WO2006100658A2 - A surgical instrument - Google Patents

A surgical instrument Download PDF

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Publication number
WO2006100658A2
WO2006100658A2 PCT/IE2006/000018 IE2006000018W WO2006100658A2 WO 2006100658 A2 WO2006100658 A2 WO 2006100658A2 IE 2006000018 W IE2006000018 W IE 2006000018W WO 2006100658 A2 WO2006100658 A2 WO 2006100658A2
Authority
WO
WIPO (PCT)
Prior art keywords
shaft
instrument
end effector
surgical
distal
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.)
Ceased
Application number
PCT/IE2006/000018
Other languages
English (en)
French (fr)
Other versions
WO2006100658A3 (en
Inventor
Frank Bonadio
John Butler
Trevor Vaugh
Catherine Deegan
Shane Joseph Macnally
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.)
Atropos Ltd
Original Assignee
Atropos Ltd
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 Atropos Ltd filed Critical Atropos Ltd
Priority to EP06711131A priority Critical patent/EP1861022A2/en
Priority to JP2008502552A priority patent/JP2008534045A/ja
Publication of WO2006100658A2 publication Critical patent/WO2006100658A2/en
Publication of WO2006100658A3 publication Critical patent/WO2006100658A3/en
Anticipated expiration legal-status Critical
Ceased 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
    • 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
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0042—Surgical instruments, devices or methods with special provisions for gripping
    • A61B2017/00424—Surgical instruments, devices or methods with special provisions for gripping ergonomic, e.g. fitting in fist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
    • A61B2017/00464—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable for use with different instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00738—Aspects not otherwise provided for part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2902—Details of shaft characterized by features of the actuating rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2904—Details of shaft curved, but rigid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2931—Details of heads or jaws with releasable head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A61B2017/3447—Linked multiple cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A61B2017/3449—Cannulas used as instrument channel for multiple instruments whereby the instrument channels merge into one single channel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • A61B2017/3466—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 for simultaneous sealing of multiple instruments

Definitions

  • a retractor can help to expose an operative site and minimise the incision required to carry out the operation.
  • Minimally invasive surgery is an evolving surgical method that attempts to reduce the size of incisions required, in many cases dramatically.
  • a so-called "keyhole” or cannula the surgeon can gain access with instruments into the abdominal cavity to carry out an operation through a very small series of holes in the abdominal wall.
  • primary retraction then must be accomplished by lifting the abdominal wall away from the abdominal viscera.
  • a cannula comprises a rigid tube, which is inserted through the abdominal wall and is held in place by the tension of the abdominal wall itself around the inserted cannula.
  • the tube must accommodate various thicknesses of abdominal wall and extend significantly both inside and outside the abdomen to avoid slipping out of the incision, and thereby causing gas pressure to escape.
  • a cannula is held in place, and thus prevents the escape of gas, by tissue tension. This tension can vary depending on the way the cannula is introduced or weaken during the operation under normal surgical manipulation.
  • a cannula extends significantly into the abdominal cavity taking up precious space and interfering with other instruments.
  • a cannula restricts the movement of instruments as they are rigid structures.
  • a rigid cannula presents significant limitations on the design of the instrument which must be passed through the cannula.
  • a cannula takes up a significant space outside of the abdomen, shortening the effective length, and therefore reach, of the surgical instrument.
  • This invention is aimed at addressing at least some of these problems.
  • a surgical device comprising a shaft, the shaft comprising a distal section, a proximal section, and a bend section located between the distal section and the proximal section.
  • the distal section is substantially parallel to the proximal section.
  • the distal section and proximal section may be substantially coaxial.
  • the distal section and the proximal section may be substantially offset.
  • the distal section is substantially straight.
  • the proximal section may be substantially straight.
  • the bend section may be at least partially of curved shape.
  • the bend section may be at least partially of arcuate shape. In one embodiment the bend section is pre-set.
  • the shaft may be at least partially rigid.
  • a distal region of the shaft adjacent a distal end of the shaft may be rigid.
  • a proximal region of the shaft adjacent a proximal end of the shaft may be rigid.
  • the shaft may be at least partially malleable.
  • the shaft may be at least partially flexible. An intermediate region of the shaft intermediate the proximal region and the distal region may be flexible.
  • the shaft defines a lumen extending therethrough.
  • the surgical device may comprise a cannula.
  • the surgical device comprises an instrument.
  • the surgical device may comprise an end effector at a distal end of the shaft.
  • the end effector may be releasably coupled to the distal end of the shaft.
  • the radial dimension of the end effector may be substantially greater than the radial dimension of the shaft.
  • the end effector may be movable between an open configuration and a closed configuration.
  • the end effector may be movable relative to the shaft.
  • the end effector may be translatable relative to the shaft.
  • the end effector may be rotatable relative to the shaft.
  • the end effector may be translatable and rotatable relative to the shaft.
  • the surgical device comprises an actuator for actuating the end effector.
  • the actuator may be movable between an end effector open configuration and an end effector closed configuration.
  • the actuator may be biased towards an end effector open configuration.
  • the actuator may be movable along the shaft.
  • the actuator may be movable parallel to the longitudinal axis of the shaft.
  • the actuator may comprise a plunger.
  • the surgical device comprises a coupling member to couple the actuator to the end effector.
  • the coupling member may comprise at least one tubular element.
  • the tubular element may extend between the actuator and the end effector.
  • the coupling member may comprise a first tubular element extending from the actuator and a second tubular element extending from the end effector.
  • the coupling member may comprise a universal joint to couple the first tubular element to the second tubular element.
  • the shaft may define a lumen extending therethrough. The coupling member may be at least partially located within the lumen.
  • the invention provides in one case a laparoscopic surgical device.
  • a surgical instrument comprising a shaft, an end effector at a distal end of the shaft, and an actuator for actuating the end effector, the actuator being movable along the shaft between an end effector open configuration and an end effector closed configuration.
  • the actuator is movable parallel to the longitudinal axis of the shaft.
  • the actuator may comprise a plunger.
  • the actuator may be biased towards an end effector open configuration.
  • the end effector may be releasably coupled to the distal end of the shaft.
  • the end effector may be movable between an open configuration and a closed configuration.
  • the end effector may be movable relative to the shaft.
  • the end effector may be translatable relative to the shaft.
  • the end effector may be rotatable relative to the shaft.
  • the end effector may be translatable and rotatable relative to the shaft.
  • the shaft is at least partially flexible.
  • the shaft may be at least partially malleable.
  • the shaft may be at least partially rigid.
  • a distal region of the shaft adjacent a distal end of the shaft may be rigid.
  • a proximal region of the shaft adjacent a proximal end of the shaft may be rigid.
  • An intermediate region of the shaft intermediate the proximal region and the distal region may be flexible.
  • the shaft of the instrument is configured for insertion through a surgical device shaft.
  • the invention provides a surgical instrument comprising a shaft and an end effector at a distal end of the shaft, the radial dimension of the end effector being substantially greater than the radial dimension of the shaft.
  • the invention provides a laparoscopic surgical instrument.
  • the invention also provides in another aspect a surgical access system comprising:-
  • a surgical access port configured for location adjacent to an incision
  • a surgical device of the invention for insertion through the access port.
  • the access port comprises an access valve or seal, through which the surgical device is insertable.
  • the access valve or seal may comprise a gelatinous elastomeric material for receiving the surgical device.
  • the access valve or seal may have a pin hole therein to receive the surgical device.
  • the access port comprises a retractor.
  • the access valve or seal may be mounted or mountable to the retractor.
  • the retractor may comprise:-
  • the retractor may comprise a proximal ring for location externally of an incision, with the elongate member extending between the distal anchoring member and the proximal ring.
  • the distal anchoring member may comprise a distal ring.
  • the distal ring may be formed from an elastomeric material.
  • the elongate member may comprise a sleeve.
  • the elongate member may comprise a single material layer. At least a portion of the elongate member may comprise two material layers.
  • the elongate member may be wrapped around the distal anchoring member.
  • the elongate member may be fixed to the proximal ring at one end, and the elongate member may extend from the proximal ring to the distal anchoring member to define an inner material layer, and the elongate member may extend from the distal anchoring member to the proximal ring to define an outer material layer.
  • the elongate member may be slidingly received over a portion of the proximal ring.
  • the proximal ring may comprise an inner proximal ring member and an outer proximal ring member between which the elongate member is led.
  • the surgical device comprises a first surgical instrument.
  • the surgical device may comprise a first end effector at a distal end of the shaft.
  • the system comprises a second surgical device for insertion through the access port.
  • the second surgical device may comprise a shaft comprising a bend section.
  • the second surgical device may comprise a second surgical instrument.
  • the second surgical device may comprise a second shaft, and a second end effector at a distal end of the second shaft.
  • the first end effector and the second end effector may be of the same type of end effector.
  • the first end effector and the second end effector may be different types of end effectors.
  • system comprises a third surgical device for insertion through the access port.
  • At least one of the surgical devices may comprise a laparoscope.
  • the system comprises a surgical instrument comprising a shaft, the instrument shaft being insertable through the surgical device shaft.
  • the instrument may comprise an instrument of the invention.
  • the invention provides a laparoscopic surgical access system.
  • a method of performing a surgical procedure comprising the steps of:-
  • the surgical device substantially maintaining the desired position and/or orientation within the wound interior after release of the manipulating action.
  • the manipulating action comprises a manipulating force to manipulate the surgical device into a desired position.
  • the manipulating action may comprise a manipulating torque to manipulate the surgical device into a desired orientation.
  • the method may comprise the step of sealing the wound opening.
  • the method may comprise the step of retracting the wound opening.
  • the surgical device comprises a surgical instrument.
  • the surgical device may comprise a shaft, the shaft comprising a bend section.
  • an access port comprising an access valve or seal for location adjacent to an incision; and a surgical device having a shaft for location in the valve adjacent to the incision, the shaft having a bend therein.
  • the shaft comprises a distal section and a proximal section and the bend is located between the distal and proximal sections.
  • the distal section may be substantially parallel to the proximal section.
  • the distal and proximal sections may be substantially co-axial. Alternatively the distal and proximal sections are substantially offset.
  • the bend is at least partially of curved shape.
  • the bend may be at least partially of arcuate shape.
  • the bend in the shaft is pre-set.
  • the shaft may be at least partially malleable or at least partially flexible.
  • the shaft defines a lumen extending therethrough.
  • the surgical device may comprise a cannula.
  • the system comprises an instrument having a shaft, the instrument shaft being insertable through the surgical device shaft.
  • the instrument shaft may be at least partially flexible.
  • the instrument shaft may be at least partially malleable.
  • the instrument shaft may be at least partially rigid.
  • a distal region of the instrument shaft adjacent a distal end of the instrument shaft is rigid.
  • a proximal region of the instrument shaft adjacent a proximal end of the instrument shaft may be rigid.
  • An intermediate region of the instrument shaft intermediate the proximal and distal regions may be flexible.
  • the instrument comprises an end effector at a distal end of the instrument.
  • the end effector may be releasably coupled to the distal end of the instrument shaft.
  • the instrument may comprise an actuator for actuating the end effector.
  • the actuator may be movable between an end effector open configuration and an end effector closed configuration.
  • the actuator may be biased towards the end effector open configuration.
  • the actuator may be movable along the instrument shaft.
  • the actuator may be movable parallel to the longitudinal axis of the instrument shaft.
  • the actuator may comprise a plunger.
  • the system may comprise a second surgical device for insertion through the access port.
  • the second device comprise a shaft having a bend therein.
  • the system may comprise a third surgical device for insertion through the access port.
  • At least one of the surgical devices comprises a laparoscope.
  • the access valve or seal may comprise a gelatinous elastomeric material for receiving the surgical device.
  • the access valve or seal may have a pin hole therein to receive a surgical device.
  • the access port comprises a retractor to which the access valve or seal is mounted or mountable.
  • the retractor comprises: -
  • the elongate member comprises a sleeve.
  • the sleeve may comprise a single material layer or at least a portion of the sleeve may comprise two material layers.
  • the sleeve is wrapped around the distal anchoring member.
  • the distal anchoring member may comprise a distal ring which may be formed from an elastomeric material.
  • the retractor comprises: -
  • a sleeve having a portion between the distal ring and the proximal ring that includes two material layers.
  • the sleeve may be fixed to the proximal ring at one end, and the sleeve may extend from the proximal ring to the distal ring to define the inner material layer, and the sleeve may extend from the distal ring to the proximal ring to define an outer material layer.
  • the sleeve may be slidingly received over a portion of the proximal ring.
  • the proximal ring comprises an inner proximal ring member and an outer proximal ring member between which the sleeve is led.
  • the invention also provides surgical device having a shaft, the shaft having a bend therein located between a distal section and a proximal section of the shaft.
  • the distal section may be substantially parallel to the proximal section.
  • the distal and proximal sections are substantially co-axial.
  • the distal and proximal sections are substantially offset.
  • the bend may be at least partially of curved shape.
  • the bend may be at least partially of arcuate shape.
  • the bend in the shaft is pre-set.
  • the shaft may be at least partially malleable or at least partially flexible.
  • the shaft defines a lumen extending therethrough.
  • the surgical device may comprise a cannula.
  • the invention provides an instrument having a shaft, the instrument shaft being insertable through a surgical device shaft.
  • the instrument shaft is at least partially flexible.
  • the instrument shaft may be at least partially malleable.
  • the instrument shaft may be at least partially rigid.
  • a distal region of the instrument shaft adjacent a distal end of the instrument shaft is rigid.
  • a proximal region of the instrument shaft adjacent a proximal end of the instrument shaft may be rigid.
  • An intermediate region of the instrument shaft intermediate the proximal and distal regions may be flexible.
  • the instrument comprises an end effector at a distal end of the instrument.
  • the end effector may be releasably coupled to the distal end of the instrument shaft.
  • the instrument may comprise an actuator for actuating the end effector.
  • the actuator may be movable between an end effector open configuration and an end effector closed configuration.
  • the actuator may be biased towards an end effector open configuration.
  • the actuator may be movable along the instrument shaft.
  • the actuator may be movable parallel to the longitudinal axis of the instrument shaft.
  • the actuator may comprise a plunger.
  • the incision may be a laparoscopic incision.
  • the sides of the incision may be retracted to a diameter of less than 40 mm, preferably to a diameter of between 3 mm and 35 mm, typically to a diameter of about 15 mm to 20 mm.
  • the instrument may be a laparoscopic instrument which may have a diameter of less than 40 mm, typically the instrument has a diameter of between 3 mm and 35 mm, in one case the instrument has a diameter of less than 10 mm.
  • Fig. 1 is a cross sectional, side view of a surgical instrument access system according to the invention, in use;
  • Fig. 2 is a view similar to Fig. 1 of the surgical instrument access system showing different positions for a surgical instrument;
  • Figs. 3(a) to 3(c) are elevational views of the shafts of various surgical instruments according to the invention.
  • Fig. 4 is a cross sectional, side view of one instrument in use with the surgical instrument access system of Fig. 1;
  • Figs. 5(a) and 5(b) are partially cross-sectional, side views of another instrument according to the invention in different positions of use;
  • Fig. 6 is a partially cross-sectional, side view of another surgical instrument access system according to the invention with two instruments;
  • Figs. 7(a) and 7(b) are cross-sectional, side views of a two surgical instrument access system according to the invention with the instruments in different configurations;
  • Fig. 8 is a partially cross-sectional, side view of another two surgical instrument access system according to the invention.
  • Fig. 9 is a partially cross-sectional, side view of a further two surgical instrument access system according to the invention.
  • Fig. 10 is a partially cross-sectional, side view of a still further two surgical instrument access system according to the invention.
  • Fig. 11 is a partially cross-sectional, side view of another surgical instrument access system according to the invention having three instruments;
  • Figs. 12(a) to 12(c) are partially cross-sectional, side views of another surgical instrument access port system according to the invention.
  • Fig. 13 is a partially cross-sectional, side view of a further surgical instrument access port system according to the invention.
  • Fig. 14(a) is a partially cross-sectional, side view of an access port system of the prior art for comparative purposes;
  • Fig. 14(b) is a partially cross-sectional, side view of another surgical instrument access port system according to the invention.
  • Figs. 15(a) and 15(b) are cross-sectional, side views of a conventional system;
  • Figs. 16(a) and 16(b) are elevational views of a surgical instrument according to the invention in different configurations of use;
  • Fig. 17 is a perspective view of a surgical device and a surgical instrument according to the invention.
  • Figs. 18 and 19 are partially cross-sectional, side views of the surgical instrument of Fig. 17 inserted through the surgical device of Fig. 17, with the surgical device located in a surgical access port according to the invention;
  • Figs. 20 and 21 are perspective views of the surgical instrument of Fig. 17 inserted through the surgical device of Fig. 17;
  • Fig. 22 is a side view of another surgical device according to the invention.
  • Fig. 23 is an enlarged, partially cross-sectional, side view of a port of the surgical device of Fig. 22;
  • Fig. 24 is a view similar to Fig. 23 of another surgical device according to the invention.
  • Figs. 25 and 26 are partially cross-sectional, side views of the surgical device of Fig. 22, in use;
  • Figs. 27 and 28 are views similar to Figs. 25 and 26 of a conventional instrument, in use;
  • Fig. 29 is another view similar to Figs. 25 and 26 of the surgical device of Fig. 22, in use;
  • Fig. 30 is a side view of another surgical device according to the invention.
  • Fig. 31 is a partially cross-sectional, side view of the surgical device of Fig. 30, in use;
  • Fig. 32 is a view similar to Fig. 31 of the surgical device of Fig. 30 and another surgical device according to the inventioin, in use;
  • Fig. 33 is a view similar to Fig. 31 of another surgical device according to the invention, in use.
  • the instrument access systems of the invention generally comprise an access port 5 having an access valve or seal 6 for location adjacent to the incision 1.
  • the system also comprises a laparoscopic surgical device comprising a cannula or an instrument 10 having a shaft 11 for location in the valve or seal 6 adjacent to the incision 1.
  • the device of the invention has a bend section 15 therein.
  • the device may be a visualisation tool such as a camera, light, or a laparoscope and/or may have any suitable end effector such as a grasper, scissors, stapler or the like.
  • valve/seal 6 has a very low profile, especially with respect to the inside of the incision 1.
  • the devices are positively retained in the incision 1 against pull-out forces.
  • This is in contrast to a conventional cannula, in which the rigid tube of the cannula must be extended significantly into the abdomen to ensure that it remains anchored in the abdomen, otherwise gas pressure may cause it to become dislodged.
  • the shaft of the instrument cannot be steered until the steerable section has exited the cannula.
  • problems are overcome at least in part using the systems of the invention.
  • the access port 5 comprises a liner and/or retractor.
  • the liner/retractor part comprises a distal anchoring member 71 and an elongate member 72 extending proximally of the distal anchoring member 71.
  • the elongate member is provided in the form of a sleeve 72 of flexible, polymeric film material which lines the sides of the wound opening 1, in use.
  • the distal anchoring member 71 in this case comprises a resilient O-ring.
  • a relatively small incision 1 is made in the abdominal wall 2 to form the wound opening.
  • a typical length for the incision 1 is in the range of from 12mm to 30mm.
  • the resilient distal O-ring 71 is then manipulated into an elongate, oblong shape by squeezing the distal O-ring 71 to facilitate insertion of the distal O-ring 71 through the wound opening 1, until the distal O-ring 71 is fully located within the abdominal cavity and the sleeve 72 lines the wound opening 1.
  • the sleeve 72 is then pulled upwardly to cause the distal O- ring 71 to engage with the internal surface of the abdominal wall.
  • valves and/or seals may be provided for the instrument 11.
  • Such valve or valves are generically indicated by the reference numeral 6 in the drawings.
  • the sleeve 72 may be a single layer sleeve or may have two layers at least in the section which lines the wound opening 1.
  • the sleeve 72 is wrapped around the distal ring 71 and has an outer layer 74 which lines the wound opening 1 and an inner layer 75.
  • a clamp is provided, in this case a proximal clamp, comprising an outer proximal ring member 77 and an inner proximal ring member 78 between which the sleeve 72 extends.
  • the inner proximal clamp 78 is mounted to or provided by part of a housing for the valve 6.
  • the sleeve 72 is mounted at one end to the ring member 78 or housing and extends to form the inner layer 75, is wrapped around the distal ring 71 and extends to form the outer layer 74.
  • the sleeve 72 is in this case slidable on at least portion of the inner proximal clamp ring 78. On pulling of the sleeve 72 upwardly the wound opening 1 is retracted. Because of the sleeve pathway a free end of the sleeve 72 is external of the valve 6 and can be readily removed, if desired.
  • the access port may be provided in any suitable form, for example the access port may be provided in the form of one or more of the devices described in International patent application No. PCT/IE2003/000141, the relevant contents of which are incorporated herein by reference, and/or in the form of one or more of the devices described in International patent application No.
  • the surgical device shaft 11 comprises a straight proximal section 20 and a straight distal section 21, and the bend section 15 is intermediate the distal and proximal sections 20, 21.
  • the distal section 21 is substantially parallel to the proximal section 20 and may be coaxial therewith.
  • the access port 5 has a very low profile.
  • the distal ring 71 when deployed the distal ring 71 is located close to the interior surface of the abdominal wall 2, and thus the access port 5 only extends distally into the abdominal cavity by a very small distance. It is therefore possible to access a very large space within the abdominal cavity using the bent shaft 11.
  • the bend 15 may be located close to the distal ring 71 to access part of the abdominal cavity laterally of the incision 1, as illustrated in Fig. 1.
  • the bend section 15 may be of any desired shape such as arcuate or partially straight.
  • the shaft shape may be pre-formed or the shaft 11 may be at least partially malleable or flexible for shaping in-situ. There may be one, two or any number of bends 15, some or all of which may be pre-formed.
  • the shaft may have a straight section 25 to facilitate linear advancement through the access valve/seal 6.
  • Fig. 6 illustrates a system of the invention including two separate surgical devices identified as a and b.
  • the system of the invention has a major advantage that a single port can be used to achieve triangulation. Using standard straight shafts this can only be achieved with two separate access ports.
  • instruments can be passed through bent cannulae.
  • the bends 15a, 15b set up triangulation.
  • the instruments may be flexible shaft instruments and can be readily advanced/retracted/rotated through the cannulae.
  • the cannulae can also be manipulated/moved to access a range of different areas in the abdomen.
  • the system may facilitate rotation of the valve/seal 6 so that the instrument positions can be moved, and comparing Figs. 7(a),
  • valve/seal 6 has a handle 30 to facilitate the rotation.
  • the system may for example comprise a conventional straight device 35 and a bent instrument/cannula according to the invention. This arrangement allows triangulation to be achieved but with potentially less access.
  • FIG. 9 Another possible system involves the use of single curved cannula with two exit holes 36, 37 for instruments.
  • the instruments may be similar or different.
  • the instrument advanced through the exit hole 37 may be a standard straight instrument
  • the instrument advanced through the exit hole 36 may be a flexible instrument.
  • the curved sections 15a, 15b may be located internally of the valve/seal 6 whilst still facilitating triangulation. Independent rotation, bending and/or vertical motion of each shaft is facilitated to provide enhanced access.
  • one of the devices is a scope 40.
  • This may be used in association with one or more instruments.
  • the end effector at the distal end of each instrument may be of the same type of end effector or different types of end effectors.
  • FIGs. 12(a) to 12(c) there is illustrated another system of the invention in which a device 50 with a bendable shaft 51 is inserted through the access valve/seal 6 (Fig. 12(a)).
  • the surgeon bends the shaft 51 in-situ by pushing the handle off-axis.
  • the shaft 51 bends against the valve housing.
  • the bending can be achieved using a single hand.
  • a flexible laparoscope 60 is provided which is allowed to flex freely just beneath the peritoneum.
  • Figs. 14(a) and 14(b) highlight the differences between the restricted field of vision which is achieved with a conventional trocar port (Fig. 14(a)), and the much wider field of vision that can be achieved using the system of the invention (Fig. 14(b)).
  • the further disadvantages of a conventional trocar system will also be apparent from Figs. 15(a) and 15(b). If a conventional trocar is tilted to one side it is biased to return to the static vertical position due to the resistance of the tissue surrounding the incision.
  • an end effector 65 of an instrument may be operated by an actuator comprising a ball-like handle 66 and a finger plate/bar 67 with a spring 68 therebetween.
  • an actuator comprising a ball-like handle 66 and a finger plate/bar 67 with a spring 68 therebetween.
  • the sphere handle 66 is located in the ball of a surgeon's hand and using his fingers the finger plate 67 is drawn upwardly against the action of the spring 68 to activate the end effector 65.
  • Such an actuating system is generally easier and more comfortable to use than a standard pistol grip type actuator.
  • FIGs. 17 to 21 there is illustrated another surgical access system 100 according to the invention, which is similar to the systems described previously, and similar elements in Figs. 17 to 21 are assigned the same reference numerals.
  • the system 100 comprises the access port 5, as described above with reference to Fig. 1, the surgical device having the shaft 11 as described above with reference to Fig. 1, and a laparoscopic surgical instrument 101.
  • the surgical device comprises a rigid cannula, in this case, having a lumen 102 extending through the shaft 11.
  • the instrument 101 is similar to the instrument described above with reference to Figs. 16(a) and 16(b).
  • the instrument 101 has a shaft 103 with a rigid proximal region 104, a flexible intermediate region 105 and a rigid distal region 106.
  • the instrument shaft 103 may be inserted through the cannula shaft 11, as illustrated in Figs. 18 to 21.
  • the instrument 101 has a rigid end effector 107 which may be releasably coupled to the distal end 108 of the instrument shaft 103, for example by means of a screw- thread arrangement.
  • An internal cable running through the instrument shaft 103 may also be coupled to the end effector 107.
  • An actuator 109 for actuating the end effector 107 is provided in the form of a plunger at the proximal end 110 of the instrument shaft 103.
  • the actuator 109 is movable along the instrument shaft 103 parallel to .the longitudinal axis of the instrument shaft 103 between an end effector open configuration (Fig. 16(a)) and an end effector closed configuration (Fig. 16(b)).
  • a coiled spring 111 engages the actuator 109 to bias the actuator 109 towards the end effector open configuration.
  • Figs. 18 and 19 illustrate axial advancement of the end effector 107 through the access port 5. It is noted that the bent cannula shaft 11 located in the access port 5 remains stationary upon advancement of the instrument 101.
  • Figs. 20 and 21 illustrate advancement of the end effector 107 into the abdomen towards a specific target.
  • Figs. 22 and 23 illustrate another surgical device 200 according to the invention, which is similar to the surgical device described previously with reference to Fig. 1, and similar elements in Figs. 22 and 23 are assigned the same reference numerals.
  • the surgical device 200 comprises a surgical instrument.
  • the instrument is a surgical instrument.
  • the 200 comprises a shaft 201 having a bend 202 therein, an end effector 203 at a distal end of the shaft 201, and an actuator 204 at a proximal end of the shaft 201 for actuating the end effector 203.
  • the shaft 201 defines a lumen 205 therethrough, and a tubular element 206 is located within the lumen 205 extending from the actuator 204 to the end effector 203 to couple the actuator 204 to the end effector 203.
  • the actuator 204 may be operated by a user to move the end effector 203 between an open configuration and a closed configuration, and/or to rotate the end effector 203 relative to the shaft 201.
  • Fig. 22 illustrates the bent laparoscopic instrument 200 with the finger wheel 204, the fixed bend 202, and the end effector 203 which spins when the finger wheel 204 is rotated.
  • Fig. 23 illustrates one option to spin/actuate the end effector 203.
  • the solid rod 206 actuates the bend effector 203 and transmits torque to spin the end effector 203.
  • the end effector 203 may be translatable relative to the shaft 201, or may be translatable and rotatable relative to the shaft 201.
  • FIG. 24 there is illustrated another surgical device 210 according to the invention, which is similar to the surgical device 200 of Figs. 22 and 23, and similar elements in Fig. 24 are assigned the same reference numerals.
  • the instrument 210 comprises a first tubular element 211 extending from the actuator 204 through the shaft lumen 205, and a second tubular element 212 extending from the end effector 203 through the shaft lumen 205.
  • the first tubular element 211 is coupled to the second tubular element 212 by means of a universal joint 213.
  • Fig. 24 illustrates another option to actuate/spin the end effector 203 using the universal joint connection 213.
  • the bend 202 in the shaft 201 of the instrument 200 results in a number of advantages. For example, by simply rotating the proximal actuator 204, a piece of tissue 220 grasped by the end effector 203 may be swung to one side with a minimum of movement required by the surgeon exterior of the wound, as illustrated in Figs. 25 and 26. This compares favourably with the excessive degree of movement required by the surgeon if it were attempted to swing the piece of tissue 220 to one side using a conventional instrument 221, as illustrated in Figs. 27 and 28.
  • the bend 202 in the shaft 201 of the instrument 200 may provide a simpler, easier means of accessing locations within the abdominal space, for example to access the space behind the piece of tissue 220, as illustrated in Fig.29.
  • the surgical device 300 comprises a laparoscopic instrument.
  • the instrument 300 comprises a straight shaft 301, an actuator 302 at a proximal end of the shaft 301, and an end effector 303 at a distal end of the shaft 301.
  • the radial dimension dl of the end effector 303 is substantially greater then the radial dimension d2 of the shaft 301.
  • the seal 6 stretches to accommodate the larger radial dimension dl of the end effector 303.
  • the seal 6 seals around the smaller radial dimension d2 of the shaft 301 to prevent gas leakage from the insufflated abdominal cavity.
  • the small diameter shaft 301 may have a diameter of 5 mm
  • the large diameter end effector 303 may comprises a 12 mm diameter stapler.
  • the pin hole in the gel valve 6 can easily stretch to allow the end effector 303 to pass through.
  • two or more instruments 300, 300 1 may be used through the same port 5 simultaneously (Fig. 32).
  • Fig. 33 there is illustrated a further surgical device 310 according to the invention, which is similar to the surgical device 300 of Figs. 30 and 31, and similar elements in Fig. 33 are assigned the same reference numerals.
  • the shaft 301 of the instrument 310 has a bend 311 therein.
  • the diameter of the shaft of the laparoscopic instrument is not necessarily dictated by the diameter of the end effector.
  • the seal in the access port may accommodate a shaft diameter which is the same or is different to the end effector diameter.
  • the gel material of the seal is flexible enough to accommodate a range of diameters, for example 5 mm to 12 mm, passing through the seal while maintaining pneumoperitoneum.
  • the surgical access ports of the invention can be used in a number of ways.
  • the retractor is used as described above, the distal inner ring being inserted into an incision, and the outer ring being slid to controllably radially expand the incision.
  • the retractor may then be locked in position. If necessary, the outer ring can be moved further downwardly to create a larger incision.
  • a device may be bent manually outside the body and the bent device is delivered through the access port to readily access the operative site.
  • a device is inserted into the access port and the surgeon uses the abdominal wall itself to bend the shaft and then insert the bent section further into the abdomen.
  • the systems of the invention can be used in a wide range of laparoscopic surgical procedures, for example, gall bladder removal.
  • a single access port is inserted as described above.
  • Two instruments may be inserted through the valve seal. One instrument is used to hold the liver whilst a second bent instrument is used to cut one side of the gall bladder, then moved as described above to cut the other side of the gall bladder.
  • the systems can also be used for carrying out a laparoscopic colonectomy, or a hernia repair, for example.

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PCT/IE2006/000018 2005-03-22 2006-03-22 A surgical instrument Ceased WO2006100658A2 (en)

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