WO2022234160A1

WO2022234160A1 - Surgical access port with cleaning capability

Info

Publication number: WO2022234160A1
Application number: PCT/ES2021/070318
Authority: WO
Inventors: Aritz LAZKOZ DEL CAMPO; Iker MARIÑELARENA ARRIZABALAGA; Juan ARREGUI ALTUNA
Original assignee: Deneb Medical, S.L.
Priority date: 2021-05-07
Filing date: 2021-05-07
Publication date: 2022-11-10

Abstract

The present invention relates to a surgical access port suitable for surgical interventions, comprising a main body configured as a tubular conduit extending in an axial direction X-X' and comprising a first access opening arranged at one end of the main body, a second opening arranged at the end of the main body opposite the first opening configured for providing access to a surgical region, an inner wall configured for sliding over a tissue dilator from among the tissue dilators formed by a plurality of cylinders housed inside one another plus a lancet in the center thereof; and a perimetral region configured for being supported on biological tissues in the surgical region; wherein the surgical access port further comprises at least one conduit which is either a suction conduit, a blowing conduit, or an irrigation conduit, housed inside the main body, wherein said conduit can be detached and removed to leave the inside of the main body unobstructed.

Description

CLEANABLE SURGICAL ACCESS PORT

DESCRIPTION

OBJECT OF THE INVENTION

The present invention is directed to a surgical access port or trocar capable of cleaning said surgical field during the course of minimally invasive surgery (MIS).

BACKGROUND OF THE INVENTION

Surgical access ports or trocars are a type of surgical instrument that fulfills a purely mechanical function: define the surgical field and the direction in which the surgeon acts, keeping the skin and other soft tissues out of the surgical field so as not to disturb the action. of the surgeon.

Minimally invasive surgeries (MIS) require the acquisition of images of the surgical field during the course of surgery. These intraoperative images provide key information for the success of the intervention as they allow the surgeon to decide how to act at all times. In order to faithfully show the surgical field to the surgeon, these images must be free of debris from cut tissue, blood, saline and other unwanted elements that, however, are continuously present in the surgical field. Thus, to avoid as much as possible that these elements are visible in the images, minimally invasive surgeries require continuous cleaning of the surgical field.

Cleaning, like the procedure itself, is done through the surgical access ports. These access ports are long, narrow tubes, so it is not easy to keep the surgical field clean throughout the duration of the procedure.

Currently, cleaning of the surgical field in MIS surgeries is done manually by inserting manual aspirators and manual cleaning devices. irrigation, such as syringes and similar devices. The introduction of these instruments through the tubular access port, unlike in open procedures, forces the surgeon to stop the operation as such, for example the cutting process, and remove the surgical instruments that were being used at that time, for example a bur, scalpel, monopolar or cutting tool. After stopping the procedure, the cleaning instrument is introduced to proceed with the cleaning of the surgical field. Once the cleaning is complete, the cleaning instrument is removed and the surgical procedure proceeds. This sequence of alternating surgery and cleaning is repeated several times during the procedure, which is a constant interruption of the procedure and is far from being an optimal cleaning solution. In addition, this solution is not valid in robotic MIS surgeries since cleaning tasks, such as aspiration, blowing and irrigation, would not only be constantly interrupting the surgical work of the robot but would also hinder its visualization of the surgical field.

DESCRIPTION OF THE INVENTION

The present invention proposes a solution to the above problems by means of a surgical access port suitable for surgical interventions according to claim 1 and a system for accessing a surgical environment according to claim 14. Preferred embodiments of the invention are defined in dependent claims.

In the state of the art, a surgical access port is defined as an instrument used to define the surgical field in minimally invasive surgeries. These instruments are used in conjunction with a lancet with a sharp point at one end and a plurality of cylindrical tissue dilators. Throughout the document, the terms surgical access port and trocar will be used interchangeably. Similarly, the terms surgical field and surgical region will be used.

First, the surgeon makes an incision in the patient's skin, usually using a cold or monopolar scalpel, slightly larger than the diameter of the lancet. From this incision, the lancet is inserted into the patient's body to define the direction in which the surgical procedure is to be performed. By For example, in spinal surgery, the lancet is inserted until it finds hard tissue, that is, until it hits the bone that will be the starting point of the surgery. Once the lancet is inserted in the desired position, the surgeon introduces a series of concentric cylindrical tissue dilators with the lancet, which gradually increase in diameter and thus dilate the soft tissues around the lancet or dilator with a diameter immediately below. Thus, the first dilator, with a smaller diameter, slides over the lancet to dilate the hole created by it; and the rest of the dilators, of increasing diameters, slide over each other to increase said dilation until reaching the size required by the surgery. This sequence is performed by small increases in the diameter of the cylindrical dilators; preferably in approximate 2-millimeter increments.

The last cylinder to be inserted is the trocar - or access port - which, once inserted, is fixed to some element present in the operating room, generally the operating table. The lancet and all cylindrical dilators are then removed, leaving the surgical field defined and free of surrounding soft tissue.

A first inventive aspect provides a surgical access port suitable for surgical interventions, comprising: a main body configured as a tubular conduit extending in an axial direction XX' and comprising: a first access opening arranged at one end of the main body , a second opening arranged at the end of the main body opposite the first opening configured to give access to a surgical region, an inner wall configured to slide over a tissue dilator, from among the tissue dilators formed by a plurality of cylinders housed one inside another plus a lancet at its core; a perimeter region configured to rest on biological tissues in the surgical region; at least one conduit, either suction or blowing, or irrigation, housed inside the main body where said conduit is detachable and removable to leave the interior of the main body diaphanous. In this first inventive aspect, a surgical access port is described that comprises a main body and at least one conduit intended for cleaning the surgical field.

The main body is a tubular duct comprising two openings located at opposite ends. The first opening is the one through which the surgical instruments are inserted. Said instruments pass through the main body to the second opening, which will give you access to the surgical field. Preferably, the main body is made of a biocompatible material; for example, medical grade stainless steel, titanium or PEEK (Polyetheretherketone) polymers.

As mentioned above, the surgical access port must be able to slide over a tissue dilator of those existing in the state of the art. To do this, the main body comprises an inner wall dimensioned for this purpose.

At the end where the second opening is located, the main body comprises a perimeter region configured to rest on biological tissues in the surgical field. Throughout the document, it will be understood that the perimeter region of the main body rests on the tissues of the surgical field that are accessible at the moment when said main body has slid over a tissue dilator of the state of the art, penetrating the space previously opened by the dilators already inserted.

The shape of the main body of the access port does not imply that it must be cylindrical since externally it can have elements that do not hinder the passage of the dilators through its interior, being able to show a different shape from the cylindrical one with a circular section as long as the perimeter region located adjacent to the second opening is of a thickness that does not cause soft tissue rupture upon insertion, as is the case with any of the dilators. This condition is ensured by keeping the thickness of the access port limited, at least in the region intended to be in contact with the tissue to keep it separated.

The range of diameters of the main body of the access port is adapted for the minimally invasive surgery to be performed. For example, for spinal surgery, the main body diameter range is preferably between 15 and 26 millimeters. On the other hand, the thickness of the wall of the main body of the access port is preferably between 0.2 and 0.6 millimeters.

In addition to the main body, the surgical access port according to the first inventive aspect comprises at least one conduit intended for cleaning the surgical field. Said at least one conduit can be for suction, blowing and/or irrigation.

Throughout this document, it will be understood that the at least one conduit evacuates debris from cut tissues, blood, saline and other unwanted elements present in the surgical field by vacuuming them and/or introducing air and/or irrigation liquid in said surgical field with a power, flow rate and/or pressure adapted for this purpose. These parameters, preferably, can be varied during the surgical intervention according to the cleaning requirements at each moment. These variations can be decided on time by the medical staff or previously automated.

Once the main body is positioned defining the surgical field - that is, an incision has been made in the patient which has subsequently been dilated with the lancet and the plurality of tissue dilators and, ultimately, the main body has been slid of the surgical access port on the larger diameter tissue dilator - the conduit(s) of the surgical access port are introduced through the first opening of the main body and are housed inside it.

The duct or ducts can be coupled or fixed either to the main body or to some other element that serves as an intermediate element with the main body. Thus, once they have been attached or fixed, they remain static inside the main body. In this way, once the duct or ducts are inside the main body, the surgery itself and the procedure for cleaning the surgical field can be carried out simultaneously.

Thanks to this double functionality of the trocar, it is guaranteed that the intraoperative image acquisition and/or the surgical operations are performed in the best possible clean conditions, which is very valuable information for the surgeon since it can be visualized in real time. the actual surgical field you are working on at that instant of time. Said surgical field will be presented to the surgeon free of unwanted elements, such as blood or debris from cut tissues, which could hinder the visibility of the target tissues of the surgery.

Additionally, the surgical intervention is not necessarily interrupted by the cleaning operation, which avoids prolonging the patient's stay in the operating room unnecessarily and the distractions that such interruptions can cause to the medical staff, thus minimizing the risks to which they are exposed. the patient during the intervention.

The at least one conduit fixed to the main body does not prevent the sliding of said main body in the last of the inserted dilators since said conduit is not present at this stage. The conduit is detachable, which allows it to be fixed to the main body once it is inserted in the patient. In this way, the shape of the inner wall surface is not modified by the conduit requirement and it is possible to closely adhere to the outer wall of the last dilator to allow smooth tissue insertion.

Cleaning functionality is especially relevant in robotic surgeries involving cutting lasers and photonic systems that allow tissue to be distinguished, since their correct performance is linked to cleaning the surgical field. Thus, the trocar of the invention enables robotic surgery to develop smoothly, without interruptions, minimizing intervention times and, consequently, leading to significant savings in resources.

Once the surgical procedure has been completed, the conduit(s) coupled to the main body - or to other additional elements of the trocar or to elements external to the trocar - are uncoupled and removed to leave their interior diaphanous. Thanks to this, the main body returns to the initial state without ducts to be able to slide over a tissue dilator of those existing in the state of the art in subsequent surgeries.

It is important to note that the increases in diameter of the tissue dilators when defining the surgical field must be small, around 2 millimeters, so that these dilators and the trocar can be introduced into the patient's body without producing soft tissue damage. Therefore, a trocar that permanently incorporates and constant suction, blowing and irrigation tubes is not a valid solution since the difference between its internal and external diameter would make it impossible to insert it into the patient's body without damaging the soft tissues.

On the contrary, the present invention allows the trocar to be introduced following the traditional dilation sequence, thus fulfilling the mechanical function of current trocars, and incorporating the cleaning function, which had not been contemplated until now in this type of surgical instrument.

On the other hand, including the cleaning functionality in the trocar makes it possible to automate the cleaning cycles, automatically adjust the parameters of irrigation, aspiration and/or blowing (flow, power, pressure) in different regimes throughout the procedure. In a preferred way, this automation is carried out, for example, through programmable robots and similar devices.

Automating the cleaning cycles and the parameter values of the duct or ducts is especially relevant in robotic surgeries since, as previously mentioned, the action of the robot - for example, by means of a cutting laser or by means of photonic systems that allow distinguish tissues - needs a clean surgical field.

In a particular embodiment, the conduit housed inside the main body is a suction conduit and comprises a detachable vacuum connection.

In this embodiment, the surgical field is cleaned by suction; that is, the unwanted elements of the surgical field are suctioned through the conduit of the surgical access port. Said conduit, as already mentioned, can be coupled and uncoupled from the main body - or other elements - for which it comprises a connection or fixing, for example, by clipping.

On the other hand, the suction duct incorporates a vacuum connection that allows said suction duct to be made independent of a vacuum source necessary to carry out the suction. When the vacuum conduit is coupled to the main body of the access port, the source becomes independent of the assembly that forms the access port. Throughout the document, a vacuum connection will be understood to be an element mechanical used, among others, in the hospital environment to connect ducts or pipes to other medical devices, in this case the vacuum source. These connections are usually of the quick connection type, that is, those in which the coupling and, at the same time, the tightness of the coupling are ensured with an insertion manoeuvre.

In a particular embodiment, the suction duct is elastically deformable and with a curvature such that it tends to press against the inner wall of the main body.

To avoid as much as possible the interference of the aspiration duct with the surgical instruments during an intervention, said duct must be positioned as close as possible to the internal wall of the main body. In this way, it is guaranteed that the surgeon can manipulate the surgical instruments inside the main body at the same time that the aspiration conduit performs its function.

To this end, the suction duct according to this embodiment is elastic and deformable, with a curvature oriented towards the inner wall of the main body. This elasticity allows that, once the conduit is housed in the main body, it always tends to be directed towards the inner wall of said main body, staying close to the inner wall with a certain force, thus making it possible to have the greatest possible space for the introduction and handling of surgical instruments in the main body.

In a particular embodiment, the suction duct shows a concave configuration towards the interior of the main body on the opposite side to the side facing the interior wall of the main body.

The concave configuration of the aspiration duct towards the interior of the main body seeks to reduce the interference of said duct with the surgical instruments during the intervention and, at the same time, to ensure a high internal section of the aspiration duct. This configuration minimizes the presence of the conduit inside the main body, thus maximizing the space available for the introduction and manipulation of the surgical instruments. In a particular embodiment, the detachable conduit - either the suction conduit, or the blowing conduit or the irrigation conduit - is fastened by clipping to the outside of the main body and outside the projection of the inside of the main body along the axial direction X-X'.

In this embodiment, the conduit or one of the conduits of the trocar has a clip fixation. Once the conduit is housed inside the main body, the fixing would be positioned outside said main body. In a preferred way, the fixing would be clipped at one end of the main body itself, for example at an edge of the first opening. In another alternative example, the fixture would be clipped to an element external to the main body.

Throughout the document, fixing by clipping will be understood as a clamp or clip-type fastening adapted to fix the conduit by means of pressure to another entity, such as the main body itself or to an external element, and whose insertion requires overcoming a certain force until reach its final position. Advantageously, the clipping allows the conduit to be easily coupled and uncoupled from the main body, by exerting a little manual pressure.

Additionally, this fixing by clipping must be outside the projection of the interior of the main body along the axial direction X-X' to avoid the interference of said conduit with the surgical instruments. Preferably, the clipping of the conduit favors said conduit being located adjacent to the inner wall of the main body to maximize the space available for the introduction and handling of surgical instruments in the main body.

In a particular embodiment, the main body has a perimeter flange in the first opening. In a particular embodiment, the clipping of the suction duct, either the blowing duct or the irrigation duct, is established in the perimeter flange.

Throughout the document, it will be understood that the perimeter flange is an annular piece, for example substantially flat, whose internal diameter is equal to the diameter of the first opening of the main body. This flange is integrated into the main body and is positioned in its first opening. In one embodiment, the cleaning duct comprises a fixing that is clipped to the flange once the duct is housed inside the main body. The presence of the flange makes it possible to thicken the wall of the main body at one of its ends, that is, it increases the size of the area for fixing the cleaning duct to the main body to facilitate the coupling and decoupling process of the duct. This flange does not prevent the sliding of the main body of the access port in the last inserted dilator nor the insertion of said main body in the patient's body since said flange is not positioned in an area where the separated tissue is found.

In a particular embodiment, the blowing conduit or the Irrigation conduit is fixed by means of a removable fastening to a support by means of an actuator that causes movement between at least two operating positions: a first operating position where the blowing conduit is tight to the internal wall of the main body and, a second operative position where the blowing duct is distanced from the internal wall of the main body, preferably in the central position.

In this embodiment, the blow pipe or the irrigation pipe is fixed to a support once it is inside the main body. Both options can occur simultaneously with a single conduit; that is, the irrigation conduit can be a blowing conduit comprising a mixing element that allows the irrigation liquid to be injected into the surgical field. Thus, with the same conduit in the region of the access port, there is a blowing function, an irrigation function and/or even a mixing function of both that gives rise to nebulization without it being necessary that inside of the access port there are more differentiated ducts.

In this embodiment, the duct or ducts are fixed to the support by means of a removable fixing in order to leave the interior of the main body diaphanous. Thus, at the beginning of a surgery, the main body would be free of conduits to slide over the corresponding dilator without any element that could interfere with said sliding. Next, once the main body of the trocar has entered the patient, the blowing and/or irrigation conduit would be introduced through it. Finally, said conduit would be fixed to the actuator of the support, so preferred, by means of a tightening type fixing or a friction fixing. For this, the conduit comprises a stop that allows it to be positioned longitudinally in a corresponding housing of the actuator.

Unlike a suction conduit, which would have sufficient capacity to suck unwanted elements from the surgical field from its position adjacent to the internal wall of the main body, the blow conduit and/or the irrigation conduit require more precise action. where the unwanted element is found.

For this, the invention contemplates that this type of conduit can act in two different positions; either close to the internal wall of the main body or distanced from it. Preferably, this second position will be the central position of the main body.

Advantageously, the blowing or irrigation can act in different areas of the surgical field where it is desired to carry out cleaning thanks to the fact that, in an example of embodiment, they can adopt any intermediate position between the two extreme positions, thus improving the efficiency of the procedure. .

Movement between the two extreme positions requires that the conduit be fixed at a point on the support capable of moving between said two positions. To this end, this embodiment contemplates that the support comprises an actuator that causes the displacement of the conduit between said two extreme positions. This displacement is rectilinear and maintains the axial orientation of the conduit at all times so that the blowing and/or irrigation are carried out in the appropriate direction with respect to the surgical field.

The displacement can be pre-established automatically or executed in a timely manner during the intervention. Preferably, the actuator pneumatically causes the conduit to move.

In a particular embodiment, the displacement caused by the actuator is established on an intermediate rod guided in such a way that rotation with respect to its axial direction is prevented. In this embodiment, the use of an intermediate rod between the actuator and the conduit itself is contemplated; that is, the actuator causes the displacement of the rod, to which the conduit would be fixed and, in this way, the conduit would reach the two target positions. Advantageously, this stem is guided in such a way as to prevent rotation with respect to its axial direction, which guarantees the correct direction and orientation of the conduit throughout the intervention, in particular ensuring that the blowing and/or irrigation conduit maintain its orientation. preferably axial. Preferably, the conduit is attached to the stem by a torque-type attachment or frictional attachment. For this, the duct comprises a stop that allows it to be positioned longitudinally in a corresponding housing of the stem.

In a particular embodiment, the perimeter region is located at the proximal end of the second opening and on the outside of the main body.

The perimeter region of the main body is configured to rest on biological tissues on which the surgical operation is to be performed. This region is located on the outside of the main body, at the proximal end of the second opening that provides access to the surgical field. This perimeter region must be sterilized and made of a material compatible with biological tissue. In a preferred example, the material of the perimeter region is medical grade stainless steel, titanium or PEEK (Polyetheretherketone) polymers. In a particular embodiment, the surgical access port additionally comprises a fixing element configured to fix the support to a fixed external element.

The main body of the trocar is attached to the bracket. Preferably, said joint is established between the support and the end of the main body where the first opening is located. In a particular example, the joint is established by means of a flange located in the first opening of the main body on which the support is fixed.

This support comprises a fixing element configured to fix said support - and therefore the main body and the conduits of the trocar when they are housed in its interior - to a fixed external element. Preferably, the fixing element is an articulated arm. Examples of such a fixed external element can be the operating table, a robotic system or the patient himself.

This fixation allows the trocar to remain immovable and, therefore, the surgical field throughout the procedure, which is key for the surgeon to be able to access the target tissues throughout the intervention.

In one embodiment, the at least one conduit is fully or partially lined with an anticoagulant material.

This anticoagulant material (for example heparin, silicone or a hydrophilic polymer such as PEG), when in contact with blood, causes it not to coagulate and thus prevents coagulated blood from penetrating into the at least one duct and clog it. This anticoagulant coating will be present in either an aspiration line, or a blow line, or an irrigation line, or a combination of any of the foregoing.

In one example, said coating is partial, so that only part of the conduit - that which will come into contact with the surgical field - is covered with the anticoagulant material.

In one embodiment, the inner wall of the main body is fully or partially coated with an anticoagulant material.

As mentioned, the anticoagulant material (for example heparin, silicone or a hydrophilic polymer such as PEG), when in contact with blood, causes it not to coagulate. In this embodiment, the surgical field defined by the access port would be free of clots that could penetrate the at least one conduit (aspiration, blowing, irrigation or a combination thereof) obstructing it. In a particular example, the part of the inner wall of the main body that coincides with the external perimeter region configured to rest on biological tissues is the one that is covered by an anticoagulant material.

A second inventive aspect provides an access system to an environment surgical, comprising: a surgical access port according to the first inventive aspect; a set of tissue dilators formed by a plurality of cylinders housed one inside the other plus a lancet in its core where the surgical access port has the inner wall configured to slide over the dilator with a larger diameter.

In this second inventive aspect, in addition to the trocar of the first inventive aspect, the set of concentric cylindrical dilators and the lancet necessary to define the surgical field prior to inserting said trocar into the patient's body are provided. The previously mentioned advantages for the first inventive aspect also apply to this second inventive aspect where the trocar is one more dilator, specifically the one with the largest diameter that is finally placed in the patient to allow the surgical operation.

All features described herein (including the claims, description, and drawings) may be combined in any combination, except for mutually exclusive combinations of such features. DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the invention will become clearer from the detailed description that follows of a preferred embodiment, given solely by way of illustrative and non-limiting example, with reference to the accompanying figures. .

Figure 1 This figure shows a trocar comprising a main body with a flange to which an aspiration duct is clipped. Figure 2a-2b These figures show the trocar of Figure 1 with a support element and a blowing tube positioned in a first position (Figure 2a) and a second position (Figure 2b).

Figure 3 This figure shows the trocar of Figure 2 with a fixation element. Figure 4 In this figure the suction duct is shown in detail with a clip fixing according to Figures 1-3. DETAILED DISCLOSURE OF THE INVENTION

Figure 1 shows a surgical access port - or trocar - suitable for surgical interventions, comprising a tubular main body (1) and a cleaning conduit which, in this particular example, is an aspiration conduit (2). In other examples, alternatively or simultaneously, the surgical access port comprises a blowing conduit (3) and/or an irrigation conduit.

As can be seen in the figure, the main body (1) comprises a first opening (1.1) and a second opening (1.2) arranged at both ends of the main body (1). This figure also shows a perimeter flange (1.5) positioned in the first opening (1.1) of the trocar, said flange (1.5) being optional in other alternative embodiments.

Prior to inserting the trocar into the patient's body, the surgeon will have defined a surgical region or field by means of a lancet and a set of tissue dilators through a procedure such as that described hereinabove. The second opening (1.2) of the main body (1) is configured precisely to give access to the surgical region. In minimally invasive surgeries, the surgical instrument is introduced through the first opening (1.1), passes through the interior of the main body (1) in the X-X' direction and finally comes into contact with the surgical region through the second opening (2.2).

At the end where the second opening (1.2) is located, the main body (1) comprises a perimeter region (1.4) configured to rest on the biological tissues (T) of said surgical region. In this figure 1, the biological tissues (T) have been schematically represented by means of a hatched region corresponding to a section of the tissue (T). On the other hand, the main body (1) comprises an inner wall (1.3) configured to slide over a tissue dilator, understanding as such any of the tissue dilators formed by a plurality of cylinders housed one inside the other plus a lancet in its core. In this example of embodiment, the diameter of the inner wall (1.3) is 2 millimeters greater than the diameter of the outer wall of the cylinder with the largest diameter, which would be housed in a tight and sliding manner inside the main body (1). In addition, in this example of embodiment, the inner wall (1.3) is covered with an anticoagulant material.

Figure 1 additionally shows how the suction duct (2) remains housed inside the main body (1) coupling to the perimeter flange (1.5). In alternative embodiments, the coupling of the conduit is made at the very end of the main body (1), when the latter (1) does not include the perimeter flange (1.5), or else at an element external to the trocar.

The coupling of the suction duct (2) to the perimeter flange (1.5) is carried out by means of a fixing (2.2) by clipping. Said fixing (2.2) is in the form of a clamp dimensioned to clamp the perimeter flange (1.5) by applying light manual pressure. In alternative examples, the cleaning conduit with a clip-on fixation (2.2) is for blowing (3) and/or irrigation. In another alternative example, the fixing (2.2) by clipping is attached to the end of the main body (1) when the latter (1) does not include the perimeter flange (1.5). In another alternative example, the clip-on fastener (2.2) is coupled to an external element.

As shown in Figure 1, the fixing (2.2) by clipping the suction duct (2) is outside the main body (1) and outside the projection or extension of the internal cylindrical wall of the main body (1) according to the axial direction X-X'.

As can be seen, the shape and composition of this suction duct (2) favors its tendency to be placed adjacent to the inner wall (1.3) of the main body (1). The figure shows a computer representation of the suction duct (2) with a curvature that causes this tendency for the lower end to come out of the main body. Since it is a computer representation, the view shows the suction duct (2) going through and coming out of the main body (1). A real device conforming to the computer representation does not traverse a physical body as the main body (1) and simply results, thanks to the fact that it is made of an elastically deformable material, in a tendency to keep its end close to the inner wall, as if it were a spring.

These characteristics can be seen in detail in Figure 4. In particular, the suction duct (2) is elastically deformable and with a curvature such that it tends to press the inner wall (1.3) of the main body (1). Additionally, the suction duct (2) has a concave configuration (2.1) towards the interior of the main body (1) on the opposite side to the side facing the inner wall (1.3) of the main body (1).

All of this makes it possible for the aspiration duct (2) to interfere as little as possible with the introduction and manipulation of the surgical instruments in the main body (1) during surgery.

Additionally, the aspiration conduit (2) comprises a detachable vacuum connection (2.3) to be able to connect to the conduits and pipes of other medical devices, such as a vacuum source.

The suction duct (2) - and the rest of the ducts, if any - is detachable and removable to leave the interior of the main body (1) diaphanous. Finally, it is also worth mentioning that the conduit or conduits (2, 3) are totally or partially covered by an anticoagulant material.

In Figures 2a and 2b the anterior trocar is shown with a support element (4) to which a blowing tube (3) is attached. In an alternative example, the trocar comprises an additional or alternative irrigation conduit to the blowing conduit (3). In an alternative example, the conduit is for blowing and irrigation at the same time.

The trocar support (4) comprises an actuator (5) capable of causing the blowing duct (3) to move between two operative positions: a first position where the blowing duct (3) is close to the internal wall of the main body (1), shown in Figure 2a, and a second operating position where the blowing duct (3) is distanced from the internal wall of the main body (1), in this case in the central position, as shown in Figure 2b. These two different extreme positions and any of the intermediate positions allow blowing and/or irrigation to be carried out in different areas of the surgical field, which increases the efficiency of the cleaning procedure.

In order to ensure that the blowing conduit (3) - or irrigation - is always oriented in the correct direction, the support (4) shown in these Figures 2a and 2b comprises an intermediate rod (3.1) that receives the movement of the actuator (5) and transmits it to the blowing duct (3). The intermediate rod (3.1) is guided in such a way that rotation with respect to its axial direction is prevented. In this example of embodiment, the section of both the stem and the guide that allows it to slide is polygonal, specifically square. In addition, in this example of embodiment, the fixing of the blowing duct (3) to the intermediate rod (3.1) is carried out by means of a tightening torque.

Figure 3 shows the trocar of Figures 2a and 2b including an additional fixation element (4.1), in particular, an articulated arm. This fixing element (4.1) allows the trocar support (4) to be fixed to a fixed external element. Preferably, said element is the patient's bed or the patient himself, for example, a clamp directly attached - not shown in this figure - to one of his vertebrae. In another example, the external element is a robotic system or a tracking system.

Claims

1.- Surgical access port suitable for surgical interventions, comprising: - a main body (1) configured as a tubular conduit that extends in an axial direction X-X' and comprising: a first access opening (1.1) arranged in a end of the main body (1), a second opening (1.2) arranged at the end of the main body (1) opposite the first opening (1.1) configured to give access to a surgical region, an inner wall (1.3) configured to slide on a tissue dilator, from among the tissue dilators formed by a plurality of cylinders housed one inside the other plus a lancet in its core; a perimeter region (1.4) configured to rest on biological tissues (T) in the surgical region; at least one conduit, either suction (2) or blowing (3), or irrigation, housed inside the main body (1) where said conduit (2, 3) is detachable and removable to leave diaphanous inside the main body (1).

2. Port according to claim 1, where the conduit housed inside the main body (1) is a suction conduit (2) and comprises a detachable vacuum connection (2.3). 3.- Port according to any of the preceding claims, where the suction duct (2) is elastically deformable and with a curvature such that it tends to press the inner wall (1.

3) of the main body (1).

4. Port according to any of the preceding claims, where the suction duct (2) shows a concave configuration (2.1) towards the interior of the main body (1) on the opposite side to the side facing the interior wall (1.3) of the main body (1).

5. Port according to any of the preceding claims, where the detachable conduit, or the suction conduit (2), or the blowing conduit (3) or the irrigation, has a fixing (2.2) by clipping on the outside of the main body (1) and outside the projection of the inside of the main body (1) along the axial direction X-X'.

6. Port according to any of the preceding claims, where the main body (1) has a perimeter flange (1.5) in the first opening (1.1).

7. Port according to claims 5 and 6, where the clipping of the suction conduit (2), either the blowing conduit (3) or the irrigation conduit, is established in the perimeter flange (1.5).

8. Port according to any of the preceding claims, where the blowing conduit (3) or the irrigation conduit is fixed by means of a removable fixing to a support (4) by means of an actuator (5) that causes movement between at least two operating positions: a first operating position where the blowing duct (3) is close to the internal wall of the main body (1) and a second operating position where the blowing duct (3) is distanced from the internal wall of the main body (1), preferably in the central position.

9. Port according to claim 8, where the displacement caused by the actuator (5) is established on an intermediate rod (3.1) guided in such a way that rotation with respect to its axial direction is prevented.

10.- Surgical access port according to any of the preceding claims, wherein the perimeter region (1.4) is located at the proximal end of the second opening (1.2) and on the outside of the main body (1).

11.- Surgical access port according to any of the preceding claims, which additionally comprises a fixing element (4.1) configured to fix the support (4) to a fixed external element.

12.- Surgical access port according to any of the preceding claims, wherein the at least one conduit is totally or partially covered by an anticoagulant material.

13.- Surgical access port according to any of the preceding claims, wherein the inner wall (1.3) of the main body (1) is totally or partially covered by an anticoagulant material.

14.- System for access to a surgical environment, comprising: a surgical access port according to any of the preceding claims; a set of tissue dilators formed by a plurality of cylinders housed one inside the other plus a lancet in its core where the surgical access port has the inner wall configured to slide over the dilator with a larger diameter.