SURGICAL TOOL

Abstract

A surgical tool extends in a longitudinal direction from proximal end to distal end and has a length defined by the free distance between proximal and distal ends. It includes proximal handle portion, which extends along a longitudinal handle axis towards lever portion. Said lever portion extends along longitudinal lever axis and is proximally adjacently connected to the handle portion on one hand and distally adjacently connected to foot portion on the other hand. The lever portion is positioned between the handle portion and the foot portion. The foot portion extends along a longitudinal foot axis and includes two distal tongues that extend in the longitudinal direction, such that their free distal ends point away from the handle portion. The two tongues are positioned at a distance from one another and an underside of the two tongues forms a common concave abutment surface for abutting against a pregnant woman's uterus.

Claims

1. Surgical tool for providing haemostatic compression to a pregnant woman's uterus in a caesarean section procedure during uterine incision, the tool extending in a longitudinal direction from a proximal end to a distal end and having a length defined by the free distance between said proximal and distal ends, the tool comprising a proximal handle portion extending along a longitudinal handle axis towards a lever portion, said lever portion extending along a longitudinal lever axis and being proximally adjacently connected to the handle portion and distally adjacently connected to a foot portion, said foot portion extending along a longitudinal foot axis and including a proximal foot area as well as two tongues that extend from the proximal foot area in the longitudinal direction and each have a distal free end located at the distal end of the tool, the two tongues being positioned at a distance from one another and having an underside forming a common abutment surface for pressing against a pregnant woman's uterus.

2. The surgical tool as claimed in claim 1, wherein the free distance between the two tongues is at least 1 cm.

3. The surgical tool as claimed in claim 1, wherein the two tongues each have a width of at least 0.8 cm.

4. The surgical tool as claimed in claim 1, wherein the two tongues each have a length of 4 to 8 cm.

5. The surgical tool as claimed in claim 1, wherein the abutment surface has a size of at least 4 cm.sup.2.

6. The surgical tool as claimed in claim 1, wherein the abutment surface has a longitudinal cross-sectional shape of an arc.

7. The surgical tool as claimed in claim 6, wherein a circular segment is enclosed between the arc and its pertaining chord, said segment having a height of at least 4 mm.

8. The surgical tool as claimed claim 1, wherein—when viewed in longitudinal section—the longitudinal lever axis is angularly disposed with relation to the longitudinal handle axis, the angle (α) at the intersection point being at least 10°.

9. The surgical tool as claimed in claim 1, wherein—when viewed in longitudinal section—the longitudinal lever axis is angularly disposed with relation to the longitudinal foot axis, the angle (β) at the intersection point being at least 60°.

10. The surgical tool as claimed in claim 1, wherein the vertical medial plane along the longitudinal lever axis is offset from the vertical medial plane along the longitudinal foot axis, with the two planes intersecting at the connection point of the foot portion and the lever portion.

11. The surgical tool as claimed in claim 1, wherein the lever portion is rigidly connected to the handle portion and/or the foot portion.

12. The surgical tool as claimed in claim 1, wherein the two tongues have blunt edges and blunt free ends.

13. The surgical tool as claimed in claim 1, wherein the surgical tool is made of metal or a metal alloy.

14. The surgical tool as claimed in claim 1, wherein the surgical tool is made from a medical grade plastic material.

15. The surgical tool as claimed in claim 14, wherein the tongues have a thickness of at least 0.5 cm.

Description

[0047] Preferred embodiments of the present invention will now be described, by way of example only, with reference to the accompanying drawings, in which:

[0048] FIG. 1 shows a top perspective view of an example embodiment of a surgical tool in accordance with the present invention;

[0049] FIG. 2 shows the surgical tool of FIG. 1 in a perspective view;

[0050] FIG. 3 shows the tool of FIG. 1 in a perspective view in the distal-proximal direction;

[0051] FIG. 4 shows the tool of FIG. 1 in a lateral view of; and

[0052] FIG. 5 shows the tool of FIG. 1 in a perspective bottom view.

[0053] FIG. 1 shows an embodiment of a surgical tool 10 in accordance with the present invention. The tool 10 extends in the longitudinal direction L from a distal end 12 to a proximal end 14 and comprises three main portions; a proximally located handle portion 16, a distally located foot portion 18 and a lever portion 20 that is positioned in between the other two portions 16, 18. Each portion 16, 18, 20 extends along a respective longitudinal axis, i.e. the handle portion 16 along a longitudinal handle axis LA.sub.H, the lever portion 20 along a longitudinal lever axis LA.sub.L and the foot portion 18 along a longitudinal foot axis LA.sub.F. The three axes intersect with each other; thus they do not run in a parallel or co-axial fashion but at an angle in relation to one another. This is best seen in the perspective side-top view of FIG. 1 and the lateral view of FIG. 4.

[0054] The tool 10 serves for providing haemostatic compression to a pregnant woman's uterus in a “C-section procedure. More specifically, the size, shape and physical characteristics of the surgical tool 10 are specifically adapted to facilitate the incision making and to reduce blood loss during the C-section. The handle portion 16 of the tool 10 is intended to be held firmly in one hand—of either the surgeon or his assistant. The foot portion 18 comprises two tongues 22 that extend along the longitudinal foot axis LA.sub.F, with their common origin being located in a proximal foot area 24 and with their free ends 26 being located at the distal end 12 of the tool 10. With the exception of their common origin, the tongues 22 are spaced apart from one another, such that there is an area of free space 28 in between them. In line with their name they have a tongue 22-like shape, i.e. they are longer than wide but wider than thick.

[0055] Each tongue 22 has an underside 30 that is facing away from the handle portion 16. The combined underside area 30 of both tongues 22 together forms a curved abutment surface 32 that is intended to press against the (pregnant woman's) uterus when making the uterine incision: After opening the abdominal cavity and having identified and opened the vesico-uterine fold, the surgeon himself or his assistant will put the surgical tool 10 in place, such that the tongues 22 of the foot portion 18 are placed above and below the level of uterine incision and the underside 30 of the tongues 22 contact the uterine tissue. The area of free space 28 in between the two tongues 22 is sized such that the incision in the uterine tissue can be made within this area. Holding the handle portion 16 in one hand, the surgeon or an assistant will apply a pressure that is directed towards the woman's abdomen with the aim to compress the tissue of the uterus. This way, blood vessels running through uterine tissue in the area of uterine incision will be compressed and bleeding from blood vessels severed when making the incision is significantly reduced.

[0056] As is best seen in FIGS. 1, 3 and 4, the three portions 16, 18, 20 of the tool 10 are positioned at an angle relative to one another. Specifically, when seen in a frontal view—i.e.

[0057] when looking onto the underside 30 of the tongues 22—as shown in FIG. 3, the longitudinal lever axis LA.sub.L and the longitudinal handle axis LA.sub.B are both running more or less along a common vertical medial plane, yet said common vertical plane is not aligned with the longitudinal medial plane MP.sub.F through the foot portion 18 but positioned at an angle δ of about 15° with respect thereto. In other words, the common vertical medial plane through the handle and lever portions 16, 20 deviates from the orientation of the vertical medial plane MP.sub.F running along the longitudinal foot axis LA.sub.F through the foot portion 18, such that the proximal end 14 of the handle portion 16 is positioned at a lateral distance from said longitudinal middle plane MP.sub.F. Said lateral distance is preferably within the range of 10 mm to 17 mm, most preferably about 14 mm. This deviation helps on one hand to keep the handle and lever portion 20 out of the surgeon's visual and working field, such that the surgeon's view of the incision site (which is in between the two tongues 22) is not restricted and on the other hand to manage to reach the uterine incision site more easily, this can be better understood if seen in a lateral view the site of incision is sometimes located more distantly (towards foot of the pregnant woman) and under the pubic symphysis thus reaching the site of initial uterine incision in this cases can be difficult. Whether the lever and handle portions 20, 16 are pointing towards the left or the right side—when seen in a top view—depends on whether the surgeon himself or an assistant is holding the tool 10 and whether this person is left or right handed.

[0058] In addition, as shown in FIG. 4, the longitudinal lever axis LA.sub.L is positioned at a more or less right angle β with respect to the longitudinal foot axis LA.sub.F and at an acute angle α of about 30° with respect to the longitudinal handle axis L.sub.AH. These angles α, β are fixed, meaning that they will not substantially change when the surgeon applies pressure to the foot portion via the handle. This angular orientation of the three portions 16, 18, 20 relative to each other serves two purposes: at the one hand pressure can be effectively transferred from the handle portion 16 towards the foot portion 18. At the other hand, as mentioned above, the lever portion 20 and the handle portion 16 should be kept outside the surgeon's working area when the tool 10 is used to apply pressure on the uterine tissue—by either the surgeon himself or by an assistant, such that the lever and handle portion 16s will neither impair the surgeon when making the incision nor obstructing his visual field of the incision site, but it actually allows the surgeon to better reach the uterine incision site.

[0059] As mentioned, the incision through the uterus will be made within the area of free space 28 between the two tongues 22. As such, the length of the tongues 22 is usually about 6 cm. The initial cut is often made shorter than required. Rather than making a longer cut, many surgeons will extend the uterine incision on either side with finger dissection, meaning that the surgeon will insert two fingers into the initial incision and expand it by repetitive stretching or tearing of the tissue. By using the fingers to expand the incision rather than cutting tools it also reduces the risk of inadvertently injuring the fetus. The tool 10 is therefore adapted to allow insertion of the surgeon's finger(s) between the two tongues 22 while still maintaining the pressure on the uterus. (Notably, if the tool 10 is used by the surgeon himself, he will insert one finger after initial incision while pressing the tongues 22 on the uterus. He will then remove the tool 10 and insert a second finger (of his other hand) into the incision in order to extend the uterine incision.) This means that the free distance 29 between the two tongues 22 is preferably such that the index finger or thumb of an average adult person fits therebetween. In terms of specific lengths, the free distance d between the two tongues 22 is generally at least 1 cm, more specifically about 2 cm (FIG. 5).

[0060] In addition, the open-end design of the foot portion 18, meaning that the two tongues 22 form together the shape of an U, allows withdrawal of the tool 10 from the surgical site by pulling it away laterally, i.e. horizontally in a direction away from the distal free ends 26 of the tongues 22, while the surgeon can keep his finger-a in the opening of the uterine tissue.

[0061] The foot portion 18 is not flat but curved, such that at least a main portion of the foot portion 18 has a concave shape, in particular the shape of a circular arc when seen in longitudinal section (FIG. 4). The curvature of the arc is adapted to match the average curvature of the uterus of a pregnant woman in her last stages of pregnancy. As such, the whole underside 30 of the tongues 22, which forms the abutment surface 32, will ideally be in full contact with the uterine tissue, thus allowing efficient transfer of force.

[0062] The handle portion 16 of the tool 10 is adapted for being held securely by one hand. The length of the handle portion 16 is therefore preferably about 9-12 cm and it has an essentially circular cross-sectional contour with a diameter of preferably about 2-3 cm.

[0063] The lever portion 20 is generally smaller in diameter than the handle portion 16. In the shown embodiment, it has a circular cross-section and a diameter of about 1 cm, however, it may also have a rectangular, polygonal or any other cross-sectional shape. The length of the lever portion 20 is within the range of the length of the handle portion 16, or a bit shorter, e.g. about 8-12 cm.

[0064] In the depicted embodiment, the tongues 22 have a length within the range of 6-8 cm, a width of about 1.5 cm and a thickness of 1-2 mm. As mentioned, the length of the tongues should allow making the initial cut in the uterine tissue within the area of free space 28 between the two tongues 22. The axial free distance 29 between the two tongues 22 is usually in the range of 1.5-2.5 cm.

[0065] As regards the thickness of each portion and in particular of the tongues 22, this variable is inter alia dependent from the chosen material. For instance, if the surgical tool 10 is made of a metal material, 1 or 2 mm thickness will generally be sufficient for the tongues 22 for avoiding breakage or deformation thereof when using the tool 10 within the idea of the described invention. On the other hand, if the tool 10 is made of a plastic material, it may be necessary to increase the thickness of the tongues 22, e.g. up to 1 cm, to insure sufficient stability.

[0066] Independent of the material used, the thickness of the tongues 22 does not need to be constant over their entire length. For instance, they may have a thickness that decreases towards their free ends 26. This is particularly preferred in case of the tongues 22 being made from a plastic material.

[0067] The portions of the surgical tool 10 may be manufactured from a single piece of plastic or metal, or consist of multiple pieces of plastic or metal that are coupled (e.g. welded or adhered) together.