Abstract:
A laparoscopic tool, the tool including an elongate shaft; a handle at one end of the shaft and an aperture at the opposed end, and; a tape selectively extendable from the aperture.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 62/135,217, filed Mar. 19, 2015, entitled “Improved Laparoscopic Device and Method,” by Joseph Tang, et al. which is incorporated herein by reference in its entirety for all purposes. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not applicable. 
       REFERENCE TO A MICROFICHE APPENDIX 
       [0003]    Not applicable. 
       BACKGROUND 
       [0004]    The invention relates to apparatus and methods used in the identification and analysis of tears, fissures and other defects in tissue, animal, human or otherwise. In particular, the invention relates to the measurement of said defects for subsequent treatment. 
         [0005]    Whilst methods exist to measure tissue defects, these are cumbersome and time consuming. Accuracy is also an issue, particularly when direct measurement is required. A defect within the abdomen when viewed through a laparoscopic endoscope distorts the visualization of this defect. 
         [0006]    There is currently no single device that can be used to take a linear measurement within the body laparoscopically. Linear measurements are currently taken by inserting a surgical measuring tape within the body and using two graspers to extend the tape. The measurement is then read from the tape through an endoscope, which could distort the reading of the measurement. This current method is cumbersome and time-consuming. 
       SUMMARY 
       [0007]    In a first aspect, the invention provides a laparoscopic tool, the tool including an elongate shaft; a handle at one end of the shaft and an aperture at the opposed end, and; a tape selectively extendable from the aperture. 
         [0008]    Accordingly, the invention provides a laparoscopic endoscope having an integral measurement device, operable from a handle of said laparoscopic endoscope. By incorporating the measurement device, the operator/surgeon is able to take measurements more efficiently and consequently more accurately. 
         [0009]    The laparoscopic endoscope may also include means to read the measurement from the handle, as compared to viewing the measurement through an endoscope, and so avoiding possible distortion. 
         [0010]    In this embodiment, the measurement may be in the form of an analogue or digital display. 
         [0011]    The measurement device may include a filament projecting from the laparoscopic endoscope in order to make the measurement. To this end, the filament may be a stainless steel tape, which may have gradations to permit reading the measurement through an endoscope. 
         [0012]    Alternatively, the filament may be a wire, with the distance the wire projects from an end of the laparoscopic endoscope measured and displayed on the handle. Alternatively, the filament may be a linear array of balls connected through a wire so as to allow articulation between adjacent balls. The connecting wire may be pre-tensioned so as to apply a pre-load to the balls, and so aiding in the stiffness of the linear array. This may consequently assist in positioning the linear array in the desired position for measurement. 
         [0013]    The laparoscopic tool may be intuitively easy to use (single operator and single-handed operation best), but not precluding the use of two-handed operation. 
         [0014]    Fits directly into current operating workflow 
         [0015]    Cost effective (an affordable single use tool) 
         [0016]    Accurate to +/−1 mm 
         [0017]    Safe for use in the operating environment 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0018]    It will be convenient to further describe the present invention with respect to the accompanying drawings that illustrate possible arrangements of the invention. Other arrangements of the invention are possible, and consequently the particularity of the accompanying drawings is not to be understood as superseding the generality of the preceding description of the invention. 
           [0019]      FIG. 1  is a schematic view of a laparoscopic endoscope according to one embodiment of the present invention; 
           [0020]      FIG. 2  are various views of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0021]      FIG. 3  is a sectional view of the laparoscopic endoscope of  FIG. 2 ; 
           [0022]      FIGS. 4 and 5  are isometric views of the laparoscopic endoscope of  FIG. 2 ; 
           [0023]      FIG. 6  are sequential views of a laparoscopic endoscope in use according to a further embodiment of the present invention; 
           [0024]      FIG. 7  is a sectional view of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0025]      FIG. 8  is various views of laparoscopic endoscopes according to several embodiments of the present invention; 
           [0026]      FIG. 9  is an isometric view of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0027]      FIG. 10  is a flow chart detailing interactions of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0028]      FIG. 11  is a sectional view of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0029]      FIG. 12  are various views of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0030]      FIG. 13  is an isometric view of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0031]      FIG. 14  is a schematic view of the operation of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0032]      FIG. 15  is a schematic view of the operation of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0033]      FIG. 16  are various views of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0034]      FIG. 17  are various views of a laparoscopic endoscope according to a further embodiment of the present invention; 
           [0035]      FIG. 18  are various views of an alternate application of the laparoscopic endoscope  FIG. 17 ; 
           [0036]      FIGS. 19 to 28  are various embodiments of laparoscopic positional devices. 
       
    
    
     DETAILED DESCRIPTION 
       [0037]    As shown in  FIG. 1 , a procedure  5  using a laparoscopic endoscope  10  and a grasper  15  are used by the surgeon to measure the size  42  of a defect  20  (such as a hernia). In this embodiment, the laparoscopic endoscope  10  includes a retractable measuring tape/steel monofilament  40 , with a ring  35  attached to the end of the tape  40  and places it across the defect  20 . The width  42  of defect  20  can either be read from the tape itself or via an analog or digital readout on the laparoscopic endoscope  10 . In this embodiment, the end of the laparoscopic endoscope  10  includes a swiveling tip to direct the tape  40  in the desired direction. 
         [0038]    As shown in  FIG. 2 , one embodiment of the present invention includes is a single use laparoscopic surgical tool, used to provide size information of a hernia defect to a surgeon in order to assist in determining the size of a hernia polymeric mesh. It is also useful in determining the size of an intra-abdominal mass, or other lesion, when laparoscopic techniques are used. 
         [0039]    The laparoscopic endoscope includes a measurement tape  45  with a hook ring  50 , an articulating tip  55 , a shaft  60  and handle  65 . In this particular embodiment, the measurement tape  45  can be extended to a maximum length of 20 cm, but it will be appreciated that the length of the tap  45  is provided by way of example and is not limiting on the scope of the invention. 
         [0040]    The tape  45  is enclosed by the handle  65  and the shaft  60 , and can be extended out by grasping the hook ring  50  with a laparoscopic grasper tool (not shown), and pulling it away from the handle or instrument tip. The shaft can be rotated up to 330 degrees using the rotation knob  70 . The extended tape would be aligned to the hernia defect for length (diameter) information through the Viewing Panel  75 . The tape can be retracted by pushing the switch  80  forward. 
         [0041]    The device works on spring loaded spool and ratchet mechanism for extending and retracting the tape. The ratchet will be affective when extending the tape, while a rotary damper will slow down the retraction of the tape by the spool. 
         [0042]      FIG. 3  shows the internal arrangement for one laparoscopic device  85  according to the present invention. As before the device  85  includes a viewing panel  90  for displaying the extent of the filament (or tape  110 , in this case) projecting from the tip  120 . In this case, a portion of the filament extends into the handle, with the base line on the filament indicating against a data, visible through the viewing panel  90 , such that as the filament extends, the length can be read as an analogue measurement. There is a release switch  95  for selectively locking the filament and a ratchet from preventing an uncontrolled retraction of the filament, which is biased to retract on release of the switch  95 . 
         [0043]    There is also a damper  105  to protect the device from over extension or retraction of the tape  110 . 
         [0044]    Further, the shaft through which the tape passes is rotatable using a rotation knob  115 . This is particularly useful for aligning the tape against the defect, and works with the articulating tip to provide pivotal movement of the tip about the longitudinal axis of the shaft. 
         [0045]      FIGS. 4 and 5  show the arrangement and handling of the device  85  of  FIG. 3 . Importantly, the arrangement of the device, whereby one handed operation  125  is permitted can be seen in  FIG. 5 . 
         [0046]    Referring to the measurement workflow  130  of  FIG. 6 , the use of the device includes the steps of over-extending  150  the filament  145  and align edge of tape measure to point A, then while edge of tape is anchored at point A, move tip of device towards point B and extend/retract  155  filament to align with point B. 
         [0047]    The position of the tip is facilitated in this embodiment by the use of an articulation of the tip  140  relative to the shaft  135 . 
         [0048]      FIG. 7  shows other possible arrangements to the device  170 , including a lever  175  which is connected to two guide wires running the length of the shaft and connecting to the articulated tip (not shown). By moving the lever  175 , the guide wires allow pivoting of the tip within a plane, defined by the placement of the guide wires on opposed sides of the tape/filament. 
         [0049]    To facilitate control of the filament retraction/extension, the device  170  of  FIG. 7  includes a motor  180 , powered by a battery  185 . 
         [0050]      FIG. 8  shows various embodiments, particularly regarding the tip. 
         [0051]    One embodiment of the tip  155  shows guide wires  215  as previously described, placed on opposed sides of the filament and connected to the tip  195 . By applying a tensile force to one guide wire, the articulated tip  195  is biased, within the laner defined by the guide wires, in the respective direction. On release of the force, a spring  205  biases the tip  195  back to the central position. In one embodiment, the articulated tip may be pivoted up to 1 pp degrees from the longitudinal axis of the shaft. 
         [0052]    Attached to the end of the tape, but not limited for use with this particular embodiment, is a frictional grip  200 . Having a plurality of minor projections, the grip  200  is arranged to engage the tissue so as to anchor the tape. In this way, a grasper may not be required allowing the surgeon to conduct the measurement one handed. 
         [0053]    An alternative grip  235  is shown, having a Y shape, and arrange to engage the tissue in a frictional engagement or alternatively to clamp or pinch flaps of tissue in order to anchor the tape. 
         [0054]    This diagram also shows an embodiment whereby the tip has multiple articulations, in particular a linkage  225 ,  227  joined by a hinge and projecting from the shaft  223 . With the guide wires connected to the end link  227 , the intermediate link  225  does not need to be controlled and the hinges  224 ,  230  providing a far greater degree of pivoting angle. 
         [0055]    It will be appreciated that the grips and tip arrangements are now limited for use with the corresponding features shown in  FIG. 8 . Each of the features may be used separately, with  FIG. 8  providing an illustrative view of each. 
         [0056]      FIG. 9  shows a further embodiment of a handle  240  according to the present invention. 
         [0057]    A digital display  245 , with a zero button is provided, together with a toggle between inches and millimetres. The handle includes a pistol grip  255 , with a trigger  260  for the articulation of the tip, the trigger connected to guide wires for reciprocal movement arranged to reciprocally pivot the tip. 
         [0058]    A rotating knob  265  is also provide, and directly connected to the shaft for rotating the shaft. Rotation of the shaft together with pivoting of the tip allows for full articulation about the longitudinal axis of the shaft. A “rocker” switch  250  is also provided for incrementally moving the tape backward and forward as a means of fine control. The switch is biased to a central position to facilitate said movement. 
         [0059]      FIG. 10  shows a flow chart of input and output from the device. 
         [0060]      FIG. 11  shows a further embodiment of the present invention. In particular is shows a handle  270  having a lever  275  connected to guide wires for articulating the tip. Rapid deployment of the tape is provided by a trigger  290 , with fine adjustment provided by a rotating knob  280 . Measurement of the extended tape is achieved by an encoder  285  tacking the movement of the tape within the handle. This compares to a rearrangement  295  of features as shown in  FIG. 12  with the coarse and fine adjustment provided by adjacent knobs  300 ,  305 , and the lever provided on an underside of the handle  295 . 
         [0061]      FIG. 13  shows a still further rearrangement  315  with an amended form of the fine  330  and coarse adjustment knobs  325  on respective bottom and top portions of the handle  315 . A lever  320  similar to that previously described is also shown adjacent to the display panel on the top portion. 
         [0062]      FIG. 14  shows one method of measurement of a defect in tissue, such as a hernia  350 , whereby a device  340  according to one embodiment of the present invention has a display on the respective handle. Here a spinal needle  335  is placed in the tissue at a point adjacent to one side of the hernia. The tape engages the needle through a hook or loop  360  and the tape is drawn out of the shaft until it aligns, through a swiveling tip  345 , with the opposed edge of the hernia. The length  362  can then be read from the display  335 , or directly from gradations on the tape. 
         [0063]    A slightly more indirect method is shown in  FIG. 15 , whereby anchoring the needle  380  in the tissue does not correspond to a convenient point of measurement. By placing the needle where convenient the tape, in this case a memory wire, can be formed into a loop, with a diameter of the loop corresponding to a dimension  395  of the hernia  390 . The displayed length will provide the circumference with the diameter  395  readily calculated. 
         [0064]      FIG. 16  shows a further embodiment of the present invention. A laparoscopic device  400  having a handle corresponding to any of the previous embodiments, includes a filament comprising a linear array  420  of steel balls  430  connected by a wire  435  passing through the centre. The balls may include flat portions  450  to provide stable abutting surfaces between adjacent balls. Further, the wire may be pre-tensioned to apply a pre-load to the balls, increasing the stiffness of the linear array. 
         [0065]    Extending  445  the linear array  420  may be according to any previous embodiment, and in this case includes a trigger  405 , and may include a recording button  415  for recording the measurement, and an articulated tip  440 . The articulation of the adjacent balls facilitates the position of the linear array so as to align the filament across of convenient dimension  425  of the hernia. 
         [0066]      FIGS. 17 and 18  show a still further embodiment, with a device  455  having a handle  460  and shaft  465  of the present invention. Here the measuring portion of the filament is a rigid linkage  470 , comprising a 1 st  and 2 nd    472 ,  475  portion having an intermediate hinge  495  in the linkage. In this case, the hinge is spring loaded. Extending  469  the linkage from the shaft  465 , permits the linkage to spring into a linear ruler for direct measurement of the hernia  485 . The length of the fissure can then be readily measured by observation. On extension, the hinge  495  is adjacent to the tip  490 , and so applying a retraction force pivots the linkage so as to fit back within the shaft  465 . 
         [0067]      FIG. 18  shows a similar arrangement, however extension  505  of the linkage  500  is only allowed so as to form a V shape, having an angle  515  between the 1 st  and 2nd links. Respective ends of the 1 st  and 2 nd  links  520 ,  525  are then positioned at convenient edges of the hernia  535  and the angle measured by observation. As the 1 st  and 2 nd  links are of the same length, the length  530  of the hernia can then be readily calculated. 
         [0068]    CMM is the Coordinate-measuring machine that is used to measure accurately points in space and distances. Its accuracy is due to a stable base and hinges/linkages that are able to tell the angle moved. 
         [0069]    Variations: 
         [0070]    Mechanical 
         [0071]    Optical/wireless linkages 
         [0072]    Use spheres of known size as references and capture and compare both the hernia defect and spheres in the photo. 
         [0073]    Variations: 
         [0074]    Image process the size to give positional info 
         [0075]    Ease of use: Medium to Low 
         [0076]    Accuracy: Medium 
         [0077]    Cost of Product: Low 
         [0078]    Development: Medium (mainly image recognition and app development) 
         [0079]    Variations for  FIG. 23 : 
         [0080]    Xbox Kinect-type sensor for 2d imaging 
         [0081]    Use 2 Lytro cameras to take image and determine focal length 
         [0082]    Use diffraction grating—interference pattern to measure distances 
         [0083]    For example Project Vernier scales 
         [0084]    Ease of use: Medium to Low 
         [0085]    Accuracy: Medium 
         [0086]    Cost of Product: Medium to High 
         [0087]    Development: High