WO2011130399A1 - Trocart de visualisation - Google Patents

Trocart de visualisation Download PDF

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Publication number
WO2011130399A1
WO2011130399A1 PCT/US2011/032305 US2011032305W WO2011130399A1 WO 2011130399 A1 WO2011130399 A1 WO 2011130399A1 US 2011032305 W US2011032305 W US 2011032305W WO 2011130399 A1 WO2011130399 A1 WO 2011130399A1
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WO
WIPO (PCT)
Prior art keywords
tip
penetrating
trocar
distal
edge
Prior art date
Application number
PCT/US2011/032305
Other languages
English (en)
Inventor
Dominick Mastri
Kurt Azarbarzin
Peter Gale
Original Assignee
Surgiquest, Incorporated
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 Surgiquest, Incorporated filed Critical Surgiquest, Incorporated
Publication of WO2011130399A1 publication Critical patent/WO2011130399A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—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, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00902—Material properties transparent or translucent
    • A61B2017/00907—Material properties transparent or translucent for light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320044—Blunt dissectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B2017/3454—Details of tips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937—Visible markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation

Definitions

  • the present invention relates to surgical instruments such as trocars for use in insertion of surgical access devices, such as access cannulas.
  • surgical access devices such as access cannulas.
  • the present invention is directed to such insertion devices having a transparent tip to allow visualization of tissue being penetrated.
  • a variety of devices and methods are known in the art for insertion of surgical access devices, such as surgical cannulas in minimally-invasive surgical procedures. Of such devices, many are configured to puncture a patient's abdominal wall. Most of such insertion devices are fully solid and opaque, so a surgeon cannot easily visually differentiate between layers of the abdominal wall and internal abdominal organs.
  • Some insertion devices have been developed that include a transparent tip or an integral endoscope While such devices can offer improved guidance to a surgeon over those with no means for visualization, such devices can be relatively complex, difficult to manufacture, and therefore can be expensive.
  • the penetrating tip includes a generally transparent body having proximal and distal ends, the body having an opaque distal tip portion, a generally straight integral edge arranged at a distal end of the body that is transverse to a longitudinal axis of the tip, and inwardly concave tapered opposed facets formed in the body, converging with one another at the integral edge, wherein the tip has a transversely oriented obscured distal region surrounding the integral edge.
  • the tip can further include an expanded-diameter region for engaging a surgical access device.
  • the opposed facets can be provided on the tip at about a 20 or 30 degree angle with respect to one another.
  • the integral edge may be a blunt edge.
  • a locking element can be provided on the body for engaging an obturator.
  • the tip can further include an inner optical surface configured so as to minimize distortion of images taken through the penetrating tip.
  • the tip can be formed of a plastic material.
  • a surgical trocar including a handle, a shaft extending from the handle, a penetrating tip as provided in this disclosure, and an optical path extending from the tip to an imaging device.
  • the imaging device can be a CCD sensor.
  • the imaging device can be an optical eyepiece.
  • the transversely oriented obscured distal region surrounding the integral edge of the tip comprises a measuring means.
  • the transversely oriented obscured distal region surrounding the integral edge of the tip can comprise measuring gradations to facilitate measurement.
  • the trocar can further include an access device configured and dimensioned to receive the shaft of the trocar such that the penetrating tip protrudes from the end of the access device. If desired, an external monitor can be provided to view images transmitted through the tip.
  • a kit including a surgical trocar having a handle and a shaft extending from the handle, one or more penetrating tips for the surgical trocar as provided in this disclosure, and a package for holding kit contents and storing kit contents in a sterile environment.
  • Figure 1 is an isometric view of an exemplary embodiment of a trocar in accordance with the present invention, for use with penetrating tips constructed in accordance with the invention;
  • Figure 2 is an isometric view of one embodiment of a penetrating tip in accordance with the invention, which includes a substantially straight edge;
  • Figure 3 is an isometric view of the penetrating tip of Figure 2, including hidden lines illustrating internal surface geometry of the tip;
  • Figure 4 is a side view of the penetrating tip of Figure 2, including hidden lines illustrating internal surface geometry;
  • Figure 5 is an end view of the penetrating tip of Figure 2, including hidden lines illustrating internal surface geometry
  • Figure 6 is a top view of the penetrating tip of Figure 2, including hidden lines illustrating internal surface geometry
  • Figure 7 is an alternate embodiment of a penetrating tip in accordance with the invention, having an arcuate penetrating surface
  • Figure 8 is an isometric view of the penetrating tip of Figure 7, including hidden lines illustrating internal surface geometry of the tip;
  • Figure 9 is a side view of the penetrating tip of Figure 7, including hidden lines illustrating internal surface geometry
  • Figure 10 is an end view of the penetrating tip of Figure 7, including hidden lines illustrating internal surface geometry
  • Figure 11 is a top view of the penetrating tip of Figure 7, including hidden lines illustrating internal surface geometry;
  • Figure 12 is a further embodiment of a penetrating tip in accordance with the invention having ovoid facets formed thereon, terminating in an arcuate penetrating edge;
  • Figure 13 is an isometric view of the penetrating tip of Figure 12, including hidden lines illustrating internal surface geometry of the tip;
  • Figure 14 is a side view of the penetrating tip of Figure 12, including hidden lines illustrating internal surface geometry;
  • Figure 15 is an end view of the penetrating tip of Figure 12, including hidden lines illustrating internal surface geometry
  • Figure 16 is a top view of the penetrating tip of Figure 12, including hidden lines illustrating internal surface geometry;
  • Figure 17 is another embodiment of a penetrating tip in accordance with the invention having multiple facets on each side thereof, including ovoid facets, and terminating in an arcuate penetrating surface;
  • Figure 18 is an isometric view of the penetrating tip of Figure 17, including hidden lines illustrating internal surface geometry of the tip;
  • Figure 19 is a side view of the penetrating tip of Figure 17, including hidden lines illustrating internal surface geometry
  • Figure 20 is an end view of the penetrating tip of Figure 17, including hidden lines illustrating internal surface geometry
  • Figure 21 is a top view of the penetrating tip of Figure 17, including hidden lines illustrating internal surface geometry
  • Figures 22A-22F are views of a further embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 23A-23D are further views of the embodiment of Figure 22;
  • Figures 24A-24D are views of still another embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 25A-25D are views of yet another embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 26A-26D are views of another embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 27A-27G are perspective and plan views of another embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 28A-28I are perspective and plan views of a further embodiment of a penetrating tip constructed in accordance with the present invention.
  • Figures 29A-29G are perspective and plan views of another exemplary trocar tip according to an embodiment of the present invention.
  • Figures 30A-30G are perspective and plan views of still another exemplary trocar tip according to an embodiment of the present invention.
  • Figures 31A-31G are perspective and plan views of an exemplary trocar tip according to still another representative embodiment of the present invention.
  • Figures 32A-32G are perspective and plan views of an exemplary trocar tip according to yet another representative embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • the present invention may be used for insertion of surgical access devices or other devices that require the puncture of biological tissue.
  • the present invention is particularly suited for insertion of surgical access devices or cannulas (or "cannulae") through the abdominal wall of a patient, in order to provide a working channel through which a surgical procedure can be performed.
  • a visualization trocar 100 which includes a handle 110, a shaft 120 extending from the handle 110, and a penetrating tip 130 arranged at the distal end of the shaft 120.
  • the trocar 100 can be used with an endoscope 190 having an eyepiece 193 at a distal end thereof, which receives images through an optical path from a lens (not shown) situated on the endoscope 190 near the penetrating tip 130.
  • images are typically transmitted by way of a transparent medium within the endoscope 190, such as an optical shaft or one or more optical fibers.
  • an attachment having an image sensor can be secured to the endoscope 190 on or in place of the eyepiece 193.
  • the endoscope 190 can further be provided with a secondary optical conduit 180, which can transmit light to the penetrating tip 130.
  • the trocar 100 can be provided with an integral endoscope, including all of the features thereof contained in one integral device.
  • an image sensor can be provided within the trocar 100 at the distal end thereof— in the shaft 120 or within the penetrating tip 130. Accordingly, electrical rather than optical connections then extend through the shaft 120 to a display device, such as a video monitor.
  • a locking element 170 can be provided in the handle portion 110 of the trocar 100.
  • the locking element 170 engages the endoscope 190 passing through the handle 110, to prevent at a minimum, relative axial movement between the trocar 100 and the endoscope 190. Additionally, relative rotational movement can be inhibited, if desired.
  • trocar 100 itself can vary, and can include additional features, as needed or desired.
  • cannulae utilized with the trocar 100 can include one or more demarcations thereon, which indicate the progress of insertion, and can therefore signal to the surgeon when the cannula has been inserted sufficiently.
  • the geometry of the penetrating tip 130 can change as desired, as will become apparent through understanding of the various embodiments of penetrating tips, which are set forth hereinbelow.
  • the term "trocar” is used herein to refer generally to an insertion device, which is capable of puncturing an anatomical structure, such as an abdominal wall, to insert a surgical access device or "port" to aid in performing a surgical procedure.
  • FIG. 2 an isometric view of an exemplary embodiment of a penetrating tip in accordance with the invention is shown in Figure 2 and is designated generally by reference number 200.
  • the penetrating tip 200 includes a body 210, at its proximal end having a reduced-diameter portion 219, and one or more rotation locking elements 217, each of which interfaces with the shaft of a trocar (e.g., shaft 120 of trocar 100).
  • a trocar e.g., shaft 120 of trocar 100.
  • the reduced-diameter portion 219 is inserted into the shaft of a trocar, thereby enabling secure mutual engagement therebetween, while the rotation locking element(s) 217 engage a mating element, such as a groove, notch or recess in the shaft of the trocar, preventing relative rotation between the penetrating tip 200 and the trocar shaft. If, however, the tip 200 is manufactured integrally with a trocar, relative positioning can be achieved and maintained in another manner, such as integrally molding, insert molding, adhering, bonding or welding the components by heat, solvent or friction, or by another suitable manufacturing technique.
  • the distal end of the penetrating tip 200 includes a distal taper 215 of the body 210, and two opposed angled facets 220, which are angled inwardly, approaching the penetrating edge 240 at the distal end of the tip 200.
  • the facets 220 are substantially planar in this embodiment, and are delimited partially by a change in contour indicated by arcuate contour interface 230 with the body 210, and partially by the distal penetrating edge 240.
  • the facets 220 are angled, with respect to one another at an angle a (alpha).
  • the angle a can be anywhere from about 5 degrees to about 90 degrees, inclusive, at any one-degree increment therebetween. In one embodiment, the angle a is about 30 degrees, and in another embodiment the angle a is about 40 degrees, for example.
  • the tip 200 is inserted into a trocar, such as trocar 100 of Figure 1, or alternatively is manufactured integrally therewith.
  • the tip 200 can be manufactured from any suitable material, but is preferably transparent, to allow a surgeon to view the layers of tissue through which the surgeon is penetrating.
  • Such materials can include, for example, polycarbonate plastic, polymethyl methacrylate ("acrylic"), a vitreous material such as glass, or an optical crystal material. Accordingly, the surgeon is able to view the tissue through which the trocar and tip 200 are passing. The surgeon is able, therefore, to determine by the general appearance of the tissue, the point at which the tip 200 has penetrated to a sufficient depth.
  • the depth will typically be a point at which the tip 200 has just entered the peritoneal cavity.
  • the tip 200 can be provided with any desired degree of sharpness. That is, the penetrating tip 240 can be formed to have a sharp point, a dissecting edge or can be rounded to any desired degree in order to provide a relatively blunt leading edge. When provided with a relatively blunt tip 240, accidental injury to internal anatomical structures, such as intestines, can be reduced.
  • FIG 3 is an isometric view of the tip of Figure 2, including hidden lines illustrating internal surface geometry of the tip 200.
  • an internal surface 350 is provided in the penetrating tip 200.
  • This internal surface 350 defines a space through which images can be taken.
  • a visualization device (not shown) is preferably provided with trocars and penetrating tips in accordance with the invention, including that illustrated in Figures 2-6.
  • Various embodiments can be used to provide an image to the surgeon inserting the trocar.
  • an imaging device such as a CCD (charge-coupled device) can be provided in the trocar (e.g., trocar 100) or in the penetrating tip (e.g., tip 200), or alternatively connected thereto via an optical path, which can include, for example, one or more fiber-optic conduits.
  • an optical path can include, for example, one or more fiber-optic conduits.
  • Such trocars can also be provided with illumination capability provided through the optical path.
  • the internal space defined by the internal surface 350 of the tip 200 includes surface features that correspond to features provided on the external surface of the tip 200.
  • an arcuate contour interface 353 and inner facet 352 correspond to the arcuate contour interface 230 and the facets 220 of the outer surface of the tip 200.
  • an inner tip 354 of the space defined by the inner surface 350 corresponds to the penetrating edge 240 of the outer surface of the tip 200.
  • Such corresponding internal geometry can reduce distortion in an image obtained from the tip 200.
  • one or more lenses can be additionally provided within the tip 200, to adjust, correct or direct images as needed.
  • Figures 4, 5 and 6 are side, end and top views, respectively, of the tip 200 of Figures 2 and 3, including hidden lines illustrating internal surface geometry of the tip 200.
  • Figures 7-11 illustrate an alternate embodiment of a penetrating tip 700 in accordance with the invention, having an arcuate penetrating surface 740.
  • the tip 700 includes a body 710, having at its proximal end a reduced-diameter portion 219, and one or more rotation locking elements 217.
  • the tip 700 is manufactured integrally with a trocar, relative positioning can be achieved and maintained without such locking elements 217.
  • the distal end of the penetrating tip 700 includes a distal taper 715 of the body 710, and two opposed angled facets 720, which are angled inwardly, approaching the cutting or dissecting edge 740 at the distal end of the tip 700.
  • the facets 720 are delimited partially by an arcuate contour interface 730 with the body 210, and partially by the distal edge 740.
  • the facets 720 are convexly contoured, rather than being planar, which can best be seen in the side view of Figure 9.
  • the facets 720 are angled, with respect to one another at an angle a (alpha).
  • the angle a can be, for example, anywhere from about 5 degrees to about 80 degrees.
  • FIG 8 is an isometric view of the tip 700 of Figure 7, including hidden lines illustrating internal surface geometry of the tip 700.
  • an internal surface 750 is formed within the tip 700, which includes surface features corresponding to features of the outer surface of the tip 700.
  • any of the embodiments set forth herein can include a solid tip.
  • such tip will include optical elements to enable adequate optical transmission of images from the distal end of the tip 700.
  • an imaging device such as a CCD is provided within the body 710 of the tip 700 at an appropriate location, such as just proximal of the facet 720, an adequate image can be obtained regardless of the optical characteristics of the remainder of the tip 700.
  • Figures 9-11 are side, end and top views of the tip 700 of Figures 7-8, including hidden lines illustrating internal surface geometry. Naturally, any of the features described in connection with any other embodiment set forth herein can advantageously be applied to this embodiment.
  • FIGS 12-16 illustrate a further embodiment of a penetrating tip, designated generally with reference number 1200, in accordance with the invention.
  • the tip 1200 includes ovoid facets 1120 formed thereon, terminating in an arcuate cutting or dissecting surface 1240.
  • the tip 1200 is similar in many respects to the foregoing embodiments.
  • the ovoid facets 1220 result in a reduced profile for insertion. That is, instead of the relatively wide surfaces 240, 740 of the above-described tips 200, 700, respectively, the cutting or dissecting edge 1240, at the distal end of the ovoid facets 1220, is relatively narrow. This aspect of the tip 1200, can facilitate initial insertion by reducing the force necessary to puncture the abdominal wall.
  • the tapered region 1215 of the body 1210 helps widen the initial incision, as the tip 1200 advances through the patient's abdominal wall.
  • the ovoid facets 1220 can be convex or planar, as desired, and are delimited by the penetrating edge 1240, and the contour interface 1230, where the contour of the tip 1200 transitions from the facet 1220 to the relatively cylindrical body 1210.
  • the facets 1220 are angled with respect to one another at an angle a (alpha).
  • the angle a can be anywhere from about 5 degrees to about 80 degrees, for example.
  • Figure 13 is an isometric view of the tip 1200 of Figure 12, including hidden lines illustrating internal surface geometry of the tip 1200. In this view, the internal surface 1350 of the tip 1200 is visible.
  • the internal surface 1350 can include features that correspond to features of the outer surface of the tip 1200.
  • the tip 1200 can include a contour interface 1353 corresponding to the contour interface 1230 of the outer surface of the tip 1200, and can include an inner facet 1352 corresponding to the facet 1220 on the outer surface of the tip 1200.
  • Figures 14-16 are side, end and top views, respectively, of the tip of Figures 12-13, including hidden lines illustrating internal surface geometry.
  • any of the features described in connection with any other embodiment set forth herein can advantageously be applied to this embodiment.
  • Figure 17-21 illustrate another embodiment of a penetrating tip 1700 constructed in accordance with the invention having multiple facets 1721, 1723, 1725 on each side thereof, including ovoid facets 1721, and terminating in an arcuate cutting or dissecting surface 1740, similar to the embodiment of Figures 7-11.
  • the penetrating tip 1700 includes a body 1710, at its proximal end having a reduced-diameter portion 219, and one or more rotation locking elements 217, as with the foregoing embodiments.
  • the distal end of the penetrating tip 1700 includes a distal taper 1715 of the body 1710, and opposed angled facets 1721, 1723, 1725, which are angled inwardly, approaching the penetrating edge 1740 at the distal end of the penetrating tip 1700.
  • the facets 1721, 1723, 1725 can be either convex or substantially planar. As illustrated, the facets include a substantially planar facet 1721, and convex facets 1723, 1725, the convexity of which is best seen, for example, in the side view of Figure 19.
  • the facets 1721, 1723, 1725 are delimited on one side by the contour interface 1730 and at the other side by the cutting or dissecting edge 1740.
  • the change in contours among adjacent facets is defined therebetween at a contour interface indicated by line 1732.
  • the facets 1721 of opposite sides of the penetrating tip 1700 are angled, with respect to one another at an angle a (alpha).
  • the angle a can be anywhere from about 5 degrees to about 80 degrees, at any one degree increment therebetween, for example.
  • the contour interface 1730 includes a corresponding inner contour interface 1853 defined on the inner surface 1850 of the tip 1700, as part of a generally corresponding overall shape.
  • Figures 19-21 are side, end and top views, respectively of the tip 1700 of Figures 17 and
  • Figures 22A-22F and 23A-D represent further embodiments of a tip 2200 made in accordance with the invention.
  • Fig. 22A depicts a lengthwise view of tip 2200 along one of two opposing substantially ovoid main facets 2220 that converge to a distal dissecting edge 2210.
  • facets 2220 are substantially flat, as opposed to concave or convex.
  • Additional smaller facets 2225 are defined between the main facets 2220.
  • the intervening facets 2225 are generally elongate concave formations or grooves. It will be appreciated that each of the facets 2220, 2225 may be substantially flat, convex or concave, as desired.
  • Fig. 22A depicts a lengthwise view of tip 2200 along one of two opposing substantially ovoid main facets 2220 that converge to a distal dissecting edge 2210.
  • facets 2220 are substantially flat, as opposed to concave or convex.
  • Additional smaller facets 2225 are defined between the main facets 22
  • Fig. 22B depicts an end view of tip 2200, showing the manner in which all four facets converge and taper to edge 2210.
  • Fig. 22C depicts a lengthwise view of tip 2200 illustrating the shape of facet 2225.
  • Fig. 22D illustrates a cross sectional view of tip 2200 taken along line "A-A" in Fig. 22C.
  • Fig. 22E illustrates a cross sectional view of tip 2200 taken along line "B-B" in Fig. 22A.
  • Fig. 22F illustrates an enlarged cross sectional view of tip 2200 illustrating a locking feature discussed below.
  • Figs. 23A-C depict similar illustrations of tip 2200 showing the interior surfaces of tip 2200 in broken lines.
  • Fig. 23D depicts an isometric view of tip 2200.
  • tip 2200 defines a hollow interior 2250 bound by a plurality of inner surfaces 2260.
  • a locking feature 2230 may be provided to facilitate attachment of tip 2200 to a trocar shaft, as described herein.
  • the tip 2200 may be fully transparent or may include one or more opaque, darkened or otherwise visually obscured regions, such as in the distal region 240 of the tip 2200, proximate the dissecting edge 2210 in region 2240. Such regions are illustrated in the embodiments of Figs. 24-26 and discussed in further detail below, and can improve visibility of the anatomy being penetrated by reducing glare from stray light entering the tip 2200.
  • the opaque distal region of the body can minimize glare by reducing errant internal reflections within the tip 2200.
  • the opaque distal region which can be colored and in contrast with the remainder of the body of the penetrating tip, can be provided in a manner such that it functions as an indicator or gauge.
  • the term opaque generally refers to an item that substantially inhibits transmission of light.
  • the opaque distal region can be black, gray, blue, white, red, green, purple, pink, yellow, orange or any color desired.
  • the tip can be translucent and can be clear or have a color imparted thereon.
  • the degree of translucidity can be selected as desired, and thus may still act to reduce glare and/or to serve as a gauge or guide. It is also conceived that providing the entire tip or only the distal region 2240 of the tip 2200 with a particular color can serve to act as an optical filter to enhance images obtained therethrough. As an example, when the colored or obscured distal region 2240 is provided in a trocar used in a surgery, a patient's abdomen can be insufflated normally, and an endoscope inserted through the abdominal wall in a conventional manner.
  • the distal region (having a color, or other feature), becomes readily visible to the surgeon. This is possible only if the surgeon views the procedure through the endoscope already inserted through the abdominal wall. This, however, may require two separate people to view two separate endoscopes.
  • Figures 24A-24D depict still another embodiment of a tip 2400 made in accordance with the present invention having a plurality of facets 2420, 2425 similar to the embodiment of Figs. 22-23 and defining a dissecting edge 2410. More
  • facets 2420 are generally flat surfaces, and facets 2425 are generally concave grooves. It will be appreciated that the shape of facets 2420, 2425 may be modified, as desired to include convex and/or concave surfaces. Locking features 2430 are further provided to facilitate a connection with a trocar tube. Moreover, a distal region 2440 is provided that is generally pyramidal shaped to ease penetration in tissue. As depicted, the distal region 2440 can be darkened, opaque or otherwise obscured, such as by a coating applied thereto, for example, or in another manner.
  • Such an obscured or opaque region can help reduce the effects of internal reflections in the tip 2400, thus improving viewing.
  • all tips disclosed herein may be provided with such an opaque, or otherwise obscured distal region, as desired.
  • the opaque or obscured region may be made by depositing an opaque material on the surface of the tip 2400 in region 2440, such as by screen printing or painting.
  • such a region may be provided by treating the surface of the tip to be obscured such as by roughening to substantially prevent light from passing through the region 2440.
  • the obscured region 2440 can be separately formed of an opaque material and combined, by insert molding or other suitable manufacturing technique, with the remaining material of the tip 2400.
  • the region 2440 may be treated by providing a second material within the material of the tip 2400 in the region 2440 in order to darken the region 2440.
  • the tip 2400 is preferably hollow as with the foregoing embodiments, in order to ease image transmission and to accommodate an endoscope therein for transmitting and receiving light.
  • Figs. 25A-25D illustrate still another embodiment of a tip 2500 made in accordance with the invention.
  • the tip 2500 includes two facets 2520 similar to the embodiments of Figs. 22-24.
  • Tip 2500 further includes a generally pyramidal distal region 2540 that is opaque or otherwise obscured. It will be understood that the entirety of tip 2500 may alternatively be transparent, as desired.
  • the distal region 2540 terminates in a tissue separating edge 2510 and locking feature 2530 as with other embodiments described herein.
  • tip 2500 further includes two longitudinal depressions 2545 formed therein. Depressions 2545 may facilitate advancement of tip 2500 through tissue by lowering resistance. As depicted, depressions 2545 may be obscured and/or provided with an opaque coating to improve the optical performance of tip 2500.
  • the tip 2500 is preferably hollow to accommodate an endoscope, and can be provided with optical features to enhance images obtained therefrom.
  • Figs. 26A-26E illustrate yet another embodiment of a tip 2600 made in accordance with the invention.
  • Tip 2600 includes a plurality of facets 2620 (four identical facets, as depicted) that join each other at edges 2622 and taper to form a distal region 2640 terminating at a penetrating edge 2610. As depicted, distal region 2640 is obscured or opaque, but may be transparent if desired. A locking feature 2630 may further be provided, if desired.
  • the cross section of tip 2600 closely resembles a rectangle with inwardly bowed sides. Such a geometry effectively forms four concave facets 2620 with a reduced cross sectional profile that can facilitate advancement of tip 2600 through tissue by lowering insertion resistance.
  • Tip 2600 is preferably hollow to accommodate an endoscope.
  • FIG. 27A-27G an isometric view of a further exemplary embodiment of a penetrating tip in accordance with the disclosure is shown in Figures 27A-27G and is designated generally by reference number 2700.
  • the penetrating tip 2700 includes a body 2710.
  • the distal end of the penetrating tip 2700 includes a distal taper 2715 of the body 2710, and two opposed angled facets 2720, which are angled inwardly, approaching the penetrating edge 2740 at the distal end of the tip 2700.
  • the facets 2720 are substantially planar in the embodiments introduced herein, and are delimited partially by a change in contour indicated by arcuate contour interface 2730 with the body 2710, and partially by the distal penetrating edge 2740.
  • the facets 2720 are angled, with respect to one another. The angle can be anywhere from about 5 degrees to about 80 degrees, inclusive, at any one- degree increment therebetween. In one embodiment, the angle a is about 30 degrees, for example.
  • the distal edge 2740 of tip 2700 differs in some aspects compared to other tips disclosed herein.
  • distal edge 2740 separates the facets 2720 without intermediate structure, such as an intermediate surface, between the facets, for about a 180° extent.
  • edge 2740 has an extent of about 180° about the perimeter of each facet 2740.
  • Edge 2740 also has a more elongate shape than other distal edges disclosed herein.
  • the coefficient "a" can be an integer, such as 1, 2, 3, etc.
  • Contour 2730 which also defines about 180° of each facet 2720, is also parabolic in shape within a plane defined by contour 2730, as well as in a side plan view as set forth in Figure 9E.
  • the parabolic shape of facet 2730 can also be defined by the same relation set forth above for edge 2740.
  • the shapes of edge 2740 and contour 2730 are preferably different in contour in the planes in which it reside from each other.
  • edge 2740 terminates at a point where an intermediate surface 2770 begins that separates the facets 2720, wherein each surface is represented by a generally triangular shape wrapped around a cylinder.
  • the pair of triangular surfaces and the facets 2720 cooperate to define a continuous surface without interruption that encloses a volume that transitions to a cylindrical shape.
  • Edge 2740 is straight in a distally- oriented plan view as set forth in Figure 9F.
  • the tip is inserted into a trocar, or alternatively is manufactured integrally therewith.
  • the tip can be manufactured from any suitable material, but is preferably transparent, to allow a surgeon to view the layers of tissue through which the surgeon is penetrating.
  • Such materials can include, for example, polycarbonate plastic, polymethyl methacrylate ("acrylic"), a vitreous material such as glass, or an optical crystal material. Accordingly, the surgeon is able to view the tissue through which the trocar and tip 2700 are passing. The surgeon is able, therefore, to determine by the general appearance of the tissue, the point at which the tip 2700 has penetrated to a sufficient depth. During an abdominal procedure, the depth will typically be a point at which the tip 2700 has just entered the peritoneal cavity.
  • the tip 2700 can be provided with any desired degree of sharpness and a hollow interior 2750. That is, the penetrating tip 2740 can be formed to have a sharp point, a dissecting edge or can be rounded to any desired degree in order to provide a relatively blunt leading edge. When provided with a relatively blunt tip 2740, accidental injury to internal anatomical structures, such as intestines, can be reduced.
  • Figures 28A-28I illustrate a further alternate embodiment of a penetrating tip 2800 in accordance with the invention, having a penetrating edge 2840.
  • the tip 2800 includes a body 2810, and the distal end of the penetrating tip 2800 includes two opposed angled facets 2820, which are angled inwardly, approaching the cutting or dissecting edge 2840 at the distal end of the tip 2800.
  • edge 2840 is comprised of a generally straight segment at the distal end of the tip that is oriented transversely with respect to an imaginary longitudinal central axis X of the tip that runs along the proximal-distal centerline of the tip.
  • the generally straight segment is not perpendicular to the longitudinal axis, but is angled, or oblique, with respect to the axis by an angle ⁇ such that one end 2841 of the generally straight segment is located distally with respect to the other end of the generally straight segment 2842.
  • the generally straight segment has a generally flat face 2843 that faces in a generally distal direction, but is oblique with respect to the longitudinal axis of the tip.
  • Each end of the generally straight segment is connected to an arcuate segment on either side of the tip 2844, 2845, such that the generally straight segment and the arcuate segment on each side form a depression or pocket 2846 on each side of the tip.
  • Each end of the generally straight segment is also connected to a straight edge 2822 that progresses proximally until the proximal portion of each facet 2820 that is defined by an arcuate section 2824.
  • Each end of edge 2822 terminates at a point 2825 where an intermediate surface 2870 begins that separates the facets 2820, wherein each surface is represented by a generally triangular shape wrapped around a cylinder. In the case of tip 2800 surfaces 2870 are connected.
  • FIGS 29-30 illustrate a further embodiment of a penetrating tip, designated generally with reference number 2900 and 3000, in accordance with the invention.
  • the tips 2900, 3000 include ovoid facets 2920, 3020 formed thereon, terminating in a cutting or dissecting surface 2940, 3040.
  • the tips 2900, 3000 are similar in many respects to the foregoing embodiments. However, the ovoid facets 2920, 3020 result in a reduced profile for insertion.
  • Figs. 29-30 are identical but for an obscured or opaque region (e.g., 3040) in the embodiment of Fig. 30 that can help reduce the effects of internal reflections in the tip 3000, thus improving viewing.
  • the opaque or obscured region 3040 may be made by depositing an opaque material on the surface of the tip 3000, such as by screen printing or painting.
  • such a region may be provided by treating the surface of the tip to be obscured such as by roughening to substantially prevent light from passing through the region.
  • Tip 3000 is preferably hollow as with the other embodiments to ease image transmission and to accommodate an endoscope therein for transmitting and receiving light.
  • Tip 2900 includes a distal edge 2945 that is substantially straight and substantially transverse to a longitudinal axis X of the tip. Facets 2920 are bordered on each side by edge
  • edge 2945 longitudinal straight edges 2946, and parabolic curved edge 2948.
  • Auxiliary surfaces 2960 are defined between edge 2948 and parabolic edge 2965.
  • Surfaces 2960 are substantially crescent ("C") shaped.
  • Edges 2965 fall on the surface of a cylinder defined by the proximal portion 2970 of tip 2900.
  • Facets 2920 are convexly shaped.
  • Opaque region 3040 of tip may also serve the purpose of providing a means of measurement at the distal tip.
  • the generally straight integral edge arranged at the distal end of the tip body, which is transverse to a longitudinal axis of the tip, is disposed within a transversely oriented obscured distal region surrounding the integral edge, wherein the obscured region provides a means for measurement.
  • opaque region 3040 is visible on a viewing screen as a darkened line traversing the viewing screen (e.g., CRT or flat screen monitor). The subject darkened line provided by opaque region can thus be correlated with the known dimension of the distal region of the tip, thereby providing a means of measurement.
  • graduations 3047 can additionally be provided along the opaque region from one side of the tip to the other to provide smaller distances for measurement, similar to a ruler. Numbers or other indicia can also be provided to permit ease of estimation of distances to a user on a viewing screen.
  • a system is contemplated for measurement during a surgical procedure, comprising any tip as described herein having a plurality of markings across the tip that may comprise darkened regions, gradation lines, or the like.
  • An endoscope as disclosed herein (see discussion relating to Figure 1) is further included, which can provide an image to an eyepiece or external monitor, with or without an additional light source as disclosed herein.
  • a blunt dissecting tip is provided, particularly having a substantially straight transverse distal edge, the tip can be rotated by way of an attached trocar to split layers of tissue apart as the tip proceeds through the skin into the abdominal cavity. Gradations or markings on the tip can be used to estimate distance, size of anatomical structures and relative placement of surgical instruments with respect to each other, as well as with respect to anatomical structures.
  • FIG. 31A-31G an isometric view of a further exemplary embodiment of a penetrating tip in accordance with the disclosure is shown in Figures 31A-31G and is designated generally by reference number 3100.
  • the penetrating tip 3100 includes a body 3110 having a proximal end 3112 and a distal end 3114.
  • the distal end of the penetrating tip 3100 includes a distal tapering region 3125 of the body 3110, and two opposed angled and concave facets 3120, which are angled inwardly, approaching the penetrating edge 3140 at the distal end of the tip 3100.
  • the angle can be anywhere from about 5 degrees to about 80 degrees, inclusive, at any one-degree increment therebetween.
  • the angle a is about 30 degrees, for example.
  • the facets 3120 are substantially concave in the embodiments of Figures 31 and 32, and are delimited partially by a change in contour indicated by arcuate contour interface 3130 with the body 3110, and partially by the distal penetrating edge 3140.
  • the facets 3120 are angled, with respect to one another.
  • a transition surface 3160 is provided between facet 3120 and region 3170 which has a surface approximating a cylindrical section. Region 3170 is parallel to generally cylindrical region 180.
  • the embodiments of Figures 31-32 are essentially the same as those of Figures 29-30, but for the fact that the facets 3120, 3220 are concave.
  • the tip is inserted into a trocar, or alternatively is manufactured integrally therewith.
  • the tip can be manufactured from any suitable material, but is preferably transparent, to allow a surgeon to view the layers of tissue through which the surgeon is penetrating.
  • Such materials can include, for example, polycarbonate plastic, polymethyl methacrylate ("acrylic"), a vitreous material such as glass, or an optical crystal material. Accordingly, the surgeon is able to view the tissue through which the trocar and tip 3100 are passing. The surgeon is able, therefore, to determine by the general appearance of the tissue, the point at which the tip 3100 has penetrated to a sufficient depth. During an abdominal procedure, the depth will typically be a point at which the tip 100 has just entered the peritoneal cavity.
  • the tip 3100 can be provided with any desired degree of sharpness and a hollow interior 3150, best viewed in Fig. 31G. That is, the penetrating tip 3140 can be formed to have a sharp point, a dissecting edge or can be rounded to any desired degree in order to provide a relatively blunt leading edge.
  • the penetrating tip 3140 can be formed to have a sharp point, a dissecting edge or can be rounded to any desired degree in order to provide a relatively blunt leading edge.
  • accidental injury to internal anatomical structures, such as intestines can be reduced, and adjacent tissue layers may be separated by rotating the tip about its longitudinal axis, thus splitting tissue layers from each other without actually cutting tissue.
  • FIG. 32A-32G A further embodiment of a tip is provided in Figures 32A-32G.
  • the embodiment of Figures 32A-32G is identical to that of Figures 31 A-31G but for an obscured or opaque region (e.g., 3240) in the embodiment of Fig. 32 that can help reduce the effects of internal reflections in the tip 3200, thus improving viewing.
  • the opaque or obscured region may be made by depositing an opaque material on the surface of the tip 3200, such as by screen printing or painting.
  • such a region may be provided by treating the surface of the tip to be obscured such as by roughening to substantially prevent light from passing through the region.
  • Tip 3200 is preferably hollow as with the other embodiments to ease image transmission and to accommodate an endoscope therein for transmitting and receiving light.
  • Images can be output from the aforementioned devices—that is in the penetrating tips or in the trocars, for example.
  • the images can be displayed for the surgeon on a monitor arranged in a convenient location. If so-desired, a monitor can be provided at and integrated with the proximal end of the trocar itself, so as to enhance the perception and ergonomic aspects of trocars in accordance with the invention. If so-equipped, the proximal end of the trocar can be configured so as to include one or more integral handles to facilitate gripping of the trocar by the surgeon.
  • images can be automatically manipulated in real time by a computer, prior to display, so as to reduce or eliminate any distortion, color imbalance or other optical aberrations which may be present in the raw image output from the image sensor.
  • Penetrating tips and trocars in accordance with the invention can be used to create an opening in an anatomical structure of a patient, such in the patient's abdominal wall.
  • the opening can be used to provide access or any of a variety of instruments, such as, for example, a feeding tube.
  • devices constructed in accordance with the invention will be used to insert surgical access devices, such as access ports and cannulas, which maintain the opening formed by a trocar and therefore provide easy access to a surgical cavity.
  • surgical access devices such as access ports and cannulas, which maintain the opening formed by a trocar and therefore provide easy access to a surgical cavity.
  • Access devices described in the aforementioned application include various types of seals to inhibit escape of insufflation gas from a patient's peritoneal cavity during a surgical procedure. Additionally, devices constructed in accordance with the invention can be used to insert flexible access devices, such as those set forth in the application entitled “Elastically Deformable Surgical Access Device” U.S. Patent Application Serial Number 11/544,856, filed October 6, 2006, which application is also incorporated herein by reference in its entirety. If used with such elastically deformable surgical access devices, engagement elements can be provided on the trocar or the penetrating tip to enable engagement with such access device. Following preparation of the patient, a trocar having a tip in accordance with the invention is used to pierce the abdominal wall of the patient.
  • the surgeon is able to view the tissue being penetrated by the penetrating tip through any of the aforementioned means, such as through a video monitor.
  • a surgical access device as those described above, will be inserted simultaneously through the opening created by the trocar.
  • the trocar with the penetrating tip is inserted through the access device such that the penetrating tip protrudes from the end of the access port, and the penetrating tip, surrounded by the access port, is inserted through the abdominal wall.
  • a scalpel is used to make an incision through the skin, and the penetrating tip with the trocar and access port is inserted through the remaining layers of tissue into the abdominal wall.
  • the trocar is then removed, leaving the surgical access device in place in order to carry out the prescribed surgical procedure.
  • the present invention encompasses methods of use of the devices described herein.
  • the present invention includes methods of use of penetrating tips described herein, in combination with insertion devices, such as trocars or obturators, and surgical access devices, such as cannulas.
  • the present invention can relate to a kit having one or more of a penetrating tip in accordance with the invention, a surgical access device, such as a cannula, and an insertion device, such as a trocar or obturator.

Abstract

L'invention concerne un trocart chirurgical et une pointe pénétrante pour celui-ci. La pointe comprend un corps généralement transparent ayant des extrémités proximale et distale et une partie de pointe distale opaque, un bord pénétrant d'un seul tenant agencé à une extrémité distale du corps, et des facettes opposées effilées vers l'intérieur formées sur le corps, convergeant les unes vers les autres au niveau du bord pénétrant d'un seul tenant.
PCT/US2011/032305 2010-04-13 2011-04-13 Trocart de visualisation WO2011130399A1 (fr)

Applications Claiming Priority (4)

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US32386810P 2010-04-13 2010-04-13
US61/323,868 2010-04-13
US36725910P 2010-07-23 2010-07-23
US61/367,259 2010-07-23

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US9211059B2 (en) 2007-06-19 2015-12-15 Minimally Invasive Devices, Inc. Systems and methods for optimizing and maintaining visualization of a surgical field during the use of surgical scopes
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US10537353B2 (en) 2013-03-14 2020-01-21 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices
US9943328B2 (en) 2015-04-28 2018-04-17 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices with an elastic force
US10874415B2 (en) 2015-06-17 2020-12-29 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices
US10363056B2 (en) 2015-06-17 2019-07-30 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices
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CN106510809A (zh) * 2016-12-09 2017-03-22 成都五义医疗科技有限公司 改良的无刀可视穿刺针

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