and are cold, which avoids overheating or undesired ²temperature variations (for example, if a thermometer should be close to the ²light source). They may be provided with variable intensity control, so that ²they can adapt to changing demands. Alternatively, the illumination device²may be a fiber-optic light. In further examples, the base may comprise two or²more illumination devices.²In further examples, one or more incandescent light bulbs may be used.² In yet a further example, the base may comprise a central opening configured²to be mounted around a portion of the handheld medical tool. Optionally, the ²base may comprise an 0-ring or a diaphragm made of a relatively flexible ²material surrounding at least a portion of the central opening. This feature ²makes the device or kit adaptable to several handheld medical tools,²particularly tools used in open surgery and in particular it may be adapted to²be mounted on scalpel-like instrumentation.²In alternative examples, the base may comprise a hinge between a first half ²and a second half of the base, and wherein a biasing element forces the first² and second half to contact each other. This feature allows moving conveying²the external part of the base in the desired direction.²<DP=7>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²7²In yet other examples, the base may comprise a mounting ring arranged at or ²near an edge of the base for mounting on a medical tool.² During an open surgery, a surgeon may take a decision based on the specific²circumstances whether to mount the base around the medical tool or not. As ²the surgery progresses, and if the situation changes, a surgeon may again ²judge to mount or dismount the base (and / or the appendages) from the tools ²he / she is using at that moment.²Flexibility or resiliency in the mounting arrangement makes it possible for ²the ²same base to be mounted on different tools.²In some examples, the device or the kit may further comprise a power cable² for connecting to a power source. A plurality of controls and / or switches may²be provided on the power source. As for switching the respective lamps on ²and off or activating the same, it can be advantageous if the lamps can be ²switched on individually or in groups. This results in a special option of ²controlling the light intensity on the one hand and the wavelength emitted on²the other, as well as controlling the use of a further element, e.g. a laser²pointer, that may further be provided at the base independently of the light ²sources or not. The device / kit can thus be adapted optimally to suit the ²respective application.² In some examples, the electrical cable comprises a plurality of fasteners for²attaching to the handheld medical tool. The fasteners, which may be of ²several kinds, allow for a compact and handy mounting of the base onto the ²medical tool, so that the cable is not disturbing to the medical professional. ²In ²alternative examples, a plurality of fasteners may be attached to the medical²tool, e.g. to a handle portion of the medical tool. For example, eyelets may ²be²used for guiding the electrical cable.²The several feasible configurations may be adapted to the requirements of a ²plurality of procedures and / or applications, depending on the most useful and² frequent uses. Thus, in some examples the further auxiliary device may be a²sensor, a smoke and / or liquid evacuator, an ultrasonography sensor or²<DP=8>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²8²another imaging device (e.g. video or photo camera).²In some examples, such a kit may comprise a first appendage configured to ²be removably fixed to the base and having a first receptacle configured to² receive a first auxiliary medical device, and a second appendage configured²to be removably fixed to the base and having a second receptacle configured ²to receive a second auxiliary medical device, wherein the first receptacle is ²of ²a different size or shape than the second receptacle.² Such a surgical kit comprises different appendages for fitting different²auxiliary devices or different types of auxiliary devices. The base may ²comprise a first fastening element, and the appendages comprise a second ²fastening element, wherein the first and second fastening elements are ²configured to mate. In some cases, a single fastening element is provided for²coupling with either the first or the second appendage. In some other cases,²the base comprises a first and a third fastening element for coupling with the ²²first and the second appendage simultaneously.²In some examples, a laser pointer may be mounted on the base such that² when the base is attached to the handheld medical tool, the laser pointer is²directed substantially towards a distal end of the handheld medical tool. The ²device or the kit may further comprise a power supply to power the laser ²pointer.²According to this aspect, a tool for pinpointing biological tissue of body ²parts²of interest is provided in proximity of a bodily cavity. Furthermore, the ²laser ²pointer may be easily controlled without distracting the medical professional.²According to another aspect, a device for illuminating a medical procedure is² provided. The device may include a base that is attachable to a handheld²medical tool, an illumination device mounted on the base, a laser pointer ²mounted on the base such that when the base is attached to the handheld ²medical tool, the laser pointer is directed substantially towards a distal end ²of ²the handheld medical tool, and further includes a connection for connecting to²a power supply to feed the illumination device and the laser pointer.²<DP=9>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²9²In yet a further aspect, a method for replacing a first auxiliary medical tool ²²mounted in a receptacle of an appendage of a device for assisting in open ²surgery, when a base of the device is mounted on a portion of a handheld ²medical tool is provided. The method comprises providing the handheld² medical tool together with the appendage supporting the first auxiliary²medical tool in a surgery position; retracting the handheld medical tool from ²the surgery position; removing the first auxiliary medical tool; mounting a ²second auxiliary medical tool on the device for assisting in open surgery; and ²²positioning the handheld medical tool in the surgery position. In accordance²with this aspect, the method is carried out during an open surgery.²Herein, the surgical position is to be understood as a position in which the ²handheld medical tool protrudes beyond the incision in the skin of the patient ²²to be able to perform a surgical action.² In accordance with this aspect, in examples, as the surgery progresses, and ²when the situation changes, a surgeon may judge to mount or dismount ²different auxiliary medical devices to the appendage, thus being able to use ²different combinations of tools rather rapidly during an open surgery. In a²laparoscopic surgery, such procedures would be much more complicated²since the surgical tool is further away from the surgeon.²In some examples, removing the first auxiliary medical tool may comprise ²removing the appendage from the device for assisting in open surgery. In² some of these examples, mounting the second auxiliary medical tool on the²device for assisting in open surgery comprises attaching a second ²appendage to the device for assisting in open surgery. Substituting one ²auxiliary medical tool for another auxiliary medical device may thus involve ²changing an appendage to quickly dismount and mount auxiliary medical²tools. In other examples, a first auxiliary medical device may be removed from²an appendage and a second auxiliary medical device may be fixed attached²<DP=10>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960² to the same appendage.²In yet a further aspect, a method for changing an auxiliary medical tool ²mounted in a receptacle of an appendage of a device for assisting in open²5 surgery, when a base of the device is mounted on a portion of a first ²handheld²medical tool is provided. The method comprises providing the first handheld ²medical tool together with the appendage supporting the first auxiliary ²medical device in a surgery position; retracting the first handheld medical ²tool ²from the surgery position; removing the device for assisting in open surgery²10 from the first handheld medical tool; providing a second handheld ²medical²tool; mounting the device for assisting in open surgery on the second ²handheld medical tool; and positioning the second handheld medical tool in ²the surgery position. In accordance with this aspect, the method is carried ²out ²during an open surgery.²In accordance with this aspect, during an open surgery, a device for assisting ²²in open surgery may be removed from the principal handheld medical tool ²and then be attached to another handheld medical tool while still carrying the ²²same auxiliary medical tools. Particularly, in the case the device comprises a² base having a central opening for being mounted around a portion of the²handheld medical tool (e.g. comprises a ring or diaphragm of flexible ²material), the device can be slid off the medical tool and be slid back onto a ²²different medical tool. In laparoscopic surgeries, such a change would be ²much more complicated.² In yet a further aspect, a device for illuminating a medical procedure is ²provided, this device comprising: a base that is attachable to a handheld ²medical tool, an illumination device mounted on the base; and optionally a ²power supply to feed the illumination device. The illuminating device²according to this aspect may incorporate one or more of the features²described in connection with the other aspects. For example:²<DP=11>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²11²The handheld medical tool may be an electric scalpel. The illumination device ²may be one or more LEDs or fiber-optic light. The base may also comprises ²two or more illumination devices, optionally diametrically opposed ²illumination ² devices.²Optionally, the base may comprise a central opening configured to be ²mounted around a portion of the handheld medical tool. And in some cases, ²the base may comprise a ring made of a relatively flexible material (e.g.² rubber or silicone gel or a combination thereof) surrounding the central²opening.²In some cases, the power supply can comprise a battery mounted within a ²housing of the base. In other cases, the power supply can comprise an² electrical cable configured to be connected to a power source.²In some examples of this illumination device, a further auxiliary device for ²use ²during a medical procedure may be mounted on the base, and optionally ²further including a switch to selectively activate the further auxiliary ²device.² Such an auxiliary device may be a temperature sensor, e.g. a thermometer or²an infrared radiation sensor, a spectrophotometer, a flow meter, a video or ²photo camera, a laser pointer or a suction device. Several of these could also ²²be combined.² In yet a further aspect, an electrical scalpel is provided comprising an²elongate shaft having a receptacle at or near the distal end of the elongate ²shaft, a blade configured to be received in the receptacle, and an ²illumination ²device as hereinbefore described mounted on the receptacle. In particular, ²the illumination device may be removably mounted on the receptacle.² BRIEF DESCRIPTION OF THE DRAWINGS²<DP=12>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²12²Non-limiting examples of the present disclosure will be described in the ²following, with reference to the appended drawings, in which:²Figure 1A schematically illustrates an example of a device for assisting in an² open surgery procedure in combination with an electrical scalpel;²Figure 1B illustrates a cross-sectional view of the device on the scalpel of ²figure 1A;² Figure 10 schematically illustrates a detail of a device according to the²example of Figure 1A;²Figure 1D illustrates a frontal view of the device of the example of figure ²1A;² Figures 2A and 2B schematically illustrate details of examples of devices for²assisting in open surgery;²Figures 3A ¨ 30 schematically illustrate different views of a further example ²of ²a device for assisting in an open surgery;² Figures 4A and 4B schematically illustrate a further example of a device for ²assisting in open surgery with different handheld medical devices and ²auxiliary medical tools;² Figures 5A ¨ 50 schematically illustrate different auxiliary medical devices²which may be used with examples of the devices for assisting in open ²surgery;²Figures 6A ¨ 60 show another example of a device for assisting in an open ² surgery;²Figures 7A and B show a further example of a device for assisting in an open ²surgery substantially as hereinbefore described; and²Figures 8A and 8B show a still further example of a device for assisting in an²open surgery substantially as hereinbefore described.²<DP=13>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²13²DETAILED DESCRIPTION OF EXAMPLES²Handheld medical devices may include a variety of tools or instruments for ²applications in several fields. Such tools generally may comprise a handle² portion or grip portion near a proximal portion of an elongated shaft and a²working tool at a distal end of the shaft. For example such a tool can be an ²electrical scalpel or electrocautery knife which can be used in electro ²surgery. ²Other tools for medical treatment include further surgical tools, or tools in ²dentistry or orthodontics.² Electrosurgery is commonly used in dermatological, gynaecological, cardiac, ²plastic, ocular, spine, ear-nose-throat (ENT), maxillofacial, orthopaedic, ²urological, neuro- and general surgical procedures as well as certain dental ²procedures. Electrosurgery is performed using an electrosurgical generator²(also referred to as power supply or waveform generator) and a hand piece²including one or several electrodes, sometimes referred to as a ²radiofrequency knife (RF knife).²Most of the examples of the present disclosure are shown in combination with² an electrical scalpel. It should be clear however that the same and similar²devices may be used in combination with other handheld medical tools. Other ²suitable medical tools include e.g. orthodontic and dental tools, probes, ²surgical graspers or tweezers, and surgical retractors. Most of the examples ²of the present disclosure are adapted and suitable for tools and procedures in²which the illumination device or further auxiliary device do not enter²completely into a bodily cavity, but rather stay outside the cavity or barely ²enters the cavity.²Examples of the present disclosure are generally configured for open² surgeries wherein an opening is created or has been created in the skin of a²patient.²Figures 1A and 1 B show an example of a kit or a device 30 for illuminating ²and assisting in a medical procedure, e.g. an open surgery, in combination²with a handheld surgical tool. In this example, the handheld surgical tool is ²an²electrical scalpel, which comprises an elongate shaft 20, having a receptacle²<DP=14>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²14²25 with a distal open end. The elongate shaft 20 may be held by a medical ²professional near a proximal end of the shaft. The proximal portion of the ²shaft 20 may have an ergonomic shape configured for gripping or handling. ²The gripping portion may extend from a proximal end to approximately a mid-² portion of the shaft. The ergonomic shape may be adapted for a pencil grip.²The receptacle 25 of the electrical scalpel is configured to receive e.g. an ²electrocautery blade 24. The receptacle 25 may be made from an electric ²insulating material. The receptacle 25 may be made from a rubbery or² polymeric material.²A power supply system for powering the scalpel, and a cable connecting a ²proximal end of the shaft with the power supply system may generally also be ²provided. A power switch allows turning on and off the power supply or² otherwise regulating the power flow.²The kit or device 30 for assisting in open surgery in this example comprises a ²²cylindrical base 32, which has a central opening 2a configured to be mounted ²around a portion of the handheld medical tool, for instance, around the²receptacle 25. Thus, the base 32 can be positioned by introducing the²receptacle 25 into the central opening 2a. As a result, the base is positioned ²²distally with respect to a handle or gripping portion of the medical tool. The ²²cylindrical base in some examples may have a diameter of e.g. approximately ²1 cm, 1.5 cm or 2 cm.² This is also illustrated in figures 10 and 1D.²In this example, eight LEDs 3 are provided. Because of their distal position ²with respect to the hand of a medical professional, the hand cannot create² any shadows. The LEDs may be strategically positioned so that regardless of²the precise orientation of the scalpel, sufficient light is provided to the ²surgical ²field. In other examples, different numbers of LEDs may be provided.²The position on the receptacle 25 of the electrical scalpel thus makes² visualization possible, but at the same time does not prevent access of the²scalpel to the surgical procedure. The device can be positioned sufficiently²<DP=15>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960² proximally such that in case of small bodily openings or cavities, it stays ²outside of the patient.²In this case, the base has a generally round, rather flat frustoconical shape.²5 Nevertheless, the base might have any geometry as long as it would be²suitable for its purpose. An example of geometry requirements might include ²being light enough to keep the ensemble illumination device-medical tool ²manageable and not being too sharp or too bulky as to hamper the ²practitioner while using said ensemble.² In this example, the base 32 comprises a diaphragm 2 surrounding the central ²opening 2a. Alternatively, an 0-ring may be used. The diaphragm 2 may be ²made of a relatively flexible material, so that it can adapt to several ²handheld ²medical tools. As the base 32 is pressed against or pulled away from the²receptacle 25 of the shaft, the diaphragm 2 can deform to admit or release the²receptacle 25 from the central opening 2a. Moreover, the flexibility of the ²diaphragm may adapt to a certain range of distal end diameters or geometries ²in a variety of handheld medical tools. This provides versatility to the ²kit / device, so that it may be used on different handheld medical tools²according to need.²The kit or device 30 also has a connection for connecting to the power ²source, namely a cable 10 connecting a rear part of the base 32 with a power ²source. Some switches in a control panel may allow to control the different² systems on the device, e.g., turning them on and off, individually or²simultaneously.²At the rear part of the base, a power supply module (not shown) receives ²electrical power from the connection (i.e. cable 10) and feeds whatever² devices are mounted on the base. In this case, illumination devices 3 are²powered. However, in a further example, a laser pointer may also be ²integrated in the base, e.g. arranged in between the illumination devices. ²Alternatively, one of the shown illumination devices may be replaced with a ²laser pointer. The power supply may thus also receive electrical power from² the same source.²<DP=16>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²16²Infrared laser pointers or green laser pointers may be useful. The integration ²²of a laser pointer in the assisting and illuminating device offers several ²advantages compared to the normal use of pen-size laser pointers. The laser ²pointer may in some examples be turned on and off through switches² provided at the power source or at the cable without the need for the²practitioner to use a hand each time that he needs the laser pointer. ²Moreover, he or she may thus use the laser with better precision than if ²having to ask someone else to do so.²In addition, conventional laser pointers are unsterile, so that precautions ²must²be taken in order to avoid contamination of the surgical field. In the ²examples ²of the present disclosure, the laser pointer is part of an assisting device ²that ²may be orderly sterilized and thus be treated as any other medical ²instrumentation. In particular, such a feature is an advantage in the medical² practice, since it may lower the risk for contamination of the surgical area,²and as a consequence of undesired complications during the patient's ²treatment.²In examples, the rear side of the base may comprise a printed circuit board² which acts as a control system for the device.²The light sources according to examples of the present disclosure may be, ²e.g., a light emitting diode (LED), a fiber-optic light, incandescent light ²bulbs ²or other. The light source may be shaped and / or oriented to promote² projection of light toward the area where the blade 24 is being used. As for²the choice of one type of light source or the other, a choice may be made in ²accordance with circumstances balancing e.g. energy consumption, light ²output, colour temperature and light source life (including lumen ²maintenance).² LEDs offer advantages for the surgical environment such as bright and highly ²uniform illumination. Its superior thermal management enables both high ²intensity light output and a long life (they yield a durability of e.g. 50,000 ²²hours of LED headlight versus 3,000 to 7,000 hours of a fiber-optic²headlight). Another advantage is the low replacement cost of single LED²lamps. Fiber-optic light, instead, has the features of being a thin and ²flexible²<DP=17>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²17²material, which may be an advantage for certain applications. These are the ²most common light sources for medical applications in the market nowadays, ²due to their well-suited technical features. However, other light sources ²might ²be considered for being implemented in the device or kit, depending on the² user's requirements and / or limitations.²If fibre optic light is used, an additional fibre optic cable may be provided ²from ²the base to a light source. In examples, wherein only fibre optic light is ²provided (i.e. no laser pointer of further auxiliary device), no power supply²would be needed on the base.²In the example of figure 1, the kit / device 30 comprises a base 32 and an ²appendage 39 removably fixed to the base 32. The base 32 in this example ²has two dovetail slots 38 which are diametrically opposite to each other. The² appendage 39 has a suitable protrusion 37 with a shape complementary to²the slot 38 to be slidably fitted in the slot 38. In this example, two ²appendages ²may be fitted to the base 32 at the same time.²In examples, the protrusion may be slightly larger than the slot such that a²friction fit is established. A friction fit is one of the ways in which it may ²be²ensured that the appendage does not move in an undesirable manner with ²respect to base 32.²Each of the appendages has a through-hole which serves as a receptacle for²receiving an auxiliary medical tool. In this case, the "primary" medical tool ²is²the electrical scalpel. The auxiliary medical tool may be any tool which may ²be used during an open surgery in combination with the electrical scalpel. ²Examples include:²- a video or photo camera,² - a laser pointer (for pinpointing tissue. A laser might in examples be²integrated in the base. In other examples, it is an auxiliary device fitted ²in the appendage),²- sensors comprising thermometers, flow meters or the like. The sensors ²may be arranged at any suitable location in the base. A suitable²position for placing sensors such as thermometers or flow meters²would be on the side of the base which more easily can be in contact²<DP=18>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²18²with the body tissue. An infrared radiation sensor may be used for ²determining temperature differences between tissues which may ²indicate vascularization. A flow meter may be based on ultrasound ²technology. The (ultrasonic) flow meter specifically in an² implementation on an electrical scalpel may serve to locate blood²vessels. A further or alternative sensor that may be incorporated in the ²device for the same purpose is a spectrophotometer.²- an irrigator (in case of electrocoagulation),²- a radioactive probe (e.g. when dissecting a tumour), or²- a liquid / gas aspirator (e.g. for aspirating smoke development when²cutting using the scalpel).²In the latter case, such an aspirator may be combined with a REIMS ²spectrometer to immediately analyse the smoke. See figure 6A² In examples, the auxiliary medical device or tool supports and / or enhances ²the functioning of the medical tool on which the device is mounted.²Figures 2A and 2B illustrate details which may be incorporated in examples of²the devices (or kits) for assisting in an open surgery. Figure 2A illustrates ²that²the protrusion 37 which is configured to mate with the slot 38 may have one ²or more local protuberance 37a which may fit in complementary local ²recesses 38a along slot 38. The engagement of the protuberance 37A in local ²recess 38A can ensure that the appendage 39 is fitted to the base 32 in the² correct position and stays in that position.²In examples, the engagement of the protrusion 37 into the slot 38 may further ²provide electrical power to provide energy supply to the auxiliary medical ²device being received in the appendage.² Figure 2B illustrates that in examples, the base may have a portion that ²functions as an electrical connector. In the example of figure 2B, a bottom ²portion of the appendage may incorporate conductive stripes 37b. If or when ²the base is provided with electrical power, the same electrical power can be²made available for e.g. an auxiliary device mounted in the appendage.²<DP=19>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²19²In yet further examples, a portion of the appendage may be shaped as an ²electrical plug (or socket) and the base may comprise a complementary ²socket (or plug), again to provide electrical power to an auxiliary medical ²device through the base.²Figures 3A ¨ 30 schematically illustrate different views of a further example ²of ²a device or kit for assisting in an open surgery. Figure 3A illustrates an ²example of a device / kit for assisting in open surgery which has an increased ²length as compared to the example of figure 1. Depending on which handheld² medical tool is used as "primary" surgical tool, the geometry of the base 32²and kit / device 30 may be adapted to fit to the tool. Also in this example, the ²²base 32 tapers outwardly from a distal end to a proximal end.²Figure 3B illustrates that, similarly, the protrusion 37 may taper outwardly² from a distal end 371 to proximal end 372. An aspect of such a tapered²protrusion (and mating slot) is that the correct position of the appendage 39 ²with respect to the base 32 can be ensured.²Again in this example, two appendages can be fitted to base 32. In further² examples, a base may be provided that is configured for only a single²appendage, or for three or more appendages. In still further examples, the ²appendage(s) may be integrally formed with the base. See figures 7A ¨ 8B.²Figures 4A and 4B schematically illustrate a further example of a kit / device² for assisting in an open surgery with different handheld medical devices and²auxiliary medical tools. In figure 4A, the kit / device 30 is fitted to an ²ultrasonic ²scalpel 40.²Figure 4B serves to illustrate that complementary to the LEDs 3, an additional²illumination device 50, e.g. an incandescent light bulb may be temporarily²positioned in appendage 39 when increased illumination is required. The ²further illumination device in this case thus acts as the auxiliary medical ²tool.²Figures 5A - 50 schematically illustrate three further auxiliary medical ²devices²which may be used with examples of the kits / devices for assisting in an open²surgery. Particularly figure 5A shows a laser pointer 60. In particular, an²<DP=20>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960² infrared laser or green laser pointer are used in operating rooms. In the ²examples of the present disclosure, such laser pointers or laser pens may be ²inserted in the receptacle of appendage 39 such that they point towards a ²distal end of the primary medical tool.²5²Figure 5B serves to illustrate that on occasions, it might be preferable to ²have ²light 51 of a different wavelength, e.g. infrared or UV light instead of white ²²light. On such occasions, a suitable LED may simply be inserted in an ²appendage 39 to provide the required illumination. And figure 50 serves to²10 illustrate that on occasions, it might be preferable to have a ²radioactive probe²in order to measure radioactive radiation and thus precisely determine the ²position of cells and tissue affected by cancer.²Figures 6A ¨ 6B show a kit or device according to a different example²15 comprising two appendages 39 and 39. The example shown in figure 6A thus²differs from that of figure 1A in that a second appendage 39' is also ²removably fixed to the base 32 substantially as explained in connection with ²figure 1A. Furthermore, a laser pointer 60 is fitted in the appendage 39 ²substantially as explained in connection with figure 5A. Further in this²20 example, the second appendage 39' is open, i.e. it has a substantially C-²²shaped portion, as clearly shown in figure 6B which shows a partial front view ²²of the kit / device illustrated in figure 6A.²If the portion with the substantially C-shaped cross-section is sufficiently² closed and / or has sufficient resiliency, an auxiliary medical device can be²positioned in the corresponding through-hole. The auxiliary medical device ²may in examples be mounted with a snap-fit.²And the kit / device of figure 6A further differs from that of figure 1A in that ²a²tube 80 aspirating the generated smoke and leading towards a REIMS²spectrometer may also be attached to the base by an elastic strap 81 that is ²connected to the base 32, between the first 39 and second 39' appendages.²Figure 6B illustrates how an elastic band or strap can function as an² appendage. The elastic band can be forced to elongate to create sufficient²space for fitting an auxiliary medical device. The auxiliary medical device in²<DP=21>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²21²this sense is then clamped between the base 32 and the elastic band.²Figure 60 shows that in further alternatives a strap 82 provided with a Velcro-²²type fastener may be foreseen e.g. for attaching the electrical cable to the² shaft 20 of the electrical scalpel. The electrical cable thus will not hinder²movements of the surgeon or of the medical devices.²Figures 7A ¨ 8B show two alternative devices for assisting in an open ²surgery. Figures 7A and 8A show perspective views of this examples and² figures 7B and 8B show exploded view of the same. These examples differ²from the examples above in that an appendage 90 (figure 7), or 91 (figure 8) ²is integrally formed with the substantially cylindrical base 900 and 910.²In both cases the base 900 and 910 comprises a central opening 901 and²911 for receiving a handheld medical tool such as the electrical scalpel of ²the²example of figure 1A. Alternatively, other handheld medical tools in ²particular ²surgical tools may be foreseen.²Further in these examples, an auxiliary through-hole working channel 905,² 915 may be integrally formed with the base 900, 910. Alternatively, the²working channel may comprise a C-shape or U-shape such that it can grip an ²auxiliary medical tool, substantially as explained in connection with figures ²6A ²or 6B.² The example of figures 7A and 7B comprises three LEDs 902 equidistantly²arranged at 120 angles between them around the central opening 901. And ²the example of figures 8A and 8B comprises five LEDs 912 equidistantly²arranged (at 72 angles between them) around the central opening 911.² Figures 7B and 8B further show that these examples are made from three²pieces 90a, 91a; 90b, 91b and 90c, 91c made of e.g. a resilient material. ²Polyamide is one of the materials suitable for this case.²In the example of figure 7B, spaces 904 for accommodating LEDs 902 are² provided between pieces 90a and 90b, and a grooved space 903 for housing²e.g. any required wiring is further defined between pieces 90a and 90b. In the²<DP=22>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²22²example of figure 8B, piece 91a is provided with spaces 913 for ²accommodating the LEDs 912. Furthermore, a grooved space 914 for housing ²required wirings is defined between pieces 91a and 91b.² In this example, the device may be relatively easy manufactured and²assembled. For assembly, the three pieces may be glued together. In these ²examples, the device incorporates base and appendage in a single integrally ²formed body, but in other examples may be separate elements to be ²assembled just prior or during surgery.² In these examples, a power cable (not shown) for connecting to a power ²source may further be attached to e.g. a rear side of respectively pieces 90a ²or 91a so as to supply power to the LEDs. In some cases a laser pointer may ²be integrated in the base 900, 910 such that it points towards a distal end of ²a²primary medical tool that may be placed around the central opening 901, 911.²The laser pointer may be arranged e.g. replacing one of the LEDs or in ²between LEDs substantially as explained in connection with figure 1.²In any of the examples disclosed herein, different types of light may be used.² In some implementations, white light may be preferred.²In some examples, a device or kit substantially as hereinbefore described ²mounted or mountable on a medical tool may include illumination systems ²configured to emit light in different ranges of wavelength. In some examples,² the wavelength of an illumination system may be varied in use.²In any of the hereinbefore described examples, the cable 10 providing ²electrical power to the kit / device 30 may comprise a fastener for attachment ²of the cable to the shaft 20 of the electrical scalpel. Suitable fasteners²include: a mounting clip, adhesives, clamps, cable ties, or Velcro TM ²fasteners,²to mention some possibilities. In some examples, a mounting clip may be ²attached to the shaft through a snap-on connection. The mounting clip can ²also have an opening to receive the cable or connection to the power source. ²The clip may be positioned at a variety of places on the shaft 20. A clip² according to this example could be attached to the shaft 20 by, e.g., sliding²the clip onto the shaft. Analogously, the clip may be easily removed from the²<DP=23>²CA 02990513 2017-12-21²WO 2017 / 001379 PCT / EP2016 / 064960²23²shaft by sliding it off the shaft. A plurality of mounting clips may be used, ²depending on the length and geometry of the medical tool.²In any of the hereinbefore described examples, the device may have a timer² linked to the lighting system provided. The device may be programmed to²automatically turn off the light(s) and / or automatically disconnect electrical ²²power after a predetermined period of time.²Although only a number of examples have been disclosed herein, other² alternatives, modifications, uses and / or equivalents thereof are possible.²Furthermore, all possible combinations of the described examples are also ²covered. Thus, the scope of the present disclosure should not be limited by ²particular examples, but should be determined only by a fair reading of the ²claims that follow.²

Claims

<DP=1>²24²CLAIMS²1. A kit for assisting in an open surgery, comprising:²a base configured to be mounted on a portion of a handheld medical ²tool; and²an appendage configured to be removably fixed to the base and ²having a receptacle configured to receive an auxiliary medical device.²2. A kit according to claim 1, wherein the receptacle is a through-hole.²3. A kit according to claim 1 or 2, comprising²a first appendage configured to be removably fixed to the base and ²having a first receptacle configured to receive a first auxiliary medical ²device, ²and²a second appendage configured to be removably fixed to the base and ²having a second receptacle configured to receive a second auxiliary medical ²device,²wherein the first receptacle is of a different size or shape than the ²second receptacle.²4. A kit according to any of claims 1 - 3, the base comprises a first ²fastening element, and the appendages comprise a second fastening ²element, wherein the first and second fastening element are configured to ²mate.²5. A kit according to claim 4, wherein the base comprises a single ²fastening element for coupling with either the first or the second appendage.²6. A kit according to claim 5, wherein the base comprises a first and a ²second fastening element for coupling with the first and the second²<DP=2>² 25²appendage simultaneously.²7. A kit according to any of claims 1 - 6, wherein the base comprises one ²or more illumination devices such that when the base is attached to the ²handheld medical tool, the illumination devices are directed towards a distal ²end of the handheld medical tool.²8. A kit according to any of claims 1 ¨ 7, further comprising one or more ²auxiliary medical devices configured to be fitted in the receptacle of the ²appendage.²9. A kit according to claim 8, wherein the auxiliary medical device is ²selected from the group consisting of a surgical aspirator or smoke / liquid ²evacuator, a laser pointer, a handheld ultrasound system, an irrigator for ²electrocoagulation, a further illuminating device, a radioactive probe, a ²camera or a sensor.²10. A kit according to any of claims 1 ¨ 9, further comprising the handheld ²²medical tool to which the base can be mounted.²11. A kit according to claim 10, wherein the handheld medical tool is ²selected from the group consisting of an electrical scalpel, a radiofrequency ²knife, a surgical clamp, a sealant or a cautery.²12. A kit according to any of claims 1 - 11, wherein the appendage has a ²substantially C-shaped or U-shaped portion.²13. A kit according to any of claims 1 - 12, wherein the appendage is or ²comprises an antiskid strap attached to the base and defining the receptacle ²for the further auxiliary medical tool.²14. A device for assisting in an open surgery, comprising:²<DP=3>²26²a base configured to be mounted on a portion of a handheld medical ²tool;²an illumination device mounted on the base such that when the base is ²attached to the handheld medical tool, the illumination device is directed ²towards a distal end of the handheld medical tool; and²an appendage to the base having a receptacle configured to receive ²an auxiliary medical device.²15. The device according to claim 14, wherein the receptacle is a through-²hole.²16. A device according to claim 15, wherein the appendage comprises a ²tubular or annular portion defining the through-hole.²17. A device according to any of claims 14 - 16, wherein the appendage ²has a substantially C-shaped or U-shaped portion defining the receptacle.²18. A device according to any of claims 14 ¨ 17, wherein the appendage is ²or comprises a strap defining the receptacle.²19. A device according to any of claims 14 - 18, wherein the appendage is ²made of a resilient material, such that the auxiliary medical device can be ²received with a friction fit.²20. A device according to any of claims 14 ¨ 19, wherein the appendage is ²integrally formed with the base.²21. A device according to any of claims 14 ¨ 19, wherein the appendage is ²removably fixed to the base.²22. A device according to claim 21, wherein one of the base and the²<DP=4>²27²appendage comprises a slot and²the other of the appendage and the base comprises a protrusion with a ²shape complementary to the slot.²23. A device according to claim 22, wherein the protrusion and the slot ²extend along a longitudinal axis, and the protrusion projecting ²perpendicularly ²to the longitudinal axis, and the slot comprises a recess complementary to the ²²protrusion.²24. A device according to any of claims 14 ¨ 23, comprising a first ²appendage and a second appendage, the first appendage having a ²receptacle configured to receive a first auxiliary medical device, and the ²second appendage having a receptacle configured to receive a second ²auxiliary medical device.²25. The device according to claim 24, wherein the first appendage and ²second appendage are arranged in diametrically opposite positions of the ²base.²26. The device according to claim 24, wherein the appendage comprises ²an antiskid strap attached to the base for housing an auxiliary medical tool, ²and optionally the antiskid strap extending from the first appendage to the ²second appendage.²27. A device according to any of claims 14 - 26, wherein the base ²comprises a ring or diaphragm having a central opening for being mounted ²around a portion of the handheld medical tool.²28. A device according to claim 27, wherein the ring or diaphragm is made ²of a relatively flexible material surrounding the central opening, optionally ²rubber or a silicone gel, or a combination thereof.²<DP=5>²28²29. A device according to any of claims 14 - 28, wherein the base ²comprises a hinge between a first half and a second half of the base, and ²wherein a biasing element forces the first and second half to contact each ²other, and wherein the biasing element optionally is a spring.²30. The device according to any of claims 14 ¨ 29, wherein the handheld ²medical tool is selected from the group consisting of an electrical scalpel, ²an ²ultrasonic scalpel, a radiofrequency knife, a surgical clamp, a sealant or a ²cautery.²31. The device according to any of claims 14 - 30, wherein the auxiliary ²medical tool is selected from the group consisting of a surgical aspirator or ²smoke / liquid evacuator, a laser pointer, a handheld ultrasound system, an ²irrigator for electrocoagulation, a further illuminating device, a radioactive ²²probe, a camera or a sensor.²32. A device according to any of claims 14 ¨ 31, further comprising a ²power supply.²33. A device according to claim 32, wherein the base comprises the power ²supply.²34. A device according to claim 32 or 33, wherein the power supply is a ²battery.²35. A device according to claim 33 or 34, wherein the power supply is an ²electrical cable configured to be connected to a power source.²36. A device according to claim 35, wherein the electrical cable comprises ²a plurality of fasteners for attaching to the handheld medical tool.²<DP=6>²29²37. A device according to claim 36, wherein the fasteners comprise ²clamps.²38. A device according to claim 37, wherein the fasteners comprise at least ²²a first clamp configured to be clamped around a portion of the medical tool ²near a proximal end of the tool.²39. A device according to claim 35, wherein the medical tool comprises a ²plurality of fasteners for attaching the electrical cable to the medical tool.²40. A device according to claim 39, wherein the fasteners comprise one or ²more eyelets on the medical tool to guide the electrical cable.²41. A device according to any of claims 14 - 40, wherein the base ²comprises two or more illumination devices.²42. The device according to any of claims 14 ¨ 41, wherein the illumination ²devices are LEDs or fiber optic lights.²43. A method for replacing a first auxiliary medical tool mounted in a ²receptacle of an appendage of a device for assisting in open surgery, when a ²base of the device is mounted on a portion of a handheld medical tool, ²wherein the method comprises²providing the handheld medical tool together with the appendage ²supporting the first auxiliary medical device in a surgery position;²retracting the handheld medical tool from the surgery position; ²removing the first auxiliary medical tool;²mounting a second auxiliary medical tool on the device for assisting in ²open surgery;²positioning the handheld medical tool in the surgery position,²wherein the method is carried out during an open surgery.²44. The method according to claim 43, wherein removing the first auxiliary²<DP=7>²30²medical tool comprises removing the appendage from the device for assisting ²in open surgery.²45. The ²method according to claim 44, wherein mounting the second²auxiliary medical tool on the device for assisting in open surgery comprises ²attaching a second appendage to the device for assisting in open surgery.²46. A method for changing an auxiliary medical tool mounted in a receptacle ²of an appendage of a device for assisting in open surgery, when a base of the ²device is mounted on a portion of a first handheld medical tool, wherein the ²method comprises²providing the first handheld medical tool together with the appendage ²supporting the first auxiliary medical device in a surgery position;²retracting the first handheld medical tool from the surgery position; ²removing the device for assisting in open surgery from the first ²handheld medical tool;²providing a second handheld medical tool;²mounting the device for assisting in open surgery on the second ²handheld medical tool;²and positioning the second handheld medical tool in the surgery ²position,²wherein the method is carried out during an open surgery.²47. The method according to claim 46, wherein mounting the device for ²assisting in open surgery on the second handheld medical tool comprises ²mounting the device with the same auxiliary medical tool on the second ²handheld medical tool.²48. The method according to claim 46, wherein mounting the device for ²assisting in open surgery on the second handheld medical tool comprises ²mounting the device with a different auxiliary medical tool on the second²<DP=8>²31²handheld medical tool.²