WO2009136871A1

WO2009136871A1 - An improved cannula adaptor

Info

Publication number: WO2009136871A1
Application number: PCT/SG2009/000162
Authority: WO
Inventors: Chong Jin Ong; Ah San Pang; Chee Kong Chui; Choon Seng Yee
Original assignee: National University Of Singapore; Mport Pte Ltd
Priority date: 2008-05-06
Filing date: 2009-05-06
Publication date: 2009-11-12

Abstract

A surgical adaptor for receiving a plurality of surgical instruments, said adaptor comprising a body having a plurality of instrument ports, each port for receiving one of said surgical instruments in sealing engagement; a connector for mounting the body to a cannula; wherein said adaptor is arranged to permit the plurality of surgical instruments to extend through respective instrument ports into the body and through the connector so as to project from the cannula.

Description

An Improved Cannula Adaptor

Field of the Invention

The present invention relates to a surgical device, in particularly, a device for laparoscopic surgery.

Background

Laparoscopic surgery is a minimally-invasive procedure most often associated with surgery for the abdominal and/or the pelvic regions. Some thoracic, cardiac and vascular surgical procedures can also be performed laparoscopically. A typical laparoscopic procedure begins with a small incision made at or near the navel, followed by an insertion of a cannula-trocar combination into the incision. The trocar is removed while the cannula is left in place. Through the cannula, carbon dioxide is passed to inflate the abdomen to create a space for the surgeon to work in. It is also through the cannula that the laparoscope and surgical instruments are passed to reach the operative site.

A typical laparoscopic operation involves numerous insertions and retrievals of various instruments, both rigid and flexible, of different diameters. As mentioned, the insertion/retrieval of a surgical instrument into/from the body is via the cannula. The cannula is a plastic or metal tubing having a diameter of about 10- 15mm held in place near the navel and serves as an opening into the abdominal region. It has a valve mechanism to prevent air leakage from the abdomen. A surgical instrument, entering the abdomen through the cannula, has to be of nearly the same diameter, to prevent loss of gas from the abdomen. To insert an instrument of a smaller diameter, an auxiliary adaptor with a smaller opening has to be attached to maintain the air-tight seal. To insert two instruments into a cannula, even if the diameter constraint is not violated, is not done as the air leakage would be excessive. Hence, one trocar/cannula can only be used with one instrument having the same or smaller diameter at any one time.

Summary of the Invention

The invention provides a multi-port adaptor comprising a body with several air-sealed ports and a connector.

In a first aspect, the invention provides a surgical adaptor for receiving a plurality of surgical instruments, said adaptor comprising a body having a plurality of instrument ports, each port for receiving one of said surgical instruments in sealing engagement; a connector for mounting the body to a cannula; wherein said adaptor is arranged to permit the plurality of surgical instruments to extend through respective instrument ports into the body and through the connector so as to project from the cannula.

In a second aspect, the invention provides a method for preparing a medical procedure, the method comprising the steps of: providing a body having a plurality of instrument ports, each port for receiving a surgical instrument in sealing engagement; mounting the body to a cannula using a connector; extending surgical instruments through respective instrument ports into the body and through the connector so as to project from the cannula.

In one embodiment, the ports may have different-sized openings for instruments of different diameters. The adaptor may be attached to the external end of a cannula through the connector. The connector may be integral with the body of the adaptor, or alternatively be a separate device mountable to the body. Such separation may be useful for cleaning of the adaptor for re-use. However, an integral connector may provide a higher degree of air tightness and general integrity to the adaptor.

The instrument ports may be arranged to permanently engage the respective surgical instruments, with the adaptor forming an assembly including said instruments, hi an alternative arrangement, the instrument ports may be arranged to permit repeated insertion and removal of surgical instruments, and thus allow for several different instruments to be used sequentially for the same port during the same surgical procedure. The sealing engagement will be according to whether a permanent engagement or repeated insertion/extraction of instruments is selected.

Several instruments, each inserted through a respective port, enter the cannula through the connector, hi a preferred embodiment, the body of the adaptor may be of an air-tight and transparent material to allow a surgeon to have clear visibility of the contents or activities in the air-tight bodyfaag. Such transparent materials may include polypropylene, silicone, polyvinylchloride, polyethylene, polyurethane and polycarbonate. Accordingly, the adaptor may be of a stiff material, such as polycarbonate, or flexible such as silicone. The adaptor may require a support structure or device to maintain position and/or not apply excessive force to the cannula. The type of structure or device may be a function of specific parameters, a non-exhaustive list including the material used for the body, the size of the adaptor and the type of surgical instruments used. Such a structure or device may include a frame from which the adaptor is supported from above. For instance, a stand similar to that used for an IV drip may support the adaptor using cords attached to the adaptor.

Alternatively, the structure/device may be a bracket attachable to the surgical bed at a first point and attachable to the adaptor at a second point.

Alternatively, the body may be an amalgamation of portions, with at least one portion being transparent.

The adaptor may facilitate multiple, simultaneous insertions of surgical instruments and minimize the need for repeated insertions and retrievals of different instruments. It may also avoid the need to engage and disengage auxiliary adaptors.

Consequently, the adaptor may reduce the duration of the surgery, and hence, enhance safety. Without limiting the scope of the invention, for the purpose of the present invention surgical instruments may include catheters for irrigation, catheters for drainage, forceps, laser, sutures; it may also be used in laparoscopic surgery performed by medical robots.

The ports may be airtight using self closing valves. For instance, the port may have a plurality of flexible and/or soft membranes arranged in an overlapping arrangement for a closure similar to an iris. Pushing an instrument into the closure will tend to deform the overlapping members to permit entry of the instrument with the flexible and/or soft members closing around the instruments so as to provide an airtight seal.

Alternatively the closure may be of a resiliently deformable ring member, similar to a sphincter, sized to seal an internal orifice of said ring. The instrument may be pushed into the center of the ring, so as to deform around the instrument and so closing off the port to maintain the airtight seal.

In one embodiment, the connector may connect to the cannula and stay fixed thereto using an external clamp. Said clamp may be a conventional spring loaded device. Alternatively the clamp may be a "circlip" arranged to engage the connector and cannula. Alternatively the connector may be press fit, screw threaded or have a bayonet fitting to the cannula to provide selective engagement and disengagement of the adaptor.

In one embodiment the distance from the ports to the connector will be substantially the same. Alternatively the distance from each port to the connector may vary. In this alternative embodiment, ports may be dedicated for use with specific surgical instruments.

In this case the port to connector distance may be a function of the surgical instrument intended for use for the respective port. For instance, one or more ports may be dedicated for the use of a camera, laparoscopic light, suction etc where the instrument is substantially stationary during the procedure and connected through a long cable or tube. One advantage of the adaptor may include having those instruments intended for manipulation at an optimal port to connector distance. Those ports dedicated for other instruments such as the aforementioned light, camera etc may then be placed at a different distance so as to not interfere with the manipulation of other instruments, hi this case the stationary surgical instruments may have a very short port to connector distance so as to place them near the cannula. Alternatively because of the available link of the associated cable, tube, etc, it may be advantageous having a very long port to connector distance.

The adaptor may be mounted to a primary cannula inserted into the patient. A secondary cannula may be provided in the patient to provide access from a different direction to facilitate the surgical procedure, hi such an arrangement, the adaptor may also connect to the secondary cannula, and so include a second connector for connecting to the secondary cannula. In such an arrangement, the instrument ports in the body may be divided into two groups so as to provide instrument access to the respective primary and secondary cannulae. In such a case, the adaptor may be substantially larger than in previous embodiments. In such a case, the support structure may be required to support the dual connector adaptor according to the present invention. In so doing the structure device may involve a single frame engaging the adaptor or alternatively may involve two or more frames.

Brief Description of the Drawings

It will be convenient to further describe the present invention with respect to the accompanying drawings that illustrate possible arrangements of the invention. Other arrangements of the invention are possible, and consequently the particularity of the accompanying drawings is not to be understood as superseding the generality of the preceding description of the invention.

Figure 1 is an elevation view of a surgical adaptor according to one embodiment of the present invention;

Figure 2 is a detailed isometric view of a connector connecting to a cannula according to a further embodiment of the present invention;

Figure 3 is a sectional view of a surgical adaptor according to a further embodiment of the present invention and;

Figures 4A and 4B are detailed views of a port of a surgical adaptor according to a further embodiment of the present invention. Detailed Description of Preferred Embodiments

Referring to Figure 1, one embodiment of the surgical adaptor is illustrated. The adaptor 5 comprising three ports 10, 15, 20 located on an air-tight clear body 6. It is also possible that clear bag has two ports. A connector 25 is adapted for attachment to a trocar/cannula (not shown). The air-sealed port 10 in the middle has the shortest distance from the connector 25 and can be used by a main surgical instrument like the forceps. Camera probes 40, 45 or other surgical devices can be inserted through the remaining ports 15, 20 of the surgical adaptor.

The clear body 6 comprises of a plastic enclosure and is air tight. The plastic enclosure 15 made of materials with sufficient toughness to withstand the air pressure within. Such materials include polypropylene fibre reinforced plastics, medical grade silicone. The body may be flexible or reinforced portions so as to have a flexible "skin" supported by a skeleton of stiffer material.

Implementation of the connector 25 in Figure 1, and its attachment 65 to the distal end of a cannula 60 is illustrated in Figure 2. The connector can be made of metallic or plastic material. It may be a close fitting clamping mechanism. The close fit is necessary to prevent or minimize loss of gas from an inflated part of a patient. In one embodiment, the connector 25 may be attached to the cannula already inserted into the patient's body, hi the embodiment of Figure 2, the connector 25 provides an aperture 70 through which the surgical instruments may enter the cannula 60 through the cannula aperture 75. Thus, when connected, the connector and cannula form a common aperture to provide a pathway for the surgical instruments into the patient's body cavity.

Releasing the connector 25 from the cannula 60 can be done via loosening the clamp. The device may be supplied sterile, using a sterilisation method (e.g ethylene oxide gas, gamma irradiation, hydrogen peroxide vapour, etc) that is appropriate for the material used to make the device.

The air sealed port 10 is intended for insertion of an introducer or surgical forceps (not shown). The threaded camera probes 40,45 from ports 15, 20 of Figure 1 can be inserted into the human cavity using the introducer or forceps. With the camera probes in place, the forceps including surgical scissors can be inserted into the abdomen to perform operations as per normal laparoscopic surgery with no or minimal loss of gas from the inflated abdomen. Ports 15, 20 are not restricted to camera probes, but can also be used for other surgical instruments/devices.

Figure 3 illustrates the deployment of several instruments through another embodiment of the surgical adaptor 80 in a typical laparoscopic surgery. In this embodiment, the body has been mounted to the cannula, with each port of the adaptor accommodating one instrument and preventing air leakage from the inflated abdominal cavity 78. The figure shows the deployment of one rigid device 140 (rigid laparoscope or rigid forceps) and several flexible devices 120, 125, 130, 135. The flexible devices may include laser fiber 135, suture 120, irrigation catheter 125 and drainage catheter 130. A laser fibre 135 is a laser which uses optical fibre doped with rare-earth elements as the active gain medium. A catheter is a thin, flexible tube that can be inserted into the human body cavity. The forceps 160 introduced from the secondary port 165 could be used to hold and maneuver the flexible devices. For example, the forceps 160 could direct the catheter 125,130 to allow drainage or injection of fluids at the surgical sites.

Further, a light 155 may be provided through feeding a cable through one port 115, and mounting 150 the magnet to the internal wall 77 of the body cavity 78.

The adaptor 80 may be held on to by a robotic arm. Intelligence can be built into the surgical adaptor to program or control the device attached to the various ports. With the adaptor held firmly, a flexible radiofrequency (RF) needle and ultrasonic probe might be inserted into the body cavity, and be directed to a targeted tumor within the liver organ. The tumor can be ablated with no requirement for an additional incision.

A physical realization of the embodiment of Figure 1 has been used in an animal experiment (IACUC Protocol No. 057/06). In the experiment, two camera probes were inserted into the pig's inflated body cavity via the multi-port surgical device. With the two probes in desired positions with clear view of the internal organs, forceps were inserted into the body cavity via port 10. Surgical forceps are handheld, hinged instruments usually made of carbon steel typically for grasping and holding objects. During the surgical experiment, they were used to navigate within the cavity, and locate the targeted site of operation. A surgical scissors connecting to an electrical surgical unit, also inserted via port 10, was used to detach the pig's Fallopian tube. The retrieval of all probes and forceps was smooth. The surgical removal of a Fallopian tube is called a salphingectomy. The multi-port surgical device could also be used for other surgical procedures using minimally invasive methods.

The embodiments of Figure 1 and 3 show the adaptor as a relatively high standing device. It will be appreciated that adaptors according to other embodiments falling within the scope of the invention may have a much lower aspect ratio.

Figure 4 shows a port 170 for a further embodiment of the present invention. In this embodiment the port 170 has an airtight seal but includes a valve system for selectively opening and closing the valve. The port 170 allows for translational motion of the wire 185 which may connected to a camera or other device for remote operation through said wire 185. Operation of the valve 175 is by means of turning 185 a handle 180 of the valve so as to maintain or release pressure within the adaptor and subsequently body cavity in which carbon dioxide has been added so as to inflate for the surgical procedure.

Such a valve may be replaced by two way ball valve or other suitable valve for maintaining air pressure. Further the valve may be made of chlorinated PVC or other such resistant plastic suitable for use in an environment which may include acid, salts and alcohols.

Claims

Claims:

1. A surgical adaptor for receiving a plurality of surgical instruments, said adaptor comprising: a body having a plurality of instrument ports, each port for receiving one of said surgical instruments in sealing engagement; a connector for mounting the body to a cannula; wherein said adaptor is arranged to permit the plurality of surgical instruments to extend through respective instrument ports into the body and through the connector so as to project from the cannula.

2. The adaptor according to claim 1 wherein each port includes a valve arranged to seal around a surgical instrument received there through.

3. The adaptor according to claim 1 or 2, wherein said port is arranged to selectively engage and disengage the respective surgical instrument so as to facilitate repeated use of said port.

4. The adaptor according to any one of the preceding claims wherein the connector is integral with said body.

5. The adaptor according to any one of claims 1 to 3 wherein the connector is selectively detachable from the body.

6. The adaptor according to any one of the preceding claims wherein each port is equidistant from the connector.

7. The adaptor according to any one of claims 1 to 5 wherein at least two of said instrument ports are of a different distance from the connector.

8. The adaptor according to any one of the preceding claims wherein at least two of said ports have different sized openings to accommodate instruments of different sizes.

9. The adaptor according to any one of claims 2 to 8 wherein said valve includes a plurality of overlapping resilient members arranged to resiliently deform around said surgical instruments.

10. The adaptor according to claim 2 or 3 wherein said valve includes a ring of resiliently deformable material, said ring sealing an internal orifice of said ring and resiliently deforming around an instrument received there through.

11. The adaptor according to any one of the preceding claims wherein said connector to cannula mounting includes any one or a combination of; a clamp, a circlip, press fitting, a screw thread arrangement or a bayonet fitting.

12. The adaptor according to any one of the preceding claims wherein said body is of a flexible material.

13. The adaptor according to any one of the preceding claims wherein at least a portion of said body is transparent.

14. A method for preparing a medical procedure, the method comprising the steps of: providing a body having a plurality of instrument ports, each port for receiving a surgical instrument in sealing engagement; mounting the body to a cannula using a connector; extending surgical instruments through respective instrument ports into the body and through the connector so as to project from the cannula.