EP2953557A1 - Trocart - Google Patents

Trocart

Info

Publication number
EP2953557A1
EP2953557A1 EP14703842.6A EP14703842A EP2953557A1 EP 2953557 A1 EP2953557 A1 EP 2953557A1 EP 14703842 A EP14703842 A EP 14703842A EP 2953557 A1 EP2953557 A1 EP 2953557A1
Authority
EP
European Patent Office
Prior art keywords
trocar
sleeve
end portion
distal
gas guide
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Withdrawn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
EP14703842.6A
Other languages
German (de)
English (en)
Inventor
Horst Pajunk
Heinrich Pajunk
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.)
Pajunk GmbH Medizintechnologie
Original Assignee
Pajunk GmbH Medizintechnologie
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 Pajunk GmbH Medizintechnologie filed Critical Pajunk GmbH Medizintechnologie
Publication of EP2953557A1 publication Critical patent/EP2953557A1/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Withdrawn legal-status Critical Current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
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3474—Insufflating needles, e.g. Veress needles
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00902—Material properties transparent or translucent
    • A61B2017/00907—Material properties transparent or translucent for light
    • 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
    • A61B2017/3454—Details of tips
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation

Definitions

  • Trocar The invention relates to a trocar according to the preamble of patent claim 1.
  • Trocars are used in medicine, especially in mininmal-invasive surgery to access the body of a patient z. B. in the abdominal space of the patient to create.
  • the trocar consists of a trocar sleeve and a trocar dome axially insertable into this trocar sleeve.
  • the trocar is also called an obturator.
  • the trocar horn alone is referred to as a trocar.
  • a valve device is arranged at the proximal end of the trocar sleeve. This serves for the airtight sealing of the trocar dart inserted into the trocar sleeve or instruments inserted through the trocar sleeve and the like. Furthermore, the valve device is used for airtight sealing of the trocar sleeve when no trocar, no instrument or optics is used. If the trocar is inserted into the trocar sleeve, the distal end of the trocar mandrel projects distally out of the trocar sleeve. This distal end of the trocar is formed as a tapered tip, which serves to penetrate and / or dilate the body tissue during insertion of the trocar.
  • the trocar has a hollow shaft and at least the tapering distal tip is transparent. rent, transparent or at least translucent.
  • an endoscope optics can be introduced, by means of which through the transparent tip through the outside at the tip adjacent tissue and thus the penetration of the trocar tip can be observed.
  • the trocar sleeve has an insufflation connection at its proximal end. If the trocar sleeve is inserted into the abdominal wall and the trocar is pulled out of the trocar sleeve, the insufflation connection and the trocar sleeve can be used
  • Gas can be introduced into the abdomen to lift the abdominal wall and expand the intracorporeal surgical field. Since in this case the insufflation can only take place when the trocar has been inserted at least so far that the distal end of the trocar sleeve is pushed completely through the abdominal wall, a residual risk of injury to organs adhering to the abdominal wall remains even when using an optical trocar vessels. It is therefore preferably carried out before the first puncture of a trocar insufflation of the abdominal cavity by means of a so-called Veress needle.
  • a trocar of the type mentioned is known, which also allows the first puncture of the trocar insufflation through the trocar, even before the distal end of the trocar sleeve has completely penetrated the abdominal wall.
  • the hollow shaft of the trocar dart wall bores and in the distal tapered tip of the trocar dome gas outlet openings are provided. Gas is introduced into the annulus between the outer wall of the trocar and the inner wall of the trocar via the proximal insufflation port. This gas enters the interior of the hollow shaft through the wall bores, and may travel along the perimeter of the endoscope optic to the distal tip of the endoscope Trocar horns flow where it can escape via the outlet openings.
  • the tip of the trocar spike is stung through the abdominal wall under view of the endoscope optics.
  • a first insufflation can be carried out via this gas outlet opening, by which the abdominal wall is distanced from internal organs, so that the trocar can be inserted further with minimal risk until the trocar Karhülse reaches her position.
  • the invention has for its object to provide a trocar of the type mentioned, which has a simpler structure. This object is achieved by a trocar having the features of claim 1.
  • the trocar according to the invention enables insufflation during the first puncture as soon as the distal tip of the trocar puncture penetrates the abdominal wall and enters the abdominal space.
  • gas is introduced into the trocar sleeve via the proximal insufflation connection.
  • the gas flows in the annulus between the outer wall of the trocar and the inner wall of the trocar sleeve to the distal end of the trocar sleeve.
  • the gas can escape through at least one gas guide channel, which extends in the mantle of a distal cylindrical end portion of the trocar dart in the longitudinal direction. This at least one gas guide channel thus undermines the otherwise tightly against this cylindrical end portion adjacent the distal end of the trocar sleeve.
  • gas can be insufflated into the abdominal cavity via the gas guide channels before the trocar completely penetrates into the abdominal cavity.
  • the at least one gas guide channel must extend in the axial direction at least over the length over which abuts the distal end of the trocar sleeve at the cylindrical end portion of the trocar used.
  • the at least one gas guide channel preferably additionally extends further distally downward beyond this cylindrical end section into the tip that tapers distally.
  • the at least one gas guide channel is formed as a gas guide groove, which extends in the outer circumferential surface of the distal end portion.
  • the gas guide groove is formed as an outwardly open recessed groove in the outer circumferential surface.
  • This design offers the advantage of ease of manufacture.
  • the at least one gas guide channel is formed as a tube extending within the wall of the shell of the distal end portion. The tube is closed at its entire circumference and has only at their ends on an inlet or outlet opening.
  • the tubular design of the gas guide channel has the advantage that the cross section of the gas guide channel can not be added. However, a larger wall thickness of the jacket is required. lent and the production of the tubular gas ducts is more expensive.
  • the distal tip which tapers in the distal direction, has essentially the shape of a cone, which has two flattened areas of the conical surface which are mirror-symmetrical to the axial center plane.
  • This shape of the tip facilitates the penetration of the tissue.
  • these gas guide grooves are preferably arranged in the flats. Upon penetration of the tip into the body tissue, the tissue is at these flats with a lower pressure than at the conical sheath areas of the tip. There is therefore less tendency for the tissue to penetrate and block the recessed gas guide grooves.
  • an endoscope optic In optical trocars, an endoscope optic is often used, the distal end face of which is chamfered against the central axis of the endoscope optic or of the trocar dart.
  • so-called 30 ° optics are customary, in which the distal end face is inclined at an angle of 30 ° to the central axis.
  • This optimal alignment is preferably inevitably effected by the distalmost edge region of the distal end surface engaging in this conical peripheral region of the tip, since there is a circular arc-shaped free circumferential angle for the insertion of the endoscope optics available. If the endoscope optics is inserted into the trocar, it aligns itself inevitably or possibly by slight rotational movements in the optimal angular position.
  • FIG. 1 is a perspective view of this trocar
  • FIG. 4 is a perspective view of the trocar sleeve
  • FIG. 5 is an axial section through the trocar sleeve
  • FIG. 6 is a perspective view of the trocar mandrel
  • FIG. 7 is a side elevation view of the trocar mandrel, partially in axial section
  • FIG. 4 is a perspective view of the trocar sleeve
  • FIG. 5 is an axial section through the trocar sleeve
  • FIG. 6 is a perspective view of the trocar mandrel
  • FIG. 7 is a side elevation view of the trocar mandrel, partially in axial section
  • FIG. 9 shows an axial top view of the distal end part
  • FIG. 10 shows an axial section of the distal end part according to the section line A-A in FIG. 9, FIG.
  • FIG. 11 shows an axial section of the distal end part according to the section line BB in FIG. 9,
  • FIG. 12 shows an axial partial section of the distal end of FIG
  • FIG. 13 is a side view of the trocar with inserted endoscope optics
  • FIG. 14 shows the distal end of the trocar with the inserted endoscope optic in a perspective view
  • FIGS. 1 and 2 show a trocar according to the invention, which has a trocar sleeve 10 into which a trocar 30 can be inserted axially.
  • the trocar sleeve 10 is shown in detail in FIGS. 4 and 5, while the trocar mandrel 30 is shown and explained in detail in FIGS. 6 to 11.
  • the trocar sleeve 10 consists of a sleeve tube 11, which is made for example of a transparent plastic. At the proximal end of the sleeve tube 11, a valve device 12 is arranged.
  • the valve device 12 has an axially aligned with the sleeve tube 11 passage through which the trocar 30 or instruments or optics can be inserted into the sleeve tube 11 therethrough.
  • the passage of the valve means is provided with a seal which hermetically closes the passage and thus the sleeve tube 11 when no trocar or instrument is inserted through the valve means.
  • an insufflation port 14 leads radially into the passage of the valve device 12 and thus to the inner lumen of the sleeve tube 11.
  • the insufflation port 14 can be closed by means of a cock 15.
  • the trocar sleeve 10 is formed with the valve device 12 in a conventional manner.
  • the trocar mandrel 30 shown in Figures 6 and 7 has a tubular hollow shaft 31, preferably made of stainless steel.
  • a knurled knob 32 is arranged, which serves to handle the Trokardorns 30.
  • a distal end portion 33 is inserted coaxially and preferably glued to the shaft 31, as can be seen in Figure 7.
  • the distal end portion 33 which is shown in Figures 8 to 11 as a single part, is preferably made as an injection molded part and consists of a transparent, preferably transparent clear plastic.
  • the distal end part 33 has a straight circular-cylindrical end section 34, which is inserted coaxially into the distal end of the shaft 31 with an attachment piece 35 and glued to the shaft 31.
  • the outer diameter of the end portion 34 coincides with the outer diameter of the shank 31, so that the peripheral sheath surfaces of the shank 31 and the end portion 34 steplessly adjoin each other.
  • the distal end portion 33 is then formed with a distally tapered distal tip 36.
  • the distal tip 36 has substantially the shape of a cone, ie a straight circular cone.
  • the surface 37 of the tip 36 is flattened on two diametrically opposite sides to form two mirror-symmetrical flats 38 extending from the end portion 34 to the distal end of the tip with respect to a central axis plane of the end portion 33.
  • the flats 38 are preferably drawn slightly inward, as can be seen in particular in FIG.
  • the distal end of the tip 36 is formed as a flat runner 39, which protrudes slightly beyond the flats 38 in the distal direction and against the plane of symmetry of the two flats 38 at an angle to the
  • the blade 39 has approximately the shape of the working tip of a Schiit z screwdriver.
  • the at least one gas guide channel has the shape of a gas guide groove 40 running in the outer circumferential surface of the distal end part 33.
  • four gas guide grooves 40 are provided.
  • the gas guide grooves 40 are formed as recessed grooves in the outer circumferential surface. The cross-sectional shape and depth of the gas guide grooves 40 are freely selectable in a wide range.
  • the gas guide grooves 40 have, for example, a triangular or semicircular cross-sectional profile and a depth of, for example, about 0.25 mm.
  • the gas guide grooves 40 extend in the longitudinal direction of the end portion 33 and extending axially from the neck nozzle 35 over the entire length of the end portion 34 and extend over the distal tip 36 to its distal end, as best seen in Figure 8.
  • a pair of two gas guide grooves 40 are arranged diametrically opposite each other.
  • the two gas guide grooves 40 of each pair run parallel next to each other and are in Um- Fangswinkel of the end portion 33 is arranged so that the pairs of gas guide grooves 40 each lead within the flats 38 to the distal end of the tip 36. This can be seen most clearly in FIGS. 8 and 9.
  • the distal end 16 of the sleeve tube 11 of the trocar sleeve 10 is shown in Figure 12 in a partial section.
  • This distal end 16 may preferably be bevelled with respect to the central axis of the sleeve tube 11, as shown in FIGS. 4 and 5.
  • the bevel is for example 30 °.
  • the distal end 16 has an inner edge 17, the inner diameter of which corresponds to the outer diameter of the end portion 34 of the end portion 33 of the trocar mandrel 30.
  • the clear inner diameter of the sleeve tube 10 extends in a region 18 toward the somewhat larger clear inside diameter of the sleeve tube 11 at this inner edge 17.
  • the inside diameter of the sleeve tube 11 is 0.5 mm larger than the inside diameter of the inside edge 17, for example.
  • the trocar 30 is inserted from the proximal end through the valve device 12 into the trocar sleeve 10 until the button 32 abuts the valve device 12.
  • the distal tip 36 of the distal end portion 33 then projects distally out of the distal end 16 of the barrel tube 11, as shown in Figs. 1-3.
  • At the proximal end of the trocar 30 is sealed in the valve device 12.
  • the sleeve tube 11 rests with the inner edge 17 close to the outer periphery of the cylindrical end portion 34 of the distal end portion 33 of the trocar 30.
  • the inner diameter of the sleeve tube 11 is slightly larger than the clear inner diameter of the inner edge 17 remains between the outer wall of the shaft 31 of the Trokardorns 30 and the inner wall of the sleeve tube 11 an annulus free.
  • the insufflation connection 14 of the valve device 12 opens into the passage of the valve device 12 and thus into this annular space between the shaft 31 of the trocar mandrel 30 and the inner wall of the sleeve tube 11.
  • Form tip 36 If a gas or other fluid is introduced through the insufflation port 14, this gas can penetrate via the insufflation port 14 into the annular space between the sleeve tube 11 and the trocar mandrel 30 and exit via the gas guide grooves 40 distally from the sleeve tube 11.
  • an endoscope optic 50 is inserted through the button 32 into the trocar mandrel 30, as shown in FIG.
  • the trocar 30 is inserted into the trocar sleeve 10, as shown in Figures 1 and 2.
  • the trocar is then pierced by a skin incision in the abdominal wall, the distal tip 36 of the trocar 30 causes together with the blade 39 a perforation of the tissue and a dilatation of the perforation opening. Since the distal end portion 33 is transparent, the body tissue in front of the distal tip 36 and the body tissue adjacent to the distal tip 36 can be observed by means of the endoscope optics 50. It can also be observed how the tip 36 penetrates the body tissue.
  • the distal end of the tip 36 has penetrated the abdominal wall and enters the abdominal cavity, it is possible via the insufflation connection, the annular space within the tube 11 and through the gas guide. 40 insufflation of gas into the abdominal cavity.
  • the abdominal wall can be distanced from internal organs of the abdominal cavity so that the further advance of the distal tip 36 into the abdominal cavity can be continued without the risk of an injury to internal organs.
  • the Gasbond ⁇ approximately grooves 40 extend in the area of the tapered distal tip 36 within the flats 38, the pressure of the voltage applied to the tip 36 of the body tissue substantially from the tapered side faces 37 of the tip 36 is received and the body tissue is not in the gas guide grooves 40 pressed so that they remain free for the passage of gas.
  • endoscope optics 50 a per se known endoscope optics can be used. Often, such endoscope optic 50 is formed with a beveled distal end surface 51. In the so-called 30 ° optics, the distal end surface 51 is inclined at an angle of 30 ° to the central axis of the endoscope optic 50, as shown in the embodiment in Figs. 13 and 14. The main direction of view of such endoscope optics 50 is perpendicular to the end face 51 and is thus angled at an angle of, for example, 30 ° relative to the central axis of the endoscope optics 50 and the trocar 30.
  • the endoscope optic 50 looks through a region of the distal tip 36, which is designed as a conical lateral surface 37 and in the circumferential direction between the flats 38 located.
  • an endoscope optic 50 with, for example, an end face 51 inclined at an angle of 30 ° is necessarily aligned in this optimum viewing direction. This is accomplished by advancing the distalmost peripheral portion of the end surface 51 axially further distally into the distal tip 36 can be when this furthest distal peripheral portion is in the region of a conical lateral surface 37, as shown in Figure 14.
  • the distal end of the tip 36 is cut to make the alignment of the end face 51 of the endoscope optic 50 more clearly visible.
  • the optimal angular orientation of the end face 51 within the distal tip 36 results. If the distal end face 51 has entered this conical lateral surface 37 of the distal tip 36 of the trocar dart 30, the
  • the at least one gas guide channel is designed as a gas guide tube 42.
  • two diametrically opposed gas guide tubes 42 are provided.
  • the gas guide tubes are formed as completely embedded in the wall of the end portion 33, closed at its entire circumference tubes.
  • the gas guide tube 42 has an inlet opening 43 and a distal outlet opening 44 only at the proximal end of the cylindrical end section 34.
  • the at least one gas guide tube 42 extends axially at least over the length of the cylindrical end portion 34 against which the distal end 16 of the trocar sleeve 10 abuts.
  • the at least one gas guide tube 42 extends distally beyond the cylindrical end portion 34 into the distal tip 36 so that the exit apertures 44 lie at the forward distal end of this tip 36.
  • the distal end part 33 is preferably made of plastic in axially separate partial shells. provided, wherein the gas guide tubes 42 are formed as grooves in the abutment surfaces, with which the partial shells are joined together.

Abstract

L'invention concerne un trocart comprenant un manchon (10) de trocart, un système de valve (12) disposé à l'extrémité proximale du manchon (10) et un mandrin (30) de trocart qui peut être introduit axialement dans le manchon (10) à travers le système de valve (12) et qui comporte une tige creuse (31) et une pointe (36) distale effilée transparente. Une optique endoscopique (50) permettant d'observer le tissu organique en contact avec la pointe distale peut être introduite dans la tige creuse (31) du mandrin de trocart. Un raccord d'insufflation (14) proximal permet d'injecter un gaz dans le manchon (10). Lorsque le mandrin (30) est inséré dans le manchon (10), l'extrémité distale (16) du manchon (10) est en appui sur le périmètre extérieur d'un segment d'extrémité cylindrique (34) du mandrin (30) qui se prolonge en direction proximale par la pointe (36) effilée. Lorsque le mandrin (30) est inséré, le gaz injecté par le biais du raccord d'insufflation (14) pénètre dans un espace annulaire entre la paroi extérieure du mandrin (30) et la paroi intérieure du manchon (10) et peut ressortir par une sortie de gaz distale. La sortie de gaz distale est formée par au moins un conduit de passage de gaz (40) qui est ménagé dans l'enveloppe extérieure du segment d'extrémité cylindrique (34) dans le sens de la longueur du mandrin (30) et qui s'étend axialement au moins sur la longueur d'appui de l'extrémité distale (16) du manchon (10) sur le segment d'extrémité cylindrique (34) du mandrin (30) inséré.
EP14703842.6A 2013-02-11 2014-02-11 Trocart Withdrawn EP2953557A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102013101336.8A DE102013101336A1 (de) 2013-02-11 2013-02-11 Trokar
PCT/EP2014/052597 WO2014122317A1 (fr) 2013-02-11 2014-02-11 Trocart

Publications (1)

Publication Number Publication Date
EP2953557A1 true EP2953557A1 (fr) 2015-12-16

Family

ID=50073187

Family Applications (1)

Application Number Title Priority Date Filing Date
EP14703842.6A Withdrawn EP2953557A1 (fr) 2013-02-11 2014-02-11 Trocart

Country Status (4)

Country Link
US (1) US20160000462A1 (fr)
EP (1) EP2953557A1 (fr)
DE (1) DE102013101336A1 (fr)
WO (1) WO2014122317A1 (fr)

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US9693802B2 (en) * 2012-06-06 2017-07-04 Covidien Lp Obturator tip with insufflation pathway
US10105161B2 (en) * 2014-08-15 2018-10-23 Covidien Lp Obturator having an insufflation pathway and an instrument guide
US20180096033A1 (en) * 2016-10-04 2018-04-05 International Business Machines Corporation Query management in database management systems
US11638578B2 (en) 2017-11-28 2023-05-02 Pneumonix Medical, Inc. Apparatus and method to seal a tissue tract
AU2019318554A1 (en) * 2018-08-09 2021-03-04 Optical Spine Translucent illuminated endoscopic probe
KR102201496B1 (ko) * 2018-11-06 2021-01-12 엑세스(주) 압력 형성 홀을 가진 의료용 트로카
USD935611S1 (en) 2018-12-10 2021-11-09 Pneumonix Medical, Inc. Tissue tract sealant device
CN109498122B (zh) * 2018-12-17 2020-04-14 江苏人冠医疗科技有限公司 一种穿刺器
CN109820577B (zh) * 2019-04-01 2021-04-23 毕强 一种组合式穿刺器

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Also Published As

Publication number Publication date
DE102013101336A1 (de) 2014-08-14
WO2014122317A1 (fr) 2014-08-14
US20160000462A1 (en) 2016-01-07

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