T-shaped abdominal wall lift with telescoping member

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FIELD OF THE INVENTION

This invention relates generally to surgical methods and devices and, more particularly, to methods and devices for lifting an abdominal wall during laparoscopic surgical and diagnostic procedures.

BACKGROUND OF THE INVENTION

Laparoscopic surgical procedures have been around for many years and have become more available due to advances in technology relating to the laparoscope or video imaging system. They are much less intrusive to the patient than typical open surgical procedures. While an open surgical procedure may involve one primary incision that is at least 6-20 centimeters long, a laparoscopic procedure typically uses smaller incisions, each only around 5-11 millimeters long. In open surgery, the surgeon cuts muscle. In laparoscopic surgery, the surgeon generally does not cut muscle. Because they are less intrusive than open surgical procedures, laparoscopic procedures have resulted in much shorter surgical procedures and recovery times.

Laparoscopic procedures have typically involved insufflation of the abdominal or peritoneal cavity with carbon dioxide and/or other gases in order to create a pneumoperitoneum. The pneumoperitoneum establishes an open space inside the peritoneal cavity to enable the surgeon to move the laparoscope and laparoscopic instruments around the inside and perform surgical and diagnostic procedures.

Typically, the pneumoperitoneum is established by puncturing the abdominal wall with a Veress needle and injecting gas from an insufflator through the Veress needle into the peritoneal cavity to a pressure of around 12 mm Hg.

After insufflation, a trocar is advanced through the opening in the abdominal wall and into the peritoneal cavity. The trocar includes a tube or cannula that usually has a gaseous seal to contain the carbon dioxide within the peritoneal cavity and maintain insufflation. The cannula is used for insertion of other medical instruments such as a laparoscope therethrough and into the peritoneal cavity.

There may be certain difficulties associated with insufflation of the peritoneal cavity. A major consideration is operative and postoperative pain which patients may experience in the abdomen or shoulder area due to migrating gas. This occurs when insufflation causes excess gas pressure in the peritoneal cavity. Excess gas pressure may also compress the pleural cavities thus making respiration difficult. Other possible difficulties associated with insufflation in laparoscopic surgery include subcutaneous emphysema, blood vessel penetration, etc.

The attendant difficulties of insufflation have led to alternatives to insufflation wherein an open space is established by elevating the abdominal wall with a mechanical lift. The lift is introduced through an opening in the abdominal wall into the peritoneal cavity before establishing an open space. The lift is elevated mechanically in order to distend the abdominal wall. When the abdominal wall is distended, ambient air enters the abdomen through the puncture opening in the abdominal wall and an open space at or near ambient air pressure is established.

By establishing an open space at ambient air pressure, insufflation and the concomitant need for gaseous seals in endoscopic instruments and trocars for maintaining a relatively high gas pressure in the peritoneal cavity is eliminated. Thus the attendant difficulties of insufflation, as well as the need for costly equipment, is eliminated.

The prior art includes several abdominal lift structures. Origin Medsystems, Inc. of Menlo Park, Calif. markets a lift under the trademark Laparofan.TM.. It has two radially extending blades that are rotatable. The blades are closed together for initial insertion into the abdominal cavity. After insertion, the blades are spread or fanned. When the lift is elevated, the blades contact and elevate the inner surface of the abdominal wall. Origin's device is described in International Patent Application PCT/FR91/4456.

Societe 3X, a French company, markets an abdominal lift and support structure. This lift is shown and described in International Patent Application PCT/FR91/227. It contains a series of curves forming a generally triangular shape. The tip of the lift is turned downwardly slightly. The support structure has a crane and boom design. Gross adjustments are made by sliding the supporting leg and the boom within their respective holders. A mechanical screw-jack is used for fine adjustment.

International Patent Application PCT/FR91/227 describes an abdominal lift having various curves in different directions. U.S. Pat. No. 5,183,033 describes a method for lifting an abdominal wall with a set of linear and non-linear abdominal lifts. International Patent Application PCT/US/4392 describes a variety of mechanical rods, arms and/or balloons for mechanically lifting an abdominal wall during laparoscopic surgery.

There are some other prior art structures for elevating and/or supporting abdominal lifts in laparoscopic surgery. U.S. Pat. No. 5,183,033 illustrates support structures using winches or U-shaped bars for use in laparoscopic surgery.

Further, there are a number of prior art support structures for supporting mechanical lifts used in open surgery. For example, see U.S. Pat. Nos. 5,109,831 and 4,143,652.

An improved abdominal lift device is disclosed in U.S. patent application Ser. No. 08/108,895, filed on Aug. 18, 1993, and assigned to the same assignee as the present invention. The device includes a curved portion that defines a substantial portion of a circle. A spoke portion extends radially inwardly from the curved portion and an upstanding member extends upwardly from the spoke portion. The upstanding member is connectable to a support structure which elevates and supports the abdominal lift device.

The ease of operation of most of these prior art lift devices without any damage to internal viscera is limited. There is a need for lift devices that may be directed through a small opening in an abdominal wall and subsequently deployed within the abdominal cavity. There is also a need for an alternative surgical lift method and device that may be used by doctors in a hospital operating room and in their offices for diagnostic purposes. It is anticipated that such diagnostic procedures may include the use of a Veress needle-type device having optical capabilities without the use of a general anesthesia.

SUMMARY OF THE INVENTION

In accordance with a first preferred embodiment of the invention, an abdominal wall lift device is provided that includes a plurality of elongated bar members that may be introduced into an abdominal cavity through a trocar or small opening in a separated end-to-end orientation. Once within the abdominal cavity, the bar members are interconnected to form a lift device.

The lift device includes a first elongated bar member and a second elongated bar member. The first bar member has a generally transverse recess portion formed into a lower surface thereof and the second bar member has a generally transverse recess portion formed into an upper surface thereof. A flexible suture is connected at one end thereof to the second bar member and extends through an opening formed through the recess portion in the first bar member so as to permit the bar members to move between first and second positions. In their first positions, the bar members are generally in an end-to-end relationship to facilitate their passage into and out of an abdominal cavity. In their second positions, the bar members are within the abdominal cavity and the recess portion of the first bar member is received within the recess portion of the second bar member so as to position them perpendicular to one another in substantially the same horizontal plane. The bar members may be provided with means to facilitate the grasping and removal thereof by a grasping instrument.

In accordance with a second preferred embodiment of the invention, an abdominal wall lift device is provided that may be introduced into the abdominal cavity through a small opening in the abdominal wall in a generally L-shaped configuration. Once within the abdominal cavity, the lift device may be deployed into a generally T-shaped configuration.

The lift device includes a first elongated tubular member and a second elongated tubular member connected together to form a generally L-shaped configuration. An extension rod is slidably received within the second tubular member and is selectively movable between first and second positions. In its first position, the rod member is substantially received within the second tubular member to facilitate insertion of the device into an abdominal cavity. In its second position, the rod member extends outwardly from the second tubular member such that the second tubular member and the rod member form a generally T-shaped configuration with the first tubular member for deployment of the device within an abdominal cavity. A flexible control link member is connected to the rod member for selectively moving the rod member between its first and second positions.

In accordance with a third preferred embodiment of the invention, an umbrella-like abdominal wall lift device is provided that may be introduced into the abdominal cavity through a small opening in the abdominal wall in a slender generally cylindrical configuration. Once within the abdominal cavity, the lift device may be deployed into an open umbrella-type configuration.

The lift device inches an upper hub member and a lower hub member. A plurality of radially spaced apart links extend between the upper and lower hub members. The links have first end portions connected to the upper hub member and second end portions connected to the lower hub member. The links are movable between a first entry configuration and a second deployment configuration. The links in their first entry configuration have intermediate portions thereof that are substantially in lineal alignment with the end portions thereof as the upper and lower hub members move away from one another. The links in their second deployment configuration have intermediate portions that extend radially outwardly from the end portions thereof as the upper and lower hub members move toward one another. The links may comprise first and second link members which are pivotally connected to one another at the intermediate portions of the links. Alternatively, the links may comprise either a flexible member or a member having a living hinge formed at an intermediate portion thereof. A flexible suture is connected at one end thereof to the lower hub member and extends through an opening formed in the upper hub member to control movement of the links between their first and second configurations.

The present invention also provides unique methods for lifting and holding an abdominal wall portion in an elevated position to perform a diagnostic or surgical procedure in an abdominal cavity. In accordance with one method, at least two elongated bar members, oriented in an end-to-end separated relationship, are directed through a small opening in the abdominal wall into the abdominal cavity. The bar members are oriented relative to one another within the abdominal cavity to form an interconnected deployed lift assembly wherein the bar members are substantially in the same horizontal plane. The deployed lift assembly is lifted and held in an elevated position to hold the abdominal wall in an elevated position. After the diagnostic or surgical procedure is performed, the bar members are disconnected from one another and separately removed from the abdominal cavity through a small opening in the abdominal wall. The bar members may be interconnected by a flexible suture such that an initial application of an upward force to the suture moves the bar members into their deployed configuration and a continued application of an upward force lifts the deployed lift assembly into its elevated position.

In accordance with an alternative method, an elongated needle is attached to an abdominal lift device that has an entry configuration and a deployed configuration. The needle and the lift device are directed through a small opening or cannula in an abdominal wall to position the lift device within the abdominal cavity in its entry configuration. The lift is transformed from its entry configuration to its deployed configuration within the abdominal cavity. The needle is directed from the abdominal cavity so as to create a small opening in the abdominal wall and pass therethrough while the deployed lift device is maintained positioned in the abdominal cavity. The lift device is lifted and held in an elevated position so as to hold the abdominal wall in an elevated position. After performing a diagnostic or surgical procedure, the lift device is transformed from its deployed configuration to its entry configuration and removed from the abdominal cavity through a small opening in the abdominal wall. The lift device is preferably transformed from its entry configuration to its deployed configuration upon contacting an inner surface of the abdominal wall after the needle is withdrawn from the abdominal cavity. The lift device is preferably transformed from its deployed configuration into its entry configuration upon contacting an inner surface of the abdominal wall adjacent the small opening or cannula through which the lift device is removed from the abdominal cavity.

These and other aspects and attributes of the present invention will be discussed with reference to the following drawings and accompanying specification.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevational view, partially in section, of an abdominal wall lift device constructed in accordance with a first preferred embodiment of the invention, that is shown in its entry configuration being inserted through an introducing cannula into an abdominal cavity;

FIG. 2 is a perspective view of the lift device of FIG. 1 shown in a deployed configuration extending into an abdominal cavity;

FIG. 3 is a cross-sectional view taken along line 3--3 in FIG. 2;

FIG. 4 is a top plan view of the top cross bar member of the lift device of FIG. 2;

FIG. 5 is an elevational view of the top cross bar member as shown in FIG. 4;

FIG. 6 is a top plan view of the bottom cross bar member of the lift device of FIG. 2;

FIG. 7 is an elevational view of the bottom cross bar member as shown in FIG. 6;

FIG. 8 is an elevational view of an abdominal wall lift device constructed in accordance with a second preferred embodiment of the invention, that is shown in its entry configuration being directed into an abdominal cavity;

FIG. 9 is an elevational view, partially in section, of the lift device of FIG. 8 in its deployed configuration extending into an abdominal cavity;

FIG. 10 is a perspective view of an abdominal wall lift device constructed in accordance with a third preferred embodiment of the invention shown in its deployed configuration;

FIG. 11 is a perspective view of an abdominal wall lift device constructed in accordance with a fourth preferred embodiment of the invention shown in its deployed configuration;

FIG. 12 is a perspective view of an abdominal wall lift device constructed in accordance with a fifth preferred embodiment of the invention shown in its deployed configuration;

FIG. 13 is a cross-sectional view taken along line 13--13 in FIG. 12

FIG. 14 is a perspective view showing the introduction of an abdominal wall lift device of the type shown in FIG. 10 in accordance with a method of the present invention; and

FIG. 15 is a perspective view similar to FIG. 14 showing the abdominal wall lift device in its deployed configuration.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

While this invention is susceptible of embodiment in many forms, there is shown in the drawings, and will be described herein in detail, specific embodiments thereof with the understanding that the present disclosure is to be considered as an exemplification of the principles of the invention and is not intended to limit the invention to the specific embodiments illustrated.

Referring to FIGS. 1-7, an abdominal wall lift device 20, constructed in accordance with a first preferred embodiment of the invention, includes a first elongated bar member 22 and a second elongated bar member 24.

Bar member 22 has a contoured generally concave shaped upper surface 26 and a generally flat lower surface 28. A transverse recess portion 30 is formed into the lower surface 28. A vertical opening 32 extends through bar member 22 at recess portion 30. Bar member 24 has a contoured generally concave shaped upper surface 34 and a generally flat lower surface 36. A transverse recess portion 38 is formed into the upper surface 34. A vertical opening 40 extends through bar member 24 at recess portion 38. The end portions of the bar members 22 and 24 have substantially horizontal openings 42 formed therein through which grasping loops 44 are received.

The bar members 22 and 24 are connected together by a flexible suture member 46 that extends through the openings 32 and 40. A distal end portion 48 of suture member 46 extends through opening 40 and is prevented from passing therethrough by a suitable means such as a knot or a retent ball 50. Opening 32 is dimensioned so as to permit suture member 46 to freely slide therethrough along a portion of its length.

Referring to FIGS. 1 and 2, the bar members 22 and 24 are respectively shown in their first entry positions and their second deployment positions. In their entry positions, the bar members 22 and 24 are generally in an end-to-end orientation to facilitate entry into an abdominal cavity through a small opening in the abdominal wall. In their deployment positions, the recess portion 30 of the bar member 22 is received within the recess portion 38 of the bar member 24 so as to position the bar members perpendicular to one another in substantially the same horizontal plane. The lower surfaces 28 and 36 are in substantially the same plane and the upper surfaces 26 and 34 form a generally concave contour.

The unique features of the lift device 20 will become more apparent from the following brief discussion of a method of deployment of the device within an abdominal cavity. The bar members 22 and 24, oriented in their first position end-to-end orientation, are directed through a small opening in an abdominal wall into an abdominal cavity. As shown in FIG. 1, one way of inserting the bar members is through a suitable trocar or cannula 52. Once the bar members are within the abdominal cavity, the suture 46 is slowly lifted so as to cause the bar members to assume their second deployment configuration, as shown in FIG. 2. The bar members are configured and weighted so as to cause them to automatically slide into their deployment configuration without the need to individually position one with respect to the other. The abdominal wall may then be lifted and held in an elevated position by lifting the suture member 46 and the bar members 22 and 24 attached thereto. Depending on the procedure to be performed, it is anticipated that a plurality of the lift devices 20 may be deployed to create the necessary pneumoperitoneum. Upon completion of the diagnostic or surgical procedure, the suture member 46 and the bar members 22 and 24 are lowered causing the abdominal wall to return to its normal position. The bar members 22 and 24 may then be removed from the abdominal cavity in a suitable manner, such as by directing a grasper device into the abdominal cavity to grasp the loops 44 and pull the bar members out through a small opening in the abdominal wall. It is anticipated that the small openings in the abdominal wall through which the bar members are inserted and removed may also be used to direct surgical and diagnostic instruments into the abdominal cavity during the procedure to be performed. In so doing, the number of openings is kept to a minimum.

Referring to FIGS. 8 and 9, an abdominal wall lift device 120 constructed in accordance with a second preferred embodiment of the invention, includes a first elongated tubular member 122, a second elongated tubular member 124, and an extension rod member 126. Tubular member 124 is oriented substantially perpendicular to the distal end portion 128 of tubular member 122 so as to define a generally L-shaped configuration.

Extension rod member 126 is slidably received within tubular member 124. Rod member 126 is movable between a