Abstract:
The invention relates to a tool for parietally anchoring a living being&#39;s organ ( 70 ) comprising means ( 12, 16, 24 ) for anchoring said organ, means ( 36 ) for fastening at least one pulling element ( 37 ) to said anchoring means, wherein said pulling element is fixable to the abdominal wall of said living being in such a way that it makes it possible to lift and keep in suspended position the organ anchored by anchoring means ( 12, 16, 24 ) in order to display an anatomical structure during a surgical intervention, in particular in laparoscopy or coeloscopy. The inventive tool also comprises means ( 14, 22, 28, 38 ) for grasping and manipulating said anchoring means by a surgical clip. The size of the tool is selected in such a way that it is enabled to pass through a laparoscopic or coelioscopic trocar. A parietally anchoring device is also disclosed.

Description:
FIELD OF THE INVENTION 
     The invention relates to an instrument for parietally anchoring an organ of a living being, for use in order to expose an anatomical structure during a surgical operation, in particular using laparoscopy or celioscopy. 
     BACKGROUND OF THE INVENTION 
     In order to perform surgery using laparoscopy or celioscopy, it is known to artificially inflate the abdomen of a human being or an animal on which an operation is to be performed, and then to introduce trocars through the abdominal wall so as to create sealed entry ports to the operation space. 
     The anatomical region on which an operation is to be performed is viewed by the surgeon using a special camera introduced into the operation space through a trocar. The anatomical region on which an operation is to be performed is exposed by one or two surgeon&#39;s assistants who move away the organs that are located in front of the operation region, using clips, spatulas, or hooks. Thus it is necessary for a surgeon and one or two assistants to be present in order to operate on a patient using laparoscopy. 
     In some operations, a surgeon&#39;s assistant can be replaced by a robotic arm. However, robotic arms are expensive to purchase, they require maintenance, and they are liable to break down. 
     SUMMARY OF THE INVENTION 
     An object of the invention is to propose an inexpensive instrument suitable for replacing a surgeon&#39;s assistant or a robotic arm when performing surgery by laparoscopy or celioscopy. 
     Moreover, an anatomical structure can be exposed using surgical forceps passing through the abdominal wall via trocars implanted therein. Thus, five to seven trocars can be implanted in the abdominal wall. Implanting each trocar requires an incision to be made in the abdominal wall. 
     Another object of the invention is to limit the number of trocars implanted, so as to reduce the number of scars that result from an operation. 
     To this end, the invention provides a parietal anchor instrument of the above-specified type, for anchoring a human or animal organ, characterized in that it comprises:
         holding means for holding said organ;   attachment means for attaching at least one traction element to said holding means, the traction element being suitable for being secured to an abdominal wall of said living being in order to raise said organ held by the holding means and keep it in suspension in order to expose an anatomical structure during a surgical operation, in particular using laparoscopy or celioscopy; and   gripping and manipulation means for gripping and manipulating said holding means with surgical forceps, the dimensions of the instrument being selected to enable it to pass through a laparoscopy or celioscopy trocar.       

     In particular embodiments, the parietal anchor instrument includes one or more of the following characteristics:
         two longitudinal elements hinged to each other about a middle hinge pin to form a clip, and said clip presents, on either side of the hinge pin, firstly said holding means, and secondly said means for gripping the instrument;   it further comprises a spring secured to at least one longitudinal element and urging said holding means towards a rest position that is closed;   the grip means comprise two bearing disks each secured to a respective longitudinal element and provided with a projection on its outside face in order to make the instrument easier to grip by means of a surgical forceps;   the attachment means for attaching a traction element are formed at the hinge pin interconnecting the two longitudinal elements;   the holding means comprise a single or multiple hook;   the means for attaching a traction element comprise an element that defines a closed passage;   said element is secured to a portion of the instrument and forms a projection therefrom; and   the means for attaching a traction element comprise at least one orifice passing through a portion of the instrument.       

     The invention also provides a device for parietally anchoring an organ, which device comprises at least one traction element and a parietal anchor instrument for anchoring an organ, said traction element being suitable for passing through the abdominal wall and for being secured firstly to the attachment means of said instrument located inside the abdominal wall, and secondly to fastener means outside the abdominal wall so as to form a stationary anchor point for the organ held suspended by the anchor instrument and the traction element 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention can be better understood on reading the following description given purely by way of example and made with reference to the accompanying drawings, in which: 
         FIG. 1  is a diagrammatic side view of a parietal anchor instrument in a first embodiment of the invention; 
         FIG. 2  is a plan view of the instrument shown in  FIG. 1 ; 
         FIG. 3  is a diagrammatic perspective view of a parietal anchor instrument in a second embodiment of the invention; and 
         FIGS. 4 to 7  are diagrammatic section views of a region of the abdomen during various steps of a method of parietal anchoring by means of an anchor instrument constituting the first embodiment of the invention. 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     The parietal anchor instrument shown diagrammatically in  FIGS. 1 and 2  comprises a clip. It has first and second longitudinal elements  4  and  6 , each made as single piece of metal or plastics material. It presents a length of about 2 centimeters. 
     As can be seen in  FIG. 1 , the first and second longitudinal elements  4  and  6  are hinged to each other in their middle portions so as to constitute clip  8 . On either side of a hinge pin  10 , the clip  8  comprises a jaw  12  for holding an organ and means  14  for gripping the instrument and controlling the opening of the jaw  12 . The longitudinal elements  4  and  6  are suitable for pivoting about the pin  10  between a closed position and an open position of the clip  8 . 
     More precisely, the first longitudinal element  4  comprises in succession a pierced flat  16 , a clevis  18 , a connection shank  20 , and a bearing disk  22 . The flat  16  and the disk  22  extend in planes that are parallel but not coplanar. The clevis  18  extends the flat  16  towards the shank  20 . 
     The second longitudinal element  6  is similar in shape to the first element  4 . It thus likewise comprises a flat  24 , a connection shank  26 , and a bearing disk  28 . Nevertheless, a convex projection  30  replaces the clevis  18 . The convex projection  30  is engaged in the clevis  18 . The pin  10  passes through the projection  30  and the clevis  18  to hinge the first element  4  to the second element  6 . 
     The two flats  16  and  24  constitute the jaw  12  of the clip for holding an organ. They present anti-skid serrations  32  on their facing faces in order to make it easier to hold human or animal organs. In addition, the flats  16  and  24  include respective oblong through openings  34  extending over their entire length. 
     A spring  35  serves to hold the jaw  12  in a closed position and is mounted between the shanks  20  and  26 . The spring  35  is suitable for exerting a pressure force suitable for bringing the flats  16  and  24  together. Thus, at rest, when no pressure is exerted on the outside surfaces of the bearing disks  22  and  28 , the clip  8  is held in a closed or organ-pinching position. The spring  35  is formed by a metal blade secured to the shank  26  and bearing against the shank  20 . The blade is suitable for exerting a force that opposes opening the clip. 
     The bearing disks  22  and  28  and the connection shanks  20  and  26  form means  14  for gripping and controlling opening of the jaw  12 . They enable the anchor instrument to be handled and moved during a surgical operation. 
     The anchor instrument also comprises an arch  36  for attaching at least one traction element  37  to the clip  8 . This traction element is preferably flexible. For example it may be constituted by a thread, a strip, a strap, etc. The traction thread  37  is suitable for being secured to the abdominal wall of the living being to be operated in order to raise and keep in suspension an organ held by the jaw  12 . The thread may also carry an organ at a point situated between the clip and the parietal exit point of the thread, as described below in the method of using the anchor instrument of the invention. 
     The traction thread  37  is secured to the arch  36 , e.g. by a flexible bond. The arch is secured at each end to the pin  10 . The arch  36  is made of a semi-elastic material of the plastics material or rubber type, so that it deforms as a function of the direction in which the thread applies traction. 
     The arch  36  is positioned at a certain distance from the jaw  12  and the means  14  for gripping and controlling said jaw, so that the thread  37  does not wind about them. Furthermore, the arch  36  projects from the jaw  12  and the means  14  so as to make it easier to engage an additional traction thread during a surgical operation. 
     The means  14  also include projections  38  projecting from the outside surfaces  39  of the bearing disks  22  and  28  so as to make it easier to grip, handle, and control opening of the clip  8  using a conventional surgical forceps. Each projection  38  has a frustoconical end portion  40  and a cylindrical base  41  secured to the bearing disks  22 ,  28 . The base  41  has a diameter that is slightly smaller than the diameter of the end windows in conventional surgical forceps so as to enable them to be inserted therein. 
       FIG. 3  shows a parietal anchor instrument in a second embodiment of the invention. This instrument is formed by a double hook  42 . It comprises a rectangular support plate  43  having mounted thereon hook means  44 , means  45  for attaching a traction thread  37 , and means  46  for gripping the anchor instrument. 
     The hook means  44  comprise two hooks  47  and  48  projecting from one side of the plate  43  and both curved in the same direction. 
     The means  45  for attaching a traction thread comprise an arch  49  secured to the side opposite the side that presents the hooks  47  and  48 . 
     The grip means  46  comprise two diverging and curved wings  50  and  51  that are secured to opposite faces of the plate  43  and that form a mean angle α relative to the plane thereof. The angle α is selected to facilitate gripping the instrument by means of surgical forceps regardless of the positioning of the double hook  42 . This positioning is imposed by the location of the trocar and the position of the operating surgeon. 
     In a variant that is not shown, the hook means  44  for hooking an organ comprise a single hook or a triple hook. 
     The parietal anchor instruments shown in  FIGS. 1 to 3  are example embodiments of the invention that are not limiting in any way. The shape of these instruments varies as a function of the type of organ that is to be held and as a function of its atraumatic nature. 
     In another variant of the first and second embodiments of the invention (not shown), the means  36  and  45  for attaching the traction thread are formed by an orifice passing through the anchor instrument. The thread is suitable for being inserted in the orifice and then attached around a wall of the instrument. For example, the orifice may be made through the convex projection  30  and the clevis  18 , or through a connection shank  20 ,  26  of the clip  8 . It may also be formed through the support plate  43 . 
       FIGS. 4 to 6  show a parietal anchoring method implemented using an anchor instrument constituting the first embodiment of the invention. 
       FIG. 4  is a diagrammatic section view of an operation space defined by an abdominal wall  52 . 
     In a first step of the operation, two trocars  53  and  54  are inserted in the wall  52 . 
     Then, during a second step of the operation, an anchor device  58  is brought via the trocar  53  into the operation space  59  of the abdomen. This device  58  comprises an anchor clip  8 , a traction thread  37 , and a needle  62 . One end of the thread  37  is secured to the arch  36  of the clip  8 . The other end of the thread  37  is secured to the needle  62 . 
     In a third step of the operation, shown in  FIG. 5 , the surgeon introduces conventional forceps  66  and  68  into each of the trocars  53  and  54 . The surgeon then moves out of the way an organ located in front of the anatomical region on which the operation is to be performed by using one of the forceps  68 . This forceps takes hold of an organ  70  in order to expose the zone on which the operation is to be performed. 
     In order to hold the organ  70  away from the operation zone in a static position, the surgeon or the surgeon&#39;s assistant inserts the projections  38  of the grip and control means  14  of the clip  8  into the windows at the ends of the free forceps  66  or  68 , opens the jaw  12  by using the grip and control means  14 , and takes hold of the organ  70  in the jaws  12 . 
     In a fourth step, shown in  FIG. 6 , the surgeon pierces the abdominal wall  52  with a needle  62  manipulated by the forceps  66  at a selected anchor point  73 . The needle  62  and a portion of the thread  37  are thus moved out from the operation space  59 . While this is taking place, the thread  37  pulls the organ  70  and the suspended clip  8  so that the organ  70  moves away from the operation zone. 
     In a fifth step, shown in  FIG. 7 , the thread  37  is secured to the outside of the abdominal cavity  59  by fastener means  76 , e.g. comprising a forceps. The thread  37  secured to the abdominal wall  52  thus constitutes a stationary anchor point  73  for the organ  70 . The organ  70  is held away from the operation zone, but without being held by a surgeon&#39;s assistant or a robotic arm. The thread  3  maintains constant traction on the organ  70  without piercing it. 
     In a variant, the thread is attached inside the abdominal cavity to a transparietal intra-abdominal anchor system, i.e. an intraparietal fastener system connected to an extraparietal system that does not pass through a trocar. Under such circumstances, a plurality of traction threads can advantageously be attached to the intraparietal fastener system. 
     Advantageously, the position of the organ  70  can be readjusted during surgery merely by applying traction on the thread  37  outside the wall (or vice versa) and repositioning the fastener means  76 . 
     A variety of anchor instruments  8 ,  42  of this type can be used simultaneously during surgery in order to optimize exposure and release the surgical forceps  66  and  68  that pass through the trocars  53  and  54  so as to enable them to perform dynamic roles during the operation. 
     Advantageously, the anchor instrument  8 ,  42  can be manipulated and moved during surgery so as to hold onto another organ in the abdominal cavity while maintaining the first anchor point  73  secured to the abdominal wall  52 . 
     In parallel, the anchor point  73  of the organ can also be moved so as to obtain another viewing angle on the operation zone, while continuing to hold the organ  70  in the jaw  12 . For example, when the surgeon seeks to orient the organ  70  in another direction, a second thread (not shown) can be inserted into the operation space  59 , which thread is secured to the needle  62 . The end of the second thread is secured to the arch  37  of the clip  8 . Thereafter the previously attached first traction thread  37  is cut. The second thread is suitable for passing through the wall  50  with the help of the needle  62  at a second anchor point  79  different from the first anchor point  73 . 
     Thus, the parietal anchor instrument makes it possible to hold an organ  70  in a certain position for a selected duration at a first anchor point, and then to move the organ  70  and to hold it suspended in a different orientation from a second anchor point  79 . 
     The parietal anchor instrument thus makes it easier to expose an operation zone without requiring an additional trocar and without requiring an extra hand for acting thereon. 
     Advantageously, by reducing the number of trocars that are implanted, the number of incisions in the abdominal wall is reduced, thereby accelerating patient recovery by reducing the duration of post-operative convalescence. 
     The anchor instrument serves to reduce the number of surgeon&#39;s assistants needed to assist the surgeon during the operation, such that in the event of a hemorrhage or some other incident, a surgeon&#39;s assistant has an additional hand available for acting and dealing with the incident. 
     Advantageously, the gripping end of the clip  8  and the wings  50 ,  51  of the double hook  42  can be manipulated by conventional celioscopic instruments. 
     To recapitulate, the method of parietally anchoring an organ of a living being for exposing an anatomical structure that is to be treated during a surgical operation comprises:
         a first step of inserting a trocar  53 ,  54  in the abdominal wall  52  of a human being or an animal;   a second step of introducing a parietal anchor instrument  8 ,  42 , a needle  62 , and at least one traction thread  37  into the abdominal cavity  59 , a first end of the thread  37  being connected to the needle  62  and a second end of the thread  37  being connected to the anchor instrument  8 ,  42 ;   a third step of releasably holding said organ  70  by means of the anchor instrument  8 ,  42 , which anchor instrument is suitable for taking hold of different organs in succession during an operation;   a fourth step of transpiercing the abdominal wall  52  from the inside to the outside by means of the needle  62 , or of attaching to a transparietal intra-abdominal anchor system, and then pulling said organ  70  by means of the anchor instrument  8  and the thread  37 ; and   a fifth step of securing the first end of the thread  37  to the outside of the abdominal wall  52  with the help of fastener means  76  so as to form a stationary anchor point  73 ,  79  for the organ held suspended by the thread and the anchor instrument.       

     This anchoring method is performed during a surgical operation. It is temporary. The organs held suspended by the thread and the anchor instrument are released at the end of the surgery. 
     The anchor instrument constituting the first embodiment of the invention serves to hold and pinch organs without piercing them or damaging them.