[go: up one dir, main page]

WO1996037157A1 - Dispositif de fasciotomie - Google Patents

Dispositif de fasciotomie Download PDF

Info

Publication number
WO1996037157A1
WO1996037157A1 PCT/US1996/007719 US9607719W WO9637157A1 WO 1996037157 A1 WO1996037157 A1 WO 1996037157A1 US 9607719 W US9607719 W US 9607719W WO 9637157 A1 WO9637157 A1 WO 9637157A1
Authority
WO
WIPO (PCT)
Prior art keywords
cutting surface
longitudinal axis
distal end
body member
cutting
Prior art date
Application number
PCT/US1996/007719
Other languages
English (en)
Inventor
John M. Levin
Original Assignee
Levin John M
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Levin John M filed Critical Levin John M
Priority to AU58780/96A priority Critical patent/AU5878096A/en
Publication of WO1996037157A1 publication Critical patent/WO1996037157A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes

Definitions

  • This invention relates generally to the field of medical devices, more particularly, to cutting devices for cutting the fascia during laparoscopic surgery.
  • the removal of body parts during laparoscopic surgery requires the removed body part (e.g., gallbladder) to be pulled through the fascia as well as the skin.
  • the fascia is a fibrous membrane covering, supporting and separating muscles. It also unites the skin with underlying tissue. Since fascia may be superficial (nearly subcutaneous covering permitting free movement of the skin) or deep (enveloping and binding muscles) , closing incisions therein may be much more difficult than closing incisions in the skin. It is, therefore, advantageous to be able to create an opening in the fascia that is large enough to allow passage of the body part to be removed while minimizing the size of the opening in the fascia. Moreover, it is extremely important that the device used to cut the fascia does not puncture the body part to be removed, nor any underlying or surrounding body parts during insertion, cutting of the fascia and removal of the device.
  • the apparatus disclosed by Shutt is a retractable surgical instrument with a curved operative element. This device permits the cutting surfaces to be in a retracted condition until correct placement is made within the patient's body. Upon extension of the curved operative element, there is provided a predetermined transverse curve for cutting in a transverse direction.
  • the apparatus disclosed by Kajiyama is a surgical cutter having a closed distal end with a cut-out in an outer tubular member.
  • An air-driven piston is used to reciprocate the blade longitudinally, in and out of the cut-out portion, to cut tissue disposed at the cut-out portion.
  • the apparatus disclosed by Mueller et al. is a catheter for making intravascular incisions.
  • the catheter has a distal end that drives a cutting blade outward from the longitudinal axis of the catheter adjacent the location of stenosis (constriction or narrowing of a passage or orifice) .
  • the catheter is then translated within the vessel so that the blade cuts through the blockage.
  • the apparatus disclosed by Mott is a surgical instrument for lancing strictures or other obstructions in the normal diameter of passages of internal organs.
  • the instrument comprises an elongated body member having a cutting blade disposed transversely to the longitudinal axis of the elongated body member at the distal end thereof and the cutting blade is encased in a streamlined, separable bulb controlled by a concentric housing. Upon correct positioning by the surgeon adjacent the constriction, the concentric housing is drawn back, thereby exposing the cutting blade. The elongated body member is then manually reciprocated by the surgeon to cut the constriction.
  • the apparatus comprises an elongated cylindrical body member having a proximal and a distal end and having a longitudinal axis and whereby this elongated cylindrical body member is insertable into a laparoscopic incision.
  • a recess is located intermediate of the distal end and the proximal end.
  • a cutting surface is fixed within the recess and against relative movement within said recess.
  • the distal end is curved away from the longitudinal axis in a first direction and wherein the longitudinal axis and the first direction are oriented to determine a plane such that the cutting surface is disposed in that plane.
  • Fig. 1 is an isometric view of the fasciotome
  • Fig. 2 is an enlarged view taken along line 2-2 of Fig. 1;
  • Fig. 3 is a cross-sectional view of a laparoscopic incision showing the organ being externally stabilized in preparation for fasciotome insertion
  • Fig. 4 is a cross-sectional view of a laparoscopic incision showing the fasciotome cutting the fascia
  • Fig. 5 is an enlarged view taken along line 5-5 of Fig. 4;
  • Fig. 6 is an enlarged view of the cutting blade of the fasciotome.
  • the fasciotome 20 comprises an elongated cylindrical body member 22 (e.g., 6 mm in diameter) having a handle 24 at the proximal end 26.
  • the distal end 28 of the body member 22 comprises a curved segment 30 having a blunt tip 32 used for insertion of the fasciotome 20 into the patient through the skin 34, fat 36 and through the fascia 38, as schematically shown in Fig. 4.
  • a recessed area 40 Adjacent the distal end 28 is a recessed area 40 in the body member 22 in which a cutting blade 42 (e.g., a scalpel, or serrated blade as shown in Fig. 6) is fixedly secured so that the cutting surface 44 is aligned to the longitudinal axis 46 of the cylindrical body member 22 (i.e., the cutting surface 44 is disposed in the same longitudinal direction as the longitudinal axis 46).
  • the recessed area 40 is created by removing approximately two-thirds of the cross- section of the cylindrical body member 22 at that location to form the recess 40 defined by end walls 48A and 48B.
  • the cutting blade 44 is fixedly secured within the recessed area 40 by a suitable bonding material or by any other suitable means such that the cutting surface 44 is located at approximately two-thirds the diameter of the cylindrical body member 22, as indicated by dimension 50 (Fig. 2). As such, the cutting surface 44 does not project beyond the outer surface of the elongated cylindrical body member 22.
  • the longitudinal axis 46 and a "curved segment" axis 52 intersect and thereby determine a plane, P, such that the cutting surface 44 is substantially contained in that plane, P.
  • P the plane
  • the curved segment 30 displaces surrounding tissue away from the cutting surface 44 during descent of the fasciotome 20 within the laparoscopic incision, as will be discussed below.
  • the handle 24 includes alignment indicia 54 (e.g., a vertical line) that provides the surgeon with a visual indication where the cutting blade 42 is located.
  • the line 54 indicates that the cutting surface 44 is positioned beneath the line 54, intermediate the proximal end 26 and the distal end 28.
  • a body part 56 to be removed e.g., gallbladder
  • a body part 56 to be removed e.g., gallbladder
  • a grasping device 60 e.g., a forceps
  • the surgeon then, referencing the alignment indicia 54, introduces the blunt tip 32 of the fasciotome 20 into the incision 58 so that the cutting blade 42 is positioned away from the body part 56 to be removed.
  • the fasciotome 20 is then forced downward into the incision 58, with the curved blunt tip 32 opening the incision 58 to allow passage of the distal end 28 of the cylindrical body member 22 without puncturing the body part 56 or any other adjacent body parts during descent of the fasciotome 20 within and through the incision 58. Because the cutting blade 42 is recessed and the curved segment 30 displaces the skin 34 and fat 36 away from the cutting surface 44 in the plane P, the passage of the fasciotome 20 downward through the skin 34 and the fat 36 does not allow the cutting surface 44 to engage either the skin 34 or fat 36.
  • the recessed area 40 is disposed at the fascial level 38, as shown in Fig. 4.
  • the surgeon receives a tactile indication that the fascia 38 has been engaged, i.e., passage of the fasciotome 20 through the skin 34 and fat 36 is relatively easy, whereas entry into the fascia 38 is felt by the surgeon as a tight or stiff movement of the fasciotome 20.
  • the fascia 38 conforms to the shape of the elongated cylindrical body member 22 disposed therein and, as such, the fascia 38 expands into the recessed area 40 and abuts the cutting surface 44.
  • the surgeon then begins to reciprocally translate the fasciotome 20 up and down in a sawing action to cut the fascia 38 and thereby increase the size of the fascial incision 64 just enough to remove the body part 56 through the fascial level 38. It is enough for the fascial incision 64 to be widened at only one point; hence, there is no need for the cutting blade 42 to be disengaged from the fascia 38 and the fasciotome 20 rotated in place in order to cut at another location along the fascial incision 64 to further widen that incision 64.
  • the body part 56 can be more easily removed.
  • the fasciotome 20 can be removed either prior to, or subsequent to, removal of the body part 56.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention se rapporte à un appareil (20) servant à découper le fascia (38) au cours d'une intervention laparoscopique et facilitant le retrait d'un élément interne du corps par une incision laparoscopique. L'appareil (20) permet l'insertion dans l'incision laparoscopique d'une surface de découpe (44) fixée dans un évidement, sans ponctionner l'organe à retirer, ou tout autre élément adjacent. La surface de découpe (44) fixée dans un évidement évite également le contact avec la peau (34) ou la graisse (36) au cours de sa descente dans l'incision laparoscopique, tout en venant en contact avec le fascia (38) pour le découper, une fois déposée dans l'incision.
PCT/US1996/007719 1995-05-26 1996-05-24 Dispositif de fasciotomie WO1996037157A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU58780/96A AU5878096A (en) 1995-05-26 1996-05-24 Fasciotome

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US45205095A 1995-05-26 1995-05-26
US08/452,050 1995-05-26

Publications (1)

Publication Number Publication Date
WO1996037157A1 true WO1996037157A1 (fr) 1996-11-28

Family

ID=23794811

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1996/007719 WO1996037157A1 (fr) 1995-05-26 1996-05-24 Dispositif de fasciotomie

Country Status (2)

Country Link
AU (1) AU5878096A (fr)
WO (1) WO1996037157A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8840631B2 (en) 2009-10-29 2014-09-23 Cook Medical Technologies Llc Compartment syndrome treatment method and surgical instrument for same
CN111110324A (zh) * 2020-03-09 2020-05-08 杨英果 一种用于切割臀肌挛缩筋膜的切刀

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2676595A (en) * 1953-01-21 1954-04-27 Dyekjaer Elith Gerhard Veterinary surgical knife
US3886943A (en) * 1973-08-10 1975-06-03 Aphrodite P Skiff Surgical instrument
US4273128A (en) * 1980-01-14 1981-06-16 Lary Banning G Coronary cutting and dilating instrument
SU1187800A1 (ru) * 1984-01-05 1985-10-30 Le Nii Khirurgicheskogo Tuberk Скальпель
US4685458A (en) * 1984-03-01 1987-08-11 Vaser, Inc. Angioplasty catheter and method for use thereof
DE3624243A1 (de) * 1986-07-18 1988-01-28 Wolfram Hein Skalpellklinge

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2676595A (en) * 1953-01-21 1954-04-27 Dyekjaer Elith Gerhard Veterinary surgical knife
US3886943A (en) * 1973-08-10 1975-06-03 Aphrodite P Skiff Surgical instrument
US4273128A (en) * 1980-01-14 1981-06-16 Lary Banning G Coronary cutting and dilating instrument
SU1187800A1 (ru) * 1984-01-05 1985-10-30 Le Nii Khirurgicheskogo Tuberk Скальпель
US4685458A (en) * 1984-03-01 1987-08-11 Vaser, Inc. Angioplasty catheter and method for use thereof
DE3624243A1 (de) * 1986-07-18 1988-01-28 Wolfram Hein Skalpellklinge

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8840631B2 (en) 2009-10-29 2014-09-23 Cook Medical Technologies Llc Compartment syndrome treatment method and surgical instrument for same
CN111110324A (zh) * 2020-03-09 2020-05-08 杨英果 一种用于切割臀肌挛缩筋膜的切刀

Also Published As

Publication number Publication date
AU5878096A (en) 1996-12-11

Similar Documents

Publication Publication Date Title
US6746457B2 (en) Snared suture trimmer
EP0738126B1 (fr) Aiguille pour biopsies medullaires
US5348541A (en) Suprapubic catheter placement apparatus (lyell sound)
US6689051B2 (en) Endoscope hood for mucous membrane resection
US6960164B2 (en) Obturator tip for a trocar
US6113610A (en) Device and method for suturing wound
AU653531B2 (en) Surgical cutting instrument
US6056766A (en) Stabilized trocar, and method of using same
US5549623A (en) Endodissector surgical instrument
US5433722A (en) Ligature carrier for endoscopic use
US5336237A (en) Removal of tissue from within a body cavity
JP3662377B2 (ja) 医療用針
US4779616A (en) Surgical suture-snagging method
US4883474A (en) Thoracic catheter
US4731052A (en) Method for removing tissue and living organisms
EP0567130A1 (fr) Instrument chirurgical de suture
US5453094A (en) Kit assembly for use during a laparoscopic surgical procedure
JPH08294493A (ja) 腹腔から組織等を除去するための装置
JPH09509852A (ja) 取替可能な栓子を有するトロカール
EP0591140A1 (fr) Appareil et procede de localisation d'une masse dans le sein
JPH09108233A (ja) 先端形状改良型トロカール
JP2009066388A (ja) トロカール・カニューレ
JP2008168136A (ja) カニューレ
JP3195012B2 (ja) シールド付きトロカール用インサート
US7011648B2 (en) Device for implanting catheters

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AL AM AT AU AZ BB BG BR BY CA CH CN CZ DE DK EE ES FI GB GE HU IS JP KE KG KP KR KZ LK LR LS LT LU LV MD MG MK MN MW MX NO NZ PL PT RO RU SD SE SG SI SK TJ TM TR TT UA UG UZ VN AM AZ BY KG KZ MD RU TJ TM

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): KE LS MW SD SZ UG AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL PT SE BF BJ CF CG CI CM GA GN ML

121 Ep: the epo has been informed by wipo that ep was designated in this application
REG Reference to national code

Ref country code: DE

Ref legal event code: 8642

122 Ep: pct application non-entry in european phase