CN102028508B - 具有非平行管腔的密封锚定件 - Google Patents

具有非平行管腔的密封锚定件 Download PDF

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CN102028508B
CN102028508B CN201010501271.7A CN201010501271A CN102028508B CN 102028508 B CN102028508 B CN 102028508B CN 201010501271 A CN201010501271 A CN 201010501271A CN 102028508 B CN102028508 B CN 102028508B
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格雷戈里·奥孔伊斯基
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A61M13/003—Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A61B2017/3429—Access ports, e.g. toroid shape introducers for instruments or hands having a unitary compressible body, e.g. made of silicone or foam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A61B2017/3466—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals for simultaneous sealing of multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/02—Gases

Abstract

本发明公开一种具有非平行管腔的密封锚定件，其限定壳体，该壳体限定一纵向轴线且该壳体包括前端和后端；并且包括多个管腔，所述管腔在前端和后端之间延伸，每个管腔适于在其内基本密封地容纳物件并限定一纵向轴线，其中至少两个管腔限定非平行的纵向轴线以便于多个仪器成角度地静止放置在密封锚定件内。

Description

具有非平行管腔的密封锚定件
相关申请的交叉引用
本申请要求享有2009年10月1日提交的申请号为61/247,654的美国临时申请的权益和优先权，其全部内容在此引入作为参考。
技术领域
本公开涉及一种在外科手术中使用的密封件。更确切地，本公开涉及一种密封锚定件，其适于插入组织内的切口中，并包括多个非平行管腔，所述非平行管腔适于密封容纳一个或多个手术物件，从而使得其与组织、与一个或多个手术物件之间均得以形成充分的流体密封。
背景技术
如今，很多外科手术是通过在皮肤上的小切口实施的，与传统的手术中通常需要大切口相比，这是为了努力减少患者的外伤以及患者的康复时间。一般情况下，这样的手术被称作为“内窥镜式”，除非是在患者的腹部上执行，这种情况下的手术被称作“腹腔镜式”。在本公开内容中，“微创”一词应当被理解为包括内窥镜式和腹腔镜式的手术。
在典型的微创手术中，手术物件，例如手术通路设备(例如：套管针和套管组件)或者内窥镜，通过组织内的切口被插入患者的体内。通常，在向患者体内引入手术物件或仪器之前，首先注入气体用来扩大目标手术部位周围的区域以形成一个更大、更易接近的工作区域。因此，为避免注入气体的逸出和经扩大的手术部位的缩小或塌陷，保持充分的流体密封是期望的。
为此，各种各样的阀或者密封件被用于微创手术过程中，并广泛地被本领域技术人员所熟知。已经开发出了各种密封件，包括用于容纳手术仪器的管腔。取决于特定的外科手术的需要，仪器可能需要在一持续时间段内相对于彼此成角度。将仪器相对彼此成角度地保持和/或克服密封锚定件(仪器通过其而插入)的内部偏置，这可能会使得外科医生疲劳和/或使得在密封锚定件和周围组织之间的流体密封壁垒破裂。
因此，对新的密封锚定件存在持续需求，这样的密封锚定件能够直接插入到组织的切口中并能够在维持注气工作区的完整性的同时容纳各种手术物件或仪器。
发明内容
这里公开一种密封锚定件，包括：壳体，所述壳体包括前端和后端；以及延伸通过前端和后端的一个或多个管腔。每个管腔适于以基本密封容纳的方式容纳手术仪器。一个或多个管腔相对于壳体的纵向轴线成角度。至少两个管腔限定相对彼此非平行的轴线。在一个实施例中，所述壳体可包括多个管腔，例如：三个管腔，其中一个管腔相对于纵向轴线平行，而另两个管腔相对彼此以及纵向轴线非平行。如这里所述，尽管管腔限定相交的轴线但管腔彼此不交叉(cross)，因为所述管腔横向(lateral)间隔开，例如，当从侧面剖面图观看壳体时，所述轴线而非管腔是相交的(intersecting)。管腔的这种配置便于多个手术物件或仪器同时、非平行地放置在密封锚定件中。然而，在其它实施例中，管腔可以是相交的。
此外，管腔可以限定在前端处的围绕后端径向间隔开的开口。可选地，管腔可以限定在前端处的沿着后端的直径间隔的开口。由管腔所限定的开口可以关于后端的轴线错开，或者可以以沿着直径但偏离前述直径的方式布置。可选地，由管腔所限定的开口可位于后端的弦或直径上。
壳体可由可压缩材料形成，以便于调节插入到管腔内的仪器相对于壳体的纵向轴线之间的角度。在没有力(例如：径向力)施加到插入在管腔内的仪器上时，管腔相对于彼此成角度，即非平行。在使用期间，通过施加力能够调节管腔的角度。
前端可包括邻近至少一个管腔的近端定位的凹槽、切口部(cut-out)或凹部。凹槽被配置为并适于通过稳定仪器并将仪器引入管腔中来便于将仪器插入到管腔中。凹槽可以基本上为弓形。凹槽可以从该凹槽的近端到远端变窄。凹槽可从至少一个管腔的近端径向向外延伸。
此外，密封锚定件的壳体可适于在第一压缩状态和第二扩张状态之间转换，在所述第一压缩状态中便于密封锚定件至少部分插入组织通道内，在所述第二扩张状态中便于密封锚定件固定在组织通道内并与限定组织通道的组织表面具有实质的密封关系。在一实施例中，壳体可由可压缩材料或泡沫材料形成。在一实施例中，泡沫材料可以是由从聚异戊二烯、氨基甲酸乙酯和硅树脂构成的组中选出的材料至少部分地组成。在另一实施例中，壳体可由胶质材料形成。
壳体还可以限定基本弓形配置。壳体可以限定大体沙漏形状。此外，管腔可以限定在前端处的围绕后端径向间隔开的开口。可选择地，管腔可以限定在前端处的沿着后端的直径间隔的开口。由管腔所限定的开口可以关于后端的轴线错开，或者可以以沿着直径但偏离前述直径的方式布置。可选地，由管腔所限定的开口可位于后端的弦或直径上。
从以下详细描述本公开的各种实施例，这里所公开的装置的这些和其它特征对本领域的技术人员将更加清晰。
附图说明
以下结合附图描述了本公开的各种实施例，其中：
图1为相对组织示出的根据本公开的密封锚定件的正视立体图；
图2A为在其中具有彼此平行的管腔的密封锚定件的正视立体图；
图2B为示出其中插有医疗仪器的图1的密封锚定件的正视立体图；
图3为根据本公开的密封锚定件的另一实施例；以及
图4为根据本公开的密封锚定件的再一实施例。
具体实施方式
在下述附图和描述中，相同的附图标记指示相同或相应元件，词语“近”表示装置在使用时靠近临床医生的一端，而词语“远”表示远离临床医生的一端，就如同本领域技术人员所熟知的一样。在公开号为2009-0093752的美国专利中示出并描述了在外科手术中所使用的密封锚定件，该专利的全部内容在此被引用作为参考。所述密封锚定件可以在将密封锚定件插入到切口中的微创手术过程中使用。可选择地，可以通过自然存在的开口(例如：肛门或者阴道)或者患者皮肤上的任何切口来使用所述密封锚定件。
将在典型的微创手术过程中讨论密封锚定件100的使用和功能。首先，对腹膜腔(未示出)注入适当的生物相容性气体(例如：CO2气体)，使得腔壁被升起并抬离腔壁内所容纳的内部器官和组织，以提供到所述内部器官和组织的更大的通路。如在现有技术中惯用的，可以通过注气针或类似的设备来执行所述注气。在注气之前或之后，在组织“T”中产生组织通道12，其尺寸可以根据手术的特性而变化。
将结合图1和图2来描述密封锚定件100。密封锚定件100限定纵向轴线“A”，并具有各个后(近)端102和前(远)端104以及布置在后端102和前端104之间的中间部106。密封锚定件100包括布置在后端102和前端104之间的一个或多个管腔(端口)108a、108b、108c，这些管腔相应限定了纵向轴线“X”、“Y”、“Z”。如图1所示，分别由管腔108a、108b、108c所限定的轴线“X”、“Y”、“Z”相对于彼此是非平行的。为了便于将仪器同时放置于管腔108a、108b、108c的每个中，管腔108a-c彼此不交叉。管腔108a-c横向间隔开，从而虽然管腔108a-c相对于彼此成角度，但是管腔108a-c彼此并不相交。然而，在另一实施例中，可将管腔设置为彼此交叉。与密封锚定件100相反的，图2A示出了具有平行的、不相交的管腔98的密封锚定件90。
如图2B所示，管腔108a-c适于以基本密封的方式在其中容纳仪器设备。管腔108a-c适于在仪器设备插入或不插入其中的情况下禁止体腔内的注入气体逸出。因此，管腔108a-c具有这样的直径：适于在没有手术仪器插入其中时收缩，且适于扩张从而以基本密封的方式容纳仪器设备。
如图2B所示，插入到管腔108内的仪器设备可以包括但不限于：摄像机20，其可插入到一个管腔108中；一对手术仪器21，其插入到另外两个管腔108中。由于插入一对手术仪器21的两个管腔108a、108c的轴线“X”和“Z”彼此交叉，所以手术仪器21的远端之间的距离大于当轴线“X”、“Z”彼此平行时远端之间的距离。因为管腔108a、108c限定了非平行的轴线，所以由于仪器21较小可能干扰到相互的使用，从而便于手术仪器21的操作。此外，由于管腔108a-c的静止状态相对于彼此成角度，所以对于那些需要在持续时间期间内进行定位的手术而言缓解了外科医生的疲劳。通过向管腔108a-c内放置的手术仪器设备施加径向力来克服密封锚定件100的内部偏置力，可以便于相对于彼此调节管腔的角度。
如前所述，图2A示出了包括彼此平行的管腔98的密封锚定件90。插入到管腔98内的是手术仪器21和摄像机20。如图2A所示，管腔98的平行配置阻碍了摄像机20获得手术部位的清楚视图。可以理解的是，与使用密封锚定件90获得的视野相比，密封锚定件100的管腔108a-c的非平行、相交配置便于获得较少受限的视野。特别地，如图2B所示，轴线“X”和“Z”在其间限定了角度“θ”。角度“θ”的值越大，手术仪器21遮蔽摄像机20视野的可能性就越小。此外，角度“θ”越大，在手术过程中仪器21之间干扰的可能性就越小。另外，角度“θ”越大，手术术野内和仪器21的到达范围内所含的内部结构的数目就越大。
密封锚定件的近端102限定了第一直径D1，而远端104限定了第二直径D2。在密封锚定件100的一个实施例中，如图1所示，近端102和远端104各自的第一直径D1和第二直径D2基本相等，但是密封锚定件100的直径D1和D2不同的实施例也落入本公开的范围内。如图1所示，近端102和远端104限定基本呈平面的表面。然而，在此也考虑到如下的实施例；其中，近端102和/或远端104分别限定基本呈弓形的表面以助于将密封锚定件100插入到由组织表面14限定并形成在组织“T”中的组织通道12(例如：切口)内，以下将详细进行讨论。
中间部106限定了径向尺寸“R”，并分别在近端102和远端104之间纵向延伸以限定轴向尺寸或长度“L”。中间部106的径向尺寸“R”沿着其轴向尺寸或长度“L”而变化。因此，密封锚定件100限定沿着其长度“L”变化的剖面尺寸，这将便于将密封锚定件100锚定在组织“T”内，如将在以下详细进行讨论的。然而，密封锚定件100的径向尺寸“R”沿着其轴向尺寸“L”保持基本均一的实施例也落入本公开的范围内。
中间部106的径向尺寸“R”显著小于近端102和远端104各自的直径D1、D2，从而密封锚定件100限定“沙漏”形状或配置以有助于将密封锚定件100锚定在组织“T”内，如在以下将更详细讨论的。然而，在可选实施例中，中间部106的径向尺寸“R”可基本等于近端102和远端104的各自的直径D1、D2。在截面图中，中间部106可呈现任意适当的配置，例如：大体圆形、椭圆形或者长方形。
密封锚定件100可适于从扩张状态转换到压缩状态，从而便于插入并固定在组织“T”内的组织通道12中。在扩张状态下，密封锚定件100处于静止，并且密封锚定件100的近端102和远端104各自的径向直径D1、D2，以及中间部106的径向尺寸R为使得密封锚定件100不能插入到组织通道12内。然而，密封锚定件100可转换到压缩状态，从而近端102、远端104以及中间部106为适于插入到组织通道12中的尺寸。
为了便于在扩张状态和压缩状态之间转换，密封锚定件100可以由可压缩材料形成，所述可压缩材料具有内部偏置力，从而当将密封锚定件100插入到组织通道12内时密封锚定件100可转换回扩张状态，从而确保密封锚定件100和组织通道12之间的密封。密封锚定件100可由形状记忆材料、泡沫材料或者胶质材料等形成，但是也可以由其它材料形成。在一实施例中，密封锚定件100可由从聚异戊二烯、氨基甲酸乙酯和硅树脂构成的组中选出的材料形成。
后端102和前端104各自的定位部件114、115可以与限定“组织通道12的体腔”的壁接合，以便于将密封锚定件100固定在体组织内。例如，在前端104处的定位部件114可以与内部腹膜壁接合，而邻近后端102的定位部件114可以与邻近组织“T”内的切口12的外部表皮组织接合。在密封锚定件100的另一实施例中，一个或多个额外的定位部件114可与中间部106结合。
在典型的微创手术过程中将讨论密封锚定件100的使用和功能。首先，对腹膜腔(未示出)注入适当的生物相容性气体(例如：CO2气体)，使得腔壁被升起并抬高远离腔壁内所容纳的内部器官和组织，以提供到所述内部器官和组织的更大的通路。如在现有技术中惯用的，可以通过注气针或类似的设备来执行所述注气。在注气之前或之后，在组织“T”中产生组织通道12，其尺寸可以根据手术的特性而变化。
结合图2和图3将描述密封锚定件的不同实施例。密封锚定件200、300与密封锚定件100基本相同，除了管腔的配置，并且进一步包括稳定插入到管腔内的仪器设备的结构。如图2和图3所示，密封锚定件200和密封锚定件300包括限定相交的轴线的管腔。密封锚定件200包括后端202和远端204。多个管腔208布置在后端202和前端204之间。管腔208限定了在后端202中的开口，这些开口沿着后端202径向布置。在前端中的从至少一个管腔208向外延伸的切口部或凹槽201便于稳定插入到管腔208内的仪器设备。
在可选实施例中，图4示出了在前和后端302，304之间布置有多个管腔的密封锚定件300。呈弓形或半圆柱形配置的切口部或凹槽301布置在后端。至少一个管腔308布置在凹槽301内。凹槽301适于便于稳定插入到布置在由凹槽301限定的区域内的至少一个管腔308内的仪器设备。
虽然在此结合附图描述了本公开的示例性实施例，但是以上描述、公开和附图并不应该被视为限制，而仅是对特定实施例的例证。因此，应该理解的是，本公开并不局限于那些精确的实施例，而是本领域的技术人员在不背离本公开的范围或精神的情况下可作出各种其它改变和修改。

Claims (8)

1.一种密封锚定件，包括：
壳体，所述壳体包括前端和后端，所述壳体限定纵向轴线；以及
多个管腔，其延伸通过所述前端和后端，每个管腔适于在其内基本密封地容纳仪器，其中至少两个管腔是直的并且相对彼此非平行，并且所述后端限定了从所述多个管腔中的至少一个管腔向外延伸的切口部或凹槽，以便于稳定插入到所述至少一个管腔内的仪器。
2.如权利要求1所述的密封锚定件，其中所述管腔横向间隔开。
3.如权利要求1所述的密封锚定件，其中所述壳体由可压缩材料形成，插入到多个管腔中的一个管腔内的仪器限定相对于壳体的纵向轴线的角度，所述角度是可调节的。
4.如权利要求1所述的密封锚定件，其中在没有由容纳在管腔内的仪器施加的径向力时，所述管腔相对于彼此是非平行的。
5.如权利要求1所述的密封锚定件，其中所述壳体适于在第一压缩状态和第二状态之间转换，在所述第一压缩状态中便于密封锚定件至少部分插入组织通道内，在所述第二状态中便于密封锚定件固定在组织通道内。
6.如权利要求1所述的密封锚定件，其中所述壳体限定大体沙漏形状。
7.如权利要求1所述的密封锚定件，其中所述前端和后端的每个具有弓形配置。
8.如权利要求1所述的密封锚定件，其中所述管腔的近端围绕后端径向间隔开。
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