Note: Descriptions are shown in the official language in which they were submitted.
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The present invention relates generally to surgical
support structure or a laparoscope, and more particularly to
a unique combination of rigid and flexible components which
provide the capability oE precisely positioning the
laparoscope incident to its use during surgery, but while
maintaining, once said position is established, a necessary
rigidity to avoid inadvertent slippage or other movement from
that position.
The advantages are already well known, from such prior
patents, for example, as U.S. patents 4,254,753 and 4,143,652,
that surgical retractors, clamps and the like held by
mechanical components result in a reduction in personnel and
thus correspondingly in a reduction in expense, as well as
providing other noteworthy benefits. Heretofore, however,
the surgical instruments so held or supported did not impose
critical requirements for positioning, so that they could be
properly used during the surgical procedure. For example, if
to allow unimpeded positioning, the support structure was
comprised of a multiplicity of interconnected link elements on
a flexible traction element in which such link elements,
because possessing at one end a ball and at the other end a
complementary ball socket, could be made to assume any shape
necessary for positioning and then caused to assume a rigid
mode by the tightening of said traction element, this
unimpeded positioning would be at the expense of possible not
having adequa~e retention forced to prevent slippage and other
inadvertent movement from the surgical position established
for the supported instrument. With a laparoscope, Eor
example, a precise anatom~-viewing position must be
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established, and once established securely maintained,
otherwise the viewing and internally inserted end o~ the
laparoscope might, due to slippage, exert pressure on tissues,
and especially on soft organs, such as the liver, pancreas, or
intestines, and othe~wise introduce a complication D
Broadly, it is an object of the present invention to
provide structure for readily positioning a laparoscope prior
to the use thereof, during surgery, which also is of noteworthy
rigidity to obviate slippage or inadvertent movement in the
laparoscope, and which otherwise overcomes the foregoing and
other shortcomings of the prior art. Specifically, it is an
object to provide a laparoscope-positioning component with a
strategically located ball and socket joint component, so that
in such combination the objectives of flexibility for
positioning and of rigidity for secure weight support are
uniquely balanced and readily achieved.
An improved suxgical holder and positioner for a
laparoscope or the like, such as an endoscope, demonstrating
objects and advantages of the present invention includes an
open ring and means for supporting same in a fixed horizontal
orientation over a patient having an incision for the ;nsertion
of the laparoscope proximal end. A generally vertically
oriented support rod is mounted adjacent its lower end at a
selected location on the open ring and a selectively tensionable
the laparoscope to engagement of its opposite end to the upper
end of the support rod. As a result, prior to the tensioning of
the tensionable member, the laparoscope proximal end is
manipulatable into a position that is proximate to that
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which is necessary for proper viewi.ng of the anatorny on which
the surgery is bein~ performed. Comple-ting the structure is a
ball and socket joint that is provided at a strategic location
at the lower end oi the .support rod for permitting the rod to
be urged through conical m~vement wi.th one hnnd by the surgeon
while sighting down -the~ laparoscope. As a consequence, the
laparoscope proximal end partàkes of corresponding conical
movement incident to assuming a more precise anatomy-viewing
position while the wci~ht of thc supporting and positioning
components remains supported on the open rlng.
The above brief description, as well as other objects,
features and advantagcs o:f the prescnt invention will be more
fully appreciated by reference to the rollowing de-tailed
description of a presently preLerred, but nonetheless
illustrative embodiment i.n accordance with the present
invention, when taken in conjuncti.on w:ith the accompanying
drawings, wherein:
FIG. 1 is a perspec-tive view illustrating the improved
surgical holder for a la~ roSc~l)e or similar :ins-trument
according to the prescnt invelltion during a -typical surgical
procedure;
~ IG. 2 is a ~nrlial pelsl)ectiv( view o.l` the ball and
socket joint oi` tl-e holder;
FIC. 3 is another pcrspcctiv(~ vi.ew illustrating degrees
of motion of the ball and socket joint; and
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FIG. 4 is a perspective view illustrating the
corresponding movement of the interconnecting laparoscope and
rod component having the ball and socket joint.
In FIG. 1 there is illustrated a typical 5mm diagnostic
laparoscope 10 as it would be held in proper viewing position
during a surgical procedure, which laparoscope could, of
course, also be larger or lOmm in diameter if used for
operative or instrument-inserting purposes. Included in the
holding structure is a surgical ring assembly 11 for supporting
the laparoscope 10 which is basically the assembly illustrated
and described in U.S. patent 4,254,763. More particularly,
the ring assembly 11 is illustrated attached to a surgical
operating room table 12 in a position as it would assume
during an op~ration on a simulated patient P. The main
components comprising this surgical ring assembly are an
elongated support post 14, an elongated extension rod 15 which
is connected to support post 14 by a coupling device 16, and
a substantially flat, oval-shaped ring member 18. The
attachment to the surgical operating room table 12 is made
by an adjustable clamp 20 attached to a rail 22 provided or.
each side of the table and generally extending the length
thereof.
As may be readily appreciated from FIG. 2, and as is
described in U.S. patent 4,254,763, the ring member 18 is
substantially oval in shape and has an open center area which
provides a large reglon for the surgical procedure. The ring
member also ir.cludes a plurality of spaced indentations 24 to
facilitate making a clamping connection thereto, all as will
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be subsequently explained. From what has been described, it
should be readily appreciated that the cantilever effect of
the elongated extension rod 15 and the further extension
provided by the rigid member 18 allows the entire ring assembly
to suf~iciently reach across the patientP so that this
assembly can be located only on one side of the patient,
without requiring a second support arm on the other side of
the patient. It is for this reason that the ring assembly 11
is selected as the most preferable in providing the support to
the improved laparoscope holder of the present invention,
which will now be described in detail.
At a selected location about the open ring 18, as at 26,
there is provided a C-shaped clamp 28 which frictionally
engages an end o~ a plate 30 having at its opposite end an
upstanding post 32. As is perhaps best understood from FIG. 2
in conjunction with FIG. 1, adapted to be attached to the post
32 is a mounting device or vise 34 of conventional and well
understood construction which includes a movable jaw 36
operated by a rotatable lever 38 so that, in practice, the
post 32 is securely engaged between the movable jaw 36 and an
opposing stationary jaw 36a.
..
As shown in FIG. 2, an integral part or connection to
vise 34 is a ball and socket joint, generally designated 40,
of a well understood operational mode and construction. It
will also be understood that the ball and socket joint 40
hereof is readily commercially available and is similar to the
ball and socket joint described and illustrated in U.S. patent
4,143,652.
-r
For present purposes, i-t su:f.Lices to note -that the ball
and socket ~joint 40 includes a cyl.indr:i.cal housing 4~ in which
there is rotatably disposed a .sleeve 44 which seats at its
outer end in a socket-shaped compartment 46 a ball 48 which is
provided at the lower end of a support rod 50.
As is perhap~ best ,sho\vn in FIG~ 3, to which figure
reference should now ~e made, the lower end of the rod 50
operates in clearance provided by a .slot 52 in the sleeve 42,
so that the rod is pivotable in the o~posi-te direc-tions noted
by the reIerence arrows 5~1. The rod 50 is also movable in the
opposite direc-tions denoted by the reference arrows 56 as a
result of the rotative movement o-f sleeve 44 within the housing
42. ~s is well understood, a -turning of a lever 58 of the ball
and socket joint 40 is opcratively efLective -to selec-tively
engage or release the sle~eve 44 and ball 48 with respect to the
movements 54, 56. That i.s, the -turning o-t I.ever 58 in one
direction releases the sleeve ~4 and ball ~8, so that rod 50
can be moved in the directions 5~, 56, which, as will be
subsequently explained is essentially a conical movement about
the vertical axis 50a o:l -the rod 50, wh:ile rotation o:f the
lever 58 in an OppOs:ita di r~ctioll causes, :in ~a well understood
manner, frictional engagement of the sleeve 44 and ball 58 so
that the rod 50 is fixed or ]ocked in the posi.ti.on o:f movement
it occupies at the Lime leVYr 58 j S tUrned .
Reference should now be rnade to FIG. 1 in conjunc-tion
~ith FIG. l. Comple-ting the improved holder for the
laparoscope lO hereo-f is a selectively tenslonable mernber 60
which will be underslood ~(? b~ re,1d.ily availa~le Irom
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numerous commercial sources and of a well understood
construction composed of a multiplicity of link elements,
individually and collectively designated 62, wherein each link
62 possesses at one end a ball and at the other end a
complementary ball socket. The link elements 62, in turn, are
threaded, in the manner of pearls upon a string of pearls, onto
an internal flexible traction element (not shown). Completing
the construction of the member 60 is a lever means 64 which, in
a well understood manner, can effectuate the tightening of the
traction element, so that the interconnected links 62, which,
as already noted, are composed of a multiplicity of ball and
socket joints which are arranged in a row, are caused to assume
a rigid structure, i.e., a structure that can be arrested at
any position selected by the surgeon or other user of the
device, such as the arcuate shape of FIG. 4 or the S shape of
FIG. 1. It will be understood that the selectively tensionable
member 60 may be of the type described in U.S. patent 3,858,578
as well as in German Petty patent nos. 6,941,781 and 7,010,461.
In practice, effective results have been achieved using a
selectively tensionable or flexible member 60 as illustrated
and described in Flexbar Machine CorpO brochure of September 1~,
1966, identified as Fleximount Instrument Holder P-38A on page
2, as referenced in U.S. Design Patent D 239,131.
As illustrated in the drawings, member 60 includes at one
end a vise clamp 66 which, by appropriate manipulation of its
lever 68 achieves attachment of the flexible member 60 to the
upper end of the rod 50. At its opposite end, flexible member
60 includes a clamp 70 which preferably has padded jaws 72
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which in a well understood manner are engaged to -the exposed
or distal end lOa of the laparoscope 10.
With specific reference to I~IC. 1, it will now be
explained how the improved holder an~ positioner for the
laparoscope lO according to the presknt invention, is used
during a -typical surgic~~l proc~ur~.
As the firs-t step O:r the procedure il will be understood
that the ring assembly 11 is .set in p]ace in overlying
relation to the patient P. The rod 50 with its ball and socket
joint 40 is then suppoIted on the open ring 18 o~ -the assembly
11, the rod 50 being in an ini-tial vertical orientation as
illustrated in FIG. 1. Assuming that the surgical procedure is
general abdominal surgery, an incisi~n 74 is made in the
patient's abdomen, typically near the umbilicus, ior insertion
o-~ the laparoscope proximal end lOb. It will be understood
that at this time -the laparoscope 10 and rod 50 are
interconnected wlth tl~c lle.~il)le meml)~r 60 and that the control
member 64 is in its opera~ive posi~ion rel.easing the individual
links 62 so that member 60 is readily flexed and thus does not
impede positioning movement of the laparoscope 10. The surgeon
sighting down the eyepiece lOc can thus efectively manipula-te
the laparoscope proximal end lOb so -that it is in a posiltion
very close to that which is require~ ior ~roper viewing o:E the
internal ana-tomy or the pa~ient thllt is the object of -the
surgical procedure. Once this positioning is achieved ~or the
laparoscope 10, the control lever 6~ is turned to lock or ~ix
the ~lexible member 60 in whatever shape it has assumed in
order to allow for the p~si~ionin~ ~r the laparoscope 10.
Once the member 60 has been rigidified it will be understood
tha-t it will not inadvertently move from its assumed shape
since it will be understood that the member 60 is designed to
readily suppor-t :four pounds. That i.s it wi.ll be unclerstood
that member 60 is approximately l0 inchcs and that the
individual links ~2 which provide this length are readily
~ixed in relative position to each other upon the twisting of
lever 64 which pulls taut the internal cable or flexible
traction element such thlt the ~rictional engagement between
the balls and their cooperating socket compartments will resist
movement against at least four pounds of force.
Although it is possiblc that the laparoscope proximal end
lOb will be in -the precise viewing position required Ior -the
surgical procedure solely as the result of the initial
manipulation by the surgeon and the po.sition o~ movement
achieved in the rigidified i`lexiblc- member 60 the present
invention contempla-tes that this might not always be the case
and that some additional movement .is necessary in positioning
the laparoscope proximal. en(l l0b. It i~ thus an essential
contribution Or the present :inverlti.on -to provide the ball and
socket joi.nt 40 -Lo-r -the lower e~nd o1 the support rod 50. It
should of course be apr)Teciate(l thlt the ent:ire weigh-t O.r the
laparoscope l0 inte.rconnecting member ~0 .Ind the support rod
itself are suppor-ted in the s.leev( 14 o~f the ball and socket
~joint 10 which joint 40 is, in tllrl-l, slll)por~ed orl tllc :fixed
open ring 18. To achieve the acld:i.tional degree o.i rnovement i.n
the laparoscope proximal end l0b that may be neede~d fOr its
proper anatomy-viewing positioning the surgeon merely rnoves
the lever 58 into its operative position relensing the support
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rod 50 for universal movemen-t a~ prcvi.ollsly descril)ed and
illustrated in specific re~exence to FIG. 3. The surgeon,
however, may mailltain his phys.ical contact with one hand on
the lever 58 and using his other hand grasp the upper end of
support rod 50 and manipu]ate saicl rod 50 through the degrees
o~ movement 54, 56, which essentially would be a conical
movement about the vertical axis 50a of the support rod 50.
This conical movement is illustrated in FIG. 4 by the reference
arrow 76. While engaged in this mani.pulation of the support
rod 50 it will of course be understood that the surgeon
continues to sight down the laparoscope 10, so that he can
determine when the laparoscope proximal end lOb is in the
precise anatomy-viewing ~ositi.on which he requires.
Still re~erring to FIG. 4, it will be understood and
appreciated that the physical :rela-tionship O:e the components
which comprises the present i.nven-tion is such that -the conical
traverse 76 of the support rod 50 provides a corresponding
conical traverse in the lap~roscope 10, said traverse being
designated 76a in FIG. 4, and, e~ven more important, that there
also results a corresponding conical traverse in the laparoscope
proximal end lOb, but of a signi.ri.cantly diminished ex-tent,
designated 76b in FIG. 4. In -this regard and still referring
to FIG. 4, it will be noted that the mecha.nical relationship
between the location of the ball and socket joint 40 and the
incision 74 in the patient :ror the laparoscope proximal end lOb .
are approximately in the same plane, which in FIG. 4 is
signi~ied by the reference line 78, such that there is the
relationship between the movements 76 and 76b, as jus-t noted.
This is important since wi.th oxl)elience the surgeon can
~2S~L369
achieve proper ana-tomy-viewing positioning ior the laparoscope
proximal end lOb with deft manipu]ation of the upper end of the
support rod 50. Stated another way, it can be readily
appreciated that there is a corresponding relationship in the
movements 76a and 76 of the respec-tlve upper ends of the
laparoscope 10 and support rod 50, and that therefore likening
the exposed length portion O:r -the 1.aparoscope 10 to a lever
with a fulcrum located at the incision 74, it will be readily
appreciated that angular movement of the upper end lOa in a
conical movement 76a will result in an equal annular or
conical movement of the laparoscope proximal end lOb, but at a
diminished extent because of the difference in distances from
the fulcrum 74 of these -two opposite ends.
It also should be noted and recognized as a significant
contribution of the present invention that during the time
that the laparoscope 10 is being positioned as just described,
that the weight thereof, as well as the weigh-t of the
connecting member 60, as well as that of the support rod 50
itself, is effectively supported in the seat or socket
compartment of the sleeve 44 inasmuch as the sleeve is in
supporting relation beneath thc ba]l ~8 oi -the ball and socket
joint 40, all as is clearly :illustrated i.n FIG. 2. Since the
components just described are in turn ei~ective:ly supported on
the fixed open ring 18, there is -thus no possibil.ity tha-tclue to the
weight o -the components, even during the piv~tal.-traverses 76
of the laparoscope proximal end lOb, that said end of the
laparoscope will exert pressure on -tissues, and especially on
soft organs, such as the liver, pancreas, intestines, etc.,
which, of course, it is important to avoid
~2
6g
Once the laparoscope proximal end 10b is in the precise
viewing position required by the surgeon and fi~ed in said
position, the surgical procedure then contemplates the making
of an additional incision 80 in the approximate location of
the laparoscope to be used by the surgeon in achieving the
surgical objective or result. It will of course be understood
that the.size of the incision 80 is characterized by being of
a nominal extent because the surgeon is not required to use
the incision opening 80 to view the internal anatomy, since
this is the function of the laparoscope 10.
For completeness sake, it is noted that the laparoscope
10 is equipped with a conventional light source attachment 82
and also an attachment 84 to a source of carbon dioxide,
which, in a well understood manner, is used during surgery to
separate the abdominal contents and also reduce the risk of
puncturing a bowel.
In addition to the surgeon sighting through the
laparoscope 10, it is also a known pra¢tice, and therefore
illustrated in phantom perspective in FIG. 1, to mount a
television camera 86 in viewing relation tothe laparoscope
eyepiece 10c and to operatively connect the camera 86 via the
electrical connector 88 to a TV monitor 90 having a display
screen 92. In this manner, a number of surgeons can attend
the patient P during the surgical procedure and can offer
assistance based on observation of the images transmitted and
displayed on the screen 92. A TV camera 86 which is under the
weight limit which could inadvertently produce movement in
the rigidified member 60 is readily available from numerous
- 13 -
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commercial sources, one such source being model S2-2 from
Codman Instruments of Randolph, Mass.
Although the surgical procedure described herein is in
the category of general surgery, it will be understood that
the holder and positioner for the laparoscope is equally
applicable for orthopedics, pediatric surgery, urology,
gynecology, thoracic surgery, heart and vascular surgery,
neurosurgery, animal surgery and veterinary surgery. Also,
the holding and positioning components described herein are
preferred for use with a laparoscope, but are equally
applicable for use with an endoscopic system.
A latitude of modification, change and substitution is
intended in the foregoing disclosure, and in some instances~
some features of the invention will be employed without a
corresponding use of other features. Accordingly, it is
appropriate that the appended claims be construed broadly and
in a manner consistent with the spirit and scope of the
invention herein.
