EP1435831A1 - Dispositif et procede d'eclairage laparoscopique - Google Patents

Dispositif et procede d'eclairage laparoscopique

Info

Publication number
EP1435831A1
EP1435831A1 EP01981697A EP01981697A EP1435831A1 EP 1435831 A1 EP1435831 A1 EP 1435831A1 EP 01981697 A EP01981697 A EP 01981697A EP 01981697 A EP01981697 A EP 01981697A EP 1435831 A1 EP1435831 A1 EP 1435831A1
Authority
EP
European Patent Office
Prior art keywords
access device
instrument
body cavity
pad
seal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP01981697A
Other languages
German (de)
English (en)
Inventor
Richard C. Ewers
Gary R. Dulak
Nabil Hilal
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Applied Medical Resources Corp
Original Assignee
Applied Medical Resources Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Applied Medical Resources Corp filed Critical Applied Medical Resources Corp
Publication of EP1435831A1 publication Critical patent/EP1435831A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
    • 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

Definitions

  • This invention relates generally to devices and apparatus facilitating illumination of surgical sites in less invasive surgery applications.
  • Trocars have been commonly used to provide instrument access in laparoscopic surgeries. These trocars have included elaborate seal structures having zero seals which prevent escape of the gases in the absence of instruments, and instrument seals which prevent escape of the gases in the presence of instruments. Unfortunately, the instrument seals have been able to accommodate only a narrow range of instrument diameters. Where wider ranges were desired multiple seal pairs had to be provided.
  • a Touhy-Borst seal requires two hands to use and does not form a seal when a guidewire or other device is about to be introduced.
  • Present trocar seals and hand-assisted seals require two valves, one forming an instrument seal in the presence of the instrument, and the other forming a zero seal in the absence of the instrument.
  • elaborate mechanisms have been required to seal around the surgeon's arm.
  • the device includes a valve structure formed of a gel including, for example, a thermoplastic base such as KRATON (a trademark of Shell Corporation) and an oil.
  • a thermoplastic base such as KRATON (a trademark of Shell Corporation)
  • an oil such as water.
  • the resulting elastomer has an excellent tear strength, elongation greater than 1,000 percent, a very low durometer or hardness, and biocompatibility.
  • a process for manufacturing this device is greatly simplified using molding techniques.
  • the access device can function as both a zero seal and an instrument seal. Furthermore, it can accommodate a full range of instrument diameters, such as a range from two French in the case of a guidewire, to three or four inches in the case of a surgeon's hand. In addition, several instruments can be accommodated at the same time with a single access device.
  • Both tear resistance and sealing capability can be enhanced by encapsulating the gel in a sheath or otherwise providing circumferential reinforcement for the valve structure.
  • Additives can be provided either on or in the gel to enhance properties such as lubricity, appearance, wound treatment and/or protection, anti-cancer protection and anti-microbial protection. Additional chemicals, compounds, pharmaceuticals or even mechanical devices can be mixed with or embedded in the gel material to vary chemical, pharmaceutical or physical properties of the access device.
  • both illumination and visualization of the operative site can be significantly increased.
  • a source of light can be provided exteriorly of the body wall and the body cavity in order to produce a path of light directed toward the body cavity.
  • the access device of the present invention can be disposed along this path of light and positioned to extend at least partially across the body wall.
  • this access device is formed of a translucent material, such as a translucent gel, the device can function as a window providing access for the light and visualization for the surgeon. This function need not interfere with the primary access which the device otherwise provides for surgical instruments. Accordingly, illumination is provided without requiring a separate access device.
  • FIG. 1 is a perspective view showing a patient prone on an operating table with his abdomen insufflated, and with instrument access provided by trocars and the access device of the present invention
  • Fig. 2 is an enlarged side elevation view of the access device of Fig. 1 operatively disposed exteriorly as the abdominal wall;
  • Fig. 3 is a side elevation view similar to Fig. 2 showing the access device operatively disposed interiorly of the abdominal wall;
  • Fig. 4 is a side elevation view similar to Fig. 2 showing the access device operatively disposed within an incision in the abdominal wall;
  • Fig. 5 is a plan view taken along lines 5-5 of Fig. 2;
  • Fig. 6 is a side elevation view similar to Fig. 2 and illustrating a further embodiment of the access device having an external flange and an internal flange;
  • Fig. 7 is a side elevation view similar to Fig. 6 and illustrating the hand of a surgeon being inserted through the access device;
  • Fig. 8 is an axially cross section view of the access device illustrated in
  • Fig. 9 is a cross section view similar to Fig. 8 and illustrating an embodiment with circumferential reinforcement members
  • Fig. 10 is an axial cross section view similar to Fig. 9 and illustrating a double-ring retractor with an access device of the present invention
  • Fig. 11 is a radial cross section view similar to Fig. 8 and illustrating an embodiment having a lead-in cavity or pocket;
  • Fig. 12 is a top plan view of the embodiment illustrated in Fig. 11;
  • Fig. 13 is an axial cross section view taken along lines 13-13 of Fig. 12;
  • Fig. 14 is an axial cross section view taken along lines 14-14 of Fig. 12;
  • Fig. 15 is an axial cross section view similar to Fig. 13 and illustrating an embodiment with a duct-bill valve
  • Fig. 16 is an axial cross-section view taken along lines 16-16 of Fig. 15;
  • Fig. 17 is a radial cross section view similar to Fig. 13 comprising a softer hand seal and a firmer base seal;
  • Fig. 18 is an axial cross section view taken along lines 18-18 of Fig. 17;
  • Fig. 19 is an axial cross section view of an embodiment having a lead-in cavity or pocket with a conical or funnel configuration
  • Fig. 20 is a top plan view of the embodiment illustrated in Fig. 19;
  • Fig. 21 is an axial cross section view similar to Fig. 13 and showing another embodiment with a trapezoidal slit;
  • Fig. 22 is an axial cross section view taken along lines 22-22 of Fig. 21;
  • Fig. 23 is an axial cross section view similar to Fig. 22 taken along lines
  • Fig. 24 is a perspective view of a further embodiment of the access device having an opening formed by multiple slits angularly disposed and axially spaced relative to each other;
  • Fig. 25 is a side elevation view of an access device with a slit having a spiral configuration
  • Fig. 26 is a top plan view of an access device having a spiral slit and axial channel
  • Fig. 27 is a side elevation view of an embodiment having a spiral slit and a septum seal
  • Fig. 28 is an axial cross section view of a further embodiment including a superelastic conical seal and a flexible base with annular spoke-like cams;
  • Fig. 29 is an axial cross section view taken along lines 29-29 of Fig. 22;
  • Fig. 30 is an axial cross section view taken along lines 30-30 of Fig. 22;
  • Fig. 31 is an axial cross section view similar to Fig. 28 and illustrating an embodiment including flappers;
  • Fig. 32 is a perspective exploded view of a further embodiment including a gel cap, a base, and a retraction sheath;
  • Fig. 33 is a top plan view of the gel cap of Fig. 32;
  • Fig. 34 is an axial cross section view taken along lines 34-34 of Fig. 33;
  • Fig. 35 is a top plan view of the base illustrated in Fig. 32;
  • Fig. 36 is an axial cross section view taken along lines 36-36 of Fig. 35;
  • Fig. 37 is a side elevation view of the retraction sheath illustrated in Fig. 32;
  • Fig. 38 is a side elevation view of a further embodiment of the retraction sheath;
  • Figs. 39-42 illustrate progressive steps in a preferred method of use associated with the embodiment of Figure 32;
  • Fig. 39 is a top plan view showing use of a template
  • Fig. 40 is a top plan view of showing placement of the retraction sheath
  • Fig. 41 is a top plan view showing placement of the base ring and securement of the traction sheath
  • Fig. 42 is an axial cross section view partially in section showing placement of the gel cap relative to the base;
  • Fig. 43 is a perspective view of an illumination system showing an external light source and a translucent access device;
  • Fig. 44 is a side elevation view of a further embodiment wherein a source of light is embedded in the access device; and Fig. 45 is a top plan view of the embodiment illustrated in Figure 44.
  • FIG. 1 A patient is illustrated in Figure 1 and designated generally by the reference numeral 10.
  • the patient 10 is shown in a prone position on an operating table 12, where abdominal surgery is being performed by a surgeon 14 having an arm 16 and a hand 17.
  • the operative procedure is performed within an abdominal cavity 18 with instrument access provided through an abdominal wall 21.
  • trocars 23 and 25 are commonly used to provide minimally invasive access through the abdominal wall 21 for instruments such as a grasper 27 and an endoscope 30
  • laparoscopic surgery is merely representative of a type of operation wherein a procedure can be performed in a body cavity with minimal access through a body wall.
  • a small incision 32 is typically created in the abdominal wall 21.
  • An access device 34 of the present invention can be provided to further facilitate this access by the hand of the surgeon 14.
  • insufflation the abdominal cavity 18 with a gas, such as carbon dioxide, in order to elevate the abdominal wall 21 and thereby increase the volume of the working space within the cavity 18.
  • a gas such as carbon dioxide
  • pneumoperitoneum is particularly difficult where access is desired across the abdominal wall 21, for example, through the trocars 23, 25, as well as the access device 34.
  • a substantial effort has been directed to providing such access devices with sealing characteristics both in the presence of instruments and in the absence of instruments, such as the grasper 29, scope 30 and hand 27.
  • the trocars 23 and 25 have typically been provided with complex valve structures, including, for each narrow range of instrument sizes, an instrument valve which forms an instrument seal in the presence of an instrument, and a zero valve which forms a zero seal in the absence of an instrument.
  • an instrument valve which forms an instrument seal in the presence of an instrument
  • a zero valve which forms a zero seal in the absence of an instrument.
  • the instrument seals have been particularly cumbersome, as noted, and have only been effective for a small range of instrument diameters. For example, separate instrument seals have been needed for instruments, such as guidewires, which may have a diameter of only two French to three French.
  • FIG. 2 An enlarged view of one embodiment of the access device 34 is illustrated in Figure 2 which also shows the abdominal wall 21 and the incision 32.
  • the access device 34 has the general configuration of a pad 35, meaning that it is generally flat and disposed in a plane such as the plane 38. Typically parallel to this plane 38 are a pair of major surfaces of 41 and 43 which provide the pad 35 with a substantial surface area.
  • An opening or slit 45 can be formed through the pad 35, generally along an axis 47 perpendicular to the plane 38.
  • the opening 45 of the pad 35 When operatively disposed, the opening 45 of the pad 35 is in communication with the incision 32 and, in this case, forms with the incision 32, the working channel 36.
  • the alignment of the opening 45 and incision 32 can occur with the pad 35 disposed exteriorly of the abdominal wall as illustrated in Figure 2, interiorly of the abdominal wall is 21 as illustrated in Figure 3, or within the abdominal wall 21 as illustrated in Figure 4.
  • operative disposition of the pad 35 relative to the abdominal wall 21 requires that the pad 35 be maintained in its operative position and that it form a seal around the incision 32.
  • these two functions are accomplished with an adhesive 50 disposed around the incision 32 between the pad 35 and the abdominal wall 21.
  • this adhesive 50 is formed as a continuous ring 52, as illustrated in Figure 5, the pad 35 can be disposed with the ring 52 positioned circumferentially around the incision 32 to form a seal between the pad 35 and the abdominal wall 21.
  • the adhesive ring 52 when the pad 35 is operatively positioned, the escape of insufflation gases is inhibited between the pad 35 and the abdominal wall 21 by the adhesive ring 52.
  • the functions of the adhesive ring 52 can be accomplished in many different ways using many different materials and shapes.
  • many materials other than adhesives can be used to maintain the pad 35 in position over the incision 32.
  • the formation of a seal around the incision 32 can also be accomplished with methods other than adhesion.
  • the shape of the continuous seal formed by the adhesive 50 need not be in the shape of a circle. Rather, any continuous pattern sufficiently large to form a perimeter around the incision 32 could facilitate the desired sealing relationship.
  • the mere placement of the pad 35 for example, interiorly of the abdominal wall 21 as illustrated in Figure 3, may produce a perimeter seal merely as a result of the insufflation pressure.
  • FIG. 6 A further embodiment of the access device 32 is illustrated in Figure 6 where elements of structure similar to those previously disclosed or designated with the same reference numeral followed by the lower case "a.”
  • the functions of position-maintenance and sealing are accomplished with an alternative configuration for the access device itself.
  • the pad 35 in this case is disposed within the incision 32 as illustrated in Figure 4.
  • an external flange 54 and an internal flange 56 are formed integral with the pad 35.
  • the external flange 54 When operatively disposed, the external flange 54 is positioned outside of the abdominal wall 21 while the internal flange 56 is disposed interiorly of the abdominal wall 21a. In this matter, the pad 35 can be disposed within the incision 32a and held in position by the flanges 54, 56.
  • the exterior flange 54 prevents the pad 35a from moving distally.
  • the interior flange 56 prevents the pad 35a from moving proximally
  • the opening 45a extends through the pad 35a as well as the flanges 54 and 56, and completely defines the working channel 34 through the incision 32.
  • the primary seal which is required between the access device 34a and the abdominal wall 21 can be formed with the adhesive ring 52a as discussed with reference to Figure 6.
  • this embodiment including the interior flange 56 may rely merely upon the surface contact between the flange 56a and the abdominal wall 21.
  • the primary seal can be formed between these structural elements and enhanced by the pneumoperitoneum pressure which forces the interior flange 56 against the abdominal wall as illustrated by a plurality of arrows 58.
  • This seal is formed primarily in a radial plan generally perpendicular to the axis 47.
  • the function of the primary seal may be further enhanced by additional sealing which occurs between the pad 35a and the portions of the abdominal wall 21 forming the incision 32.
  • additional sealing occurs between the pad 35a and the portions of the abdominal wall 21 forming the incision 32.
  • the abdominal wall 21 is radially compressed by the mere presence of the pad 35 within the incision 32.
  • the resulting pressure produces an axial seal between the pad 35a and the abdominal wall 21.
  • the adhesive ring 52a is desired for this embodiment, it is most advantageously placed around the incision 32, between the exterior flange 54 and the abdominal wall 21. It will be noted that whenever an instrument, such as the arm 16 or hand
  • the arm 16 and hand 17 of the surgeon 14 are merely examples of instruments which can be inserted through the access device 34a.
  • the opening or slit 45a merely closes against itself to form a zero seal, thus preventing the escape of insufflation gases through the access device 34a.
  • an instrument seal is formed between the material of the access device 34a and the exterior surface of the instrument. This prevents the escape of insufflation gases through the access device 34a, even when an instrument is present. Thus, insufflation pressures can be maintained within the abdominal cavity 18 whether or not the instrument is in place.
  • these seals, the zero seal and the abdominal seal can be formed as a single valve structure having properties for accommodating a full range of instrument sizes. Formation of the pad 35 a will typically be accomplished in a simple molding process described in greater detail below. In such a process, the opening or slit 45a may be formed as part of the molding process.
  • the single access opening 45a will be sufficient to accommodate the operative procedure.
  • a further advantage of the access device 34a will be particularly appreciated by the surgeon 14 who requires even more access through the pad 35a.
  • the surgeon 14 having his/her arm 16 inserted through the opening 45 a when he/she decides that a further instrument is required for the operative procedure.
  • a further opening through the pad 35a can be established by merely inserting the desired operative instrument through the pad 35a. In this manner, the instrument can create its own access hole beside the primary opening 45a.
  • the instrument can merely be forced through the pad 35a forming its own access hole , such as the opening 45a, as it is moved distally.
  • This opening created by the operative instrument itself, would automatically form an instrument seal as the instrument is inserted, as well as a zero seal as the instrument is withdrawn.
  • the pad 35 is formed of a KRATON/oil mixture including a KRATON Tri-block with a Styrene-Ethylene/Butylene-Styrene (S-E/B-S) structure in combination with a mineral oil.
  • KRATON Tri-block with a Styrene-Ethylene/Butylene-Styrene (S-E/B-S) structure in combination with a mineral oil can be used for this application such as Styrene-Isoprene-Styrene, (S-I-S), Styrene-Butadiene-Styrene (S-B-S), Styrene- Ethylene Propylene-Styrene (S-E P-S) manufactured under the trademark SEPTON by the Kuraray Co.
  • Grade 1650 is a S-E/B-S tri-block with a 29/71 styrene to rubber ratio.
  • di-block versions of these materials where styrene is present at only one end of the formula, for example, Styrene- Ethylene Butylene (S-E/B) di-block.
  • the various base formulas may also be alloyed with one another to achieve a variety of intermediate properties.
  • KRATON G1701X is a 70% S-E/B 30% S-E/B-S mixture with an overall Styrene to rubber ratio of 28/72. It can be appreciated that an almost infinite number of combinations, alloys, and Styrene to rubber ratios can be formulated, each capable of providing advantages to a particular embodiment of the invention. These advantages will typically include low durometer, high elongation, and good tear strength. It is contemplated that the material of the pad 35 may also include silicone, soft urethanes and even harder plastics which might provide the desired sealing qualities with the addition of a foaming agent. The silicone materials can be of the types currently used for electronic encapsulation.
  • the harder plastics may include PNC, Isoprene, KRATO ⁇ neat, and other KRATO ⁇ /oil mixtures.
  • KRATO ⁇ /oil mixture for example, oils such as vegetable oils, petroleum oils and silicone oils might be substituted for the mineral oil.
  • all of these mixtures can be described generally as a gel.
  • the gel will typically have properties including an ability to "flow" which approaches that of a fluid. Particularly in the vicinity of any opening or slit 45 extending through the access device 34, propagation of the opening may be of concern. Stresses resulting from the presence of an instrument will be concentrated at the ends of such an opening or slit. For this reason, a good tear resistance is desired for the gel material.
  • Such a tear resistance is often inherent in the KRATON/oil mixtures and may be enhanced by encapsulating the gel in other materials.
  • a low tear resistant gel could be encapsulated in a urethane sheath to improve the tear resistant qualities of the resulting products.
  • Such a sheath need not be elastic but could be comprised, for example, of overlapping sheets of anon-elastic material.
  • any of the gel materials contemplated could be modified to achieve different properties such as enhanced lubricity, appearance, and wound protection, or to provide anti-cancer or anti-microbial activity.
  • Additives can be incorporated directly into the gel, for example in the case of pharmaceuticals, or applied as a surface treatment to the gel, for example, to improve lubricity or appearance.
  • Other compounds could be added to the gel to modify its physical properties or to assist in subsequent modification of the surface by providing bonding sites or a surface charge.
  • Antioxidants and antirads can be added to the mixture to extend the shelf life of the finished product or increase its ability to withstand radiation sterilization.
  • Sealing materials used in medical access devices of the past have been chosen primarily for their durometer and elongation. It is these properties which measure the ability of the material to move into small spaces and crevices as may be required to form an instrument seal across the working channel of a trocar.
  • a silicone mixture was used in medical valves. This mixture had the following properties: an ultimate elongation less than about 1000 percent and a durometer not less than about 5 Shore A.
  • the ultragel includes KRATON and mineral oil and provides a sealing material with the following properties: an ultimate elongation exceeding about 1500 percent, and a durometer of less than about 200 Bloom.
  • the durometer in this case is considerably lower than that of the prior art materials. In fact, the durometer of the present material is so soft it cannot even be measured on the Shore A scale.
  • the resulting elongation and durometer of the present material facilitates its use with as an access valve which is capable of forming seals with a full range of instrument sizes , but is also capable of functioning as a zero seal.
  • access devices of the prior art may have required as many as six separate seals in order to accommodate a full range of instrument sizes
  • access devices can now be made with only a single valve formed of the ultragel material.
  • the KRATON G1651 is mixed with the mineral oil in a ratio by weight of 1 to 9. In order to manufacture this material, the combination is heated to a temperature of about 200° centigrade.
  • the mold is provided with a circumferential ring insert which is molded into the gel, and slit inserts which can be removed from the gel to form the opening or slit 45.
  • the resulting gel can be coated with cornstarch to reduce tack and cooled at room temperature.
  • KRATON/oil mixture Many of the properties of the KRATON/oil mixture will vary with adjustments in the weight ratio of the components. In general, the greater the percentage of mineral oil, the more fluid the mixture; the greater the percentage of KRATON, the more rigid the material. Weight ratios of KRATON to oil as low as 1 to 5 have been contemplated for a more rigid structure. As the KRATON/oil weight ratio approaches 1 to 10, the mixture becomes more liquid. Ratios as high as 1 to 15 have been contemplated for this invention.
  • the processing temperature can also vary considerably as it is primarily dependent on the type of KRATON used. Temperatures in a range of about 150° centigrade to about 250° centigrade have been contemplated.
  • an outer layer might be formed of a KRATON/oil mixture having more rigid properties, thereby providing the pad 35 with an outer layer that is more rigid. After that layer is at least partially cured, another layer of the material can be poured inside of the outer layer. This second layer might be softer providing the pad 35 with the significant sealing properties. It has been found that successive layers will tend to fuse slightly at their interface, but will generally maintain their separate identities. Additional layers could be added to provide a progression of properties in a particular device.
  • This same embodiment can be reinforced with o-rings 61 and 63 as illustrated in Figure 9 where elements of structure are designated by the same reference number followed by the lower case letter "b."
  • Providing these o-rings 61 and 63 may facilitate several functions associated with the access device 34b.
  • the rings 61, 63 will typically aid in maintaining a radial sealing pressure on all sides of the opening 45b.
  • the rings 61 and 63 will also tend to maintain the flanges 54b and 56b respectively, in their generally planar configurations. This further ensures that the flanges 54, 56 will not collapse into the incision 32 with the insertion or withdrawal of an instrument, such as the surgeon's hand 17.
  • the o-rings 61 and 63 must be sufficiently large to accommodate the instrument during insertion and removal.
  • FIG. 10 A further embodiment of the invention is illustrated in Figure 10, where elements of structure are similar to those previously disclosed are designated with the same reference numerals followed by the lower case letter "c.”
  • This embodiment includes the pad 35c with the opening or slit 45c.
  • the external perimeter o-ring 61c is inserted molded into the circumference of the pad 35c.
  • the internal o-ring 63c is coupled to the pad 35c, for example, by way of attachment to the o-ring 61c for example, by a membrane 65.
  • the membrane 65 has a generally cylindrical configuration and elastomeric properties.
  • the membrane 65 is formed of urethane, neoprene or isoprene.
  • the pad 35c and external o-ring 61c are left outside the incision 32 so that the only material extending across the incision 32 is the membrane 65. It will be noted that in this case, the working channel 36c is formed by the slit 45c, the cylindrical membrane 65, and the internal o-ring 63b.
  • the pad 35c functions generally as described with reference to Figure 2.
  • the primary seal between the pad 35c and the abdominal wall 21 can be formed either with a circumferential ring, such as the adhesive ring 52c, or by relying on the sealing characteristics of the insufflation gas against the internal o-ring 63b and membrane 65.
  • This embodiment of Figure 10 is of particular advantage as it incorporates the pad 35c in perhaps its simplest configuration, while providing a primary seal between the device 34c and the abdominal wall 21 which is facilitated by the insufflation pressure.
  • the membrane 65 enhances the sealing characteristics of the device 34c, and provides a lining for the incision 32. With the membrane 65, the incision 32 need not be stretched to a diameter greater than that required by any instrument inserted through the working channel 36c.
  • FIG. 11 A further embodiment of the invention is illustrated in Figure 11 where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter "d.”
  • This embodiment is similar to that of Figure 8 in that it includes the pad 35b, slit 45d, exterior flange 54d, and internal flange 56d.
  • the embodiment of Figure 11 differs from that of Figure 8 in that it includes a lead-in cavity 70 which is in communication with the slit 45d.
  • this cavity 70 is sized and configured to receive the arm 16 of the surgeon 14 in a manner illustrated in Figure 7.
  • the slit 45d would function primarily to maintain a zero seal, while the portions of the pad 35d or flange 54d which form the cavity 70 would function primarily to form the instrument seal.
  • the lead-in cavity has the general shape of a cylinder 72 with an axis that is collinear with the axis 47e of the pad 35 e.
  • the slit 45e has a trapezoidal configuration. Thus, it begins proximally with a narrow length which may generally be equivalent to the diameter of the cylinder 32. From the cavity 70e, the length of the slit 45e increases with progressive positions distally through the pad 35e.
  • the trapezoidal slit 45e is formed as the frustum of an isosceles triangle.
  • FIG. 15 and 16 A further embodiment of the invention is illustrated in Figures 15 and 16 wherein elements of structure similar to those previously described are designated with the same reference numeral followed by the lower case letter "f."
  • this embodiment of the pad 35f is formed with a proximal surface 71 and a distal surface 73.
  • the pad 35f also includes the coaxial lead-in cylinder 72f and the trapezoidal slit 45f.
  • a duck-bill valve 74 is provided to further enhance the characteristics of the zero zeal.
  • the working channel 36f is formed by the lead-in cavity 70f, the slit 45f, and an extension of the slit 45 f which is defined by the duck-bill valve 74f .
  • the duck-bill valve 72 can be formed with opposing flanges 76 and 78 which extend distally of the distal surface 73.
  • the pad 35f When operatively disposed, the pad 35f can be positioned with its distal surface 73 against the exterior surface of the abdominal wall 21 ( Figure 2) and with the flanges 76 and 78 extending into the incision 32. With this configuration and operative disposition, the abdominal wall 21 at the incision 32 will produce opposing forces on the flanges 76 and 78 which tend to close the slit 45f, particularly in the absence of an instrument. In this manner, the duck-bill valve 74 can be relied on to enhance the characteristics of the zero seal.
  • FIG. 17 and 18 A further embodiment of the invention is illustrated in Figure 17 and 18 wherein elements of structure similar to those previously discussed are designated by the same reference numeral followed by the lower case letter "g.”
  • the pad 35g can be formed generally as discussed with reference to Figure 13. In this embodiment, however, the pad 35g can be enclosed along its sides and the distal surface 73g, by a base 81. In this case, the pad 35g might be formed by the highly elastic material previously discussed, while the base 81 might be formed of a more rigid but nevertheless flexible material such as a urethane.
  • the duck-bill valve 74f would be structured to extend distally of a distal surface 83 associated with the base 81. This would enable the duck-bill valve 74f to be formed of the base material rather than the superelastic material. This might also improve the zero seal characteristics for particular operative applications.
  • the lead-in cavity 78h in this case, is formed as an inverted cone 77 having its base at the proximal surface 71h and its apex in proximity to the distal surface 73h.
  • the lead-in cavity 70h has an area in radial cross section which decreases with progressive positions distally through the pad 35h.
  • the proximal regions near the base of the cone 87 form the instrument seal, while the distal regions at the apex of the cone form the zero seal.
  • the conical configuration of the lead-in cavity 70h also tends to funnel an instrument into the opening 45h leading distally to the apex of the cone 87.
  • the slit 45 and lead-in cavity 70 can be provided with many different individual and cooperative configurations.
  • the pad 35 is illustrated in the embodiment of Figure 21 and 22 wherein elements of structure similar to those previously described are designated by the same reference numeral followed by the lower case letter "j.”
  • the pad 35j with its proximal surface 71j and distal surface 73j is provided with a simple trapezoidal slit 45j.
  • the slit 45j extends between the proximal surface 71 j and the distal surface 73 j.
  • the slit 45j in this embodiment of Figure 21 is typical of many structures which will define the slit 45j with a planar configuration.
  • the portions of the pad 35j which form the slit will comprise opposing planar surfaces such as those designated by the reference numerals 90 and 92 in Figure 22.
  • the slit 45 need not be formed by opposing surfaces having a planar configuration. Nevertheless, these opposing surfaces need to be capable of coming into sealing contact with each other in order to establish the zero seal.
  • Other slit configurations capable of accomplishing this function may offer further advantages in particular procedures.
  • Other examples of slit configurations are illustrated merely by way of example in Figures 23-26.
  • the embodiment of Figure 23 is similar to that of Figure 22 in that the opening 45j comprises a single slit which extends from the proximal surface 71j to the distal surface 73j.
  • the axis 47j is disposed within the plane of the slit 45j.
  • the plane of the slit 45j does not include the axis 47j. Rather, the slit 45j is formed in a plane which has an angular relationship with the axis 47j, the proximal surface 71j, as well as the distal surface 73j. This construction enables the slit 45j to have a length greater than the thickness of the pad 35j.
  • elements of structure similar to those previously discussed are designated with the same reference numeral followed by the lower case letter "k.”
  • the opening 45k is configured as two slits 94 and 96 formed in individual planes that are angularly spaced with respect to each other.
  • planar slits 94 and 96 may be equally angularly spaced around the axis 47k.
  • the individual planar slits 94 and 96 intersect at the axis 47k.
  • the slits 94 and 96 may be axially spaced in order to facilitate formation of the instrument seal.
  • the opening 45m is defined as a slit 98 having a curved rather than planar configuration.
  • the curved slit 98 is formed as a spiral around the axis 47m. Along the axis 47m, the opposing surfaces forming the spiral slit 98 can "flow" into sealing proximity in order to produce the zero seal.
  • Figure 26 illustrates a similar embodiment including a spiral slit.
  • elements of structure similar to those previously discussed are designated by the same reference numeral followed by the lower case letter "n.”
  • the spiral slit 98n in this embodiment is also formed around the axis 47n of the pad 35n, but in this case the portions forming the slit 98n do not extend completely to the axis 47n.
  • an axial channel 100 is formed at least partially along the axis 47n.
  • This channel 100 can function in a manner similar to the lead-in cavity 70 discussed with reference to Figures 11-12.
  • This channel 100 can even be formed with a conical configuration similar to that discussed with reference to Figure 19.
  • a zero seal might be provided by positioning a septum valve across the channel 100.
  • a septum valve is designated with a reference numeral 101 and the other elements of structure similar to those previously discussed are designated with the same reference numerals followed by the lower case letter "p.”
  • the embodiment of Figure 27 includes the spiral slit 98p, the pad 35p, and the axis 47p.
  • This embodiment of Figure 27 is merely representative of many other embodiments that will combine a slit, such as the slit 98p, with other valve structures, such as the septum valve 101.
  • curved slit configurations would include embodiments wherein the slit is curved, sinusoidal, or S-shaped in a side elevation view. Such configurations provide a slit part having a length greater than the thickness of the pad. Normally, the more circuitous the slit path, the better the sealing characteristics.
  • the pad 35q is formed with a base 110 which is disposed circumferentially of a core 112.
  • the core 112 is formed of the superelastic material or gel and provided with the shape of the cone 87q as discussed with reference to Figures 19 and 20.
  • the base 110 is formed from a material that may not be elastic, but preferably is flexible.
  • the base 110 is formed of a urethane. In this construction, the base 110 is provided with a plurality of spokes
  • the core 112 extends from the axis 47q outwardly to the tips 118 of the spokes 114.
  • the core 112 has fingers 121 which extend beyond the tips 118 and toward the bases 116 between each adjacent pair of the spokes 114. These fingers 121 extend radially outwardly to an end surface 123 which stops short of the base 116 leaving a void 125 therebetween.
  • the voids 125 are of particular interest to this embodiment and can be incorporated into any of the embodiments previously discussed. Such voids 125 provide a space or absence of material into which the highly elastic material, such as that of the fingers 121, can expand during insertion of an instrument such as the arm 16 ( Figure 7). Since the gel material is almost fluid in its properties, the voids 125 permit expansion of the gel with very little resistance. Voids, such as the voids 125 in the embodiment of Figure 28, can be defined solely in the gel material or between the gel material and any other base material. In the case of Figure 28, the spokes 114 and fingers 121 are defined generally in planes which are parallel to the axis 47q.
  • Similar fingers illustrated in the embodiment of Figure 31 are defined generally in a plane which is perpendicular to the axis.
  • elements of structure similar to those previously disclosed are designated by the same reference numeral followed by the lower case letter "r.”
  • the pad 35r can be formed with a relatively large opening 45r having the configuration of a coaxial cylinder 130.
  • a plurality of fingers or flaps 132 extend into the opening 45r and tend to form a lead-in cavity 70r with properties such as those discussed with reference to Figure 19.
  • the annular flaps 132 have a conical configuration extending from a base 134 to an apex 136. It will be noted that the areas between the flaps 132, form voids 125r into which the flaps 132 can be displaced upon insertion of an instrument, such as the arm 16.
  • FIG. 32 A further embodiment of the invention is illustrated in Figure 32 where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter "s.”
  • This exploded view of the access device 34s includes not only the pad 35s but also a complimentary structure for maintaining the position of the pad 35s, for forming a seal between the pad 35s and the abdominal wall 21, and for dilating the incision 32 to a variable extent as required by the surgeon 14.
  • the access device 34s includes three components, a jell cap 143, base 145, and a retraction sheath 147.
  • the gel cap 143 includes not only the gel pad 35s, but also a circumferential cap ring 154 which can be inserted and molded to the pad 35s.
  • the resulting gel cap 143 forms a seal with the base 145, thereby defining the working channel 36s through the pad 35s, the cap ring 154, the base 145, and the retraction sheath 147.
  • this working channel 36s includes the single valve formed by the gel pad 35s which provides both a zero seal and an instrument seal for a wide range of instrument diameters.
  • the structure associated with the gel cap 143 is described in greater detail with reference to Figures 33 and 34.
  • this embodiment includes the gel pad 35s centrally disposed within the circumferential cap ring 154.
  • Holding tabs 156 can be provided to extend radially outwardly of the cap ring 154. These holding tabs 156 can facilitate the sealing engagement of the gel cap 143 with the base 145 in the manner described in greater detail below.
  • the gel pad 35s can be formed of any of the materials previously discussed although the preferred embodiment includes the KRATON/mineral oil gel.
  • the cap ring 154 for such an embodiment can be advantageously formed of KRATON only. This will make the cap ring 154 more rigid than the gel pad 35s while maintaining an excellent material interface between the pad 35s and the ring 154. In a typical manufacturing operation, the cap ring will be pre-disposed in the mold for the gel pad 35s with the unitary structure of the gel cap 143 resulting.
  • FIG. 34 The cross section view of Figure 34 shows the gel cap 143s and illustrates an annular void 158 formed on the inner circumference of the cap ring 154.
  • This void 158 is of particular advantage in forming a sealing relationship with the base 145 in the manner discussed in greater detail below.
  • the base 145 of this embodiment is shown in greater detail in the plan and cross section of views of Figures 34 and 35, respectively. From these views it will be noted that the base 145 can be provided with a smooth generally cylindrical inner surface 161 which extends proximally to a rounded end surface 163 and outwardly from the end surface 163 along an annular lip 165. A plurality of tabs 167 can be equally spaced to extend outwardly and distally around the circumference of the lip 165. Distally of the inner surface 163, an annular flange 170 can be provided with an annular projection 172 sized and configured to form the desired sealing relationship between the gel cap 143 and the base 145. The process of molding the base 145 can be facilitated by forming the base as two separate components divided, for example, by a dotted line 174 in Figure 35. In a preferred embodiment, the base 145 is molded from a polycarbonate material.
  • FIG. 37 A preferred embodiment of the retracting sheath 147 is illustrated in Figure 37.
  • the retraction sheath 147 includes a tubular wall 175 which has the configuration of the frustum of a cone 176 at its distal end and the configuration of a cylinder 177 at its proximal end.
  • a flexible retaining ring 152 terminates the distal end while a fold 154 is formed at the proximal end.
  • the tubular wall 175 is illustrated to include an outer surface 180 and an inner surface 181.
  • the sheath 147 is formed of an elastomer, such as neoprene, so its frustule conical and cylindrical configurations exist primarily in the natural unstretched state.
  • the sheath 147 As the sheath 147 is stretched axially, the diameter of the cylindrical proximal end increases thereby placing radial forces on the incision 32. The more the sheath 147 is stretched axially, the greater becomes the diameter of the sheath and consequently the larger becomes the opening through the incision 32.
  • This feature is of particular advantage as it permits the surgeon to define the size of the incision 32 with an appropriate degree of axial tension on the sheath 147. By maintaining this tension, the preferred size of the incision 132 is maintained throughout the operation.
  • the axial tension is maintained by stretching the sheath 147 over the tabs 167 ( Figure 34) of the base 145.
  • Indicia 182 can be printed on the sheath 147 to provide an indication of the relationship between the axial stretch of the sheath 147 and the size of the incision 32.
  • the fold 153 is provided to facilitate a grip on the proximal end of the sheath 147.
  • This fold 153 can also function to provide reinforcement where the walls of the sheath 147 engage the tabs 167 of the base 145.
  • additional folds 184, 186 are provided at spaced axial locations, such as those defined by the indicia 182 in Figure 37. With these folds 184 and 186, additional points of reinforcement are provided to engage the tabs 167 while providing the sheath 147 with predetermined degrees of axial stretch associated with different sizes of the incision 32.
  • the method of using the embodiment of Figure 32 is illustrated the progressive use of Figures 39-42.
  • a top plan view of the abdominal wall 21 of the patient 10 is illustrated with a template 195 positioned to facilitate location of the incision 32.
  • the size of the incision 32 can be determined with the indicia 182 on the template 195 showing, for example, multiple lengths of a line 197, each length being equated with a glove size for the surgeon's hand 17 ( Figure 7). Knowing his/her glove size, the surgeon will merely cut the incision in accordance with an appropriate length of the line 197. The longer lengths of the line 197 are associated with the larger incisions, the larger glove sizes and accordingly the larger hands 17.
  • the template 195 can be removed.
  • the retraction sheath 147 can then be mounted through the incision 32.
  • the ring 152 is compressed and fed through the incision 32.
  • the ring 152 is free to expand to its larger diameter, as shown by a dotted line 158 in Figure 40.
  • the portions of the wall 176 which define the cylinder 177 are left to extend proximally through the opening 32 as shown in Figure 40.
  • the base 145 Prior to or after inserting the sheath 147, the base 145 can be disposed around the incision 32. Then the exposed portions of the sheath 147 will extend through the incision 32 and within the circumferential base 145. As illustrated in Figure 41, the wall 176 of the sheath 147 can then be drawn proximally, outwardly of the page in Figure 41, to axially stretch the sheath 147. As noted, when the sheath 147 is axially stretched, it will create radial forces. on the abdominal wall 21 which will tend to enlarge the incision 32. The greater the axial stretch, the larger the incision 32.
  • the stretched sheath 147 can be drawn over the tabs 167 to maintain the axial stretch and the desired size for the incision 32.
  • the seal between the abdominal wall 21, the sheath 147, and the base 145 is fully established.
  • a final step remaining in this process is the attachment of the gel cap 143 to the base 145. This is accomplished as illustrated in Figure 36 by capturing the lip 172 of the base 145 in the annular void 158 of the gel cap 143. Bending the holding tabs 156 upwardly and outwardly facilitates this engagement which ultimately forms a seal between the base 145 and the gel cap 143.
  • FIG 43 A further embodiment of the present invention is illustrated in Figure 43 wherein elements of structure similar to those previously discussed are designated with the same reference numeral followed by the lower case letter "t."
  • the body cavity 18 and abdominal wall 21 are illustrated along with the access device 34t in the form of the pad 35t.
  • the retention ring 152t and retention sheath 147t are also illustrated in this embodiment.
  • a light source 200 is disposed exteriorly of the abdominal wall 21. From this position, the light source 200 provides a path of light which is directed onto the pad 35t.
  • Forming this access device 34t of a translucent material makes it possible for the device 34t to function as a window permitting the light to fully illuminate the abdominal cavity 18.
  • the translucent gel material of the access device 34t facilitates external illumination as well as a direct visualization of the abdominal cavity. Of course, transparent materials would even further facilitate this illumination and visualization.
  • Figure 44 and Figure 45 illustrate an access device 34t wherein the source of illumination 200 comprises multiple illumination devices that are embedded in the translucent material of the pad 35t.
  • the illumination devices associated with the present invention can be carried on or in the access device 34t, or spaced exteriorly from the access device 34t.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pathology (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Optics & Photonics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif d'accès (34) particulièrement adapté pour la chirurgie laparoscopique, facilitant le passage avec des instruments, tels que la main (17) du chirurgien (14), à travers une paroi corporelle (21), dans une cavité corporelle (18). Le dispositif peut être constitué d'un gel possédant des propriétés permettant de former un joint parfaitement étanche ou un joint d'étanchéité pour instrument pouvant s'adapter à divers diamètres d'instruments. Le gel peut être translucide pour faciliter l'éclairage et la visualisation du champ opératoire par le dispositif d'accès.
EP01981697A 2001-10-17 2001-10-17 Dispositif et procede d'eclairage laparoscopique Withdrawn EP1435831A1 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2001/032393 WO2003032819A1 (fr) 2001-10-17 2001-10-17 Dispositif et procede d'eclairage laparoscopique

Publications (1)

Publication Number Publication Date
EP1435831A1 true EP1435831A1 (fr) 2004-07-14

Family

ID=21742917

Family Applications (1)

Application Number Title Priority Date Filing Date
EP01981697A Withdrawn EP1435831A1 (fr) 2001-10-17 2001-10-17 Dispositif et procede d'eclairage laparoscopique

Country Status (4)

Country Link
EP (1) EP1435831A1 (fr)
JP (1) JP2005505371A (fr)
CA (1) CA2428847A1 (fr)
WO (1) WO2003032819A1 (fr)

Families Citing this family (35)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE60142978D1 (de) 2000-10-19 2010-10-14 Applied Med Resources Chirurgisches zugangsgerät und -verfahren
EP1416981B1 (fr) 2001-08-14 2013-07-24 Applied Medical Resources Corporation Appareil de fermeture hermetique d'un accès
US20050033246A1 (en) 2002-05-14 2005-02-10 Ahlberg Russell E. Surgical device with tack-free gel and method of manufacture
WO2003026512A1 (fr) 2001-09-24 2003-04-03 Applied Medical Resources Corporation Obturateur sans lame
US6958037B2 (en) 2001-10-20 2005-10-25 Applied Medical Resources Corporation Wound retraction apparatus and method
EP1503677B1 (fr) 2002-05-16 2011-05-04 Applied Medical Resources Corporation Obturateur pointe conique
EP1534201B1 (fr) 2002-06-05 2011-05-25 Applied Medical Resources Corporation Ecarteur
US20050020884A1 (en) 2003-02-25 2005-01-27 Hart Charles C. Surgical access system
WO2004075930A2 (fr) * 2003-02-25 2004-09-10 Applied Medical Resources Corporation Appareil et procede pour eclairer une cavite peritoneale pendant une intervention laparoscopique
US7163510B2 (en) 2003-09-17 2007-01-16 Applied Medical Resources Corporation Surgical instrument access device
EP2543329B1 (fr) 2003-10-03 2014-02-12 Applied Medical Resources Corporation Obturateur optique sans lame
EP3744271B1 (fr) 2004-06-29 2022-02-23 Applied Medical Resources Corporation Instrument chirurgical optique à insufflation
EP1948047B1 (fr) * 2005-10-14 2010-09-08 Applied Medical Resources Corporation Dispositifs chirurgicaux, systemes et procedes correspondants possedant des materiaux en gel, des couvertures en gel ou des lubrifiants en gel
US7909760B2 (en) 2005-10-14 2011-03-22 Applied Medical Resources Corporation Split hoop wound retractor with gel pad
EP2073717B1 (fr) 2006-10-06 2015-12-23 Applied Medical Resources Corporation Port d'insufflation visuel
US8109873B2 (en) 2007-05-11 2012-02-07 Applied Medical Resources Corporation Surgical retractor with gel pad
EP2237815B1 (fr) 2008-01-22 2020-08-19 Applied Medical Resources Corporation Dispositif d'accès d'instrument chirurgical
CA2714889C (fr) 2008-01-25 2016-05-03 Applied Medical Resources Corporation Systeme d'acces par gonflement
ES2748523T3 (es) 2008-09-29 2020-03-17 Applied Med Resources Sistema de trócar de primera entrada
EP2349032B1 (fr) 2008-10-13 2017-12-06 Applied Medical Resources Corporation Système d'accès à orifice unique
EP2467087B1 (fr) * 2009-08-21 2019-09-25 3M Innovative Properties Company Méthodes et produits permettant d'éclairer un tissu
JP6247003B2 (ja) 2009-08-31 2017-12-13 アプライド メディカル リソーシーズ コーポレイション 多機能手術用アクセスシステム
ES2743503T3 (es) 2010-10-01 2020-02-19 Applied Med Resources Sistema quirúrgico para orificio natural
US9289115B2 (en) 2010-10-01 2016-03-22 Applied Medical Resources Corporation Natural orifice surgery system
JP6066428B2 (ja) 2011-05-02 2017-01-25 アプライド メディカル リソーシーズ コーポレイション 低輪郭の外科用万能アクセスポート
WO2012154845A1 (fr) 2011-05-10 2012-11-15 Applied Medical Resources Corporation Écarteur de plaie
ES2768612T3 (es) 2013-03-15 2020-06-23 Applied Med Resources Dispositivo mecánico de gel para acceso quirúrgico
KR102444866B1 (ko) 2014-07-18 2022-09-19 어플라이드 메디컬 리소시스 코포레이션 영구적인 점착성-없는(tack free) 코팅을 갖는 겔 및 그의 제조 방법
ES2930777T3 (es) 2014-08-15 2022-12-21 Applied Med Resources Sistema de cirugía por orificios naturales
US9949730B2 (en) 2014-11-25 2018-04-24 Applied Medical Resources Corporation Circumferential wound retraction with support and guidance structures
EP3236865B1 (fr) * 2014-12-23 2021-01-27 Surgitent GmbH Dispositif de fourniture d'un espace limité stérile pour une chirurgie
WO2017048512A1 (fr) 2015-09-15 2017-03-23 Applied Medical Resources Corporation Système d'accès chirurgical robotisé
ES2951168T3 (es) 2015-10-07 2023-10-18 Applied Med Resources Retractor de heridas con anillo exterior multisegmento
AU2017324450B2 (en) 2016-09-12 2022-09-29 Applied Medical Resources Corporation Surgical robotic access system for irregularly shaped robotic actuators and associated robotic surgical instruments
IT201700036460A1 (it) * 2017-04-03 2018-10-03 Luca Petruzzelli Dispositivo retrattore/protettore di ferita

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5810721A (en) * 1996-03-04 1998-09-22 Heartport, Inc. Soft tissue retractor and method for providing surgical access
US5906577A (en) * 1997-04-30 1999-05-25 University Of Massachusetts Device, surgical access port, and method of retracting an incision into an opening and providing a channel through the incision
US5865729A (en) * 1997-10-10 1999-02-02 Olympus America, Inc. Apparatus for facilitating gynecological examinations and procedures
US6162172A (en) * 1998-01-30 2000-12-19 Edwards Lifesciences Corporation Methods and apparatus for retracting tissue

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO03032819A1 *

Also Published As

Publication number Publication date
JP2005505371A (ja) 2005-02-24
WO2003032819A1 (fr) 2003-04-24
CA2428847A1 (fr) 2003-04-24

Similar Documents

Publication Publication Date Title
US6939296B2 (en) Laparoscopic illumination apparatus and method
EP1326524B1 (fr) Appareil et procede d'acces chirurgical
EP1435831A1 (fr) Dispositif et procede d'eclairage laparoscopique
US7163510B2 (en) Surgical instrument access device

Legal Events

Date Code Title Description
PUAI Public reference made under article 153(3) epc to a published international application that has entered the european phase

Free format text: ORIGINAL CODE: 0009012

17P Request for examination filed

Effective date: 20030512

AK Designated contracting states

Kind code of ref document: A1

Designated state(s): AT BE CH CY DE DK ES FI FR GB GR IE IT LI LU MC NL PT SE TR

STAA Information on the status of an ep patent application or granted ep patent

Free format text: STATUS: THE APPLICATION HAS BEEN WITHDRAWN

18W Application withdrawn

Effective date: 20070629