Surgical apparatus with annular penetrator

(Technical field) The present disclosure relates to surgical instruments for use in minimally invasive surgical procedures such as endoscopic or laparoscopic procedures.

(Background of related technology) Minimally invasive procedures are constantly increasing in number and variants. Forming a relatively small-diameter temporary pathway to the surgical site is an important feature of the least invasive surgical procedure. The most common way to provide such a pathway is by inserting a trocar assembly through the skin. In many procedures, the trocar assembly is inserted into the patient's abdominal cavity. In such procedures, a trocar assembly with a sealing mechanism is utilized to provide the required route to the surgical site while minimizing the leakage of pneumoperitoneum gas.

Trocar assemblies typically include emboluses that are retractably inserted through the cannula. The embolus may include a safety shield that protects against accidental puncture by the sharp tip of the embolus. The safety shield includes a mechanism for controlling the relative movement and locking of the safety shield. An embodiment of a safety shielding mechanism is disclosed in Patent Document 1 of Stellon et al., Assigned to the applicant of the present application, the entire contents of which are incorporated herein by reference.

Therefore, the present disclosure is directed to further improvements in the trocar assembly.

<p><patcit num="1"><text>U.S. Pat. No. 6,319,266</text></patcit></p>

<p> Surgical instruments for puncturing tissue include an outer member that defines a longitudinal axis and has an outer peripheral wall, and an inner member that is at least partially located within the outer member. The inner member includes a puncture member adjacent to the distal end of the outer member. The puncture member has a substantially annular perimeter that is adapted to puncture the tissue. The inner and outer members are fitted for relative longitudinal movement between the first and second longitudinal positions. In the first position, the annular peripheral edge of the puncture member is substantially constrained within the outer peripheral wall of the outer member, and in the second position, the annular peripheral edge is at least partially exposed from the outer peripheral wall. Promotes puncture through tissue.</p><p> The housing member is mounted adjacent to the proximal end of the outer member. The outer member is adapted for longitudinal movement relative to the housing member and the inner member and moves between the first and second longitudinal positions. The outer member may be deflected towards a second longitudinal position.</p><p> The puncture member may define a cross-sectional dimension that surrounds a peripheral edge that approximately approximates the outer dimension of the outer member. The puncture member may be longitudinally separated from the distal end of the outer member when in the second longitudinal position. The distal end of the lateral surface may demarcate the non-traumatic nose and, in one embodiment, is substantially closed.</p><p> The outer member defines a longitudinal induction channel for receiving the inner member, at least in part. The inner member traverses the induction channel in response to the longitudinal movement of the outer member between the first and second longitudinal positions. The outer member includes an opposing groove extending through the outer wall. The annular peripheral edge extends through the opposing groove in response to the movement of the outer member to the second longitudinal position.</p><p> The inner member and the puncture member may be integrally formed.</p><p> Also, the surgical instrument may include a cannula and the outer and inner members may be able to be placed within the cannula.</p>

Preferred embodiments of the present disclosure will be described later with reference to the drawings.<figref num="1">FIG. 1 is a perspective view of a surgical instrument according to the principles of the present disclosure, showing a cannula and an embolus that can be positioned within the cannula.</figref><figref num="2">FIG. 2 is a perspective view of the embolus of the surgical instrument of FIG.</figref><figref num="3">FIG. 3 is a perspective view of an disassembled part of the embolus showing the embolus housing, the outer member, and the inner member provided with the annular puncture member mounted on the outer member.</figref><figref num="4">FIG. 4 is a side sectional view of the embolus showing the outer member at the first longitudinal position relative to the inner member and the puncture member.</figref><figref num="5">FIG. 5 is a perspective view of the tip portion of the embolus showing the annular puncture member sealed inside the outer member when it is in the first longitudinal position of the outer member.</figref><figref num="6">FIG. 6 is an enlarged separation view of a region detailed in FIG. 3, showing a mounting configuration of the annular puncture member and the outer member.</figref><figref num="7">FIG. 7 is a plan view of the tip portion of the embolus further showing the first longitudinal position of the outer member and the coupling relationship between the inner member and the puncture member.</figref><figref num="8">FIG. 8 is a diagram showing surgical instruments applied to body tissues.</figref><figref num="9">FIG. 9 shows the surgical instrument on the cross section and the movement of the outer member in a second longitudinal position relative to the inner and puncture members in response to the engagement of the outer member with the tissue. Is.</figref><figref num="10">FIG. 10 is a plan view of the tip portion of the embolus, similar to the figure of FIG. 7, showing an outer member in a second longitudinal position with a puncture member that is at least partially exposed.</figref>

Next, referring in detail to the drawings (same reference numbers indicate similar or identical elements), FIGS. 1 and 2 are configured according to preferred embodiments of the present disclosure and are generally designated as reference number 10. Surgical instruments are shown. Surgical instrument 10 is particularly adapted for use in minimally invasive surgical procedures such as endoscopic or laparoscopic procedures. In general, surgical instrument 10 includes two major subassemblies: the embolus assembly 100 and the cannula assembly 1000.

The cannula assembly 1000 may be any cannula assembly suitable for use in laparoscopic surgery procedures. In one preferred embodiment, the cannula assembly 1000 comprises a cannula housing 1002 and a cannula sleeve 1004 extending from the cannula housing 1002. One or both of the cannula housing 1002 and the cannula sleeve 1004 may be partially or wholly transparent and may be processed from a biocompatible metal or polymer material. The cannula sleeve 1004 may include locking ribs 1006 on its outer surface. The locking rib 1006 is configured to engage the tissue, assist in retaining the cannula sleeve 1004 within the tissue, and prevent the cannula sleeve 1004 from rushing backwards from the tissue. The locking ribs 1006 may be spaced along the longitudinal axis "m" of the cannula sleeve 1004. The cannula assembly 1000 may include an internal seal such as a duck bill valve or other zero closure valve that closes in the absence of surgical instruments and is adapted to prevent the passage of pneumoperitoneum gas through the cannula assembly 1000.

The surgical instrument 10 may also preferably include a seal assembly 2000 that is releasably mounted in the cannula housing 1002. Means for releasably connecting the seal assembly 2000 to the cannula housing 1002 may include plug-in couplings, screw couplings, latches, friction fittings, actual splicing configurations, snap fittings and the like. The seal assembly 2000 includes a seal housing 2002 and at least one internal seal adapted to form a fluid seal around the instrument inserted through the seal assembly 2000. One of the suitable seals is disclosed in US Pat. No. 6,702,787, filed March 9, 2003, which was assigned to the applicant of the present application, the entire contents of which are incorporated herein by reference. , May be a fabric seal. The seal disclosed in No. 6,702,787 may be a flat diaphragm seal having a first layer of elastic material and a second fabric layer parallel to the first layer. Further details of the seal will be found by referring to Nos. 6,702,787. The seal assembly 2000 may or may not be a component of the cannula assembly 1000. For example, the seal assembly may be a separate removable assembly. In an alternative example, the seal assembly comprises an integrated portion of the cannula assembly 1000 and does not have to be removable.

Next, referring to FIG. 3-4 in relation to FIG. 2, the embolus assembly 100 includes an embolus enclosure 102 and an embolus shaft or inner member 104 extending distally from the enclosure 102. .. The inner member 104 defines a longitudinal axis "k", the details of which will be described later. The embolus housing 102 includes a housing base 106 and a housing cover 108. Once the appropriate components are placed therein (as described below), the housing base 106 is latched on the housing base 106, for example, correspondingly sized by engaging with the mating surface. It may be attached to the housing cover 108 by an elastic latch 110 of the cover 108 that interconnects with the opening 112. Preferably, in order to connect the base 106 and the cover 108 evenly, at least three corresponding latches 110 and openings 112 are evenly spaced around the cover 108 and the base 108, respectively.

The inner member 104 includes an inner rod 114, a rod mounting portion 116 adjacent to the proximal end of the inner rod 114, and a puncture member 118 adjacent to the distal end of the inner rod 114. The rod mounting portion 116 fixes the inner member 104 inside the embolus housing 102, and fixes the inner member 104 to the embolus housing 102 in the longitudinal direction. In one embodiment, the rod mount 116 includes a deflectable locking detent 120. As best shown in FIG. 4, the housing cover 108 of the embolus housing 102 includes a mounting extension 122 that hangs inside the housing cover 108 that is substantially aligned with the longitudinal axis "k". The mounting extension 122 defines a locking groove 124 that receives the locking detent 120 during insertion and assembly of the rod mounting 116 within the mounting extension 122 of the housing cover 108. Upon insertion, the locking detent 120 bends inward in the radial direction and when in contact, the locking groove 124 is fixed to the locking shelf 124a adjacent to the locking groove 124 due to its inherent elasticity. Will return to engage.

With reference to FIG. 4-7, the puncture member 118 is preferably annular in construction and defines an outer peripheral edge or peripheral end 126 that extends radially outward with respect to the inner rod 114. Each of the peripheral edges 126 extends through the superior arc portion of the outer periphery of the puncture member 118. In one embodiment, the marginal 126 is generally non-traumatic to the tissue and serves the function of dissecting or puncturing the tissue without incising or penetrating the tissue. In some alternatives, the margin 126 may be sharpened to make an incision in the tissue. The puncture member 118 is disclosed as a substantially circular or wheel-shaped configuration. The puncture member 118, adjacent to the peripheral edge 126, defines a reduced outer shape, for example, is relatively thin and improves passage through the tissue. Other configurations are also envisioned, including ellipses, rectangles, polygons and the like. In addition, the puncture member 118 is separated from the distal end 114a of the inner rod 114 by a predetermined distance "b" (FIG. 7).

In one embodiment, the inner rod 114, the rod mounting portion 116, and the inner member 104 including the puncture member 118 are integrally formed as a single unit. Suitable materials for the structure of the inner member 104 include biocompatible materials such as stainless steel and titanium, or suitable polymeric materials such as acrylics and polycarbonates manufactured based on known injection molding techniques.

In connection with FIG. 1, further referring to FIG. 4-7, the embolus assembly 100 further includes a protective shield or outer member 128 that is coaxially arranged around the inner member 104. The outer member 128 is adapted for mutual longitudinal movement relative to the embolic housing 108, the inner member 104, and the puncture member 118. The outer member 128 includes a proximal mounting ring 130, a main outer body 132, and a distal or tip protection 134. The outer member 128 may be integrally formed as a single unit by any of the biocompatible materials described above in connection with the inner member 104. In one embodiment, the outer member 128 includes a longitudinal portion 128a. The longitudinal portions 128a may be fixed to each other by conventional means after the inner member 104 is assembled within the outer member 128. Such means may include adhesives, glues, snap fits and the like.

The mounting ring 130 of the outer member 128 is received in the cylindrical mounting portion 136 of the base 108 of the embolus housing 102, and the outer member 128 is mounted on the embolus housing 102. The mounting ring 130 may traverse the cylindrical mounting portion 136 along the inner rod 114 during longitudinal movement of the outer member 128 relative to the embolus housing 102. The outer member 128 moves the outer member 128 in the mutual longitudinal direction along the inner member 104 between the first relative forward position shown in FIG. 4 and the second relative retract position described later. The longitudinal bore 138 is defined so as to receive the inner rod 114 of the inner member 104 in such an manner as possible.

The outer member 128 may be spring biased distally by the coil spring 140. At its proximal or rear end, the coil spring 140 is coaxially located around the mounting extension 122 and around the proximal end of the inner member 104, and at its distal end with the mounting ring 130 of the outer member 128. It is received in the cylindrical mounting portion 136 in the engaged state. In this way, the coil spring 140 usually deflects the outer member 128 in the distal direction.

Then, referring to FIG. 4-6, the tip protection 134 of the outer member 128 may generally be tapered and incorporate a pointed or truncated conical configuration as shown. The interior of the tip protection 134 is adapted to accommodate the puncture member 118 and is configured to move the tip protection 134 along the puncture member 118 upon longitudinal movement of the outer member 128, an internal recess. Includes 142. The tip protection 134 further defines a diametrical opening or groove 144 within the wall of the tip protection 134 communicating with the internal recess 142. The puncture member 118 extends through the opening 144, at least in part, when in the second receding longitudinal position of the outer member 128. Tip protection 134 defines an arched distal nose 146 configured to puncture or pass tissue in a non-traumatic manner. The distal nose 146 is closed, i.e. lacks an opening or void, but would otherwise undesirably accept tissue during puncture and impair the puncture ability of the embolus assembly 100. There will be.

Next, we discuss the use of surgical instruments. With reference to FIG. 8, the surgeon initiates the insertion of the assembled surgical instrument 10 through the body wall, eg, the patient's abdominal cavity. The tip protection 134, especially initially, allows the outer member 128 to be relative to the inner member 104 shown in FIGS. 4 and 7, through the reaction force applied by the tissue when the distal nose 146 contacts the tissue. It is driven upward against the deflection of the coil spring 140 from the first longitudinal position to the second longitudinal position of FIGS. 9 and 10. This retreat movement exposes the puncture member 118 from the tip protection 134 by at least partial expansion of the peripheral edge 126 of the puncture member 118 through the opposing opening 144 of the tip protection 134. In the second longitudinal position, the distal end 114a of the inner rod 114 contacts or "reaches" the cross section 138a of the longitudinal bore 138 of the outer member 128. The exposed puncture member 118 may cause the surgeon to exert a distally directed force on the surgical instrument 10 to puncture the tissue. In particular, the distal nose 146 of the tip protection 134, in combination with the puncture capability of the peripheral 126 of the puncture member 118, facilitates passage through the tissue in a non-traumatic embodiment. In one embodiment, the cross-sectional dimension or diameter "t" of the puncture member 118 including the peripheral edge 126 may approximate the outer shape of the body 132 of the outer member 128 (see FIG. 10). Therefore, once the periphery 126 has passed through the tissue, the outer member 128 and the cannula sleeve 1004 may easily continue to advance through the tissue with minimal effort by the surgeon.

When the puncture member 118 and the tip protection 134 pass through the patient's body wall, the tip protection 134 is no longer forced and moves freely in the distal direction relative to the puncture member 118. As a result, the outer member 128 is driven distally to the first relatively longitudinal position of FIG. 1 under the influence of the coil spring 140, with the tip protection 134 restraining the puncture member 118. The embolus assembly 100 is removed from the cannula assembly 1000 and surgery is performed with an instrument inserted through the cannula assembly 1000.

Unless otherwise stated, the materials utilized in the components of the trocar assembly disclosed herein are generally, for example, ABS, polycarbonate, stainless steel, titanium, and any other suitable biocompatible metal and / or polymer. Includes materials such as materials. A preferred ABS material is CYCOLAC commercially available from General Electric. Also, preferred polycarbonate materials are commercially available from General Electric under the LEXAN trademark. An alternative polycarbonate material available is CALIBRE Polycarbonate commercially available from Dow Chemical Company. The polycarbonate material may be partially glass filled for increased strength.

Illustrative embodiments of the present disclosure are described herein with reference to the accompanying drawings, but the present disclosure is not limited to those exact embodiments, and various other modifications and modifications may be made. It should be understood that it can be achieved herein by one of ordinary skill in the art without departing from the scope or spirit of this disclosure.