Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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TITLE OF INVENTION
METHOD FOR DISTENDING THE ABDOMINAL CAVITY WITH A LIQUID
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application claims the benefit under 35 U.S.C.
119(e) of the U.S. Provisional Patent Application Serial No. 60/829,052, filed
on
October 11, 2006, the content of which is incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention relates to distending the abdominal cavity
during laparoscopy, and, more particularly, to separating the abdominal wall
from
the organs and separating organs from each other within the abdominal cavity
with a liquid.
BACKGROUND OF THE INVENTION
[0003) Laparoscopy is a surgical method typically performed to examine
the abdominal or pelvic organs. This method utilizes a laparoscope to
investigate or perform surgery within this region. During laparoscopy a
surgeon
will make small incisions into the abdomen to gain access to the abdominal
cavity. One of these incisions will be made just below the navel. A needle
connected to a carbon dioxide, nitrous oxide, or other gas source is inserted
into
this incision. The gas is pumped into the abdomen and enables the abdominal
wall to be lifted away from the organs. Separating the abdomen from the
organs makes it easier to insert the laparoscope into the abdominal cavity and
examine the organs. After separation, the laparoscope can be inserted into a
second cut in the abdomen. Once the investigation or surgery is completed, the
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instruments are removed and most of the insufflated gas is able to escape.
However, the removal of the gas is incomplete and some gas will be trapped and
cause residual pain for a period after the surgery. The pain will subside once
the
gas is absorbed into the lining of the abdomen and eliminated via the lungs.
[0004] The application of gas pressure during laparoscopy is only able to
separate the abdominal wall from the abdominal organs. The introduction of gas
is unable to cause separation between the organs. Such a factor requires
mechanical manipulation of the organs in order to inspect them. This can be
acceptable when laparoscopy is performed via the abdominal wall because the
surgeon can utilize multiple points of access to gain the necessary leverage.
The
drawback of gaining access through the abdominal wall is that scars will be
left in
the stomach region.
[ooo5] To address this issue, new procedures have been developed to
provide for laparoscopy to inspect the abdominal cavity without going through
the
abdominal wall. Kalloo et al. (U.S. Publication No. 2005/0101837), which is
incorporated herein by reference, describes a transluminal procedure in which
an
overtube is inserted through a natural body orifice such as the esophagus or
the
colon and guided by an endoscope to the gastrointestinal tract. Once the
desired
location is achieved within the stomach, a knife makes a small incision in the
stomach wall to expose the abdominal cavity. This hole is dilated and the
overtube is inserted through the dilated hole. The overtube is then anchored
to
the wall of the stomach with balloons that are inflated on both sides of the
wall.
Subsequently the abdominal cavity is insufflated with a gas. This enables the
abdominal cavity to distend and separate the abdominal tissue from the organs.
Wilk '536 Patent (U.S. Patent No. 5,297,536) and Wilk '131 Patent (U.S. Patent
No. 5,458,131), which are incorporated herein by reference, also describe
transluminal procedures in which the abdominal cavity is insufflated with a
gas.
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[ooos1 While this method is beneficial in that it avoids access to the
abdominal cavity through the abdominal wall, it also has deficiencies. As
mentioned before, pressurized gas is only capable of separating the abdominal
wall from the organs. Further, this method only allows access to the cavity
through the hole created by the overtube. Thus, a surgeon is only given
limited
access in which to manipulate the organs for inspection. The method does not
provide for a second position to gain leverage and manipulate an organ. If the
surgeon wants to inspect another aspect of the relevant organ or wants to
inspect an organ in another location, the surgeon will need to withdraw the
overtube, seal the incision, move to another location and create a new
incision.
This increases the time and complexity of inspecting the abdominal cavity. It
also increases the risk of injury.
[0007] What is needed is a method that allows for improved visualization
of the abdominal cavity utilizing a transluminal laparoscopy. Such a method
would enhance the ability of transluminal laparoscopy to effectively inspect
necessary organs and reduce the risk associated with making multiple incisions
in the gastrointestinal tract.
SUMMARY OF THE INVENTION
[0008] These and other objects are achieved by providing a transiuminal
laparoscopic method that injects a liquid such as saline or water into the
abdominal cavity.
[0009] In one advantageous embodiment of the present invention, a
transiuminal laparoscopy is performed by creating an incision in a
gastrointestinal
wall, exposing an abdominal cavity to a liquid injection tube, and injecting a
liquid
into the cavity.
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[ooolo] The incision in the gastrointestinal wall can be created by
inserting a distal end of a tubular member through a natural body orifice of a
mammal to the digestive tract of the mammal and utilizing an endoscopic
surgical
tool such as a knife to cut the incision in the wall.
[00011] The abdominal cavity can be exposed to the liquid injection tube
by disposing the liquid injection tube in the tubular member and advancing the
distal end of the tubular member through the incision in the gastrointestinal
wall.
A liquid is injected into the abdominal cavity from the distal end of the
fluid
injection tube causing the organs in the abdominal cavity to float and retract
the
abdominal tissue from the organs.
[00012] It is another aspect of the invention for the fluid injection tube to
continue to inject pressurized liquid into the abdominal cavity while a
surgical
task is performed within the abdominal cavity with an endoscopic surgical tool
disposed in the tubular member. As fluid is injected into the abdominal
cavity, a
fluid irrigation port can be provided in the tubular member to simultaneously
remove fluid and maintain visibility within the abdominal cavity. The rate of
fluid
injection and irrigation should be set so that a baseline liquid pressure is
maintained in the abdominal cavity. The baseline liquid pressure can be
provided by a pressure limited pump coupled to the liquid injection tube.
[00013] It is yet another aspect of the invention to cease the injection of
liquid into the abdominal cavity and irrigate the remaining liquid in the
cavity
through the irrigation port when the endoscopic surgical task is completed.
Any
residual liquid can be removed by aspirating the liquid through the incision.
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[00o14] Other objects of the invention and its particular features and
advantages will become more apparent from consideration of the following
description.
DETAILED DESCRIPTION OF THE INVENTION
[oool5] The present invention improves the transiuminal procedure
described above. A tubular member is introduced into the gastrointestinal
tract
guided by an endoscope. Preferably the endoscope is disposed within the
tubular member. At the desired location within the gastrointestinal tract an
endoscopic surgical tool such as a knife is used to cut an incision in the
wall of
the tract. The incision can be cut to a size that corresponds to the diameter
of
the insertion tube or dilated with a balloon that is inserted in to the
incision and
expanded by a pressurized source such as a gas. The distal end of the tubular
member is inserted through the incision into the abdominal cavity. A liquid
injection tube is provided within the tubular member and exposed to the
abdominal cavity. A pressurized liquid such a saline, water or other liquid is
ejected from the distal end of the liquid injection tube into the abdominal
cavity.
[00016] The injection of pressurized liquid is maintained such that the
abdomen becomes distended by the liquid. This enables the abdominal tissue to
become separated from the organs. The presence of the liquid also enables the
organs to float within the cavity due to their buoyancy relative to the liquid
and
separate from each other.
[oo017] Various endoscopic surgical tools known to those skilled in the
endoscopic art can be disposed within the tubular member. These surgical tools
are introduced into the abdominal cavity through the distal end of the tubular
member in order to perform a endoscopic surgical task. An endoscopic surgical
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task includes, but is not limited to, visually inspecting organs or tissues in
the
abdominal cavity with an endoscope, employing a cauterizing endoscopic
surgical tool in the abdominal cavity, dissecting tissue in the abdominal
cavity,
and removing an organ in the abdominal cavity. Endoscopic surgical tools used
to perform an endoscopic surgical task include, but are not limited to,
endoscopes, cauterizing tools, lasers, clippers, cutters, knifes and the like.
[00m] The presence of the liquid also increases the ability for debris
such as blood and loose tissue to obstruct the visibility within the abdominal
cavity. As a result, a liquid irrigation port can be disposed within the
tubular
member. The liquid irrigation port enables a continuous flow of liquid from
the
liquid injection tube, into the cavity, and out the irrigation port. This
improves the
clarity of the liquid in the cavity and assists in the inspection of the
relevant
abdominal organs.
[oooTS] It is beneficial if a baseline pressure is maintained within the
abdominal cavity by a pressure limited pump. At such a pressure a certain
degree of distention and separation can be maintained. The pressure limited
pump assures that a minimum pressure is achieved within the cavity and
facilitates a constant influx and outfluxes of liquid through the cavity.
[000201 Once the endoscopic surgical task is complete, the pressure
limited pump is disengaged and the liquid injection tube ceases the injection
of
pressurized liquid. The liquid irrigation tube is permitted to draw the liquid
within
the abdominal cavity down and remove a significant portion of the distending
liquid. Any remaining liquid is removed via aspiration. This can be done
through
the incision in the gastro intestinal tract. If necessary, manual pressure can
be
applied to the abdominal wall to encourage aspiration. Once the procedure is
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complete, the incision can be sealed by suture and the tubular member removed
from the gastrointestinal tract.
[00021] This method provides numerous benefits towards utilizing
laparoscopy to inspect the abdominal cavity. Transluminal laparoscopy enables
laparoscopic procedures to be performed without going through the abdominal
wall. The presence of liquid in the abdominal cavity enables both the
abdominal
tissue and the organs within the abdomen to separate. This enables an incision
that normally provides a limited view of a given area greater access to organs
within the cavity. The buoyancy of the organs also reduces the need to
manipulate them in order inspect a particular area. This reduces the
possibility of
damage to the organ. The presence of residual liquid within the abdominal
cavity
further provides the benefit of being less painful for the patient and more
readily
absorbed into the surrounding tissue.
[00022] Liquids such as saline have been used in other medical
procedures. For instance, Meyer (U.S. Patent No. 4,998,527) discloses an
endoscopic resecting apparatus for use in the abdominal cavity that utilizes a
liquid such as saline to remove debris away from the end of the endoscope to
maintain clear visualization. Meyer discloses that the apparatus distends the
cavity using a gas insufflator.
[00023] The use of liquids such as saline or water to distend portions of
the body has been recognized in limited applications. However, the use of
saline
or water to distend the abdominal cavity during laparoscopy is not recognized
as
a useful or beneficial method. This skepticism is demonstrated in Goble (U.S.
Patent No. 6,923,803). Goble discloses that it is typical during laparoscopic
surgery to perform gaseous or mechanical distension; however a liquid may be
used to distend low volume body cavities. To address the perceived limited
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application of liquid distension, Goble discloses a method for performing
electrosurgery that forms artificial cavities and distends those artificial
cavities.
Goldrath (U.S. Patent No. 5,242,390), Johnson et al. (U.S. Patent No.
5,437,660)
and Sutter, Jr. et al. (U.S. Patent No. 4,878,894) provide examples of using
saline to distend low volume cavities. Goldrath and Johnson et al. disclose
methods for coagulating endometrial tissue of the uterus that utilize the step
of
distending the uterine cavity by injecting saline in to the uterine cavity
with a tool
such as a hysteroscope. Sutter, Jr. et al. discloses that saline insufflation
is used
in arthroscopy to distend a joint for inspection.
[00024) This skepticism is further demonstrated in Brosens et al. (U.S.
Patent No. 6,156,006), which discloses a method for performing
minihydroculdoscopy. The method disclosed in Brosens et al. utilizes saline to
distend the Douglas cavity during culdoscopy. Brosens et al. states that the
benefit of this method is that it enables the use of hydroflotation to inspect
pelvic
organs, which was impracticable during diagnostic laparoscopy.
[0002s] The use of liquids to distend the abdominal cavity during
traditional laparoscopic procedures through the abdominal wall is generally
considered disadvantageous and not appreciated as beneficial. The method
described above provides a novel approach for performing transiuminal
laparoscopy in which a liquid is advantageously used to distend the abdominal
cavity causing separation of the abdominal wall and between the organs within
the cavity. This method provides for a unique function for liquids such as
saline
or water within the abdominal cavity during laparoscopy that has not been
previously recognized or utilized.
[00026) Although the invention has been described with reference to a
particular arrangement of steps, parts, features, and the like, these are not
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intended to exhaust all possible arrangements, steps or features, and indeed
many modifications and variations will be ascertainable to those of skill in
the art.
