US20160158468A1 - Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures - Google Patents

Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures Download PDF

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Publication number
US20160158468A1
US20160158468A1 US14/907,517 US201314907517A US2016158468A1 US 20160158468 A1 US20160158468 A1 US 20160158468A1 US 201314907517 A US201314907517 A US 201314907517A US 2016158468 A1 US2016158468 A1 US 2016158468A1
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United States
Prior art keywords
lumen
pump
recited
insufflation
abdominal cavity
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.)
Abandoned
Application number
US14/907,517
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English (en)
Inventor
Raymond Yue-Sing Tang
Kenneth Blier
Ralph Stearns
Kurt Azarbarzin
Dominick Mastri
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Surgiquest Inc
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Surgiquest Inc
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Filing date
Publication date
Application filed by Surgiquest Inc filed Critical Surgiquest Inc
Priority to US14/907,517 priority Critical patent/US20160158468A1/en
Publication of US20160158468A1 publication Critical patent/US20160158468A1/en
Abandoned legal-status Critical Current

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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
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A61M13/003—Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing
    • A61M13/006—Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing with gas recirculation
    • 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
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A61B2218/006—Irrigation for smoke evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007—Aspiration
    • A61B2218/008—Aspiration for smoke evacuation
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3337—Controlling, regulating pressure or flow by means of a valve by-passing a pump
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3344—Measuring or controlling pressure at the body treatment site
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/75—General characteristics of the apparatus with filters
    • A61M2205/7545—General characteristics of the apparatus with filters for solid matter, e.g. microaggregates
    • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
    • F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
    • F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
    • F04C2270/00—Control; Monitoring or safety arrangements
    • F04C2270/04—Force
    • F04C2270/041—Controlled or regulated

Definitions

  • the subject invention is directed to laparoscopic surgery, and more particularly, to systems and methods for conducting smoke removal and evacuation from the abdominal cavity of a patient during a laparoscopic surgical procedure utilizing a dual lumen cannula.
  • Laparoscopic or “minimally invasive” surgical techniques are becoming commonplace in the performance of procedures such as cholecystectomies, appendectomies, hernia repair and nephrectomies. Benefits of such procedures include reduced trauma to the patient, reduced opportunity for infection, and decreased recovery time.
  • Such procedures within the abdominal (peritoneal) cavity are typically performed through a device known as a trocar or cannula, which facilitates the introduction of laparoscopic instruments into the abdominal cavity of a patient.
  • a pneumoperitoneum commonly involve filling or “insufflating” the abdominal (peritoneal) cavity with a pressurized fluid, such as carbon dioxide, to create what is referred to as a pneumoperitoneum.
  • a pressurized fluid such as carbon dioxide
  • the insufflation can be carried out by a surgical access device, e.g., a cannula or trocar, equipped to deliver insufflation fluid, or by a separate insufflation device, such as an insufflation (veress) needle.
  • a surgical access device e.g., a cannula or trocar
  • a separate insufflation device such as an insufflation (veress) needle.
  • Introduction of surgical instruments into the pneumoperitoneum without a substantial loss of insufflation gas is desirable, in order to maintain the pneumoperitoneum.
  • a surgeon makes three to four small incisions, usually no larger than about twelve millimeters each, which are typically made with the surgical access devices themselves, typically using a separate inserter or obturator placed therein. Following insertion, the inserter is removed, and the trocar allows access for instruments to be inserted into the abdominal cavity. Typical trocars often provide means to insufflate the abdominal cavity, so that the surgeon has an open interior space in which to work.
  • the trocar must provide a means to maintain the pressure within the cavity by sealing between the trocar and the surgical instrument being used, while still allowing at least a minimum freedom of movement of the surgical instruments.
  • Such instruments can include, for example, scissors, grasping instruments, and occluding instruments, cauterizing units, cameras, light sources and other surgical instruments.
  • Sealing elements or mechanisms are typically provided on trocars to prevent the escape of insufflation gas. Sealing elements or mechanisms typically include a duckbill-type valve made of a relatively pliable material, to seal around an outer surface of surgical instruments passing through the trocar.
  • electrocautery and other techniques create smoke and other debris in the surgical cavity, reducing visibility by fogging the view from, and coating surfaces of endoscopes and the like.
  • harmonic scalpels e.g. harmonic scalpels
  • SurgiQuest, Inc. Milford, Conn. USA has developed surgical access devices that permit access to an insufflated surgical cavity without conventional mechanical seals, and has developed related systems for providing sufficient pressure and flow rates to such access devices, as described in whole or in part in U.S. Pat. No. 7,854,724.
  • the subject disclosure is directed to a new and useful surgical gas delivery system for use during laparoscopic surgical procedures, e.g., in an abdominal cavity of a patient, and more particularly, to an insufflation and smoke evacuation system that includes a pump for circulating pressurized gas within the system and a dual lumen cannula configured to provide access to the abdominal cavity of a patient, which includes a first lumen communicating with the source of insufflation fluid and a second lumen communicating with the pump.
  • the dual lumen cannula includes a first lumen communicating with the source of insufflation fluid and a pressure side of the pump for delivering pressurized gas and insufflation fluid to the abdominal cavity, and a second lumen communicating with a suction side of the pump for removing gas from the abdominal cavity.
  • the dual lumen cannula includes a first lumen communicating with the source of insufflation fluid and a second lumen communicating with a pressure side of the pump for delivering pressurized gas to the abdominal cavity.
  • the system includes a second cannula which has a single lumen communicating with a suction side of the pump for removing gas from the abdominal cavity.
  • a bypass valve is operatively associated with the pump for controlling a gas circulation rate within the system.
  • a mechanical seal is operatively associated with the second lumen to maintain abdominal pressure, and the first lumen serves as a sense line for sensing abdominal pressure.
  • a filter device is also provided for filtering gas circulating through the system to remove smoke and debris therefrom.
  • FIG. 1 is cross-sectional view of the upper portion of a dual lumen cannula constructed in accordance with a preferred embodiment of the subject invention, which includes, among other things a mechanical duckbill seal;
  • FIG. 2 is a schematic drawing of an embodiment of the insufflation and smoke evacuation system of the subject invention, which employs the dual lumen cannula shown in FIG. 1 , as well as an additional single lumen cannula;
  • FIG. 3 is s schematic drawing of an embodiment of the insufflation and smoke evacuation system of the subject invention, which employs the dual lumen cannula shown in FIG. 1 ;
  • FIG. 4 is a schematic drawing of yet another embodiment of the insufflation and smoke evacuation system of the subject invention, which employs a tri-lumen cannula, as well as an additional single lumen cannula.
  • FIG. 1 a partial view of an exemplary embodiment of an insufflation and smoke evacuation system in accordance with the disclosure is shown in FIG. 1 and is designated generally by reference character 10 .
  • FIGS. 2-4 Other embodiments of insufflation and smoke evacuation systems in accordance with the disclosure, or aspects thereof, are provided in FIGS. 2-4 , as will be described.
  • the systems, devices and methods presented herein may be used for surgical gas delivery, including insufflation, smoke evacuation, and/or recirculation in connection with suitable surgical devices, and in applicable surgical procedures.
  • the present invention relates to multimodal systems, and related devices and methods, capable of performing multiple surgical gas delivery functions, including insufflation to standard or specialized surgical access devices or other instruments, such as veress needles and the like, smoke evacuation through standard or specialized surgical access devices, and specialized functions, such as recirculation and filtration of insufflation fluids, such as with the above-mentioned surgical access devices described for example in U.S. Pat. No. 7,854,724; as well as those in U.S. Pat. Nos. 7,182,752; 7,285,112; 7,413,559 or 7,338,473; each of which is incorporated by reference herein in its entirety.
  • the present invention is particularly suited for minimizing the amount of equipment needed in a surgical operating room, in that the subject systems are capable of performing multiple functions, and therefore also allow flexibility of surgical technique. It is envisioned that the gas delivery system disclosed herein can be used in general laparoscopic procedures including but not limited to laparoscopic cholecystectomy, laparoscopic appendectomy, laparoscopic hernia repair, Nissen-Y and Lap Nephrectomy.
  • Access device 10 is configured as a dual lumen cannula. That is, it includes a proximal housing 12 , an outer cannula 14 and an inner cannula 16 .
  • the inner cannula 16 defines a central or inner lumen 18 and an annular or outer lumen 20 is formed between the outer cannula 14 and the inner cannula 16 .
  • the housing 12 includes a first flow port 28 communicating with the central lumen of the inner cannula 16 and a second flow port 30 communicating with the annular passage 20 .
  • a main access port 32 is provided in the end cap 34 of the housing 12 , and a duckbill seal 36 is supported within the housing 12 to prevent the egress of pressurized gas from the device through the access port 32 .
  • gas from the abdomen e.g., pneumoperitoneum 116
  • interchanges with gas coming from the access device 10 a portion of which is collected and recycled through the system, and is re-pressurized along the way, passing through one or more filters, e.g., filter 123 described below.
  • filters e.g., filter 123 described below.
  • smoke and/or other circulating debris such as atomized fluids, are removed by the filters, improving visibility within the surgical cavity, thus aiding in the surgical procedure.
  • An example of a filter that can be utilized with the subject invention is disclosed in U.S. Pat. No. 8,088,189, the disclosure of which is herein incorporated by reference in its entirety.
  • FIG. 2 there is illustrated an insufflation and smoke evacuation system constructed in accordance with the subject invention and designated generally by reference numeral 100 that includes a recirculation pump 112 for circulating pressurized gas within the system.
  • the system 100 includes a dual lumen cannula 10 as illustrated in FIG. 1 .
  • the dual lumen cannula 10 includes a first or outer lumen 20 communicating with a source of insufflation fluid 114 through a conduit 115 connected to the flow port 30 in housing 12 .
  • the source of insufflation fluid 114 maintains pressure within pneumoperitoneum 116 .
  • the outer lumen 20 of dual lumen cannula 10 also serves as a sense line for sensing and controlling abdominal pressure within the system 100 .
  • the dual lumen cannula 10 of system 100 further includes a second or central lumen 18 communicating with a pressure or supply side of the recirculation pump 112 through a conduit 117 connected to the flow port 28 in housing 12 for delivering pressurized gas to the abdominal cavity, e.g., for recirculation as described below.
  • system 100 includes a second cannula 150 which has a single lumen that communicates with a suction side of the recirculation pump 112 through a conduit 119 , e.g., by way of a luer connection, for removing gas from the abdominal cavity.
  • System 100 further includes a bypass valve 125 that is operatively associated with the recirculation pump 112 through a conduit 121 connecting conduit 117 to conduit 119 to control the gas circulation rate within the system 100 .
  • bypass valve 125 When bypass valve 125 is closed, pump 112 recirculates gas through connecting conduit 117 , central lumen 18 , pneumoperitoneum 116 , second cannula 150 , and conduit 119 , which includes a filter 123 .
  • Filter 123 can remove smoke, particles, moisture, and the like from the insufflation gas circulating through pneumoperitoneum 116 .
  • Bypass valve 112 can be opened and adjusted as needed to reduce the flow of recirculation through pneumoperitoneum 116 .
  • FIG. 3 there is illustrated another insufflation and smoke evacuation system constructed in accordance with the subject invention and designated generally by reference numeral 200 that includes a recirculation pump 212 for circulating pressurized gas within the system.
  • the system 200 further includes a dual lumen cannula 10 as illustrated in FIG. 1 .
  • the dual lumen cannula 10 includes a first annular lumen 20 communicating with a source of insufflation fluid 214 and a high pressure side (or supply side) of the pump 212 through a conduit 217 connected to the flow port 30 in housing 12 .
  • the annular lumen 20 of dual lumen cannula 10 also serves as a sense line for sensing abdominal pressure within the system 200 .
  • the dual lumen cannula 10 further includes a second lumen 18 communicating with the suction side of the recirculation pump 212 through a conduit 219 connected to the flow port 28 of housing 12 for removing gas from the abdominal cavity, e.g. pneumoperitoneum 116 of FIG. 1 .
  • second lumen 18 has only one line, namely conduit 219 , which is a suction line, i.e., there is no sense/insufflation line for second lumen 18 .
  • System 200 further includes a bypass valve 225 that is operatively associated with the recirculation pump 212 through a conduit 221 connecting conduit 217 to conduit 219 to control the rate of gas circulation within the system 200 .
  • Bypass valve 225 can be used to control the amount of recirculation flow through dual lumen cannula 10 as described above.
  • Filter 223 operates as described above with respect to filter 123 .
  • System 300 includes a source of insufflation gas 314 , pump 312 , bypass valve 325 , second cannula 350 , and filter 323 , and is substantially identical to the system 100 shown in FIG. 2 , except that system 300 includes a tri-lumen cannula 320 and a communication line 360 that extends between the inner bowl area of the cannula 320 and the vacuum line 319 .
  • the tri-lumen cannula 320 is used as an access port for a laparoscope, smoke will exit the abdominal cavity in an area that is located away from the distal end of the scope so as not to adversely impact visibility through the scope.

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US14/907,517 2012-11-20 2013-11-20 Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures Abandoned US20160158468A1 (en)

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US201261728608P 2012-11-20 2012-11-20
US201361826088P 2013-05-22 2013-05-22
PCT/US2013/070933 WO2014081783A1 (en) 2012-11-20 2013-11-20 Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures
US14/907,517 US20160158468A1 (en) 2012-11-20 2013-11-20 Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures

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