JP2005505371A - Laparoscopic illumination apparatus and method - Google Patents

Abstract

An access device specially adapted for use in laparoscopic surgery to facilitate access of an instrument, such as a surgeon's hand, across a body wall or into a body cavity. It is a device. The device is formed from a gel material that has the property of forming a zero seal and capable of forming an instrument seal for a wide range of diameter instruments. The gel material is translucent and facilitates illumination and viewing of the surgical site through the access device.
[Selection] Figure 1

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an apparatus and method for easily illuminating a surgical site in less invasive surgical applications.
[0002]
[Prior art]
In some areas of surgery, there is a need for a mechanism or device that can introduce a surgical instrument such as a guidewire, endoscope, or even a surgeon's hand while sealing and sealing a body cavity or space. Existing. A typical example of such a surgical field is laparoscopic surgery, in which a surgical instrument is inserted through the abdominal wall to the surgical site within the abdominal cavity. In order to enlarge the space around the surgical site in the body cavity, typically, gas is blown in and the body cavity is expanded to raise the abdominal wall. Applying pressure to the abdominal cavity in this way is called a pneumoperitoneum. In this context, the need to maintain a pneumoperitoneum even in the presence of an instrument arises from the need to hermetically seal the body cavity or body space.
[0003]
Trocars have been commonly used to provide instrument access in laparoscopic surgery. These trocars include elaborate seal structures, zero seals that prevent gas from leaking in the absence of instruments, and instrument seals that prevent gas from leaking in the presence of instruments And have. Unfortunately, instrument seals could only fit a narrow range of instrument diameters. If a wide range of needs were needed, multiple seal pairs had to be provided.
[0004]
Some instruments, such as the surgeon's hand, were too large for trocar access. Under such circumstances, a assisted laparoscopic seal was provided. Such devices are large, cumbersome, and often ineffective in providing the necessary hermetic seal mechanism. Other access devices such as the Touhy-Borst seal are also used, but only for the very small diameter access that a guidewire requires.
[0005]
Each device in the prior art has inconveniences that make it difficult or cumbersome to use. For example, the Touhy-Borst seal needed to be used with two hands and did not form a seal when it was about to introduce a guide wire or other device. Current trocar seals and hand assisted seals require two valves, one of which forms an instrument seal in the presence of the instrument and the other forms a zero seal in the absence of the instrument. For example, in hand-assisted devices, sophisticated mechanisms were required to hermetically seal around the surgeon's arm. When the arm was removed, another zero seal was required to prevent blood and insufflation gas from leaking out.
[0006]
[Problems to be solved by the invention]
In laparoscopic surgery, there is a need for an access device that can hermetically seal around the surgeon's hand so that the hand can be used in a pressurized peritoneal space. In a conventional laparoscopic surgical operation, viewing is performed through a laparoscopic camera, and the camera itself is provided with illumination. Although under-required lighting was not usually used, however, there were few options available to the surgeon to increase visibility in the surgical field. Conventional laparoscopic illumination has been performed using only a point light source. Since this tends to cause a shadow, it is difficult to recognize a three-dimensional situation.
[0007]
[Means for Solving the Problems]
The present invention solves the disadvantages of the prior art described above and includes a sealing device and a method for performing elaborate surgical procedures using such a device. An apparatus according to one embodiment includes a valve structure formed of a gel and oil based on a thermoplastic material such as KRATON (registered trademark of Shell). The resulting elastomer has excellent tear strength, elongation greater than 1,000%, very low durometer or hardness, and biocompatibility. The process for manufacturing such a device is greatly simplified if mold technology is used.
[0008]
Importantly, the access device can function as both a zero seal and an instrument seal. Furthermore, the device can accommodate a wide range of instrument diameters, ranging from 2 French in the case of a guidewire to 3-4 inches in the case of the surgeon's hand. In addition, a single access device can be used to accommodate multiple instruments simultaneously.
[0009]
In order to improve both tear resistance and hermetic sealing ability, it is preferable to enclose the gel with a sheath or to provide a reinforcing member around the valve structure. By adding an additive to or on the surface of the gel, properties such as lubricity, appearance, wound treatment and / or protection, anti-cancer protection, and anti-bacterial protection can be improved. Altering the chemical, pharmaceutical or physical properties of the access device by adding or embedding additional chemicals, compounds, pharmaceuticals, etc., or even mechanical devices in the gel material Can do.
[0010]
According to the present invention, it is possible to remarkably improve illumination and visibility of a surgical site. A light source can be provided on the exterior of the body wall and body cavity to create a light path towards the body cavity. An access device according to the present invention is positioned along such a path of light and positioned to extend at least partially across the body wall. If the access device is formed from a light transmissive material, such as a translucent gel, the device can function as a window providing light and field access to the surgeon. Such functionality does not impede the primary access that the device provides for surgical instruments. Thus, illumination can be provided without the need for a separate access device.
The above and other features and advantages of the present invention will become apparent by reference to the description of the preferred embodiment and the accompanying drawings.
[0011]
DETAILED DESCRIPTION OF THE INVENTION
In FIG. 1, a patient is shown, and the whole body is indicated by reference numeral 10. The patient 10 shown in the figure is laid on his back on the operating table 12, and abdominal surgery is performed by the arm 16 and the hand 17 of the surgeon 14. In the illustrated example, a surgical procedure is performed inside the abdominal cavity using an instrument provided to access through the abdominal wall 21. In this type of surgery, commonly referred to as laparoscopic surgery, the trocars 23 and 25 are typically used to minimize the use of instruments such as the gripper 27 and endoscope 30 to penetrate the abdominal wall 21. Provides invasive access.
[0012]
Although the details of the disclosure in this application are centered on preferred laparoscopic surgery, laparoscopic surgery is merely representative of the type of surgery performed on a body cavity with minimal access through the body wall. Note that there is no.
[0013]
It should be noted that in spite of the universality described above, in laparoscopic surgery it is often required that the surgeon 14 be able to insert his hand 17 through the abdominal wall 21 into the abdominal cavity 18. is important. Such insertion of the hand 17 allows the surgeon 14 to directly access various anatomical elements.
A small incision 32 is typically made in the abdominal wall 21 to accommodate the hand 17 and arm 16 of the surgeon 14. The access device 34 according to the present invention further facilitates such surgeon 14 hand access.
[0014]
Particularly in the case of laparoscopic surgery, it is advantageous to blow a gas such as carbon dioxide into the abdominal cavity 18 so as to raise the abdominal wall 21 to increase the volume of the working space inside the abdominal cavity 18. Maintaining such insufflation pressure, commonly referred to as pneumoperitoneum, is particularly difficult when access through the abdominal wall 21 is required, for example through the trocars 23 and 25 and the access device 34. . For these reasons, an access device having a hermetic seal characteristic in the presence or absence of instruments such as the gripping tool 29, the endoscope 30, and the hand 27. Considerable efforts have been made to provide
[0015]
Accordingly, trocars 23 and 25 are typically provided with a complex valve structure, each of which is intended to form an instrument seal in the presence of an instrument to accommodate a narrow range of instrument sizes. It included an instrument valve and a zero valve to form a zero seal in the absence of the instrument. By providing both an instrument seal and a zero seal, the valve structure was able to prevent gas from leaking through the trocar, both in the presence of the instrument and in the absence of the instrument. .
[0016]
Instrument seals are particularly troublesome and have been effective only for a small range of instrument diameters. For example, separate instrument seals were required for instruments such as guidewires having a diameter of only 2 French to 3 French. For intermediate size instruments having a diameter of 3 mm to 5 mm, a second instrument seal was required. In some cases, a third instrument seal was required to accommodate instruments having diameters such as 9 mm to 12 mm. Typically, as the instrument size changed, a separate zero seal was required for each range. Thus, for complex trocars, such as trocar 23, there were as many as six separate seals associated with the access device.
[0017]
If there is no need to maintain a pneumoperitoneum, there will be no requirement for trocars 23 and 25 or access device 34. You would simply cut through the abdominal wall 21 and insert the instrument directly through the incision. However, without an appropriate valve or seal, the insufflation gas simply leaks from the incision. This is particularly detrimental in cases where the incision 32 must be large enough to accept the hand 17 of the surgeon 14. Accordingly, the primary purpose of the access device 34 is to form an access or working channel 34 with the incision 32 to provide a valve or other sealing structure that crosses the working channel to maintain a pneumoperitoneum. is there.
[0018]
FIG. 2 shows an enlarged view of one embodiment of the access device 34, showing both abdominal walls 21 and 32. In this simple form, the access device 34 has a substantially pad-like form, that is, is substantially flat and is arranged in a plane such as the plane 38. Typically, there are a pair of main surfaces 41 and 43 parallel to such a plane 38 that provide a substantial surface area of the pad 35. An opening or cut 45 is formed through the pad 35, which is generally along an axis 47 perpendicular to the plane 38.
[0019]
In the arrangement at the time of operation, the opening 45 of the pad 35 communicates with the incision 32, and in this case, together with the incision 32, a working passage 36 is formed. In order to align the opening 45 and the incision 32, the pad 35 is disposed outside the abdominal wall as shown in FIG. 2, is disposed inside the abdominal wall 21 as shown in FIG. 3, or the abdominal wall 21 as shown in FIG. Or place it inside In any arrangement, the arrangement of pad 35 relative to abdominal wall 21 during surgery requires that pad 35 be maintained in the surgical position to form a hermetic seal around incision 32. Referring to the plan view of FIG. 5, an adhesive 50 is used around the incision 32 between the pad 35 and the abdominal wall 21 to achieve these two functions.
[0020]
As shown in FIG. 5, the adhesive 50 is formed in a continuous ring 52 shape, and the pad 35 is disposed with the ring 52 disposed around the incision 32, and the pad 35, the abdominal wall 21, A seal is formed between the two. In the illustrated example, when the pad 35 is placed at the time of surgery, leakage of the blowing gas from between the pad 35 and the abdominal wall 21 is prevented by the adhesive ring 52.
Leakage of the blown gas through the opening 45 of the pad 35 is prevented by the self-sealing properties of the material forming the pad 35. Such materials and their highly advantageous features will be described later.
[0021]
It should be understood that the function of the adhesive ring 52 can be achieved in a number of different ways using a number of different materials and shapes. For example, the pad 35 can be maintained overlying the incision 32 by using a number of materials other than the adhesive. Methods other than bonding may be used to form a seal around the incision 32. Furthermore, the shape of the continuous seal formed by the adhesive 50 need not be round. Rather, any continuous pattern formed sufficiently large around the incision 32 can facilitate the desired hermetic seal relationship. Finally, it should be noted that simply placing a pad 35 inside the abdominal wall 21, for example as shown in FIG. 3, can create a peripheral seal as a result of the blowing pressure.
[0022]
FIG. 6 shows an access device 32 according to another embodiment, in which structural elements similar to those described above are shown by adding the lowercase letter “a” to the same reference numerals. In the present embodiment, the functions of maintaining the position and sealing are achieved by a modification of the access device itself. The pad 35 in this case is disposed inside the incision 32 as shown in FIG. However, the outer flange 54 and the inner flange 56 are formed integrally with the pad 35.
[0023]
In the arrangement at the time of operation, the outer flange 54 is arranged outside the abdominal wall 21, while the inner flange 56 is arranged inside the abdominal wall 21a. Thus, the pad 35 is placed inside the incision 32a and placed in place by the flanges 54 and 56. When the surgeon 14 inserts the hand 17 through the access device 34, the outer flange 54 prevents the pad 35a from moving distally. Similarly, when the surgeon 14 pulls out the hand 17, the inner flange prevents the pad 35a from moving proximally.
[0024]
In this embodiment, the opening 45 a extends with the pad 35 through the flanges 54 and 56 to completely form the working channel 34 through the incision 32.
[0025]
The main seal required between the access device 34a and the abdominal wall 21 is formed by an adhesive ring 52a as described with reference to FIG. As a modification, in the present embodiment including the inner flange 56, it may depend only on the surface contact between the flange 56 a and the abdominal wall 21. In such a case, a primary seal is formed between these structural elements, and the pneumo-abdominal pressure presses the inner flange 56 against the abdominal wall as shown by arrows 58 to Increase the ability. Such a seal is mainly formed in a radial plane substantially perpendicular to the axis 47.
[0026]
The primary seal function is further enhanced by an additional seal that occurs between the pad 35a and the portion of the abdominal wall 21 forming the incision 32. In such a position, the abdominal wall 21 is compressed in the radial direction only by the presence of the pad 35 inside the incision 32. The resulting pressing force creates an axial seal between the pad 35a and the abdominal wall 21.
[0027]
In this embodiment, if an adhesive ring 52a is required, it is most advantageous to place it around the incision 32 between the outer flange 54 and the abdominal wall 21.
[0028]
It should be noted that whenever an instrument such as the arm 16 or hand 17 of the surgeon 14 is inserted into the pad 35, the pad conforms to the surface of the instrument and forms an instrument seal with the instrument. Thus, substantially all of the loss of insufflation gas through the pad 35a and any loss of pneumoperitoneum inside the abdominal cavity 18 will occur over the entire period from the start of instrument insertion to the completion of instrument withdrawal. There is no.
[0029]
Further, referring to FIG. 7, it will be appreciated that the arm 16 and hand 17 of the surgeon 14 are merely examples of instruments that can be inserted through the access device 34a. In the case of the instrument or in the absence of the hand 17 in the case of FIG. 7, the opening or cut 45a simply abuts itself to form a zero seal, thus preventing the insufflation gas from leaking through the access device 34a. . When an instrument such as the hand 17 is inserted through the opening or cut 45a, an instrument seal is formed between the material of the access device 34a and the outer surface of the instrument. This prevents leakage of the insufflation gas through the access device 34a even when an instrument is present. Therefore, the blowing pressure inside the abdominal cavity 18 is maintained regardless of whether the instrument is in a predetermined position. Note that these zero and abdominal seals are formed by a single valve structure that has properties that fit the full range of instrument sizes.
[0030]
The formation of the pad 35a is typically achieved by a simple molding process, which will be described in detail later. In such a process, the opening or cut 45a is formed as part of the molding process.
[0031]
In many cases, a single access opening 45a is sufficient to accommodate a surgical procedure. However, the additional advantages of the access device 34a will be particularly appreciated when the surgeon 14 requires more access through the pad 35a. For example, suppose that when the surgeon 14 is inserting the arm 16 into the opening 45a, the surgeon considers that additional instruments are needed for the surgical procedure. In such a situation, a further opening through the pad 35a can be established simply by passing the desired surgical instrument through the pad 35a. Thus, apart from the main opening 45a, the instrument can create an access hole for the instrument.
[0032]
Particularly, in the case of a surgical instrument having a pointed distal end, an access hole of the instrument itself such as an opening 45a is formed in the pad 35a simply by pushing the pad 35a and moving the instrument in the distal direction. The The opening thus created by the surgical instrument itself automatically forms an instrument seal when the instrument is inserted and a zero seal when the instrument is withdrawn.
[0033]
For surgical instruments having a non-pointed distal end, a new access hole can be formed by using a secondary instrument such as an occlusion trocar. After the access hole is formed, the obturator is removed and an access hole for receiving a surgical instrument is opened. Throughout this procedure, the access hole is first formed and finally the surgical instrument is inserted into the hole, a zero seal and an instrument seal are formed to maintain the pneumoperitoneum.
[0034]
Because of the advantages associated with (1) the ability to form instrument seals and zero seals using a single valve that can accommodate a wide range of diameters, and (2) the instrument itself can be used to form instrument openings. It will be appreciated that the inventive concept is typically embodied as a structure that is particularly dependent upon the material from which the access device 34 is formed. In a preferred embodiment, the pad 35 is a KRATON and oil combination such that the mineral oil is combined in a 3-block of KRATON with a structure of Styrene-Ethylene / Butylene-Styrene (SE / BS). Formed from a mixture. Other 3-block polymers that can be used in the present application include Styrene-Isoprene-Styrene (S-I-S), Styrene-Butadiene-Styrene (S-B-S), Styrene- or Ethylene / Examples include Propylene-Styrene (SE / PS) and others manufactured by Kuraray as SEPTON (registered trademark). These general formulations become more prominent depending on the ratio of rubber content to styrene, for example, grade 1650 is a 3-block of S / E / BS, where styrene and rubber The ratio is 29:71.
[0035]
In addition to the 3-block, there are also 2-block variants of these materials, such as the presence of styrene at one end of the chemical formula, eg, Styrene-Ethylene / Butylene (SE / B). 2-blocks and the like.
Various basic chemical formulas can also be combined with each other to obtain various intermediate properties. For example, KRATON G1701X is a mixture of 70% S-E / B and 30% S-E / B-S with an overall rubber to styrene ratio of 28:72. It will be appreciated that an almost infinite number of combinations and mixtures and ratios of styrene and rubber can be formulated, each of which can provide advantages for certain embodiments of the present invention. Such advantages are typically low durometer, high elongation, and good tear strength.
[0036]
Examples of the material of the pad 35 include silicone, soft urethane, and a harder plastic substance that can obtain a desired seal quality by adding a foaming agent. The silicone material may be of the type used to encapsulate today's electronic components. Stiffer plastics include PVC, isoprene, pure KRATON, and other mixtures of KRATON and oil. In the mixture of KRATON and oil, for example, vegetable oil, petroleum oil, and silicone oil may be used instead of mineral oil. In the broadest sense, all these mixtures are commonly referred to as gels. Typical properties of a gel include the ability to “flow” like a fluid. In particular, in the vicinity of an opening or cut 45 extending through the access device 34, it is an important concern that the opening is widened. The stress caused by the presence of the instrument is concentrated at the end of such an opening or cut. For this reason, the gel material is required to have good tear resistance. Such tear resistance is typically inherent in a mixture of KRATON and oil and can be enhanced by encapsulating the gel with other materials. For example, if a gel having low tear resistance is encapsulated with a urethane sheath, the tear resistance of the resulting product can be improved. Such a sheath need not be elastic, for example it can be provided with a stack of sheets of inelastic material.
[0037]
Any contemplated gel material can be modified to achieve different properties such as lubricity, appearance, wound protection, or anti-cancer or anti-bacterial effects. Additives can be included directly in the gel, for example in the case of pneumoperitoneum, or applied as a surface treatment of the gel to improve, for example, lubricity and appearance. Other compounds can be added to the gel to assist in the resulting modification of the surface by altering its physical properties or providing adhesion sites or surface charge. Antioxidants and anti-radiation agents can be added to the mixture to extend the shelf life of the final product or to improve resistance to radiation sterilization.
[0038]
Seal materials used in conventional medical access devices have been selected mainly based on their durometer and elongation rate. These are the properties that measure the ability of material to move to small spaces and recesses that are required to form an instrument seal across the working channel of the trocar. For example, conventionally, a mixture of silicones has been used as a medical valve. Such mixtures had properties of up to an elongation of less than about 1000% and a Shore A hardness of greater than about 5.
[0039]
The properties associated with the present invention far surpass these properties of prior art materials and provide completely superiority in some respects. In practice, the difference between the prior art material and the material of the present invention is significant, and simply referring to the material of the present invention as a gel will probably be misleading. That is, the properties of the material of the present invention include a maximum elongation of greater than about 1000% and a durometer with a Shore A hardness of less than about 5, referred to herein as "ultragel". To do.
[0040]
In a preferred embodiment of the present invention, the ultragel comprises KRATON and mineral oil, and the properties of the provided sealing material comprise a maximum elongation greater than about 1500% and a durometer less than about 200 Bloom. . The durometer in this case is significantly smaller than that of the prior art material. In fact, the durometer of the material of the present invention is so flexible that it cannot even be measured with Shore A hardness.
[0041]
The resulting elongation and durometer of the material of the present invention facilitates the use of this material as an access valve, which can form a seal for a full range of instrument sizes and It can also function as a zero seal. Prior art access devices required six separate seals to accommodate the full range of instrument sizes, but now access devices using only a single valve formed of ultragel material. Can be made.
[0042]
In a typical manufacturing process, KRATON G1651 is mixed with mineral oil in a weight ratio of 1-9. To produce such a material, the mixture is heated to a temperature of about 200 ° C. In a preferred manufacturing method, the mold is provided with a round ring insert, which is molded into a gel and the cut insert is removed from the gel to form an opening or cut 45. The resulting gel is coated with corn starch to reduce stickiness and cool to room temperature.
[0043]
Many of the properties of the KRATON and oil mixture vary depending on the weight ratio of the mixture. In general, the greater the proportion of mineral oil, the greater the fluidity of the mixture, and the greater the proportion of KRATON, the harder the material. For a harder structure, the weight ratio of oil to KRATON is expected to be as low as 1-5. As the weight ratio of KRATON to oil approaches 1 to 10, the mixture becomes more fluid. In the present invention, a ratio of 1 to 15 is assumed.
[0044]
The processing temperature is also significantly changed since this mainly depends on the type of KRATON used. Temperatures in the range of about 150 ° C. to about 250 ° C. are envisioned.
[0045]
If it is recognized that these ratios and temperatures produce significantly different properties, it is clear that such materials can be layered so that the properties of each layer are different. For example, the outer layer can be formed from a mixture of KRATON and oil having harder properties to make the outer layer of pad 35 harder. After such a layer is at least partially cured, another layer of material can be injected into the outer layer. This second layer should be softer to provide a pad 35 with significant sealing properties. Although successive layers tend to merge slightly at their interface, it has been found that they generally maintain their separate uniqueness. Additional layers can be added to advance the characteristics of a particular device.
[0046]
Having described the properties required for the gel material and the manufacturing process, the concepts of other embodiments that provide additional advantages for specific surgical procedures will now be described. FIG. 8 shows a cross-sectional view in the axial direction of the embodiment of the access device 34 whose position at the time of surgery is shown in FIG.
[0047]
FIG. 9 shows the same embodiment reinforced by O-rings 61 and 63, and corresponding structural elements are indicated by adding the lower case letter “b” to the same reference numerals. By providing these O-rings 61 and 63, some functions associated with the access device 34b are facilitated. For example, rings 61 and 63 typically help maintain a radial seal pressure on all sides of opening 45b. Also, the rings 61 and 63 tend to maintain each of the flanges 54b and 56b in a generally flat form. This further prevents the flanges 54 and 56 from collapsing into the incision 32 when an instrument such as the surgeon's hand 17 is inserted or withdrawn. Of course, the O-rings 61 and 63 need to be large enough to accommodate the instrument during insertion and withdrawal.
[0048]
FIG. 10 shows still another embodiment of the present invention, and structural elements corresponding to the above-described embodiment are shown by adding the lowercase letter “c” to the same reference numerals. This embodiment includes a pad 35c having an opening or a cut 45c. The outer circumferential O-ring 61c is insert-molded around the pad 35c. The inner O-ring 63c is attached to the O-ring 61c by a film 65, for example, and is coupled to the pad 35c. In this case, the membrane 65 has a substantially cylindrical shape and has elastomeric properties. In a preferred embodiment, the membrane 65 is formed from urethane, neoprene, or isoprene.
[0049]
When the embodiment of FIG. 10 is in the surgical position, the inner O-ring 63b is first assembled and then inserted through the incision 32 (see FIG. 2). The pad 35c and the outer O-ring 61c are left outside the incision 32, and the only material that extends across the incision 32 is the membrane 65. Note that in this case, the working channel 36c is formed by a cut 45c, a cylindrical membrane 65, and an inner O-ring 63b.
In this particular embodiment, pad 35c functions generally as described with reference to FIG. The primary seal between the pad 35c and the abdominal wall 21 is formed by a surrounding ring, such as an adhesive ring 52c, or depending on the sealing properties that the blowing gas presses against the inner O-ring 63b and the membrane 65. Is done.
[0050]
The embodiment of FIG. 10 includes a pad 35c, which is probably the simplest form, while the main seal between the device 34c and the abdominal wall 21 is particularly advantageous in that it is facilitated by the insufflation gas. . In addition, the membrane 65 improves the sealing properties of the device 34c and provides a backing for the incision 32. Because of the membrane 65, the incision 32 need not be stretched beyond the diameter required for any instrument inserted into the working channel 36c.
[0051]
FIG. 11 shows still another embodiment of the present invention, in which structural elements corresponding to the above-described embodiment are shown by adding the lowercase “d” to the same reference numerals. This embodiment is similar to the embodiment of FIG. 8 in that it includes a pad 35b, a cut 45d, an outer flange 54d, and an inner flange 56d. The embodiment of FIG. 11 differs from the embodiment of FIG. 8 in that it includes a pull-in cavity 70 that communicates with the cut 45d.
[0052]
In the preferred embodiment, the size and configuration of the cavity 70 is adapted to receive the arm 16 of the surgeon 14 in the manner shown in FIG. In this case, the cut 45d functions primarily to maintain a zero seal, while the portion of the pad 35d or flange 54d that forms the cavity 70 functions primarily to form an instrument seal.
[0053]
The plan view of FIG. 12 and the cross-sectional views of FIGS. 13 and 14 illustrate still another embodiment of the present invention. In the present embodiment, the structural elements corresponding to the above-described embodiments are shown by adding the lowercase “e” to the same reference numerals. In this case, the lead-in cavity has a substantially cylindrical shape 72, and its axis is collinear with the axis 47e of the pad 35e.
[0054]
As best shown in FIG. 13, the cut 45e has a trapezoidal shape. That is, in the proximal direction, it starts with a short length that is substantially the same as the diameter of the cylinder 32. The length of the cut 45e gradually increases from the cavity 70e toward the distal direction of the pad 35e. In the illustrated embodiment, the trapezoidal cut 45e is formed as an isosceles triangular truncated body.
[0055]
15 and 16 show still another embodiment of the present invention, in which structural elements corresponding to the above-described embodiment are shown by adding the same reference numeral to the lower case letter “f”. . As described with reference to FIG. 12, the pad 35 f of the present embodiment includes the proximal surface 71 and the distal surface 73. The pad 35f includes a coaxial drawing cylinder 72f and a trapezoidal cut 45f. However, in this case, a beak-like valve 74 is provided to further enhance the zero seal capability. As shown in the figure, the working passage 36f is formed by a retracting cavity 70f, a cut 45f, and an extended portion of the cut 45f formed by a beak-shaped valve 74f.
[0056]
The beak-shaped valve 72 is formed by opposing flanges 76 and 78 extending distally from the distal surface 73. In the placement at the time of surgery, the pad 35f is placed so that the distal surface 73 of the pad 35f abuts the outer surface of the abdominal wall 21 (see FIG. 2) and the flanges 76 and 78 extend into the incision 32. With this configuration and placement during surgery, the incision 32 portion of the abdominal wall 21 creates a pressing force on the flanges 76 and 78, which tends to close the cut 45f, particularly in the absence of an instrument. Thus, relying on the beak-shaped valve 74 can enhance the zero seal characteristics.
[0057]
FIG. 17 and FIG. 18 show still another embodiment of the present invention. Structural elements corresponding to the above-described embodiment are shown by adding the lowercase letter “g” to the same reference numerals. . In the access device 34g according to the present embodiment, the pad 35g is roughly formed as described in FIG. However, in this embodiment, the side surface of the pad 35g and the distal surface 73g are wrapped by the base 81. In this case, the pad 35g is made from the highly elastic material described above, while the base 81 is made from a harder but flexible material such as urethane. In this configuration, the beaked valve 74f is configured to extend distally from a distal surface 83 associated with the base 81. This allows the beak-shaped valve 74f to be formed from a base material rather than a superplastic material. This will improve the characteristics of the zero seal in certain surgical applications.
[0058]
FIGS. 19 and 20 show another simplified embodiment of the present invention, in which structural elements corresponding to the above-described embodiment are shown by adding the same reference numeral to the lower case letter “h”. ing. In this case, the retracting cavity 78h is an inverted cone 77 whose base is at the proximal face 71h and whose apex is near the distal face 73h. That is, the area of the pull-in cavity 70h in the radial cross section gradually decreases toward the distal direction of the pad 35h. In this embodiment, the proximal region near the base of the cone 87 forms an instrument seal, while the distal region at the apex of the cone forms a zero seal. The conical form of the retracting cavity 70h has a funnel-like tendency to guide the instrument distally through the opening 45h and through the apex of the cone 87.
[0059]
It should be understood that the cut 45 and the retracting cavity 70 can generally be provided in a number of different and independent cooperating forms. Illustratively, the embodiment of FIGS. 21 and 22 shows a pad 35, perhaps in the simplest form, with structural elements corresponding to the previously described embodiment having the same reference numerals with a lowercase letter “j”. "Is added. In the present embodiment, a simple trapezoidal cut 45j is provided on the proximal surface 71j and the distal surface 73j of the pad 35j. In this case, the cut 45j extends between the proximal surface 71j and the distal surface 73j.
[0060]
The cut 45j in the embodiment of FIG. 21 is representative of a number of structures that will form a flat cut 45j. In such a case, the portion of the pad 35j where the cut is formed has an opposing flat surface as indicated by reference numerals 90 and 92 in FIG.
Obviously, the cut 45 need not be formed by a facing surface having a flat configuration. However, these opposing surfaces need to be able to make sealing contact with each other to establish a zero seal. Other forms of breaks that can achieve such a function would provide additional advantages in certain surgical procedures. FIGS. 23 to 26 show examples of other forms of cuts merely as examples.
[0061]
The embodiment of FIG. 23 is similar to the embodiment of FIG. 22 in that the opening 45j includes a single cut extending from the proximal surface 71j to the distal surface 73j. In the case of the embodiment of FIG. 22, the axis 47j is disposed within the plane of the cut 45j. In the case of the embodiment of FIG. 23, the plane of the cut 45j does not include the axis 47j. Rather, the cut 45j is formed in a plane that is oblique to the axis 47j, the proximal surface 71j, and the distal surface 73j. According to this structure, the cut 45j can have a length larger than the thickness of the pad 35j.
[0062]
In the embodiment of FIG. 24, the structural element corresponding to the above-described embodiment is shown by adding the lowercase letter “k” to the same reference numeral. In this case, the opening 45k is configured as two cuts 94 and 96, such as in separate planes that are obliquely separated from each other. Of course, two or more flat cuts 94 and 96 may be arranged at equal angular intervals around the axis 47k. In one embodiment, the individual flat cuts 94 and 96 intersect at an axis 47k. As a modification, the cuts 94 and 96 may be separated in the axial direction to facilitate the formation of the instrument seal.
[0063]
In the embodiment of FIG. 25, the structural element corresponding to the above-described embodiment is shown by adding the lowercase letter “m” to the same reference numeral. In the present embodiment, the opening 45m is not formed in a planar shape, but is formed as a bent cut 98. In the illustrated embodiment, the bent cut 98 is formed as a helix around the axis 47m. Along the axis 47m, the opposing surfaces forming the spiral cut 98 can "flow" in close proximity to form a seal to create a zero seal.
[0064]
FIG. 26 shows a similar embodiment comprising a spiral cut. In the present embodiment, the structural elements corresponding to the above-described embodiments are shown by adding the lowercase letter “n” to the same reference numerals. Although the spiral cut 98n in this embodiment is formed around the axis 47n of the pad 35n, in this case, the portion forming the cut 98n does not completely reach the axis 47n. . As a result, an axial passage 100 is formed that is at least partially along the axis 47n. The passage 100 functions in the same manner as the retracting cavity 70 described with reference to FIGS. The passage 100 may be formed in a conical shape similar to that described with reference to FIG.
[0065]
In embodiments where the passage 100 remains open, a zero seal may be provided by placing a septum valve over the passage 100. FIG. 27 shows such an embodiment, and the partition valve is indicated by reference numeral 101, and the structural element corresponding to the above-described embodiment is added with the lowercase letter “p” to the same reference numeral. Show. That is, the embodiment of FIG. 27 includes a spiral cut 98p, a pad 35p, and an axis 47p. This embodiment of FIG. 27 is merely a representative example of many other embodiments in which a break such as a break 98p is combined with another valve structure such as a septum valve 101.
[0066]
Other bent cut forms include embodiments in which the cut is bent into a sinusoidal shape or is S-shaped in a side view. The cut portion having such a configuration has a length that is larger than the thickness of the pad. Usually, the more the path of the cut becomes a detour, the better the sealing properties.
[0067]
In the embodiment of FIG. 28, an opening 45 having a more complicated configuration is shown, and the structural element corresponding to the above-described embodiment is shown by adding the lowercase “q” to the same reference numeral. . This embodiment is formed from intricate shapes and different materials to achieve the desired function, such that a single valve can form an instrument seal that can accommodate a full range of instrument sizes with a zero seal. This is a representative example of many other complex embodiments. In the embodiment of FIG. 28, the pad 35q is formed with a base 110 disposed around the core 112. In this case, the core 112 is formed from a superplastic material or gel and has the shape of a cone 87q as described with reference to FIGS. The base 110 is preferably made of a material that is not elastic but flexible. In a preferred embodiment, the base 110 is formed from urethane.
[0068]
In this structure, the base 110 includes a plurality of spokes 114, each of which extends radially inward from the base 116 toward the tip 118. The core 112 extends outward from the tip end portion 118 of the spoke 114 from the axis 47q. In the illustrated embodiment, the finger portion 121 of the core 112 extends beyond the tip 118 and is directed to the base 116 between each adjacent pair of spokes. These finger portions 121 extend radially outward from the end surface 123 and terminate in the middle of the base 116 to leave a cavity 125.
[0069]
In this embodiment, the cavity 125 is of particular interest and can be included in any of the previously described embodiments. Such a cavity 125 provides a space or a portion where no material is present, into which a highly elastic material constituting the finger 121 or the like is inflated during insertion of an instrument such as the arm 16. Can do. Because the properties of the gel material are mostly fluid, the cavity 125 allows the gel to expand with very little resistance. Cavities, such as cavity 125 in the embodiment of FIG. 28, can be formed in the gel material alone or between the gel material and other base materials.
[0070]
In the example of FIG. 28, the spoke 114 and the finger 121 are roughly formed in a plane that is parallel to the axis 47q. In the embodiment shown in FIG. 31, similar fingers are roughly formed in a plane perpendicular to the axis. In the present embodiment, the structural elements corresponding to the above-described embodiments are shown by adding the lowercase “r” to the same reference numerals. As shown, the pad 35r is formed with a relatively large opening 45r having the form of a coaxial cylinder 130. A plurality of fingers or flaps 132 extend into the opening 45r to form a lead-in cavity 70r having the characteristics described with reference to FIG. In this case, the annular flap 132 is in the form of a cone and extends from the base 134 to the apex 136. Note that the area between the flaps 132 forms a cavity 125r that is displaced upon insertion of an instrument such as the arm 16.
[0071]
FIG. 32 shows still another embodiment of the present invention, in which structural elements corresponding to the above-described embodiment are shown by adding the lowercase “s” to the same reference numerals. The access device 34s of this exploded view includes not only the pad 35s but also a complementary structure for holding the position of the pad 35s to form a seal between the pad 35s and the abdominal wall 21, The incision 32 can be widened to the extent required by the surgeon 14. In this case, the access device 34s includes three components: a gel cap 143, a base 145, and a retractor sheath 147.
[0072]
The gel cap 143 includes not only the gel pad 35s but also a surrounding cap ring 154 that is insert-molded to the pad 35s. The resulting gel cap 143 forms a seal with the base 145 to form a working passage 36s that passes through the pad 35s, the cap ring 154, the base 145, and the retractor sheath 147. In the manner described above, this working channel 36c includes a single valve formed by the gel pad 35s, which provides a zero seal and provides an instrument seal for a wide range of instrument diameters.
[0073]
33 and 34 show the structure related to the gel cap 143 in detail. As shown in the plan view of FIG. 33, the present embodiment includes a gel pad 35 s arranged in the center of the inside of the surrounding cap ring 154. The retention tab 156 extends radially outward of the cap ring 154. These retaining tabs 156 facilitate the sealing engagement of the gel cap 143 with the base 145, as will be described below.
[0074]
The gel pad 35c can be formed from any of the materials described above, but in a preferred embodiment includes a gel of KRATON and mineral oil. Advantageously, the cap ring 154 of such an embodiment is formed solely from KRATON. As a result, in a typical manufacturing process in which the cap ring 154 is made firmer than the gel pad 35s and the interface between the pad 35s and the ring 154 is well maintained, the cap ring is formed into a mold for the gel pad 35s. By arranging in advance, a gel cap 143 having a unified structure can be obtained.
[0075]
The cross sectional view of FIG. 34 shows a gel cap 143s and an annular cavity 158 formed on the inner periphery of the cap ring 154. This cavity 158 is particularly advantageous in that it forms a sealing relationship with the base 145 in the manner described below.
[0076]
34 and 35 respectively show the base 145 according to the present embodiment in detail in a plan view and a cross-sectional view. As shown in these figures, the base 145 has a smooth, generally cylindrical inner surface 161 that extends proximally to a rounded end surface 163 and an end surface. 163 follows an outwardly annular lip 165. The plurality of tabs 167 extend outwardly and distally at equal intervals around the circumference of the lip 165.
[0077]
An annular flange 170 is provided on the distal side of the inner surface 163 so that the size and configuration of the annular protrusion 172 form a desired sealing relationship between the gel cap 143 and the base 145. It has become. In order to facilitate the molding process of the base 145, the base may be divided into two separate components, for example as shown by the dotted line 174 in FIG. In a preferred embodiment, base 145 is formed from a polycarbonate material.
[0078]
FIG. 37 shows a retractor sheath 147 according to a preferred embodiment. As shown, the retractor sheath 147 has a tubular wall 175 that is in the form of a truncated cone at the distal end and is cylindrical in shape at the proximal end. The distal end terminates in a flexible retaining ring 152 and the proximal end is a fold 154. As shown, the tubular wall 175 includes an outer surface 180 and an inner surface 181. In a preferred embodiment, the sheath 147 is formed of an elastomer, such as neoprene, and has a truncated cone and cylindrical configuration in the normal unstretched state.
[0079]
When the sheath 147 is extended in the axial direction, the diameter of the cylindrical proximal end increases, so that a radial force is applied to the incision 32. The more the sheath 147 is stretched axially, the larger the diameter of the sheath, and thus the larger the opening through the incision 32. This feature is particularly advantageous in that the surgeon can size the incision 32 by making the axial tension of the sheath 147 appropriate. By maintaining this tension, the preferred size incision 132 is maintained throughout the procedure. In the preferred apparatus and method, the sheath 147 is pulled over the tab 167 (see FIG. 34) of the base 145 to maintain axial tension. A mark 182 is printed on the sheath 147 and serves as an index indicating the relationship between the axial extension of the sheath 147 and the size of the incision 32.
[0080]
A fold 153 is provided to facilitate grasping of the proximal end of the sheath 147. The fold 153 also functions to reinforce the portion where the wall of the sheath 147 is engaged with the tab 167 of the base 145. In the embodiment shown in FIG. 38, additional folds 184 and 186 are provided at positions spaced apart in the axial direction, and have the same configuration as the mark 182 in FIG. These folds 184 and 186 provide additional reinforcement points for engaging tabs 167 and provide sheath 147 with a predetermined amount of axial extension associated with different sized incisions 32. Can be provided.
[0081]
39 to 42 show the usage method of the embodiment of FIG. 32 in order. FIG. 39 shows a plan view of the abdominal wall 21 of the patient 10, and the template 195 is positioned to easily determine the position of the incision 32. The size of the incision 32 is determined using indicia 182 on the template 195 showing a plurality of length lines 197, each of which is the size of the slot for the surgeon's hand 17. It corresponds. Since the surgeon knows the size of his slot, he simply needs to make an incision according to the appropriate line 197. The longer line 197 is associated with a larger incision and the longer slot size corresponds to the larger hand 17. After making the incision 32 along line 197, the template is removed.
[0082]
Next, as shown in FIG. 40, a retractor sheath 147 is attached through the incision 32. Initially, the ring 152 is compressed and fed through the incision 32. On the inner surface of the abdominal wall 21, the ring 152 is free-released and expands to a large diameter, as shown by the dashed line 158 in FIG. As shown in FIG. 40, the portion of wall 176 that forms cylinder 177 is left proximally through opening 32.
[0083]
A base 145 is placed around the incision 32 before or after insertion of the sheath 147. The exposed portion of the sheath 147 then extends through the incision 32 and is disposed within the circumference of the base 145. As shown in FIG. 41, the wall 176 of the sheath 147 is pulled in the proximal direction and in the direction out of the paper surface of FIG. As described above, when the sheath 147 is extended in the axial direction, the sheath creates a radial force against the abdominal wall 21, which tends to enlarge the incision 32. The greater the axial extension, the larger the incision 32 will be.
[0084]
Once the incision 32 has the desired size, the stretched sheath 147 is hooked on the tab 167 to maintain the axial extension and maintain the desired size of the incision 32. Either the indicia 182 shown in FIG. 36 or the additional folds 184 and 186 shown in FIG. 37 are aligned with the tabs 167 to provide a predetermined size incision 32. At this point, the hermetic seal between the abdominal wall 21, the sheath 147, and the base 145 is fully established.
[0085]
The final step left in this procedure is to attach the gel cap 143 to the base 145. To do so, the lip 172 of the base 145 is captured in the annular cavity 158 of the gel cap 143 as shown in FIG. By bending the retention tab 156 upward and outward, such engagement is facilitated to form a final seal between the base 145 and the gel cap 143.
[0086]
FIG. 43 shows still another embodiment of the present invention, in which structural elements corresponding to the above-described embodiment are shown by adding the lowercase letter “t” to the same reference numerals. In this side elevation, the body cavity 18 and abdominal wall 21 are shown along an access device 34t in the form of a pad 35t. In the present embodiment, a retaining ring 152t and a retractor sheath 147t are shown.
[0087]
In this case, a device and method that allows the abdominal wall 18 to be illuminated and viewed from outside the abdominal cavity 18 are of particular interest. For example, in the illustrated embodiment, the light source 200 is disposed outside the abdominal wall 21. From such a position, the light source 200 provides a light path that is directed onto the pad 35t. By forming the access device 34t from a translucent material, the device 34t can function as a window that allows light to illuminate the abdominal cavity 18 completely. Such translucent properties that facilitate illumination of the abdominal cavity 18 also allow an observer to view the illuminated abdominal cavity 18. That is, the access device 34t made of a translucent gel material facilitates illumination from the outside and allows the abdominal cavity to be directly viewed. Of course, transparent materials will further facilitate such illumination and visibility.
[0088]
44 and 45 show an access device 34t according to another embodiment of such a lighting device, where the light source 200 is composed of a plurality of lighting devices and is embedded in the translucent material of the pad 35t. By arranging the plurality of lighting devices 200 around the circumference or the periphery of the pad 35t, the generation of shadows can be substantially eliminated. Accordingly, the lighting device related to the present invention is supported by or embedded in the access device 34t, or is disposed outside the access device 34t.
[0089]
Although the invention has been described with reference to certain structural forms, it should be understood that these embodiments are merely representative of many embodiments of the invention. Accordingly, those skilled in the art should not limit the concept of the invention to the disclosed embodiments, but the scope of the invention should only be determined by reference to the claims.
[Brief description of the drawings]
[Figure 1]
FIG. 1 is a schematic view showing a state where gas is blown into the abdomen of a patient lying on the operating table, and access to the instrument is provided by the trocar and the access device according to the present invention. It is.
[Figure 2]
FIG. 2 is an enlarged side elevational view showing a state in which the access device of FIG. 1 is disposed outside the abdominal wall during surgery.
[Fig. 3]
FIG. 3 is a side elevational view similar to FIG. 2 showing the access device being placed inside the abdominal wall during surgery.
[Fig. 4]
FIG. 4 is a side elevational view similar to FIG. 2 showing the access device being placed inside the abdominal wall incision during surgery.
[Figure 5]
FIG. 5 is a plan view taken along line 5-5 in FIG.
[Fig. 6]
FIG. 6 is a side elevational view similar to FIG. 2 showing an access device according to another embodiment comprising an outer flange and an inner flange.
[Fig. 7]
FIG. 7 is a side elevational view similar to FIG. 6, showing the surgeon's hand inserted through the access device.
[Fig. 8]
8 is a cross-sectional view in the axial direction showing the access device of FIG.
FIG. 9
FIG. 9 is a cross-sectional view similar to FIG. 8 and shows an embodiment in which a reinforcing member is provided around the periphery.
FIG. 10
FIG. 10 is an axial cross-sectional view similar to FIG. 9 showing an access device according to the present invention comprising a double ring retractor.
FIG. 11
FIG. 11 is a radial cross-sectional view similar to FIG. 8, showing an embodiment having a retracting cavity or pocket.
FIG.
FIG. 12 is a plan view showing the embodiment of FIG.
FIG. 13
13 is a cross-sectional view in the axial direction along line 13-13 in FIG.
FIG. 14
14 is an axial cross-sectional view along line 14-14 of FIG.
FIG. 15
FIG. 15 is an axial cross-sectional view similar to FIG. 13 and shows an embodiment with a beak-shaped valve.
FIG. 16
FIG. 16 is an axial cross-sectional view along line 16-16 in FIG.
FIG. 17
FIG. 17 is a radial cross-sectional view similar to FIG. 13 with a softer hand seal and a stiffer base seal.
FIG. 18
FIG. 18 is an axial cross-sectional view taken along line 18-18 of FIG.
FIG. 19
FIG. 19 is an axial cross-sectional view showing an embodiment having a retracting cavity or pocket in the form of a cone or funnel.
FIG. 20
FIG. 20 is a plan view of the embodiment shown in FIG.
FIG. 21
FIG. 21 is an axial cross-sectional view similar to FIG. 13 and shows another embodiment provided with a trapezoidal cut.
FIG. 22
22 is a cross-sectional view in the axial direction along line 22-22 of FIG.
FIG. 23
FIG. 23 is an axial cross-sectional view similar to FIG. 22 along line 23-23 of FIG. 21, showing an embodiment having a cut that is not perpendicular to the surface of the pad. Yes.
FIG. 24
FIG. 24 is a perspective view of an access device according to yet another embodiment having an opening formed by a plurality of cuts that are angled apart from each other in an axial direction. Show.
FIG. 25
FIG. 25 is a side elevation view showing an access device provided with a spiral cut.
FIG. 26
FIG. 26 is a plan view showing an access device having a spiral cut and an axial passage.
FIG. 27
FIG. 27 is a side elevational view showing an embodiment having a spiral cut and a septum seal.
FIG. 28
FIG. 28 is an axial cross-sectional view of yet another embodiment that includes a superplastic conical seal and a flexible base with an annular spoke-like cam.
FIG. 29
29 is an axial cross-sectional view taken along line 29-29 in FIG.
FIG. 30
30 is an axial cross-sectional view taken along line 30-30 in FIG.
FIG. 31
FIG. 31 is an axial cross-sectional view similar to FIG. 28, showing an embodiment including a flapper.
FIG. 32
FIG. 32 is an exploded perspective view showing still another embodiment, which includes a gel cap, a base, and a retractor sheath.
FIG. 33
FIG. 33 is a plan view showing the gel cap of FIG.
FIG. 34
34 is an axial cross-sectional view taken along line 34-34 of FIG.
FIG. 35
FIG. 35 is a plan view showing the base of FIG.
FIG. 36
36 is an axial cross-sectional view taken along line 36-36 of FIG.
FIG. 37
FIG. 37 is a side elevation view showing the retractor sheath of FIG.
FIG. 38
FIG. 38 is a side elevation view showing a retractor sheath according to yet another embodiment.
FIG. 39
FIGS. 39-42 show the progression of steps for the preferred embodiment of FIG. 32, and FIG. 39 is a plan view showing the use of templates.
FIG. 40
FIG. 40 is a plan view showing the placement of the retractor sheath.
FIG. 41
FIG. 41 is a plan view showing the arrangement of the base ring and the fixation of the retractor sheath.
FIG. 42
FIG. 42 is an axial cross-sectional view showing a part of the arrangement of the gel cap with respect to the base.
FIG. 43
FIG. 43 is a schematic view showing an illumination device including an external light source and a translucent access device.
FIG. 44
FIG. 44 is a side elevational view showing still another embodiment, in which a light source is embedded in an access device.
FIG. 45
FIG. 45 is a plan view showing the embodiment of FIG.

Claims (14)

A combination for illuminating an internal region of a body cavity formed by a body wall having an outer surface, the combination comprising:
A light source disposed outside the body cavity, wherein the light source irradiates light into the body cavity along a light path;
A translucent material supported by the body wall for an internal region of the body cavity,
The translucent material is disposed in the light path and has the property of transmitting at least a portion of the light from the light source into the body cavity to illuminate an internal region of the body cavity.
A combination characterized by that. The combination according to claim 1, wherein the translucent material is a gel. A combination according to claim 2, characterized in that the gel is an ultragel. The combination of claim 1, wherein the translucent material comprises an access device adapted to receive a surgical instrument across the body wall and into the body cavity. 5. A combination as claimed in claim 4, characterized in that the access device has such characteristics as to form a zero seal in the absence of an instrument and an instrument seal in the presence of the instrument. 5. A combination according to claim 4, wherein the light source is supported by an access device. 7. A combination according to claim 6, wherein the light source is at least partially embedded in a translucent material. 8. A combination according to claim 7, wherein the access device has an outer edge and the light source is arranged around the outer edge of the access device. A method for illuminating an internal region of a body cavity formed by a body wall, the method comprising:
Incising the body wall and providing a working passage through the body wall and into the body cavity;
Positioning the access device relative to the body wall, wherein the access device is sized and configured to receive a surgical instrument through the working passage and into the body cavity;
Providing a light source for illuminating an internal region of the body cavity;
Illuminating the access device outside the body cavity with light from the light source;
Forming an access device of translucent material, wherein at least a portion of the irradiated light is passed through the access device to illuminate an internal region of the body cavity;
A method characterized by comprising: The method is further
Injecting gas into the body cavity in the laparoscopic procedure,
Providing an access device comprising a valve having characteristics to form an instrument seal in the presence of the instrument;
The method of claim 9, comprising: The method of claim 10, wherein providing includes providing a valve that is characteristic to form a zero seal in the absence of an instrument. The method of claim 9, wherein forming comprises providing a translucent material in the form of a gel. 13. The method of claim 12, wherein forming comprises providing a gel that is in the form of an ultragel. 10. The method of claim 9, wherein forming comprises forming a translucent material access device.