EP2519162A1 - Port de dissection à élément extensible - Google Patents

Port de dissection à élément extensible

Info

Publication number
EP2519162A1
EP2519162A1 EP10798936A EP10798936A EP2519162A1 EP 2519162 A1 EP2519162 A1 EP 2519162A1 EP 10798936 A EP10798936 A EP 10798936A EP 10798936 A EP10798936 A EP 10798936A EP 2519162 A1 EP2519162 A1 EP 2519162A1
Authority
EP
European Patent Office
Prior art keywords
insert component
expandable member
patient
elongate member
lumen
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Withdrawn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
EP10798936A
Other languages
German (de)
English (en)
Inventor
David W. Robertson
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.)
Boston Scientific Scimed Inc
Original Assignee
Boston Scientific Scimed Inc
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 Boston Scientific Scimed Inc filed Critical Boston Scientific Scimed Inc
Publication of EP2519162A1 publication Critical patent/EP2519162A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets 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
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065—Functions of balloons
    • A61B2017/22067—Blocking; Occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320044—Blunt dissectors
    • A61B2017/320048—Balloon dissectors
    • 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

Definitions

  • Embodiments of the present invention generally relate to surgical tools. Specifically, the present invention relates to a device for use in medical applications, such as for introducing a working port with a dissection balloon or other expandable member into a patient's body. Embodiments of the present invention also cover methods of using such devices. Those skilled in the art will recognize the benefits of applying the present invention to similar fields not discussed herein.
  • open surgery for a therapeutic or diagnostic purpose, is an invasive medical procedure with significant attendant risks. Since the performance of open surgery typically requires relatively large incisions, relatively large amounts of blood may be lost, the risk of infection may increase, and the potential for post-operative hernias may be higher. Furthermore, relatively large incisions require extended recovery times to allow the incisions to heal.
  • Laparoscopic procedures are generally less invasive than open surgery.
  • Laparoscopic cholesystectomy (lap choly) is a laparoscopic procedure that involves incisions through the skin to access various body organs.
  • lap choly may involve access through a small incision in the skin and placement of a port into the peritoneal cavity to allow removal of an inflamed gall bladder.
  • a working instrument may be introduced into the body through the port.
  • the working instrument may be a flexible instrument, such as an endoscope, introduced into the body to further access the inside of the body.
  • a surgeon may use ports and working instruments to perform any desired therapeutic or diagnostic procedure at a work site inside the body.
  • a device to provide working access to a surgical site in a patient may include a port component including an elongate member configured to pass through an opening in the patient.
  • the elongate member may include a bore extending between a distal end and a proximal end of the elongate member.
  • the port component may also include an expandable member disposed on the elongate member.
  • the device may also include an insert component configured to be removably received inside the bore in the elongate member of the port component.
  • the insert component may include at least one lumen.
  • FIGs. 4 and 5 are perspective views of insert components of a dissection port, according to exemplary embodiments of the invention.
  • the elongate member 30 may include a distal end 32 and a proximal end 34, and may be rigid, malleable, or flexible.
  • the elongate member 30 may also include a cannula 36, a housing 38, and a hollow cavity or bore 40 extending through the cannula 36 and the housing 38.
  • the housing 38 may be disposed proximal to the cannula 36 and may include one or more valves or other devices that may be controlled by the surgeon or other user.
  • the bore 40 may extend longitudinally (axially) between the distal end 32 and the proximal end 34 of the elongate member 30. As shown in the embodiment of Fig. 3, the bore 40 may extend from an opening at a distal end of the cannula 36 to a port opening 42 in the housing 38 at the proximal end 34 of the elongate member 30. The insert component 80 may be inserted into the bore 40. [037] Although the elongate member 30 shown in Figs.
  • 2 and 3 includes a single bore 40 extending through the distal end 32 and proximal end 34 of the elongate member 30, one or more additional bores or lumens (not shown) extending through the distal end 32 and/or the proximal end 34 of the elongate member 30 may be included.
  • one or more of an aspiration lumen, an irrigation lumen, an illumination lumen, a viewing lumen, and a working lumen may run longitudinally through the elongate member 30.
  • the elongate member 30 may include one or more lumens extending longitudinally through the elongate member 30, and such lumen(s) may or may not extend through the distal end 32 and/or the proximal end 34 of the elongate member 30.
  • the elongate member 30 may include an inflation lumen 44 extending longitudinally through the elongate member 30, but not extending through the distal end 32 or the proximal end 34 of the elongate member 30.
  • the inflation lumen 44 is a cavity in the elongate member 30 through which a fluid, such as a liquid or gas, may pass to expand (inflate) and contract or collapse (deflate) the expandable member 60.
  • the inflation fluid may be air, water, carbon dioxide, or saline solution.
  • the inflation lumen 44 may be fluidly connected at one end to a first valve 46 disposed on the housing 38 and at an opposite end to the expandable member 60.
  • the inflation lumen 44 may extend through the housing 38 and the cannula 36 of the elongate member 30.
  • the inflation lumen 44 may extend through the cannula 36 only, and the first valve 46 may be disposed on the cannula 36.
  • the first valve 46 may permit fluid to enter the inflation lumen 44 and may prevent fluid from exiting from inside the inflation lumen 44.
  • the first valve 46 may also allow the surgeon to vent fluid from inside the inflation lumen 44 and the expandable member 60.
  • a source of the inflation fluid such as a pump or syringe, may be connected to the first valve 46 to direct inflation fluid into the inflation lumen 44 and the expandable member 60.
  • the source of the inflation fluid may be disconnected from the first valve 46, and then the first valve 46 may prevent the inflation fluid from exiting the inflation lumen 44 and the expandable member 60.
  • the surgeon may also control the first valve 46 to release or vent inflation fluid from the inflation lumen 44 and the expandable member 60.
  • the phrase “expandable member” is used in a broad sense to denote any expandable structure, such as a balloon or other inflatable structure, regardless of the elasticity of the material comprising the structure.
  • the phrase “expandable member” may denote a thin-walled structure made of material of low elasticity (which does not stretch significantly during inflation) or highly elastic material (which does stretch significantly during inflation).
  • the expandable member 60 may be made from polyethylene terephthalate (PET), polyurethanes, polyethylenes and ionomers, copolyesters, rubbers, polyamides, silicone, latex, or any other suitable materials known in the art.
  • PET polyethylene terephthalate
  • the expandable member 60 may be mechanically, electrically, pneumatically or hydraulically expanded and collapsed without departing from the scope of the invention.
  • Fig. 2 shows an exemplary embodiment of the expandable member 60 in an expanded configuration
  • Fig. 3 shows the expandable member 60 in a collapsed configuration.
  • the particular expanded exterior configuration of the expandable member 60 such as the volume, width, depth, radius, length, or other dimension, may be selected depending on the particular circumstances of use.
  • the expandable member 60 in its expanded configuration may be toroidal or doughnut-shaped.
  • the expandable member 60 may be spherical or cylindrical (e.g., extending farther along the length of the cannula 36). As shown in Figs. 1-3 and 9- 13, the expandable member 60 may include a hole through the center, through which the cannula 36 passes through and is attached, and the outer profile of the expandable member 60 may be circular (Figs. 1-3 and 9-12), oval, elliptical, teardrop-shaped, triangular (Fig. 13), square, etc.
  • the housing 38 may include a second valve 48 fluidly connected to the bore 40 extending through the housing 38 of the elongate member 30, as shown in Figs. 2 and 3.
  • the second valve 48 may be fluidly connected to one or more lumens 88 in the insert component 80 instead of, or in addition to, being fluidly connected to the bore 40.
  • the second valve 48 may be disposed on the cannula 36.
  • the second valve 48 may permit fluid to enter the bore 40 or the lumen(s) 88 in the insert component 80, and may prevent fluid from exiting the bore 40 or the lumen(s) 88.
  • the second valve 48 may also allow the surgeon to vent fluid from inside the bore 40 or the lumen(s) 88.
  • insufflation fluid may be directed through the second valve 48, and through the bore 40 or the lumen(s) 88 in the insert component 80 placed in the bore 40.
  • the insufflation fluid may be supplied to the working space WS (Figs. 17 and 18), for example, to maintain or further extend the separation between tissue layers after dissecting the tissue layers.
  • the insufflation fluid may be a liquid or gas, such as air, water, carbon dioxide, or saline solution.
  • a source of the insufflation fluid such as a pump or syringe, may be connected to the second valve 48 to direct the insufflation fluid into the bore 40 or the lumen(s) 88 in the insert component 80, which directs the insufflation fluid through a respective opening of the bore 40 or the lumen(s) 88 at the distal end 32 of the elongate member 30.
  • the source of the insufflation fluid may be disconnected from the second valve 48.
  • the second valve 48 may prevent the insufflation fluid from exiting the bore 40, the lumen(s) 88 in the insert component 80, and/or the working space WS. Also, after removing the source of the insufflation fluid, the surgeon may control the second valve 48 to release or vent insufflation fluid from the bore 40, the lumen(s) 88 in the insert component 80, and/or the working space WS.
  • the housing 38 may also include a third valve or seal 50 located at or near the port opening 42, and fluidly connected to the bore 40.
  • the third valve 50 may be disposed in the cannula 36. The third valve 50 may permit fluid to enter the bore 40 and may prevent fluid from exiting the bore 40.
  • the housing 38 may also include a button 52 or other user-controlled device connected to the third valve 50.
  • the surgeon may push the button 52 to open the third valve 50 so that the insert component 80 may be inserted into the bore 40.
  • the third valve 50 may close, thereby preventing fluids or other substances from exiting the bore 40.
  • Each of the first valve 46, the second valve 48, and the third valve 50 may be any type of suitable valve known to those skilled in the art for controlling the flow of fluid therethrough, such as a flexible diaphragm, membrane, septum, elastomeric seal, or other flow control device.
  • Figs. 2 and 3 show that the housing 38 is provided proximally to the cannula 36 so that respective bores extending through the cannula 36 and the housing 38 align to form the bore 40 extending through the elongate member 30.
  • the cannula 36 may extend longitudinally between the distal end 32 and the proximal end 34 of the elongate member 30, and the housing 38 may surround a portion of the cannula 36 near a proximal end of the cannula 36.
  • the second valve 48 may extend through the cannula 36 to allow fluid to enter the bore 40 or the lumen(s) 88 in the insert component 80, e.g., through a hole in a wall of the insert component 80.
  • Additional space for fluid flow between the bore 40 and the insert component 80 may be provided, e.g., by at least one longitudinal or spiral groove 89 on an outer surface of the insert component 80 or using one or more spacers on an inner surface of the bore 40.
  • Fig. 4 shows an exemplary embodiment of the insert component 80 that includes the groove 89 that is capable of receiving fluid from the second valve 48 when the insert component 80 is placed inside the bore 40 in the elongate member 30 and that extends to the distal end 82 of the insert component 80.
  • the groove 89 may be omitted from the insert component 80 shown in Fig. 4.
  • the port opening 42 may be provided at the proximal end of the cannula 36 (instead of the housing 38), and the third valve 50 may be provided at the port opening 42 in the cannula 36.
  • Figs. 4, 5, 6a, 6b, 7, and 8 depict the insert component 80, according to various exemplary embodiments.
  • the insert component 80 is configured to be slidably inserted into the bore 40 in the elongate member 30, and may be rigid, malleable, or flexible.
  • both the elongate member 30 and the insert component 80 may be malleable and/or flexible so that when the insert component 80 is inserted into the elongate member 30, the elongate member 30 and the insert component 80 may be bent or shaped, e.g., to follow a curving path in the patient's body, to direct or steer the distal ends 32, 82 of the elongate member 30 and the insert component 80, etc.
  • the insert component 80 may include zero lumens.
  • the insert component 80 may include a blunt and/or rounded tip at the distal end 82 of the insert component 80 (e.g., an obturator).
  • the rounded tip may be used to separate tissue layers when the distal end 32 of the elongated member 30 is inserted into the patient, as described below and shown in Fig. 15.
  • the insert component 80 may include at least one partial lumen, such as a lumen that does not extend through the distal face of the insert component 80.
  • the partial lumen may extend towards a window or other opening near the distal end, e.g., on a circumferential surface or other outer surface of the insert component 80, and an optical device, e.g., a rigid optical device as described below, may be inserted into the partial lumen and positioned near the window.
  • an optical device e.g., a rigid optical device as described below
  • the insert component 80 may include an attached or removable seal 87 (Figs. 9 and 10) disposed on the proximal end 84 of the insert component 80.
  • Each lumen 88 may include a separate seal 87.
  • the seal 87 may permit fluid to enter the lumen(s) 88 in the insert component 80 and may prevent fluid from exiting the lumen(s) 88 through the proximal end 84 of the insert component 80 with or without a suitable working instrument 90 (Figs. 9-13) passed through the lumen 88.
  • the seal 87 may be any type of suitable seal known to those skilled in the art for sealing fluid therethrough, such as a flexible diaphragm, membrane, septum, elastomeric seal, or other flow control device.
  • An optical device (such as the optical device 94 shown in Figs. 9-13) or other sensor device may be embedded into the insert component 80 at or near the distal end 82 of the insert component 80, e.g., mounted on the distal face.
  • the optical device may include an illumination component, and a camera, lens, digital imaging chip, or other image receiving device, which may transmit (e.g., wirelessly, or using wires or fiber optics embedded along the length of the insert component 80) an image or other signal to a signal processing device, a recorder, or a monitor or other display device viewable by the surgeon.
  • the sensor device may monitor and transmit other characteristics, such as temperature, pressure, pH, etc.
  • the dissection port 10 may be provided with a plurality of
  • Fig. 9 shows exemplary working instruments 90 inserted into the lumens 88 in the insert component 80, which is configured to be inserted into the port component 20.
  • Figs. 10-13 show exemplary working instruments 90 inserted into the lumens 88 in the insert component 80, which is inserted into the port component 20.
  • the insert component 80 includes two lumens 88, and one working instrument 90 is inserted into one lumen 88 while two working instruments 90 are inserted into the other lumen 88.
  • the insert component 80 includes three lumens 88, and one working instrument 90 is inserted into each of the three lumens 88.
  • each working instrument 90 may move longitudinally (e.g., in the distal and proximal directions, axially), laterally (e.g., side to side), and/or rotationally with respect to the dissection port 10.
  • Fig. 12 shows the dissection port 10 with the working instruments 90 retracted longitudinally into the insert component 80.
  • the working instruments 90 may be flexible, rigid, bent, straight, steerable, etc., and may include one or more lumens for additional working instruments, fluids, etc., to pass into the working space.
  • Each working instrument 90 may include an end effector 92 at a distal end of the working instrument 90.
  • the end effector 92 may include, but is not limited to, a cutting device (e.g., scissors, forceps, tissue cutter, etc.), a fixation device, a manipulation device, a dissection device, a support device, a sealing device, a closure device (e.g., clips, staples, loops, ligator, suturing device, etc.), a retrieval device (e.g., snare, basket, loop, a fluid extraction device, etc.), a tissue exploration device (e.g., the optical device 94, etc.), a tissue sampling device, a delivery device, a device for aiding in the patency of a lumen or for dilating an opening (e.g., a balloon or other expandable member, patency brush, stent, fan retractor, wire structure, etc.), a grasping device, an active device such as a radiofrequency (RF
  • the working instrument 90 may include control wires or other devices connected to the end effector 92 to allow the surgeon to control the movement of the end effector 92.
  • the end effector 92 may include an articulating portion 96, that provides a longitudinal, lateral, and/or rotational articulation, or manipulation of the end effector 92.
  • the end effector 92 may deliver a mesh layer or other substance to the working space, and control wires may be provided to control the movement, fixation, and release of the mesh layer or other substance into the patient using the articulation portion 96.
  • working instruments 90 and end effectors 92 may be any type of suitable working instruments and end effectors known to those skilled in the art.
  • the working instrument 90 may not include an end effector.
  • the working instrument 90 may include a blunt and/or rounded tip for exploration and/or for assisting another working instrument or end effector (e.g., an obturator).
  • the working instrument 90 may include an open distal end for the delivery of a treatment fluid or solid and/or for collection of a bodily fluid or tissue sample.
  • Figs. 14-18 depict a method to provide surgical access to a site within a patient using the dissection port 10, according to an embodiment of the invention.
  • the method is described in the context of placing an access port through the abdominal wall by separating the tissue layers with balloon dissection to perform a surgical procedure inside the abdominal wall. Variations on the described embodiment (and in the apparatus employed to perform it) are useful for performing other medical procedures throughout the body.
  • an incision e.g., about 5-20 mm long, is made in the epithelium of an abdominal wall AW. Additional blunt or sharp dissection forms an opening OP.
  • the opening OP is made after passing the dissection port 10 through a natural orifice, e.g., mouth, anus, nose, urethra, vagina, etc., and making an incision in a lumenial wall.
  • the expandable member 60 is in the collapsed configuration.
  • the distal end 32 of the elongated member 30 of the port component 20 is inserted into the opening OP to bring the distal end 32 of the elongated member 30 in the port component 20 into contact with the
  • the bore 40 in the elongated member 30 may be empty (without the insert component 80 inserted into the bore 40), or the insert component 80 may be placed in the bore 40.
  • the expandable member 60 is in the collapsed configuration.
  • the insert component 80 with a blunt and/or rounded tip (an obturator) with or without optical imaging components may be inserted into the bore 40 in the elongated member 30, and the blunt and/or rounded tip of the insert component 80 may be brought into contact with the peritoneum P.
  • the obturator may include zero lumens.
  • the insert component 80 with one or more lumens 88 may be replaced and/or inserted into the bore 40 in the elongated member 30, and the working instrument 90 with a blunt and/or rounded tip (the obturator described above) may be inserted into one of the lumens 88 in the insert component 80.
  • the blunt and/or rounded tip of the insert component 80 or the working instrument 90 may be brought into contact with the peritoneum P.
  • Additional pressure may be exerted on the proximal end 34 of the elongated member 30, the proximal end 84 of the insert component 80 with the blunt and/or rounded tip, and/or the proximal end of the working instrument 90 with the blunt and/or rounded tip, which presses against the peritoneum P, thereby detaching the part of the peritoneum in the immediate vicinity of the opening OP.
  • the obturator may also include the optical device 94 embedded into or on the distal end of the obturator.
  • the obturator may also be removed and replaced by the insert component 80 with the optical device 94 at or near its distal end 82, or the working instrument 90 with the optical device 94 at or near its distal end.
  • the obturator is provided as a working instrument 90 in one of the lumens 88 in the insert component 80
  • another working instrument 90 with the optical device 94 may be provided in another lumen 88 in the insert component 80.
  • the optical device 94 enables viewing of the space between the dissected tissue layers as the layers are separated.
  • the expandable member 60 may be at least partially expanded and at least partially collapsed a number of times to progressively separate the tissue layers. Also, the surgeon may use the optical device 94 described above to observe the dissection of the tissue layers and may decide whether and how much to expand and/or collapse the expandable member 60 based on the observations. The surgeon may also observe the dissection of the tissue to determine where to reposition the expandable member 60. The surgeon may also use tactile feedback from expanding, collapsing, and/or moving the expandable member 60 to determine whether and how much to expand and/or collapse the expandable member 60.
  • the new plane of dissection may be located between tissue layers that are different from the tissue layers previously separated by the expansion of the expandable member 60.
  • the new plane of dissection may be initiated by at least partially collapsing the expandable member 60, pulling or pushing the port component 20 in a new direction, and expanding the expandable member 60.
  • the new plane of dissection may be initiated by using a deflectable portion of a working instrument 90, e.g., with at least one of a blunt tip, an end effector 92 such as a grasper, or an expandable member on the working instrument 90.
  • the insert component 80 and the working instruments 90 to be inserted may be selected based on the intended use for the working instruments 90 and the tasks to be completed.
  • the expandable member 60 when the expandable member 60 is inflated, the expandable member 60 forms a seal to limit the escape of fluids, such as insufflation fluid and body fluids, from the working space WS within the patient by providing a substantially fluid-tight seal of the tunnel T with the tissue contacting an outer circumference of the expandable member 60.
  • the seal may be used to block flow of any type of fluid, such as the insufflation fluid, water, saline, body fluids (e.g., gastric fluids, colonic fluids, blood, etc.), etc.
  • FIGs. 19-22 depict possible movement of the port component 20 and the expandable member 60 while the expandable member 60 maintains a seal inside the patient, as described above and shown in Figs. 17 and 18.
  • the port component 20 may be moved longitudinally (as indicated by the arrows).
  • Fig. 20 shows the expandable member 60 maintaining the seal inside the patient and the shape of the expandable member 60 when the port component 20 is moved longitudinally.
  • FIG. 21 shows the expandable member 60 maintaining the seal inside the patient and the shape of the expandable member 60 when the port component 20 is moved laterally (as indicated by the arrows, with the elongate member 30 in a first position shown in dashed lines and in a second position shown in solid lines).
  • Fig. 22 shows the expandable member 60 maintaining the seal inside the patient and the shape of the expandable member 60 when the port component 20 is moved angularly (as indicated by the arrows, with the elongate member 30 in a first position shown in dashed lines and in a second position shown in solid lines).
  • the expandable member 60 may serve as a seal while allowing the port component 20 to move longitudinally, laterally, angularly, and/or rotationally.
  • the port component 20 may include more than one expandable member 60, e.g., of different shapes or sizes.
  • another expandable member 60 may be positioned on the cannula 36 proximal to the expandable member 60 shown in Figs. 1-3 and 9-13.
  • the expandable members 60 may be connected to the same inflation lumen 44 or to separate inflation lumens 44. If individually controlled, the expandable members 60 may be expanded and collapsed by the surgeon, e.g., sequentially, alternately, simultaneously, etc., to progressively dissect the tissue layers in the patient and/or to provide support for retracting tissue.
  • the insert component 80 may be replaced with a different insert component 80, e.g., to provide a different configuration of lumens 88 based on the intended tasks to be performed and the working instruments 90 to be used, and/or the working instruments 90 may be replaced with different working instruments 90.
  • the expandable member 60, insert component 80, and/or working instrument 90 may be used to retract, move, or push/pull against tissue or body organs inside the patient with or without insufflating the working space WS.
  • the expandable member 60 in its expanded configuration, when positioned between two dissected tissue layers, may not only anchor the cannula 36 and the port component 20 to the patient but may also retract the dissected tissue layers by a desired amount.
  • a device to provide working access to a surgical site in a patient may include a port component including an elongate member configured to pass through an opening in the patient.
  • the elongate member may include a bore extending between a distal end and a proximal end of the elongate member.
  • the port component may also include an expandable member disposed on the elongate member.
  • the device may also include an insert component configured to be removably received inside the bore in the elongate member of the port component.
  • the insert component may include at least one lumen.
  • the opening in the patient may be through a natural orifice.
  • the opening in the patient may be one of a mouth, anus, nose, urethra, umbilicus, and vagina of the patient.
  • the expandable member may be configured to expand in at least one of a radial, lateral, or longitudinal direction with respect to a longitudinal axis of the elongate member and a longitudinal axis of the insert component.
  • the second valve and at least one of the bore and the lumen in the insert component may be configured to receive an insufflation fluid and direct the insufflation fluid into a working space between tissue layers in the patient.
  • the lumen in the insert component may be configured to removably receive a working instrument configured to extend through the respective lumen and exit through a distal end of the lumen.
  • the working instrument may be a first working instrument, and the first working instrument may include a lumen configured to removably receive a second working instrument.
  • only one expandable member is disposed on the elongate member.
  • the device may further include an optical device disposed on, in, or through the insert component near a distal end of the insert component.
  • the expandable member may be toroidal when expanded and may have an outer profile that is circular, oval, elliptical, teardrop-shaped, triangular, or square.
  • the expandable member may have an axis that is parallel to a longitudinal axis of the elongate member and a longitudinal axis of the insert component.
  • At least one of the elongate member or the insert component may be flexible or malleable.
  • a method to provide working port access to a surgical site in a patient may include advancing an expandable member in a collapsed configuration and an elongate member through an opening in the patient.
  • the expandable member may be disposed on the elongate member.
  • the method may also include expanding the expandable member to an expanded configuration to separate tissue layers in the patient and inserting a removable insert component including at least one lumen into a bore in the elongate member.
  • the method may further include positioning the expandable member in the expanded configuration to form a seal between the expandable member and tissue of the patient.
  • the method may further include directing insufflation fluid through at least one of lumen in the insert component and the bore in the elongate member so that the insufflation fluid forms a working space in the patient when the expandable member forms the seal between the expandable member and the tissue of the patient.
  • the expandable member in the expanded configuration may be positioned to form the seal after expanding the expandable member and without removing the expandable member from inside the patient.
  • the seal may be formed between a circumference of the expandable member and the tissue of the patient.
  • the method may further include repositioning the elongate member while maintaining the seal between the expandable member and tissue of the patient.
  • the opening in the patient may be through a natural orifice.
  • the opening in the patient may be one of a mouth, anus, nose, urethra, umbilicus, and vagina of the patient.
  • the method may further include making an incision in epithelium of the patient, and the incision may be the opening in the patient through which the elongate member is advanced.
  • the elongate member may include only one bore extending through a distal end of the elongate member.
  • the method may further include inserting an obturator into the elongate member, and using the obturator and the expandable member in the expanded configuration to separate the tissue layers in the patient.
  • the obturator may include a rounded tip on a distal end of the obturator positioned distal to the expandable member, and the rounded tip of the obturator may assist in separating the tissues layers in the patient.
  • the method may further include removing the obturator from the elongate member before inserting the insert component into the bore in the elongate member.
  • the insert component may include a plurality of lumens extending between a distal end of the elongate member and a proximal end of the elongate member.
  • the method may further include inserting a working instrument into the lumen in the insert component, and the working instrument may include an end effector at a distal end of the working instrument.
  • the expandable member on the elongate member may be a first expandable member
  • the working instrument may include a second expandable member disposed on the working instrument.
  • the method described above may further include positioning the first expandable member in the expanded configuration to form a seal between the first expandable member and tissue of the patient, and advancing the second expandable member distal to the first expandable member and expanding the second expandable member while the first expandable member forms the seal.
  • the second expandable member may form a seal with tissue contacting the second expandable member.
  • the second expandable member may be expanded to separate tissue layers in the patient.
  • the method may further include selecting the insert component to place into the bore of the elongate member based on the configuration of at least one lumen in the insert component.
  • the method may further include observing the separating of the tissue layers.
  • the method may further include inserting a working instrument including an optical device for observing the separating of the tissue layers into at least one lumen in the insert component.
  • the image signal may be transmitted to a user wirelessly or with a wire embedded into the insert component.
  • expanding the expandable member to the expanded configuration may create a first plane of dissection, and the method described above may further include inserting an insert component and/or a working instrument into the lumen in the insert component and positioning the working instrument to initiate a second plane of dissection.
  • the method may further include observing the working space in the patient.
  • the method may further include inserting at least one working instrument into at least one lumen in at least one of the first and second insert components.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Des modes de réalisation de l'invention comprennent un dispositif pour permettre un accès opérationnel à un site chirurgical chez un patient. Le dispositif peut comprendre un composant de port comprenant un élément allongé configuré pour traverser une ouverture dans le patient. L'élément allongé peut comprendre un orifice s'étendant entre une extrémité distale et une extrémité proximale de l'élément allongé. Le composant de port peut comprendre en outre un élément extensible sur l'élément allongé qui peut effectuer une dissection et peut former un joint d'étanchéité pour maintenir une pression d'insufflation dans un espace de travail. Le dispositif peut comprendre en outre un composant d'insert configuré pour être reçu de manière amovible à l'intérieur de l'élément allongé du composant de port. Le composant d'insert peut comprendre au moins une lumière qui peut recevoir de manière amovible au moins un instrument de travail.
EP10798936A 2009-12-29 2010-12-23 Port de dissection à élément extensible Withdrawn EP2519162A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US29080909P 2009-12-29 2009-12-29
PCT/US2010/062025 WO2011082108A1 (fr) 2009-12-29 2010-12-23 Port de dissection à élément extensible

Publications (1)

Publication Number Publication Date
EP2519162A1 true EP2519162A1 (fr) 2012-11-07

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Application Number Title Priority Date Filing Date
EP10798936A Withdrawn EP2519162A1 (fr) 2009-12-29 2010-12-23 Port de dissection à élément extensible

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EP (1) EP2519162A1 (fr)
WO (1) WO2011082108A1 (fr)

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6352503B1 (en) * 1998-07-17 2002-03-05 Olympus Optical Co., Ltd. Endoscopic surgery apparatus

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5632761A (en) * 1991-05-29 1997-05-27 Origin Medsystems, Inc. Inflatable devices for separating layers of tissue, and methods of using
US5354302A (en) * 1992-11-06 1994-10-11 Ko Sung Tao Medical device and method for facilitating intra-tissue visual observation and manipulation of distensible tissues
US5681342A (en) * 1995-08-17 1997-10-28 Benchetrit; Salomon Device and method for laparoscopic inguinal hernia repair
US6527753B2 (en) * 2000-02-29 2003-03-04 Olympus Optical Co., Ltd. Endoscopic treatment system
DE60327864D1 (de) * 2002-10-04 2009-07-16 Tyco Healthcare Ballondissektor mit kanüle
US20050251091A1 (en) * 2004-05-10 2005-11-10 Usgi Medical Inc. Apparatus and methods for transgastric tissue manipulation

Patent Citations (1)

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Publication number Priority date Publication date Assignee Title
US6352503B1 (en) * 1998-07-17 2002-03-05 Olympus Optical Co., Ltd. Endoscopic surgery apparatus

Non-Patent Citations (1)

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Title
See also references of WO2011082108A1 *

Also Published As

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WO2011082108A1 (fr) 2011-07-07

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