CN100409819C - Laparoscopic stone safety device and method - Google Patents

Abstract

A laparoscopic netting assembly is provided for conducting a gallbladder or bile duct procedure through one of the throughbores in a carrier sheath (40), which in turn may be positioned within a laparoscopic port (5). The carrier sheath includes at least one through channel for conducting a frame control rod (90), and optionally a deployment rod (95). The netting assembly includes a collapsible and expandable frame (20) and a fluid permeable netting (10), which preferably includes a plurality of netting layers, suspended on the frame for collecting stones released from the gallbladder or bile duct. The frame is sized to also collect the gallbladder. The carrier sheath may also include one or more through channels for a cutting instrument.

Description

Laparoscopic stone safety device and method

Technical field

Present invention relates in general to a kind of armarium, and more particularly, relate to a kind of laparoscopically surgical operation apparatus that is used in the type in gallbladder and BDE and the calculus taking-up process.This surgical safety device can prevent reliably that calculus is from gallbladder or bile duct hepatobiliary tree and common bile duct migration.

Background technology

Many patients form calculus in their gallbladder.The gallbladder of pathological changes can comprise tens or a hundreds of calculus, and typically cut by the laparoscopic cholecystectomy of opening operation or minimum degree wound.In the laparoscopic cholecystectomy operation process, gallbladder is subjected to cutting through regular meeting and draws and tear.As a result, calculus may be spilled in the abdominal cavity of abdominal part.Thisly do not expect that occurring in the operation of having carried out of incident accounts for 10%-40%.If there is not the present invention, then therefore the calculus of not fetching of contiguous abdominal cavity, liver or other vitals may be closed in the patient body when operation technique finishes, and the location and the removing of these calculus are extremely difficult and both expensive subsequently.For example, the calculus of not fetching that is positioned at liver rear region (retrohepatic region) may produce the complication of delay for patient, comprises forming abscess or fistula, and this health and recovery to patient is deleterious.Diversified calculus may be shifted from gallbladder or bile duct, and may move to subsequently in the space of liver back, and this will cause the surgeon to spend more time and be used to give for change extra biliary stones (and usually being unsuccessful).

The calculus of being scattered is typically moved to the position that is generally common bile duct and portal vein boundary, the side of this position is chest wall and diaphragm, be liver above, be below colon to the influential sweep of liver (hepatic flecture) and duodenal C ring (C-loop), the back is posterior peritoneum (retroperitoneum) and right kidney.The surgeon typically uses suction, grasping or digging tool to remove loose calculus.Even the surgeon is through after the painstaking efforts, these calculus also usually still can be omitted.The calculus that can not fetch may become the source of infection, and has fistula to wear diaphragm and even the fistula report of wearing the skin in the association abdomen zone.For the surgeon, the calculus of omission can thereby become the root of high incidence and potential responsibility.In laparoscopic common bile duct exploration (LCBDE), the calculus that removes from bile duct may fall into because of carelessness after the liver with kidney on identical space.Calculus can be smashed with lithotrite or laser, and usually becomes fragment.In laparoscopic cholecystectomy operation, the calculus of the calculus of the monoblock of Qu Chuing and fragmentization is not tended to move to and is positioned under the liver and the zone on right side, abdominal cavity, and to fetch be very difficult for subsequently peritoneoscope in this zone.When calculus can not be retrieved, will be necessary to forward to and open operation from laparoscopic surgery.

Owing to can not know fully by laparoscopic technique to present and expose, so locate and remove the calculus that misplaces the position or the process of stone matter fragment usually is difficult.For the surgeon, search process may be depressing, tedium and anxiety.In the calculus probe procedure of migration, may need extra operation to patient's liver, with the little calculus that is used to find drop from gallbladder or bile duct, this will cause the extra organ injury that liver is hemorrhage that comprises.In having the glutinous patient who connects of large-area tissue, such search often needs a large amount of operating times.

When calculus was omitted, it was cumulative complicated and time-consuming problem that the prior art surgical band that is used for removing cholelithiasis and is positioned at the calculus of biliary tract is given the doctor's.Too continually, even after a large amount of operating times, laparoscopic surgeon may not reach the purpose of expecting of removing calculus fully yet.United States Patent (USP) 6,520,968 have disclosed a kind of medical retrieval device that has the basket thing that forms from two or more a plurality of circle.The article relevant with this invention is authorized to: " Jaundice Due to Extrabiliary Gtevens ", Stevens, et al., Vol.7, Number 3, JSLS, 277 (July-September 2003).

The present invention has overcome the defective of prior art, can greatly reduce the harm of not fetching calculus improvement laparoscopic stone safety device and method will disclose following.

Summary of the invention

When relating to when comprising that the laparoscopic surgery of physiological calculus (" calculus ") is detected and removed to gallbladder and choledoch-hepatic duct (heparoscopic tract), can use the present invention.Laparoscopic surgical tool collect safely get loose from gallbladder and bile duct, not so will be spilled into the intravital calculus of patient because of carelessness, therefore prevented not so contingent complication when calculus is moved the free peritoneum space in abdominal cavity into.This surgical safety instrument thereby stoped the migration of calculus, and the too much operation by avoiding not so will involving when the surgeon searches the calculus of losing, the protection patient avoids suffering causing a disease and injury for organ (comprising liver).Because the search of the calculus of losing is removed or is reduced as much as possible, so this safety device makes the shortizationest of operating time equally.

The feature of preferred embodiment provides a kind of general laparoscopically surgical operation safety apparatus to the practitioner, is used to improve the success rate that the surgeon fetches calculus, and thereby reduces patient's damage and risk.

Feature in addition provides a kind of laparoscopically surgical operation screen component that has improved, be used to carry out peritoneoscope gallbladder or biliary surgery, this laparoscopically surgical operation screen component that has improved can be implemented routinely by laparoscopic port, this laparoscopic port has above the outer surface of abdominal wall the outer end of axially extending, and below the inner surface of abdominal wall extension and the abdominal end that enters the abdominal cavity.Laparoscopic port is included in the interior through hole that extends between outer end and the abdominal end, and through hole provides the conduit that enters the abdominal cavity in this.Carrier sheath is contained in the interior through hole of laparoscopic port, and has carrier sheath external end and instrument guide abdominal end.Carrier sheath external end is extended above the outer surface of stomach wall, and carrier sheath abdominal extension and near gallbladder or bile duct below the laparoscopic port abdominal end.Carrier sheath comprises that at least one is used to transport and launch the through channel of surgical operation screen component.This surgical operation screen component is made up of the collapsible and extensible skeleton that can be compressed and pre-packing is advanced in the piped deployment sheath.Skeleton can be by launching to open from deployment sheath, is used to limit in fact the periphery greater than the skeleton after folding.In one embodiment, but when the net that is suspended on the permeate fluid on the skeleton allows fluid to see through, collect the calculus of discharging from gallbladder or bile duct from net in fetching the process of screen component.From the disclosure of preferred embodiment, it is clear and definite that method of the present invention will become.

Be characterised in that skeleton can have elasticity, this elasticity limits unfolded skeleton substantially.Unfolded skeleton can be made into and present elastic bending and can have the observable elliptical shape that has saddle-shaped geometry in side view.In a preferred embodiment, the major axis of elliptical shape is parallel to the central shaft of instrument guide substantially, and the minor axis of elliptical shape is perpendicular to the central shaft of instrument guide simultaneously.Major axis can be for from about 3 inches to 5 inches, and minor axis is from 1 inch to 3 inches.The top surface of net can be configured to be lower than 1/2 inch of minor axis or more at intermediate point.The degree of depth of screen component and the geometry of skeleton can be revised as the function from the amount of deployment sheath selectively by the surgeon.

Be further characterized in that net can comprise two or the more a plurality of stratum reticulare that separates when skeleton is in its deployed condition.Following stratum reticulare has the zone that sees through less than the online layer region.In a preferred embodiment, provide three or more stratum reticulares, when skeleton was in its expansion shape, each stratum reticulare and adjacent stratum reticulare were spaced apart.In one embodiment, net can comprise the strand of a plurality of lopping, and one circle is substantially perpendicular to the skeleton of netting.In the withdrawal process, skeleton can return back to its folded state substantially.In one embodiment, elongated tether is fixed on the skeleton, is used for helping to fetch screen component.

Be characterised in that screen component can have by outer skeleton parts and isolated inner frame member constitutes in the skeleton part outside skeleton.Outer skeleton parts can comprise elongated outside line, and at least one through channel in the carrier sheath is passed at the two ends of the outside line that this is elongated, thereby elongated outside line can be extended and contraction at least one through channel in carrier sheath.Inner frame member can comprise the internal skeleton stringing, and at least one through channel in the carrier sheath is passed at the two ends of this internal skeleton stringing similarly.Outer frame wire and internal skeleton stringing can extend and shrink at least one through channel individually, are used to change the shape of skeleton.Outer skeleton can support the net of fine mesh, and inner frame can support the net of coarse mesh of the top of the net that is positioned at fine mesh.

In another embodiment, but screen component has the net that hangs on the permeate fluid on the skeleton.Make the size to fit of skeleton and net, in order to one or more calculus of collecting gallbladder and discharging from gallbladder or bile duct.Skeleton also can support the fluidic layer that can not permeate fluid that is used to collect from gallbladder or bile duct.

In yet another embodiment, carrier sheath has a plurality of through channel, and one of them passage holds skeleton and net.Surigical tool passes another passage in a plurality of passages in the carrier sheath, and wherein Surigical tool comprises in dissecting knife, shears or the cutter sweep one.

The method according to this invention, not only gallbladder but also one or more calculus of discharging from gallbladder or bile duct can be collected in the net of skeleton.

These and follow-up purpose, feature and advantage of the present invention will come into focus from following explanation with reference to the accompanying drawings.

Description of drawings

Fig. 1 is used in the abdominal cavity from the partial schematic sectional view of the open surgical operation screen component of carrier sheath;

Fig. 2 is the sketch map with the complete open screen component shown in Fig. 1 of single stratum reticulare;

Fig. 3 shows partly open screen component,

Fig. 4 shows and further opens but also incomplete open identical screen component;

Fig. 5 shows the deployment rod of screen component and the screw thread coupling between the skeleton;

Fig. 6 shows permeable foam film stratum reticulare;

Fig. 7 shows another embodiment of permeable stratum reticulare;

Fig. 8 is used for the outer membrane stratum reticulare of center stratum reticulare and the cutaway view of multifilament layer;

Fig. 9 shows the screen component of skeleton by basket deployment rod local opening;

The screen component that Figure 10 shows as shown in Figure 9 opens with respect to moving of interior shape control stick further by outer deployment rod;

Figure 11 shows the cutaway view that sees through regional stratum reticulare that diminishes gradually that is used for screen component;

Figure 12 shows the cross section as the screen component of selecting with lopping strand;

Figure 13 shows the cutaway view of another embodiment of assembly of the present invention;

Figure 14 is the cutaway view of the carrier sheath shown in Figure 13.

The specific embodiment

Device of the present invention provides a kind of film, and this film is as capture mechanism, be used for when calculus and calculus fragment when gallbladder and bile pipe are discharged, fix, stop or catch calculus and calculus fragment, prevent to enter undesirable migration in abdominal cavity thus.This film can be skim, perhaps various three-dimensional geometries structure, and perhaps their combination, this membrane cover is lived space under the liver in the abdominal cavity, is used to prevent that calculus is in the migration after gallbladder or bile duct are discharged.The present invention stops calculus migration and thereby has reduced and performed the operation from laparoscopic cholecystectomy operation and laparoscopic common bile duct exploration and fetched relevant patient trauma of calculus and common complication.

Screen component can be compressed and pre-packing is advanced carrier and managed and protected in the cover, and carrier is managed and protected cover and passed carrier sheath and be unfolded by inserting in laparoscopic port.The far-end of device can be managed and protected from carrier and extract the cover and can be opened by hand by the surgeon, perhaps is pre-formed elasticity, is used to form to stop stopping that liver calculus down moves.As the result who uses this device, any calculus of discharging from gallbladder or common bile duct keeps being prevented from moving to the liver back.The device that wherein has the calculus of catching is when operation is finished or by takeing in carrier sheath or being removed by inserting sample sack.This calculus fixture thereby improved the risk that is operable to power and has reduced postoperative infection or organ injury improves the ability that the surgeon removes calculus and relevant fragment.

Peritoneoscope/surgicaloperation screen component 10 uses common laparoscopic port size, typically between 5mm and 12mm.Unfolded shape of this screen component and relative position be can change and can be made to adapt to the feature on surgical needs and the specific anatomy, this point is tangible for the person of ordinary skill of the art.Unfolded this screen component typically is positioned at below the gallbladder and choledoch-right side, so that catch calculus and calculus fragment, thereby has avoided the deleterious migration of calculus and calculus fragment in operation process.

Although can select for use, can use ellipse, the circular or rectangular geometry of skeleton with the shape of saddle type such as polygon or trapezoidal other geometry that waits.In a preferred embodiment,unfolded skeleton 20 has elliptical shape substantially, and this elliptical shape has the major axis 22 that is parallel to the apparatus guide rod substantially.Minor axis is substantially perpendicular to major axis.In a preferred embodiment, major axis is about 3 inches to about 5 inches on length, and minor axis is about 1 inch to about 3 inches on width.Major axis is preferably about 4 inches and minor axis and is preferably about 2 inches.The intermediate point of the superiors of net materials is preferably lower than 1/2 inch of minor axis or more.In a preferred embodiment, the actual size of theskeleton 21 during expansion is enough, so that the net that is supported on the skeleton not only can be collected gallbladder but also can collect from one or more a plurality of calculus of gallbladder or bile duct discharge.This actual size is same to allow a large amount of calculus easily to be collected in the net, and this a large amount of calculus may cover and be used to catch the relatively large zone that not so may fall into endoceliac calculus.

Stratum reticulare 30 as shown in Figure 2 can comprise thin and flat sponge, perforation film, have filter screen (screen) or the net or the mesh material of the element of lopping.Net materials is preferred, and netting twine limits and see through the zone and pass through to help liquid, and can comprise the shape of rectangle, hexagon, octagon or other selection.In a preferred embodiment,stratum reticulare 30 comprises two-layer at least and preferably includes at least three layers, and every layer separates with adjacent interlayer and has the less zone that sees through so that calculus layer with layer between effectively caught.Fig. 6 and Fig. 7 have described screen component and have all had threelayer 30A, 30B and the 30C of rectangular area.See through the zone and be in order to be used to catch bigger calculus, bigger calculus has about 2 centimetres diameter usually, and the microlith that passes net simultaneously can regain by vacuum usually, and the diameter of these microliths is common 3 millimeters or littler.In the demonstration example as shown in figure 11, screen component comprises as discussed aboveskeleton 20 and threelayer 30A, 30B and 30C.For this demonstration example, seeing through the zone and can have common square configuration in the upper strata is so that can pass the diameter that the calculus of the minimum diameter on upper strata can have about 36A as shown in Figure 1.Second or the intermediate layer can have and be used for the less ofminimum diameter 36B and see through the zone, and the net that the 30C of lower floor can have adiameter 36C sees through the zone.Be used for undermost net see through the zone can be for from about 1 millimeter to about 5 millimeters, therefore can catch the calculus of those minimums that can not regain by vacuum usually effectively.The intermediate layer can have from about 5 millimeters to 10millimeters diameter 36B of seeing through, simultaneously thesuperiors 38 can have about 10 millimeters to about 2 centimetres zone that sees through.

Among the embodiment that conduct is as shown in Figure 12 selected, net materials can form thestrand 38 of lopping, and as shown in figure 12, thestrand 38 of lopping extends upward along the planar direction that is basically perpendicular to stratum reticulare substantially.As selection, also can adopt the stratum reticulare of 3-D shape with concavity or more complicated molded shape.

Stone barrier orstratum reticulare 30 andskeleton 20 can be compressed or be furled in thecarrier sheath 40, are used to be inserted through laparoscopicport.Screen component 10 can then be launched from sheath by the surgeon and open in the abdominal cavity.As selection, device can mechanically launch by straight-bar 90 is pushed sheath.Along with the expansion in peritoneum,device 10 can present the reservation shape relevant with the predetermined elasticity of skeleton.Self-sealing valve 41 as shown in Figure 1 can be provided, be used between the outside of the inside ofsheath 40 andbar 90, sealing, and also be used to seal whenbar 90 and when sheath removes, run through flowing ofsheath 40, be used to prevent gas evolution.In all embodiments, can usevalve 41, but only shown in Figure 1.Device can be guaranteed to close, thereby catches calculus by pulling around bag mouth tether 60 (see figure 2)s of stone barrier periphery.Can envision such as twisting, rotate, collapse or twine stone barrier, attached wire or rope as the method for closing of selecting.Device 10 with the calculus of catching can then be removed from the abdominal cavity, and randomly can fetch by laparoscopic port.

Permeable membrane 30 can have the fabric structure of high accumulation or lopping, is used to capture stone material.An embodiment of device provides the permeability barrier layer, and this barrier layer allows liquid and blood easily to see through, but stone material is filtered out.Permeable membrane is preferably by not forming with the chemical constituent of bodily tissue adhesion.

After stone barrier being embedded by port, the surgeon operating theater instruments can be positioned at be arranged under the gallbladder, under choledoch-the right, liver and colon to the space on the influential sweep of liver, thereby stop the darker recess migration of calculus to the liver back.Stone barrier prior to calculus from gallbladder or bile duct discharge and launch.After calculus was spilled into this spatial dangerous past, stone barrier was then gathered and is removed.

By make to the delay that is spilled into the calculus in the abdominal cavity catch the investigation minimize, the laparoscopic cholecystectomy operation and the efficient of laparoscopic common bile duct exploration and the process that removes of calculus can be enhanced, and can eliminate with the abdominal cavity in the residual calculus complications associated with arterial system, therefore patient is beneficial to.This surgical operation screen component is collected the calculus from comprising that gallbladder and choledoch-liver and gall pipeline are unrestrained because of carelessness.As selection, suction catheter or calculus are salvaged pipe and can be introduced by the instrument guide bar, are used to remove the calculus fragment.

In view of top disclosure,, be tangible for those those of ordinary skill in the art to the use of the laparoscopically surgical operation screen component that is used to implement peritoneoscope gallbladder or bile duct procedure.This operation can be carried out routinely by laparoscopic port, this laparoscopic port has the outer end that is positioned at the abdominal wall top and is positioned at Intraabdominal the inner, this laparoscopic port has the through hole that extends between two ends, be used to provide the conduit that enters the abdominal cavity, and help the introducing of pneumoperitoneum, be used to be blown into (insuflasuffrate) abdominal cavity.

But surgical operation screen component thereby can import with folding up and passing laparoscopically mode along the membranous skeleton of its peripheral support permeate fluid.Passing being inserted through ofcarrier sheath 40 pushes away, draws or rotateskeleton control stick 90 and realize thatskeleton control stick 90 is connected toscreen component skeleton 30 by detachable adapter 80.And thenskeleton 20 can be extracted out from itscarrier sheath 40 and open, so the elasticity of skeleton presents than the folding big area of skeleton.Thenet 10 that is supported on the open skeleton will thereby have enough areas so that the surgeon screen component that is in deployed position can be positioned over gallbladder and/or bile duct below, be used to the calculus of collecting thereby becoming and collecting easily and remove.Screen component can still be connected on itsskeleton control stick 90 or can separate byadapter 80, so that laparoscopic port can be used for other instrumentation.As selection, the surgeon can select to use such screen component, and this screen component has by expose the net surface zone of smaller portions partly from carrier, and this screen component makes this device be used for manual operations to take calculus and calculus fragment equally.The geometry of net surface also can be by rotating and push away orpull lever 95 being controlled and adjusted.Also can be seen as thebar 95 of deployment rod, as shown in figure 10, when opening, affact on the skeleton.In holding the same through channel ofcontrol stick 90, deployment rod can move with respect tocontrol stick 90, and perhapsdeployment rod 95 can be located in another through channel in thecarrier.Bar 95 and skeleton are being connected with spaced positions place, junction that skeleton is connected tobar 90, and effect changes frame configuration.

Screen component is changed by the extension ofskeleton control stick 90 by the surgeon from the amount of carrier sheath horizontal expansion, so that control the geometry of the net of skeleton extending range and device selectively.In the process of the calculus of fetching screen component and capturing, net allows fluid to see through this net.The very little calculus that sees through net can be collected by vacuum tube.

Fig. 2 shows the common saddle-shaped oval configuration that is used forpreferred skeleton 20, and wherein the rear end of skeleton preferably has the grasping button that is fixed on the skeleton.The end of grasping and releasing tool 98 can thereby be used for the mobile network assembly byelongated pipe 40, and as shown in Figure 2, is discharging in the process of screen components from managing 40, can be by surgeon's activity.If desired, lashing (langard) 60 can be connected with skeleton, and as selecting, and can be used to help wherein to have the fetching of screen component of the calculus of capturing.Equally,lashing 60 can comprise retrieval loop as shown in Figure 2, and this retrieval loop links to each other with skeleton fake 62, so that the belt that is combined to form lopping of retrieval loop and skeleton fake.The intention of this selection is that the surgeon can catchretrieval loop 60 and spur retrieval loop, therefore " tighten up " maximum gauge ofskeleton fake 62, shrink around screen component in a kind of mode that is similar to sack or wallet backguy with the calculus of capturing to make skeleton effectively.This characteristics thereby further reduced the probability that calculus is discharged because of carelessness before being retrieved in the patient body from screen component.In another embodiment, skeleton can have common round-shaped, and stratum reticulare or a plurality of stratum reticulare have common funnel shaped configuration.

Fig. 5 has described thescrew thread coupling 80 that the conduct betweenskeleton control stick 90 and theskeleton 20 is selected.Nettle 32 can have common rectangle or squared-shaped passthrough openings 34 as shown in the figure.

Be provided as the screen component of selection among Fig. 6, wherein this screen component is not conventional net, but the flexible barrier that is used to capture calculus is provided in some sense, but the abundant porous permeable of this flexible barrier, so that blood and other fluid see through screencomponent.Screen component 30 equally, does not as shown in Figure 6 haveskeleton.Screen component 30 is formed by commonplastic tab 70, and thisplastic tab 70 can be rolled into less diameter and be used for passingpipe 40, then launches to occupy fully big area, is used to conform with and captures calculus with wishing.Plastic layer 70 can have the throughhole 72 that fluid flows through that is used for of selectable size, and the great majority of these through holes preferably are generally circular cross section, are used for reducing manufacturing cost and are reduced in the probability that the process of using this screen component is tornthin slice 70.

Fig. 7 has also disclosed further selection example, and whereinplastic tab 70 comprisesperforation centre bore 72, and has the screen component at the edge that is fixed to large diameter hole.In this embodiment, because the profile ofthin slice 70, calculus moves tonet 74 under action of gravity, owing to calculus moves tonet 74 under action of gravity, thus can capture most calculus, soscreen component 74 can be captured most calculus.

Fig. 8 has also disclosed another embodiment, and once more with cross-sectional illustration have athin slice 70 of through hole 72.In such an embodiment, the macropore at the center ofplastic tab 70 is filled filtering material, and this filtering material can be held in position bynet 74 in one embodiment.Thetop layer 76A of design filter makes most of calculus therefrom to pass, so that calculus joins the seconddead level 76B to.The 3rd layer of 76C has the littler zone that sees through, so that most of calculus is captured on the top of layer 76C.Last layer 76D has the minimum zone of pass through, and this is designed to capture by the zone is about to the calculus of the minimum of being fetched by screen component.Eachlayer 76A, 76C and 76D can be formed by fibrous material or moulding material, and have better desirable elasticity and low cost, to reach purpose of the present invention, also between different layers, capture most calculus selectively simultaneously, therefore guarantee that calculus is removed from patient when surgical operation is finished on one's body.Moreover if desired,various layer 76A, 76C and 76D can encode with color, so that a certain color is corresponding to a certain zone that sees through.If desired, can select the zone that sees through of one or more layer by the surgeon based on the detailed problem of performing the operation.If the surgeon learns the diameter of the calculus of the intravital maximum of patient and will be 10 millimeters, this surgeon can select to capture the most reliably down to the stratum reticulare than all calculus of the calculus of minor diameter that need be captured by screen component.

In as the embodiment that selects, screen component can be packed in advance, be used for that (just skeleton and screen component all can be rolled into the elongated shape than minor diameter in spiral mobile mode, and skeleton and screen component move along the cardinal principle central shaft of pre-packing assembly is spiral) passsheath 40, this makes that skeleton and screen component can controllably discharge in reverse unfolded mode when screen component during from the outlet release ofsheath 40 from sheath 40.For example, the surgeon can know thatbar 90 is inserted into Chosen Point will cause screen component to discharge 50% from sheath, and rotation and expansion when further inserting another inch and can cause screen component.Screen component is for the shape of controlling skeleton better and the position that is positioned at the screen component under the Target organ with respect to the controlled rotation and the controlled axial location of sheath, to serve the purpose in its intention.The inside ofsheath 40 can dispose the claw that is positioned on thebar 90, to slide in elongated spiral mobile slit, in order to the release of control screen component from sheath.

In another embodiment of the present invention, carrier sheath has a plurality of penetrating vias.One of them penetrating via can pass screen component and frame configuration control stick fully.Can pass in a plurality of through channel another such as the Surigical tool of dissecting knife, shears or other cutter sweep, so that the surgeon can cut and organize in the zone of bile duct and gallbladder, and screen component has been positioned at appropriate location under the cutting part in order to capture the calculus of discharging from gallbladder or bile duct.

Figure 13 is the viewgraph of cross-section according to assembly of the present invention, has described laparoscopic port 5, and this laparoscopic port 5 has outer end that the outer surface in abdominal wall axially extends and extension and enter the abdominal end of peritoneal cavity below the inner surface of abdominalwall.Carrier sheath 40 comprise a plurality of in through holes, and from 2 to 4 interior through holes preferably are used to provide the conduit that enters the abdominalcavity.Carrier sheath 40 is located in the interior through hole of laparoscopic port, and has carrier sheath external end and instrument guide abdominal end.Carrier sheath external end is extended above the outer surface of stomach wall and carrier sheath abdominal extension and near gallbladder or bile duct below the laparoscopic port abdominal end.

As shown in figure 13, carrier sheath comprises a plurality of throughchannel 80 and 82, one of thempassage 80 some as crescent, be used to pass net, and another passage has more conventional circular cross section, be used to transmit Surigical tool (such as dissecting knife).Figure 13 has described thecontrol stick 90 that is used for screen component is penetrated and passes carrier sheath 40.In the end of control stick is a pair ofline 70,72, the skeleton that this is provided for netting toline 70,72, and be provided for bottom fine-structure mesh 30A and the thick skeleton that separates that pushes up net 30B.Each screen component has common heart-shaped configuration, is used for more easily holdinggallbladder 15 and one or more calculus.Next calculus 16 can pass net 30B and be captured bynet 30A.Layer 92 that can not permeate fluid can be located among the 30A of lower floor, is used to capture the fluid of discharging from gallbladder, perhaps is used for capturing the fluid of gallbladder and gallbladder.Although show a layer part of 92, layer that can not permeate fluid can be located atlayer 30A the top or below, and can have and the same zone of net 30A.

As shown in figure 13,outer frame wire 70 and internal skeleton stringing 72 all pass a through channel in thecarrier sheath 40, and come out from the top of carrier sheath.Outside line and interior lines all can be stretched respectively and shrink in the through channel of carrier sheath, are used to change the shape of skeleton.More particularly,outer frame wire 72 can be contracted, and is higher than the coarse net 30B that is supported on the internal skeleton stringing to be pulled at least partially, and thereforegallbladder 15 and/orcalculus 16 is trapped in the screen component effectively.

In some applications, can remove sheath, and will comprise that a plurality of instruments of screen component are installed by laparoscopic port.Yet in many application, sheath is preferred, because its abdominal end can easily be positioned at the position near gallbladder or bile duct.

Although describe several preferred embodiments of the present invention in detail, yet for the person of ordinary skill of the art, can expect that the preferred embodiment is carried out other significantly to be revised and adjust.Thereby the embodiment that illustrates and describe is exemplary, and various other modifications of preferred embodiment, can obtain in spiritual scope of the present invention.Therefore, should be expressly understood that these modifications and adjustment within the scope of the invention, scope of the present invention is defined by the claims.

Claims (25)

1. laparoscopically surgical operation screen component that is used for being undertaken peritoneoscope gallbladder or biliary surgery by laparoscopic port, described laparoscopic port has outer end of axially extending and the abdominal end of extending and entering the abdominal cavity below the inner surface of abdominal wall above the outer surface of abdominal wall, laparoscopic port is included in the interior through hole that extends between outer end and the abdominal end, be used to provide the conduit that enters the abdominal cavity, and carrier sheath, carrier sheath is contained in the interior through hole of laparoscopic port, and have carrier sheath external end and utensil guide abdominal end, carrier sheath external end is extended above the outer surface of stomach wall, and carrier sheath abdominal extension and near gallbladder or bile duct below the laparoscopic port abdominal end, carrier sheath comprises that at least one is used to transport and launch the through channel of surgical operation screen component, it is characterized in that described surgical operation screen component comprises:

The periphery of the skeleton when collapsible and extensible skeleton, the skeleton during expansion limit greater than at least one through channel that folds and pass in the carrier sheath, the skeleton during expansion has outer skeleton parts and inner frame member;

But but be suspended on the net of first permeate fluid on the skeleton and the net of second permeate fluid, be used to collect calculus from gallbladder or bile duct discharge;

Skeleton control stick, this control stick are connected to extensible and regracting at least one through channel on the skeleton and in carrier sheath, to move to outer skeleton parts and inner frame member simultaneously; And

Deployment rod, be used to act on isolated a part of skeleton from the junction of control stick and skeleton, move in the through channel of holding control stick of deployment rod in can at least one through channel in carrier sheath, perhaps move the shape when being used to change the skeleton expansion in another at least one through channel.

2. screen component as claimed in claim 1 further comprises:

Be used for removably with the interconnective adapter of the skeleton of skeleton control stick and screen component.

3. screen component as claimed in claim 1 further comprises:

Support is used to collect from the skeleton of the fluidic layer of the fluidic impermeable of gallbladder or bile duct.

4. screen component as claimed in claim 1, wherein when when carrier sheath passes, unfolded skeleton has elliptical shape substantially, the major axis of elliptical shape is parallel substantially with the central shaft of the inside end of carrier sheath, and the minor axis of elliptical shape is substantially perpendicular to major axis, and major axis is about 3 inches to 5 inches on length, and on width about 1 inch to 3 inches of minor axis.

5. screen component as claimed in claim 4, wherein Wang the superiors are lower than minor axis at least about 1/2 inch near its intermediate point.

6. screen component as claimed in claim 1, wherein net comprises that two or more work as skeleton isolated stratum reticulare when being in deployed condition.

7. screen component as claimed in claim 6, it is regional wherein to descend stratum reticulare to have less than seeing through of last stratum reticulare.

8. screen component as claimed in claim 1, wherein unfolded skeleton has heart-shaped configuration substantially.

9. screen component as claimed in claim 1, wherein net comprises three layers or more multi-layered, when skeleton was in expansion shape, each layer separated with adjacent interlayer.

10. screen component as claimed in claim 1, wherein net comprises strand, and strand comprises a plurality of fakes that extend perpendicular to the planar direction of net along substantially.

11. screen component as claimed in claim 1, wherein net comprises thin spongy layer.

12. screen component as claimed in claim 1, wherein outer skeleton parts comprise elongated outside line, at least one through channel in the carrier sheath is passed at the two ends of this elongated outside line, thereby elongated outside line can be extended and contraction at least one through channel in carrier sheath;

Inner frame member comprises the internal skeleton stringing, and at least one through channel in the carrier sheath is passed at the two ends of this internal skeleton stringing, thereby interior lines can be extended and contraction at least one through channel in carrier sheath; And

Outer frame wire and internal skeleton stringing can extend and shrink at least one through channel individually, are used to change the shape of skeleton.

13. screen component as claimed in claim 1, the net of wherein outer skeleton member supporting fine mesh, and inner frame member supports the net of the online side's who is positioned at fine mesh coarse mesh.

14. screen component as claimed in claim 1 further comprises:

Be fixed to elongated tether on the skeleton, that be used to help to fetch screen component.

15. laparoscopically surgical operation screen component that is used for being undertaken peritoneoscope gallbladder or biliary surgery by laparoscopic port, described laparoscopic port has outer end of axially extending and the abdominal end of extending and entering the abdominal cavity below the inner surface of abdominal wall above the outer surface of abdominal wall, laparoscopic port is included in the interior through hole that extends between outer end and the abdominal end, be used to provide the conduit that enters the abdominal cavity, it is characterized in that this surgical operation screen component comprises:

Extensible and retractible skeleton control stick in the interior through hole in laparoscopic port;

Collapsible and extensible skeleton, the skeleton during expansion limit the periphery of the skeleton when folding; And

But be suspended on the net of the permeate fluid on the skeleton, be used to collect the calculus that gallbladder or one or more discharge from gallbladder or bile duct, net comprises that two or more work as skeleton isolated stratum reticulare when being in deployed condition.

16. screen component as claimed in claim 15, wherein unfolded skeleton has elliptical shape substantially, the major axis of elliptical shape is parallel to the central shaft of the inside end of carrier sheath substantially, and the minor axis of elliptical shape is substantially perpendicular to major axis, and major axis is about 3 inches to 5 inches on length, and on width about 1 inch to 3 inches of minor axis.

17. screen component as claimed in claim 15 further comprises:

Carrier sheath, this carrier sheath is contained in the laparoscopic port through hole, and have outer end of above the outer end of laparoscopic port, extending and the carrier sheath abdominal of below the abdominal end of laparoscopic port, extending, at least one through channel in the carrier sheath extends to the conductor abdominal end from the conductor outer end, is used to transport and launch screen component.

18. screen component as claimed in claim 15 further comprises:

Support is used to collect from the skeleton of the fluidic layer of the fluidic impermeable of gallbladder or bile duct.

19. screen component as claimed in claim 15 further comprises:

Skeleton, this skeleton have outer skeleton parts and isolated inner frame member in the skeleton part outside.

20. laparoscopically surgical operation screen component that is used for being undertaken peritoneoscope gallbladder or biliary surgery by laparoscopic port, described laparoscopic port has outer end of axially extending and the abdominal end of extending and entering the abdominal cavity below the inner surface of abdominal wall above the outer surface of abdominal wall, laparoscopic port is included in the interior through hole that extends between outer end and the abdominal end, be used to provide the conduit that enters the abdominal cavity, and carrier sheath, carrier sheath is contained in the interior through hole of laparoscopic port and has carrier sheath external end and utensil guide abdominal end, carrier sheath external end is extended above the outer surface of stomach wall, and carrier sheath abdominal is extended below the laparoscopic port abdominal end and near gallbladder or bile duct, carrier sheath comprises a plurality of through channel, it is characterized in that this surgical operation screen component comprises:

Collapsible and extensible skeleton, the skeleton during expansion limit the periphery of the skeleton when folding;

The skeleton control stick, this control stick is connected on the skeleton, and extensible and regracting in the through channel in a plurality of through channel;

Deployment rod, be used to act on a part of skeleton that removes from the junction of control stick and skeleton, deployment rod can be in carrier sheath at least one hold in the through channel of control stick or another of at least one through channel in carrier sheath in move the shape when being used to change skeleton and launching;

But be suspended on the net of the permeate fluid on the skeleton, be used to collect calculus from gallbladder or bile duct discharge; And

Surigical tool, this Surigical tool pass another passage in a plurality of passages in the carrier sheath, and Surigical tool comprises in dissecting knife, shears or the cutter sweep.

21. screen component as claimed in claim 20, wherein unfolded skeleton has elliptical shape substantially, the major axis of elliptical shape is parallel to the central shaft of the inside end of carrier sheath substantially, and the minor axis of elliptical shape is substantially perpendicular to major axis, and major axis is about 3 inches to 5 inches on length, and on width about 1 inch to 3 inches of minor axis.

22. screen component as claimed in claim 20, wherein net comprises that two or more work as skeleton isolated stratum reticulare when being in deployed condition.

23. screen component as claimed in claim 20 further comprises:

Skeleton, this skeleton have outer skeleton parts and isolated inner frame member in the skeleton part outside.

24. screen component as claimed in claim 23, wherein outer skeleton parts comprise elongated outside line, at least one through channel in the carrier sheath is passed at the two ends of this outside line, thereby elongated outside line can be extended and contraction at least one through channel in carrier sheath;

Inner frame member comprises the internal skeleton stringing, and at least one through channel in the carrier sheath is passed at the two ends of this internal skeleton stringing, thereby interior lines can be extended and contraction at least one through channel in carrier sheath; And

Outer frame wire and internal skeleton stringing can extend and shrink at least one through channel individually, are used to change the shape of skeleton.

25. screen component as claimed in claim 23, the net of wherein outer skeleton member supporting fine mesh, and inner frame member supports the net of coarse mesh of the top of the net be positioned at fine mesh.

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