Robotic Surgery Applicator

Abstract

The present disclosure relates to a laparoscopic applicator for dispensing a substance, such as a substance including a hemostatic agent, to a selected site by a surgical robotic arm, the laparoscopic applicator comprising a delivery tube configured to hold the substance under pressure, and an applicator tip connected to a distal end of the delivery tube, the applicator tip configured to be spatially steered by the robotic arm and controllably manipulated by the robotic arm by controllably releasing the substance from the delivery tube by the robotic arm.

Description

[Technical field]

[0001] The present disclosure relates to applicators, and more particularly to laparoscopic applicators for dispensing medical substances or fluids to a selected site by a surgical robotic arm. The present invention further relates to laparoscopic applicator tips for laparoscopic applicators, kits of parts including said applicator tips and / or applicators. [Background technology]

[0002] Robotic systems are increasingly being used in surgery, especially in minimally invasive surgical procedures, to avoid the more invasive traditional open surgical techniques. Robotic systems include several robotic arms to which medical devices are attached, and the robotic arms and medical devices are controlled and steered by the surgeon from a console via controls such as joysticks and foot pedals. Thus, the robotic arms replace the surgeon's hands at the surgical site, and the surgeon is instead located remotely from the patient and views the surgical site via a display showing a three-dimensional view of the surgical site.

[0003] Similar to traditional open surgery techniques where an assistant provides the necessary medical devices to the physically present surgeon, in robotic surgery, an assistant is positioned near the robotic arm and provides the necessary medical devices to the arm. For example, the assistant can replace medical devices on the robotic arm and provide medical fluids either directly to the robotic arm as medical devices or via applicator tubes introduced into the body through trocar ports.

[0004] Surgical hemostatic agents and other medical fluids and pastes are traditionally dispensed to a target site by using a manually operated syringe containing the paste within the syringe barrel. However, for minimally invasive surgical procedures, the target site cannot be directly accessed with a syringe cannula. Thus, to dispense the paste to a target site within a body cavity, an elongated applicator tube pre-filled with the paste is typically introduced into the body through a trocar port. The insertion of the elongated applicator tube is performed at the trocar port and is therefore not visible to the surgeon performing the minimally invasive surgical procedure, as the surgeon's field of view is limited to a display showing the internal target site in high resolution. Thus, the insertion of the applicator tube and the dispensing of the paste from the applicator tube are typically performed by a surgeon's assistant upon the surgeon's verbal command. As a result, the dispensing of the paste using currently available systems is not directly controlled by the surgeon.

[0005] U.S. Pat. No. 9,636,177 discloses a robotic arm that is fitted with a hemostatic applicator comprising a catheter and syringe filled with a hemostatic agent, and when the surgeon presses a button that activates the syringe plunger, the hemostatic agent is expelled from the catheter to the surgical site.

[0006] US Patent Publication No. 2012 / 0289894 discloses an aspiration / irrigation device for laparoscopic surgery with a tip that can be grasped by a robotic tool. The liquid / vacuum supply to the device is delivered from a remotely located valve unit that includes a valve located outside and away from the surgical field. The device is thus adapted for irrigation with free-flowing fluids, such as liquids and gases, from a remote source.

[0007] EP 1915950 discloses an adhesive applier in which the distal applicator tip can be moved via a cable extending to a proximal hand handle. Similarly, U.S. Patent Application Publication No. 2009 / 171332 discloses a distal applicator tip that can be moved by a cable.

[0008] To further improve robotic-assisted surgery, a medical device adapted to be controlled by a robotic arm and thus directly by the surgeon is desirable. In particular, a device is needed that can be controlled by a robotic arm with greater precision, accuracy, and intuitive tactile control, so that the replicated remote control of the robotic arm more highly simulates the surgeon's interaction. Furthermore, it is desirable to have a medical device that provides feedback to the surgeon, for example regarding the amount of paste available in an elongated applicator tube. Summary of the Invention

[0009] The present disclosure relates to an applicator particularly suitable for robotic assisted surgery. In particular, the present disclosure provides an applicator suitable for insertion into a trocar port and having an applicator tip, the orientation and / or activity of the applicator being actuated via the distal end or applicator tip of the inserted applicator. The applicator can thus be steered and actuated via the applicator tip and is therefore particularly suitable for being steered and actuated by a robotic arm interacting with the distal end / tip of the applicator, e.g., in the abdominal cavity during a medical procedure at a surgical site, e.g., the applicator is configured for intraperitoneal delivery of a medical substance. The medical substance may be a medical fluid, a medical paste and / or a medical powder.

[0010] Replacing the movements of an actual human hand with a robotic arm controlled by computer software facilitates very precise and controlled movements. Thus, a laparoscopic applicator spatially steered by a robotic arm can be controlled with greater precision and accuracy, as well as with greater reliability, reducing the risk of accidental movements that are important during surgery. Thus, for example, a laparoscopic applicator for dispensing a medical substance by a robotic arm can dispense the substance at a selected site with greater precision and reliability. In particular, a robotically steered applicator for dispensing a hemostatic substance at a selected site can more efficiently stop bleeding.

[0011] Because the robotic arms and fingers themselves have limited tactile feedback and design compared to the human hand, the means for steering and actuating the distal end / tip of the applicator can preferably be adapted to the robotic arms / fingers to increase the safety, accuracy and reliability of the applicator.

[0012] Applicator and applicator tip Thus, the present disclosure generally relates to applicators whose orientation and / or activity can be precisely and reliably controlled by a robotic arm with limited design and haptic feedback. In particular, the present disclosure generally relates to applicators having an applicator tip configured to be controllably manipulated by a robotic arm such that only the tip is accessible to and needs to be visible from the robotic arm.

[0013] A first aspect of the present disclosure relates to a laparoscopic applicator for dispensing or withdrawing a substance, such as a substance including a hemostatic agent, at a site selected by a surgical robotic arm, the laparoscopic applicator comprising: a delivery tube for holding the substance; spatially navigated by a robotic arm; and / or Controllably releasing the substance from the delivery tube by the robotic arm or controllably drawing the substance from the selected site into the delivery tube. an applicator tip connected to a distal end of the delivery tube; Equipped with.

[0014] Preferably, the applicator tip is configured to be controllably manipulated by a robotic arm by having the tip be spatially maneuvered by the robotic arm and / or by having the tip be configured to eject / withdraw substance by the robotic arm.

[0015] The spatial evacuation of the material is determined primarily by the orientation of the distal end of the delivery tube and / or the orientation of the applicator tip. The flexibility of the orientation of the distal end / applicator tip can be obtained by a partially deformable applicator, for example at least a part of the delivery tube being stretchable and / or flexible. Thus, the delivery tube can comprise a deformable portion. The distal end of the tube / applicator tip is preferably steered by a robotic arm during laparoscopic surgery so that the surgeon can orient and position the distal end / tip by use of the robotic arm. To reduce the risk that the robotic arm will crush, break or kink the applicator during steering, the applicator can comprise a surface area adapted for safe interaction with the robotic arm. For example, the applicator can comprise a rigid portion that is less likely to deform and therefore particularly tangible and adapted for safe steering by the robotic arm. The rigid portion may be provided on the delivery tube and / or on the applicator tip.

[0016] The release of the substance is preferably controlled by a robotic arm in-situ during laparoscopic surgery. Thus, the applicator may include at least one actuator adapted for safe interaction with the robotic arm, such as an actuator configured to be actuated by a specific pressure level and / or a specific pressure orientation applicable via the robotic arm. Alternatively, the actuator may be actuated by pulling or rotating the actuator.

[0017] Preferably, the delivery tube of the applicator is configured to hold the substance under pressure, or at least to hold the substance pressurized just prior to the substance being expelled. This can provide a more precise and reliable expulsion of the substance at a determined site and at a determined time, for example this has the advantage that the substance can be released from the delivery tube by simple interaction with the applicator tip without a significant time delay.

[0018] Accordingly, a related aspect of the present disclosure relates to a laparoscopic applicator for dispensing or withdrawing a substance, such as a substance including a hemostatic agent, at a site selected by a surgical robotic arm, the laparoscopic applicator comprising: a delivery tube configured to hold the substance under pressure; an applicator tip connected to a distal end of the delivery tube, the applicator tip configured to controllably expel the substance from the delivery tube by a robotic arm; Equipped with.

[0019] Thus, depending on the form of the substance to be pressurized, the distal end of the delivery tube may include one or more flow control elements, such as a valve adapted to allow the substance to be contained within the delivery tube and pressurized. Alternatively or additionally, the delivery tube may be dimensioned such that the substance may be pressurized due to capillary forces present. Capillary forces may also be defined as the pressure drop that occurs over the length of the delivery tube. Thus, the delivery tube, and in particular the applicator tip, is preferably dimensioned and / or configured to hold the substance under pressure or to hold a pressurized substance and / or to include one or more flow control elements.

[0020] A second aspect of the present disclosure relates to a laparoscopic applicator tip for connection to a laparoscopic delivery tube for holding a substance, such as a substance including a hemostatic agent, the applicator tip comprising: at least one valve configured to release the substance from the delivery tube upon opening of said valve; at least one actuator configured to open / close at least one valve; Equipped with.

[0021] The applicator tip may be removably attached to the distal end of the delivery tube, allowing the tip to be reused when the delivery tube is discarded (possibly including a fluid or pressure source, as further described below). Thus, the delivery tube and / or the applicator tip and / or the fluid source may be configured for disposable / single use. Alternatively, the applicator tip may be an integral part of the delivery tube, such that the delivery tube and the applicator tip are a single unit. In some embodiments, the applicator tip simply refers to the distal end of the delivery tube. The applicator tip may comprise a rigid portion configured to be gripped by a robotic arm. The applicator tip may further comprise an adjustable nozzle for adjusting the dispensing rate and / or dispensing angle of the substance. The applicator tip may further comprise a pressure sensor, such as a resistive pressure sensor, for sensing the pressure applied to the actuator (e.g., by the robotic arm). In this case, the applicator tip preferably further comprises a pressure indicator light for indicating the pressure applied to the at least one actuator.

[0022] Parts Kit An applicator according to the present disclosure may be provided as part of a kit of parts for laparoscopic procedures, particularly as a kit of parts suitable for robotic assisted surgery. Optionally, the applicator may be provided as a separate part of the kit, for example as a delivery tube and an applicator tip, which upon assembly form an applicator according to the first aspect.

[0023] The kit may optionally further comprise one or more substance reservoirs for loading or filling the delivery tube prior to use. For example, the substance reservoir may be a syringe configured to be filled with a substance and configured to form a fluid connection to a delivery tube of the applicator, such as a distal opening of the delivery tube.

[0024] To reduce the number of parts and simplify assembly, a kit of parts can include an applicator and a pressure source configured to be easily assembled and to deliver a substance under pressure upon assembly. For example, the pressure source can be a gas cartridge configured to form a fluid connection to a delivery tube of the applicator, such as a proximal opening of the delivery tube.

[0025] To further simplify assembly, one or more pressure sources can be incorporated into the applicator. For example, a pressure source can be incorporated into the delivery tube in the form of a spring located at the proximal end, with spring energy being pre-stored and / or stored upon loading the delivery tube with the substance.

[0026] A third aspect of the present disclosure relates to a kit of parts comprising an applicator according to the first aspect or an applicator tip according to the second aspect, one or more pressure sources, and optionally one or more substance reservoirs. For example, the substance reservoirs may be one or more syringes configured to be filled with a substance and configured to form a fluid connection to a delivery tube, such as a distal opening of the delivery tube. One embodiment relates to a kit of parts comprising an applicator according to the first aspect, one or more pressure sources, and optionally a syringe configured to be filled with a substance.

[0027] A kit of parts has the advantage that all parts can be manually assembled and operated and all parts are disposable after use and suitable for single use.

[0028] Alternatively, the kit of parts may include parts adapted for multiple uses to obtain a more reproducible and sustainable applicator design. For example, the applicator can be assembled into a reusable unit or holder that may include a pressure source in the form of a reusable piston or motor.

[0029] The kit of parts may further comprise a driver unit for holding the parts, namely the applicator and the pressure source.

[0030] A fourth aspect of the present disclosure is A laparoscopic applicator according to a first aspect; at least one fluid source for holding a fluid in fluid communication with the delivery tube; and / or At least one pressure source, such as a motor, configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube A driver unit to hold the The present invention relates to a kit of parts comprising:

[0031] To further increase the sustainable impact, the driver unit can be replenished with a fluid source. Accordingly, the kit of parts optionally comprises one or more fluid source reservoirs, the fluid source reservoirs configured to be removably attached to a fluid source in the driver unit.

[0032] Pressure Source Expelling a substance, e.g., a medical paste, from the applicator means that the substance held within the tube is forced through the delivery tube to the distal and tip ends where it is expelled and dispensed. The pressure source for pressurizing the substance within the applicator may be any sufficient pressure source in the form of a solid stylus or a fluid that is forced to advance into the tube, e.g., via a manual or motor-driven piston, spring force, and / or trigger.

[0033] To precisely and reliably expel the substance at a determined site and time, the delivery tube or applicator tip is preferably configured to hold the substance under pressure at least just before the substance is expelled. Depending on the form of the substance to be pressurized, the distal end of the delivery tube or applicator tip may include one or more flow control elements, such as valves, adapted to accommodate and pressurize the substance within the delivery tube. Alternatively, the delivery tube may be dimensioned such that the substance can be pressurized due to existing capillary forces.

[0034] A fifth aspect of the present disclosure relates to a laparoscopic applicator further comprising at least one pressure source configured to apply pressure to at least one fluid source and / or to apply pressure to an inside of a delivery tube, such as to a material within the delivery tube.

[0035] Thus, the pressure source preferably comprises a drive mechanism configured to move at least one fluid source and / or substance in the delivery tube towards the distal end. The drive mechanism can be mechanically and / or electrically operated. For example, the at least one pressure source can comprise a drive mechanism selected from the group of a manual piston, a motorized piston, a spring force, and a gas pressure.

[0036] Mechanical Drive Mechanism For easy assembly of the kit according to the third and fourth aspects, for reducing the number of operation steps, and for manual operation of the laparoscopic applicator, the pressure source can preferably include a predetermined and / or controllable pressure. For example, the pressure source can include a fluid source including a predetermined propellant, such as a gas cartridge or a predetermined gas pressure in a syringe with a predetermined amount of liquid. Alternatively, the pressure source can be a spring with a predetermined spring energy stored therein. Thus, the drive mechanism of the pressure source is mechanically controlled. For example, by simple assembly of the applicator and the pressure source, the applicator is adapted to dispense a (medical) substance, such as a medical paste.

[0037] Electric drive mechanism Additionally or alternatively, the drive mechanism of the pressure source may be controllable via a motor, for example as a piston driven by the motor to pressurize the material in the delivery tube and provide for the ejection of the material. The pressure source may also be a fluid stream driven by the motor, for example a fluid stream obtained from a bellows, piston, paddle wheel, or compressor that pressurizes and dispenses the material from the delivery tube. Thus, the drive mechanism of the pressure source is controlled by a motor or electrically. For example, an actuator of the laparoscopic applicator or applicator tip may be configured to send an electrical signal to the drive mechanism or motor, and upon receiving the electrical signal, is configured to exert pressure on the pressure source or material in the delivery tube.

[0038] powder The laparoscopic applicator is configured to dispense or draw a substance including a hemostatic agent, which may be in the form of a liquid, a paste, or a powder. Due to the flow characteristics of the powder, the pressure source or drive mechanism for transporting the hemostatic powder through the delivery tube and out of the delivery tube preferably comprises a combination of a variable speed feeder, such as a screw conveyor, or a vibrating device, in combination with a gas pressure source.

[0039] A sixth aspect of the present disclosure is a laparoscopic applicator for dispensing hemostatic powder at a selected site by a surgical robotic arm, comprising: a delivery tube for holding the hemostatic powder; a variable speed feeder, such as a screw conveyor, configured to transport the hemostatic powder through the delivery tube to the outside of the delivery tube, thereby dispensing the hemostatic powder from the applicator; The present invention relates to a laparoscopic applicator comprising:

[0040] A seventh aspect of the present disclosure is a laparoscopic applicator for dispensing hemostatic powder at a selected site by a surgical robotic arm, comprising: a delivery tube for holding the hemostatic powder; a valve disposed at a distal end of the delivery tube configured to open at a predetermined opening pressure; a vibration device, such as an ultrasonic vibration device, configured to shake the hemostatic powder out of the delivery tube when the valve is open; The present invention relates to a laparoscopic applicator comprising:

[0041] Preferably, the applicator for dispensing hemostatic powder further comprises one or more pressure sources, such as one or more gas pressure sources, configured to transport the hemostatic powder through the delivery tube. The gas pressure source may be, for example, a motorized gas pressure source, or a pressurized container, such as a gas cartridge. The pressurized container may be characterized as having stored pressure energy, which may be converted to kinetic energy, for example, by releasing the pressure upon manually opening the container. For example, the pressurized container may contain a fluid, which is expelled from the container upon pressure release.

[0042] A seventh aspect of the present disclosure relates to the use of a laparoscopic applicator according to the first aspect to dispense a substance, such as a substance comprising a hemostatic agent, from the applicator.

[0043] The invention will now be described in more detail with reference to the accompanying drawings. [Brief description of the drawings]

[0044] [Figure 1] 1 illustrates one embodiment of an applicator according to the present disclosure. [Diagram 2] FIG. 1 is a perspective view of one embodiment of an applicator according to the present disclosure being manipulated by a robotic arm. [Diagram 3] 1A-1D show an embodiment of an applicator according to the present disclosure, including an embodiment in which the delivery tube is elastic and includes a rigid surface region at the tip (A, B), in which the delivery tube includes a rigid surface region positioned a distance from the tip (C), and in which the delivery tube is semi-rigid (D). [Figure 4] 1A-1C illustrate an embodiment of an applicator according to the present disclosure, including an embodiment of a deformable portion that is stretchable, compressible, and / or flexible. [Diagram 5] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure including a spring loaded check valve. [Figure 6] 1 illustrates an embodiment of an applicator according to the present disclosure including a duckbill valve. [Figure 7] 1 illustrates one embodiment of an applicator according to the present disclosure including a pressure source. [Figure 8] 1 illustrates one embodiment of an applicator according to the present disclosure including a pressure source. [Figure 9] 1 illustrates one embodiment of an applicator according to the present disclosure including a pressure source. [Figure 10] 1 illustrates one embodiment of an applicator according to the present disclosure including a pressure source. [Figure 11] 1 illustrates one embodiment of an applicator according to the present disclosure including a pressure source. [Figure 12] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator comprising a delivery tube for holding a substance, a fluid source for holding the fluid, and a pressure source for exerting pressure on the fluid source. [Figure 13] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator including a driver unit for holding a fluid source and a delivery tube. [Figure 14] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator including a driver unit for holding a fluid source and a delivery tube. [Figure 15] 1A-C show the actuator's actuation mechanisms for pushing (A), pulling (B) and rotating (C). [Figure 16] 1A-1C show actuator embodiments in which a single button covers a portion of the applicator tip (A), two buttons are placed opposite each other on the tip (B), and a single button surrounds the entire circumference of the applicator tip (C). [Figure 17]FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator comprising a deformable portion and an actuator that may be located on either side of the deformable portion. [Figure 18] FIG. 1 shows a driver unit that holds a fluid source (here a syringe) and can feature various controls, such as a flow controller for controlling the flow rate of a substance emitted from the applicator. [Figure 19] FIG. 1 illustrates one embodiment of an applicator tip according to the present disclosure, the tip including an actuator and a pressure light indicator for indicating pressure applied to the actuator. [Figure 20] FIG. 1 illustrates one embodiment of an applicator tip according to the present disclosure, the tip comprising an actuator, a pressure light indicator for indicating pressure applied to the actuator, and a status indicator for indicating the amount of substance remaining in the delivery tube. [Figure 21] 1 illustrates one embodiment of an applicator tip according to the present disclosure, the tip comprising a status indicator, an actuator, a rigid portion, and a deformable portion. Measurements are provided by way of example only. [Figure 22] FIG. 1 shows a cross-section of one embodiment of a delivery tube according to the present disclosure, the delivery tube comprising multiple lumens (here four lumens). [Figure 23] 1A-1C show three different embodiments of a delivery tube having various deformable rigid portions. [Figure 24] 1A-1C show an embodiment of an applicator according to the present disclosure in which a deformable portion allows steering of the applicator tip approximately 360° (A), a delivery tube comprises a malleable wire such that the applicator tip can be repositioned but remains in the same position relative to the tube (B), and the wire allows the deformable portion to bend along one or more planes at a predetermined angle (C). [Diagram 25] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, where the applicator tip includes an actuator and a status indicator. [Figure 26] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator including a screw conveyor for transporting powder through a delivery tube. [Figure 27] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator including a vibration device for shaking powder through a delivery tube. [Figure 28] FIG. 28 shows the embodiment of FIG. 27 from another angle where the end of the valve is visible. [Figure 29] FIG. 28 shows the embodiment of FIG. 27 from another angle, with the robotic arm squeezing the valve, thereby forcing it open so that powder is released from the applicator. [Diagram 30] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator comprising two fluid sources (here two syringes) and a drive mechanism for pressurizing the two fluid sources. [Diagram 31] 1A and 1B are perspective and cross-sectional views of one embodiment of an applicator according to the present disclosure, in which the applicator includes a gas pressure source for transporting powder through a delivery tube, the gas pressure source being a bellows actuated by a motorized piston, e.g., a piston that oscillates back and forth horizontally. [Diagram 32] 1A and 1B are perspective and cross-sectional views of one embodiment of an applicator according to the present disclosure, in which the applicator comprises a gas pressure source for transporting powder through a delivery tube, the gas pressure source being obtained via a motorized propeller and, optionally, a gas inlet; [Diagram 33] 1A is a partial perspective view of an embodiment of an applicator according to the present disclosure with the distal end enlarged within an inserted frame, and (B) is a cross-sectional view of the distal end enlarged in perspective within an inserted frame, the applicator comprising a pressure source for transporting powder through a delivery tube, the pressure source being a distally disposed piston having an aperture, the distally disposed piston being motorized to oscillate back and forth horizontally. [Diagram 34]FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, comprising a gas pressure source for transporting powder through a delivery tube, the gas pressure source being derived from a rotating paddle wheel or impeller, which may be further controlled by a gas cartridge in combination with a gas flow control valve. [Diagram 35] 1A-1C show an embodiment of an applicator according to the present disclosure, in which the applicator comprises a pressure source for transporting powder through a delivery tube and a further flow restricting element for reducing gas flow at the powder delivery site, the flow restricting element being a grid or slit element in the delivery tube (A), and the flow restricting element being a screw conveyor for transporting powder through the delivery tube in combination with a separate gas flow path. [Diagram 36] FIG. 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator comprising first and second substance reservoirs. [Figure 37] A diagram illustrating one embodiment of an applicator according to the present disclosure, the applicator comprising first and second substance reservoirs, the second substance reservoir being removably attached to the first substance reservoir via an auxiliary connector element, showing the attached reservoir (A) and the detached reservoir (B). [Figure 38] 1A-1C show an embodiment of an applicator according to the present disclosure, in which the applicator is configured to be loaded with a substance from a distal end (A), the distal end includes an auxiliary connector element removably attached to a substance reservoir (B), and the distal end includes a flow control element (C). [Figure 39] 1 illustrates one embodiment of an applicator according to the present disclosure, where the applicator is configured to be loaded with a substance from a distal end (B), the pressure source for pressurizing the substance to be dispensed is a spring (C), and the pressure source for pressurizing the substance to be dispensed is a spring (D). [Diagram 40] 1 illustrates one embodiment of an applicator according to the present disclosure, where the applicator is configured to load a substance from a distal end (A) and the pressure source for pressurizing and dispensing the substance is a spring (D). [Diagram 41] 1 illustrates one embodiment of an applicator according to the present disclosure, the applicator comprising two first substance reservoirs and a detached drive mechanism for pressurizing the two first substance reservoirs. [Diagram 42] 42 shows the applicator of FIG. 41 having two first substance reservoirs and further having two second substance reservoirs (here two syringes), showing the loading of the first reservoirs by the syringes (A) and the loaded applicator (B). [Diagram 43] 43 shows the applicator of FIGS. 41-42, with a removable drive mechanism attached for pressurizing the two first substance reservoirs (A) and after the drive mechanism has emptied the two first reservoirs (B). DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0045] The present invention is described below with the aid of the accompanying drawings. Those skilled in the art will appreciate that the same features or components of the device are referred to by the same reference numbers in different figures. A list of the reference numbers can be found at the end of the Detailed Description section.

[0046] Applicator for dispensing a substance For surgical procedures, particularly endoscopic and / or laparoscopic procedures, a substance, such as a medical substance, e.g. a surgical hemostatic substance in the form of a powder, fluid or paste, is dispensed to a target site in a body cavity via an elongated applicator 1 comprising a delivery tube 2 pre-filled with a medical fluid / paste / powder 4 or configured to be filled with a medical fluid / paste / powder during surgery, as shown in FIG. 1. The distal end 2.2 of the delivery tube may be introduced into the body cavity, e.g. via a trocar port, e.g. manually by an assistant. To facilitate handling and insertion of the delivery tube, which may be flexible, the applicator preferably comprises a rigid sheath 3 configured to insert the delivery tube into a trocar. The rigid sheath may be, for example, in the form of a rigid tubular sheath, which may be attached to a portion of the delivery tube, as shown in FIG. 1, or may be placed around a portion of the delivery tube, such as forming a coating layer around the outer delivery tube portion.

[0047] The delivery tube can have an inner diameter of about 1-8 mm, for example about 5 mm, which ensures good flow of the material without requiring a lot of power from a pressure source or variable speed feeder to transport the material through the delivery tube. The delivery tube can have an inner diameter of less than 5 mm, or less than 3 mm, or less than 2 mm. If the delivery tube comprises multiple lumens, the inner diameter refers to the inner diameter of the lumen configured to accommodate the material to be dispensed.

[0048] If the delivery tube or lumen for holding the substance has an inner diameter of less than 2 mm, this means that only a small residue of the substance remains within the delivery tube after the substance has been dispensed.

[0049] In one embodiment of the present disclosure, the applicator further comprises a rigid sheath configured to insert the delivery tube into the trocar, such as a sheath configured to be disposed around a portion of the delivery tube.

[0050] The delivery tube may be pre-filled with a substance (e.g., a medical fluid, paste or powder) and / or configured to be filled with a substance after insertion into the trocar port. Thus, the delivery tube may contain a substance, such as a substance including a bioactive agent, said substance being in the form of a fluid, paste or powder. The substance may be a hemostatic substance including a hemostatic agent. Preferably, filling of the delivery tube may be performed via a proximal end 2.1 of the delivery tube, which is accessible to the surgeon or assistant during surgery, as shown in FIG. 1. Filling of the delivery tube is preferably performed using a separate syringe containing the substance in a syringe barrel, which may be pre-filled with the substance or configured to aspirate the substance from a substance source, such as a medical fluid source. Thus, the container or syringe containing the substance may be referred to as a substance reservoir 24. To facilitate safe and precise filling with minimal substance waste, the proximal end 2.1 preferably comprises one or more connectors 6 for removably attaching a fluid source, such as a syringe pre-filled with the substance. Examples of connectors are luer locks for attaching a syringe, or compression or adhesive joints for attaching a substance reservoir or fluid container. Alternatively, the delivery tube and the fluid source, e.g., a syringe, may be attached without the use of a connector.

[0051] The substance is then dispensed from the filled delivery tube by a driving force, such as a pressure source 8. The driving force for expelling the substance is preferably pressure generated at the proximal end 2.1 of the delivery tube, which is directly accessible to an assistant during surgery. For example, the pressure can be generated by a second fluid being forced to enter the proximal end from a separate fluid source 7, as can be seen in Figure 1, thereby pressurizing the substance present in the delivery tube.

[0052] In one embodiment of the present disclosure, the applicator further comprises at least one pressure source configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube, such as to a substance within the delivery tube.

[0053] Thereby, the pressure source preferably comprises a drive mechanism configured to move at least one fluid source and / or substance in the delivery tube towards the distal end. The drive mechanism can be mechanically and / or electrically operated. For example, the at least one pressure source can comprise a drive mechanism selected from the group of a manual piston, a motorized piston, a spring force, and a gas pressure.

[0054] Further preferably, the pressure of the second fluid is predetermined and / or controllable, for example by being in the form of a predetermined source of pressurized fluid, which is released upon fluid connection with the proximal end of the delivery tube. To facilitate safe and precise pressure transfer, the proximal end of the delivery tube preferably comprises one or more connectors 6 for releasably attaching a pressure source 8 or a fluid source 7, such as a fluid container, more preferably a fluid container configured to be pressurized.

[0055] More preferably, the fluid connector is configured to form a fluid connection between the fluid source and the proximal end of the delivery tube upon connection, for example in the same manner as a vial adapter where a rubber seal of the fluid source is pierced by a hollow piercing element. Thus, a fluid connection can be obtained between the sealed fluid source and the delivery tube by the piercing element. Alternatively, it is not necessary to pierce the fluid source to form a fluid connection. Instead, it may simply be attached to the delivery tube, either directly (e.g., with a connected tube and syringe) or via a connector.

[0056] In one embodiment of the present disclosure, the proximal end of the delivery tube includes one or more connectors 6 for releasably attaching a fluid source, such as a luer lock, a compression joint, and / or an adhesive joint for attaching a syringe and / or a fluid container. In further or alternative embodiments, the one or more connectors include a hollow piercing element for piercing the fluid source, thereby establishing a fluid connection between the fluid source and the delivery tube.

[0057] The drive mechanism of the pressure source can thus be mechanically controlled by attachment of the pressure source to the applicator, and thus by mechanical assembly the applicator is adapted to dispense a (medical) substance, such as a medical paste.

[0058] Additionally or alternatively, the drive mechanism of the pressure source may be controllable via a motor, for example as a piston driven by a motor that pressurizes the substance in the delivery tube or fluid source and thus provides for the ejection of the substance. For example, the pressure source 8 may be a flow of fluid source 7 driven by a motor, and thus the drive mechanism of the pressure source is motor or electrically controlled.

[0059] Preferably, the delivery tube of the applicator is configured to hold the substance under pressure, or at least to hold the substance pressurized immediately prior to the substance being expelled. This provides for more precise and reliable expulsion of the substance at a determined site and at a determined time, for example this has the advantage that the substance can be released from the delivery tube by simple interaction with the applicator tip without a significant time delay.

[0060] Thus, depending on the form of the substance to be pressurized, the distal end of the delivery tube may include one or more flow control elements 26, such as a valve adapted to allow the substance to be contained and pressurized within the delivery tube. For example, the applicator tip may include at least one valve configured to hold and release the substance under pressure, or a flow control element, such as a three-way valve. Additionally or alternatively, the valve may be a restriction valve. A valve is defined as a device that regulates, directs, or controls the flow of fluids (i.e., gases, liquids, and fluidized solids such as pastes and slurries) by opening, closing, and / or partially occluding a fluid passage. Thus, one example of a valve includes a flow restriction element, such as a protrusion in a fluid passage, such that when the fluid pressure is below a threshold value, the protrusion blocks the fluid passage, and when the fluid pressure is above the threshold value, the fluid flows around the protrusion. Valves that include a flow restriction element are also referred to as "restriction valves."

[0061] In one embodiment of the present disclosure, the delivery tube is configured to hold a substance under pressure or to hold a pressurized substance. In another or further embodiment, the laparoscopic applicator tip comprises at least one valve configured to hold and release a substance under pressure. For example, the valve can comprise a flow controller, such as a three-way valve, that can control the amount and direction of flow.

[0062] Alternatively or additionally, the delivery tube and / or the applicator tip may be dimensioned such that the substance can be pressurized in the delivery tube due to the capillary forces present. Thus, suitably, the delivery tube has a length of more than 200 mm, preferably a length of 300-600 mm, for example 440 mm or 500 mm. Furthermore, the outer diameter of the delivery tube is preferably 3-10 mm, for example 5 mm. Furthermore, the inner diameter of the delivery tube, or at least the inner diameter of the applicator tip, is preferably 2 mm or less, for example 1.5 or 1.8 mm. In case the delivery tube comprises multiple lumens, the inner diameter refers to the inner diameter of the lumen configured to accommodate the substance to be dispensed. In case the delivery tube or the lumen for holding the substance has an inner diameter of less than 2 mm, this means that only a small residue of the substance remains in the delivery tube after the substance is dispensed.

[0063] Thus, the delivery tube, and particularly the applicator tip, is preferably dimensioned and configured to hold a substance under pressure or to hold a pressurized substance and / or configured to include one or more flow control elements.

[0064] The delivery tube may comprise multiple lumens, for example at least two lumens, or at least three lumens, or at least four lumens. FIG. 22 shows an embodiment in which the delivery tube comprises four lumens. At least one of the multiple lumens should be configured to accommodate the substance to be dispensed from the applicator. In one embodiment, the delivery tube comprises a first lumen and a second lumen, the first lumen configured to accommodate the substance and the second lumen configured to accommodate electrical wiring or optical fibers. The electrical wiring can be used to electrically connect an actuator, for example located at the distal or tip end of the tube, to a control unit or pressure source, for example located at the proximal end of the tube. The delivery tube may also comprise multiple lumens, at least two lumens configured to hold the substance. As an example, the tube may comprise a first lumen for holding a first type of substance and a second lumen for holding a second type of substance. In some applications, the two types of substances are mixed once the substances are dispensed or before they are dispensed. In this case, one substance may be in the form of a liquid and the other substance may be a powder that is mixed into the liquid. The two substances may also be two liquids or two pastes, or other combinations of liquids, pastes, and powders. An applicator having a delivery tube with two lumens is shown in FIG.

[0065] In another embodiment, at least one of the multiple lumens is configured to accommodate a malleable wire or rod installed within the inner lumen of the delivery tube (as shown in FIG. 24(B) and FIG. 24(C)). Thus, the applicator may further comprise a malleable wire or rod configured to bend the deformable portion of the delivery tube into a desired shape, which shape is substantially maintained upon release of the delivery tube. This has the advantage that the deformable portion can be bent without the tube returning to its original point. This allows the surgeon more freedom to orient the distal end of the tube and / or the applicator tip in a desired direction, for example to more easily reach difficult to access areas of the body. In one embodiment, the deformable portion of the delivery tube can be bent along two planes at two predetermined angles, such as at least 30° or at least 45°. This can be similarly achieved by using a malleable wire or rod installed inside the delivery tube.

[0066] Spatial Maneuvering Replacing the movements of the human hand with a robotic arm controlled by computer software facilitates very precise and controlled movements. Thus, a laparoscopic applicator that is spatially steered by a robotic arm can be controlled with greater precision and accuracy, as well as with greater reliability, with reduced risk of accidental movement. Thus, for example, a laparoscopic applicator for dispensing a substance by a robotic arm can dispense the substance at a selected site with greater precision and reliability. In particular, a robotically steered applicator for dispensing a hemostatic substance at a selected site can more efficiently stop bleeding.

[0067] 2 shows a perspective view of one embodiment of an applicator configured to be spatially maneuvered by a robotic arm 5. The robotic arm can include a medical device, e.g., a surgical tool such as a grasper, tweezers, or similar robotic finger elements for grasping, pressing, or forming an attachment to the applicator.

[0068] The robotic arm and fingers may not include haptic feedback. Thus, to reduce the risk of the applicator being damaged and ensure a safe robotic use of the applicator, the applicator may preferably include a rigid surface area 2.4 or a rigid portion 2.8, the area or portion being configured for manipulation by the robotic arm / fingers. Thus, the delivery tube may include at least one rigid portion, such as a rigid tubular portion or a rigid surface area. The rigid portion and / or the rigid surface area is preferably dimensioned such that the robotic arm / fingers can grasp, press or form an attachment to the rigid surface area without risking breaking the applicator. For example, in the case of a robotic arm including a grasper, the rigid surface area is preferably a rigid tubular portion, as shown in FIG. 2. The rigid portion is preferably provided with an opening so that the robotic arm can press an actuator placed in the opening, the actuator being configured to open a valve when the pressure exceeds a predetermined pressure level, thereby allowing the medical substance to be dispensed from the applicator.

[0069] In one embodiment of the present disclosure, the distal end of the delivery tube comprises one or more rigid surface regions configured for manipulation by a robotic arm. In a further embodiment, the rigid surface regions are dimensioned to be contoured by the robotic arm, such as by gripping, pressing, or attaching. In a further embodiment, the distal end comprises a rigid tubular portion.

[0070] To facilitate precise and easy delivery of the substance at a selected site, one or more rigid surface regions 2.4 are preferably located at the distal end 2.2 of the applicator and / or at the applicator tip, as shown in Figures 1 and 2. This allows for more precise and easier to guide delivery of the substance when the rigid surface is in the vicinity of where the substance is to be dispensed.

[0071] However, the rigid surface region 2.4 may also be positioned at a distance from the distal tip, as shown in Figure 3C. This may be preferred when the substance is to be dispensed where space is limited within a body cavity. Thus, the rigid surface region may be a rigid tubular portion of the delivery tube 2 positioned at a distance from the distal tip, as shown in Figure 3C. Thus, the orientation of the distal end is steered by using a rigid tubular portion positioned at a distance from the tip.

[0072] Additionally or alternatively, flexible steering of the distal end of the delivery tube can be obtained by use of a delivery tube, where a portion of the delivery tube, or optionally the entire delivery tube, comprises a semi-flexible or semi-rigid material, as shown in Figure 3D. Because the semi-rigid material is sufficiently tangible by the robotic arm / fingers, interaction can occur at any point along the delivery tube and any distance up to the distal tip 2.2 being spatially steered.

[0073] The flexible and precise steering of the distal end can be further improved by a delivery tube equipped with a deformable portion 2.3. The term deformable portion means a portion that can be deformed plastically or elastically when subjected to a deforming force such as a tensile, compressive or bending force. Preferably, the deformable portion is plastically deformed, meaning that the deformation remains after the deforming force is removed. Alternatively, the deformation is elastic, meaning that the deformation is reversible upon removal of the deforming force.

[0074] For example, the deformable portion 2.3 can be configured to be stretchable or extensible such that when a tensile force is applied in a longitudinal direction, for example by a robotic arm pulling on the tip of the delivery tube, the delivery tube is stretched as shown by the arrows in Figures 3A-3B and 4A-4B. Additionally, the deformable portion may be correspondingly configured to be compressible such that when a compressive force is applied, for example by a robotic arm pushing on the tip of the delivery tube, as shown in Figure 4B. Additionally, correspondingly, the deformable portion is preferably further configured to be flexible or bendable as shown by the arrows in Figure 4B.

[0075] The deformable portion may comprise an elastically or plastically stretchable, compressible, and / or flexible material. Additionally or alternatively, the deformable portion may comprise a corrugated surface profile, e.g., in the form of a plurality of circumferentially extending twisted folds, as shown in Figures 4C-4D and 17. The corrugated surface profile allows for stretching, compression, and / or bending similar to a drinking straw. Thus, the delivery tube may comprise a compressible deformable portion, e.g., in the form of a corrugated tube, such that the length of the tube may be altered.

[0076] In one embodiment of the present disclosure, the delivery tube comprises a deformable portion. Preferably, the deformable portion is located at the distal end of the delivery tube so that the applicator tip can be steered by a smaller torque / moment. Alternatively, the deformable portion is located at a distance from the distal end of the delivery tube so that the tip can be steered by a defined torque / moment. In a further embodiment, the deformable portion is configured to be stretchable and / or flexible, such as by including a stretchable and / or flexible tubing. In a further or alternative embodiment, the deformable portion includes a corrugated surface profile. In a further embodiment, the corrugated surface profile includes a plurality of circumferential folds, such as the kinks of a drinking straw.

[0077] Controllable substance release For precise, reliable and easy-to-use substance ejection at a selected site, e.g. for intraperitoneal substance distribution, substance ejection can be controlled, preferably by a robotic arm. This can be obtained by one or more actuators 2.6, e.g. in the form of valves, configured to eject the substance from the delivery tube.

[0078] To make the robot arm movement more efficient, one or more actuators are preferably located near the applicator tip that is used for spatially maneuvering the delivery tube. Thus, the actuators are preferably located at the distal end and / or within one or more rigid surface areas of the delivery tube and / or at the applicator tip. For example, the actuator 2.6 may be preferably located within the opening 2.5 of the rigid surface area, as shown in FIG. 2. Thus, after the robot arm directs the distal end through the rigid surface area to the selected target site, only a relatively small translation of the robot arm is required for the robot arm to activate the actuator to release the substance. The actuators may be configured to be activated by pressure applied, for example, by the robot arm, or by current applied, for example, by an energy tool. In one embodiment, the actuator is provided in the form of a pressure-sensitive button, for example, located at the applicator tip, the button configured to open the valve when pressed. The actuator / button may be sensitive to the amount of pressure (e.g., in a stepped or continuous manner) such that the valve opens to a certain degree based on the pressure applied to the actuator / button. In another embodiment, the actuator is configured to be actuated by pulling the actuator along the longitudinal axis of the tube / applicator tip and / or by rotating the actuator about the longitudinal axis. These embodiments are shown in FIG.

[0079] In one embodiment of the present disclosure, the distal end includes one or more actuators configured to expel the substance from the delivery tube by the robotic arm, hi a further embodiment, the one or more actuators are disposed within the one or more rigid surface regions, such as within an opening in the rigid surface region.

[0080] In one embodiment of the present disclosure, the at least one actuator covers a predetermined circumferential portion of the tube and / or applicator tip, such as less than 180°, preferably less than 140°, of the circumference of the tube and / or applicator tip 9. This embodiment is shown in FIG. 16(A). An advantage is that the applicator, and therefore also the applicator tip, can be rotated such that the risk of the robotic arm inadvertently activating the actuator 2.6 is reduced. In another embodiment, the at least one actuator covers at least 180° of the circumference of the tube and / or applicator tip. An advantage is that the robotic arm can activate the actuator 2.6 regardless of the direction of rotation of the applicator and the actuator. Substance can be delivered from the applicator without the applicator being correctly oriented relative to the robotic arm. In yet another embodiment, two actuators are provided on opposing parts of the applicator tip and / or tube, each of said actuators covering less than 120°, preferably less than 90° respectively, of the circumference of the tube and / or applicator tip. Again, the advantage is that the applicator, and therefore also the applicator tip, can be rotated such that the risk of the robotic arm accidentally activating the actuator 2.6 is reduced. This is shown in FIG. 16(B). In yet another embodiment, at least one actuator covers 360° of the circumference of the tube and / or applicator tip such that at least one actuator surrounds a portion of the tube and / or applicator tip. This is shown in FIG. 16(C). Providing the applicator tip with an actuator that surrounds the entire circumference of the tip, for example a pressure sensitive button, has the advantage that it allows 360° actuation, i.e. the robotic arm can actuate the actuator / button regardless of how the actuator is gripped.

[0081] The one or more actuators 2.6 may be in the form of a valve 2.7 or may be combined with one or more valves, such as electronically or manually controlled valves. Thus, the applicator may comprise at least one valve configured to release the substance from the delivery tube upon opening of the valve. The valve may be controllable by an actuator located on the applicator and / or an external actuator, such as a foot pedal. The actuator / button may be located at the distal end of the delivery tube, such as on the rigid portion, on the applicator tip, or on an external device, such as a driver unit. Preferably, the actuator / button is located directly above the valve. Suitably, the at least one valve is actuated by pressure, such as manual pressure from a robotic arm. Thus, for example, as shown in FIG. 5, by pressing the actuator 2.6, the valve 2.7 is actuated electronically or manually to open the valve 2.7 and release the substance. Thus, the applicator may comprise at least one actuator configured to open and / or close the at least one valve. To ensure that the substance is efficiently transported to and through the distal tip, the valve is preferably a one-way valve. The at least one valve may be a pressure-activated valve, such as a valve having a predetermined opening pressure threshold. Preferably, the substance is dispensed from the applicator when the predetermined opening pressure threshold is exceeded. The at least one valve may be disposed within the delivery tube and / or within the applicator tip. Alternatively, the applicator does not include a valve, but rather is dimensioned such that the substance is retained within the applicator below a certain pressure threshold. This may be accomplished, for example, by providing a long delivery tube (e.g., greater than 30 cm) with a small diameter (e.g., 2-4 mm or less), whereby the delivery tube itself provides resistance to fluid flow within the tube.

[0082] To improve the simplicity of the applicator and reduce the number of electronic controls and components, the actuator is preferably a manually controlled valve. An example of a manually controlled pressure valve is a spring loaded check valve 2.7 as shown in Figure 5, where the spring force can be configured to be overcome by pressure applied by, for example, a robotic arm.

[0083] In another example, the actuator 2.6 when activated does not necessarily mechanically actuate the valve 2.7, but may instead send an electrical signal to a pressure source (not shown) which actuates the valve 2.7, applying pressure to the material to overcome the spring in the spring-loaded check valve 2.7, thereby opening the spring-loaded check valve 2.7 and causing the material to flow out of the delivery tube 2.

[0084] Other examples of one-way valves that can be manually pressure controlled are elastomeric one-way valves, such as duckbill valves and cross slit valves.

[0085] An example of a manual pressure control valve is the duckbill valve 2.7 shown in FIG. 6. The duckbill valve is made of an elastically deformable material and comprises a deformable linear closure. Perspective views of the duckbill valve in the undeformed and closed states are shown in FIGS. 6B-6C. FIG. 6A shows an embodiment of a duckbill valve in a delivery tube 2, where it can be seen that the duckbill valve in the undeformed state prevents flow from the left to the right of the figure. When the duckbill valve is elastically deformed, for example by a compressive pressure parallel to the linear closure, as shown in FIG. 6D, the linear closure deforms, thereby opening the valve and allowing flow from the left to the right of the figure. An enlarged perspective view of an embodiment of a duckbill valve in the deformed open state is shown in FIGS. 6E-6F.

[0086] This allows the use of elastomeric valves with any number and orientation of deformable closures. However, to ensure precise actuation, elastomeric valves in which the opening of the valve is obtained by a well-defined pressure orientation are preferred. In the case of duckbill valves, the opening of the valve is only obtained when a compressive pressure is applied parallel to the linear closures.

[0087] The cross-slit valve is similar to the duckbill valve, but with two deformable linear closures oriented perpendicular to each other. Opening of the valve can therefore be obtained when a compressive pressure is applied parallel to either of the linear closures. This has the advantage that in the case of a robotic gripping arm, the valve can be actuated in at least two positions.

[0088] In further embodiments, the one or more actuators are one or more valves. In further embodiments, the one or more valves are pressure actuated valves. In further embodiments, the one or more valves are selected from the group of one-way valves, elastomeric one-way valves, duckbill valves, cross slit valves, and spring loaded check valves.

[0089] Feedback Mechanism Preferably, the applicator is configured to provide feedback, for example regarding the pressure applied to the actuator / pressure sensitive button, or regarding the amount of substance remaining in the delivery tube. This feedback can be provided by incorporating various sensors into the applicator. The applicator can include a first pressure sensor for sensing the pressure in the delivery tube. The pressure can be communicated to a user, for example a surgeon, via wires or wirelessly.

[0090] In one embodiment, the applicator comprises a second pressure sensor for sensing the pressure applied to the actuator / pressure sensitive button. By way of example, the second pressure sensor may be a resistive pressure sensor and / or a force sensitive resistor and / or a weight sensor, preferably provided below the actuator. Thus, the applicator may comprise at least one pressure sensitive button covering a portion of the applicator tip, and a second pressure sensor for sensing the pressure applied to the actuator is integrated into said button or located below the button. The applicator may further comprise a pressure indicator light for indicating the pressure applied to the at least one actuator / pressure sensitive button. The pressure indicator light may be located in or on the applicator tip as shown in Figures 19-20. In one embodiment, the pressure indicator light is provided as a circular band arranged around the circumference of the applicator tip as shown in Figure 19. Preferably, the pressure indicator light is: displaying a first color, e.g., green light, when the applied pressure falls below a first predetermined threshold; and When the applied pressure exceeds a second predetermined threshold, a second color, e.g., a red light, is displayed. It is configured as follows.

[0091] The pressure indicator light may be further configured to display a third color, for example a yellow light, when the applied pressure is between the first and second predetermined thresholds. Other alternative configurations of light or sound for indicating pressure by the pressure indicator light may be readily contemplated.

[0092] The applicator may further comprise a status indicator, for example in the form of a light diode, said status indicator being configured to indicate the amount of substance remaining in the applicator. As an example, the status indicator may comprise four light diodes (for example LEDs), for example with two diodes lit indicating 50% remaining relative to the initial volume of contained substance, and three diodes lit indicating 75% remaining. This is shown in FIG. 25. The status indicator may be located in any part of the applicator, for example the driver unit, the delivery tube, and / or the applicator tip. Thus, the applicator tip may comprise a status indicator, for example in the form of a light diode, said status indicator being configured to indicate the amount of substance remaining in the delivery tube. The amount of substance remaining in the applicator (i.e. in the delivery tube and / or in the fluid source) may be estimated using various methods depending on the type of substance contained in the applicator. Some of these methods are described below. Other alternative configurations of light or sound for indicating the amount of substance remaining in the applicator may be readily envisaged. Alternatively, the status indicator may comprise only one light that is illuminated when, for example, only 25% of the substance remains in the applicator.

[0093] In some embodiments, the laparoscopic applicator comprises a fluid source in the form of a syringe, such as a medical syringe, comprising a barrel for holding the fluid and a plunger for pushing the fluid out of the syringe. The syringe may be filled with a fluid, e.g. saline or gas, to push the substance out of the delivery tube, or may be filled with the substance to be dispensed. In one embodiment, the applicator further comprises a second position sensor configured to determine the position of the plunger of the syringe. This may be achieved by providing the plunger with a magnet, the second position sensor being a magnetic sensor configured to detect the presence of the magnet. The position of the plunger may be used to estimate the remaining amount of fluid / substance in the barrel of the syringe, and / or its position may be used to estimate the remaining amount of substance in the delivery tube. Thus, the applicator may comprise at least one fluid source comprising a plunger in a barrel, the position of the plunger being used to estimate the remaining amount of substance in the delivery tube, the remaining amount being indicated by a status indicator, preferably located at the distal / tip end. Alternatively, the second position sensor may be an optical sensor.

[0094] In other embodiments, the laparoscopic applicator includes a hemostatic powder contained, for example, in a delivery tube. In this case, the applicator can include a variable speed feeder, such as a screw conveyor, configured to transport the hemostatic powder through the delivery tube and out of the delivery tube, whereby the hemostatic powder is dispensed from the applicator. To determine the remaining amount of powder, the applicator can include a first position sensor configured to determine a position of the variable speed feeder, such that the position can be correlated with the remaining amount of powder. The variable speed feeder can be provided with a magnet, and the first position sensor is a magnetic sensor configured to detect the presence of the magnet. Alternatively, the first position sensor can be an optical sensor.

[0095] In yet another embodiment, the applicator includes a vibration device, such as an ultrasonic vibration device, configured to shake the hemostatic powder out of the delivery tube. In this case, the applicator may further include a clock configured to measure the elapsed time when the vibration device is activated / vibrating. The elapsed time may be used to estimate the remaining amount of hemostatic powder in the delivery tube.

[0096] Thus, the remaining amount may be determined by the first position sensor, the second position sensor, a clock, and / or a combination thereof.

[0097] According to another embodiment, the delivery tube comprises one or more light-sensitive sensors configured to sense light in a predetermined wavelength range passing through the delivery tube; the delivery tube comprises a light source disposed opposite one or more light-sensitive sensors; and / or The delivery tube is transparent to at least a portion of the wavelength range.

[0098] In one embodiment, the one or more light-sensing sensors are disposed at a distal portion of the delivery tube. In another embodiment, the delivery tube comprises at least two light-sensing sensors, a first sensor disposed at a distal portion of the tube and a second sensor disposed at a different location than the first light-sensing sensor, such as further away from the distal portion. The one or more light-sensing sensors can be used to provide an indication of whether there is a remaining substance in the tube and / or can be used to estimate the amount of substance remaining in the tube.

[0099] Pressure Source The release of the substance from the applicator means that the substance held in the tube is pushed through the delivery tube to the distal and tip ends where it is expelled and dispensed. If the substance is a paste, a pressure source 8 preferably provides the driving force for dispensing the paste. The pressure source is preferably configured to pressurize the delivery tube and / or to pressurize the fluid source. The substance held in the delivery tube is preferably pressurized at least immediately before the paste is expelled. In some embodiments, the applicator forms a pressurized system, and the substance in the delivery tube is pressurized. When a valve is actuated (e.g. via an actuator or button), said pressure is released, thereby dispensing the substance. In other embodiments, the system (applicator) is not pre-pressurized. Rather, pressure is applied when the actuator is actuated, for example by sending an electrical signal from said actuator to the pressure source. An advantage of the first type of embodiment (i.e. pressurized applicator) is that there is less delay between the actuation of the valve and the dispensing of the substance.

[0100] If the medical substance is a powder, such as a hemostatic powder, a pressure source is not necessarily required as the powder may be expelled from the applicator by other means. In this case, as an alternative to or in addition to a pressure source, the applicator may include a variable speed feeder configured to transport the hemostatic powder through the delivery tube to the outside of the delivery tube, whereby the hemostatic powder is dispensed from the applicator. Alternatively, the applicator may include a vibrating device for shaking the powder out of the applicator.

[0101] As an example, the pressure source may be a solid stylus that advances through the delivery tube by linear movement, for example, by use of a piston, spring force, and / or trigger, where the piston or trigger can be manually or electronically controlled. One example of an intermediate pressure source includes a fluid source 7 that contains a liquid (e.g., saline or medical paste to be dispensed) or a gas (e.g., air, nitrous oxide, or carbon dioxide), where the pressure source exerts a force on the fluid source, forcing the liquid or gas to advance through the delivery tube, as shown in FIG. 7. The pressure source may comprise a spring, a gas, and / or a piston, where the pressure source is configured to exert pressure on at least one fluid source. In this case, the piston, spring, and / or trigger can be manually or electronically controlled and actuated. Preferably, the fluid source includes a non-compressible liquid for more efficient pressure transmission.

[0102] In one embodiment of the present disclosure, the applicator further comprises one or more pressure sources, hi a further embodiment, the pressure sources are selected from the group of a solid stylus configured to translate through a delivery tube, a drive mechanism such as a motor having a piston, a pump, and / or a pressurized fluid source.

[0103] In one embodiment, the pressure source is a drive mechanism, such as a motor comprising at least one piston configured to exert pressure on at least one fluid source. The motor may be a mechanical motor or an electric motor. The applicator may comprise an actuator configured to, upon actuation, transmit an electrical signal to the drive mechanism, whereby, upon receiving said electrical signal, the drive mechanism exerts pressure on at least one fluid source to dispense the substance from the applicator.

[0104] In a further embodiment, the drive mechanism comprises two pistons, the first piston configured to exert a first pressure on the first fluid source and the second piston configured to exert a second pressure on the second fluid source. This embodiment is shown in FIG. 30. In this case, the drive mechanism may further comprise a switching mechanism, such as a gear mechanism, configured to switch the operation of the first piston and / or the second piston. Alternatively, the drive mechanism may drive the two pistons simultaneously to dispense two substances. This is suitable, for example, when two substances are both required to achieve a desired reaction. This may be the case, for example, of thrombin and fibrinogen. Preferably, the drive mechanism further comprises a directional control configured to control the direction (forward or backward) of the selected piston. The reverse direction allows for the aspiration of a substance, for example blood, from the surgical site to allow the surgeon to better determine what to do.

[0105] To ensure reproducible and easy-to-use dispensing of the substance, the pressure source is preferably configured to deliver a predetermined and / or controllable pressure. For example, the pressure source can be a pressurized fluid source, e.g., a fluid container containing a pre-established positive pressure, such that when an opening is formed in the fluid container, the fluid source is forced through the opening as defined by the established pressure.

[0106] The pre-established positive pressure can be obtained by a fluid source 7 pressurized by a propellant 8.1, such as a gaseous propellant, as is known in food spray dispensers such as spray cream. Figures 8 and 10A show an embodiment of the fluid source 7 containing a gaseous propellant 8.1. Upon forming a fluid connection between the applicator 2 and the pressure source 8, the propellant pressure can be released and the fluid source is forced forward into the delivery tube.

[0107] Alternatively, the pressure source may include a housed spring-loaded element in physical communication with the fluid source. When the spring-loaded element is released, the element acts as a propellant 8.1 that advances the fluid source into the delivery tube, as shown in FIG. 9A.

[0108] Alternatively, the pressure source may include a movable piston, such as a manually driven piston as shown in Figure 9B, or a mechanically or electronically driven piston as shown in Figure 10B. In both embodiments, the piston acts as a propellant 8.1 and can generate a predetermined pressure based on the movement of the piston.

[0109] Alternatively, pressure source 8 may be a fluid source 7 contained in an inflatable balloon or bladder, as shown in Figure 11. Upon forming a fluid connection between applicator 2 and pressure source 8, the inflated balloon elastically contracts or collapses, thereby exerting pressure on the substance contained in the delivery tube, thereby pressurizing the substance.

[0110] In one embodiment of the present disclosure, the pressure source is configured to deliver a predetermined pressure. In a further embodiment of the present disclosure, the pressure source comprises a propellant selected from the group of a spring-loaded element, a gaseous propellant, an inflatable balloon or bladder, and / or a movable piston, such as an electrically or manually driven piston.

[0111] fluid source Preferably, the applicator comprises at least one fluid source for holding a fluid, said fluid source being in fluid connection with the delivery tube (see, for example, FIG. 7 or FIGS. 12-13). The fluid source may act as an intermediate pressure source, i.e. a component that transmits pressure from the pressure source to the substance in the delivery tube. Thus, the fluid source does not have to contain the substance to be dispensed, but can instead contain an inert fluid, such as saline or a gas. In one embodiment, the fluid source comprises a liquid, such as saline. In another embodiment, the fluid source comprises a gas selected from the group of CO2 (carbon dioxide), N2 (dinitrogen), N2O (nitrous oxide), and air. However, the fluid source may alternatively contain the substance to be dispensed, for example a medical substance, such as a medical paste, such that the substance is contained within the fluid source and / or the delivery tube. In one embodiment, the delivery tube and the at least one fluid source comprise the same substance provided in the form of a liquid, a paste, or a powder. Thus, the fluid source constitutes the substance reservoir 24.

[0112] The applicator may also include at least two fluid sources as shown in Figure 30. This has the advantage that each fluid source may contain a particular type of substance, thereby allowing a number of different substances to be dispensed and / or drawn by the applicator.

[0113] Driver Unit The applicator is at least one fluid source for holding a fluid in fluid communication with the delivery tube; and / or At least one pressure source configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube. The device may further include a driver unit for holding the

[0114] In its simplest form, the driver unit may constitute a housing for holding a fluid source and / or for holding a pressure source. However, the driver unit may also comprise additional, more advanced features that will be described in more detail in this section. The advantage of providing the driver unit as a separate component from the rest of the laparoscopic applicator is that it provides a modular design, where the driver unit can be reused multiple times, while the delivery tube and the fluid source can be discarded after each use. FIG. 14 shows how the delivery tube and the fluid source (here a syringe) can be inserted into the driver unit, optionally via a connector. FIG. 18 shows another perspective view of the driver unit with the fluid source inserted. The driver unit is preferably configured to exert pressure on the fluid source by a drive mechanism, e.g., a motor and a piston, such that the driver unit is configured to provide a driving force for driving the substance out of the applicator. As an example, the fluid source may be a medical syringe or another container with a plunger, and the driver unit comprises a piston configured to exert a force on the plunger. In this case, the driver unit may be similarly configured to draw the plunger to draw the substance into the applicator.

[0115] The applicator may be provided with a safety mechanism configured to switch between two modes (on / off), with "off mode" meaning that the substance cannot be discharged from the applicator and "on mode" meaning that the substance can be discharged. The safety mechanism may be located on the delivery tube, the applicator tip or the driver unit. The applicator may further comprise a flow controller configured to control the flow rate of the substance discharged from the applicator. The flow controller may be located in the driver unit, or the driver unit may be provided with a button or potentiometer on its exterior configured to adjust the flow rate, for example by pressing the button.

[0116] Parts Kit The applicator according to the present disclosure can be provided as part of a kit of parts for laparoscopic procedures, in particular as a kit of parts suitable for robotic assisted surgery. Preferably, the kit of parts is a medical substance kit, such as a hemostatic matrix kit for laparoscopic procedures. The kit preferably includes an applicator, one or more pressure sources, and optionally a syringe configured to be filled with a medical substance, e.g. a hemostatic substance such as a hemostatic paste. Preferably, the syringe is pre-filled with the substance to constitute the substance reservoir 24. Optionally, the applicator may be provided as a separate part of the kit, e.g. a delivery tube and an applicator tip, which upon assembly form the applicator according to the first aspect.

[0117] The kit may optionally further comprise one or more substance reservoirs 24 for loading or filling the delivery tube prior to use. For example, the substance reservoir may be a syringe configured to be filled with a substance and configured to form a fluid connection to the delivery tube of the applicator, such as via a connector 6 to a proximal opening of the delivery tube or via an auxiliary connector element 25 to a distal opening of the delivery tube.

[0118] To reduce the number of parts and simplify assembly, a kit of parts can include the applicator and a pressure source 8 that is easily assembled and configured to deliver a substance under pressure upon assembly. For example, the pressure source can be a gas cartridge 8.2 configured to form a fluid connection to a delivery tube of the applicator, such as a proximal opening of the delivery tube, as shown in Figures 38 and 40.

[0119] To further simplify assembly, one or more pressure sources 8 can be incorporated into the applicator. For example, a pressure source can be incorporated into the delivery tube in the form of a spring 8.3 located at the proximal end, as shown in Figure 38, where spring energy is pre-stored and / or stored upon loading the delivery tube with substance.

[0120] A third aspect of the present disclosure relates to a kit of parts comprising an applicator according to the first aspect or an applicator tip according to the second aspect, one or more pressure sources, and optionally one or more substance reservoirs. For example, the substance reservoirs may be one or more syringes configured to be filled with a substance and configured to form a fluid connection to a delivery tube, such as a distal opening of the delivery tube.

[0121] A kit of parts has the advantage that all parts can be manually assembled and operated and all parts are disposable after use and suitable for single use.

[0122] Alternatively, the kit of parts may include parts adapted for multiple uses to obtain a more reproducible and sustainable applicator design. For example, the applicator can be assembled into a reusable unit or holder that may include a pressure source 8 in the form of a reusable piston or motor.

[0123] To further increase the sustainable impact, the driver unit can be refilled with substance 4 or fluid source 7. Thus, the kit of parts optionally comprises one or more substance reservoirs 24 or fluid source reservoirs configured to be removably attached to a fluid source in the driver unit.

[0124] According to one embodiment, a kit of parts comprises a laparoscopic applicator according to the first aspect and a driver unit for holding at least one fluid source for holding a fluid in fluid connection with a delivery tube and / or for holding at least one pressure source, such as a motor, configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube.

[0125] The kit of parts may further comprise at least one fluid source for holding a fluid, said fluid source in fluid communication with the delivery tube, In one embodiment, the fluid source is a syringe having a plunger, and the driver unit further comprises a position sensor configured to determine a position of the plunger.

[0126] The kit of parts may further comprise at least one pressure source configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube.

[0127] The driver unit in the kit of parts can be configured to hold at least two fluid sources, such as at least two syringes. The advantage of this is that two different substances can be dispensed from the applicator. Alternatively, one of the at least two syringes can be used to draw a substance, such as blood, from a patient.

[0128] material The applicator tube of the present disclosure is preferably configured to dispense a substance. The substance may be in the form of a liquid, paste, or powder. As an example, the substance may be a medical paste. The term "medical paste" refers to a paste that includes a bioactive agent. Examples of bioactive agents include thrombin or fibrinogen, also referred to as hemostatic agents. As another example, the substance may include a non-biological adhesive / glue agent, such as cyanoacrylate or polyethylene glycol hydrogel (PEG). As yet another example, the substance may include a material selected from the group of oxidized regenerated cellulose (OCR), microporous polysaccharide spheres, and microfibrillar collagen. When the substance is a powder, the powder is preferably a hemostatic powder that includes particles having a particle size greater than 180 microns. A particle size greater than 180 microns means that the particles have good flowability so that they can be easily spread over an area. This is particularly preferred when the powder is a hemostatic powder, since it is important to cover the entire wound as quickly as possible to stop the bleeding.

[0129] A "bioactive agent" is defined as any agent, drug, compound, composition or mixture that provides some pharmacological, often beneficial, effect that can be demonstrated in vivo or in vitro. Thus, an agent is considered to be bioactive if it has an interaction with or effect on cellular tissues in the human or animal body. As used herein, the term further includes any physiologically or pharmacologically active substance that produces a local or systemic effect in an individual. A bioactive agent may be a protein, such as an enzyme. Further examples of bioactive agents include, but are not limited to, agents that include or consist of oligosaccharides, polysaccharides, optionally glycosylated peptides, optionally glycosylated polypeptides, oligonucleotides, polynucleotides, lipids, fatty acids, fatty acid esters, and secondary metabolites. This can be used prophylactically, therapeutically, in connection with the treatment of an individual, such as a human or any other animal. As used herein, the term "bioactive agent" does not encompass cells, such as eukaryotic or prokaryotic cells.

[0130] A "paste" according to the present disclosure has a malleable, putty-like consistency, such as toothpaste. A paste is a thick, fluid mixture of a solid in pulverized / powdered form and a liquid. A paste is a material that behaves as a solid until a sufficiently large load or stress is applied, at which point it flows like a fluid, i.e., the paste is flowable. A fluid conforms efficiently to irregular surfaces when applied. A paste typically consists of a suspension of granular material in a background fluid. The individual particles pack together, like sand in a sandy bed, forming an irregular glassy or amorphous structure, giving pastes their solid-like characteristics. It is this "packed together" that gives pastes some of their most unusual properties, which causes them to exhibit the properties of a brittle material. A paste is not a gel / jelly. A "slurry" is a fluid mixture of powdered / pulverized solids and a liquid, such as water. A slurry behaves like a thick fluid in some ways, flows under gravity, and can be pumped if not too thick. A slurry can be functionally considered a thin, watery paste, although a slurry generally contains more water than a paste. Substantially water-insoluble powder particles, such as cross-linked gelatin particles, form a paste when mixed with an aqueous medium.

[0131] A "gel" is a solid, jelly-like material that can have properties ranging from soft and weak to hard and strong. A gel is defined as a substantially dilute crosslinked system that does not exhibit flow when in a steady state. By weight, a gel is mostly liquid, but behaves like a solid due to a three-dimensional crosslinked network within the liquid. It is the crosslinks within the fluid that give the gel its structure (hardness) and contribute to its cohesiveness (stickiness). Thus, a gel is a dispersion of molecules of a liquid within a solid, where the solid is the continuous phase and the liquid is the discontinuous phase. A gel is neither a paste nor a slurry. For example, non-crosslinked gelatin is soluble and forms a gel when in contact with an aqueous medium such as water.

[0132] The medical paste expelled from the syringe and applicator tube must be flowable when subjected to a force applicable to the syringe. Thus, the term "flowable paste" refers to a paste having a viscosity that promotes consistent flow when subjected to a force applicable to the syringe. An example of a flowable paste is a paste having a viscosity of 500-3500 Pa·s when measured at 30° C. and 65-75% relative humidity. In one embodiment of the present disclosure, the paste is flowable.

[0133] To form a medical paste, such as a flowable medical paste, a bioactive agent must be mixed with a paste or paste-forming material. Typically, the bioactive agent is stored in a solid and dry state, such as a powder form, which facilitates stable storage of the active agent, and allows flexibility in concentration by mixing the bioactive agent with a diluent in an adjustable ratio. Thus, for a bioactive agent to be administered by syringe injection, the solid bioactive agent must first be reconstituted. Thus, to form a medical paste, typically, a step is required to mix the solid bioactive agent with a liquid or diluent to reconstitute the bioactive agent, followed by mixing the reconstituted bioactive agent with a paste-forming material, also called a "paste precursor". The bioactive agent may be a hemostatic agent, such as thrombin or fibrinogen.

[0134] The term "paste-forming material" refers to a material for forming a paste from a liquid phase, such as a reconstituted bioactive agent. As such, a paste-forming material may also be referred to as a precursor material for forming a paste.

[0135] A reconstituted bioactive agent is obtained by mixing the bioactive agent with a low viscosity liquid, such as sterile water or saline, thereby ensuring a uniform reconstitution. The reconstituted bioactive agent is thus a low viscosity liquid. A paste can be obtained from the reconstituted bioactive agent by adding a paste-forming material that essentially increases the viscosity.

[0136] material loading As mentioned above, the delivery tube of the applicator may be pre-filled with a substance (e.g., a medical fluid, paste or powder) prior to use, e.g., prior to inserting the applicator into a trocar port. Alternatively, the delivery tube may be configured to be continuously filled with substance after insertion into the trocar port, e.g., immediately prior to or during application of the substance.

[0137] Proximal Loading In a first preferred embodiment, the filling of the delivery tube is performed via the proximal end 2.1 of the delivery tube, which is accessible to the surgeon or assistant during the operation, as shown in FIG. 1. The filling of the delivery tube is preferably performed using a separate syringe containing the substance 4 in a syringe barrel, as shown in FIGS. 12-14, which may be pre-filled with the substance or configured to aspirate the substance from a substance source, such as a medical fluid source. The container or syringe containing the substance 4 may thus be referred to as a substance reservoir 24. To facilitate safe and precise filling with minimal substance waste, the proximal end 2.1 preferably comprises one or more connectors 6 for removably attaching a fluid source, such as a syringe pre-filled with the substance. Examples of connectors are a luer lock for attaching a syringe, or a compression or adhesive joint for attaching a substance reservoir or fluid container. Alternatively, the delivery tube and the fluid source, e.g., a syringe, may be attached without the use of connectors.

[0138] In one embodiment of the present disclosure, the delivery tube and the at least one fluid source contain the same substance or are configured to contain the same substance, such as a substance including a hemostatic agent, and the substance is provided in the form of a liquid, a paste, or a powder, such that the at least one fluid source constitutes a first substance reservoir.

[0139] Continuous Loading In addition to being pre-filled and configured to be filled or loaded with substance 4 from the proximal end after insertion into the trocar port, the applicator may preferably be further configured to be continuously filled while inserted into the trocar. This can be achieved by configuring the applicator to be loaded from multiple amounts of substance reservoir 24.

[0140] FIG. 36 shows an embodiment of an applicator according to the present disclosure, where the applicator 1 comprises a first substance reservoir 24.1 and a second substance reservoir 24.2. Thus, for example, the syringe substance reservoir 24 shown in FIG. 14 is replaced by an integrated first substance reservoir 24.1, which is different from a separate syringe, thereby avoiding a separate syringe and plunger. The integrated first substance reservoir can comprise a barrel for holding the substance and a stopper defining the first substance reservoir, which can also act as a piston for pushing the substance out of the barrel. The integrated first substance reservoir is not limited to having conventional syringe dimensions, and can preferably have a relatively wider diameter and shorter length than a conventional syringe.

[0141] In one embodiment of the present disclosure, the first substance reservoir comprises a barrel for holding the substance and a piston for expelling the substance from the barrel. In a further embodiment, the barrel has a diameter of 10-30 mm, more preferably 12-20 mm, and most preferably 14-18 mm.

[0142] As shown in Figures 36-37, the second substance reservoir 24.2 is removably attachable to the first substance reservoir 24.1 via an auxiliary connector element 25. Figure 37A shows the second reservoir attached and Figure 37B shows the second reservoir removed.

[0143] To dispense a substance from the applicator before or during operation, an assistant can attach a second substance reservoir 24.2, optionally while the applicator is inserted into the trocar port. The assembly may be configured to transfer a substance, such as a hemostatic agent, from the second substance reservoir to the first substance reservoir. For example, the second substance reservoir may be pressurized and the auxiliary connector element may include a one-way valve luer lock to facilitate transfer.

[0144] In one embodiment of the present disclosure, the applicator comprises one or more second substance reservoirs. In a further embodiment, the first and / or second substance reservoirs are disposable.

[0145] In one embodiment of the present disclosure, the second substance reservoir is removably attached to the first substance reservoir via at least one auxiliary connector element. In a further embodiment, the connector element comprises a luer lock, a compression joint, or an adhesive joint.

[0146] The substance can then be dispensed by activating a dispensing button or actuator 2.6 at the distal end 2.2 of the delivery tube. The actuator can activate a drive mechanism of the pressure source, for example a mechanically controlled drive mechanism or a motor-controlled or electrically controlled drive mechanism. For example, the pressure source can correspond to the drive unit 10 shown in FIG. 14, which is a motor-controlled advancing piston that can exert pressure on the first substance reservoir 24.1. Due to the wide diameter and short length of the first substance reservoir, the force required to dispense the substance is small. Therefore, the pressure can be a manually driven piston, since only a relatively low force is required for priming. Furthermore, the dimensions of the first substance reservoir allow for easy dispensing of any substance 4 regardless of viscosity.

[0147] The auxiliary connector element can be configured to avoid backfilling of the second substance reservoir from the pressure source. This can be obtained by the auxiliary connector element being adapted to establish a continuous fluid connection between 1) the first substance reservoir and the second substance reservoir, and 2) between the first substance reservoir and the delivery tube. Thus, the auxiliary connector element can have two configurations that can be obtained by a one-way valve.

[0148] In one embodiment of the present disclosure, the auxiliary connector element is configured to establish a continuous fluid connection between 1) the first and second substance reservoirs and 2) the first substance reservoir and the delivery tube. In a further embodiment, the auxiliary connector element is adapted to have a first configuration providing a fluid passage between the first and second substance reservoirs and a second configuration providing a fluid passage between the first substance reservoir and the delivery tube. In one embodiment of the present disclosure, the auxiliary connector element comprises at least one one-way valve.

[0149] This allows the first substance reservoir to be replenished at any time by the nurse by removing and installing any number of additional second reservoirs. Furthermore, the reservoirs are preferably disposable for easy and flexible use. For example, all parts except the driver unit may be disposable.

[0150] As a result of the above, the applicator comprising the first and second substance reservoirs can have a particularly compact design due to the form factor of the first substance reservoir and be particularly suitable for both high and low viscosity substances, such as liquids, pastes and powders.

[0151] Sequential loading can be applied to applicators with any number of substance reservoirs, as well as to applicators for mixtures of substances. For example, this can be applied to the embodiment shown in FIG. 30, where the delivery tube comprises a first lumen for holding a first type of substance and a second lumen for holding a second type of substance, and the two types of substances are mixed as the substances are dispensed or before they are dispensed. For example, the applicator tip can comprise a nozzle with a mixing chamber. In this case, one substance may be in the form of a liquid and the other substance may be a powder that is mixed into a liquid. The two substances may also be two liquids or two pastes, or other combinations of liquids, pastes, and powders. The drive mechanism of FIG. 30 comprises two pistons, the first piston configured to exert a first pressure on two different reservoirs simultaneously or with a time delay to ensure sufficient mixing.

[0152] Similar to Fig. 30, Fig. 41 shows an embodiment of an applicator according to the present disclosure, where the applicator 1 comprises two first substance reservoirs 24.1 and a detached drive mechanism 10 for pressurizing the two first substance reservoirs. The drive mechanism is illustrated as a motorized driver unit having two pistons.

[0153] Figure 42 shows the applicator of Figure 41, where two first substance reservoirs 24.1 are connected to two second substance reservoirs 24.2 (shown as two syringes) via check valves 25. (A) shows the loading of the first reservoirs with the syringes, and (B) shows the loaded applicator, with stoppers defining the first substance reservoirs, after the two syringes have been removed.

[0154] Figure 43 shows the applicator of Figures 41-42, in (A) fitted with a removable drive mechanism for pressurizing the two first substance reservoirs 24.1 and in (B) with the piston of the drive mechanism translating the stoppers, thereby emptying the two first reservoirs.

[0155] Distal Loading In addition to or instead of proximal loading, the applicator may also be configured to be loaded from the distal end, which can further improve the compact design, reduce the number of parts in the applicator, and provide a completely disposable applicator.

[0156] FIG. 38A shows an embodiment of an applicator according to the present disclosure, which is configured to be loaded with a substance 4 from a distal end 2.2 opposite to a pressure source 8 located at a proximal end 2.1. This can be obtained by a distal or tip end of the delivery tube comprising a detachably attached auxiliary connector element 25 for forming a fluid communication with a substance reservoir, as shown in FIG. 38B, and a flow control element 26, as shown in FIG. 38C. The flow control element may for example be a three-way valve having three configurations, namely a first configuration providing a fluid passage from a distally attached substance reservoir into the delivery tube, a second configuration in which no fluid passage is provided so that the substance in the delivery tube can be pressurized, and a third configuration providing a fluid passage from the delivery tube out of the distal end of the delivery tube. Preferably, the flow control element is configured to establish a continuous fluid connection in the opposite direction, first 1) between the substance reservoir and the delivery tube, then 2) between the delivery tube and the detached substance reservoir.

[0157] In one embodiment of the present disclosure, the delivery tube is configured to be filled with a substance from a distal end. In one embodiment of the present disclosure, the delivery tube includes one or more removably attached connectors for a substance reservoir and / or a flow control element.

[0158] FIG. 39A shows an embodiment of an applicator according to the present disclosure, configured to be loaded with a substance from a distal end 2.2 by a substance reservoir 24 in the form of a syringe containing a substance 4. The applicator 1 comprises a pressure source 8, preferably a spring 8.3 integrated in a delivery tube, as shown in FIG. 39A. The syringe 24 is attached to the distal end 2.2 of the delivery tube via an auxiliary connector element 25, which may be a luer lock connector, as shown in FIG. 39B. As shown in FIG. 39C, the syringe contents are transferred to the delivery tube, thereby compressing the spring 8.3. Thus, a pressure source in the form of spring energy is stored upon loading the delivery tube. Alternatively, the spring energy may be pre-stored by pre-compression, such that a predetermined amount of spring energy is provided by the applicator. The syringe and the auxiliary connector element can then be removed, and the flow control element 26 facilitates the substance in the delivery tube to be pressurized by the spring force. The applicator is ready for use and substance 4 can be dispensed, for example as indicated by the arrow, by an actuator contained within the flow control element as shown in Figure 39D.

[0159] The present embodiments provide an applicator that has a particularly compact design and small form factor.More preferably, the embodiments provide a non-powered, fully disposable applicator for single use.

[0160] In one embodiment of the present disclosure, the at least one pressure source is a spring configured to exert pressure on the at least one fluid source and / or the substance in the delivery tube, hi a further embodiment, the spring energy is pre-stored and / or the spring energy is stored upon loading the delivery tube.

[0161] Alternatively or in addition to the spring 8.3, the pressure source may comprise a gas pressure source such as a pressurized container, for example a gas cartridge 8.2. FIG. 40A shows an embodiment of an applicator according to the present disclosure, where the applicator 1 is configured to be loaded with a substance from the distal end 2.2 via a substance reservoir 24 in the form of a syringe attachable to the distal end via an auxiliary connector element 25. The applicator further comprises a pressure source 8 for pressurizing and dispensing the substance, in the form of a gas cartridge 8.2. After loading, the syringe 24 and the auxiliary connector element 25 are removed, as shown in FIG. 40B, and the substance 4 is dispensed by the applied gas pressure, as shown in FIG. 40C. Thereby, the gas pressure can be obtained from other means than a gas cartridge, for example an electrically powered bellows, an electrically powered propeller, an electrically powered compressor.

[0162] In one embodiment of the present disclosure, the at least one pressure source is a gas configured to exert pressure on the at least one fluid source and / or substance in the delivery tube. In one embodiment of the present disclosure, the gas pressure source is selected from the group of a gas cartridge, a motorized bellows, a motorized propeller, a motorized compressor, and combinations thereof.

[0163] Hemostasis powder application According to one embodiment, a laparoscopic applicator is configured to dispense hemostatic powder at a selected site by a surgical robotic arm, the laparoscopic applicator comprising: a delivery tube for holding the hemostatic powder; a variable speed feeder, such as a screw conveyor, configured to transport the hemostatic powder through the delivery tube to the outside of the delivery tube, thereby dispensing the hemostatic powder from the applicator; Equipped with.

[0164] The hemostatic powder preferably comprises a hemostatic agent. Suitably, the hemostatic powder comprises particles having a particle size greater than 180 microns. In one embodiment, the hemostatic powder comprises particles having an average particle size of at least 275 microns, such as an average of about 300 microns. Further, the particles have a density of at least 0.3 g / cm 3, more preferably at least 0.4 g / cm 3 , and even more preferably at least 0.44 g / cm 3 In one example, the particles may have a tap density of 0.3 to 1 g / cm 3 The applicator may have a tap density in the range of 0.5 to 1.0 mm. In one embodiment, the variable speed feeder is a screw conveyor. This is shown in FIG. 26. In another embodiment, the variable speed feeder is a paddle wheel. The applicator may comprise a first position sensor, such as a magnetic or optical sensor, configured to determine the position of the screw conveyor and / or the paddle wheel. The first position sensor is preferably configured to record each revolution of the screw conveyor and / or the paddle wheel, each revolution being added or subtracted depending on the direction of rotation so that the position of the screw conveyor and / or the paddle wheel can be determined. If a processor is used to control the screw conveyor and / or the paddle wheel processor, the processor knows the direction of rotation. Alternatively, the first position sensor may sense the direction, for example by having two sensors adjacent to each other. The position of the screw conveyor (determined, for example, by the number of revolutions) may be used to determine the remaining amount of powder in the delivery tube.

[0165] In another embodiment, a laparoscopic applicator for dispensing hemostatic powder at a selected site by a surgical robotic arm includes: a delivery tube for holding the hemostatic powder; a valve disposed at a distal end of the delivery tube configured to open at a predetermined opening pressure; a vibration device, such as an ultrasonic vibration device, configured to shake the hemostatic powder out of the delivery tube when the valve is open; Equipped with.

[0166] A laparoscopic applicator comprising a vibration device is shown in Figures 27-29. If the applicator comprises a vibration device, the applicator may further comprise a clock configured to measure the elapsed time when the vibration device is activated / vibrating. The elapsed time may be used to estimate the remaining amount of hemostatic powder in the delivery tube. Alternatively, the applicator may comprise one of the sensors described above for determining the amount of material in the applicator.

[0167] The laparoscopic applicator is configured to dispense or draw a substance including a hemostatic agent, which may be in the form of a liquid, a paste, or a powder. Due to the flow characteristics of the powder, the pressure source or drive mechanism for transporting the hemostatic powder through the delivery tube and out of the delivery tube preferably comprises a combination of a variable speed feeder, such as a screw conveyor, or a vibrating device, in combination with a pressure source, such as a gas pressure source.

[0168] If the medical substance is a powder, such as a hemostatic powder, the pressure source is not necessarily required, since the powder can be discharged from the applicator by other means. In this case, the applicator can include, as an alternative or additional form of pressure source, a variable speed feeder configured to transport the hemostatic powder through the delivery tube to the outside of the delivery tube, whereby the hemostatic powder is dispensed from the applicator. Alternatively, the applicator may include a vibration device for shaking the powder out of the applicator. However, preferably, the variable speed feeder further includes a pressure source, such as a gas pressure source, to obtain, for example, sufficient flow characteristics and spray angle for efficient and precise discharge of the powder.

[0169] FIG. 31 shows an embodiment of an applicator according to the present disclosure, where the applicator 1 comprises a gas pressure source 8 for transporting powder through a delivery tube. For example, the gas pressure source is a bellows, which is actuated by a motorized piston 10.1, e.g., a piston that oscillates back and forth horizontally, as shown by the large double arrow. (A) shows a perspective view of the applicator, and (B) shows a cross-sectional view of the applicator. The drive mechanism of the pressure source can be actuated by an actuator 2.6, such as an electric actuator, which sends an electric signal to the motor 10.1, as shown in FIG. 31A, whereby the powder 20 is dispensed from the distal end 2.2 of the delivery tube. The powder may be pre-loaded in the applicator or supplied from a second substance reservoir 24.2 via an auxiliary connector element 25, or the bellows may comprise a substance reservoir, such as a reservoir of powder 20, such that the powder is transported simultaneously with the gas pressure source, as shown in FIG. 31B.

[0170] FIG. 32 shows an embodiment of an applicator according to the present disclosure, comprising a gas pressure source 8 for transporting powder 20 through a delivery tube, the gas pressure source being obtained via an electric propeller and optionally a gas inlet. (A) shows a perspective view of the applicator, and (B) shows a cross-sectional view of the applicator. The drive mechanism of the pressure source can be actuated by an actuator 2.6, such as an electric actuator, which sends an electric signal to a motor 10.1, as shown in FIG. 32A, whereby powder 20 is dispensed from the distal end 2.2 of the delivery tube. Powder can be pre-loaded in the applicator or can be supplied from a second substance reservoir 24.2 via an auxiliary connector element 25.

[0171] FIG. 33 shows one embodiment of an applicator according to the present disclosure, comprising a pressure source for transporting powder through a delivery tube, the pressure source being a distally located piston or actuator 2.6 having an aperture for establishing fluid communication to the distal end 2.2 of the delivery tube. The distally located piston can be motorized to oscillate back and forth horizontally at 10.1, as indicated by the large double arrow, whereby powder 20 is dispensed from the distal end 2.2 of the delivery tube. (A) shows a partial perspective view of the distal end enlarged in an inserted frame, and (B) shows a cross-sectional view of the distal end enlarged in a perspective view in an inserted frame. Powder may be pre-loaded in the applicator or may be supplied from a second substance reservoir via an auxiliary connector element.

[0172] FIG. 34 shows one embodiment of an applicator according to the present disclosure, comprising a gas pressure source for transporting powder through a delivery tube, the gas pressure source being derived from a rotating paddle wheel or impeller. The impeller may be further controlled by a gas cartridge 8.2 in combination with a gas flow control valve, for example in combination with a connector 6. Thus, powder supply may be controlled by the rotational speed of the impeller and gas cartridge supply. Powder may be pre-loaded within the applicator or may be supplied from a first or second material reservoir 24, such as contained within the impeller, as shown most clearly in FIG. 34B.

[0173] In an embodiment of the present disclosure, the variable speed feeder further comprises a pressure source, such as a gas pressure source, optionally selected from the group of a gas cartridge, a motorized bellows, a motorized propeller, a motorized compressor, and combinations thereof. In an embodiment of the present disclosure, the variable speed feeder comprises a powder reservoir, the reservoir optionally comprising a reservoir feed control, such as an adjustable reservoir opening.

[0174] To efficiently and precisely eject the powder, e.g. to obtain sufficient flow characteristics and spray angle, the gas pressure source preferably provides the possibility of reducing the gas flow, e.g. reducing the air flow or reducing the air volume, so that the powder ejection is more controlled and powder turbulence during ejection is avoided. This can be obtained by an applicator equipped with a flow restricting element to reduce the gas flow at the powder delivery site.

[0175] Figure 35 shows one embodiment of an applicator according to the present disclosure, where the applicator 1 comprises a gas pressure source 8 for transporting powder through a delivery tube and an additional flow restricting element for reducing gas flow at the powder delivery site. For example, the flow restricting element 22 may be a grid or slit element in the delivery tube through which the powder 20 and gas must pass, as shown in Figure 35A. Alternatively, the flow restricting element 22 may be a separate gas flow path running parallel to the screw conveyor 19 transporting the powder 20, as shown in Figure 35B.

[0176] In one embodiment of the present disclosure, the variable rate feeder includes one or more flow restricting elements, such as a grid element or separate gas flow passages.

[0177] Further details of the invention 1. A laparoscopic applicator for dispensing or withdrawing a substance, e.g., a hemostatic agent, at a selected site by a surgical robotic arm, comprising: a delivery tube for holding the substance; spatially navigated by a robotic arm; and / or Controllably releasing the substance from the delivery tube by a robotic arm; and / or Controllably drawing a substance from a selected site into a delivery tube an applicator tip connected to a distal end of the delivery tube; A laparoscopic applicator comprising: 2. The laparoscopic applicator of item 1, wherein the delivery tube comprises at least one rigid portion, such as a rigid tubular portion or a rigid surface region. 3. The laparoscopic applicator of item 2, wherein at least one rigid portion is dimensioned to be tangible by a robotic arm, such as by grasping, pushing, or attaching. 4. The laparoscopic applicator of any one of items 1 to 3, wherein the delivery tube comprises a deformable portion. 5. A laparoscopic applicator according to item 4, wherein the deformable portion is compressible, for example in the form of a corrugated tube, so that the length of the tube can be changed. 6. A laparoscopic applicator according to any one of items 4 to 5, wherein the deformable portion has a corrugated surface profile, preferably the corrugated surface profile has a plurality of circumferential folds. 7. The laparoscopic applicator of any one of items 4 to 6, wherein the deformable portion is disposed at a distal end of the delivery tube. 8. The laparoscopic applicator of any one of items 4 to 6, wherein the deformable portion is positioned a distance from the distal end of the delivery tube. 9. A laparoscopic applicator according to any one of items 1 to 8, wherein the delivery tube and / or applicator tip are dimensionally configured to hold a substance under pressure and / or are configured to include one or more flow control elements. 10. A laparoscopic applicator according to any one of items 1 to 9, wherein the delivery tube and / or applicator tip has an inner diameter of less than 5 mm, preferably less than 3 mm, and even more preferably less than 2 mm. 11. A laparoscopic applicator according to any one of items 1 to 10, wherein the delivery tube contains a substance, such as a substance including a hemostatic agent, said substance being in the form of a liquid, a paste, or a powder. 12. The laparoscopic applicator according to item 11, wherein the substance comprises a bioactive agent and / or a hemostatic agent. 13. The laparoscopic applicator according to item 11, wherein the substance comprises a material selected from the group of polyethylene glycol (PEG), cyanoacrylate, oxidized regenerated cellulose, microporous polysaccharide spheres, and microfibrillar collagen. 14. The laparoscopic applicator according to item 11, wherein the substance is a hemostatic paste containing a hemostatic agent. 15. The laparoscopic applicator according to item 14, wherein the hemostatic agent is selected from the group of thrombin and fibrinogen. 16. The laparoscopic applicator according to item 11, wherein the substance is a hemostatic powder. 17. The laparoscopic applicator of item 16, wherein the hemostatic powder comprises particles having a particle size greater than 180 microns. 18. The laparoscopic applicator of any one of items 16-17, wherein the hemostatic powder comprises particles having an average particle size of at least 275 microns. 19. The laparoscopic applicator of any one of items 16-18, wherein the hemostatic powder comprises particles having a tap density of at least 0.4 g / mL. 20. A laparoscopic applicator as described in any one of items 16 to 19, further comprising a variable speed feeder, such as a screw conveyor, configured to transport the hemostatic powder through the delivery tube to the outside of the delivery tube, whereby the hemostatic powder is dispensed from the applicator. 21. The laparoscopic applicator according to item 20, wherein the variable speed feeder is configured to be driven / rotated by an external motor. 22. The laparoscopic applicator of item 20, further comprising a motor for driving / rotating the variable speed feeder. 23. The laparoscopic applicator according to any one of items 20 to 21, wherein the variable speed feeder is a screw conveyor. 24. The laparoscopic applicator of any one of items 20-21, wherein the variable speed feeder is a paddle wheel. 25. The laparoscopic applicator of any one of items 20-24, wherein the variable speed feeder further comprises a gas pressure source optionally selected from the group of a gas cartridge, a motorized bellows, a motorized propeller, a motorized compressor, and combinations thereof. 26. A laparoscopic applicator according to any one of items 20 to 25, wherein the variable speed feeder comprises a powder reservoir, the reservoir optionally comprising an adjustable reservoir opening and / or a reservoir feeding control, such as a paddle wheel. 27. A laparoscopic applicator according to any one of items 20 to 26, wherein the variable speed feeder comprises one or more flow restricting elements, such as grid elements or separate gas flow paths. 28. The laparoscopic applicator of any one of items 20 to 27, further comprising a first position sensor configured to determine a position of the variable speed feeder. 29. The laparoscopic applicator according to item 28, wherein the first position sensor is an optical sensor. 30. A laparoscopic applicator according to item 28, wherein the variable speed feeder is provided with a magnet and the first position sensor is a magnetic sensor configured to detect the presence of the magnet. 31. A laparoscopic applicator according to any one of items 16 to 30, further comprising a vibration device, such as an ultrasonic vibration device, configured to shake the hemostatic powder out of the delivery tube. 32. The laparoscopic applicator according to item 31, further comprising a clock configured to measure the elapsed time when the vibration device is activated / vibrating. 33. The laparoscopic applicator according to item 32, wherein the elapsed time is used to estimate the remaining amount of hemostatic powder in the delivery tube. 34. The laparoscopic applicator of any one of items 1-33, wherein the delivery tube comprises multiple lumens, such as at least two lumens, or at least three lumens, or at least four lumens. 35. The laparoscopic applicator of item 34, wherein the multiple lumens comprise a first lumen and a second lumen, the first lumen configured to accommodate a substance, such as a hemostatic agent, and the second lumen configured to accommodate electrical wiring or optical fibers. 36. A laparoscopic applicator according to item 35, wherein the inner diameter of the first lumen is less than 4 mm, preferably less than 3 mm, and even more preferably less than 2 mm. 37. A laparoscopic applicator according to any one of items 34 to 36, wherein at least one of the multiple lumens is configured to accommodate a malleable wire or rod. 38. A laparoscopic applicator as described in any one of items 4 to 37, further comprising a malleable wire or rod configured to enable the deformable portion of the delivery tube to be bent into a desired shape, said shape being substantially maintained upon release of the delivery tube. 39. A laparoscopic applicator according to any one of items 4 to 38, wherein the deformable portion of the delivery tube can be bent along two planes at two predetermined angles, such as at least 30° or at least 45°. 40. A laparoscopic applicator according to any one of items 1 to 39, wherein the applicator tip is removably attached to the distal end of the delivery tube. 41. A laparoscopic applicator according to any one of items 1 to 40, wherein the applicator tip is integrated into the delivery tube such that the delivery tube and the applicator tip are a single unit. 42. The laparoscopic applicator of any one of items 1-41, wherein the delivery tube and / or the applicator tip are disposable. 43. A laparoscopic applicator according to any one of items 1 to 42, wherein the applicator or applicator tip further comprises at least one valve configured to release the substance from the delivery tube upon opening of the valve. 44. The laparoscopic applicator of item 44, wherein at least one valve is a pressure-activated valve having a predetermined opening pressure threshold. 45. The laparoscopic applicator of item 44, wherein the substance is dispensed from the delivery tube when a predetermined opening pressure threshold is exceeded. 46. ​​A laparoscopic applicator according to any one of items 43 to 453, wherein at least one valve is controllable by an actuator disposed on the applicator. 47. A laparoscopic applicator according to any one of items 43 to 46, wherein at least one valve is controllable by an external actuator, such as a foot pedal. 48. The laparoscopic applicator of any one of items 43-47, wherein at least one valve is selected from the group of a one-way valve, an elastomeric one-way valve, a duckbill valve, a cross slit valve, and a spring-loaded check valve. 49. A laparoscopic applicator according to any one of items 43 to 48, wherein at least one valve is disposed within the delivery tube. 50. A laparoscopic applicator according to any one of items 43 to 49, wherein at least one valve is disposed at the applicator tip. 51. A laparoscopic applicator according to any one of items 1 to 50, wherein the applicator or applicator tip further comprises at least one actuator configured to open / close at least one valve. 52. A laparoscopic applicator according to item 51, wherein at least one actuator is configured to be actuated by pressure applied, e.g., by a robotic arm, or by electric current applied, e.g., by an energy tool. 53. A laparoscopic applicator according to any one of items 51-52, wherein at least one actuator is actuated by pulling the actuator along the longitudinal axis of the tube / applicator tip and / or by rotating the actuator about the longitudinal axis. 54. A laparoscopic applicator according to any one of items 51 to 53, wherein at least one actuator is disposed at a distal end of the delivery tube. 55. A laparoscopic applicator according to any one of items 51 to 54, wherein at least one actuator is disposed on a rigid portion of the delivery tube. 56. A laparoscopic applicator according to any one of items 51 to 55, wherein at least one actuator is disposed at the applicator tip. 57. A laparoscopic applicator according to any one of items 51 to 56, wherein at least one actuator is disposed on an external device. 58. A laparoscopic applicator according to any one of items 51 to 57, wherein at least one actuator is a pressure sensitive button. 59. A laparoscopic applicator according to any one of items 51 to 58, wherein at least one actuator covers a predetermined circumferential portion of the tube and / or applicator tip. 60. A laparoscopic applicator according to item 59, wherein at least one actuator covers less than 180°, preferably less than 140°, of the circumference of the tube and / or applicator tip. 61. A laparoscopic applicator according to any one of items 59 to 60, wherein two actuators are provided on opposing portions of the applicator tip and / or tube, each of said actuators covering less than 120° of the circumference of the tube and / or applicator tip, preferably less than 90° each. 62. A laparoscopic applicator according to any one of items 59-61, wherein at least one actuator covers at least 180° of the circumference of the tube and / or applicator tip. 63. A laparoscopic applicator according to any one of items 59 to 62, wherein at least one actuator covers 360° of the circumference of the tube and / or applicator tip such that at least one actuator surrounds a portion of the tube and / or applicator tip. 64. A laparoscopic applicator according to any one of items 51 to 63, wherein at least one actuator is configured to send an electrical signal to a pressure source, such as a drive mechanism, configured to exert sufficient pressure, upon actuation, to dispense a substance from the laparoscopic applicator. 65. A laparoscopic applicator according to any one of items 1 to 64, further comprising a first pressure sensor for sensing pressure within the delivery tube. 66. A laparoscopic applicator according to any one of items 51 to 65, further comprising a second pressure sensor for sensing pressure applied to the actuator. 67. A laparoscopic applicator according to item 66, wherein the second pressure sensor is a resistive pressure sensor and / or a force sensing resistor. 68. A laparoscopic applicator according to any one of items 51 to 67, wherein at least one actuator is a pressure sensitive button and a pressure sensor for sensing pressure applied to the actuator is incorporated into or located beneath the button. 69. A laparoscopic applicator according to any one of items 51 to 68, wherein at least one actuator is a pressure-sensitive button covering a portion of the applicator tip, said portion surrounding the entire circumference of the applicator tip, and a second pressure sensor for sensing pressure applied to the actuator is incorporated into or located beneath the button. 70. The laparoscopic applicator of any one of items 51 to 69, further comprising a pressure indicator light for indicating pressure applied to at least one actuator. 71. A laparoscopic applicator according to item 70, wherein the pressure indicator light is located within or on the applicator tip. 72. A laparoscopic applicator according to any one of items 70-71, wherein the pressure indicator lights are provided as a circular band disposed around the circumference of the applicator tip. 73.The pressure indicator light is displaying a first color, e.g., green light, when the applied pressure falls below a first predetermined threshold; and When the applied pressure exceeds a second predetermined threshold, a second color, e.g., a red light, is displayed. The laparoscopic applicator according to any one of items 70 to 72, configured as follows: 74.The pressure indicator light is When the applied pressure is between a first and a second predetermined threshold, display a third color, e.g., a yellow light. Item 74. The laparoscopic applicator of item 73, further configured as follows: 75. A laparoscopic applicator according to any one of items 1 to 74, wherein the applicator or applicator tip further comprises a status indicator, for example in the form of a light diode, said status indicator configured to indicate the amount of substance remaining in the applicator. 76. The laparoscopic applicator of item 75, wherein the remaining amount is determined by a first position sensor, a second position sensor, a clock, and / or a combination thereof. 77. A laparoscopic applicator as described in any one of items 75 to 76, further comprising at least one fluid source having a plunger in a barrel, the position of the plunger being used to estimate the amount of substance remaining in the delivery tube, the amount remaining being indicated by a status indicator. 78. A laparoscopic applicator according to any one of items 75-77, wherein a status indicator is disposed within or on the applicator tip. 79. The delivery tube comprises a first light-sensitive sensor configured to sense light in a predetermined wavelength range passing through the delivery tube; and the delivery tube comprises a light source disposed opposite the first light-sensitive sensor; and / or the delivery tube is transparent to at least a portion of the wavelength range; Item 79. A laparoscopic applicator according to any one of items 1 to 78. 80. The applicator according to item 79, wherein the first light-sensitive sensor is disposed in a distal portion of the delivery tube. 81. An applicator according to any one of items 79 to 80, wherein the delivery tube is provided with a second light-sensing sensor positioned farther from the distal end than the first light-sensing sensor. 82. A laparoscopic applicator as described in any one of items 1 to 81, wherein the applicator tip further comprises a rigid portion configured to be grasped by a robotic arm. 83. A laparoscopic applicator according to any one of items 1 to 82, wherein the applicator tip further comprises an adjustable nozzle for adjusting the dispensing rate and / or dispensing angle of the substance. 84. The laparoscopic applicator of any one of items 1 to 83, further comprising at least one fluid source for holding fluid, the fluid source in fluid connection with the delivery tube. 85. A laparoscopic applicator according to item 84, wherein the at least one fluid source is a syringe, such as a medical syringe, for example a single-use medical syringe. 86. A laparoscopic applicator according to item 85, wherein the syringe comprises a barrel for holding the fluid and a plunger for expelling the fluid from the syringe. 87. The laparoscopic applicator of item 86, further comprising a second position sensor configured to determine a position of the plunger. 88. The laparoscopic applicator according to item 87, wherein the second position sensor is an optical sensor. 89. A laparoscopic applicator according to item 87, wherein the plunger is provided with a magnet, and the second position sensor is a magnetic sensor configured to detect the presence of the magnet. 90. A laparoscopic applicator according to any one of items 87 to 89, wherein the position of the plunger is used to estimate the amount of substance remaining in the barrel and / or delivery tube. 91. The laparoscopic applicator according to item 84, wherein the at least one fluid source is a container, such as a vessel configured to be pressurized. 92. The laparoscopic applicator according to item 84, wherein at least one fluid source is a flexible balloon. 93. A laparoscopic applicator according to any one of items 84 to 92, comprising at least one connector, such as a luer lock, a compression joint, and / or an adhesive joint, for removably attaching at least one fluid source. 94. A laparoscopic applicator as described in item 93, wherein at least one connector comprises a hollow piercing element for piercing at least one fluid source, thereby establishing a fluid connection between the fluid source and the delivery tube. 95. A laparoscopic applicator according to any one of items 84 to 92, wherein at least one fluid source comprises a liquid, such as saline. 96. The laparoscopic applicator of any one of items 84-95, wherein at least one fluid source includes a paste, such as a hemostatic paste including a hemostatic agent. 97. A laparoscopic applicator according to any one of items 84 to 96, wherein at least one fluid source includes a gas. 98. A laparoscopic applicator according to item 97, wherein the gas is selected from the group of CO2 (carbon dioxide), N2 (dinitrogen), N2O (nitrous oxide), and air. 99. A laparoscopic applicator according to any one of items 84 to 97, wherein the delivery tube and the at least one fluid source contain the same substance, such as a substance comprising a hemostatic agent, and the substance is provided in the form of a liquid, a paste, or a powder, such that the at least one fluid source constitutes a first substance reservoir. 100. The laparoscopic applicator of item 99, wherein the first substance reservoir comprises a barrel for holding the substance and a piston for expelling the substance from the barrel. 101. The laparoscopic applicator according to item 100, wherein the barrel has a diameter of 10 to 30 mm, more preferably 12 to 20 mm, and most preferably 14 to 18 mm. 102. A laparoscopic applicator according to any one of items 99 to 101, comprising one or more second substance reservoirs. 103. A laparoscopic applicator according to any one of items 99-102, wherein the second substance reservoir is removably attached to the first substance reservoir via at least one auxiliary connector element. 104. The laparoscopic applicator according to item 103, wherein the auxiliary connector element comprises a luer lock, a compression joint, or an adhesive joint. 105. A laparoscopic applicator according to any one of items 103 to 104, wherein the auxiliary connector element is configured to establish a continuous fluid connection between 1) the first substance reservoir and the second substance reservoir, and 2) between the first substance reservoir and the delivery tube. 106. A laparoscopic applicator according to any one of items 103 to 105, wherein the auxiliary connector element is adapted to have a first configuration providing a fluid passage between the first substance reservoir and the second substance reservoir, and a second configuration providing a fluid passage between the first substance reservoir and the delivery tube. 107. A laparoscopic applicator according to any one of items 103 to 106, wherein the auxiliary connector element comprises at least one one-way valve. 108. A laparoscopic applicator according to any one of items 99 to 107, wherein the first and / or second substance reservoirs are disposable. 109. A laparoscopic applicator according to any one of items 84 to 108, wherein at least one fluid source is configured to be pressurized, for example by use of a pressure source. 110. A laparoscopic applicator according to any one of items 84 to 109, comprising at least two fluid sources. 111. A laparoscopic applicator according to any one of items 1-110, wherein the delivery tube is configured to hold a substance under pressure or to hold a pressurized substance. 112. A laparoscopic applicator according to any one of items 1 to 111, further comprising at least one pressure source configured to apply pressure to the at least one fluid source and / or to apply pressure to the inside of the delivery tube, such as to a substance within the delivery tube. 113. The laparoscopic applicator according to item 112, wherein the delivery tube is configured to be filled with the substance from a distal end. 114. A laparoscopic applicator according to item 113, wherein the delivery tube comprises one or more detachably attached connectors for a substance reservoir and / or a flow control element. 115. A laparoscopic applicator according to any one of items 112 to 114, wherein the at least one pressure source is a spring configured to exert pressure on the at least one fluid source and / or substance within the delivery tube. 116. A laparoscopic applicator according to item 115, wherein the spring energy is pre-stored and / or the spring energy is stored upon loading of the delivery tube. 117. A laparoscopic applicator according to any one of items 112 to 114, wherein the at least one pressure source is at least one fluid source and / or gas configured to exert pressure on a substance in the delivery tube. 118. The laparoscopic applicator according to item 116, wherein the source of gas pressure is selected from the group of a gas cartridge, a motorized bellows, a motorized propeller, a motorized compressor, and combinations thereof. 119. A laparoscopic applicator according to items 112 to 118, wherein at least one pressure source comprises a propellant selected from the group of a spring-loaded element, a gaseous propellant, an inflatable balloon or bladder, and / or a movable piston, such as an electrically driven piston or a manually driven piston. 120. A laparoscopic applicator according to items 112 to 119, wherein the at least one pressure source is a drive mechanism selected from the group of a manual piston, an electric piston, a spring force, and a gas pressure such as a motor having at least one piston configured to exert pressure on the at least one fluid source. 121. The laparoscopic applicator according to item 120, wherein the drive mechanism is an electric motor. 122. A laparoscopic applicator according to any one of items 120 to 121, wherein at least one actuator, when activated, is configured to send an electrical signal to the drive mechanism, such that upon receipt of the electrical signal, the drive mechanism is configured to exert pressure on at least one fluid source to dispense a substance from the laparoscopic applicator. 123. A laparoscopic applicator according to any one of items 120 to 122, wherein the drive mechanism comprises two pistons, the first piston configured to exert a first pressure on a first fluid source and the second piston configured to exert a second pressure on a second fluid source. 124. The laparoscopic applicator according to item 123, wherein the drive mechanism includes a switching mechanism, such as a gear mechanism, configured to switch the operation of the first piston and / or the second piston. 125. A laparoscopic applicator according to any one of items 120 to 124, wherein the drive mechanism further comprises a directional control configured to control the direction (forward or backward) of at least one piston. 126. The laparoscopic applicator of any one of items 1-125, further comprising a rigid sheath surrounding at least a portion of the delivery tube, the sheath configured to allow the delivery tube to be inserted into the trocar. 127. At least one fluid source for holding a fluid, in fluid communication with the delivery tube; and / or At least one pressure source configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube. Item 127. The laparoscopic applicator of any one of items 1 to 126, further comprising a driver unit for holding the laparoscopic applicator. 128. A laparoscopic applicator as described in item 127, comprising a syringe having a barrel for holding a substance fluid and a plunger for pushing the fluid out of the syringe and / or drawing the substance into the syringe, the driver unit being configured to receive and hold the syringe. 129. The laparoscopic applicator of item 128, wherein the driver unit is further configured to draw the plunger to draw the substance into the applicator. 130. A laparoscopic applicator according to any one of items 1 to 129, wherein the delivery tube and / or at least one fluid source is disposable. 131. A laparoscopic applicator according to any one of items 1 to 130, further comprising a safety mechanism configured to switch between two modes (on / off), the "off mode" meaning that no substance can be released from the applicator and the "on mode" meaning that the substance can be released. 132. The laparoscopic applicator according to item 131, wherein the safety mechanism is located on the delivery tube or the applicator tip or the driver unit. 133. The laparoscopic applicator of any one of items 1-132, further comprising a flow controller configured to control the flow rate of the substance emitted from the applicator. 134. The laparoscopic applicator according to item 133, wherein the flow controller is disposed within the driver unit. 135. A laparoscopic applicator tip for connection to a laparoscopic delivery tube for holding a substance, such as a substance containing a hemostatic agent, comprising: at least one valve configured to release the substance from the delivery tube upon opening of the valve; at least one actuator configured to open / close at least one valve; 1. A laparoscopic applicator tip comprising: 136. The laparoscopic applicator tip of item 135, wherein at least one valve is configured to retain and release a substance under pressure. 137. A laparoscopic applicator tip according to any one of items 135 to 136, further comprising a pressure sensor, such as a resistive pressure sensor, for sensing pressure applied to the actuator. 138. The laparoscopic applicator tip of any one of items 135 to 137, further comprising a pressure indicator light for indicating pressure applied to at least one actuator. 139. A laparoscopic applicator tip according to any one of items 135 to 138, further comprising a status indicator, for example in the form of a light diode, the status indicator configured to indicate the amount of substance remaining in the delivery tube. 140. A laparoscopic applicator tip according to any one of items 135 to 139, further comprising a rigid portion configured to be grasped by a robotic arm. 141. A laparoscopic applicator tip according to any one of items 135 to 140, further comprising an adjustable nozzle for adjusting the dispensing rate and / or dispensing angle of the substance. 142. A laparoscopic applicator for distributing or withdrawing a substance, such as a hemostatic agent-containing substance, to a selected site by a surgical robotic arm, comprising: a delivery tube for holding the substance; 142. The applicator tip according to any one of items 135 to 141, connected to a distal end of a delivery tube, spatially navigated by a robotic arm; and / or Controllably releasing the substance from the delivery tube by the robotic arm or controllably drawing the substance from the selected site into the delivery tube. The applicator tip portion and A laparoscopic applicator comprising: 143. A kit of parts comprising a laparoscopic applicator according to any one of items 1 to 134, one or more pressure sources, and optionally one or more fluid sources, such as one or more substance reservoirs. 144. The kit of parts according to item 143, wherein the substance reservoir is one or more syringes configured to be filled with the substance and configured to form a fluid connection to a delivery tube, preferably a distal opening of the delivery tube. 145. A kit of parts according to any one of items 143 to 144, wherein the pressure source is one or more gas cartridges configured to form a fluid connection to a delivery tube, preferably a proximal opening of the delivery tube. 146. A kit of parts according to any one of items 143 to 145, wherein the pressure source is integrated into the applicator, and optionally the pressure source is a spring at the proximal end of the delivery tube. 147. A laparoscopic applicator according to any one of items 1 to 134; at least one fluid source for holding a fluid in fluid communication with the delivery tube; and / or At least one pressure source, such as a motor, configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube A driver unit to hold the A kit of parts comprising: 148. The kit of parts according to item 147, further comprising at least one fluid source for holding a fluid, said fluid source in fluid communication with the delivery tube. 149. The kit of parts of any one of items 147-148, further comprising at least one pressure source configured to apply pressure to the at least one fluid source and / or configured to apply pressure to the inside of the delivery tube. 150. The kit of parts of any one of items 147 to 149, further comprising at least one fluid source, the fluid source being a syringe having a plunger, and the driver unit further comprising a position sensor configured to determine a position of the plunger. 151. The kit of parts of any one of items 147-150, wherein the driver unit is configured to hold at least two fluid sources, such as at least two syringes. 152. Use of a laparoscopic applicator according to any one of items 1 to 134 to dispense a substance from the applicator, such as a substance comprising a hemostatic agent. [Explanation of symbols]

[0178] 1 Laparoscopic applicator 2 Delivery Tube 2.1 Proximal End 2.2 Tip 2.3 Transformable Parts 2.4 Rigid surfaces 2.5 Rigid surface opening 2.6 Actuators 2.7 Valves 2.8 Rigid parts 3 Hard sheath 4 substances 5. Surgical Robot Arm 6 Connectors 7 Fluid source 8. Pressure Source 8.1 Propellant 8.2 Gas Cartridges 8.3 Springs 9 Applicator tip 10 Driver unit 10.1 Motor 11 Flow Controller 12 Pressure indicator light 13 Status Indicators 14 First Lumen 15 Second Lumen 16 Third Lumen 17 Fourth Lumen 18 Malleable Wire / Rod 19 Screw Conveyor 20 Hemostatic powder 21 Vibration device 22 Flow Restriction Elements 24 Material Reservoir 24.1 First substance reservoir 24.2 Secondary Material Reservoir 25 Auxiliary Connector Element 26 Flow Control Elements

Claims

1. A laparoscopic applicator (1) for dispensing a substance (4) including a hemostatic agent for stopping bleeding at a selected site by an external robotic arm (5) for surgery, said laparoscopic applicator (1) comprising: a delivery tube (2) configured to hold said substance (4); an applicator tip (9) connected to the distal end (2.2) of said delivery tube (2) and configured to hold said substance under pressure, is spatially steered by the external robotic arm (5); and Controllably releasing the substance (4) from the delivery tube (2) at the applicator tip by the external robotic arm (5). an applicator tip (9) configured to be controllably operated by said external robotic arm (5) by A laparoscopic applicator (1).

2. The laparoscopic applicator (1) of claim 1, wherein the delivery tube (2) and / or the applicator tip (9) have an inner diameter of less than 5 mm.

3. 3. The laparoscopic applicator (1) of claim 1 or 2, wherein the applicator tip (9) further comprises at least one valve (2.7) configured to release the substance (4) from the delivery tube (2) upon opening of the valve (2.7).

4. 4. The laparoscopic applicator (1) of claim 3, wherein the applicator tip (9) further comprises at least one actuator (2.6) configured to open and / or close the at least one valve (2.7).

5. 5. The laparoscopic applicator (1) of claim 4, wherein the at least one actuator (2.6) is actuated by pulling the actuator (2.6) along the longitudinal axis of the tube (2) / applicator tip (9) and / or by rotating the actuator (2.6) around the longitudinal axis.

6. 6. A laparoscopic applicator (1) according to claim 4 or 5, wherein the at least one actuator (2.6) is configured to transmit an electrical signal to a pressure source (8) configured to exert a pressure sufficient to dispense the substance (4) from the laparoscopic applicator (1) upon actuation.

7. A laparoscopic applicator (1) according to any one of claims 1 to 6, wherein the applicator tip (9) further comprises a status indicator (13), the status indicator (13) being configured to indicate the amount of substance (4) remaining within the applicator (1).

8. The laparoscopic applicator (1) according to any one of claims 1 to 7, further comprising at least one fluid source (7) for holding a fluid, said fluid source (7) being in fluid connection with said delivery tube (2).

9. 9. The laparoscopic applicator (1) of claim 8, wherein the delivery tube (2) and the at least one fluid source (7) are configured to contain the same substance (4), such that the at least one fluid source (7) constitutes a first substance reservoir (24.1).

10. 10. The laparoscopic applicator (1) according to claim 9, comprising one or more second substance reservoirs (24.2), said second substance reservoirs (24.2) being detachably attached to said first substance reservoir (24.1) via at least one auxiliary connector element (25).

11. Laparoscopic applicator (1) according to any one of claims 8 to 10, wherein the at least one fluid source (7) is configured to be pressurized.

12. A laparoscopic applicator (1) according to any one of claims 8 to 11, further comprising at least one pressure source (8) configured to apply pressure to the at least one fluid source (7) and / or configured to apply pressure to the inside of the delivery tube (2).

13. The laparoscopic applicator (1) according to claim 12, wherein the at least one pressure source (8) is a drive mechanism selected from the group of a manual piston, a motorized piston, a spring force, and gas pressure.

14. A kit of parts comprising a laparoscopic applicator (1) according to any one of the preceding claims and one or more pressure sources (8).

15. A laparoscopic applicator (1) according to any one of claims 1 to 13, At least one fluid source (7) for holding a fluid, in fluid connection with said delivery tube (2); and / or At least one pressure source (8) configured to apply pressure to the at least one fluid source (7) and / or configured to apply pressure inside the delivery tube (2); A driver unit (10) for holding the A kit of parts comprising:

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