DE102022128530A1 - Surgical port system for insertion into body openings - Google Patents

Abstract

The disclosure relates to a surgical port system (1) with a preferably funnel-shaped port (2) which defines a substantially cylindrical passage (4) in order to introduce a flexible endoscope (16) and at least one rigid instrument (18) into a cavity (44) of a patient through the passage (4), and an adapter ring (6) which is or can be coupled to a proximal end section of the port (2), wherein the adapter ring (6) has a guide structure (12) which is designed to guide the flexible endoscope (16) such that the flexible endoscope (16) emerges concentrically from the passage (4) at a distal end section of the port (2) and the at least one rigid instrument (18), in particular in a satellite-like manner, is movable around the flexible endoscope (16).

Description

The disclosure relates to a surgical port system for insertion into body openings with a, preferably funnel-shaped, port which defines a substantially cylindrical passage for inserting a flexible endoscope and at least one rigid instrument into a cavity of a patient through the passage, and an adapter ring which can be coupled or is coupled to a proximal end portion of the port.

Background of the revelation

Access devices/access systems/port systems are commonly used in surgery to facilitate the introduction of various surgical instruments into natural biological vessels, channels, openings, cavities and other internal areas of the body. These access devices include, for example, devices that facilitate the insertion of a needle into a vessel, as well as port systems or trocars that facilitate the introduction of laparoscopic instruments into the abdominal cavity of the body.

Some of these access devices are inserted into body regions that contain a fluid or gas under pressure. In the case of a needle access device, the pressure may come from a fluid, such as blood. In the case of a trocar, the pressure may come from a gas, such as an insufflation gas. In any case, however, it is desirable to allow the surgical instrument to be inserted into the cavity without the pressurized fluid or gas escaping.

In the case of trocars, a cannula at the distal end of the trocar is typically connected to a sealing housing at the proximal end of the trocar. Together, the cannula and housing form a working channel through which various instruments can be inserted to gain access to the cavity. Sealing mechanisms are usually located within the housing, such as a septum valve that seals the working channel when an instrument is inserted or a zero-closure valve that closes the working channel when the instrument is removed.

Current surgical access ports allow single instrument access through each port or access to multiple instrument ports through a rigid cannula. Some surgical procedures and their associated devices, such as those for transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS), require the device to be secured to the operating table to support the weight of the device and to determine the position of the device in relation to the patient. These devices offer the surgeon little/no flexibility in selecting instrument size and limit instrument movement with their rigid cannulas. In addition, surgeons perform laparoscopic surgical procedures through a single or a limited number of ports. Procedures can be performed through a single umbilical incision a few centimeters long or, in certain cases, transvaginally or transanally.

State of the art

For example, EP 2 621 348 B1 a surgical access system that is suitable for carrying out laparoscopic surgical interventions on a natural body opening. The access system has several accesses through which several instruments, such as a flexible endoscope and/or a rigid instrument, can be introduced. For this purpose, the access system has a removable cover that can be attached to a proximal section of the port in a fluid-tight manner and provides a flat access surface with individual accesses for the medical instruments. The sealable access surface is designed, for example, as a gel pad, so that the individual instruments or the individual accesses for the instruments are arranged essentially stationary on the cover.

Furthermore, FR 2 904 210 B1 a port system with a trocar that defines a passageway for inserting multiple instruments into a patient's body opening. For this purpose, multiple individual accesses are formed in a sealing element inserted into the trocar.

In addition, EP 2 139 377 B1 a port system with a trocar/port, which defines an opening through which instruments and an endoscope can be introduced into the patient. For this purpose, a plate, which in turn has two openings, is rotatably received in the opening. A second plate is rotatably received in one opening. At least one tubular element is attached to the second plate, which forms an elastic holder for the instrument. In the area of the other opening, another tubular element is attached, which forms an elastic holder for the endoscope. The port system thus enables the instruments to move around a center line of the port.

However, with the port systems known from the state of the art, the instruments can only be moved slightly within the port. This limits the freedom of movement for the operator or surgeon.

A system is needed to meet the requirements of these new procedures and allow more flexible movement of laparoscopic instruments through a single or a limited number of ports, prevent the escape of pressurized fluids or gases, and allow the collection of large samples.

Summary of Revelation

The objects and aims of the disclosure are to eliminate or at least reduce the disadvantages of the prior art and in particular to provide a surgical port system which enables a surgeon to insert several instruments and to move them as freely as possible when inserted.

The objects and aims are achieved with regard to a generic surgical port system according to the disclosure by the subject matter of claim 1.

The port system is accordingly configured/adapted according to the disclosure such that the adapter ring has a guide structure which is designed to guide the flexible endoscope such that the flexible endoscope exits the passage substantially concentrically at a distal end portion of the port and the at least one rigid instrument, in particular satellite-like, is movable around the flexible endoscope.

Advantageous embodiments are claimed in the subclaims and are explained below.

In a preferred variant, the guide structure can be designed as a guide channel which is attached to the adapter ring and extends through the passage of the port. It can be preferred that the guide channel is attached off-center to the adapter ring and extends through the passage of the port towards the concentric position.

According to an advantageous embodiment, the port can be made of a flexible material, preferably a flexible plastic, in particular silicone. This makes it easier to insert the port into a patient's body opening and can prevent or reduce complications.

Preferably, the port system according to the disclosure can further comprise at least one guide disk (rotation disk) which is rotatably mounted on the guide structure in order to guide the movement of the at least one rigid instrument around the flexible endoscope. In an advantageous embodiment, the at least one guide disk can guide several rigid instruments relative to the flexible endoscope.

According to a preferred development, the port system according to the disclosure can further comprise a sealing element which is attached to the adapter ring in order to seal the patient's cavity and which has at least two valve openings through which the flexible endoscope and the at least one rigid instrument can be inserted. The sealing element can particularly preferably be designed in the manner of a sealing bag in order to ensure the movement of the at least one rigid instrument around the flexible endoscope in the inserted state.

Furthermore, the port system according to the disclosure can preferably comprise a locking mechanism which is pivotally connected to the port system, in particular to the adapter ring, in order to lock (fix) the adapter ring to the port in a locking position.

In addition, it can be advantageous if the adapter ring has at least one barb that can be brought into engagement with a notch on the port in order to connect a distal end section of the adapter ring and a proximal end section of the port in a fluid-tight manner. The barb and the notch ensure sufficient surface pressure between a distal end face of the adapter ring and a proximal end face of the port, so that no fluid can pass through/leak between the two end faces.

According to an advantageous development, the port can have at least one connecting tab extending in the proximally direction, which has a locking opening designed to receive a locking lug/locking knob formed on the adapter ring in order to fix the adapter ring relative to the port. In other words, the port system can have a tab mechanism, with at least one connecting tab being formed on the port. This can extend from an outer peripheral surface of the proximal end section of the port in the proximal direction. The locking opening can preferably be formed in the connecting tab, so that the locking lug formed on the adapter ring, in particular on the intermediate seal, can engage in the locking opening in order to hold the adapter ring on the port.

In other words, the present disclosure relates to a port system through which both a flexible endoscope and a rigid instrument can be used to treat lesions in the rectum. The endoscope is located in the center of the port and the rigid instrument can be moved around the endoscope like a satellite. In the picture below, the rigid instrument is guided around the endoscope by rotating disks, although the rotating disks are not absolutely necessary. The instruments are surrounded by a funnel (port) made of flexible material (silicone or a comparable flexible plastic) that is inserted into the rectum through the anus. It keeps the anus open so that the instruments can be inserted. At the same time, it seals the pneumorectum and ensures that air can be insufflated and retained. The flexible material ensures that the port can be guided into the anus with little complications. The material can be compressed. The port system according to the disclosure can also be designed in such a way that the port and the access for the instruments can be uncoupled (separated) from one another. This makes it possible to remove resected tissue from the rectum. The mechanism can have a lock that locks or unlocks two separate port parts together. In addition, a type of sealing bag can be integrated into the adapter ring as a seal. The aim of this is to maintain the pneumorectum and to provide access for the instruments. It is important to achieve a large radius of movement for the rigid instrument, which enables 360° rotation around the endoscope in the middle. Valves for the corresponding instruments can be integrated into the sealing bag. The seal can be imagined as the shift bag around the gear lever in a manual transmission. It enables rotation around the endoscope.

In still other words, the present disclosure is based on the idea of providing a port system for TEM or TAMIS applications which allows a combination of a flexible endoscope and at least one rigid instrument. The flexible endoscope is placed centrally through the guide channel and the rigid instrument can move almost 360° around the flexible endoscope.

Short description of the characters

• 1 eine isometrische Ansicht eines Portsystems gemäß einer bevorzugten Ausführungsform;
• 2 eine perspektivische Teilschnittansicht des Portsystems gemäß der bevorzugten Ausführungsform mit einem eingeführten flexiblen Endoskop und einem medizinischen Instrument;
• 3 eine schematische Draufsicht auf das Portsystem gemäß der bevorzugten Ausführungsform;
• 4 eine Draufsicht auf das Portsystem gemäß der bevorzugten Ausführungsform;
• 5 eine Explosionsdarstellung des Portsystems gemäß der bevorzugten Ausführungsform;
• 6 eine Perspektivansicht des Portsystems gemäß der bevorzugten Ausführungsform mit einem Abdichtbeutel; und
• 7 eine Perspektivansicht eines Portsystems gemäß einer Modifikation der bevorzugten Ausführungsform.

The disclosure is explained in more detail below using preferred embodiments with the aid of figures. They show:

• 1 an isometric view of a port system according to a preferred embodiment;
• 2 a perspective partial sectional view of the port system according to the preferred embodiment with an inserted flexible endoscope and a medical instrument;
• 3 a schematic plan view of the port system according to the preferred embodiment;
• 4 a plan view of the port system according to the preferred embodiment;
• 5 an exploded view of the port system according to the preferred embodiment;
• 6 a perspective view of the port system according to the preferred embodiment with a sealing bag; and
• 7 a perspective view of a port system according to a modification of the preferred embodiment.

The figures are schematic in nature and are intended only to facilitate understanding of the disclosure. Like elements are designated by like reference numerals.

Detailed description of a preferred embodiment

1 shows a perspective view of a port system 1 according to a preferred embodiment. The port system 1 has a funnel-shaped port 2 which defines a substantially cylindrical passage 4 in its interior. According to the preferred embodiment, the port 2 is provided and designed to be inserted through the anus of a patient into his rectum for the treatment of lesions. The port 2 keeps the anus open so that a surgeon can carry out a treatment in the patient's rectum via the passage 4, as explained in more detail below.

In such procedures, the rectum is usually filled with gas to prevent the rectum from collapsing. A rectum filled with gas is referred to as a pneumorectum. The port 2 according to the preferred embodiment makes it possible to seal the pneumorectum and ensures that gas, in particular air, can be insufflated and retained. This means that the port 2 according to the disclosure serves on the one hand to keep the anus open and on the other hand to seal the pneumorectum.

According to the preferred embodiment, the port 2 is made of a flexible material, in particular a flexible plastic, such as silicone, so that the port 2 can be compressed and consequently can be inserted into the patient's anus with few complications.

The port system 1 also has an adapter ring 6 that is detachably connected to the port 2. The adapter ring 6 can be attached to a proximal end section of the port 2, as explained in more detail below. In order to fix the adapter ring 6 to the proximal end section of the port 2 or to release it from it, a locking mechanism 8 in the form of a folding mechanism is provided. This means that the locking mechanism 8 has a tensioning/folding lever 10 that is pivotally connected to the adapter ring 6 in order to be pivoted between a locking position and an unlocking position, whereby, for example, an inner diameter of the adapter ring 6 increases/decreases or a locking element selectively engages with the port 2.

On an inner peripheral surface of the adapter ring 6, as shown in 1 As can be seen, a guide channel 12 is arranged which extends through the passage 4 of the port 2 when the adapter ring 6 is connected to the port 2. The guide channel 12 is supported by a (radially extending) web 14 on the inner circumferential surface of the adapter ring 6 and enables a flexible endoscope 16 to be introduced through the guide channel 12 into the patient's rectum. In addition to the flexible endoscope 16, which is introduced through the guide channel 12, as in 2 shown, at least one further, in particular rigid, medical instrument 18 can be introduced through the passage 4 of the port system 1 according to the preferred embodiment.

The port system 1 according to the disclosure is therefore designed such that the port 2 and the adapter ring 6, which represents an access for the endoscope 16 and the at least one instrument 18, can be uncoupled/separated from one another. This makes it possible to remove resected tissue from the rectum.

3 and 4 each show plan views of the distal end portion of the port system 1 according to the preferred embodiment. As in 3 As shown, the guide channel 12 is provided on the adapter ring 6 such that it extends from an off-center position with respect to the adapter ring 6 at a proximal end portion to a central position at a distal end portion. That is, the guide channel 12 is designed such that the flexible endoscope 16 emerges from the passage 4 at the distal end portion of the port 2 concentrically thereto.

Such guidance of the flexible endoscope 16 with the guide channel 12 makes it possible to move the at least one instrument 18 around the circumference of the guide channel 12. In other words, in the port system 1 according to the disclosure, in particular at the distal end section of the port 2, the at least one instrument 18, as in 3 As indicated schematically, it can be moved satellite-like almost 360° around the concentrically arranged guide channel 12.

In order to ensure guidance of the satellite-like movement of the at least one instrument 18 around the guide channel 12, the port system 1 according to the preferred embodiment, as shown in 4 shown, at least one rotary disk 20 is provided. The rotary disk 20 has a first through-hole 22, via which it is attached to the guide channel 12, and a second through-hole 24, through which the instrument 18 extends. The rotary disk 20 can also have several second through-holes 24, whereby an instrument 18 can extend through every second through-hole 24. Consequently, one rotary disk 20 can be used to guide several instruments 18.

5 shows an exploded view of the port system 1 according to the preferred embodiment. As in 5 As can be seen, the adapter ring 6 of the port system 1 according to the preferred embodiment is in two parts consisting of an annular intermediate seal 26 and an annular sealing cap 28.

The guide channel 12 is formed on the intermediate seal 26, where it is supported by the web 14 for stabilization, as mentioned above. At a proximal end section (in 5 A circumferential sealing bead 30 in the form of a sealing nose protruding from an outer circumferential surface of the intermediate seal 26 is formed on the outer peripheral surface of the intermediate seal 26. The intermediate seal 26 is pressed onto the sealing cap 28 via the sealing bead 30. For this purpose, in the preferred embodiment, a groove is formed in the sealing cap 28 (not shown), which receives the sealing bead 30.

At a distal end section (in 5 A fastening section in the form of a barb 32 protruding in the distal direction and extending partially over the circumference of the intermediate seal 26 is formed on the end portion (bottom) of the intermediate seal 26. The barb 32 is provided and designed to be positively connected to a notch 34 formed on the proximal end portion of the port 2. The barb 32 ensures the necessary surface pressure and a force-fit connection between the port 2 and the adapter ring 6, ie the intermediate seal 26 and the sealing cap 28.

For correct positioning of the sealing cap 28 and the intermediate seal 26 during assembly, the sealing cap 28 has a positioning spring 36 which engages in a corresponding (in 5 not shown) formed on the intermediate seal 26.

As mentioned above, the locking mechanism 8 is designed as a folding mechanism in the preferred embodiment. The folding lever 10 is designed in the form of a ring section/ring segment such that its curvature is adapted to an outer diameter of the adapter ring 6, i.e. the intermediate seal 26 and the sealing cap 28. The locking mechanism 8 or the folding lever 10 are pivotably/foldably articulated to the sealing cap 28 via a hinge 36. The hinge 36 has a support 38 in which the folding lever 10 is secured via a cylindrical pin 40. In other words, the locking mechanism 8 in the port system 1 according to the preferred embodiment is designed such that the folding lever 10 is pivotably articulated to the sealing cap 28 and, when pivoted into the locking position, nestles against or rests against an outer contour of the adapter ring 6. The locking mechanism 8 or the folding lever 10 are dimensioned such that they extend approximately one third of the outer circumference of the adapter ring 6.

Furthermore, the locking mechanism 8 has a locking spring (not shown) on a radially inner side of the folding lever 10, which engages in a corresponding locking groove (not shown) formed in the intermediate seal 26 in the manner of a spring-groove system. When the adapter ring 6 is now placed on the port 2 so that the barb 32 engages around the notch 34, the locking mechanism 8 is fixed in the support 38 with the cylindrical pin 40 and is pivoted into the locking position, the spring-groove system in combination with the barb 32, as mentioned above, ensures the corresponding surface pressure and the force-fitting connection of the port 2 with the adapter ring 6.

6 shows a perspective view of the port system 1 according to the preferred embodiment. The port system 1, as shown in 6 schematically indicated, placed in a body opening 42 of a patient, in particular the anus. On a distal side (in 6 In the lumen of the pelvis (right) the pneumorectum 44 is formed by insufflation in order to prevent the rectum from collapsing, as mentioned above. Due to its flexible material, the port 2 conforms to the contour of the body opening 42 and thereby enables a seal between port 2 and body opening 42.

On a proximal side (in 6 left) or outside the body opening 42, the port system 1 has a sealing element (seal) 46. The sealing element 46 is provided on the adapter ring 6 in order to maintain the pneumorectum 44 and to provide access to the at least one instrument 18 and the flexible endoscope 16. For this purpose, the sealing element 46 has valve openings 48 through which the at least one instrument 18 or the endoscope 16 can be inserted. The valve openings 48 are arranged on proximal end sections of finger-like bulges 50 of the sealing element 46. Furthermore, the sealing element 46 is made of an elastic/flexible material, which ensures the freedom of movement of the at least one instrument 18 around the endoscope 16.

According to the preferred embodiment, the sealing element 46 is designed as a sealing bag in the manner of a gearshift bag around the gearshift lever. It is important here to realize a large radius of movement for the at least one rigid instrument 18, with which the 360° rotation around the endoscope 16 in the middle is made possible.

In 7 the port system 1 is shown according to a modification of the preferred embodiment. The port 2 has three connecting tabs 52. The connecting tabs 52 are formed on the proximal end section of the port 2 and extend from an outer peripheral surface of the proximal end section of the port 2 further in the proximal direction or towards the adapter ring 6. As in 7 As shown, according to the modification of the preferred embodiment, three connecting tabs 52 are arranged evenly over the circumference of the port 2 on the port 2, so that in a plan view of the port 2 the connecting tabs 52 each enclose an angle of approximately 120° between them.

At a proximal end section of the connecting tabs 52, i.e. at an end section of the connecting tabs 52 facing away from the port 2, the connecting tabs 52 each have a locking opening 54. The locking openings 54 are designed as a through-opening and are set up to receive a locking lug 56 formed on the adapter ring 6, in particular the intermediate seal 26. When the locking lugs 56 of the adapter ring 6 engage in the locking openings 54 of the connecting tabs 52 of the port 2, the adapter ring 6 is held firmly on the port 2. In other words, the connecting tabs 52 together with the locking openings 54 and the locking lugs 56 enable the creation of a firm, but detachable, connection between the adapter ring 6 and the port 2.

List of reference symbols

1

Port system

2

port

4

Passage

6

Adapter ring

8th

Locking

10

Folding lever

12

Guide channel

14

web

16

flexible endoscope

18

medical instrument

20

Rotating disc

22

first through hole

24

second through hole

26

Intermediate seal

28

Sealing cap

30

Sealing bead

32

Barbs

34

notch

36

Positioning spring

38

In stock

40

Cylinder pin

42

Body opening

44

Pneumorectum

46

Sealing element

48

Valve opening

50

bulge

52

Connecting strap

54

Latching opening

56

locking lug

QUOTES INCLUDED IN THE DESCRIPTION

This list of documents listed by the applicant was generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions.

Cited patent literature

• EP 2621348 B1 [0006]
• FR 2904210 B1 [0007]
• EP 2139377 B1 [0008]

Claims (10)

Surgical port system (1) with a preferably funnel-shaped port (2) which defines a substantially cylindrical passage (4) which is provided and designed to introduce a flexible endoscope (16) and, parallel thereto, at least one rigid instrument (18) into a cavity (44) of a patient, and an adapter ring (6) which can be coupled or is coupled to a proximal end section of the port (2), characterized in that the adapter ring (6) has a guide structure (12) which is designed to guide the flexible endoscope (16) such that the flexible endoscope (16) emerges concentrically from the passage (4) at a distal end section of the port (2), so that the at least one rigid instrument (18), in particular in a satellite-like manner, can be moved around the flexible endoscope (16). Port system (1) to Claim 1 , characterized in that the guide structure is designed as a guide channel (12) which is fastened to the adapter ring (6) and extends through the passage (4) of the port (2). Port system (1) to Claim 2 , characterized in that the guide channel (12) is eccentrically attached to the adapter ring (6) and extends through the passage (4) of the port (2) towards the concentric position. Port system (1) according to one of the preceding Claims 1 until 3 , characterized in that the port (2) is made of a flexible material, preferably a flexible plastic, in particular silicone. Port system (1) according to one of the preceding Claims 1 until 4 , further characterized by at least one guide disk (20) which is rotatably received on the guide structure (12) in order to guide the movement of the at least one rigid instrument (18) around the flexible endoscope (16). Port system (1) to Claim 5 , characterized in that the at least one guide disc (20) guides several rigid instruments (18) relative to the flexible endoscope (16). Port system (1) according to one of the preceding Claims 1 until 6 , further characterized by a sealing element (46) which is attached to the adapter ring (6) in order to seal the cavity (44) of the patient, and which has at least two valve openings (48) through which the flexible endoscope (16) and the at least one rigid instrument (18) can be introduced. Port system (1) to Claim 7 , characterized in that the sealing element (46) is designed in the manner of a sealing bag in order to ensure the movement of the at least one rigid instrument (18) around the flexible endoscope (16) in the inserted state. Port system (1) according to one of the Claims 1 until 8th , characterized by a locking mechanism (8) which is pivotally connected to the port system (1), in particular to the adapter ring (6), in order to lock the adapter ring (6) to the port (2) in a locking position. Port system (1) according to one of the Claims 1 until 9 , characterized in that the adapter ring (6) has at least one barb (32) which can be brought into engagement with a notch (34) on the port (2) in order to connect a distal end portion of the adapter ring (6) and the proximal end portion of the port (2) in a fluid-tight manner.

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