WO2014126757A2 - Interface chirurgicale utilisable avec un endoscope - Google Patents

Interface chirurgicale utilisable avec un endoscope Download PDF

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Publication number
WO2014126757A2
WO2014126757A2 PCT/US2014/014816 US2014014816W WO2014126757A2 WO 2014126757 A2 WO2014126757 A2 WO 2014126757A2 US 2014014816 W US2014014816 W US 2014014816W WO 2014126757 A2 WO2014126757 A2 WO 2014126757A2
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WO
WIPO (PCT)
Prior art keywords
endoscope
interface
surgical
distal end
proximal end
Prior art date
Application number
PCT/US2014/014816
Other languages
English (en)
Other versions
WO2014126757A3 (fr
Inventor
Joseph L. Mark
Brian C. Dougherty
Original Assignee
Nico Corporation
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
Priority claimed from US13/768,776 external-priority patent/US20130237753A1/en
Application filed by Nico Corporation filed Critical Nico Corporation
Publication of WO2014126757A2 publication Critical patent/WO2014126757A2/fr
Publication of WO2014126757A3 publication Critical patent/WO2014126757A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A61B1/00119—Tubes or pipes in or with an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
    • A61B1/00128—Connectors, fasteners and adapters, e.g. on the endoscope handle mechanical, e.g. for tubes or pipes

Definitions

  • the present disclosure relates generally to surgical interfaces and adapters for introducing a surgical device into the body of a patient and, more particularly, to surgical interfaces for use with delivering a surgical device through an endoscope.
  • Endoscopic surgery allows for surgery to be performed while reducing damage to the surrounding tissue as compared to open surgical procedures.
  • An endoscope typically includes at least one working channel allowing insertion and deployment of various medical devices to the surgical site. The endoscope also provides visualization of the surgical site during the procedure.
  • a surgical instrument may be inserted through the working channel and protrude from the distal end of the working channel at the visualized surgical site.
  • a surgical cutting device is introduced to excise tissue samples from the surgical site.
  • Such a surgical cutting instrument generally requires connection to a handpiece that provides rotary or reciprocative (or both) motion to the cutting portion of the instrument.
  • tissue is generally drawn through the mouth of the cutting instrument, severed, and removed from the surgical site.
  • the handpiece must be constantly controlled by the surgeon to control the extension of the instrument beyond the working channel of the endoscope.
  • the distal end of the surgical cutting device may move independently from the endoscope.
  • a surgeon must continually manipulate both the endoscope and the surgical cutting device, relying on the surgeon's hand-eye coordination, to insure proper placement of the surgical cutting instrument, and to prevent inadvertent movement away from a selected area of interest or moving too deep into area, thereby causing unintended damage to surrounding tissues or structures.
  • This constant control of the instrument causes fatigue in the surgeon and makes it difficult to hold the endoscope still while precisely controlling the surgical cutting instrument during the procedure.
  • a surgical interface is needed that permit a surgical cutting device to be operatively connected to an endoscope, without requiring constant attention to fine hand-eye coordination. Further, a need exists for a surgical interface and adapter that facilitates adjustable and fixed positioning of the device within the patient, removal of the device from the working channel, and reinsertion of the device through the working channel to a desired position.
  • FIG. 1 is a side elevational view of an embodiment of an exemplary endoscope
  • FIG. 2A is a side elevational view of an embodiment of a trocar for use with the endoscope of FIG. 1;
  • FIG. 2B is a detail view of a distal tip of the trocar of FIG. 2A;
  • FIG. 3 is a perspective view of an exemplary surgical cutting device
  • FIG. 4 is a side elevational view of an embodiment of a surgical system that includes an endoscope, a trocar and surgical cutting device;
  • FIG. 5 is perspective view of an exemplary surgical adapter for use with a surgical system
  • FIG. 6 is an exploded view of the surgical adapter of FIG. 5;
  • FIG. 7 is a partial side view of the surgical adapter of FIG. 5, as a surgical cutting device is being operatively connected thereto.
  • FIG. 8 is a partial side view of the surgical adapter of FIG. 5 with the surgical cutting device operatively connected thereto to form a surgical sub-assembly.
  • FIG. 9 is a side view of the surgical sub-assembly of FIG. 8, as the subassembly is being operatively connected to a first type of endoscope.
  • FIG. 10 is a side view of the connected surgical sub-assembly of FIG. 8 operatively connected to the endoscope shown in FIG. 9.
  • FIG. 11 is an enlarged view of encircled area 11 taken from FIG. 10.
  • FIG. 12 is a perspective view of an alternative embodiment of a surgical adapter for use with a surgical system
  • FIG. 13 is an exploded view of the surgical adapter of FIG. 12;
  • FIG. 14 is side view of the surgical adapter of FIG. 12 as a surgical cutting device is being operatively connected thereto;
  • FIG. 15 is a side view of the surgical adapter of FIG. 12 with the surgical cutting device operatively connected thereto to form a surgical sub-assembly;
  • FIG. 16 is a side view of the surgical sub-assembly of FIG. 15 being operatively connected to the connected together endoscope and the trocar of FIGS. 1 and
  • FIG. 17 if a side view of the connected surgical sub-assembly of FIG. 15 operatively connected to the connected together endoscope and trocar of FIGS. 1 and 2;
  • FIG. 18 is an enlarged view of encircled area 18 taken from FIG. 17;
  • FIG. 19 is a side view of another embodiment of a surgical system including a connector adapter for use with the surgical adapter of FIG. 5, an endoscope, and a surgical cutting device.
  • FIG. 20 is an enlarged view of encircled area 20 taken from FIG. 19.
  • FIG. 21 is a perspective view of the connector adapter shown in the surgical system illustrated in FIG. 19.
  • FIG. 22 is a top plan perspective, as the connector adapter is being secured to the endoscope shown in FIG. 19.
  • FIG. 23 is a perspective view of a funnel attachment for use with an endoscope
  • FIG. 24 is a partial perspective view of the funnel attachment of FIG. 23 operatively attached to an endoscope; and [0033] FIG. 25 is a side view of the funnel attachment of FIG. 23 attached to the endoscope as a working channel of the surgical cutting device is being inserted therein.
  • FIG. 26 is a side view of another embodiment of a surgical system including a surgical interface, an endoscope, and a surgical cutting device.
  • FIG. 27 is a partial cross-sectional view of the surgical system of FIG. 26.
  • FIG. 28 is a partial perspective view of the surgical system of FIG. 26.
  • FIG. 29 is a side view of another embodiment of a surgical system including a surgical interface, an endoscope, and a surgical cutting device.
  • FIG. 30 is a partial cross-sectional view of the surgical system of FIG. 29.
  • FIG. 31 is a partial perspective view of the surgical system of FIG. 29.
  • FIG. 32 is a perspective exploded view of the surgical system of another embodiment of a surgical system.
  • FIG. 33 is a partial perspective view of the surgical system of FIG. 32.
  • FIG. 34 is a partial cross-sectional view of the surgical system of FIG. 32.
  • Endoscopes are used to visualize various areas of interest within a patient.
  • Endoscope 300 comprises a housing 301, an eye -piece 302, a fiber optic light cable connector 304, and a shaft 306.
  • Shaft 306 is defined by a proximal end 308 which is disposed in and connected to housing 301 and a distal end 310. As may be seen, distal end 310 is spaced apart from proximal end 308.
  • Endoscope 300 is configured to allow a user to view a surgical area of interest proximate distal end 310 through eye -piece 302, when distal end 310 is inserted into a surgical site.
  • shaft 306 also includes a conduit (not separately shown) for transmitting light provided via fiber optic connector 304 to the surgical area.
  • Shaft 306 may also include a lens (not separately shown) for magnifying and viewing the surgical area.
  • Eye -piece 302 is connected to housing 301. Eye -piece 302 may also be connected to a camera with a camera connector (not shown) so that the image generated by endoscope 300 can be viewed remotely on a display monitor.
  • a trocar 307 may also be provided, as best seen in FIGS. 2 A and 2B.
  • Trocar 307 is especially useful for closed surgical procedures.
  • Trocar 307 comprises a trocar body 314 and a trocar shaft 312.
  • Trocar 307 is defined by a proximal end 316, with a proximal opening formed in trocar body 314, and a distal end 318 of shaft 312.
  • Shaft 312 defines one or more channels in its interior.
  • shaft 312 may have a plurality of channels, 324, 326, 328, and 330 which terminate at a tip distal face 322.
  • a working channel 324 is sized to accommodate an outer cannula 444 of a surgical cutting device 440 (to be described below in further detail).
  • Channel 326 is sized to accommodate endoscope shaft 306.
  • Channel 328 may be configured as an irrigation channel used to direct irrigation fluid from an irrigation conduit 320 to the surgical site.
  • Channel 330 may be configured as a relief channel used to relieve fluid pressure at the surgical site. During closed procedures, as irrigation fluid flows to a surgical site it can pressurize the site.
  • Surgical cutting device 440 includes a handpiece 442 and a cutting element that includes an outer cannula 444 and an inner cannula (not shown). A distal end 447 of the cutting element is configured for insertion into a patient.
  • handpiece 442 is configured with a generally cylindrical shape. Handpiece 442 may be sized and shaped to be grasped with a single hand. Handpiece 442 also includes a lower housing 450 comprising a proximal section 446 and a distal section 448. A front housing section 455 may be connected to a cam housing positioned in distal section 448. An upper housing 452 is also provided. The cutting element is mounted to upper housing 452 and may be fluidly connected to a tissue collector 458. In one exemplary arrangement, tissue collector 458 may be operatively connected directly to upper housing 452. Alternatively, tissue collector 458 may be remotely connected to the cutting element by appropriate tubing.
  • a vacuum line (not shown) may be connected to a proximal end of tissue collector 458 to direct tissue into the cutting element, as well as to deliver severed tissue to tissue collector 458.
  • a rotation dial 460 for selectively rotating the outer cannula 444 with respect to handpiece 442 is also mounted to upper housing 452.
  • tissue cutting device 440 may be combined with an imaging device to define a surgical system 303 that is capable of simultaneously imaging and cutting a target tissue, such as tissue associated with a patient's neurological system. Because assembly 303 effectively combines both imaging and cutting operations into a single, integral device, it is particularly advantageous in performing closed procedures where a surgical access path is created percutaneously.
  • FIG. 4 an exemplary surgical system 303 is depicted.
  • Surgical system 303 comprises a surgical cutting device, such as surgical cutting device 440, trocar 307, and an endoscope, such as endoscope 300.
  • endoscope 300 is inserted through trocar 307 via endoscope channel 326 (best seen in FIG. 2B) such that endoscope distal end 310 exits through, is flush with, or projects from trocar 307 at trocar shaft distal tip face 322.
  • Surgical cutting device 440 is connected to trocar 307 such that outer cannula 444 of the cutting element is inserted in the open proximal end 316, through trocar body 314, and through working channel 324 of trocar shaft 312. Distal end 447 of the cutting element of surgical cutting device 440 projects through and away from shaft distal end 318 of trocar 307 at trocar shaft distal tip face 322.
  • tissue cutting device 440 is positioned with a proximal portion of outer cannula 444 adjacent to endoscope housing 301.
  • Proximal end 319 of endoscope housing 301 is positioned distally of and adjacent to front housing 455 of surgical cutting device handpiece 442.
  • surgical assembly 303 To use surgical assembly 303, a surgical access path is first created and/or the target tissue is accessed using an open procedure or a closed procedure. However, surgical assembly 303 is especially suited for closed procedures.
  • the surgeon places one eye at eye -piece 302 and manipulates trocar shaft 312 to position distal trocar tip 318 proximate the target tissue.
  • a camera is attached to eye -piece 302 and the surgeon views an image on a monitor that is connected to the camera.
  • a vacuum level to be applied to device 440 is then set using panel controls on an attached surgical console.
  • device 440 is configured to be gripped with a single hand so as to allow simultaneous manipulation of endoscope 300, trocar 307, and surgical cutting device 440.
  • a variety of different grips may be used.
  • surgical cutting device 440 is held like a writing instrument, with distal housing section 448 placed between the thumb and forefinger of one hand and proximal housing section 446 placed between the base of the forefinger and the base of the thumb.
  • the thumb is placed on one side of distal housing section 448 and the forefinger is placed on top of upper housing 452 with proximal housing section 446 between the base of the thumb and forefinger.
  • the proximal housing section 446 is gripped with the thumb placed adjacent proximal -most housing portion 442.
  • dial 460 may be rotated to selectively rotate outer cannula 444 about its own longitudinal axis and to orient an outer cannula opening 449 immediately adjacent the target tissue.
  • Surgical cutting device 440 is preferably configured such that when outer cannula 444 rotates, an inner cannula also rotates to maintain a fixed angular orientation between outer cannula 444 and the inner cannula.
  • a motor of surgical cutting device 440 is activated.
  • the surgeon views the target tissue through eyepiece 302 to visualize the tissue's response (e.g., traction) to various levels of vacuum and selects a desired level.
  • the target tissue proximate trocar distal end 318 is drawn into outer cannula opening 449.
  • an irrigation fluid such as saline may be fed to the target tissue area via irrigation conduit 320 (shown in FIG. 2B).
  • Endoscope 300 is configured to allow a surgeon to view the target tissue through eye -piece 302.
  • a camera may also be connected to a camera connector (not shown) attached to eyepiece 302 allowing the image generated by endoscope 300 to be viewed on a display monitor.
  • the surgeon views the target tissue on the display monitor while manipulating surgical system 303 and cutting tissue.
  • surgical device 440 is configured such that its outer cannula 444 can be accommodated by working channels in known, industry standard sized trocars.
  • working channel 324 has an inner diameter of less than 8mm, preferably less than 6mm, more preferably less than 4mm, and most preferably about 2mm.
  • Outer cannula 444 is also configured with an outer diameter that allows outer cannula 444 to be slidably received in working channel 324.
  • outer cannula 444 is at least as long as known working channels.
  • outer cannula 444 is at least about 6 inches, preferably at least about 8 inches, more preferably at least about 10 inches, and even more preferably at least about 12 inches in length.
  • Surgical assembly 303 is useful in a number of procedures, but is especially beneficial in closed procedures.
  • surgical assembly 303 is used to perform closed, percutaneous tissue cutting procedures in the third ventricle of the brain. Such procedures include removing tumors and membranes in the third ventricle.
  • cerebrospinal fluid circulates through the third ventricle and into the spinal column.
  • occlusions can form in the third ventricle, blocking the fluid circulation.
  • Surgical assembly 303 may be used to remove such occlusions and restore circulation.
  • Other closed procedures for which surgical assembly is particularly well suited include the removal of tumors from the hypothalamus.
  • surgical system 303 of FIG. 4 represents an advancement in surgical devices and procedures, there is no mechanism that suitably secures surgical cutting device 440 to endoscope 300.
  • distal end 447 of surgical cutting device 440 may move independently from shaft 312 of trocar 307. Accordingly, the surgeon must be sure to manipulate both trocar 307 and surgical cutting device 40 to insure proper placement of distal end 447 of surgical cutting device 440 to prevent distal end 447 from inadvertently moving away from an area of interest or moving too deep into the area of interest causing unintended damage to surrounding tissues and structures.
  • Surgical adapter 500 comprises a connecting portion 502, a housing portion 504 and an attachment mechanism 506.
  • housing portion 504 may be constructed of a first portion 504a and a second portion 504b that fit together, such as in a snap-fit arrangement.
  • Housing portion 504 may house an advancing mechanism 508, a gear member 509 and a thrust washer or spring member 510.
  • a dial member 512 is partially received within housing portion 504 and rotatably mounted thereto.
  • a shaft member 514 is partially received within a distal end 516 of housing portion 504.
  • Gear member 409 is rotatably mounted within housing portion 504 and includes gear teeth 518 that mesh with gear teeth 520 mounted on dial member 512.
  • a channel 522 is formed through gear member 509.
  • a proximal end 524 of advancing mechanism 508 is fixedly received within channel 522.
  • Advancing mechanism 508 further includes threads 526 formed on an outer surface thereof, and a receiving channel 528, both of which will be explained below in further detail.
  • a proximal end 530 of attachment mechanism 506 is secured to a distal end 532 of shaft member 514.
  • Shaft member 514 further comprises at least one slot member 534 into which a tab member 536 (seen, for example, mounted on first portion 504a) from housing portion 504 is slidably received.
  • shaft member 514 may comprise more than slot member 534 that mate with a plurality of corresponding tab members 536.
  • tab members 536 are arranged in an opposing manner within housing portion 504. It is understood that various locations for tab members 536 on housing portion 504 are contemplated. It is also understood that other configurations for keying shaft member 514 to housing 504 are also contemplated.
  • Threads 526 operatively engage with threads formed on an internal surface of shaft member 514, to be explained in further detail below.
  • Attachment mechanism 506 further includes a shaft member 538 and a cap member 540.
  • Shaft member 538 defines a passageway 539 therethrough.
  • distal end 447 (best seen in FIG. 3) of surgical cutting device 440 is inserted into surgical adapter 500. More specifically, distal end 447 of the cutting element of surgical cutting device 440 is inserted into a top portion 542 of connecting portion 502 and into receiving channel 528 of advancing mechanism and advanced through attachment mechanism 506. Top portion 542 further includes a mounting groove that receives a distal end 462 of upper housing 452 for frictional engagement. A bottom portion 444 of connecting portion 502 also includes a mounting groove that receives distal end 451 of lower housing 450 for frictional engagement, as shown in FIG. 8.
  • assembly of surgical adapter 500 to surgical cutting device 440 is performed at the factory prior to packaging and delivery of the devices. Further, to provide increased stability to the surgical system, distal end 451 may be fixedly connected to the mounting groove. [0065] Once secured, distal end 447 of the cutting element of surgical cutting device 440 is then received in a proximal end 446' of an endoscope 300'.
  • attachment mechanism 506 fixedly engages a portion 447 of endoscope 300', thereby securing tissue cutting device 440 to endoscope 300'. More specifically, attachment mechanism 506 is disposed around proximal end 446' such that proximal end 446' is received within endoscope receiving portion 540. Mounting groove member 538 is received within portion 447 of endoscope 300'.
  • distal end 447 may extend outwardly from a distal end of endoscope 300' may be selectively controlled by the surgeon. More specifically, dial member 512 may be selectively rotated in a first direction to advance distal end 447 of the cutting element of surgical cutting device 440 with respect to the distal end of endoscope 300'. Dial member 512 may be selectively rotated in a second direction to move distal end 447 of surgical cutting device 440 toward proximal end 446' of endoscope 300'.
  • Gear teeth 520 of dial member 512 mesh with gear teeth 518 of gear member 509 such that when dial member 512 is rotated, gear member 509 also rotates. Because proximal end 524 of advancing mechanism 508 is fixedly secured to gear member 509, as gear member 509 rotates, advancing mechanism 508 also rotates. Receiving channel 528 is sized to receive outer cannula 444. Thus rotation of advancing mechanism 508 causes shaft member 514 to move along tab member 536, effectively moving distal end 447 of the cutting element.
  • surgical adapter 500 secures surgical cutting device 440 to endoscope 300', the surgeon may better control the amount of extent of distal end 447 of outer cannula 444 to allow for safer, more secure, more stable and a more accurate placement of the cutting mechanism.
  • Surgical adapter 600 is similar to surgical adapter 500 in that it comprises a connecting portion 602, a housing portion 604 and an attachment mechanism 606.
  • housing portion 604 is constructed of a first portion 604a and a second portion 604b that matingly fit together, such as in a snap-fit arrangement.
  • Housing portion 604 may house an advancing mechanism 608, a gear member 609 and a wave washer or spring member 610.
  • a dial member 612 is partially received within housing portion 604 and rotatably mounted thereto.
  • a shaft member 614 is partially received within a distal end 616 of housing portion 604, similar to that which was described above in connection with surgical adapter 500.
  • Gear member 609 is rotatably mounted within housing portion 604 and includes gear teeth 618 that mesh with gear teeth 620 mounted on dial member 612.
  • a channel 622 is formed through gear member 609.
  • a proximal end 624 of advancing mechanism 608 is fixedly received within channel 622.
  • Advancing mechanism 608 further includes threads 626 formed on an outer surface thereof, and a receiving channel 628, both of which will be explained below in further detail.
  • Attachment mechanism 606 is secured to a distal end of shaft member
  • Shaft member 614 further comprises at least one slot member 634 into which a tab member 636 from housing portion 604 is slidably received. Threads 626 operatively engage with threads formed on an internal surface of shaft member 614, to be explained in further detail below.
  • Attachment mechanism 606 includes a mounting groove member 638 having a cannula receiving portion 639 and an endoscope receiving portion 640. A retaining member 641 is selectively engageable with attachment mechanism 606, to be explained below in further detail. A locking washer 643 may also be included.
  • distal end 447 (best seen in FIG. 3) of surgical cutting device 440 is inserted into surgical adapter 600. More specifically, distal end 447 of the cutting element of surgical cutting device 440 is inserted into a top portion 642 of connecting portion 602 and into receiving channel 628 and advanced through cannula receiving portion 639 of attachment mechanism 606.
  • Top portion 642 includes a mounting groove that receives distal end 462 of upper housing 452 for frictional engagement.
  • a bottom portion 644 of connecting portion 602 also includes a mounting groove that receives a distal end 451 of lower housing 450 for frictional engagement, as shown in FIG. 15.
  • assembly of surgical adapter 600 to surgical cutting device 440 is performed at the factory prior to packaging and delivery of the devices.
  • attachment mechanism 606 fixedly engages a portion of endoscope 300, thereby securing surgical cutting device 440 to endoscope 300. More specifically, endoscope receiving portion 640 is sized to engage an outer surface of endoscope 300, leaving cannula receiving portion 639 open, but in general alignment with working channel 324. Once properly positioned, fastening mechanism 641 is actuated to frictionally attach attachment mechanism 606 to endoscope 300. Endoscope 300 is also attached to trocar 307, as described above. Thus, tissue cutting device 40 is also fixed with respect to trocar 307.
  • distal end 447 may extend outwardly from distal end face 322 of trocar 307 may be selectively controlled by the surgeon. More specifically, dial member 612 may be selectively rotated in a first direction to advance distal end 447 of outer cannula 444 of tissue cutting device 440 with respect to distal end face 322 of trocar 307. Dial member 612 may be selectively rotated in a second direction to move distal end 447 of outer cannula 444 toward trocar 307.
  • Gear teeth 620 of dial member 612 mesh with gear teeth 618 such that when dial member 612 is rotated gear mechanism 609 rotates. Because proximal end 624 of advancing mechanism 608 is fixedly secured to gear mechanism 609, as gear mechanism 609 rotates, advancing mechanism 608 also rotates. Receiving channel 628 is sized to receive outer cannula 444. Thus rotation of advancing mechanism 608 causes shaft member 614 to move along tab member 636, effectively moving distal end 447 of outer cannula 444.
  • surgical adapter 600 secures surgical cutting device 440 to endoscope 300, the surgeon may better control the amount of extent of distal end 447 of outer cannula 444 to allow for safer, more secure, more stable and more accurate placement of the cutting mechanism.
  • Surgical system 800 comprises an endoscope 300", a surgical adapter 500 and a connector adapter 700.
  • endoscope 300" is a LOTTA® style endoscope distributed by the Karl Storz Endoscopy-America, Inc., El Segundo, California, and further includes a proximal end 446".
  • Connector adapter 700 comprises a shaft member 702, a proximal mounting member 704, a support member 706 and selectively engageable connecting members 708.
  • a seal member 709 (best seen in FIG. 22) is secured to support member 706.
  • Each connecting member 708 is operatively secured to support member 706 by a living hinge 710.
  • Connector adapter 700 provides a user with the ability to utilize a variety of instrumentation with endoscope 300", without requiring any permanent modifications to endoscope 300" or to the instrumentation by a user in the field, or by the manufacturer of endoscope 300". Moreover, connector adapter 700 is configured to provide a selectively attachable sealed interface between a working channel of endoscope 300" and a surgical instrument such as, for example, the NICO MYRIAD® manufactured and distributed by Nico Corporation of Indianapolis, Indiana.
  • shaft member 702 is fixedly mounted to support member 706.
  • a working channel 712 extends through support member 706 and shaft member 702.
  • Mounting member 704 may be secured to a proximal end of shaft member 702.
  • mounting member 704 is configured as a flange member.
  • other mounting elements may also be provided including, but not limited to, threaded engagements.
  • connector adapter 700 further includes connecting members 708.
  • connecting members 708 are arranged in an opposing manner, as shown in FIG. 21.
  • connecting adapter 700 includes at least two connecting members 708a, and 708b.
  • First connecting member 708a is configured with at least one selectively depressible locking tab 714.
  • Second connecting member 708b is configured with a corresponding number of receiving grooves 716.
  • Locking tabs 714 are configured to be selectively received and retained within corresponding receiving grooves 716 when connector adapter 700 is mounted to a surgical system, as will be explained in further detail below.
  • surgical adapter 500 is attached to a surgical cutting instrument such as that discussed above in connection with FIG. 3.
  • Mounting member 704 of connector adapter 700 is then connected to cap member 540 of surgical adapter 500 such that shaft member 538 (best seen in FIG. 6 above) is received within working channel 712.
  • Mounting member 704 is configured to engage with a corresponding mounting feature formed in cap member 540.
  • an internal surface of cap member 540 may be configured with frictional members that secure mounting portion 704 therein.
  • both cap member 540 and mounting portion 704 may be provided with corresponding threads such that a threaded attachment may be achieved.
  • seal member 709 engages proximal end 446".
  • Seal member 709 is also configured with an opening therethrough (not shown) that is axially aligned with working channel 712 of shaft member 702.
  • Seal member 709 which is constructed of a suitable sealing material to achieve a fluid-tight seal, is also configured so as to have a circumference that is at least as large as a circumference of an entrance piece to proximal end 446" of endoscope 300".
  • first and second connecting member 708a and 708b oriented toward support member 706 such that connecting members 708a, 708b are separated form one another, as shown in FIGS. 21 and 22.
  • first and second connecting members 708a and 708b pivoted about living hinges 710.
  • first and second connecting members are identical to first and second connecting members.
  • Connecting members 708a, 708b are each configured with a mount surface 718 that mates with seal member 709 when first and second connecting members 708a, 708b are in a connected position (as shown in FIGS. 19-20).
  • Connecting members 708a, 708b each may also be provided with an angled contacting face 720 that extends from living hinge 710 to an outer surface 722 of each connecting member 708a, 708b.
  • Angled contacting face 720 is configured with cooperate with a corresponding angled contacting face 724 disposed on either side of support member 706.
  • connecting members 708a, 708b are then pivoted toward one another so as to surround and mate to proximal end 446" of endoscope 300".
  • Locking tabs 714 are then engaged with receiving grooves 716 so as to lock connecting members 708a, 708b quickly and easily together, thereby securing connector adapter 700 onto endoscope 300".
  • connector adapter 700 may be selectively detached from endoscope 300" by simply depressing a portion of locking tabs 714 that is disposed externally from an outer surface 726 of connector adapter 700 (best seen in FIG. 20) to release locking tabs 714 form retaining grooves 716.
  • a funnel attachment 900 designed to direct distal end 447 of a cutting element from a surgical cutting instrument, such as cutting instrument 440, into a working channel 328 of trocar 307 is shown.
  • a surgical cutting instrument such as cutting instrument 440
  • the surgeon is viewing the surgical field, either through eyepiece 302 or on a display monitor.
  • the surgeon may also be trying to insert distal end 447 into working channel 328 blindly. This approach often results in multiple frustrating attempts at trying to locate the opening of working channel 328 for receiving the outer cannula or other surgical component, and cause the loss of efficiency and valuable operating time.
  • funnel attachment 900 comprises a directing portion 902 and leg members 904.
  • Leg members 904 are configured to fit over a housing 301 of an endoscope 300 and abut up against a proximal end of trocar 307.
  • Feet members 906 extending from leg members 904 engage a bottom surface of housing 301 to secure funnel attachment 900 thereto.
  • Funnel attachment 900 is further defined by a proximal side 908 and a distal side 910.
  • Directing portion 902 is defined by a funnel-like surface 912 that tapers toward a directing groove 914.
  • directing portion 902 is positioned such that directing groove 914 generally aligns with working channel 328 of trocar 307.
  • the funnel-like surface 912 will serve to direct distal end 447 of an outer cannula 44 of a surgical cutting instrument 440 into directing groove 914, resulting in outer cannula 444 being correctly placed within working channel 328.
  • funnel attachment 900 is not shown in use with surgical adapters
  • funnel attachment 900 may be used with all of these components.
  • a surgical interface 1000 is now described for operably connecting a medical instrument 1040 to an endoscope 300 via an interface housing 1005.
  • the interface housing 1005 may be operably connected to a luer 1015, which may be operably connected to an attachment mechanism 1006 of the adapter 500.
  • the interface housing 1005 may include an inner attachment portion 1010 disposed therein, as shown in FIG. 27.
  • the inner attachment portion 1010 has an inner body 1020 and an inner extension 1025 extending at the proximal end of the inner attachment portion 1010 such that the inner body 1020 has a larger diameter than that of the inner extension 1025.
  • the inner body 1020 of the inner attachment portion 1010 defines an opening at a proximal end of the inner attachment portion 1010.
  • the distal end of the interface housing 1005 may also define an interface retainer 1030 at the opening for receiving a proximal portion of the endoscope 300.
  • the interface retainer 1030 may include an interface lip 1035 that is sloped outwardly at the opening at the distal end of the interface housing 1005.
  • the inner extension 1025 extends into the proximal portion of the endoscope 300.
  • the proximal portion of the endoscope 300 is flared and the interface retainer 1030 defined by the distal end of the interface housing 1005 is configured to receive the flared portion 1032.
  • a seal 1045 is disposed around the inner extension, abutting the proximal portion of the endoscope 300.
  • the luer 1015 has a proximal male extension 1050 at a proximal end of the luer 1015 and a distal male extension 1055 at a distal end of the luer 1015.
  • the opening at a proximal end of the inner body 1020 is configured to receive the distal male extension 1055.
  • a luer body portion 1060 extends perpendicular and in-between the male extensions 1050, 1055.
  • the proximal end of the interface housing 1005 abuts the distal male extension 1055 and aligns adjacent the luer body portion 1060.
  • the attachment mechanism 1006 is configured to receive the distal male extension 1055.
  • the interface housing 1005 is configured to operably connect to the luer and endoscope such that a portion of the endoscope is receivable within the interface housing 1005 so as to be operably connected to a distal end of the medical instrument 1040 via the interface housing 1005.
  • the interface housing 1005 is attached to an endoscope 300 such as that discussed above in connection with FIG. 21.
  • the interface housing 1005 may include first and second connecting members 1065a, 1065b connected at a hinge 1070. Once the proximal portion of the endoscope 300 is placed in the interface retainer 1030 of the inner attachment portion 1010, and once the distal end of the luer 1015 is placed within the opening defined by the inner attachment portion 1010 at the proximal end, the connecting members 1065 a, 1065b may be pivoted toward one another so as to surround and mate to the proximal portion of the endoscope.
  • the distal end of the luer 1015 may be inserted into the opening after the connecting members 1065a, 1065b have closed around the endoscope 300.
  • the seal 1045 may be an O-ring such that the proximal end of the endoscope 300 is securely received within the interface housing 1005 and a sealed connection between the interface housing 1005 and the endoscope 300 is created.
  • the attachment mechanism 1006 of an adapter 500 is operably connected to the medical device 1040.
  • the inner attachment portion 1010 is defined by a proximal end member 1075 and a distal cap member 1080, wherein the distal cap member 1080 may be selectively engaged with the proximal male extension 1050 of the luer 1015.
  • the proximal male extension 1050 may include threads (not shown) that operatively engage with threads 1090 formed on an internal surface of the cap member 1080.
  • the cap member 1080 further includes a shaft member 1095 extending therethrough.
  • the shaft member 1095 defines a passageway 1100 through which the portion of the medical device 1040 may extend.
  • the proximal end of the interface housing 1005 has an outer support ring 1105 engaging the inner attachment portion 1010 (see FIG. 30.)
  • the inner attachment portion 1010 is disposed within the housing portion 1005 and defines a channel 1110 within the interface housing 1005 between the housing walls and the inner attachment portion 1010.
  • the inner attachment portion 1010 includes a protrusion 1115 at the proximal end thereof and the outer support ring 1105 defines a cavity 1120 for receiving the protrusion 1115.
  • a proximal end of the outer support ring 1105 aligns with the proximal end of the inner attachment portion 1010.
  • the proximal ends of the inner attachment portion 1010 and outer support ring 1105 are flush with each other and adjacent the luer body portion 1060.
  • the shaft 1095 of the attachment mechanism 1006 extends beyond the attachment mechanism 1006 at the distal end thereof.
  • the proximal male extension 1050 defines a luer recess 1030 for receiving the extended shaft 1095 whereby a portion of the proximal male extension 1050 extends into the attachment mechanism 1006.
  • the proximal portion of the endoscope 300 defines an endoscope recess
  • the proximal portion of the endoscope 300 also includes an endoscope lip 1040 configured to engage the interface retainer 1030.
  • the interface retainer 1030 includes an interface lip 1035 at the opening of the interface housing 1005.
  • the endoscope 300 may be pushed into the opening and the endoscope lip 1040 may engage the interface lip 1035, thus locking the proximal end of the endoscope 300 with the interface housing 1005.
  • the seal 1045 may be an O-ring and be disposed between and adjacent to the proximal end of the endoscope and the inner body portion. Thus, a sealed connection is created between the endoscope 300 and the interface housing 1005.
  • the 1000 includes an interface housing 1205.
  • the interface housing 1205 may be a hallow cylinder with each of its proximal and distal ends defining an opening.
  • the opening at the distal end may include a tapered wall 1210.
  • the interface 1000 includes an inner attachment portion 1010 such that the inner body 1020 has a larger diameter than that of the inner extension 1025.
  • the inner body 1020 includes an inner base 1215 on the proximal end of the inner body 1020.
  • the inner base 1215 defines an opening at a proximal end of the inner attachment portion 1010 for receiving the distal male extension 1055 of the male luer 1015.
  • the inner base 1215 may also include a plurality of inner base nobs 1220 extending outwardly from the inner base 1215.
  • the inner base nobs 1220 may provide leverage for rotating the inner attachment portion 1010 as it is inserted into the interface housing 1025.
  • the inner body 1020 includes inner body threads 1230 formed on an outer surface thereof.
  • the inner body threads 1230 extend around the inner body 1020 from the inner base and to the inner extension 1025.
  • the inner extension 1025 may present at least one wing 1235 extending radially outwardly from the inner extension.
  • a flexible surround 1245 may be configured to surround the inner attachment portion 1010.
  • the flexible surround 1245 defines a hollow center and includes a cylindrical base portion 1250 configured to surround at least a portion of the inner body 1020.
  • the base portion 1250 includes base portion threads 1255 for engaging the inner body threads 1230.
  • the surround 1245 may also include a plurality of surround extensions 1260 extending from a distal end of the base portion 1250.
  • the surround extensions 1260 may be spaced from one another and increase in thickness and/or width as each extends from the base portion 1250. Thus, the thickness of the surround extensions 1260 at their distal ends is greater than the thickness of their proximal end at the base portion 1250.
  • Distal ends 1265 of the surround extensions 1260 may form a triangular shape with a base of the triangular shape facing an outer surface of the flexible surround 1245.
  • the outer surface of each surround extension 1260 may include a pair of guides 1270 defining a recess 1275 therebetween.
  • the surround extensions 1260 extend inwardly at the distal ends 1265 towards the hollow center of the surround 1245 forming a void between the extensions. The void is configured to receive the proximal portion of the endoscope 300.
  • a seal 1045 may be disposed between and adjacent to the proximal end of the endoscope 300 and the inner extension 1025.
  • An inner lip 1285 may extend outwardly at the distal end of the inner extension 1025 to act as a retainer for the seal 1045.
  • the proximal portion of the endoscope 300 is a flared portion
  • the surround extensions 1260 may be radially movable so as to allow the flared portion 1032 to be inserted into the void.
  • Each distal end 1265 of the extensions 1260 may form a lip 1280 for receiving the flared portion 1032 of the endoscope 300.
  • the flexible surround 1245 is received by the interface housing 1205.
  • the flexible surround may be pushed into the distal end of the interface housing 1205.
  • the base portion 1250 will thus be inserted first.
  • the guides 1270 on the outer surface of the surround extensions 1260 will abut the inside surface of the interface housing 1205.
  • the guides may be made of a less frictional surface than that of the surround 1245.
  • the extensions 1260 may be pressed radially inwardly thus tightening the hold that the distal ends 1265 have on the flared portion 1032.
  • the distal ends 1265 may extend flush with the distal end of the housing 1205 such that the distal ends are received at the tapered wall 1210. Moreover, the proximal end of the endoscope is securely locked within the surgical interface 1000. [0106]
  • the inner attachment portion 1010 may then be inserted at the proximal end of the interface housing 1205.
  • the inner attachment portion 1010 may be rotated and pushed into the housing 1205 so that the inner body threads 1230 may engage the base portion threads 1255 of the flexible surround 1245. Once the inner attachment portion 1010 has been inserted into the flexible surround, the proximal end of the interface housing 1205 may abut the inner base 1215.
  • the at least one wing 1235 on the inner extension 1025 may extend outwardly so as to operably engage the inner surface of at least one of the surround extensions 1260.
  • a sealed connection is created between the endoscope 300 and the interface housing 1205 allowing the surgical interface 1000 to operably connect a medical instrument 1040 to an endoscope 300.

Landscapes

  • Life Sciences & Earth Sciences (AREA)
  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biophysics (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Mechanical Engineering (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Abstract

La présente invention concerne des interfaces chirurgicales et des adaptateurs permettant de positionner correctement une partie d'un instrument médical se trouvant dans un endoscope au niveau d'un site d'intérêt.
PCT/US2014/014816 2013-02-15 2014-02-05 Interface chirurgicale utilisable avec un endoscope WO2014126757A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US13/768,776 2013-02-15
US13/768,776 US20130237753A1 (en) 2009-11-06 2013-02-15 Surgical interface for use with endoscope

Publications (2)

Publication Number Publication Date
WO2014126757A2 true WO2014126757A2 (fr) 2014-08-21
WO2014126757A3 WO2014126757A3 (fr) 2014-10-16

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN110267612A (zh) * 2017-02-07 2019-09-20 Cmr外科有限公司 内窥镜在手术机器人上的安装
EP3737325A4 (fr) * 2018-01-10 2022-01-19 Covidien LP Ensembles chirurgicaux robotisés et ensembles adaptateurs associés
CN117084767A (zh) * 2023-08-10 2023-11-21 中科智博(珠海)科技有限公司 脊柱内窥镜

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8317689B1 (en) * 1999-09-13 2012-11-27 Visionscope Technologies Llc Miniature endoscope system
JP4324758B2 (ja) * 2002-10-23 2009-09-02 フジノン株式会社 内視鏡の送液装置
WO2009015394A1 (fr) * 2007-07-26 2009-01-29 Ceramoptec Industries, Inc. Adaptateur pour endoscopes et procédé apparenté
AU2010314966B2 (en) * 2009-11-06 2016-06-16 Nico Corporation Surgical adapter for use with an endoscope
CN103200878B (zh) * 2010-09-07 2015-09-09 波士顿科学医学有限公司 内镜超声细针穿刺装置

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN110267612A (zh) * 2017-02-07 2019-09-20 Cmr外科有限公司 内窥镜在手术机器人上的安装
CN110267612B (zh) * 2017-02-07 2023-04-25 Cmr外科有限公司 内窥镜在手术机器人上的安装
EP3737325A4 (fr) * 2018-01-10 2022-01-19 Covidien LP Ensembles chirurgicaux robotisés et ensembles adaptateurs associés
CN117084767A (zh) * 2023-08-10 2023-11-21 中科智博(珠海)科技有限公司 脊柱内窥镜
CN117084767B (zh) * 2023-08-10 2024-05-03 中科智博(珠海)科技有限公司 脊柱内窥镜

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