Surgical Method Utilizing Transluminal Endoscope and Instruments

• US 20080269557A1
• Filed: 09/28/2007
• Published: 10/30/2008
• Est. Priority Date: 04/25/2007
• Status: Active Grant

• Current Assignee: Karl Storz Endovision, Inc. (Karl Storz Se & Co. Kg)
• Original Assignee: Karl Storz Endovision, Inc. (Karl Storz Se & Co. Kg)
• Inventors: Marescaux, Jacques Francois Bernard, Dallemagne, Bernard, Mutter, Didier Raoul Daniel, Leonhard, Martin, Barry, James P., Leroy, Joel, Melanson, Jeffrey S., Storz, Stefan
• Granted Patent: US 8,591,399 B2
• Time in Patent Office: Days
• US Class Current: 600/106
• CPC Class Codes: A61B 1/00066 Proximal part of endoscope body, e.g. handles A61B1/0052 takes precedence
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/00098 Deflecting means for inserted tools
• CPC Class Codes: A61B 1/00165 with light-conductive means, e.g. fibre optics A61B1/07 takes precedence
• CPC Class Codes: A61B 1/008 Articulations
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/0034 adapted to be inserted through a working channel of an endoscope
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2906 Multiple forceps
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61M 13/003 : Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing

Abstract

A method of transluminal surgery is provided, which utilizes an endoscopic surgery apparatus having pivotable arms attached by hinges on its distal end. The arms are interchangeable with arms of various configurations. The method includes the steps of inserting an endoscopic surgery apparatus into a body cavity of a patient, making an incision in the body cavity wall to allow access to the patient'"'"'s abdominal cavity, and further inserting the apparatus through the incision. Surgery is performed at the desired surgical site and the apparatus is withdrawn into the body cavity where the incision is closed. Finally, the apparatus is withdrawn from the patient'"'"'s body.

Claims

1. A method of transluminal surgery, comprising the steps of:

providing an endoscopic surgery apparatus including a tubular member having a plurality of channels along its longitudinal axis, a handle located on a proximal end of the tubular member, two or more arms pivotably connected to a distal end of the tubular member by hinges, wherein said arms have guiding channels passing therethrough adapted to receive endoscopic surgical tools;

inserting the distal end of the tubular member through a natural body orifice into a body cavity with the arms in a closed position;

creating an incision in a body cavity wall sized to accommodate the tubular member using at least one endoscopic surgical tool;

advancing the distal end of the tubular member through the incision to a desired surgical site;

pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

performing at least one surgical task at the surgical site; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

2. The method of claim 1, wherein the step of creating an incision in a body cavity wall further comprises the steps of pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

using at least one endoscopic surgical tool to create the incision; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

3. The method of claim 1, wherein the step of creating an incision in a body cavity wall further comprises the steps of advancing an endoscopic surgical tool from the tubular member through an opening between the arms, wherein the arms include a ramp for deflecting the endoscopic surgical tool;

using the endoscopic surgical tool to create the incision; and

withdrawing the endoscopic surgical tool into the tubular member.

4. The method of claim 1, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of pivoting the arms about the hinges into an open position using a mechanism on the handle so as to provide a wider view of an area proximal to the distal end via an optical channel disposed in the tubular member.

5. The method of claim 1, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the steps of:

insufflating the abdominal cavity using an insufflation channel disposed in the tubular member; and

monitoring the pressure in the abdominal cavity in the region adjacent to the distal end of the tubular member via an insufflation channel disposed in the tubular member.

6. The method of claim 1, wherein the step of performing at least one surgical task at the surgical site further comprises the step of introducing a device for delivery of fluid or gaseous matter through a channel in the tubular member for the delivery of fluid or gaseous matter to the surgical site.

7. The method of claim 1, wherein the step of performing at least one surgical task at the surgical site comprises the step of providing an endoscopic retrieving bag for the removal of dissected tissue.

8. The method of claim 1, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to attach a surgical clip to the incision.

9. The method of claim 1, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to suture the incision.

10. The method of claim 9, wherein the step of closing the incision is performed by a suturing system incorporated into the arms.

11. The method of claim 1, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to employ an endoloop to the incision.

12. The method of claim 1, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a cauterizing endoscopic surgical tool.

13. The method of claim 1, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a laser.

14. The method of claim 1, wherein the step of providing an endoscopic surgery apparatus further comprises that the distal end of the tubular member articulates.

15. The method of claim 12, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of articulating the distal end of the tubular member into a desired position relative to a surgical site.

16. The method of claim 1, wherein the steps of pivoting the arms about the hinges into an open position a first and a second time further comprise the step of displacing tissue using the arms.

17. The method of claim 1, wherein the step of providing an endoscopic surgery apparatus further comprises that the arms are interchangeable with arms of different configurations;

and

the method further comprises the step of selecting two arms having a desired configuration from a group of interchangeable arms of different configurations.

18. The method of claim 17, wherein the step of selecting two arms having a desired configuration includes selecting arms adapted to grasp tissue.

19. The method of claim 17, wherein the step of selecting two arms having a desired configuration includes selecting arms adapted to cut tissue.

20. The method of claim 17, wherein the step of selecting two arms having a desired configuration includes selecting arms which form an obturator shape when the arms are in a closed position.

21. The method of claim 1, wherein the step of providing an endoscopic surgery apparatus further comprises that one of said channels is an optical channel for the transmission of images and at least one other of said channels is an illumination channel for the transmission of light and wherein when the arms are in a closed position an opening is defined for viewing of an area proximal to the distal end via said optical channel and illumination of an area proximal to the distal end via said at least one illumination channel;

and

wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of using the optical channel to view an area proximal to the distal end of the tubular member.

22. The method of claim 1, further comprising the step of using the arms to hold tissue resected from a patient'"'"'s body for removal from the patient'"'"'s body.

23. A method of transluminal surgery, comprising the steps of:

providing an endoscopic surgery apparatus including a tubular member having a plurality of channels along its longitudinal axis, a handle located on a proximal end of the tubular member;

selecting two arms having a desired configuration from a group of interchangeable arms of different configurations, to be pivotably connected to a distal end of the tubular member by hinges, wherein said arms have guiding channels passing therethrough adapted to receive endoscopic surgical tools;

inserting the distal end of the tubular member through a natural body orifice into a body cavity with the arms in a closed position;

creating an incision in the body cavity wall sized to accommodate the tubular member using at least one endoscopic surgical tool;

advancing the distal end of the tubular member through the incision and to a desired surgical site;

pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

performing at least one surgical task at the surgical site; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

24. The method of claim 23, wherein the step of selecting two arms further comprises selecting arms adapted to grasp tissue when the arms are pivoted about their hinges.

25. The method of claim 23, wherein the step of selecting two arms having a desired configuration further comprises selecting arms adapted to displace tissue when the arms are pivoted about their hinges.

26. The method of claim 23, wherein the step of selecting two arms having a desired configuration further comprises selecting arms adapted to cut tissue when the arms are pivoted about their hinges.

27. The method of claim 23, wherein the step of selecting two arms having a desired configuration further comprises selecting arms which form an obturator shape when the arms are in a closed position.

28. The method of claim 23, wherein the step of creating an incision in a body cavity wall further comprises the steps of pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

using at least one endoscopic surgical tool to create the incision; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

29. The method of claim 23, wherein the step of creating an incision in a body cavity wall further comprises the steps of advancing an endoscopic surgical tool from the tubular member through an opening between the arms, wherein the arms include a ramp for deflecting the endoscopic surgical tool;

using the endoscopic surgical tool to create the incision; and

withdrawing the endoscopic surgical tool into the tubular member.

30. The method of claim 23, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of pivoting the arms about the hinges into an open position using a mechanism on the handle so as to provide a wider view of an area proximal to the distal end via an optical channel disposed in the tubular member.

31. The method of claim 23, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the steps of:

insufflating the abdominal cavity using an insufflation channel disposed in the tubular member; and

monitoring the pressure in the abdominal cavity in the region adjacent to the distal end of the tubular member via an insufflation channel disposed in the tubular member.

32. The method of claim 23, wherein the step of performing at least one surgical task at the surgical site further comprises the step of introducing a device for delivery of fluid or gaseous matter through a channel in the tubular member for the delivery of fluid or gaseous matter to the surgical site.

33. The method of claim 23, wherein the step of performing at least one surgical task at the surgical site comprises the step of providing an endoscopic retrieving bag for the removal of dissected tissue.

34. The method of claim 23, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to attach a surgical clip to the incision.

35. The method of claim 23, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to suture the incision.

36. The method of claim 35, wherein the step of closing the incision is performed by a suturing system incorporated into the arms.

37. The method of claim 23, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to employ an endoloop to the incision.

38. The method of claim 23, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a cauterizing endoscopic surgical tool.

39. The method of claim 23, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a laser.

40. The method of claim 23, wherein the step of providing an endoscopic surgery apparatus further comprises that the distal end of the tubular member articulates.

41. The method of claim 40, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of articulating the distal end of the tubular member into a desired position relative to a surgical site.

42. The method of claim 23, wherein the step of providing an endoscopic surgery apparatus further comprises that one of said channels is an optical channel for the transmission of images and at least one other of said channels is an illumination channel for the transmission of light and wherein when the arms are in a closed position an opening is defined for viewing of an area proximal to the distal end via said optical channel and illumination of an area proximal to the distal end via said at least one illumination channel;

and

wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of using the optical channel to view an area proximal to the distal end of the tubular member.

43. The method of claim 42, wherein the step of identifying a location in a body cavity wall further comprises the step of using the optical channel to view the area in front of the distal end of the tubular member.

44. The method of claim 23, further comprising the step of using the arms to hold tissue resected from a patient'"'"'s body for removal from the patient'"'"'s body.

45. A method of transluminal surgery, comprising the steps of:

providing an endoscopic surgery apparatus including a tubular member having a plurality of channels along its longitudinal axis, wherein at least one of the channels of said tubular member is an optical channel for the transmission of images and at least one other of the channels is an illumination channel for the transmission of light, a handle located on a proximal end of the tubular member, two or more arms pivotably connected to a distal end of the tubular member by hinges and having guiding channels passing therethrough adapted to receive endoscopic surgical tools, wherein when the arms are in a closed position an opening is defined allowing for viewing of an area proximal to the distal end via the optical channel and illumination of the area proximal to the distal end via the at least one illumination channel;

inserting the distal end of the tubular member through a natural body orifice with the arms in a closed position;

advancing the distal end of the tubular member into a body cavity using the optical channel to view the body cavity;

creating an incision in the body cavity wall sized to accommodate the tubular member using at least one endoscopic surgical tool;

advancing the distal end of the tubular member through the incision into the abdominal cavity;

advancing the distal end of the tubular member to a desired surgical site using the optical channel to view the abdominal cavity;

pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

performing at least one surgical task at the surgical site; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

46. The method of claim 45, wherein the step of creating an incision in a body cavity wall further comprises the steps of pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

using at least one endoscopic surgical tool to create the incision; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

47. The method of claim 45, wherein the step of creating an incision in a body cavity wall further comprises the steps of advancing an endoscopic surgical tool from the tubular member through the opening between the arms, wherein the arms include a ramp for deflecting the endoscopic surgical tool;

using the endoscopic surgical tool to create the incision; and

withdrawing the endoscopic surgical tool into the tubular member.

48. The method of claim 45, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of pivoting the arms about the hinges into an open position using a mechanism on the handle so as to provide a wider view of an area proximal to the distal end via an optical channel disposed in the tubular member.

49. The method of claim 45, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the steps of:

insufflating the abdominal cavity using an insufflation channel disposed in the tubular member; and

monitoring the pressure in the abdominal cavity in the region adjacent to the distal end of the tubular member via an insufflation channel disposed in the tubular member.

50. The method of claim 45, wherein the step of performing at least one surgical task at the surgical site further comprises the step of introducing a device for delivery of fluid or gaseous matter through a channel in the tubular member for the delivery of fluid or gaseous matter to the surgical site.

51. The method of claim 45, wherein the step of performing at least one surgical task at the surgical site comprises the step of providing an endoscopic retrieving bag for the removal of dissected tissue.

52. The method of claim 45, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to attach a surgical clip to the incision.

53. The method of claim 45, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to suture the incision.

54. The method of claim 53, wherein the step of closing the incision is performed by a suturing system incorporated into the arms.

55. The method of claim 45, further comprising the step of closing the incision in the body cavity wall using at least one endoscopic surgical tool to employ an endoloop to the incision.

56. The method of claim 45, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a cauterizing endoscopic surgical tool.

57. The method of claim 45, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a laser.

58. The method of claim 45, wherein the step of providing an endoscopic surgery apparatus further comprises that the distal end of the tubular member articulates.

59. The method of claim 45, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of articulating the distal end of the tubular member into a desired position relative to a surgical site.

60. The method of claim 45, wherein the steps of pivoting the arms about the hinges into an open position a first and a second time further comprise the step of displacing tissue using the arms.

61. The method of claim 45, wherein the step of providing an endoscopic surgery apparatus further comprises that the arms are interchangeable with arms of different configurations;

and

the method further comprises the step of selecting two arms of a desired configuration from a group of interchangeable arms of different configurations.

62. The method of claim 61, wherein the step of selecting two arms of a desired configuration includes selecting arms adapted to grasp tissue.

63. The method of claim 61, wherein the step of selecting two arms of a desired configuration includes selecting arms adapted to cut tissue.

64. The method of claim 61, wherein the step of selecting two arms of a desired configuration includes selecting arms which form an obturator shape when the arms are in a closed position.

65. The method of claim 45, further comprising the step of using the arms to hold tissue resected from a patient'"'"'s body for removal from the patient'"'"'s body.

66. A method of transluminal surgery, comprising the steps of:

providing an endoscopic surgery apparatus including a tubular member having a plurality of channels along its longitudinal axis, a handle located on a proximal end of the tubular member;

wherein at least one of the channels of said tubular member is an optical channel for the transmission of images and at least one other of the channels is an illumination channel for the transmission of light;

selecting two arms having a desired configuration from a group of interchangeable arms of different configurations, to be pivotably connected to a distal end of the tubular member by hinges, wherein said arms have guiding channels passing therethrough adapted to receive endoscopic surgical tools and wherein when the arms are in a closed position an opening is defined allowing for viewing of an area proximal to the distal end via the optical channel and illumination of the area proximal to the distal end via the at least one illumination channel;

inserting the distal end of the tubular member through a natural body orifice into a body cavity with the arms in a closed position;

advancing the distal end of the tubular member into a body cavity using the optical channel to view the body cavity;

creating an incision in the body cavity wall sized to accommodate the tubular member using at least one endoscopic surgical tool in at least one channel of the tubular member;

advancing the distal end of the tubular member through the incision into the abdominal cavity;

advancing the distal end of the tubular member to a desired surgical site using the optical channel to view the abdominal cavity;

pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

performing at least one surgical task at the surgical site;

pivoting the arms about the hinges into a closed position using a mechanism on the handle;

withdrawing the distal end of the tubular member via the incision in the body cavity wall into the body cavity;

closing the incision in the body cavity wall using at least one endoscopic surgical tool; and

withdrawing the distal end of the tubular member from the natural body orifice.

67. The method of claim 66, wherein the step of creating an incision in a body cavity wall further comprises the steps of pivoting the arms about the hinges into an open position using a mechanism on the handle such that the guiding channels passing through the arms create a desired degree of triangulation for endoscopic surgical tools disposed in the guiding channels;

using at least one endoscopic surgical tool to create the incision; and

pivoting the arms about the hinges into a closed position using a mechanism on the handle.

68. The method of claim 66, wherein the step of creating an incision in a body cavity wall further comprises the steps of advancing an endoscopic surgical tool from the tubular member through the opening between the arms, wherein the arms include a ramp for deflecting the endoscopic surgical tool;

using the endoscopic surgical tool to create the incision; and

withdrawing the endoscopic surgical tool into the tubular member.

69. The method of claim 66, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of pivoting the arms about the hinges into an open position using a mechanism on the handle so as to provide a wider view of an area proximal to the distal end via an optical channel disposed in the tubular member.

70. The method of claim 66, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the steps of:

insufflating the abdominal cavity using an insufflation channel disposed in the tubular member; and

monitoring the pressure in the abdominal cavity in the region adjacent to the distal end of the tubular member via an insufflation channel disposed in the tubular member.

71. The method of claim 66, wherein the step of performing at least one surgical task at the surgical site further comprises the step of introducing a device for delivery of fluid or gaseous matter through a channel in the tubular member for the delivery of fluid or gaseous matter to the surgical site.

72. The method of claim 66, wherein the step of performing at least one surgical task at the surgical site comprises the step of providing an endoscopic retrieving bag for the removal of dissected tissue.

73. The method of claim 66, wherein the step of closing the incision in the body cavity wall using the at least one endoscopic surgical tool further comprises the step of attaching a surgical clip to the incision.

74. The method of claim 66, wherein the step of closing the incision in the body cavity wall using the at least one endoscopic surgical tool further comprises the step of suturing the incision.

75. The method of claim 74, wherein the step of suturing the incision is performed by a suturing system incorporated into the arms.

76. The method of claim 66, wherein the step of closing the incision in the body cavity wall using the at least one endoscopic surgical tool further comprises the step of employing an endoloop to the incision.

77. The method of claim 66, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a cauterizing endoscopic surgical tool.

78. The method of claim 66, wherein the step of performing at least one surgical task at the surgical site comprises the step of employing a laser.

79. The method of claim 66, wherein the step of providing an endoscopic surgery apparatus further comprises that the distal end of the tubular member articulates.

80. The method of claim 66, wherein the step of advancing the distal end of the tubular member to a desired surgical site further comprises the step of articulating the distal end of the tubular member into a desired position relative to a surgical site.

81. The method of claim 66, wherein the steps of pivoting the arms about the hinges into an open position a first and a second time further comprise the step of displacing tissue using the arms.

82. The method of claim 66, wherein the step of selecting two arms having a desired configuration includes selecting arms adapted to grasp tissue.

83. The method of claim 66, wherein the step of selecting two arms having a desired configuration includes selecting arms adapted to cut tissue.

84. The method of claim 66, wherein the step of selecting two arms having a desired configuration includes selecting arms which form an obturator shape when the arms are in a closed position.

85. The method of claim 66, further comprising the step of using the arms to hold tissue resected from a patient'"'"'s body for removal from the patient'"'"'s body.