Apparatus for peritoneal retraction

#The present invention relates to an apparatus and method for mechanically lifting the abdominal wall away from the underlying abdominal organs during laparoscopic procedures. In its more specific aspects, the invention is concerned with such an apparatus and method wherein the abdominal wall is lifted internally by a mechanical device which is introduced blindly or laparoscopically and, once in place, expanded to engage an extensive area of the abdominal wall. The invention is also concerned with an apparatus and method for draping the abdominal organs and displacing a particular organ, such as the gallbladder, for treatment.

#Laparoscopy dates back to the turn of the 20th Century. Early laparoscopic techniques were used primarily for diagnostic purposes to view the internal organs, without the necessity of conventional surgery. Since the 1930s, laparoscopy has been used for sterilization and, more recently, for the suturing of hernias. U.S. Pat. Nos. 4,919,152 and 4,944,443 are concerned with techniques of the latter type. Another very recent innovation is the use of laparoscopic surgery for removal of the gallbladder.

#The concept of using mechanical retraction schemes to lift the abdominal wall away from the underlying abdominal organs during laparoscopic procedures is new to the present invention. Procedures presently in use use carbon dioxide insufflation to tent up the interior of the abdominal wall. This requires gas seals to be present at all entry ports through the abdominal wall; and because of the doming effect of insufflation, the laparoscopic instruments (graspers, scissors, electrocautery instruments, etc.), need long shafts (on the order of 12 to 13 inches) to reach the treatment site. Such instruments are difficult to control and result in exaggerated movements during instrument application.

#FIG. 1 is a transverse cross-sectional elevational view of a body, showing a first embodiment of the invention in the process of lifting the abdominal wall;

#FIG. 2 is a transverse cross-sectional elevational view of a body, showing a second embodiment of the invention in the process of being placed for lifting of the abdominal wall;

#FIG. 3 is a transverse cross-sectional view similar to FIG. 2, showing the second embodiment in the process of lifting the abdominal wall;

#In those embodiments of the present invention which employ balloons, the balloon material should be relatively inelastic and tough. Examples of such material are Mylar, Polyethylene and Polyurethane. The thickness of the balloon wall is typically from 0.5 to 5 mils.

#Referring now to FIG. 1, a body is designated therein in its entirety by the letter "B" and is shown having an abdominal cavity "C" with an upper wall "W". The solid lines illustrate the wall in the retracted elevated condition. The phantom lines depict the position the wall would assume when relaxed.

#The lifting device of the first embodiment (FIG. 1) comprises a stiff transverse bar 10 passed through a puncture site below the costal margin on one side of the body and out another puncture site below the costal margin on the other side. The puncture sites are placed as far laterally as possible; close to the anterior axiallary line on both sides. The bar is then lifted and placed on slotted posts 12 secured to both sides of the operating table 14. The placement of the bar below the costal margin places the maximum lift at the site of the gallbladder, for cholecystectomy procedures. The bar may be placed through puncture sites located more inferiorly for other procedures. A second transverse bar may also be used to define an entire plane of lift, as four puncture sites are then made in the abdominal wall. Alternatively instead of using a rigid bar, a cable may be passed through the abdominal wall and variable tension applied to the cable to yield different degrees of retraction.