Surgical instrument

Abstract

A surgical instrument (10) for penetration into a human or animal body, the instrument (10) comprising an inner part (11) movably arranged within a needle-like outer part (12), wherein the outer part (12) is connected to the inner part (11) by a spring (13) in order to exert a load on the inner part (11) together with the outer part (12) during use, wherein the outer part (12) is provided with a proximal sleeve (14) which provides a finger grip for the surgeon, wherein the sleeve (14) can be releasably connected to the outer part (12) and the instrument (10) is provided with a release mechanism (17) for releasing the sleeve (14) from the outer part (12), which release mechanism (17) can be actuated by a movement of the inner part (11).

Description

[0001] The present invention relates to a surgical instrument for insertion into a human or animal body, the instrument comprising an inner portion disposed in a movable manner within a needle-like outer portion, wherein the outer portion is connected to the inner portion by a spring to apply a load on the inner portion together with the outer portion during use, wherein the outer portion is provided with a proximal sleeve that provides a finger gripping portion for the surgeon.

[0002] A typical example of this surgical instrument is the veress needle, referred to below as a VN. The VN is known to be used to obtain an initial access to the patient's peritoneal cavity to establish pneumoperitoneum. The use of the VN involves blind insertion into the patient's peritoneal cavity.

[0003] The use of the trocar (VN) is popular due to its simplicity and effectiveness. The procedure involves making a small incision at or near the navel or in the upper left quadrant of the abdomen, then blindly inserting a needle through the subcutaneous tissue, abdominal wall, and parietal peritoneum into the abdominal cavity. The VN technique is based on the ability of its blunt inner core needle to spring forward (as it is spring-loaded), and the sharp, angled tip of the outer cannula covering the needle as resistance decreases after passing through all tissue layers. However, surgeons cannot rely entirely on this mechanism and therefore need to develop a feel for the appropriate insertion angle and force to successfully puncture the abdominal wall without over-penetrating the underlying organs. The risk of the cannula tip damaging the underlying tissue increases when the reaction force generated by the abdominal wall (within the abdominal cavity) drops instantaneously to almost zero. Due to the slow reaction of the human control system, the lack of rigid forearm / hand support, and the relatively large mass of the surgeon's arm, the immediate loss of resistance at the tip of the VN after puncture causes the needle to accelerate toward the underlying tissue. Therefore, skillful and safe use of the VN requires a long learning curve to achieve optimal instrument handling and prevent over-rush. Furthermore, each patient's abdomen presents unique surgical conditions that surgeons are unaware of before surgery. These factors include the presence of adhesions, the location of underlying tissues and internal organs, and the thickness of the abdominal wall.

[0004] In the existing technology, there are different suggestions for solving the above-mentioned overshoot problem.

[0005] US2015 / 0265777 discloses an instrument in which a surgeon sets a maximum insertion depth. Unfortunately, the thickness of the tissue layers is not always known, and these layers are flexible, making adjustment of the insertion depth difficult.

[0006] US 5,364,365 allow overshoot, but lock the pneumoperitoneum mechanism in place once it is launched. However, it appears possible that even a blunt probe with a locking outer sleeve could easily damage the internal structure.

[0007] The article by Nevler, A., Har-Zahav, G., Rosin, D., and Gutman, M. (2016): Safer trocar insertion for closed laparoscopic access: ex vivo assessment of an improved veress needle. Surgical endoscopy, 30(2), 779-782. The Theia Soteria: Alternative Design for Safer Initial Entry During Laparoscopic Procedures (2019) focuses on directly enlarging the blunt area of ​​the tip after insertion to reduce stress when the tip impacts the underlying organ or structure.

[0008] The article by Schaufler, A, Sühn, T, Esmaeili, N, Boese, A, Wex, C, Croner, R… and Illanes, A (2019): Forcematic differentiation between Veress needle events in laparoscopic access using proximally attached audio signal characterization. Current Directions in Biomedical Engineering, 5(1), 369-371, by Schaller, G, Kuenkel, M and Manegold, BC (1995). The optical "Veress-needle"—initial puncture with a minioptic. Endoscopic surgery and allied technologies, 3(1), 55-57, reported the possibility of obtaining information about in vivo tissue tool interactions at the tip of a VN by using acoustic emission or optical information recorded at the external end of the needle.

[0009] Greenberg, JA (2008). LapCap TM An article in *Reviews in Obstetrics and Gynecology*, 1(2), 84, teaches the creation of a vacuum cup around the ventricular nucleus (VN). As air is aspirated from the cup, the abdominal wall is lifted away from critical structures as the VN penetrates the tissue. A drawback here is that the surgeon loses operational flexibility due to the fixed configuration of the needle.

[0010] Finally, overshoot can be prevented by introducing a faster control system. This can be achieved by attaching a tactile robotic arm to the body of the VN that generates the driving force, as suggested by Nillahoot, N and Suthakorn, J. (December 2013). In their presentation at the 2013 IEEE International Conference on Robotics and Biomimetics (ROBIO) (pp. 645-650), titled "Development of Veress Needle Insertion Robotic System and its Experimental Study for Force Acquisition in Soft Tissue Veress," they suggested this approach.

[0011] While some proposals have shown interesting results, the complexity of the proposed systems and their impact on workflow jeopardize wider acceptance. Therefore, the object of the present invention is to provide a surgical instrument that avoids the complexity of known solutions and minimizes disruption to the surgeon's operation, thereby approximating existing surgical practices.

[0012] According to the present invention, a surgical instrument is provided according to one or more of the appended claims. It should be noted that although the foregoing discussion focuses on applications of the VN, the preamble as described above indicates that the invention has a broader range of applications and relates to any surgical instrument for insertion into the human or animal body, wherein the instrument comprises an inner portion movably disposed within a needle-like outer portion, wherein the outer portion is spring-connected to the inner portion to apply load on the inner portion together with the outer portion during use, and wherein the outer portion is provided with a proximal sleeve that provides a gripping portion for the surgeon's fingers. Examples include, for instance, the direct insertion of a sharp cannula during laparoscopic surgery, and emergency or selective surgical airways in chest tube thoracostomy.

[0013] US2013 / 0310750 discloses an apparatus having the features of the preamble of claim 1, wherein the sleeve is releasably connected to an external portion, and the apparatus is provided with a release mechanism for releasing the sleeve from the external portion, the release mechanism being actuated by movement of the internal portion.

[0014] In the device of the present invention, the outer portion is provided with a proximal ring or edge, and the sleeve is provided with a movable hook for hooking behind the ring or edge, thereby providing a connection between the outer portion and the sleeve, wherein a release mechanism can be operated on the hook to remove the hook from its position behind the ring or edge. This results in the sudden drop in resistance upon insertion and the subsequent immediate forward movement of the spring-loaded inner portion when the surgeon or robot uses the sleeve to push the outer portion into and insert it into the patient's peritoneal cavity, having the effect that the inner portion activates the release mechanism, which then counteracts the driving force applied to the sleeve by the surgeon or robot due to its release from the outer portion.

[0015] Suitablely, the release mechanism is mounted near the end of the inner portion and arranged to operate on the hook of the sleeve as the inner portion moves toward the sleeve, so as to release the sleeve from the outer portion.

[0016] When the release mechanism includes an inclined first contact surface, the surgical instrument of the present invention can be constructed to operate effectively and still be provided at a limited cost, the inclined first contact surface being adapted to a corresponding inclined second contact surface disposed on the hook.

[0017] Preferably, the hook is elastically mounted on the sleeve, such that when the inclined first contact surface of the release mechanism strikes the second contact surface disposed on the hook, the hook is displaced from its position behind the ring or edge of the outer portion.

[0018] Suitable, the release mechanism includes a lever arm mounted near the proximal end of the internal portion.

[0019] Optionally, the proximal sleeve of the instrument is provided with an extension including either a breathing tube or a cannula. This relates to using the surgical instrument of the present invention to intubate the trachea or the abdominal wall using a cannula, respectively.

[0020] The invention will be further described below with reference to the accompanying drawings of exemplary embodiments of the surgical instruments according to the invention, which do not limit the scope of the appended claims.

[0021] In the attached diagram:

[0022] - Figure 1 A pneumoperitoneum needle according to the prior art is shown;

[0023] - Figure 2 The pneumoperitoneum needle according to the present invention is shown;

[0024] Figure 3 shows Figure 2 Details of the proximal portion of the pneumoperitoneum needle shown; and

[0025] - Figure 4 and Figure 5 The applications of the surgical instruments of the present invention are shown respectively for intubation of the trachea or the abdominal wall using a cannula.

[0026] Whenever the same reference numerals are used in a figure, these reference numerals indicate the same or similar parts.

[0027] The pneumoperitoneum needle shown in the attached diagram is used for insertion into the human or animal body. Figure 1 and Figure 2 As shown, devices 1 and 10 include internal portions 2 and 11, which are movably arranged within needle-shaped external portions 3 and 12, wherein the external portions 3 and 12 are connected to the internal portions 2 and 11 by springs. In prior art devices 1, springs are depicted by reference numeral 4. Detail A of the proximal portion of the device 10 of the present invention shown in Figure 3 illustrates the spring depicted by reference numeral 13.

[0028] In both the prior art device 1 and the present invention device 10, a spring is used to apply a load to the internal portions 2 and 11 together with the outer portions 3 and 12 during use. Relatedly, the outer portions 3 and 12 are provided with proximal sleeves 5 and 14, which provide a gripping portion for the surgeon's fingers. So far, although the construction of the proximal sleeve 5 of device 1 differs from that of the proximal sleeve 14 of device 10, the prior art device 1 and the present invention device 10 have corresponding features.

[0029] The difference between the device 10 of the present invention and the prior art is that the sleeve 14 can be releasably connected to the outer portion 12, and the device 10 is provided with a release mechanism for releasing the sleeve 14 from the outer portion 12, which can be actuated by movement of the inner portion 11. Preferred embodiments can be further explained with reference to the details of the device of the present invention depicted in FIG3.

[0030] As shown in Figure 3, the outer portion 12 is provided with a proximal ring or edge 15, and the sleeve 14 is provided with a repositionable hook 16 for hooking behind the ring or edge 15, thereby providing a connection between the outer portion 12 and the sleeve 14. A release mechanism 17, including a lever arm mounted near the proximal end of the inner portion 11, can then be operated on the hook 16 to remove the mechanism 16 from its position behind the ring or edge 15, as described below.

[0031] A release mechanism 17 is mounted near the proximal end of the inner portion 11 and is arranged to operate on the hook 16 of the sleeve 14 as the inner portion 11 moves toward the sleeve 14 to release the sleeve 14 from the outer portion 12. Preferably, the release mechanism 17 includes an inclined first contact surface 18 adapted to a correspondingly inclined second contact surface 19 disposed on the hook 16. The hook 16 is elastically mounted on the sleeve 14 by means of an elastic support 20, such that when the inclined first contact surface 18 of the release mechanism 17 strikes the second contact surface 19 disposed on the hook 16, the hook 16 can be displaced from its position behind the ring or edge 15 of the outer portion 12.

[0032] Now turn to Figure 4 The surgical instrument of the present invention is shown, wherein the proximal sleeve 14 is provided with an extension in the form of a breathing tube 18'. This configuration is used for tracheal intubation. After puncture, all parts of the instrument 10 except for the sleeve 14 with the breathing tube 18' are ejected rearward and can be removed from the surgical site. The proximal sleeve 14 is then removed from the breathing tube 18, which remains in place for breathing.

[0033] Figure 5 Another application for using a trocar to puncture the abdominal wall is shown. After the puncture, all parts of the instrument 10 except for the sleeve 14 having an extension implemented as a trocar tube 18” are ejected posteriorly and can be removed from the surgical site. The proximal sleeve 14 is then removed from the trocar tube 18”, which remains in place for guiding the instrument into the abdominal cavity.

[0034] Although the invention has been discussed above with reference to exemplary embodiments of the surgical instruments thereof, the invention is not limited to these particular embodiments, which can be varied in many ways without departing from the invention. Therefore, the exemplary embodiments discussed should not be used to interpret the appended claims strictly according to the discussed exemplary embodiments. Rather, the embodiments are intended only to interpret the wording of the appended claims and not to limit the claims to these exemplary embodiments. Therefore, the scope of protection of the invention should be interpreted only according to the appended claims, wherein any possible ambiguities in the wording of the claims should be resolved using the exemplary embodiments.

Claims

1. A surgical instrument (10) for insertion into a human or animal body, said instrument (10) comprising an inner portion (11) movably disposed within a needle-like outer portion (12), wherein, The outer portion (12) is connected to the inner portion (11) by a spring (13) so as to apply loads on the inner portion (11) together with the outer portion (12) during use. The outer portion (12) is provided with a proximal sleeve (14) that provides a finger gripping portion, typically for surgeons. The sleeve (14) is releasable to the outer portion (12), and the instrument (10) is provided with a release mechanism (17) for releasing the sleeve (14) from the outer portion (12). The release mechanism (17) is actuated by movement of the inner portion (11), characterized in that the outer portion (12) is provided with a proximal ring or edge (15), and the sleeve (14) is provided with a displaceable hook (16) for hooking behind the ring or edge (15), thereby providing a connection between the outer portion (12) and the sleeve (14), wherein the release mechanism (17) is operable on the hook (16) to remove the hook (16) from a position where the hook (16) is located behind the ring or edge (15).

2. The surgical instrument according to claim 1, characterized in that, The release mechanism (17) is mounted on the proximal end of the inner portion (11) and is arranged to operate on the hook (16) of the sleeve (14) when the inner portion (11) moves toward the sleeve (14) to release the sleeve (14) from the outer portion (12).

3. The surgical instrument according to claim 1 or 2, characterized in that, The release mechanism (17) includes an inclined first contact surface (18) adapted to a correspondingly inclined second contact surface (19) disposed on the hook (16).

4. The surgical instrument according to claim 3, characterized in that, The hook (16) is elastically mounted on the sleeve (14) so ​​that when the inclined first contact surface (18) of the release mechanism (17) strikes the second contact surface (19) disposed on the hook (16), the hook (16) is displaced from a position behind the ring or edge (15) of the outer portion (12).

5. The surgical instrument according to any one of claims 1 to 4, characterized in that, The release mechanism (17) includes a lever arm mounted on the proximal end of the internal portion (11).

6. The surgical instrument according to any one of claims 1 to 5, characterized in that, The proximal sleeve (14) is provided with an extension including either a breathing tube (18') or a cannula (18”).

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