Valve assembly including diameter reduction structure for trocar
Abstract
This record has no abstract on file.
Term
Term ended
Expired 12 October 2021, 5 years ago.
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- Today
15 claims: 4 independent, 11 dependent
- 1套管針と共に使用され、且つ、中の器具の回りに実質的な液密シールを形成するための弁アセンブリーにおいて、 長手方向軸線を定義するハウジング(210、610、910、1610)を備え、該ハウジング(210、610、910、1610)は、その中を通って伸びる長手方向の通路を有しており、 さらに、前記ハウジング(210、610、910、1610)の中に装着されるシール部材(125、825、1525)を備え、前記シール部材(125、825、1525)は、前記ハウジング(210、610、910、1610)を通して導入される器具にシール状態で係合するようになった開口部(129)を前記シール部材(125、825、1525)の中に有しており、 さらに、前記ハウジング(210、610、910、1610)内において、前記シール部材(125、825、1525)の遠位に装着された少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)を備え、前記スタンドオフ素子(250、650、950、1350、1650)は、前記ハウジング(210、610、910、1610)の長手方向の通路を横切る初期位置と、前記器具を通過させる旋回位置との間で旋回移動できるようになっており、前記スタンドオフ素子(250、650、950、1350、1650)は、相互に動作的に結合され、それによって、前記スタンドオフ素子のうちのいずれか一つ(250、650、950、1350、1650)の旋回移動により、前記スタンドオフ素子の残りのすべて(250、650、950、1350、1650)の対応する同時の旋回移動を生じさせるようになっており、前記スタンドオフ素子(250、650、950、1350、1650)は、初期位置に付勢され前記器具に係合して、前記器具を前記シール部材(125、825、1525)の軸線に対して整列した位置に向けて移動させるようになっている、 ことを特徴とする弁アセンブリー。
- 2請求項1に記載の弁アセンブリーであって、前記スタンドオフ素子(250、650、950、1350、1650)は、前記ハウジング(210、610、910、1610)の長手方向軸線に対して同軸的に配置されることを特徴とする弁アセンブリー。
- 3請求項1又は2に記載の弁アセンブリーであって、前記スタンドオフ素子(250、650、950、1350、1650)を動作的に結合するためのギアリンク機構(225、255、270、275、670、970、1670)を含み、前記ギアリンク機構(225、255、270、275、670、970、1670)は、隣接するスタンドオフ素子(250、650、950、1350、1650)の間に配置された少なくとも一つのギアリンク(271、671、971、1671)を含んでいることを特徴とする弁アセンブリー。
- 4請求項1から3のいずれか1項に記載の弁アセンブリーであって、前記シール部材(125、825、1525)の遠位に配置された弾性フランジ(1450)を含み、前記弾性フランジ(1450)は、該弾性フランジ(1450)と一体に形成されたスタンドオフ素子(250、650、950、1350、1650)を有することを特徴とする弁アセンブリー。
- 5請求項1から4のいずれか1項に記載の弁アセンブリーであって、前記スタンドオフ素子(250、650、950、1350、1650)は、初期位置と、第一の旋回位置および第二の旋回位置との間で旋回運動するようになっており、前記スタンドオフ素子(250、650、950、1350、1650)は、前記ハウジング(210、610、910、1610)の長手方向の通路を通して前記器具を挿入する際に前記第一の旋回位置へと移動するようになっており、前記スタンドオフ素子(250、650、950、1350、1650)は、前記長手方向の通路から前記器具を抜取る際に前記第二の旋回位置へと移動するようになっていることを特徴とする弁アセンブリー。
- 6請求項1から5のいずれか1項に記載の弁アセンブリーであって、前記シール部材(125、825、1525)は、周縁部分(126)を含み、かつ、開口部(129)を定義する内部シール部分(127)を含み、前記内部シール部分(127)は、遠位方向に伸びて、前記内部シール部分(127)の中への前記器具の導入を容易にすることを特徴とする弁アセンブリー。
- 7請求項1から6のいずれか1項に記載の弁アセンブリーであって、少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)が、前記ハウジング(210、610、910、1610)の長手方向軸線に対して配置され、それによって、隣接するスタンドオフ素子(250、650、950、1350、1650)は、ギャップを定義することを特徴とする弁アセンブリー。
- 8請求項1から7のいずれか1項に記載の弁アセンブリーであって、少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)を含み、前記少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)は、前記少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)の初期位置にあるときに、前記少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)の間にあり、かつ、第一の内部寸法を有する第一の開口部を定義し、前記少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)の動作位置にあるときに、前記少なくとも3つのスタンドオフ素子(250、650、950、1350、1650)の間にあり、かつ、第二の内部寸法を有する第二の開口部を定義するように、前記ハウジング(210、610、910、1610)の中に配置され、前記第二の内部寸法は、前記第一の内部寸法よりも大きいことを特徴とする弁アセンブリー。
- 9手術器具において、 長手方向軸線を定義するハウジング(210、610、910、1610)を備え、該ハウジング(210、610、910、1610)は、その中を通って伸びる長手方向の通路を有し、且つ、近位端および遠位端を有しており、 さらに、前記通路を横切って装着されるシール部材(125、825、1525)を備え、前記シール部材(125、825、1525)は、前記通路の中に導入される物体と、実質的にシールした関係で係合するようになっており、 さらに、前記シール部材の遠位にある前記ハウジング(210、610、910、1610)内に装着された少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)を備え、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、前記ハウジング(210、610、910、1610)の長手方向軸線と長手方向に整列した位置になるように前記物体を付勢するようになっており、いずれか1つのスタンドオフ素子(250、650、950、1350、1650)と、前記通路の中に導入された前記物体とが係合するときに、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、初期位置と動作位置との間で前記通路の中を移動することができ、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、前記長手方向軸線と一致した位置に向って前記物体を移動させる傾向をもっており、少なくとも1つの歯車(255、275)が、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)に動作的に結合されるようになっており、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は動作的に結合され、少なくとも1つのスタンドオフ素子(250、650、950、1350、1650)が移動することにより、他のスタンドオフ素子(250、650、950、1350、1650)のすべてが対応して移動するようになっていることを特徴とする ことを特徴とする手術器具。
- 10請求項9に記載の手術器具であって、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、初期位置と動作位置との間で旋回するようになっていることを特徴とする手術器具。
- 11請求項9又は10に記載の手術器具であって、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、それらの初期位置に付勢されるようになっていることを特徴とする手術器具。
- 12請求項9から11のいずれか1項に記載の手術器具であって、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、初期位置にあるときに、前記通路を横切るように、前記ハウジング(210、610、910、1610)の中に配置されることを特徴とする手術器具。
- 13請求項9から12のいずれか1項に記載の手術器具であって、前記少なくとも2つのスタンドオフ素子(250、650、950、1350、1650)は、前記シール部材(125、825、1525)の遠位に装着されることを特徴とする手術器具。
- 14手術器具において、 長手方向軸線を定義するハウジング(210、610、910、1610)を備え、該ハウジング(210、610、910、1610)は、その中を通って伸びる長手方向の通路を有しており、 さらに、前記通路を横切って装着されるシール部材(125、825、1525)を備え、前記シール部材(125、825、1525)は、前記通路の中に導入される物体と、実質的にシールした関係で係合するようになっており、 さらに、前記シール部材の遠位にある前記ハウジング(210、610、910、1610)内に装着された複数のスタンドオフ素子(250、650、950、1350、1650)を備え、前記複数のスタンドオフ素子(250、650、950、1350、1650)は、前記ハウジング(210、610、910、1610)の長手方向軸線と長手方向に整列した位置になるように前記物体を付勢するようになっており、前記スタンドオフ素子(250、650、950、1350、1650)は、前記物体と前記スタンドオフ素子(250、650、950、1350、1650)のいずれか一つが係合したときに、初期位置と旋回した位置との間で前記通路の中を旋回移動することができるようになっており、さらに、少なくとも1つの歯車(255)が、前記スタンドオフ素子のすべて(250、650、950、1350、1650)を動作的に結合し、それによって、前記隣接するスタンドオフ素子(250、650、950、1350、1650)は、初期位置と旋回した位置との間で、同期した関係で旋回移動するようになっている、 ことを特徴とする手術器具。
- 15請求項14に記載の手術器具であって、前記スタンドオフ素子(250、650、950、1350、1650)は、複数の歯車(255)によって動作的に結合され、それによって、前記スタンドオフ素子(250、650、950、1350、1650)は、初期位置と旋回した位置との間で、同期した関係で旋回移動するようになっていることを特徴とする手術器具。
Independent claims15
1 paragraph, as filed
[0001] [Cross-reference of related applications] This application claims the priority of US Provisional Application No. 60 / 240,506 filed on October 13, 2000, the entire contents of which are incorporated herein by reference. [0002] [background] 1. Technical field The present disclosure relates to a mechanism for controlling the operable inner diameter of a passage through a valve assembly of a hypodermic needle housing (trocar housing). More specifically, the present disclosure relates to a reduced diameter structure, which limits the movement of small surgical instruments and also accommodates large diameter surgical instruments within the passage of the manipulative needle housing and is formed by a valve assembly. Facilitates maintenance of airtight seals. [0003] 2. Background of related technology The trocar needle valve assembly (trocar valve assembly) preferably provides a liquidtight seal around the surgical instrument introduced through the trocar needle during minimally invasive surgery. A typical valve assembly includes an outer seal, which can be fixed or suspended in combination with an additional inner seal. The fixed outer seal is limited by the ability to maintain the seal as the small surgical instrument moves eccentrically with respect to the central axis of the manipulative needle. The fixed seal is also limited by its ability to maintain its integrity when angled the surgical instrument. Extreme movements within the scrotum of such small-diameter surgical instruments can form a "cat eye" or an increasingly large gap in the fixed seal, which is the seal's. It will lose its integrity. A further problem involves the flexibility of the seal to maintain the integrity of the seal when using both small and large diameter surgical instruments. [0004] Devices that limit the diameter of the passage within the needle housing require an additional mechanism, typically located at the proximal end of the needle housing, to limit the range of movement of the small surgical instrument. However, these diameter reduction devices typically use additional seals and / or structures that require user adjustment to accommodate different sized surgical instruments, thereby complicating the surgical process. To do. [0005] There is a continuing need for diameter-reducing structures that can limit eccentric movement and angular movement of small-diameter surgical instruments and can accommodate large-diameter surgical instruments without external adjustment. [0006] [Summary of Invention] A valve assembly is provided for use with casing needles,<u style="single">This valve assembly</u>Includes a reduced diameter structure to assist the valve assembly in maintaining the seal. This reduced diameter structure includes a standoff assembly that can be movably placed to control eccentric translation and angular movement of small diameter surgical instruments. In one preferred embodiment, the valve assembly includes a housing that defines a longitudinal axis and has a longitudinal passage that extends through it, and a valve member mounted within the housing.<u style="single">this</u>The valve member is<u style="single">In it</u>It has one opening that engages the instrument introduced through the housing in a sealed state. [0007] At least one standoff element<u style="single">That is, the standoff member</u>Is mounted in a housing distal to the valve assembly.<u style="single">This standoff element (standoff member)</u>Allows swivel movement between an initial position across the longitudinal passage of the housing and a swivel position through which the instrument is passed. The standoff element is usually in the initial position to engage the instrument.<u style="single">Being urged</u>, The instrument is generally urged towards a position aligned with the axis of the valve member. Preferably, a plurality of standoff elements are provided and are arranged coaxially with respect to the longitudinal axis of the valve housing. These standoff elements are operably interconnected, thereby allowing them to standoff.<u style="single">element</u>Moves between the initial position and the turning position at the same time. In one preferred configuration, the standoff elements are operatively coupled via a gear link mechanism. This gear link mechanism is an adjacent standoff<u style="single">element</u>Includes at least one gear link placed between. The valve assembly also includes an elastic flange located distal to the valve member.<u style="single">this</u>The elastic flange is one that is integrally formed with it.<u style="single">Standoff element (standoff member)</u>Have. [0008] The housing may include a first housing member and a second housing member. The first housing member has one standoff member mounted therein. The first housing member is connected to the second housing member to allow longitudinal movement of the first housing member with respect to the second housing member. The valve assembly also includes an elongated seal mounted around the first housing member and the second housing member. This elongated seal maintains a substantially liquidtight seal during longitudinal movement of the first housing member. [0009] Also, the valve assembly includes a standoff member that swivels between an initial position and a first swivel position and a second swivel position. This one standoff member is adapted to move to the first swivel position when the instrument is inserted through the longitudinal passage of the housing. The one standoff member is adapted to move to the second swivel position when the instrument is withdrawn from the longitudinal passage. The valve assembly may include a peripheral portion and an internal sealing portion that defines the opening. This internal sealing portion extends distally, facilitating the introduction of the instrument into it. [0010] Thus, in a preferred embodiment, the diameter-reducing structure controls the area of motion of the passageway within the tract during surgery without any external adjustment or intervention of an independent operator. The standoff assembly of the reduced diameter structure reduces the size of the operating area when utilizing smaller instruments, and the larger instruments eliminate the standoff members in the longitudinal direction so that they can be adjusted or adjusted by a separate operator. Automatically accommodates large instruments below the aisle operating area without intervention. The movement of the standoff member is designed to accommodate a large surgical instrument having a cross-sectional area equal to the operating area of the passage. [0011] [Detailed Description of Preferred Examples] Hereinafter, preferred embodiments of the stalk needle diameter reduction structure disclosed herein will be described with reference to the accompanying drawings. The disclosure is intended to accommodate all types of surgical instruments, including clip applyers, grippers, anatomical instruments, retractors, staple instruments, laser fibers, endoscopes, and electronic surgical cutting devices, aggregating devices and ablation devices. It is assumed that the surgical needle (trocar) is introduced into the patient's body. The drawings are then referred to for specific details, but here, over several figures, similar numbers indicate similar or identical elements. First, with reference to FIG. 1, a novel valve assembly and diameter reduction structure 100 for a casing needle, constructed according to a preferred embodiment of the present disclosure, is shown. It is intended for use in combination with the conventional hypodermic needle assembly (trocar assembly), which defines a passage 25 aligned with the central longitudinal axis X, and the cannula (cannula) 50. The passage 25 defines the first operating area. [0012] The valve assembly and diameter reduction structure 100 includes a diameter reduction assembly 200 located adjacent to the proximal end portion and a valve assembly 300 located adjacent to the distal end portion. The reduced diameter assembly 200 of the present disclosure, alone or in combination with the valve assembly 300, provides a seal between the cavity formed in the patient and external air when and after insertion of the instrument through the cab 50. To do. In addition, the valve assembly and reduced diameter structure 100 can accommodate instruments of various diameters, eg, 5 mm to 12 mm, by providing an airtight seal with each instrument during surgery. The flexibility of this valve assembly and diameter reduction structure 100 to maintain a liquidtight seal often requires a variety of instruments with different diameters during a single operation, as well as eccentric movement and small surgical instruments. It greatly facilitates endoscopic surgery, such as when surgical flexion is used. [0013] The valve assembly and the reduced diameter structure 100 can preferably be detachably attached to the proximal end 54 of the stalk 50. During surgery, the surgeon can remove the diameter reduction assembly 200 from the valve assembly 300 at any time during surgery. Similarly, the diameter reduction assembly 200 can be attached to the valve assembly 300 to reconstruct the diameter reduction structure and valve assembly 100. In addition, the diameter and valve assembly 100 is designed to be easily mounted on conventional casing of different structures, materials and lengths. The ability to remove the reduced diameter assembly 200 from the valve assembly 300 facilitates removal of the specimen through the casing 50 and also profile the tubing 50 when the reduced diameter assembly 300 is not required at a particular point in surgery. Reduce. It is also envisioned that the assembly 200 can be configured to fit a variety of valve assemblies. [0014] Next, with reference to FIGS. 2 to 3, one preferred embodiment of the novel valve assembly and diameter reduction structure 100 of the present disclosure will be described in detail. The diameter reduction assembly 200 includes a terminal cap 110, a first seal 125, a diameter reduction structure housing or first housing 210, a first O-ring 225, a diameter reduction structure 240, and a diameter reduction structure base element 280. Includes. The diameter-reduced structure foundation 280 is coupled with the valve assembly 300. The seal housing 30 is detachably coupled to the stalk 50. The end cap 110 is generally tubular and includes a distal end portion 112 and a proximal end portion 114. The ring-shaped disc 116 defines a hole 115 aligned with a central longitudinal axis. The end cap 110 is removably coupled to the diameter reduction structure housing 210. [0015] The first seal 125 is disposed in a sealed state between the distal end of the ring-shaped disc 116 of the end cap 110 and the proximal end portion of the diameter reduction structure housing 210. The first seal 125 forms the first outer seal of the assembly 100 and may be any conventional type of seal, such as a fixed seal or a floating seal (but not limited to these). The reduced diameter structure housing 210 generally has a hemispherical shell shape with a reduced circumference from the distal end portion 212 to the proximal end portion 214. Correspondingly, the distal end portion 212 defines a hole 215 having a diameter larger than the diameter defined by the annular portion 213 of the proximal end portion 214. The holes 215 are concentrically aligned with the central longitudinal axis X. Proximal end portion 214 is configured to be housed and coupled to distal end portion 112. The distal end 212 includes an outer cylindrical portion 216 with a scalloped surface for ease of handling. The first O-ring 225 is seated on the inner surface of the reduced diameter structure housing 210 in the vicinity of the annular portion 213. [0016] Next, referring to FIGS. 2 and 4, the diameter reduction structure basic element 280 seats the diameter reduction structure 240 on its proximal end portion 284 and of the diameter reduction structure 240 through a predetermined range of motion. In cooperation with the housing 210, in support of movement and in limiting the operating diameter of the passage 25 through the valve assembly and diameter reduction structure 100,<u style="single">Standoff element or standoff member</u>It is configured to provide a suitable support structure for the 250. The base element 280 has an outer cylindrical surface 286 and further defines a tube-shaped portion 285 that is generally distally located and centered on the longitudinal axis. [0017] The reduced diameter structure 240 includes a standoff assembly 245 with three standoff members 250 connected by a link mechanism 270 with three link members 271 in this embodiment. The standoff member 250 provides a predetermined degree of control over the movement of the instruments placed within the assembly 100. The link mechanism 270 integrates and synchronizes the movement of the standoff member 250.<u style="single">Each of the link members 271</u>But two adjacent standoffs<u style="single">Element</u>As a result of being connected to and placed between them, the reduced diameter structure 240 forms a substantially hexagon centered around the longitudinal axis X by alternating standoff members 250 and link members 271. It has become. [0018]<u style="single">Each of the standoff members 250</u>It has an opposing cylindrical end portion 254 with a gear that includes a cylindrical implant gear portion 252 that defines the longitudinal axis Y (see FIG. 8) and has teeth 225 extending parallel to the longitudinal axis Y. .. The link member 271 also has a cylindrical shape, which defines a cylindrical end 274 with a gear having a longitudinal axis Z (see FIG. 6) and teeth 275. The teeth 275 extend parallel to the longitudinal axis Z. The link member 271 and the standoff member 250 are located within the diameter reduction structure foundation element 280, and each tooth 275 or 255 is a corresponding tilted slot in an adjacent interrelated portion of the diameter reduction structure 240. Fitted in 257 or 277,<u style="single">Each of the standoff members 250</u>It is configured, measured and arranged in the appropriate angle orientation to integrate and harmonize the simultaneous movement of. [0019] Link member 271 standoffs over the entire range of motion<u style="single">Element</u>It provides a synchronous function for 250 swivel movements, where the reduced diameter structure 240 is at least partially rearranged to accommodate larger diameter surgical instruments. Restrictions on the movement of the diameter-reduced structure 240 in the second position include the diameter of the stalk, standoff<u style="single">Member 250</u>Includes factors such as the shape of the needle and the internal portion of the casing needle, which standoff away from the longitudinal axis.<u style="single">Element</u>Limit 250 swivel or rotary movements. This second position is the standoff<u style="single">Element</u>When the 250 is swiveled, bent, or rotated in a seating position within the reduced diameter structure 280, generally away from the longitudinal axis, to increase the aisle 25, the reduced diameter structure 240 Defined as the diameter defined by the interrupted annular barrier of. The reduced diameter structure housing 210 and the reduced diameter structure basic element 280 are configured to support the placement, diameter control function, and movement of the reduced diameter structure 240. The housing 210 and the base element 280 are adapted to interface with various different end caps, first seals, and seal housings, as well as varying cavities sizes. [0020] Next, referring to FIGS. 2 and 5, the valve assembly 300 is a second O-ring 335, a first seal support member 350, a second seal 365, a second seal support member 380, a third. Includes an O-ring 395 and a sealed housing or a second housing 310 configured for connection to the stalk 50. The reduced diameter foundation 280 provides a seat for the second O-ring 335, which is the seal between the distal end 282 and the proximal end portion 354 of the first seal support element 350. give. [0021] [0021] The second seal 365 includes a flange 367 for being placed in a sealed state between the distal end portion 352 of the first seal support element 350 and the proximal end of the second seal support element 380. There is. The first seal support element 350 is generally ring-shaped with an outer cylindrical surface 356 and has three distally extending tabs 358. The second seal support element 380 also generally has a ring shape with an outer cylindrical surface 386 and is configured to include a tab 388 extending radially. The third O-ring 395 provides a seal between the second seal support element 380 and the seal housing 30. The seal housing 310 utilizes a proximal end portion 314 containing a radially aligned slot configured to engage with the tab 388, and a suitable mounting mechanism such as a bayonet or screw coupling. It has a distal end portion 312 configured to engage the housing 50. [0022] The seal housing 310 further includes two diametrically opposed cantilever portions 325. Each cantilever portion includes two opposing notches 326 with a suture attachment 327 that is generally orthogonal to the portion 325. The attachment 327 easily ties off the suture to actively hold the suture needle assembly in place within the patient against the inflatable pressure typically used in minimally invasive surgery. Includes a cylindrical portion 328 and a hemispherical portion 329 configured to do so. The second seal 365 is shown as a duck beak-shaped seal, but this is any sealing system that is designed to perform the function of the second seal, such as a truncated cone seal. There may be. [0023] The end cap 110, the reduced diameter structure housing 210, the reduced diameter structure basic element 280, the first seal support element 350, the second seal support element 380, and the seal housing 310 are preferably medical grade plastics, metals, Or made of a composite material with suitable strength and impact resilience for that application. In one preferred embodiment, the assembly is injection molded using medical grade plastic. O-rings are generally made of medical grade plastic or rubber suitable for providing a liquidtight seal between rigid structural members. [0024] Next, referring to FIGS. 6 to 8, in one preferred embodiment, the link member 271 is shown aligned with the longitudinal axis Z. A strip 272 with an increased circumference and a predetermined width is arranged on the cylindrical surface of each linkage 270. The teeth 275 have teeth with a first arch width on the outer surface of the cylindrical portion 274, and each tooth 275 tapers or slopes to a narrow second arch width on the opposite side. Thus, the tooth 275 extends inward from the surface 274 to a predetermined point between the surface 274 and the longitudinal axis Z. Teeth 275 extend beyond a recessed flat portion 278 that may include at least one pin 279 and at least partially surround the portion. Pin 279 is concentric with respect to the longitudinal axis Z and extends in the axial direction. Slot 277 is defined by protrusions or teeth 275 and slanted portions of cylindrical portion 274. [0025] A reduced diameter structure foundation element 280 is shown with a distal end portion 282 and a proximal end 284 coupled to a tubular portion 285. The tubular portion 285 is arranged to guide the instrument inserted into the second seal and has an inner diameter at least approximately equal to the diameter of the passage 25. Radially extending tabs 287 and 289 located on the tubular portion 285 and the cylindrical portion 286 are such that the first seal support element 350 is hermetically engaged with the base element 280 combined with the O-ring 335, respectively. Configured and measured. Cylindrical portion 286 has a ring shape that includes a lip 281 extending radially. A tab 288 extending towards the proximal end and at least a partially recessed cavity 290 are configured to support rotation or deflection of the diameter reduction structure 240 within the proximal end portion 284. [0026] The standoff member 250 has a head 260 coupled to a base portion 251 by an arm 256, with opposing cylindrical end portions 254 aligned with the longitudinal axis Y. The tubular strip 252 has a circumference larger than the circumference of the end portion 254. Longitudinal aligned notches 252a are formed in the strip 252 near the base of the arm 256. The tooth 255 has a first arch width that matches the surface of the cylindrical portion 254, which tapers to a narrow second arch width on the opposite side of each tooth. Thus, the tooth 255 extends inward from the surface 254 to a predetermined point between the surface 254 and the longitudinal axis Y. Slot 257 is defined by a protrusion or tooth 255 and an inclined portion of a cylindrical end portion 254. Teeth 255 extend along axis Y beyond a recessed flat portion 258 that may include pin 259, and at least partially surrounds that portion. Pin 259 is concentric with the longitudinal axis Y and extends axially from portion 258. The head 260 is generally hemispherical or bulbous with an outer surface and an inner concave surface 266. [0027] The head 260 includes a first surface 262, which generally has a flat surface, and an opposing tapered second surface 268. The first surface 262 includes a cantilever-shaped extension 261. The third surface 264 generally includes a recess and an inclined side portion 265. The fourth surface 266 facing the third surface has a generally flat surface coupled to the arm 256. The head 260 also includes a recessed notch 263 that is substantially orthogonal to the longitudinal axis Y and is centered and partitioned. Generally, the concave notch 263 is configured and measured to accommodate the restricted eccentric movement by small surgical instruments when the diameter reduction structure 240 is in the primary or initial position. The arm 256 connects the head 260 to the base portion 251. [0028] The parts of the reduced diameter structure 240, including the stand-off assembly 245 and the link mechanism 270, are preferably at least one having flexibility, bias, stiffness, and compressive strength suitable for use as a reduced diameter structure. Manufactured from two medical grade plastics, medical grade plastic laminates, or composites. Further, depending on the application, different materials may be combined to form this structure. For example, the head 260 may be made from one medical grade plastic that has greater impact resilience than the second medical grade plastic that forms the arm 256. Similarly, the link member 271 may be made of one or more suitable medical grade plastics or composites. In addition, standoffs<u style="single">Element</u>Gear system that synchronizes the operation of 250 and link member 271 standsoff<u style="single">Element</u>One link mechanism 270 known to those of skill in the art (eg, a pulley system, a flexible synchronous shaft, or a joint performing the same function, suitable for synchronizing the movements of the 250 and other suitable alternative mechanisms. , But not limited to these) is assumed. [0029] Next, with reference to FIGS. 9 and 10, the valve assembly and diameter reduction structure 100 and casing 50 are shown in cross section. The first seal 125 includes a concave or arched membrane portion 127 that extends radially inward to form a tip portion 128 that defines the hole 129. The portion 127 is in close proximity to or in contact with the standoff member 250. The standoff member 250 is generally shown in a first position having an orientation orthogonal to the central longitudinal axis X. The depth and width of the segmented notch 263 is shown relative to the hole 129 and the second surface 264, with a limited and increased degree of eccentric movement or angular movement of the small surgical instrument. I will provide a. Standoff<u style="single">Element</u>The 250 includes a base portion 251 arranged in close proximity to or abutting the cantilever portion 218. The cantilever portion 220 includes a wall 222 configured to act as a stop member to limit the radial outward movement of the head 260 of the standoff member 250. The structural materials of the standoff members 250, especially the head 260, may be selectively controlled to provide a range of flexible compression biases to the parallel eccentric and angular movements of the surgical instrument. [0030] The reduced diameter structure housing 210 surrounds the reduced diameter structure basic element 280 and the first seal support element 350 at least partially. The flange 367 of the second seal 365 is fixed between the first seal support element 350 and the second seal support element 380. The seal housing 310 surrounds the second seal support element 380 at least partially. The mantle 50 is connected to the distal end portion of the seal housing 310. In FIG. 11, the radius reduction structure 240 is shown as an integrated assembly in a first position for placement within the diameter reduction structure foundation element 280. The base element 280 is configured such that the diameter reduction structure 240 provides an appropriate arrangement for controlling its operating diameter, and the sealing system of the assembly 100 provides its integrity during procedures utilizing small instruments. Improve your ability to maintain. This is a standoff<u style="single">Element</u>Includes a suitable support structure for the 250 to provide a controlled restriction on the movement of the surgical instrument and to act as a barrier to support the movement of the diameter reduction structure 240 between the first and second positions. I'm out. [0031] The first position of the structure 240 is defined by the head 260, which results from a parallel eccentric or angular movement that is generally orthogonal to the longitudinal axis of the small surgical instrument located in the passage 25. It forms an interrupted annular barrier structure suitable for controlling forces in a plane that is generally orthogonal to the directional axis X. The third surface of the head 260 defines a second operating area in the first position. In the first position, the tilted portion 265 of the head 260 defines a gap or break in the annular barrier structure formed by the diameter reduction structure 240. The size of this gap is controlled by the shape and position of the head 260 and is configured to ensure that passage of small diameter surgical instruments between the head 260 is eliminated. The reduced diameter structure 240 further includes a controlled bias configured to resist the radial inward and outward movement of the reduced structure 240, as well as the movement from the first position to the second movement. I'm out. This bias in the structure 240 also acts to return the structure 240 to its primary position after removing the large diameter surgical instrument. [0032] The second position is defined by the diameter-reducing structure 240 and the diameter-reducing structure 240 that moves at least partially distally to fit the unrestricted passage of individual large-diameter surgical instruments through the casing 50. Will be done. The base element 280 includes at least a partially recessed seating position 296 for the link members 271 and 290 for the standoff member 250. Seating position 290 defines an interrupted channel with two different seating or supports configured and measured to accommodate the cylindrical end 254. The strip 252 is arranged between the supports 292. The seating position 290 further includes an arched support member 294 with a linear portion 299 extending proximally. Seating position 296 defines at least a partially recessed channel portion separated by a slot or recess 297 that is configured and measured to accommodate the surface 274 and strip 272 of link member 271. Seating position 296 includes a straight section 299 extending in the proximal direction. [0033] Seating positions 290 and 296 are structurally supported by a member 295 extending in the proximal direction. Member 295 is connected to parts 292 and 298 by an arm to structurally support parts 292 and 298 from excessive modification or movement. Seating positions 290 and 296 standoff<u style="single">Element</u>It provides the alignment, spacing, and angular orientation that are important for the interrelationship between the teeth 255 and 275 and their slots 277 and 257 for synchronizing the movements of the 250 and the link member 271. In addition, the reduced diameter structure 240 contains a bias to the first position, either as a separate part or as an assembly. This is the result of its placement within the reduced diameter structure foundation element 280, or by a separate bias member such as an elastic band, or by a combination thereof. When fully assembled with the reduced diameter structure housing 210 (see Figure 2) and the reduced diameter structure foundation element 280, the reduced diameter structure 240 is mounted at any angle or in any orientation without any operator action. , The function can be implemented. [0034] Next, with reference to FIGS. 12 and 13, the diameter reduction structure 100 is shown in operating position. The large diameter medical device 80 that defines the second longitudinal axis is placed through the valve assembly and diameter reduction structure 100 and casing 50. Larger diameter surgical instruments are instruments that have a diameter or cross-sectional area that is orthogonal to the second longitudinal axis, and this diameter or cross-sectional area is greater than the first diameter or first working area of the passage 25. Smaller but larger than the second diameter or second working area orthogonal to the central longitudinal axis as defined by the stand-off assembly in the first position. Similarly, the smaller diameter surgical instrument 60 that defines the first longitudinal axis is smaller than the second diameter or working area defined by the stand-off assembly in the first position, in the first longitudinal direction. It has a diameter or cross-sectional area perpendicular to the axis. Therefore, by definition, instruments larger in diameter than the second working area deflect the standoff assembly 240 at least partially distally to enter the aisle. In contrast, small instruments can be placed axially within the second operating region without deflecting the standoff assembly 240. In this one preferred embodiment, the larger instrument is defined as having a diameter greater than 5.5 mm and the smaller instrument is defined as having a diameter less than 5.5 mm. [0035] The 5.5 mm distinction between large and small instruments is related to the diameter of the passage defined within the casing and varies with the diameter of the cusp device, valve assembly and diameter reduction structure 100. be able to. The large diameter instrument 80 is moved distally through the first seal 125 along the central longitudinal axis X and is the axis that moves the large diameter instrument 80 when in contact with the reduced diameter structure 240. The directionally aligned force components must overcome the bias configured to hold the diameter reduction structure 240 in the first position shown in FIG. [0036] When the force behind the instrument 80 exceeds the bias configured to keep the diameter reduction structure 240 in the primary position, the diameter reduction structure 240 is initially generally in a distally generally arcuate motion. A large diameter instrument that swivels and then continues its swivel or rotary arc, as indicated by the arrows "A" and "B", away from the central longitudinal axis, defining a third region of motion. Fits 80 passes. The amount of bias used to hold the diameter-reduced structure 240 in the first position is the constituent material of the diameter-reduced structure 240, as well as the first in the diameter-reduced structure basic element 280. It is controlled by factors such as the method used to fix it in place. [0037] Standoff when urged towards the inner diameter of wall 356 by the shaft of the larger instrument 80<u style="single">Element</u>The 250 moves to a second position where the surface 262 of the head 260 is located substantially parallel to and abutting the wall 356. The spatial relationship between the wall 356 and the diameter reduction structure 240 in this second position is intended for the internal structure of the individual casing, the inner circumference of the passage 25, and the valve assembly and diameter reduction structure 100. It is a function of use. The valve assembly and the reduced diameter structure 100 are configured to provide suitable space for swiveling or bending the reduced diameter structure 240. When the large diameter instrument 80 is pulled out, the diameter reduction structure 240 stands off each standoff.<u style="single">Element</u>A portion of the 250 is urged to relocate to a primary location adjacent to the wall 220. [0038] Next, referring to FIGS. 14 and 15, the standoff member 250 is shown in the first position, or diameter reduction position, where the head 260 generally extends radially with respect to the longitudinal axis X. The cantilever portion 222 provides a generally rigid barrier configured to structurally support and limit the radial deviation of the head 260. The reduced diameter structure 240 in the first position is adapted to allow the smaller diameter instrument 60 to penetrate through the valve assembly and the reduced diameter structure 100 into the casing 50 without any movement. It is composed. [0039] When in this primary position, as a result of orthogonal or angular movements of the smaller diameter surgical instrument, the standoff member 250 is at least partially parted by a force having a component orthogonal to the central longitudinal axis X. It is compressed and arranged in the axial direction. Each standoff member 250 is mounted within a diameter reduction assembly 200 to limit excessive parallel eccentric movement and angular movement of the smaller diameter surgical instrument 60. The small diameter surgical instrument 60 is typically placed in the casing 50 through the seal 125 with little or no substantial contact with the diameter reduction structure 240. However, when the small-diameter surgical instrument 60 is manipulated for eccentric movement or angular movement, the small-diameter surgical instrument 60 contacts at least one head portion 260 and the inner circumference of the mantle 50, which collaborate. It acts as two separate, substantially parallel structural barriers, controlling eccentric movement and angular movement outward from the central longitudinal axis X. The combination of the head 260 and the cantilever portion 222 can be configured as a rigid or flexible bias structure. This control mechanism constrains the operational movement of the small diameter surgical instrument 60 to provide sufficient integrity of the sealing system. [0040] Then, referring to FIGS. 16A, 16B and 16C, in another preferred embodiment, the valve assembly and diameter reduction structure 500, as in the previous embodiment, is the proximal end portion or diameter reduction assembly 600. , And the valve assembly 700, but the diameter reduction structure 640 is located proximal to the first seal 525. The reduced diameter structure 500 includes a terminal cap 510, a reduced diameter structure housing 640, a reduced diameter structure foundation element 680, and, optionally, a first O-ring. [0041] The end cap 510 generally has a cylindrical shape and includes a distal end portion 512 and a proximal end portion 514. Proximal end portion 514 includes a ring-shaped disc or portion 516 that defines a hole 515 aligned with the central longitudinal axis X. In this configuration, the annular portion 516 may be a rigid plastic or flexible membrane that is not configured as a seal. Thus, the hole 515 can be configured as a rigid or flexible barrier and will have a diameter equal to at least the inner diameter of the rigid casing. [0042] The reduced diameter structure 610 generally has a hemispherical shell shape with a diminishing circumference from the distal end portion 612 to the proximal end portion 614. Proximal end portion 614 includes an annular portion 613 that defines the hole 615. Proximal end portion 614 is configured to be contained and coupled to distal end portion 514. The distal end portion 612 includes an outer cylindrical portion 616 with a scalloped surface for ease of handling. The diameter reduction structure 640 has three<u style="single">Standoff element i.e.</u>Includes standoff assemblies with standoff members 650, and link members 670 are placed in close proximity to the first seal 525. Standoff<u style="single">Element</u>The 650 provides a predetermined degree of control and restriction on the movement of instruments placed within the assembly 600. The link mechanism 670 in the form of three link members 671 stands off.<u style="single">Element</u>Unify and synchronize 650 movements. The specific configuration of the standoff member 650 or the link mechanism 670 can vary, but as described in all examples herein, operationally the standoff assembly 645 is used to bias small surgical instruments. Limit axial movement and angular movement. [0043] The reduced diameter structure basic element 680 is configured to seat the reduced diameter structure 640 on its proximal end portion 682 and at least partially as indicated by the arrow "A" in a predetermined range of motion. Includes a seating position 690, at least partially cantilever-supported, configured to support and control the movement of the reduced structure 640 throughout. A tubular portion 685 extending distally is configured to position the first seal 525. The first seal 525 is arranged substantially at right angles to the longitudinal axis X and may be a fixed or floating seal. The first seal support element 750 generally has a tubular shape and includes a distal end 754 and a proximal end 752 adjacent to the proximal side of the cantilever seating portion 690. The first support element 750 has an inner wall 756, which is a standoff<u style="single">Element</u>It can be configured to limit the distal range of movement of the 650. The cantilever portion 753 of the first seal element 750 is arranged to secure and seal the flange 767 of the second seal 765, which is located between the proximal portions of the second seal support element 780. [0044] The distal end of the first support element 750, in cooperation with the distal end portion 782 of the second seal support element 780, surrounds and seals the flange 767 of the second seal 765 at least partially. Deploy. The second seal 765 may be any type of seal, but is preferably a duck beak-shaped seal, usually configured for use with a fixed or floating first seal. In a preferred embodiment, the second seal 765 is a duck beak-shaped seal that extends distally into the seal housing 710. The seal housing 710 is configured to secure at least a portion of the second seal 765 and the second seal support element 780 and the first seal support element 750, and at least partially surround them. Includes part 714. Further, the second seal support element 780 generally has a ring shape and is configured to engage with the first seal support element. The seal housing 710 is configured to fit into the trowel. [0045] The valve assembly and reduced diameter structure 500 are configured as an assembly to control the eccentric movement and angular movement of small surgical instruments outward or proximal to the sealing system. This configuration further limits the range of angular motion that the first seal receives by manipulating small surgical instruments, thereby reducing the strain applied to the first seal and thereby improving the integrity of the tract seal system. .. In addition, the valve assembly and diameter reduction structure 500 can be removably coupled to the correspondingly sized casing 50. Also, the end cap 510, housing 610, diameter reduction structure 640, and base element 680 may be used with a wide range of casing with fixed or floating seals to interfere with the integrity of the sealing portion of the casing. It can be easily adapted as an integrated assembly, for example with or without the integrated first seal 525, to advantageously control the eccentric movement and angular movement of small surgical instruments. It is also assumed. [0046] Then, referring to FIGS. 17 and 18A-18C, one preferred embodiment of the valve assembly and diameter reduction structure 800 is the proximal end or diameter reduction assembly 900 and the distal end or valve assembly 1000. And include. The reduced diameter structure 940 is located distal to the first seal 825 and within the reduced diameter structure housing 910. Three standoffs in which the reduced diameter structure 940 is placed within the reduced diameter structure foundation 980.<u style="single">Element or standoff member</u>Illustrated with a 950 and a standoff assembly 945 with three link members 971. The general configuration of the reduced diameter structural foundation 980 and the link member 971 is structurally and operationally similar to the previous embodiment, but with standoffs.<u style="single">Element</u>The 950 has a head portion 960 with a different configuration similar to that shown in FIG. 16A, and the side portion 950 generally has a flat shape and a width approximately equal to the arm 956. [0047] The head portion 960 also includes a mounting mechanism 963 and a cantilever extension or flange 967. The flange 967 extends radially from the head 960 towards the base 961 in the first portion. In the second portion of the standoff member 950, the flange 967 standsoff by contacting the inner wall of the diameter reduction structure housing 910.<u style="single">Element</u>It can be configured with an appropriate length so as to limit the range of movement of the 950 at least partially. Mounting mechanism 963 is a standoff<u style="single">Element</u>On the 950, it is configured to accommodate and hold the ring-shaped bias member 969 over its entire range of motion. Ring-shaped bias member 969 standsoff<u style="single">Element</u>Configured to bias the 950 to a primary position, added when the standoff member 950 is compressed radially outward with respect to the diameter reduction structure foundation 980 or housing 910 due to the action of eccentric movement or angular motion. It also serves as a continuous barrier to prevent small diameter surgical instruments from penetrating between the standoff members 950. [0048] The combined effect of mounting mechanism 963, flange portion 967, and bias member 969 is the movement of small diameter surgical instruments by standoff assemblies when forces that are generally oriented orthogonal to the longitudinal axis are used. The ability of the standoff assembly 940 to automatically adapt to large diameter instruments. In FIG. 19, additional preferred embodiments of the valve assembly and diameter reduction structure 200 are four diametrically opposed standoffs placed independently within the diameter reduction structure foundation 1380.<u style="single">Element or standoff member 1350</u>Consists of using a reduced diameter structure 1340, including a standoff assembly 1345. Each standoff<u style="single">Element</u>The 1350 swivels independently without a link mechanism to limit eccentric movement and angular movement of small instruments. [0049] The standoff member 1350 includes a head 1360, an arm 1356, and a base element 1351 configured for mounting with the foundation 1380. The standoff member 1350 can be mounted fixed to, for example, the foundation 1380, or in another base element 1351, swivelly placed and correct on the foundation 1380 using a positioning element (not shown). It may be held in place. Bias is used to place the standoff member 1350 in the first position adjacent to the housing 1310. As yet another embodiment, the linkage may be arranged to work with the head 1360, eg, to perform one or both of the functions of the linkage shown above. Another head 1360 configuration includes a nested mechanism, a convex and groove mechanism, or a bevel gear mechanism, which is a standoff.<u style="single">Member 1350</u>Correlate to a substantially continuous annular structure throughout their range of motion. [0050] Standoff<u style="single">Element</u>The bias towards the diameter-reducing structural foundation 1380, which is unique to the 1350 or in combination with its positioning elements, stands off unless biased by a large-diameter surgical instrument.<u style="single">Element</u>Keep the 1350 in the first position. As shown in other examples, the reduced diameter structure 1380 can be used proximally or distally to the first seal. Standoff<u style="single">Element</u>The 1350 also includes a bulb-shaped head 1360 similar to the head 260 to control the movement of small diameter surgical instruments in its configuration. [0051] 20A and 20B show two examples of standoff members.<u style="single">That is, the standoff member 950 and the standoff member 1350</u>It is shown corresponding to FIGS. 18A to 18C and FIG. 19, respectively. But these standoffs<u style="single">Element</u>The two main configurations should be considered as merely representative of all standoff configurations described herein. Standoff member 950 and<u style="single">Standoff member</u>The 1350 includes base portions 951 and 1351 that form an axis "y" that forms an angle alpha (α) with respect to the axis "Y". The axis "Y" is orthogonal to the central longitudinal axis "X". Heads 960 and 1360 define an axis "x" that forms an angle theta (θ) with respect to "X". Depending on the configuration and application of the casing housing, the angles "α" and "θ" may coincide with the respective "Y" and "X" axes, or standoff.<u style="single">Element</u>950 and<u style="single">Standoff member</u>In another embodiment of 1350, it may extend to the opposite side of each axis. The axis "X" is parallel to the central longitudinal axis "X". [0052] All standoff members described herein generally provide a compression resistant bias structure against forces acting in a plane generally oriented orthogonal to the "X" or central longitudinal axis. Standoff<u style="single">Element</u>950 and<u style="single">Standoff member</u>1350, as well as standoffs here<u style="single">Element</u>All other variants provide a compression-resistant bias structure, at least in general, for forces in the plane at angles ranging from approximately plus or minus 15 ° from an angle orthogonal to the central longitudinal axis. And arranged for a structure such as a reduced diameter housing. Individual standoff members 950 and<u style="single">Standoff member</u>The 1350 is a configuration of various head parts 960 and 1360, eg, adjacent standoffs.<u style="single">Element</u>950 and<u style="single">Standoff member</u>Can include wing extensions or flanges that overlap, correlate, or interleave between 1350s. The holding mechanism 939 can also be included in the head portions 960 and 1360, for example for positioning the bias member 939. [0053] Then, referring to FIG. 20C, in yet another embodiment of the reduced diameter structure 1440, a single integrated standoff assembly 1445 standsoff with one continuous complete flange.<u style="single">Element</u>Alternatively, it is formed in the flange structure 1445. The flange structure 1445 has any shape suitable for performing a function of limiting the movement of a small diameter surgical instrument when it generally undergoes parallel eccentric movement or angular movement, such as the head 1460, arm 1456, etc. And can take the configuration of base 1451. The reduced diameter structure 1440 may be at least partially partitioned using a plurality of slots 1431 defining a partitioned head portion 1460 and arm 1456. A holding mechanism 1439 can also be used to further bias the reduced diameter structure 1440. The embodiment also takes the structural form of a generally linear cantilever flexible flange structure or tilted standoff structure, which is at least partially cantilever supported by a correspondingly arranged structural housing. Can also be done. [0054] Independent standoff<u style="single">Element</u>Flange Structure Standoffs Constructed Using 1450s or Unifiedly Integrated<u style="single">Element</u>The reduced diameter structure 1440, configured as 1450, is subject to forces in a plane that cross the central longitudinal axis "X" and special forces in a plane that are approximately orthogonal to the central longitudinal axis "X". Properly configured to resist. Flange structures 1450 are generally configured to bend or swivel with a force aligned with the longitudinal axis "X" to fit large diameter surgical instruments without any operational adjustment. In another embodiment, the diameter reduction structure is an integrated structure, where the arms are joined to form an annular structure, which is placed in the casing housing as an assembly. The standoff assembly in this embodiment may also include a separate or integral bias member. In yet another embodiment, one or more diameter reduction structures may be used together in succession or as an assembly to create parallel diameter reduction structures or diameter reduction structures of different diameters. Would be good. [0055] With reference to FIGS. 21 and 22A, yet another embodiment of the valve assembly and diameter reduction structure 1500 includes a diameter reduction assembly 1600 and a valve assembly 1700. The valve assembly and reduced diameter structure 1500 define a passage 1505 concentric with the central longitudinal axis X. The reduced diameter assembly 1600 includes a first seal 1525, a reduced diameter structure housing or distal housing 1610, a reduced diameter structure 1640, and a reduced diameter structure foundation element 1680. The reduced diameter basic element 1680 is coupled to the valve assembly 1700. The seal housing or proximal housing 1710 of the valve assembly 1700 is configured to be removably coupled to the stalk 50. [0056] The reduced diameter structure housing 1610 is generally tubular and includes a tubular wall 1615 that defines the distal end portion 1612 and the proximal end portion 1614. The proximal end portion 1614 has a proximally extending rim 1616 that defines a recessed portion or flange 1618. Flange 1618 is substantially orthogonal to longitudinal axis X and also includes a rim 1619 that defines a hole or passage 1505 aligned with longitudinal axis X. The diameter-reduced structure housing 1610 of this configuration includes a first seal 1515 located distal to the flange 1618, which is held in place by the first seal support element 1620. The first sealing element 1620 also defines a rim 1622 aligned with respect to the rim 1619. The distal end of the rim 1622 forms the edge 1623 with the distal end of the seal support element 1620. The distal end portion 1612 includes a flanged portion 1613. [0057] The inner diameter of the tube wall 1615 is configured to abut and slide against the first member 1630 and the second annular member 1635. The distal edge 1631 of the annular member 1630 is located adjacent to the proximal edge 1636 of the second annular member 1635. The second annular member 1635 has a radial protrusion or tab 1637. The reduced diameter housing 1610 is coupled to an annular member 1611 extending distally from the distal end 1612. The stop member 1608 is located adjacent to the seal support element 1750 and on the distal end 1609 of the member 1611 that defines the first position of the housing 1610. Also, the stop member 1608 interfaces with tab 1637 and is restricted by the tab to at least partially restrict the proximal movement of housing 1610 and define a second position for housing 1610. [0058] [0058] The diameter reduction structure 1640 is arranged on the diameter reduction base element 1680. The diameter reduction base element 1680 has a distal end 1682 and a proximal end 1684. The distal end 1682 abuts the seal support element 1750. The base element 1680 also comes into contact with a portion of the interior of the annular members 1630 and 1635. The reduced diameter structure 1640 moves each standoff member 1650 from a position extending distally substantially parallel to the longitudinal axis to a position extending proximally approximately parallel to the longitudinal axis. It is configured to support up to approximately 180 °. [0059] In the first position of the standoff assembly 240, the standoff member 250 is generally placed in a plane orthogonal to the central longitudinal axis, reducing the operating area of the passage 1505 with the structural support of the housing 1610. .. In the second position of the standoff assembly 240, the standoff member 250 is generally located at least partially distal to the first position. At the third position of the standoff assembly 240, the standoff member 250 is generally located at least partially proximal to the first position. The standoff member 1650 has a head 1660 coupled by an arm 1656 to a base portion 1651 with opposed cylindrical ends 1654. The standoff members 250 are coupled by a link mechanism that includes three link members 1671, as described in the previous embodiment. [0060] The head 1660 has a first surface 1662, which generally has a flat surface, and a tapered second surface 1668 on the opposite side, which is close to the first seal 1525 when the diameter reduction structure 1640 is in the first position. And include. The first surface 1662 includes a cantilever extension 1661. The third surface 1664 generally includes a convex and inclined side portion 1665. The fourth surface 1666, which opposes the third surface, has a generally flat surface coupled by the arm 1656 so that the flat surface extends to the second surface 1662 and the cantilever portion 1661. There is. The arm 1656 is a narrow portion connecting the base 1651 and the head 1660. The head 1660 also includes a compartmentalized recessed notch 1663 that is centered and substantially orthogonal to the longitudinal axis Y. The generally recessed shape of this notch 1663 is configured and sized to accommodate a limited degree of eccentric movement by small surgical instruments when the diameter reduction structure 1640 is in the primary or initial position. Will be done. [0061] Diameter reduction structure 1640 has three standoffs<u style="single">Element or standoff member</u>Although illustrated with a standoff assembly 1645 with 1650 and a link mechanism 1670 with three link members 1671, the general configuration of the reduced diameter structural foundation 1680 and link member 1671 is structurally and operationally illustrated. 6 to the same as the previous embodiment of FIG. [0062] The valve assembly 1700 includes a first seal support member 1750, a second seal 1765, and a seal housing 1710 configured to connect to the mantle 50. In addition, an elastic tubular seal or a third seal 1601 is placed between the valve assembly 1700 and the diameter reduction assembly 1600 in a sealed state over the sliding joint 1600. The second seal support element 1750 is arranged between the diameter reduction base element 1680 and the seal housing 1710. The second seal support element 1750 generally has a ring shape with a tube wall having a cylindrical outer surface. In addition, the second seal support element 1750, along with the proximal end 1714 of the seal housing 1710, seals the second seal 1765 in place. Proximal end 1714 of the seal housing 1710 includes a position for seating the second seal support element 1750 and the second seal 1765. The distal end 1712 of the seal housing 1710 is configured to fit into the stalk 50 using a suitable mounting mechanism such as a bayonet or screw coupling. [0063] The third tubular seal 1601 has a proximal end 1605 and a distal end 1603. The proximal end 1715 engages the flange 1613 of the reduced diameter housing 1601 in a sealed state. The proximal end 1714 of the seal housing 1710 and the distal end 1752 of the second seal support element 1750 are arranged to engage in a sealed state with the distal end portion 1603 of the third seal 1601. The third seal 1601 is configured and measured as a flexible elastic tubular seal placed over it to provide a seal for the sliding joint 1699. The third seal 1601 has a first position where the stop member 1608 abuts on the second seal support element 1750 and a second position where the stop member 1608 is rearranged proximally and abuts on the tab 1637. It has the appropriate flexibility to accommodate the movement of the diameter reduction housing 1610 between. In addition, the third seal 1601 provides a bias of the seal housing 1710 to the first position of the reduced diameter housing 1610. [0064] The third seal 1601 is preferably made from a flexible and / or stretchable material, preferably an extrusion or injection moldable material, most preferably an elastomeric material. The third seal 1601 can include a central v-shaped indentation 1601a to allow longitudinal extension and contraction of the structure housing 1610. Alternatively, as shown in FIG. 23, the third seal is completely tubular with no v-shaped indentation and has the appropriate elasticity to allow the seal to expand and contract as the housing 1610 expands and contracts. You may be doing it. Elastomer materials have a suitable thickness for external device applications that can encounter rough handling and also provide a flexible bias while being resistant to tearing or penetration, for example. It is also envisioned that the third seal 1601 can be easily attached and detached as needed for autoclaving or sterilization. [0065] Next, referring to FIGS. 22A to 22C, the diameter-reduced structure 1640 has at least a part of the fourth surface of the head 1660 and the arm 1656 having a diameter as in the examples of FIGS. 15, 16A and 20A. Close to a portion of the reduced structure housing 1610 and biased to a first position where the stop member 1608 abuts the second seal support element 1750. In this embodiment, the rim 1621 and the distal end of the first seal support element 1620 are close to at least a portion of the fourth surface 1666 and the arm 1656, respectively, and in particular the corners 1623 are the arms 1656 and the fourth. It is placed at the joint with the surface 1666. Thus, the first seal support element 1620 stands off so as to limit the eccentric movement and angular movement of the small diameter surgical instrument.<u style="single">Element</u>Standoff by providing structural support for the 1650<u style="single">Element</u>Support the 1650 in the first position. [0066] As shown in FIG. 13, the diameter-reducing structure 1640 is distally displaced by a large surgical instrument to a second position where the surface 1662 is swiveled inward in the tube wall 1755 of the second seal support element 1750. When displaced, the stand-off member 1650 fits into the increased diameter of a large surgical instrument without any external adjustment by the surgeon or operator. But standoff members<u style="single">1650</u>Holds their bias towards the first position. [0067] The combination of bias and elasticity of the standoff member 1650 may constrain the large instrument as the large surgical instrument is pulled proximally through the valve assembly and the reduced diameter structure 1500. To eliminate unwanted binding, the distal end 1612 is slidably engaged with the first annular member 1630, the second annular member 1635, and the second seal support element 1750, allowing the instrument to bind the binding. The reduced diameter housing 1610 slides proximally until it stops or the stop member 1608 abuts on tab 1637. The movement of the reduced diameter structure 1610 from the position of the first housing 1610 in the proximal direction is an increased volume within the diameter housing 1610 suitable for the standoff member 1650 to swivel proximally to the third position. And also increase the operating area of passage 1505 from the second operating area to the third operating area. At least here, the operating area is increased as well as the operating area in the second position of the standoff assembly so that large instruments can be withdrawn with limited resistance. [0068] An additional embodiment for eliminating shackles is an external emission mechanism, or friction reducing means such as one or more wheels located on the second surface 1668 and / or the third surface 1664. While in the distal or second position, the rotation of the wheels can accommodate the extraction of large instruments, and when in the first position it provides sufficient resistance to the movement of small surgical instruments). With, in the second position<u style="single">For each of the standoff members</u>Includes catch or engagement receiver. [0069] Although exemplary embodiments of the present disclosure have been described herein with reference to the accompanying drawings, the present disclosure is not limited to these embodiments themselves and will be made by those skilled in the art without departing from the scope and spirit of the present disclosure. It should be understood that various modifications and modifications of can be made. All these changes and modifications are within the scope of the claims. [Simple explanation of drawings] FIG. 1 is a perspective view showing a preferred embodiment of a valve assembly and diameter reduction structure for a troupe needle constructed according to the present disclosure. FIG. 2 is an exploded perspective view of the valve assembly and diameter reduction structure of FIG. FIG. 3 is an enlarged perspective view showing the valve assembly of FIG. 1 and the proximal end portion of the reduced diameter structure. FIG. 4 is an enlarged perspective view with a part of the valve assembly and the diameter reduction structure of FIG. 3 removed, showing the diameter reduction structure arranged in the diameter reduction structure basic element. .. FIG. 5 is an enlarged perspective view with a portion of the valve assembly and diameter reduction structure of FIG. 1 removed, showing a second seal. [Fig. 6] FIG. 6 is an enlarged perspective view of the link member according to the disclosure of FIG. FIG. 7 is an enlarged perspective view of a distal end portion of a diameter-reduced structure basic element according to the disclosure of FIG. FIG. 8 is an enlarged perspective view of the standoffs according to the disclosure of FIG. FIG. 9 is a cross-sectional view of the valve assembly and diameter reduction structure of FIG. 1 along lines 9-9. FIG. 10 is an enlarged cross-sectional view of the valve assembly and diameter reduction structure of FIG. FIG. 11 is an exploded view of the diameter-reducing structure and the diameter-reducing structure basic element of FIG. FIG. 12 is a perspective view showing the valve assembly and diameter reduction structure of FIG. 1 used in motion, along with a large diameter surgical instrument and patient tissue penetrating the valve assembly and diameter reduction structure. Is. FIG. 13 is an enlarged cross-sectional view along lines 13-13 of FIG. 12, showing the rearrangement of a reduced diameter structure for a large diameter surgical instrument. FIG. 14 is an enlarged cross-sectional view of the valve assembly and diameter reduction structure of FIG. 10 showing a small diameter surgical instrument at least partially placed therein. [Fig. 15] FIG. 15 is a cross-sectional view of FIG. 14 showing a diameter-reducing structure that controls the angular movement of a small-diameter surgical instrument placed therein. FIG. 16A is a plan view showing a second embodiment of a valve and diameter reduction structure configured in accordance with the present disclosure. FIG. 16B is a cross-sectional view taken along line 16B-16B of FIG. 16A, showing typical movement of one standoff member in a reduced diameter structure. FIG. 16C is a cross-sectional view taken along line 16C-16C of FIG. 16A, showing a reduced diameter structure in the first position. FIG. 17 is a perspective view showing the proximal end of a third embodiment of a reduced diameter structure in a trouser needle constructed according to the present disclosure. FIG. 18A is a cross-sectional view of a casing needle showing a diameter reduction structure along line 18A-18A of FIG. FIG. 18B is a cross-sectional view of the valve assembly and diameter reduction structure along line 18B-18B of FIG. 18A. FIG. 18C is a cross-sectional view of the valve assembly and diameter reduction structure along line 18C-18C of FIG. 18A. [Fig. 19] FIG. 19 is a cross-sectional view showing a fourth embodiment of a valve assembly and diameter reduction structure constructed in accordance with the present disclosure. FIG. 20A is an enlarged cross-sectional view showing a second embodiment of a standoff configuration in the reduced diameter structures of FIGS. 18A, 18B and 18C. FIG. 20B is an enlarged cross-sectional view showing a standoff configuration of a diameter reduction structure for the casing needle of FIG. FIG. 20C is a partial cross-sectional perspective view showing a fifth embodiment of a diameter-reduced structure constructed in accordance with the present disclosure. FIG. 21 is a plan view showing a sixth embodiment of a valve assembly and diameter reduction structure for a casing needle having a movable diameter reduction assembly configured according to the present disclosure. FIG. 22A is a cross-sectional view showing a valve assembly and diameter reduction structure for a casing needle, shown along line 21A-21A of the casing needle of FIG. 21A. FIG. 22B is a cross-sectional view showing a valve assembly and a reduced diameter structure for the cusp needle of FIG. 22A with the standoff assembly in the second position. [Fig. 22C] FIG. 22C is a cross-sectional view showing the standoff configuration of FIG. 22A with the standoff assembly in the third position. FIG. 23 is a cross-sectional view showing another embodiment of the valve assembly and diameter reduction structure of FIG. 22A.
Every citation, both ways
| Document | Relation | Office |
|---|---|---|
| JP6509009A | Cites | Japan |
| JP7241298A | Cites | Japan |
| JP67369A | Cites | Japan |
| JP2001137253A | Cites | Japan |
29 members in 8 offices
Priority claims9
| Document | Office | Kind | Date |
|---|---|---|---|
| 24050600 | United States of America | P | |
| 24050600 | United States of America | P | |
| 60240506 | United States of America | – | |
| 0131911 | United States of America | W | |
| 0131911 | United States of America | W | |
| 2000240506 | – | – | – |
| 2001031911 | – | – | – |
| US20000240506P | – | – | – |
| WO2001US31911 | – | – | – |
Members29
| Document | Office | Kind | |
|---|---|---|---|
| CA2424914A1 | Canada | A1 | |
| WO0230305A2 | World Intellectual Property Organization (WIPO) | A2 | |
| AU9682401A | Australia | A | |
| WO0230305A3 | World Intellectual Property Organization (WIPO) | A3 | |
| EP1324711A2 | European Patent Office (EPO) | A2 | |
| US2004064100A1 | United States of America | A1 | |
| JP2004510537A | Japan | A | |
| US2006020281A1 | United States of America | A1 | |
| US7025747B2 | United States of America | B2 | |
| AU2001296824B2 | Australia | B2 | |
| CA2541307A1 | Canada | A1 | |
| EP1707135A1 | European Patent Office (EPO) | A1 | |
| AU2006201294A1 | Australia | A1 | |
| JP2006280959A | Japan | A | |
| EP1324711B1 | European Patent Office (EPO) | B1 | |
| DE60135765D1 | Germany | D1 | |
| US2008319396A1 | United States of America | A1 | |
| ES2312474T3 | Spain | T3 | |
| CA2424914C | Canada | C | |
| JP2010115516A | Japan | A | |
| JP4472924B2This record | Japan | B2 | |
| US7744569B2 | United States of America | B2 | |
| US2010331783A1 | United States of America | A1 | |
| EP2269523A1 | European Patent Office (EPO) | A1 | |
| EP1707135B1 | European Patent Office (EPO) | B1 | |
| DE602006019513D1 | Germany | D1 | |
| AU2006201294B2 | Australia | B2 | |
| JP2011251138A | Japan | A | |
| US8282603B2 | United States of America | B2 |
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Numbers
- Publication
- 4472924
- Publication, DOCDB
- 4472924
- Publication, EPODOC
- JP4472924B
- Application
- 2002533754
- Application, DOCDB
- 2002533754
- Application, EPODOC
- JP20020533754
Titles2
- Japanese
- 弁アセンブリーおよび手術器具
- English
- Valve assembly and surgical instruments
Classification
- CPC, 3
- A61B17/3462
- A61B17/3498
- A61B2017/3464
- IPC, 2
- A61B17 34
- A61M5 178