MULTIFUNCTIONAL SURGICAL INSTRUMENT

Abstract

A multifunctional surgical instrument for extension of laparotomic, laparoscopic, robotic and thoracotomic incisions allows at the same time the spreading apart of the cutaneous/subcutaneous corners, pinching and lifting of the deep parietal layer, its dissection with the electrosurgical knife and protection of the surrounding and underlying tissues, particularly the intestinal ansae in the peritoneal cavity, during the dissection itself.

Claims

1. Multifunctional surgical instrument for extension of laparotomic, Iaparoscopic, robotic and thoracotomic incisions, constituted by a handle including two rings, one upper ring and one lower ring, two straight articulated branches, one upper branch and one lower branch, and a toothed rack stopper, wherein the two straight branches, after their connection through a hub, both extend to constitute two prongs of a bite, one upper prong and one lower prong, the lower straight branch extends to constitute the upper prong of the bite which, after an angle of approximately 130 degrees, becomes shaped as an L ribbon-like retractor, centrally fenestrated, for its length except proximal and distal borders with a paddle angulated at 90 degrees, facing upwards, terminating at the top with an outwards angulation, which thereby permits to spread apart cutaneous/subcutaneous corners of the surgical wound, and to incise a deep parietal layer, the upper straight branch extends to constitute the lower prong of the bite which, too, after an angle of approximately 130 degrees at the same level as the angle of the upper prong, becomes shaped as a curved concave valve, so as to ensure protection of surrounding tissues and underlying organs in a peritoneal cavity, particularly an intestinal ansae during a section with an electrosurgical knife, with all the components of the surgical instrument situated distally to an upper third of the straight articulated branches of the handle being covered with electrical insulating coating.

2. Surgical instrument according to claim 1, wherein the upper prong of the bite terminates as an L ribbon-like retractor, with a curved paddle at an angle of 90 degrees, facing upwards, ending at the top with an outwards angulation.

3. Surgical instrument according to claim 1, wherein the lower prong of the bite is shaped as a curved concave valve.

4. Surgical instrument according to claim 1, wherein the upper prong of the bite, shaped as a ribbon-like flat lamina, immediately after its formation, divides into two arms of identical shape and length, which course parallel, creating among them a central fenestration serving as a guide binary for the electrosurgical knife.

5. Surgical instrument according to claim 1, wherein the two prongs, constituted after the hub as extensions of the two straight articulated branches, both bend at the same level at an angulature of approximately 130 degrees, to form the bite of the instrument.

6. Surgical instrument according to claim 1, wherein grip surfaces of the two prongs of the bite are blunt, allowing an atraumatic grip of the deep parietal layer when the bite is tightened.

7. Surgical instrument according to claim 1, wherein all its components distal to the upper third of the handle are covered with electrical insulating coating, which avoids transmission and propagation of electricity produced by the electrosurgical knife during its use.

Description

5) FIGURES

[0013] FIG. 1a: surgical instrument with open bite, lateral vision; blunt upper surface of the borders of the lower prong, atraumatic

[0014] FIG. 1b: detail of the upper prong of the bite, with blunt surface of the inferior borders of the bite, atraumatic

[0015] FIG. 2: surgical instrument with closed bite; lateral vision

[0016] FIG. 3a: surgical instrument with closed bite; vision from above

[0017] FIG. 3b: surgical instrument with closed bite; vision from below

[0018] FIG. 4: surgical instrument in use

[0019] FIG. 5a: detail of the handle of the surgical instrument, with stop self-retaining rack indicated with the letter R

[0020] FIG. 5b: detail of the handle of the surgical instrument, without stopper or free

6) DESCRIPTION OF THE FIGURES

[0021] FIG. 1 a shows the invented surgical instrument, shaped as a hemostatic clamp of short-medium length, constituted by a ring handle 1,2, with toothed rack stopper 3,4, two straight articulated branches, one upper branch 5, and one lower branch 6. The upper branch 5, and the lower branch 6, after the hub 7, both extend to constitute the prongs of the surgical bite, indicated with the letters S, U, and then become bent at the same level with an angle of 130 degrees 8. The lower branch 6 extends to form the upper prong of the bite S, in the shape of a ribbon-like flat lamina 9 similar to that of a ribbon-like retractor, which immediately divides into two small arms 10,11, of identical shape and length, which course parallel, creating between them a central fenestration 12, and at their reunification, reconstitute a ribbon-like lamina 13, similar to the initial one 9, with blunt surface of the inferior borders 19a of the two small arms 10,11 providing atraumatic grip FIG. 1b, which terminates immediately after in an L ribbon-shaped, upwards facing, retractor 14, with a paddle angled at 90 degrees 15, terminating at the top with a slight outwards angulation 16. The upper branch 5, extends, after the hub 7, to form the lower prong U of the bite, at the same level as the upper lamina 9, always with the same angulation 8, in the shape of a curved concave valve 18, with the same width and length of the upper prong S with blunt upper surface of the borders 19b, providing atramatic grip, and, at closed bite, with the surfaces of the two prongs fitting together perfectly FIG. 2, 3a, 3b. All the components of the surgical instrument situated distally to the upper third of the branches of the handle are covered with high technology insulated coating, shown in the FIGS. 1a,1b, 2, 3a, 3b, 4, 5a and 5b with shaded grey color, indicated with the letter K. 7) Functioning: instrument with open bite, the lower prong U of the bite is inserted into the peritoneal cavity with the upper surface 19b tangent the parietal peritoneum, while the lower surface 19a of the upper prong S rests on the deep parietal layer P, formed by fascia, muscles and parietal peritoneum, both prongs embrace the layer without tightening it, while the curved paddle angled at 90 degrees of the upper prong, shaped as an L ribbon-like retractor, upwards oriented 14, with which it terminates, is pushed against the cutaneous/subcutaneous borders of one angle to open wide and keep them opened, allowing the uncovering of the deep parietal layer which has to be incised.

[0022] Once the optimal extension is reached, the bite is tightened, and the deep parietal layer P is pinched and lifted. At this point the deep parietal layer P can be incised, with the electrosurgical knife Z, through the central fenestration 12 of the upper prong S of the bite which serves as a guide FIG. 4.

[0023] The surfaces of the upper borders 19b, with atraumatic blunt grip, of the curved concave valve 18 of the lower prong U of the bite adhere perfectly to the parietal peritoneum, and the concavity of the valve 18 allows a possible downward excursion of the tip of the electrosurgical knife Z and, during the section, protects all the underlying and adjacent structures FIG. 4, particularly the intestinal ansae. If a further extension of the incision is necessary, the whole described procedure can be repeated at the opposite angle.

8) INDUSTRIAL APPLICATION

[0024] the invented instrument can be employed in all types of laparotomic surgical interventions, laparoscopic interventions and eventually also thoracoscopic interventions in operating rooms of divisions of: general surgery, paediatric surgery (in miniaturized form, baby, short), emergency surgery, digestive surgery, urologic surgery, vascular surgery, thoracic surgery, plastic surgery, laparoscopic surgery, robotic surgery, and in every other use in any other surgical branch (particularly in laparotomic interventions of appendectomy, with incision according to Mac Burney).

9) ADVANTAGES

[0025] the multifunctionality of the surgical instrument offers several concurrent advantages: (A) safe protection of the intestinal ansae and all the surrounding tissues during the section with the electrosurgical knife; B) spreading apart of skin/subcutis; (C) atraumatic grip of the deep parietal layer to be incised; D) guide to direction of the incision procedure of the deep parietal layer with the elctrosurgical knife. The instrument thus offers the advantages of facilitating, rendering more precise, safer and more rapid (reduction of the operating time) the surgical manoeuver of extension of a small laparotomy, without further incision of the skin.

[0026] A) The invented surgical instrument is advantageous because it protects the intestinal ansae in the peritoneal cavity during the section of the deep parietal layer (fasciamusclesparietal peritoneum) with the electrosurgical knife, thanks to the curved concave valve of the lower prong of the bite. When the bite tightens the deep parietal layer, the upper borders of the valve adhere perfectly to the parietal peritoneum, the concavity of the valve allows a possible downward excursion of the tip of the electrosurgical knife during the incision, protecting all the underlying and adjacent structures.

[0027] Being provided with a high technology insulating coating, the instrument furthermore prevents any possible trasmission of the electrical energy to the sourrounding structures during the section of the deep parietal layer by the electrosurgical knife, allowing the first operator surgeon to incise this layer in safe conditions.

[0028] B) The invented surgical instrument is advantageous because it facilitates the manoeuver of the spreading apart of the cutaneous/subcutaneous borders, eventually at both corners of a small laparotomy, allowing the exposure of the deep parietal layer to be incised (fascia, muscles, parietal peritoneum). The first surgeon, by personally manoeuvering the instrument, can modulate the strength to be impressed to the instrument itself to spread apart the cutaneous borders, being able to regulate the right extension which permits the gain of the necessary centimeters of opening of the small laparotomy, thus obtaining the most favourable exposure of the operating field, with savings of the cutaneous incision and avoidance of unaesthetic scars.

[0029] C) The invented surgical instrument is advantageous because, thanks to the blunt surface of the borders of the two prongs of the bite, it allows an atraumatic grip of the deep parietal layer to be incised.

[0030] D) The invented surgical instrument is advantageous because it provides a precise orientation guide for the section of the fasciamusclesparietal peritoneum, allowing the tip of the electrosurgical knife to easily cut the deep parietal layer through the central opening of the upper prong, formed by small arms which act as a binary guide.

10) VARIANTS

[0031] variants can be performed in the handle stopper: with toothed rack stopper FIG. 5a, without stop or free FIG. 5b. Furthermore a short or baby instrument can be conceived for the use in paediatric surgery.