Abstract:
Auxiliary forceps are provided for video-assisted minimally-invasive surgery, such as hand-assisted laparoscopic surgery, the forceps being intended for operation by a surgeon&#39;s non-dominant hand inserted through an incision for entering a patient&#39;s natural body cavity. The forceps comprises a plurality of actuating plates hinged elastically to one another and having a size and shape suitable for operation when held by the tips of two fingers. The forceps also has a plurality of jaws extending from each actuating plate, and a member for temporarily connecting the forceps to the surgeon&#39;s hand so as to maintain the forceps at an adjustable distance from the hand of not greater than a predetermined value. In addition, a structure is provided for housing the jaws relatively close to one another, within which the jaws are engaged during operation when the forceps is not in use.

Description:
FIELD OF THE INVENTION 
   The present invention relates generally to precision instruments and, more particularly, to instruments for minimally invasive surgery. 
   BACKGROUND OF THE INVENTION 
   Traditional hand-assisted laparoscopic surgery (or HALS) combines conventional minimally-invasive laparoscopic surgical techniques with those of classical open field surgery. More specifically, by the laparoscopic approach, through application of trocars (generally speaking, three access points) for the introduction of instruments used during surgical intervention by a laparoscope (either of the optical fiber type or those equipped with a CCD camera), a surgeon can visually access and maneuver relevant inner portions of a patient&#39;s abdomen. The diameter of the incisions made is typically between about 5mm and about 25 mm. Through insufflation of an inert gas, a working space, known as a pneumaperitoneum, is then created in the abdomen. This enables the surgeon to operate readily, without hindrance due to a lack of adequate space. In addition, an incision about 5-7 cm long is made near the first access points or incisions, through which the surgeon may introduce his/her generally non-dominant hand into the patient&#39;s abdomen and perform support operations (such as tissue displacement, retraction of organs to be operated on, palpation, interaction with other instruments, etc.). 
   To prevent loss of pneumaperitoneum through the incision(s), several types of sealing devices have been developed. These devices are intended to be applied to an incision so as to allow passage of the surgeon&#39;s hand therethrough, while preventing gas from escaping. Currently available sealing devices are of several types, for instance, either those having an adhesive flange to be secured to the abdominal wall or devices of an inflatable type. A conventional sealing device of the inflatable type that is considered especially comfortable and easy to use is one having a substantially tubular inflatable sleeve, with a twisted inner cross section, for providing a seal against the surgeon&#39;s arm once her/his hand has been inserted through the sleeve. The device also has a pair of sealing rings for closing the innerside and the outerside of the abdominal wall corresponding to the incision. 
   Hand-assisted laparascopic surgery has been successfully applied to a wide range of surgical procedures for example gastric resection, gastric by-pass, transhiatal esophgectomy, pancreatic and hepatic surgery, nephrectomy, colorectal surgery, aortic aneurysm repairs, etc. The main advantages of this technique as compared to conventional laparascopic surgery is that the surgeon retains both (i) direct tactile sensation of traditional surgery, which is not provided by modern, remotely controlled instruments, and (ii) the hand-eye coordination lost previously when surgeons began perfoeming surgery through a monitor. Furthermore the presence of the surgeon&#39;s hand in the surgical field enables greater ease in, and atraumatic displacement of, the organs, an immediate control of potentially dangerous situations, and gives him/her the ability to perform blunt dissections. In addition, the facility provided by use of an assisting hand makes the surgeon&#39;s task easier to perform, thereby reducing the level of training and experience usually required to master laparoscopic surgery techniques. 
   However, in the course of hand-assisted laparoscopic surgery, situations often occur where the surgeon&#39;s dexterity is no longer adequate to perform extraordinarily precise operations such as fine dissections, vascular peduncula isolation, limphade-nectomy, etc. In conventional open field surgery, when tissue to be grasped is only a few millimeters in size such that the surgeon&#39;s finger tips can be ineffective, the use of forceps, which is generally operated by the surgeon&#39;s non-dominant hand, is not problematic. During minimally invasive procedures, on the other hand, such as hand-assisted laparoscopic surgery, the use of conventional surgical forceps has not been possible. This is because of their shape, incompatibility with the space available in the surgical field, and the manner in which this type of minimally invasive intervention is carried out, namely, a need to minimize the number of times the non-dominant hand is extracted from and re-inserted into the surgical field. 
   OBJECTS AND SUMMARY OF THE INVENTION 
   Accordingly, it is an object of the present invention to provide relatively small dimension, structurally simple, and reliable forceps for surgical use, which are not only suitable for general use by a surgeon, as necessary, but also for video-assisted, minimally invasive surgical procedures, in particular, hand assisted laparoscopic techniques. 
   Another object of the present invention is to provide forceps having a shape, dimensions and structure suitable to be kept at the surgeon&#39;s disposal for selected use in the patient&#39;s abdominal cavity during intervention and in such a position that it may be quickly and easily grasped using the surgeon&#39;s fingers, when necessary, or can be parked after use without risk of accidental damage to surrounding organs and tissue. 
   A further object of the present invention is to provide forceps adapted for positioning integral to a surgeon&#39;s hand upon use and, when not in use during intervention, may be parked in a patient&#39;s abdominal cavity without risk of its jaws posing a danger of lesions to surrounding body structures. 
   Still another object of the present invention is to provide forceps configured for operation by a minimum number of fingers (e.g., two). 
   Yet another object of the present invention is to provide a method of performing hand-assisted laparoscopic surgery, which is not only easier for the surgeon, but also allows operations to be accomplished that would otherwise be impossible to perform manually alone. 
   According to one aspect of the present invnetion, an auxiliary forceps is provided for video-assisted, minimally invasive surgery, such as hand-assisted laparoscopic surgery. The forceps preferably comprise a plurality of actuating plates, hinged elastically to one another and having a shape and dimensions such that they may be operated when kept between the tips of two fingers of a surgeon&#39;s hand, and by a plurality of jaws, each extending from a respective actuating plate. The forceps further provide for temporary connection to the surgeon&#39;s hand, for maintaining the forceps at an adjustable distance from the hand of not greater than a predetermined value, and for housing the jaws in a mutually side-by-side condition, within the housing structure, the jaws being engaged when, during intervention, the forceps are not in use. 
   In accordance with another aspect of the present invention, a forceps is provided that may be secured to a surgeon&#39;s hand by a cord joined to actuating plates. The forceps includes an anchoring device, such as a loop made from the same cord, and an elastic ring or a clamp that is adjustable in width and distance relative to the plates. Preferably, a housing of the jaws is formed either of a removable prtoective cap connected to the plates by a cord of adjustable length, or by a seat perimetrically formed at an edge of the plates. In the latter case, the jaws are of a retractable type - the jaws having a curved shape and an angular displacement from an operating position to a rest position within the seat. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     A specific, illustrative auxiliary forceps for video-assisted, minimally invasive surgery, according to the present invention, is described below with reference to the accompanying drawings, in which: 
       FIG. 1  is a plan view of an auxiliary forceps, according to one aspect of the present invention; 
       FIG. 2  is an enlarged perspective view of the forceps of  FIG. 1 ; 
       FIG. 3  shows a diametric section of the forceps of  FIG. 2 , taken along the axis of the forceps jaws; 
       FIG. 4  is a perspective view of a forceps, in accordance with another aspect of the present invention, in a closed position; 
       FIG. 5  is a perspective view of the forceps according to  FIG. 4  in an open position; 
       FIG. 6  is a sectional view taken along line VI-VI of  FIG. 4 ; 
       FIG. 7  is a partially sectioned, plan view of the forceps illustrated in  FIG. 5 ; and 
       FIG. 8  is a plan view of an auxiliary forceps, according to another aspect of the present invention. 
   

   DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
   Referring now to the drawings and, more particularly, to  FIGS. 1-8 , there is shown generally a specific, illustrative auxiliary forceps for hand-assisted laparoscopic surgery, in accordance with various aspects of the present invention. According to one embodiment, shown generally in  FIGS. 1 ,  2  and  3 , a forceps  10  is provided, that preferably includes a pair of substantially circular actuating plates  1   a ,  1   b  joined to one another by a pin  3  extending at a chord thereof. Actuating plates  1   a ,  1   b  are very small, but sufficient in size to be grasped and actuated by-holding-them when held between the tips of two fingers such as of a surgeon&#39;s hand, which size corresponds to a few centimeters in diameter (for example, about 3 cm). Respective jaws  2   a ,  2   b  may be mounted securely to plates  1   a ,  1   b  in any suitable fashion, for example, as shown in the drawings, by screws  4 , and extend from a portion diametrically opposed to pin  3  and perpendicularly thereto. The heads of screws  4  are desirably housed within respective seats  5  formed on plates  1   a ,  1   b  and concealed by covering caps  6  mounted suitably thereon such as by snap-fit reception. A spring  7 , for example of a flat type, is interposed between plates  1   a  and  1   b  to keep jaws  2   a ,  2   b  in spaced apart relation relative to one another. A diametrical channel  9 , extending from the perimetrical edge of plate  1   a  to the inner end of jaw  2   a , is formed in plate  1   a  to connect jaw  2   a  through an electric cable to an electric power source, for instance, to enable the forceps to be used for unipolar or bipolar electrocoagulation. 
   A bracket  12  with through hole  13  extends from a facing  11  formed on a perimetrical edge of plate  1   a  (plate  1   b  having a corresponding facing), from the portion diametrically opposed to jaw  2   a . A cord  14  is tied to hole  13  and a cap  15  is secured to cord  14  for acting as a sheath for jaws  2   a, b  of the forceps, when not in use. Cord  14  forms a loop  14   a  of adjustable width by sliding a cord-clamping slider  15 . A second slider  16 , engaged with cord  14  immediately dowstream of bracket  12 , aids in adjusting the length of the cord at the end to which cap  15  is affixed. Equivalently, and as an alternative to loop  14   a,  cord  14  may be provided with an elastic ring or a securing clamp. 
   In use, forceps is desirably secured by loop  14   a  to a phalanx or the wrist of a surgeon&#39;s non-dominant hand, before inserting the hand in the abdomen, while jaws  2   a ,  2   b  are placed in cap  15 . In this manner, any risk of lesions caused accidentlly to the surrounding tissues is avoided and, simultaneously, jaws  2   a ,  2   b  are maintained in relatively close proximity to one another, thus overcoming the bias of spring  7  and retaining forceps  10  in a closed position. When the forceps is to be used, the surgeon removes cap  15  and operates the forceps by holding the actuating plates between two finger tips. To make it easier for them to be grasped between his/her fingers, a surface of plates  1   a, b  may be worked or otherwise processed in various ways, such as by grooving, as in the present embodiment, or by ribbing, curling and/or the like. 
   When not in use, the forceps remains anchored to the surgeon&#39;s hand through cord  14  at a selected distance not greater than the length of the cord portion of the cord comprised between cord clamps  15  and  16 , and then secured at such distance, as needed. 
   Alternatively or concurrently, protective cap  15  is replaced by a substantially C-shaped sheath (not shown) pivotally connected to one of the plates. Upon rotation in one direction, the sheath jaws may be engaged within the C-shaped sheath, or can be disengaged therefrom upon their rotation in another direction, thus achieving the same function as cap  15 . 
   In accordance with another aspect of the present invention, shown generally in  FIGS. 4-7 , jaws  20   a  and  20   b are provided which are retractibly housable within a housing seat  22  formed on a perimetrical edge of actuating plates  1   a  and  1   b ; the same numerals being used to indicate the respective components as those used with the forceps in  FIGS. 1-3 . Consequently, jaws  20   a    20   b  have a curved shape that extend from an enlarged portion, or root,  23 ,  24 , respectively, from which they are hinged to actuating plates  1   a,    1   b  by respective pins  21 . Actuating plates  1   a,    1   b  are hinged to one another through a pin  34 , as before. An elastic member  30 , for instance, as shown in  FIG. 6 , is provided therebetween to keep the forceps in an open position. 
   As best seen in  FIG. 4 , jaws  20   a ,  20   b  are formed at roots  23 ,  24 , respectively, having a side protrusion  25  that allows a tangential force to be exerted on the roots, releasing jaws  20   a ,  20   b  and thus enabling them to achieve reach the operative or working position shown in  FIG. 5 . 
   To maintain the forceps in a closed position when the jaws are in a stowed or resting position, illustrated in  FIG. 4 , a fastening device is provided between the actuating plates. The device, according to one arrangement, is a substantially T-shaped bracket  26  affixed to one of the plates, e.g., plate  10   b , by its leg  26   a  and extends with its transverse portion  26   b  within housing seat  22 , in a groove  27  correspondingly formed in the other plate, e.g., plate  10   a . In this manner, when jaws  20   a ,  20   b  are placed in the housing seat, the jaw integral to the plate, and within which groove  27  is formed, abuts on transverse portion  26   b  of the bracket, such that it cannot escape from the groove, thereby securing the plates to one another. 
   So that relatively precise mutual parallelism of jaws  20   a    20   b  is achieved in any position, a pin  28  (see  FIGS. 6 and 7 ) extends from one plate to the other and engages a slot  29  formed in the root of the latter plate. Slot  29  is so oriented as to be generally perpendicular to the forceps hinge when the jaws are in an operative position. Pin  28  may then tilt within slot  29  when the jaws are in spaced apart relation to one another, and keeps the jaws secured to one another when they are closed. 
   The force exterted on jaws  20   a ,  20   b , while in the stowed or retracted position, by elastic member  30  through transverse portion  26   b  of bracket  26 , normally keeps the forceps in the closed position it being necessary to slightly urge against protrusion  25  to open the forceps. To then maintain the jaws in the operative position, an end-stroke locking device is provided, such as a tooth  31  (shown in  FIGS. 5 and 7 ), protruding from one of the plates towards the other and snap engaging within a cavity  32  formed correspondingly in the jaws integral to the same plate. Cavity  32  and/or tooth  31  can be formed with inclined walls or sides to make snap engagement/disengagement easier, while also taking advantage of the elasticity of the material. Although the present invention has been shown and described in connection with the above-described locking arrangement, use of other functionally equivalent, end-stroke locking devices, may be appreciated by those skilled in the art, based on a rearview this disclosure. 
   The forceps, according to the present invention, are advantageously in not requiring that the jaws be capped. This is because, when not in use, the jaws are housed retractably in seat  22 , formed perimetrically on edges of plates  1   a ,  1   b . To secure the forceps to a surgeon&#39;s hand, the same solution as is provided by the forceps of  FIGS. 1-3  above may be used. Specifically, a cord  14  is tied to bracket  12  through hole  13 , forming a loop  14   a  of a diameter which is adjustable by a cord clamp slider  15 . 
   Another method of securing auxiliary forceps to the surgeon&#39;s hand, according to the present invention, is illustrated generally in  FIG. 8 . In particular, the forceps includes a cord-anchoring adhesive member  14   b  for application to the glove worn by the surgeon. The member is applied in such a position as to not hinder movement of the surgeon&#39;s hand, such as on the back of his/her hand, or at the base of a finger phalanx (like a ring or hemi-ring with an adhesive plate). 
   Facing surfaces of the jaws are shaped in a substantially conventional manner, according to the function they are intended to perform. For example, the jaw surfaces can be toothed for better grasping of the tissues and/or formed with a suitable seat for holding a needle, or with other shapes according to the function desired. 
   Overall, the auxiliary forceps, according to the present invention, has numerous advantages for hand-assisted laparoscopic surgery. First, it allows a number of different types of operations to be performed which could not otherwise be carried out without the help of a surgeon&#39;s hand (vascular peduncula isolation, lynphoglandula ablation, grasping of small portions of tissues). Second, the very small size of the forceps (operating plates  1   a ,  1   b  being a few centimeters in diameter) a minimizes interference, while still allowing relatively easy and firm handling of the forceps when the plates are grasped by two fingers. Third, they have a relatively wide actuating surface for the surgeon&#39;s fingers which makes a third fulcrum (e.g., the hollow at the thumb root), unnecessary, as is otherwise required by conventional, elongated structure forceps. 
   Moreover, their substantially circular shape, with streamlined and/or rounded off edges, makes them extremely safe to use, being nearly risk-free for causing accidental lesions to the tissues. Furthermore, with the forceps described above in which the jaws are curved, the shape of the jaws provides the benefit of minimizing hindrance or obstruction when the instrument is in a stowed or resting condition. This also allows the forceps to be used both for grasping and dissecting the tissues, with the possibility of surrounding vascular structures according to techniques well-known in the art. 
   Generally speaking, the forceps, according to the present invention, is intended for use as a disposable instrument. However, in the alternative, it may be constructed of one or more materials suitable for sterilization according to known techniques and, therefore, re-used. Preferably, the operating plates are either relatively dark in color or transparent, to avoid undesirable reflection which can disturb the surgeon&#39;s view of the surgical field through a monitor. The transparency also allows sight of the otherwise concealed portion of the surgical field to be maintained through the plates. 
   Various modifications and alterations to the invention may be appreciated based on a review of this disclosure. These changes and additions are intended to be within the scope and spirit of the invention as defined by the following claims.