WO2008122565A1

WO2008122565A1 - Trocar and insertion aid for a trocar

Info

Publication number: WO2008122565A1
Application number: PCT/EP2008/053990
Authority: WO
Inventors: Manfred Dworschak; Gottfried Müller
Original assignee: Aesculap Ag & Co. Kg
Priority date: 2007-04-04
Filing date: 2008-04-03
Publication date: 2008-10-16
Also published as: DE102007017454A1

Abstract

In order to be able to more easily and safely insert instruments into a trocar, a surgical insertion aid is proposed for the easier insertion of instruments into a trocar, comprising an instrument guide and a connecting device to affix the insertion aid on a trocar. An improved trocar is further proposed.

Description

Trocar and insertion aid for a trocar

The present invention relates to a surgical introducer for easier insertion of instruments into a trocar. Further, the present invention relates to a trocar for insertion into an accessway opened to a human or animal body comprising a proximal and a distal end and a trocar port extending from the proximal to the distal end.

Trocars of the type described above are used in particular for minimally invasive laparoscopic procedures. They are known as disposable or reusable products and are standard equipment in general surgery. In particular, trocars have the function of closing the access opening to the body in a gastight manner, regardless of whether or not instruments have been introduced into the body through the trocar, ie through its trocar opening. This is necessary because typically the body is inflated by introducing an inert gas to provide more space for making the required surgical procedure. Typically, a trocar therefore includes a seal, for example in the form of a flap valve or a ball valve, to prevent leakage of the gas introduced into the body of the patient. On the other hand, if instruments, in particular endoscopic instruments, are inserted through the trocar with elongate shafts or optics, this seal is open. A gas loss is then prevented by an additionally provided, preferably annular sealing lip. This also compensates for differences between an inner diameter of the trocar seal and an outer diameter of the optics or an instrument shaft. Furthermore, surgery using a trocar usually requires multiple changes of instruments inserted into the trocar. Among other things, this is due to the fact that only a finite number of accesses to the body of the patient is opened and thus only a finite number of trocars for the introduction of instruments is available. Therefore, if necessary, an instrument must be replaced if another operation step is to be performed. Another reason for removing instruments from a trocar is that they need to be cleaned every now and then. Thus, an optic of an endoscope can become dirty, monopolar and also bipolar instruments can be contaminated as a result of tissue coagulation by adhering tissue and in particular also impaired in their functionality.

Often laparoscopic procedures open three or more accesses to the patient's body. As a rule, an assistant to the surgeon holds the endoscope with the camera and assists the surgeon with an instrument. The surgeon himself usually works with two different instruments and makes an effort not to lose sight of the surgical site when changing an instrument, since a reorientation is time consuming and an instrument unchecked in the body of the patient poses a potential risk of injury. Since removal of an instrument from a trocar due to uneven weight distribution on the trocar does not ensure that its axis retains its orientation after removal of the instrument, it is very difficult for a surgeon to insert an instrument into the empty trocar, as he already mentioned above, must keep an eye on the surgical site. He then inevitably relies on the help of an assistant, who hands him the instruments. This must bring the trocar back to its original position. Otherwise, the surgeon must hold the other Release the instrument and insert the instrument under manual alignment of the trocar head, whereby the instrument already in the body is quasi "abandoned", ie left uncontrolled for a short time in the body. Alternatively, the surgeon may attempt to locate the trocar port with an instrument tip of the instrument to be inserted and raise the trocar to the correct position. In any case, all procedures described for inserting an instrument, especially with a very long shaft, are time consuming and may also pose a risk of injury to the patient.

It is therefore an object of the present invention to provide a device and a trocar with which the insertion of an instrument into a trocar is facilitated.

This object is achieved by a surgical insertion for easier insertion of instruments into a trocar, comprising an instrument guide and a connecting device for fixing the insertion of a trocar.

With such an insertion aid, it is much easier for a surgeon, so to speak "blind", so without looking at the trocar to introduce an instrument in the trocar. This is made possible, in particular, by the instrument guide, which assists the surgeon in moving the instrument to and from the trocar and its trocar port. With the connecting device, it is possible, in particular, to securely connect the surgical insertion aid to the trocar and, if necessary, to detach it from it again. Of course, it would also be conceivable to permanently connect the surgical insertion aid to a trocar or to form it. In any case, with the surgical introducer, it is possible to quickly and safely, especially without the help of another person, in a trocar inserted in the patient's body.

It is favorable if the instrument guide comprises a passage opening for insertion of an instrument through the insertion aid into a trocar connected thereto. Thus, an instrument shaft or an endoscope shaft can be easily and safely inserted through the passage opening, for example into the trocar opening of the trocar.

Conveniently, a passage opening limiting sealing element is provided. In this way, additional sealing of the inserted instrument or endoscope is achieved at the trocar when the introducer is connected to the trocar. In particular, gas loss during the surgical procedure can be minimized. Furthermore, the sealing element can also take over the function of the sealing lip of the trocar, if it is damaged during the procedure as a result of the insertion and withdrawal of instruments through the trocar. Furthermore, the sealing element offers the option of using trocars which have only one seal for completely closing the trocar opening, if no instrument is inserted into the trocar. The sealing element of the insertion aid can then also be clearly spaced from the seal of the trocar, so that the trocar seal can always completely close the trocar opening before the instrument is completely pulled out of the trocar and / or the insertion. The same applies in the reverse manner for the insertion of the instrument into the trocar.

A particularly simple construction of the insertion aid can be achieved in particular in that the sealing element is arranged in a transition region between the instrument guide and the connecting device. FER This also increases the stability of the insertion aid. In addition, the sealing element helps to center the instrument to be introduced and also to lead.

The structure of the introducer further simplifies when the sealing element is a ring seal.

A particularly good sealing relative to instrument or endoscope shafts can be achieved in that the sealing element comprises a projecting in the direction of a longitudinal axis of the instrument guide sealing lip. Preferably, this is designed such that it bulges slightly in the distal direction when inserting an instrument and when pulling out the instrument in the proximal direction.

In principle, it would be conceivable to design the sealing element such that it completely closes the passage opening when no instrument is inserted into the insertion aid. It is favorable, however, if the sealing element defines a minimum inner diameter of the passage opening. The fact that the sealing element defines in this way a size, namely the inner diameter of the passage opening, the insertion of an instrument is much easier, because an instrument opposite resistance by the sealing element is the smaller, the smaller a difference between the inner diameter of the passage opening and an outer diameter of the instrument.

Advantageously, the minimum inner diameter of the passage opening is variable. This has the advantage that the sealing element can be optimally adapted to different outer shank diameters of instruments and thus ensures an optimal seal. The variability of the minimum inner diameter of the passage opening can also facilitating the insertion of shanks with different outer diameters, that is, a force acting against the shaft of the instrument by the sealing element need not increase, if at all, to the extent that a non-changeable minimum inner diameter of the passage opening.

In order to be able to optimally adapt the insertion aid to instruments having a minimum and a maximum outer diameter, it is advantageous if the minimum inner diameter of the passage opening can be varied within a range between a smallest and a largest minimum inner diameter.

Preferably, the largest minimum inner diameter is 1.5 to 4 times the smallest minimum inner diameter. Thus, a large stem outside diameter range can be covered, that is, instruments having different sized stem outer diameters can be easily and safely inserted through and sealed relative to the introducer.

It is favorable if the smallest minimum inner diameter has a value in the range of 2 mm to 5 mm. In particular, instruments with a very small outer shaft diameter can still be optimally sealed.

Advantageously, the largest minimum inner diameter has a value in a range of 3 mm to 20 mm. This makes it possible, in particular, to introduce instruments with a shaft outer diameter which is greater than 20 mm. The insertion aid is particularly easy to produce if the sealing element comprises a membrane provided with an opening. In particular, the opening can define the passage opening of the insertion aid.

A particularly good sealing of elongate instrument and endoscope shafts can be achieved, in particular, by the membrane being oriented perpendicularly or substantially perpendicular to the longitudinal axis.

It is advantageous if the sealing element is provided with one or more cuts. Preferably, these extend in the radial direction. Thus, one or more sealing tabs can be formed in a simple manner, which make it possible that instruments with different outer diameters can be introduced in a simple manner by the insertion aid in the trocar. In particular, it can thus also be provided in a simple manner that the minimum inner diameter of the passage opening can be changed within a range between a smallest and a largest minimum inner diameter.

The sealing of instrument shafts can be optimized in particular by the fact that the multiple incisions are distributed symmetrically over a circumference of the sealing element. In particular, symmetrical may also mean that they are distributed uniformly over a circumference of the sealing element.

Preferably, four, six or eight cuts are provided. As a result, in particular the manufacture of the insertion aid is simplified.

According to a preferred embodiment of the invention it can be provided that the incision or the plurality of incisions have a length which is a difference between the largest minimum inner diameter and corresponds to the smallest minimum inner diameter of the sealing element. A variability of the minimum inner diameter of the passage opening in a range between the smallest and the largest minimum inner diameter is particularly easy to achieve.

It is expedient if the instrument guide defines a longitudinal axis and has an inner cross section transverse to the longitudinal axis, which increases at least in sections in the proximal direction. Such an instrument guide facilitates the insertion of an instrument into the trocar for a surgeon, because he has to move a tip of the instrument to be inserted through the trocar only roughly in the direction of the insertion, which then, by the thus in the distal direction at least partially increasing inner cross section Instrument guide safely and targeted to the trocar and its trocar opening is introduced.

Preferably, the instrument guide has a wall which is inclined at least in sections relative to the longitudinal axis by an insertion angle. For example, such a funnel-shaped configuration of the instrument guide can be realized, wherein the wall forms, for example, a part of a cone sheath.

It is advantageous if the insertion angle has a value in a range of 20 ° to 60 °. In particular, the wall can thus easily and safely lead a tip of the instrument as far as the passage opening, even if the trocar is tilted by up to 60 ° when an instrument has been completely removed from the trocar. Preferably, the insertion angle has a value in a range of 30 ° to 40 °. To ensure the insertion of an instrument as possible without visual contact, it is advantageous if the instrument guide is parallel to the longitudinal axis 0.5 cm to 10 cm long. Preferably, the instrument guide is 1 cm to 5 cm long.

Preferably, the instrument guide is parallel to the longitudinal axis 1.5 cm to 2.5 cm long. In particular, instruments with very long shanks can be introduced into the trocar in a simple and secure manner.

The structure of the introducer further simplifies when the instrument guide is rotationally symmetrical or substantially rotationally symmetrical.

The handling of the insertion aid for an operator when inserting an instrument into the trocar improves in particular when the instrument guide is funnel-shaped or substantially funnel-shaped. For example, a funnel shape can be achieved in that the instrument guide has a wall which defines a part of a cone sheath.

In order to be able to handle the surgical insertion aid in a simple and safe manner, for example when connecting to a trocar, it is advantageous if it has a handling device.

The handling of the introducer further improves when the handling device comprises a protruding from the outside of the insertion aid grip element. The insertion aid can be detected very easily. Furthermore, the grip element can also serve to improve handling of the insertion aid when connecting to the trocar. In accordance with a further preferred embodiment of the invention, it can be provided that the insertion aid has a proximal and a distal end and that the connection device is arranged at the distal end or forms same. This embodiment in particular allows a direct connection of the insertion aid with a trocar.

It is advantageous if the connecting device comprises at least one fastening element for fixing the insertion aid to a trocar. In particular, the fastening element can be designed such that the insertion aid can be released from the trocar, if necessary. Furthermore, the insertion aid can also be easily and securely fixed to the trocar with a fastening element.

A particularly simple construction of the insertion aid can be achieved in that the fastening element is designed in the form of a clamping element.

Preferably, the clamping element is in the form of an elastic ring or an elastic sleeve. This makes it possible, for example, to put the clamping element over a proximal end of the trocar or aufzustülpen on this. If an inner diameter of the ring or of the sleeve is slightly smaller than an outer diameter of the proximal end of the trocar, then the insertion aid can be held simply and securely clamped on the trocar. In particular, the clamping element can form the distal end of the insertion aid.

A particularly simple construction of the surgical insertion aid can be achieved in that the connecting device comprises a sleeve-shaped connecting section, in which a proximal end of a trocar can be guided in a small amount. at least in sections is insertable. The sleeve-shaped connecting portion may in particular be designed to be elastic and form a clamping element. However, the sleeve-shaped connecting portion may also be formed inelastic, so that the insertion aid, for example, attached to a proximal end of a trocar, but relative to this can still be twisted.

In order to establish a clear relative position between the insertion aid and the trocar, it is advantageous if the fastening element comprises a clamping screw. With a clamping screw, in particular, a sleeve-shaped connecting portion, which is not elastic, can be easily and securely fixed to a proximal end of a trocar.

Preferably, the insertion aid is integrally formed. It can thus be produced in particular in a single injection molding process from a plastic by injection molding.

In order to use the surgical introducer in a sterile surgical environment, it is advantageous if it is made of a sterilizable material. This makes it possible, if necessary, to use the insertion aid multiple times.

The surgical insertion aid can be produced in a particularly cost-effective manner if the sterilisable material is a plastic. The plastic may in particular be a non-elastic or an elastic plastic.

Preferably, the insertion aid is at least partially formed of an elastic material. On the one hand, this reduces the risk of damage to instruments to be inserted through the insertion aid into a trocar, and on the other hand, it can in particular facilitate a connection with the trocar.

The object stated in the introduction is achieved according to the invention in a trocar of the type described in the introduction by providing a surgical insertion aid for easier insertion of instruments into the trocar, comprising an instrument guide and a connection device for fixing the insertion aid to the trocar.

Optionally, it is also conceivable to dispense with the connection device and to form the instrument guide in one piece with a proximal end of the trocar or to define a proximal end of the trocar by the insertion aid. In any case, the provision of an insertion aid facilitates the insertion of instruments into the trocar in the manner described in particular above.

Advantageously, the insertion aid is one of the insertion aids described above. It then also has the advantages explained above in connection with the various embodiments.

The following description of preferred embodiments of the invention is used in conjunction with the drawings for further explanation. Show it :

FIG. 1 shows a perspective view of a first embodiment of an insertion aid connected to a trocar;

FIG. 2 shows a view similar to FIG. 1 of a second embodiment of an insertion aid; and Figure 3: a plan view of the insertion shown in Figure 2.

In FIG. 1, by way of example, a proximal end 11 of a trocar, generally designated by the reference numeral 10, is shown, which is connected to a surgical insertion aid 12.

The proximal end 11 of the trocar 10 is in the form of a short cylindrical portion 14. Between the proximal end 11 of the trocar 10 and a distal end of the trocar 10 not shown in detail in FIG. 1, a trocar opening 16 extends through the interior of the trocar 10 through which an instrument, not shown, can be inserted. The trocar 10 may further include seals in the manner described above.

The surgical introducer 12 includes an instrument guide 18, which is substantially funnel-shaped. It defines a longitudinal axis 20 and is rotationally symmetrical with respect to this longitudinal axis 20. A wall 22 of the instrument guide 18 is relatively thin relative to expansions thereof parallel and transverse to the longitudinal axis 20. The wall 22 is also inclined relative to the longitudinal axis 20 by an insertion angle 24. A total opening angle of the instrument guide 18 thus corresponds to twice the value of the insertion angle 24. The insertion angle 24 is in the embodiment shown in Figure 1 about 20 °. However, it may also have a value in a range of 20 ° to 60 °. Due to the configuration of the wall 22 in the form of a conical shell cutout, this has an inner cross section which increases in the proximal direction. A distal end of the instrument guide 18 has a minimal inner cross section with an inner diameter 26, a proximal end of the instrument guide. Ment guide 18 a maximum inner cross-section with an inner diameter 28th

Parallel to the longitudinal axis 20, the instrument guide 18 has a length 30, which may have a value in a range of 3 cm to 10 cm. Preferably, it is 4 cm to 5 cm long.

On the distal side, a connecting device 32 connects to the instrument guide 18 and forms a distal end 34 of the insertion aid 12. The connecting device 32 comprises a clamping element 36 in the form of an elastic sleeve 38 whose inner diameter corresponds approximately to the inner diameter 26. A height of the sleeve 38 is about 1/4 of the length 30. The sleeve 38 can be placed over the proximal end 11 of the trocar 10 or pulled onto this and holds on this clamping.

Optionally, the sleeve 38 could not be elastic. A rotationally fixed and axial fixing of the insertion aid 12 could then be achieved for example via a fastening element in the form of a clamping screw, which is screwed into a radially oriented threaded bore of the sleeve 38 and is supported on the section 14.

Furthermore, the insertion aid 12 comprises a handling device 40, which comprises a grip element 44 in the form of a tab-like projection which projects radially outward and is arranged in a transition region 42 between the instrument guide 18 and the connection device 32. The grip element 44 defines a plane which is oriented perpendicular to the longitudinal axis 20. Furthermore, a sealing element 46 in the form of a flat membrane 48 is provided on the insertion aid, which defines a passage opening 50 of the instrument guide 18. The sealing element 46 is arranged in the interior of the insertion aid 12 in the transition region 42. Optionally, it can also be designed as a ring seal. It also includes a sealing lip 52 pointing in the direction of the longitudinal axis 20. Furthermore, the sealing element 46 defines a minimum inner diameter 54 of the passage opening 50. Due to an elasticity of the diaphragm 48, the minimum inner diameter 54 is variable so that instruments with different outer shaft diameters are also introduced and can be sealed relative to the insertion aid 12.

An improved variability of the passage opening 50 can be achieved in that the sealing element 46 is provided with one or more incisions 56 which extend in the radial direction from an inner edge 58 and the sealing lip 52 of the membrane 48 to the outside. Ends of the cuts 56 facing away from the longitudinal axis 20 define a circular boundary 60 which defines a largest minimum inner diameter 62 of the passage opening. A length 64 of the incisions 56 thus corresponds to a difference between the inner diameter 62 and the inner diameter 54.

In FIGS. 2 and 3, a second exemplary embodiment of a surgical insertion aid 12 is shown schematically, which essentially corresponds to the insertion aid 12 illustrated in FIG. 1, so that identical parts are provided with the same reference numerals. The insertion aid shown in FIG. 1 can optionally also be provided with notches 56, as shown in FIGS. 2 and 3. In the embodiment of the insertion aid 12 illustrated in FIGS. 2 and 3, a total of six notches 56, which are distributed uniformly, that is to say symmetrically distributed over a circumference of the passage opening 50, are provided. However, only one incision 56, four, eight or more incisions 56 may be provided. Of course, an odd number of incisions 56 is conceivable.

The smallest minimum inner diameter 54 of the sealing element 46 may have a value in a range of 2 mm to 5 mm. The largest minimum inner diameter 62 preferably has a value in a range of 3 mm to 20 mm. This means that the largest minimum inner diameter 62 can be 1.5 to 4 times larger than the smallest minimum inner diameter 54.

Through the incisions 56 sealing tabs 66 are each defined between two incisions, which are deflectable in the distal and proximal directions. As a result of the cuts 56, the minimum inner diameter 54 can thus be changed in a simple manner between the smallest minimum inner diameter 54 and the largest minimum inner diameter 62. Further enlargement of the largest minimum inner diameter 62 can also be achieved due to an elasticity of the sealing element 46. Instruments with an outer shaft can then also be introduced through the insertion aid 12 and sealed relative thereto, which have an outer diameter which is greater than 20 mm.

The insertion aid is preferably made of a sterilizable material, for example of a sterilizable plastic. It can, as shown in Figures 1 to 3, be integrally formed, optionally the parts of the insertion aid 12 also be made separately and connected to each other.

Preferably, the insertion aid 12 is at least partially formed from an elastic material, in particular it may be the connecting device 32 and / or the sealing element 46. Of course, the instrument guide 18 and the handling device 40 may be formed of an elastic material.

In another preferred embodiment, the insertion aid 12 illustrated in FIGS. 1 to 3 can also be formed directly on the proximal end 11 of the trocar 10 and thus formed in one piece therewith.

The introducer 12 allows an operator to easily and safely insert an instrument with an elongated shaft into the trocar 10, even without the surgeon seeing the trocar 10.

Claims

claims

A surgical introducer (12) for facilitating insertion of instruments into a trocar (10), comprising an instrument guide (18) and a connector (32) for securing the introducer to a trocar (10).

2. Surgical insertion aid according to claim 1, characterized in that the instrument guide (18) comprises a passage opening (50) for insertion of an instrument by the insertion aid (12) in a trocar connected to this (10).

3. Surgical insertion aid according to claim 2, characterized in that a passage opening (50) delimiting sealing element (46) is provided.

4. surgical insertion aid according to claim 3, characterized in that the sealing element (46) in a transition region (44) between the instrument guide (18) and the connecting means (32) is arranged.

5. Surgical insertion aid according to claim 3 or 4, characterized in that the sealing element (46) is a ring seal.

6. Surgical insertion aid according to one of claims 3 to 5, characterized in that the sealing element (46) in the direction of a Longitudinal axis (20) of the instrument guide (18) projecting sealing lip (52).

7. surgical insertion aid according to one of claims 3 to 6, characterized in that the sealing element (46) defines a minimum inner diameter (54) of the passage opening (50).

8. Surgical insertion aid according to claim 7, characterized in that the minimum inner diameter (54) of the passage opening (50) is variable.

9. Surgical insertion aid according to claim 7 or 8, characterized in that the minimum inner diameter (54) of the passage opening (50) is variable in a range between a smallest and a largest minimum inner diameter (54, 62).

10. Surgical insertion aid according to claim 9, characterized in that the largest minimum inner diameter (62) is 1.5 to 4 times as large as the smallest minimum inner diameter (54).

11. Surgical insertion aid according to claim 9 or 10, characterized in that the smallest minimum inner diameter (54) has a value in the range of 2 mm to 5 mm.

12. Surgical insertion aid according to one of claims 9 to 11, characterized in that the largest minimum inner diameter (62) has a value in a range of 3 mm to 20 mm.

13. Surgical insertion aid according to one of claims 3 to 12, characterized in that the sealing element (46) comprises a with an opening (50) provided with membrane (48).

14. A surgical introducer according to claim 13, characterized in that the membrane (48) is oriented perpendicular or substantially perpendicular to the longitudinal axis (20).

15. Surgical insertion aid according to one of claims 3 to 14, characterized in that the sealing element (46) is provided with one or more cuts (56) which extend in the radial direction.

16. A surgical introducer according to claim 15, characterized in that the plurality of incisions (56) are distributed symmetrically over a circumference of the sealing element (46).

17. surgical insertion aid according to claim 15 or 16, characterized in that four, six or eight cuts (56) are provided.

18. A surgical introducer according to any one of claims 15 to 17, characterized in that the incision (56) or the plurality of incisions (56) have a length (64) which is a difference between the largest minimum inner diameter (62) and the smallest minimum Inner diameter (54) of the sealing element (46) corresponds.

19. Surgical insertion aid according to one of the preceding claims, characterized in that the instrument guide (18) defines a longitudinal axis (20) and an inner cross section transverse to the longitudinal axis (20), which increases in the proximal direction at least in sections.

20. Surgical insertion aid according to claim 19, characterized in that the instrument guide (18) has a wall (22), which is inclined at least in sections relative to the longitudinal axis (20) by an insertion angle (24).

21. Surgical insertion aid according to claim 20, characterized in that the insertion angle (24) has a value in a range of 20 ° to 60 °.

22. Surgical insertion aid according to one of claims 19 to 21, characterized in that the instrument guide (18) parallel to the longitudinal axis (20) 0.5 cm to 10 cm long.

23. Surgical insertion aid according to claim 22, characterized in that the instrument guide (18) parallel to the longitudinal axis (20) is 1.5 cm to 2.5 cm long.

24. Surgical insertion aid according to one of the preceding claims, characterized in that the instrument guide (18) is rotationally symmetrical or substantially rotationally symmetrical.

25. Surgical insertion aid according to one of the preceding claims, characterized in that the instrument guide (18) is funnel-shaped or substantially funnel-shaped.

26. Surgical insertion aid according to one of the preceding claims, characterized in that the insertion aid (12) has a handling device (40).

27. Surgical insertion aid according to claim 26, characterized in that the handling device (40) comprises an outside of the insertion aid (12) protruding grip element (44).

28. Surgical insertion aid according to one of the preceding claims, characterized in that the insertion aid (12) has a proximal and a distal end and that the connecting means (32) at the distal end (34) is arranged or forms.

29. Surgical insertion aid according to one of the preceding claims, characterized in that the connecting device (32) comprises at least one fastening element (36) for fixing the insertion aid (12) on a trocar (10).

30. Surgical insertion aid according to claim 29, characterized in that the fastening element (36) in the form of a clamping element (36) is formed.

31. Surgical insertion aid according to claim 30, characterized in that the clamping element (36) in the form of an elastic ring or an elastic sleeve (36) is formed.

32. Surgical insertion aid according to one of claims 29 to 31, characterized in that the connecting device (32) is a sleeve-shaped migen connecting portion (36), in which a proximal end (11) of a trocar (10) is at least partially inserted.

33. Surgical insertion aid according to one of claims 29 to 32, characterized in that the fastening element (36) comprises a clamping screw.

34. Surgical insertion aid according to one of the preceding claims, characterized in that the insertion aid (12) is integrally formed.

35. Surgical insertion aid according to one of the preceding claims, characterized in that the insertion aid (12) is made of a sterilizable material.

36. Surgical insertion aid according to claim 35, characterized in that the sterilizable material is a plastic.

37. Surgical insertion aid according to one of the preceding claims, characterized in that the insertion aid (12) is at least partially formed of an elastic material.

A trocar (10) for insertion into an accessway opened to a human or animal body, having proximal and distal ends (11) and a trocar port (16) extending from the proximal to the distal end (11) therethrough characterized in that a surgical introducer (12) is provided for facilitating the insertion of instruments into the trocar (10), which comprises an instrument tenführung (18) and a connecting device (32) for fixing the insertion aid (12) on the trocar (10).

39. Trocar according to claim 38, characterized in that the insertion aid (12) is an insertion aid (12) according to one of claims 2 to 37.