Surgical instrument guide with injection channel

Abstract

The present application discloses a surgical instrument guide with an injection channel. A cannula and instrument guide assembly includes a cannula having a proximal portion and a tube. The instrument guide is removably inserted into the proximal portion of the cannula and extends through the cannula to the distal end of the tube. The proximal portion of the cannula has an injection port. The instrument guide provides at least one internal passage to support the shaft of a surgical instrument passing through the instrument guide. One or more channels on the outer surface of the instrument guide are passages for receiving injection gas from the injection port to the distal end of the tube. The one or more channels have a first cross-sectional area at the proximal end and a second, larger cross-sectional area at the distal end. The one or more channels may have a first cross-sectional area along most of the length of the channel.

Description

[0001] This application is a divisional application of Chinese patent application 201780043125.4 (PCT / US2017 / 041787) filed on July 12, 2017 and entitled “Surgical Instrument Guide with Injection Channel”.

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] This application claims the benefit of U.S. Provisional Application No. 62 / 361,931, filed on July 13, 2016, under 35 U.S.C. 119(e), which is incorporated herein by reference in its entirety. Technical Field

[0004] Embodiments of the present invention relate to the field of endoscopic surgical instruments, and in particular to an instrument guide for an endoscopic surgical instrument including a channel for introducing an insufflation gas. Background Art

[0005] Minimally invasive medical techniques have been used to reduce the amount of extraneous tissue that may be damaged during a diagnostic or surgical procedure, thereby reducing patient recovery time, discomfort, and harmful side effects. Traditional forms of minimally invasive surgery include endoscopy. A common form of endoscopy is laparoscopy, which is a minimally invasive examination or surgical procedure within the abdominal cavity. In traditional laparoscopic surgery, the patient's abdominal cavity is insufflated with gas, and a cannula sleeve is passed through a small (about 12 mm) incision in the patient's abdominal muscle tissue to provide an access port through which laparoscopic surgical instruments can be passed in a sealed manner.

[0006] Laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field and a surgical instrument having an end effector. Typical surgical tools include, for example, clamps, graspers, surgical scissors, staplers, and needle holders. The surgical instruments are similar to those used in conventional (open) surgery, except that the end effector of each surgical instrument is separated from its handle by an extension tube approximately 30 cm long, for example, to allow the operator to introduce the end effector into the surgical site and control the movement of the end effector relative to the surgical site from outside the patient's body.

[0007] To further reduce the trauma of minimally invasive surgery, technology is being developed that allows minimally invasive surgery that uses only a single access port (e.g., a single incision or a single natural body orifice) to enter the body. This entry can be accomplished using a slightly larger cannula that can accommodate all the instruments required for the surgery. Minimally invasive surgery performed through a single incision or natural orifice can be referred to as single-port access (SPA) surgery. A single cannula providing a single port can be introduced through a body orifice or through an incision.

[0008] If multiple surgical instruments and / or camera instruments are introduced into the surgical site through a single cannula, it is desirable to use as small a cannula as possible, the size of which is consistent with the size of the instruments to be passed through it. Access must also be provided to supply insufflation gas to inflate the surgical site and continually replace gas lost to leaks. Access may also allow evacuation of the surgical site.

[0009] Therefore, there is a need for a better and more efficient device for introducing surgical instruments through a small incision and supplying insufflation gas to the surgical site. BRIEF DESCRIPTION OF THE DRAWINGS

[0010] The present invention may be best understood by referring to the following description and accompanying drawings, which are used to illustrate embodiments of the present invention by way of example and not limitation. In the accompanying drawings, like reference numerals represent similar elements:

[0011] Figure 1 is a view of an illustrative teleoperated surgical system.

[0012] Figure 2 is a schematic diagram of the unassembled access port.

[0013] Figure 3 is a side view of the assembled access port with a portion of the cannula cut away to show the instrument guide inserted into the cannula.

[0014] Figure 4 is along Figure 3 A cross section of the instrument guide taken along line 4-4 in FIG.

[0015] Figure 5A is along Figure 3 A cross section of the instrument guide taken along line 5-5 in FIG.

[0016] Figure 5B is along Figure 3 An enlarged cross-section of the instrument guide taken along line 5-5 in FIG.

[0017] Figure 6 is a schematic side view of an instrument guide inserted into a cannula to illustrate the flow of insufflation gas. DETAILED DESCRIPTION

[0018] In the following description, many specific details are set forth. However, it should be understood that embodiments of the present invention can be practiced without these specific details. In other cases, well-known circuits, structures, and techniques are not shown in detail to avoid obscuring the understanding of this specification.

[0019] In the following description, reference is made to the accompanying drawings that illustrate several embodiments of the present invention. It should be understood that other embodiments may be utilized and that mechanical composition, structural, electrical, and operational changes may be made without departing from the spirit and scope of the present disclosure. The following detailed description should not be taken in a limiting sense, and the scope of the embodiments of the present invention is limited only by the claims of the published patents.

[0020] The terms used herein are only used for the purpose of describing specific embodiments and are not intended to limit the present invention. Spatial relative terms (e.g., "below," "below," "lower," "above," "upper," etc.) may be used herein for ease of description, to describe the relationship between an element or feature as shown in the figure and another one or more elements or features. It should be understood that spatial relative terms are intended to include different orientations of the device in use or operation except for the orientation shown in the figure. For example, if the device in the figure is flipped, the element described as "below" or "below" other elements or features will be oriented "above" other elements or features. Therefore, the exemplary term "below" may include two orientations above and below. The device may be oriented otherwise (e.g., rotated 90 degrees or in other orientations), and the spatial relative descriptors used herein are interpreted accordingly.

[0021] As used herein, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context indicates otherwise. It will be further understood that the terms "include" and / or "comprise" specify the presence of stated features, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof.

[0022] The term "object" generally refers to a component or group of components. For example, an object may refer to a pocket or a boss of a disk in the specification or claims. Throughout the specification and claims, the terms "object," "component," "portion," "part," and "segment" may be used interchangeably.

[0023] As used herein, the terms "or" and "and / or" should be interpreted as inclusive or meaning any one or any combination. Thus, "A, B, or C" or "A, B, and / or C" means "any of the following: A; B; C; A and B; A and C; B and C; A, B, and C". Exceptions to this definition will only occur when a combination of elements, functions, steps, or acts are inherently mutually exclusive to some extent.

[0024] Approximate terms used herein (e.g., "substantially" and "about") should be interpreted as being equal to a specified amount within a tolerance that is applicable to the manufacturing process that produces the specified amount or to the use or requirement of the specified amount. Thus, if the length is produced by a precise process or represents a critical dimension, then a length that is substantially the specified amount may be the specified amount plus or minus a small amount. Conversely, if the length is produced by an inaccurate process or represents a non-critical dimension, then a length that is substantially the specified amount may be the specified amount plus or minus a large amount.

[0025] The terms "instrument" and "surgical instrument" are used herein to describe a medical device configured to be inserted into a patient and used to perform a surgical or diagnostic procedure. Surgical instruments typically include end effectors associated with one or more surgical tasks, such as forceps, needle drivers, scissors, bipolar cautery devices, tissue stabilizers or retractors, clip appliers, stapling devices, imaging devices (e.g., endoscopes or ultrasound probes), etc. Some instruments used with embodiments of the present invention also provide an articulated support (sometimes referred to as a "wrist") for surgical tools, so that the position and orientation of surgical tools can be manipulated using one or more mechanical degrees of freedom relative to the axis of the instrument. In addition, many surgical end effectors include functional mechanical degrees of freedom, such as jaws that open or close, or knives that translate along a path. Surgical instruments may also contain stored (e.g., on a semiconductor memory inside the instrument) information that may be permanent or may be updated by a surgical system. Therefore, the system may provide one-way or two-way information communication between an instrument and one or more system components.

[0026] Figure 1 A view of a minimally invasive teleoperated surgical procedure on a patient 110 is shown using a single access port 100 for teleoperated surgical instruments 102, 104, 106. The single access port 100 is inserted through a single incision 112. Typically, three or four surgical instruments (instruments 102, 104, and 106 are shown), including a camera instrument, are introduced through the single access port 100. In addition, there is typically an insufflation gas (e.g., carbon dioxide (CO)) introduced at or near the single access port 100. 2 It should be understood that single port surgery uses a large amount of equipment located in a small amount of space.

[0027] Teleoperated surgical instruments 102, 104, and 106 (which may include camera instruments that can provide images of the surgical site and other instruments at the surgical site) are each coupled to a corresponding actuator (e.g., one of actuators 122, 124, 126, and 128). Actuators 122, 124, 126, and 128 are servo actuators that allow a surgeon to manipulate the surgical instrument using a computer-mediated control station 120. These manipulations may include functions such as changing the position and orientation of the end effector (including the camera) of the surgical instrument and operating the end effector (such as closing the jaws to achieve grasping, cutting, etc.). Such actuator control of surgical instruments may be referred to by various terms (e.g., teleoperated surgery). Actuators 122, 124, 126, and 128 may be supported on a separate structural arm that, once positioned, may be fixed relative to patient 110. In various embodiments, the support arm may be manually positioned, may be positioned by the surgeon, or may be automatically positioned by the system as the surgeon moves one or more surgical instruments.

[0028] The control system couples the computer-mediated control station 120 to the remotely operated actuators 122, 124, 126, and 128. Here, "computer" broadly includes a data processing unit that includes memory and addition or logic functions, such as an arithmetic logic unit, that can be programmed to perform arithmetic or logic operations. The control system can coordinate the movement of the input device with the movement of the surgical instrument with which it is associated so that the image of the surgical instrument 102, 104, 106 as displayed to the surgeon appears to be at least substantially connected to the input device in the surgeon's hand. Further levels of connectivity are also often provided to enhance the surgeon's dexterity and ease of use of the surgical instruments 102, 104, and 106.

[0029] The computer-mediated control station 120 may provide a manually operated master controller 130 that allows the teleoperated surgical instruments 102, 104, 106 to be manipulated by transmitting signals (such as electrical control signals or optical control signals provided by cables 132) to actuators 122, 124, 126, and 128, which control the motion of the coupled surgical instruments 102, 104, and 106. Typically, one of the surgical instruments (e.g., surgical instrument 102) will be a camera instrument that is manipulated to place the remaining surgical instruments and the manipulated object within the field of view of the camera. The camera instrument transmits signals to the control station 120 so that images of the instruments and objects within the field of view captured by the camera can be displayed on a visual display 134 that the surgeon observes as the coupled surgical instruments 104, 106 are manipulated. The manually operated controller 130 and the visual display 134 may be arranged to provide intuitive control of the surgical instruments 104 , 106 , wherein the instruments move in a manner similar to how the operator's hands move with the controller.

[0030] Figure 2 is a schematic diagram of an unassembled cannula and instrument guide assembly forming an access port 100 that can be inserted through incision 112. Access port 100 is shown prior to assembling the components into a configuration for use during a surgical procedure. When assembled, the cannula and instrument guide assembly provides Figure 1 The single port entry shown in .

[0031] The access port 100 includes a cannula 200 having a lumen or tube 202 that is inserted through the incision 112 to separate and protect the incision. The access port 100 also includes an instrument guide 220 inserted into the cannula 200. The instrument guide 220 can be coupled to the cannula 200 in a variety of ways to maintain the instrument guide in the cannula during the surgical procedure. The instrument guide 220 guides one or more instruments through the cannula 200 to facilitate entry of the instruments into the surgical site.

[0032] The cannula 200 includes a proximal portion 204 having an injection port 206 and a tube 202 coupled to the proximal portion. The injection port 206 receives an injection gas (e.g., carbon dioxide (CO 2 )), the insufflation gas is introduced into the surgical site through the tube 202 portion of the cannula 200.

[0033] Access port 100 may include sealing assembly 210 coupled to cannula 200. When instrument guide 220 is not inserted into cannula 200, sealing assembly 210 seals access port 100 to reduce loss of insufflation gas.

[0034] The instrument guide 220 can be connected to a funnel assembly 230, which provides an instrument receiver 232 to guide the instrument into the passage in the instrument guide at the proximal end of the instrument guide. The funnel assembly 230 can include a seal that seals the instrument passage in the instrument guide 220 to reduce the loss of injection gas when the instrument is not inserted into the instrument passage. The instrument guide 220 may include one or more instrument passages. The instrument guide may include one, two, three, four, five, six or more instrument passages. The instrument passages may all have the same size and shape, or their size and / or shape may be different. Each instrument passage may have a circular cross-section or an elliptical cross-section or other cross-sectional shapes corresponding to the shape of the instrument shaft supported by the instrument passage.

[0035] The distal portion of the instrument guide 220 is configured to fit tightly within the tube 202 portion of the cannula 200. Each of the one or more instrument passages in the instrument guide 220 is configured to support a single surgical instrument at a defined location within the cannula 200. Surgical instruments are inserted into the access port 100 through the instrument receiver 232 in the funnel assembly 230 so that they are guided into the instrument passage at the proximal end of the instrument guide 220. The surgical instruments are supported by the instrument passage until they extend from the distal end of the instrument guide 220. In some embodiments, the instrument guide 220 can be formed of a non-conductive material to help electrically isolate instruments that can carry an electrical charge for electrosurgical applications (e.g., cautery). In other embodiments, the instrument guide 220 can be formed of a conductive material (e.g., metal or conductive plastic) to help dissipate any charge that may accumulate on the instrument passing through the guide.

[0036] In some embodiments, cannula 200 can be reusable (e.g., after cleaning and sterilization). Some or all of instrument guide 220, funnel assembly 230, and seal assembly 210 can be provided as a sterile disposable kit (e.g., a gamma sterilization kit) so that a new instrument guide, a new funnel assembly, and / or a new seal assembly can be used for each surgical procedure.

[0037] Figure 3 A side view of the access port 100 is shown with the cannula 200 cut away along the diameter to show the instrument guide 220 inserted into the cannula. The instrument guide 220 includes at least one channel 224 on the outer surface 222 of the outer wall of the instrument guide to form a passage for injection gas from the injection port 206 to the distal end of the tube 202 portion of the cannula 200.

[0038] The channel 224 is adjacent to the inner surface of the tube 202 to form a passage for the insufflation gas when the instrument guide 220 is inserted into the tube. The channel 224 extends completely to the distal end 300 of the instrument guide 220. The channel 224 extends toward the proximal end of the instrument guide 220 but does not reach the proximal end of the instrument guide 220. The channel 224 extends sufficiently toward the proximal end so that the proximal end 302 of the channel receives the insufflation gas flowing from the injection port 206 and passing through the proximal portion 204 of the cannula 200.

[0039] The seal assembly 210 may include a proximal seal 306 and sealing flaps 304. The proximal seal 306 seals the instrument guide 220 beyond the proximal end 302 of the channel 224 to prevent the escape of insufflation gas from the instrument guide at the proximal end of the cannula 200. When the instrument guide 220 is inserted into the tube 202, the sealing flaps 304 open. Although the sealing flaps 304 appear to prevent the insufflation gas from flowing from the injection port 206 to the proximal end 302 of the channel, there are openings between the flaps that allow the insufflation gas to flow through the proximal portion 204 of the cannula 200. Thus, the cannula and instrument guide assembly of the access port 100 provides a mechanism for introducing insufflation gas into the surgical site while minimizing the loss of insufflation gas from the assembly.

[0040] Figure 4 is a cross-section of instrument guide 220 taken along section line 4 - 4 . Figure 5A and Figure 5B is a cross-section of instrument guide 220 taken along section line 5 - 5 . Figure 5A Omitted Figure 5B Detail of the channel end view shown in the enlarged view.

[0041] It is necessary to provide a flow rate of injection gas sufficient to inflate the surgical area to a set pressure (which may be 8 mm Hg to 14 mm Hg) and replace gas losses caused by leaks. The injection gas can be supplied at a pressure of about 15 mm Hg (about 2,000 Pa). The flow rate can be about 20 l / min. It should be understood that the speed of the injection gas flowing through one or more channels 224 depends on the cross-sectional area of ​​the channel. When the cross-sectional area is small, the flow will have a higher speed, and when the cross-sectional area is large, the flow will have a lower speed. However, it is desirable that one or more channels 224 have a small cross-sectional area to minimize the diameter of the tube 202 of the instrument guide 220 and the cannula. The cross-sectional area of ​​one or more channels 224 is constrained by the need to maintain a certain wall thickness for the structural integrity and manufacturability of the instrument guide 220.

[0042] It is also desirable to avoid high velocity flows of insufflation gas that may disturb or even damage tissue near the distal end of cannula 200 where the insufflation gas is discharged into the surgical site. In order to provide a small diameter instrument guide 220 while minimizing the discharge velocity of the insufflation gas, one or more channels 224 have a first cross-sectional area at the proximal end of the channel and a second cross-sectional area at the distal end of the channel, the second cross-sectional area being larger than the first cross-sectional area.

[0043] One or more channels 224 have a first cross-sectional area for most of the length of the channel. Transition portion 308 begins near the distal end of channel 224 to provide a transition to a second cross-sectional area. The transition is made long enough to avoid introducing turbulence in the flow of the injection gas. In some embodiments, the transition from the first cross-sectional area to the second cross-sectional area is about 1 inch (25 mm) long. By limiting the larger cross-sectional area to the distal end 300 of the instrument guide 220, the adverse consequences of the larger cross-sectional area are minimized. This allows the instrument guide 220 to have a smaller diameter than the diameter that would be possible if the channel 224 had a second cross-sectional area over its entire length. In some embodiments, the second cross-sectional area is at least twice the first cross-sectional area, thereby reducing the discharge velocity of the injection gas to half or less of the velocity at the proximal end of the channel. For example, in one embodiment, the first cross-sectional area is about 0.0023 square inches (1.5 square millimeters), and the second cross-sectional area is about 0.0050 square inches (3.0 square millimeters).

[0044] One or more channels 224 are positioned relative to the internal passageway to provide the instrument guide with a first wall thickness where the channel has a first cross-sectional area and to provide the instrument guide with a second wall thickness where at least one channel has a second cross-sectional area, the second wall thickness being less than the first wall thickness.

[0045] Figure 6 A schematic side view of an instrument guide 220 inserted into a cannula 200 is shown to illustrate the flow of insufflation gas from the insufflation port 206 to a surgical site 602. The double dashed arrows represent the flow of insufflation gas 600. The cannula 200 is inserted through the incision 112, which seals against the exterior of the cannula. The proximal portion 204 of the cannula 200 forms a gas chamber that supplies insufflation gas. The proximal portion 204 is sealed at the proximal end by a proximal seal 306 that seals against the instrument guide 220.

[0046] The insufflation gas enters the one or more channels 224 on the outer surface 222 of the instrument guide 220 from the plenum formed by the proximal portion 204 of the cannula 200 and flows toward the distal end 300 of the instrument guide. The one or more channels 224 include a transition portion 308 having an increased cross-sectional area at the distal end 300 of the channel. As indicated by the reduced length of the double dashed arrow in the transition portion 308, the increased cross-sectional area of ​​the transition portion reduces the velocity of the insufflation gas before it is discharged into the surgical site 602.

[0047] Although certain exemplary embodiments have been described and illustrated in the accompanying drawings, it should be understood that these embodiments are merely illustrative of the invention and not limiting, and the invention is not limited to the specific structures and arrangements shown and described, as various other modifications may occur to one of ordinary skill in the art. For example, although the use of a channel of an instrument guide to deliver insufflation gas to a surgical site has been described, the same or similar channels may be used to exhaust gas and / or smoke from the surgical site. Therefore, this description is to be regarded as illustrative and not limiting.

Claims

1. A medical device comprising: an instrument guide comprising an outer wall, a distal end, an interior passageway, and an insufflation gas channel; wherein the internal passageway is sized and shaped to receive a shaft of a surgical instrument; wherein the outer wall of the instrument guide includes an outer surface and a gas introduction location on the outer surface at which injection gas is introduced into the injection gas passage; wherein the injection gas passage is defined in the outer surface of the outer wall and extends from the gas introduction location to the distal end of the instrument guide; and wherein a cross-sectional area of ​​the insufflation gas passage changes from the gas introduction location to the distal end of the instrument guide.

2. The medical device according to claim 1, wherein: The cross-sectional area of ​​the insufflation gas channel is greatest at the distal end of the instrument guide.

3. The medical device according to claim 1, wherein: The injected gas passage has a first cross-sectional area at the gas introduction location; The insufflation gas passage has a second cross-sectional area at the distal end of the instrument guide; and The second cross-sectional area is greater than the first cross-sectional area.

4. The medical device according to claim 3, wherein: The injection gas channel has the first cross-sectional area along a majority of the length of the injection gas channel.

5. The medical device according to claim 3, wherein: the insufflation gas passage being positioned relative to the internal passageway to provide the outer wall of the instrument guide with a first wall thickness where the insufflation gas passage has the first cross-sectional area; the insufflation gas passage being positioned relative to the internal passageway to provide the outer wall of the instrument guide with a second wall thickness where the insufflation gas passage has the second cross-sectional area; and The second wall thickness is less than the first wall thickness.

6. The medical device according to claim 3, wherein: The second cross-sectional area of ​​the injection gas channel is at least twice the first cross-sectional area.

7. The medical device according to claim 1, wherein: The instrument guide further includes a proximal end opposite the distal end; The insufflation gas channel extends toward the proximal end of the instrument guide but does not reach the proximal end of the instrument guide.

8. The medical device according to claim 1, wherein: The medical device further comprises a cannula; The cannula includes a proximal portion and a tube; The tube includes a proximal end and a distal end opposite the proximal end; The proximal end of the tube is coupled to the proximal portion of the cannula; and The instrument guide is removably inserted into the proximal portion of the cannula and extends through the cannula to the distal end of the tube.

9. The medical device according to claim 8, wherein: The sleeve includes an injection port adjacent to the gas introduction location; The tube of the sleeve comprises an inner surface; and The insufflation gas passageway through the inner surface of the tube adjacent the cannula forms a pathway for insufflation gas from the insufflation port of the cannula to the distal end of the instrument guide.

10. The medical device of claim 1, wherein: The instrument guide further includes a proximal portion opposite the distal end, and a funnel assembly coupled to the proximal portion of the instrument guide; The funnel assembly is configured to guide the shaft of the surgical instrument into and through the interior passageway of the instrument guide; and The funnel assembly is configured to reduce leakage of insufflation gas from the proximal portion of the instrument guide.

11. The medical device of claim 1, wherein: The instrument guide further comprises a plurality of internal passageways; and The interior aisle is one of the plurality of interior aisles.

12. The medical device according to claim 11, wherein: The instrument guide further comprises a plurality of radial walls; and Each individual radial wall of the plurality of radial walls is located between two individual interior aisles of the plurality of interior aisles.

13. The medical device of claim 12, wherein: Each individual radial wall of the plurality of radial walls connects the outer wall of the instrument guide; The instrument guide further includes a plurality of insufflation gas channels; The injection gas channel is one of the plurality of injection gas channels; and Each individual one of the plurality of injection gas channels is in the outer surface of the outer wall and is opposite to where a corresponding individual one of the plurality of radial walls joins the outer wall.

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