Surgical devices for suction, irrigation, and tissue traction.

Abstract

A system for surgical suction and / or perfusion is provided, which can be made rigid or flexible. In some embodiments, the system comprises a rod and two flexible and substantially coaxially aligned conduits. The second conduit of the two substantially coaxially aligned conduits can be sealed at its distal end and may have an inner diameter greater than or equal to the outer diameter of the rod. The rod may have an elastic modulus of at least 1 mPa. The second conduit may be configured to pass the rod through it without being removed from the patient while being surgically inserted into the patient. At least a first portion of the first conduit of the two substantially coaxially aligned conduits can be joined to at least a second portion of the second conduit or co-extruded to at least a second portion of the second conduit.

Description

Technical Field

[0001] The present disclosure relates to surgical instruments, and more particularly to a variable stiffness aspiration and irrigation surgical system.

Background Art

[0002] In surgical procedures, it is often necessary to irrigate the surgical field with a sterile solution and / or aspirate body fluids or irrigation fluid from the surgical field. Conventionally, aspiration / irrigation devices have been designed to function as hand-held tools intended for use by a surgeon or surgical assistant. These hand-held devices typically incorporate a valve mechanism that is manually operated by the surgeon to control the aspiration and irrigation functions. A common valve configuration is known as a "trumpet valve". The trumpet valve consists of an irrigation button and an aspiration button, and each button can be manually depressed by the operator against a compression spring to engage the valve barrel. Manual depression of the aspiration button allows aspiration through the device, while depression of the irrigation button allows irrigation of fluid through the device.

[0003] Recently, robot-assisted surgery has been increasingly adopted by surgeons to perform technically difficult procedures in a minimally invasive manner. In robot-assisted surgery, the surgeon uses a robot console to remotely control a robotic arm within the surgical field to perform the surgery. The aspiration / irrigation device can be manipulated by the robotic arm, but doing so would distract the surgeon's attention. In addition, an assistant surgeon may be present on the patient's side to manually manipulate surgical tools, such as tools that cannot be controlled by the robot. Improvements in the art would include a single aspiration / irrigation device that can be manipulated by a robotic arm or manually by an assistant on the patient's side without removing the device from the surgical field.

Summary of the Invention

[0004] In the first example, a surgical suction and perfusion device is provided, comprising a rod and two flexible and substantially coaxially aligned first and second conduits, the second of the two substantially coaxially aligned conduits having an inner diameter configured to receive the rod, with the second conduit sealed at its distal end, and the first conduit in fluid communication with a vacuum source and a perfusion source.

[0005] Example 2 incorporates the subject matter of Example 1, wherein the rod is at least twice as stiff as the coaxially aligned conduit when tested using Test 1.

[0006] Example 3 includes the subject matter of Example 1, wherein the rod comprises metal, metal alloy, steel, stainless steel, glass, or polymer.

[0007] Example 4 includes the subject of Example 1, wherein at least a first portion of the first conduit of two substantially coaxially aligned conduits is solvent-bonded to at least a second portion of the second conduit, or co-extruded to at least a second portion of the second conduit.

[0008] Example 5 includes the subject matter of Example 1, and by Test 1, the rod has a stiffness grade of A or B, and the coaxially aligned conduit has a stiffness grade of C or D.

[0009] Example 6 incorporates the subject matter of Example 1, wherein the second conduit is configured to allow a rod to pass through without being removed from the patient while it is surgically inserted into the patient.

[0010] Example 7 includes the subject matter of Example 1, wherein the second conduit is shorter and / or narrower than the first conduit.

[0011] Example 8 includes the subject matter of Example 1, wherein the surgical suction and irrigation device is configured to be used to pull the patient's tissue while the rod is inserted into the second conduit.

[0012] Example 9 incorporates the subject matter of Example 1, wherein the first conduit of two substantially coaxially aligned conduits is configured to perform suction and / or irrigation during surgery.

[0013] Example 10 includes the subject matter of Example 1, wherein the conduit includes a lumen through which it passes, and / or the distal portion of the coaxially aligned conduit is reversibly bendable.

[0014] Example 11 includes the subject matter of Example 1, wherein the first conduit is in fluid communication with the suction / perfusion tip, and the second conduit is not in fluid communication with the suction / perfusion tip.

[0015] Example 12 describes a method using a surgical suction and irrigation device comprising a rod and two substantially coaxially aligned conduits. The second conduit of the two substantially coaxially aligned conduits can be sealed at its distal end and may have an inner diameter greater than or equal to the outer diameter of the rod, allowing the rod to pass through. The method may include performing suction and / or irrigation during surgery using the first conduit of the two substantially coaxially aligned conduits.

[0016] Example 13 includes the subject matter of Example 12 and further includes inserting a rod into a second conduit. Performing suction and / or perfusion may include performing suction and / or perfusion using the first conduit while the rod is inserted into the second conduit. The method may further include removing the rod from the second conduit. Performing suction and / or perfusion may include performing suction and / or perfusion using the first conduit while the rod is not inserted into the second conduit.

[0017] Example 14 includes the subject matter of Example 13, wherein the surgical suction and irrigation device is surgically inserted into the patient during surgery, and the rod is inserted and removed while the device is in place.

[0018] Example 15 includes the subject matter of Example 12, wherein the rod has an elastic modulus of at least 1 megapascal.

[0019] Example 16 includes the subject matter of Example 12, wherein at least a first portion of a first conduit is solvent-bonded to at least a second portion of a second conduit, or co-extruded to at least a second portion of a second conduit.

[0020] Example 17 includes the subject matter of Example 12, wherein inserting the rod into the second conduit makes the second conduit inflexible.

[0021] Example 18 includes the subject matter of Example 1 and further includes using a surgical suction and irrigation device to pull the patient's tissue while the rod is inserted into the second conduit.

[0022] Example 19 provides a surgical suction and perfusion system. The surgical suction and perfusion device comprises a vacuum pump, a perfusion tip, a perfusion fluid source, and two coaxial conduits having an inner conduit and an outer conduit. The inner conduit has an elastic modulus of at least 1 megapascal and is detachable from the outer conduit of the surgical suction and perfusion device.

[0023] Example 20 incorporates the themes of Example 19, and the outer conduit is flexible.

[0024] Example 21 incorporates the subject matter of Example 19, wherein the surgical suction and irrigation device is configured to be used to pull the patient's tissue while the inner conduit is inserted into the outer conduit of the surgical suction and irrigation device.

[0025] Example 22 provides a suction and perfusion device. The suction and perfusion device comprises a vacuum pump, a perfusion tip, a perfusion fluid source, and two coaxial conduits having an inner conduit and an outer conduit. The outer conduit is rigid or malleable. The inner conduit is detachable from the outer conduit of the surgical suction and perfusion device.

[0026] Example 23 includes the subject matter of Example 22, and the inner conduit is flexible.

[0027] Example 24 includes the subject matter of Example 22, and the surgical suction and irrigation device is configured to be used to retract a patient's tissue while the inner conduit is inserted into the rigid or malleable outer conduit of the surgical suction and irrigation device.

[0028] Example 25 includes the subject matter of Example 22, and the outer conduit has a stiffness grade of A or B using Test 1.

[0029] In Example 26, a method of retracting tissue at a surgical site is provided. The method includes inserting a flexible suction / irrigation probe into a patient's surgical port, accessing the surgical site using the flexible suction / irrigation probe, stiffening the suction / irrigation probe while maintaining the position of the suction / irrigation probe at the surgical site, and manipulating the stiffened suction / irrigation probe to retract tissue at the surgical site.

[0030] Example 27 includes the subject matter of Example 26, and further includes perfusing and / or suctioning the surgical site using the suction / irrigation probe.

[0031] Example 28 includes the subject matter of Example 27, and further includes perfusing and suctioning the surgical site using the suction / irrigation probe.

[0032] Example 29 includes the subject matter of Example 26, and stiffening the suction / irrigation probe further includes sliding a rod through the lumen of the suction / irrigation probe.

[0033] Example 30 includes the subject matter of Example 29, and sliding the rod through the lumen further includes sliding the rod through a first conduit adjacent to a second conduit, and the second conduit is in fluid communication with the surgical site.

[0034] Example 31 includes the subject matter of Example 29, and further includes sliding the rod through the lumen, inserting the rod into the lumen, and allowing air to pass through the lumen and pass the rod in the opposite direction to the direction of insertion.

[0035] Example 32 includes the subject matter of Example 26, and further includes restoring flexibility to the suction / perfusion probe after hardening.

[0036] Example 33 incorporates the subject matter of Example 32, and restoring flexibility involves withdrawing the rod from the lumen of the conduit.

[0037] Example 34 includes the subject matter of Example 26, and further includes rigidifying the suction / perfusion probe by inserting a rigid conduit into the suction / perfusion probe.

[0038] Example 35 includes the subject matter of Example 34, wherein the rigid conduit comprises an inner conduit of two coaxial conduits.

[0039] Example 36 incorporates the subject matter of Example 34, wherein the rigid conduit comprises an outer conduit of two coaxial conduits.

[0040] Example 37 provides a method for pulling tissue at a surgical site. The method includes inserting a rigid suction / perfusion probe into the patient's surgical port, accessing the surgical site using the rigid suction / perfusion probe, making the suction / perfusion probe flexible while maintaining its position at the surgical site, and maneuvering the suction / perfusion probe to pull tissue at the surgical site.

[0041] Example 38 includes the subject matter of Example 37 and further includes irrigating and / or aspirating the surgical site using a suction / irrigation probe.

[0042] Example 39 includes the subject matter of Example 37, and further comprises making the suction / perfusion probe flexible by removing the rod from the lumen of the suction / perfusion probe.

[0043] Example 40 comprises a rigid conduit and a flexible conduit aligned coaxially with the rigid conduit and slidable axially relative to the rigid conduit, the flexible conduit being in fluid communication with a vacuum source and a perfusion source.

[0044] Example 41 incorporates the subject matter of Example 40, wherein the rigid conduit is located outside the flexible conduit.

[0045] Example 42 incorporates the subject matter of Example 40, wherein the flexible conduit is located outside the rigid conduit.

[0046] The features and advantages described herein are not exhaustive, and in particular, many additional features and advantages will be apparent to those skilled in the art in consideration of the drawings, specification, and claims. Furthermore, it should be noted that the language used herein is not intended to limit the scope of the subject matter described herein, but is chosen primarily for readability and explanatory purposes.

[0047] The drawings described herein are for illustrative purposes only and are not intended to limit the scope of this disclosure in any way. [Brief explanation of the drawing]

[0048] [Figure 1A] This disclosure illustrates the exemplary use of a flexible suction and irrigation surgical system according to several embodiments of this disclosure. [Figure 1B] This figure illustrates components of a flexible suction and perfusion system according to some embodiments of the present disclosure. [Figure 1C] The components of a surgical suction / irrigation system according to one embodiment are illustrated below. [Figure 2] This disclosure illustrates exemplary uses of flexible suction and perfusion devices for tissue traction during surgery, according to several embodiments of this disclosure. [Figure 3] Perspective views illustrating some embodiments of the present disclosure of a flexible suction and irrigation surgical system having a removable rod for pulling tissue. [Figure 4]Perspective views illustrating some embodiments of the present disclosure of a suction and perfusion surgical system having two coaxial conduits with a rigid internal conduit for tissue traction. [Figure 5a] Perspective views illustrating some embodiments of the present disclosure of a suction and perfusion surgical system having two coaxial conduits with a rigid lateral conduit for tissue traction. [Figure 5b] Figure 5a illustrates an example with a quick disconnect that allows the rigid outer conduit to be separated from the inner conduit. [Figure 6] This is a flowchart of the process for using a suction and irrigation surgical system according to some embodiments of the present disclosure. [Figure 7A] This is a flowchart of a process for using a suction and perfusion surgical system for tissue traction, according to some embodiments of the present disclosure. [Figure 7B] This is a flowchart of a process for using a suction and perfusion surgical system for tissue traction, according to some embodiments of the present disclosure.

[0049] These and other features of this embodiment will be better understood by reading the following detailed description along with the figures provided herein. The accompanying drawings are not intended to be drawn to scale. In the drawings, each identical or nearly identical component illustrated in various figures may be represented by similar numbers. For clarity, not all components may be labeled in all drawings. [Modes for carrying out the invention]

[0050] As mentioned above, robot-assisted surgery is increasingly being adopted by surgeons to perform technically difficult procedures in a minimally invasive manner. In robot-assisted surgery, the surgeon uses a robotic console to remotely control robotic arms within the surgical field to perform the surgery. Suction / irrigation devices can be operated by the robotic arms, but doing so would distract the surgeon. In addition, an assistant surgeon may be present at the patient's side to manually operate surgical tools, such as those that cannot be controlled by the robot.

[0051] As used herein, “surgical field” and “sterile field” have their meanings as they are used in the art. Specifically, the surgical field is the space within the patient in which surgery is performed. The sterile field is the area immediately surrounding the patient in which personnel and equipment must maintain a sterile environment during surgery. The surgical field is located within the sterile field.

[0052] Disclosed herein are surgical devices that provide suction / irrigation and traction capabilities at the surgical site. The rigidity of the suction / irrigation probe can be changed before or during the surgical procedure. In its rigid state, the probe can be manually operated by a human or robot to traction tissue or transmit force to an object in the surgical field. In its flexible state, the probe is easily maneuverable using a gripper or other surgical tool that can grasp the rigid tip at the distal end of the probe. The ability to shift between a rigid and flexible tool allows for the completion of more surgical tasks without requiring the exchange of surgical tools, and without requiring the exchange of devices or the withdrawal and reinsertion of surgical devices into the surgical field.

[0053] Referring here to the drawings to illustrate exemplary embodiments of the present disclosure, Figure 1A shows an illustrative use of the Flexible Suction and Perfusion Surgical System 100 according to several embodiments of the present disclosure. The Flexible Suction and Perfusion System 100 is described in detail in International Patent Applications PCT / US2012 / 037516 and PCT / US2020 / 41658, both of which are incorporated herein by reference.

[0054] In this example, the robotic arm 102 maneuvers a gripper 104 that can operate the suction / perfusion probe 108 and / or associated tube. In this example, the suction / perfusion probe 108 is used to perform suction of fluid 110, for example, to prevent the accumulation of blood, liquefied fat, or other body fluids. The suction / perfusion probe 108 can also be used to perform perfusion, such as perfusing sterile solution into the surgical field, and / or to perfuse such solution from the surgical field after their use. Alternatively, or additionally, depending on the circumstances, the suction / perfusion probe 108 can be used for air supply, smoke removal, for example to improve visibility during cauterization, and / or for tissue traction, as shown in the example in Figure 2 below. As shown, while the suction / perfusion probe 108 is in use, surgical instruments 106 (e.g., scissors) can be used simultaneously to perform surgical procedures on tissue 112, etc.

[0055] As described in International Patent Application PCT / US2012 / 037516, a flexible tube connected to the suction / perfusion probe 108 can offer several advantages compared to a non-flexible suction / perfusion probe. For example, such advantages may include an increased range of motion and improved range of movement in the surgical field. For instance, the flexible design of the suction / perfusion probe 108 may allow a console surgeon to apply suction and / or perfusion 110 to areas within the surgical field that would be inaccessible with a rigid probe inserted through a fixed port. These inaccessible areas may include spaces behind membranes, tissues, organs, or surgical devices that would require the probe to bend or curve to access the space at the probe tip. This flexible design can also provide a degree of freedom of movement at the probe tip, allowing the user to articulate the tip by 180°, thereby directing the suction or perfusion 110 in the opposite direction to the orientation of the probe 108. Tuning materials such as braided or reinforced tubes may be used to allow for significant bending of the probe tip without forming an obstructive twist in the tube lumen.

[0056] Such degrees of freedom of movement can be particularly useful in minimally invasive procedures when the suction / perfusion probe 108 and the laparoscope or robotic camera are oriented from similar positions or angles within the surgical field. In such cases, the degrees of freedom of movement at the probe tip may allow the surgeon to clean a contaminated camera lens by directing the perfusion towards the camera.

[0057] Figure 1B is a block diagram illustrating the components of a flexible suction and perfusion system 150 according to several embodiments of the present disclosure. In various examples, the system 150 may be used to perform suction, perfusion, and / or smoke removal (e.g., during cauterization) to improve visibility.

[0058] In this example, the flexible distal suction / irrigation probe 10 comprises a flexible tube 12 that can be inserted into the surgical field and a graspable tip 14. The tube 12 may have at least one, two, or three lumens and may be configured to be inserted through a trocar and / or surgical port for use in minimally invasive or robot-assisted surgery. In one simple example, the graspable tip 14 may include a hollow, rigid cylindrical attachment to the tube with a suction release hole, allowing the surgeon to grasp the tip 14 with a surgical tool 16 and easily manipulate the flexible probe. The surgical tool 16 may include a tool integrated into a robotic arm (e.g., a gripper 104 and / or robotic arm 102 in the example in Figure 1A). The flexible distal probe 10 may include a flexible tube 12, as well as a porous, low-profile, rigid, semi-rigid, or flexible tip 14 which may be made of any biocompatible material, including but not limited to polyvinyl chloride (PVC), polytetrafluoroethylene (PTFE), polyurethane, another plastic, polycarbonate, polyetheretherketone (PEEK), polyamide, nylon, silicone, and / or polyetherblock amide (PEBAX). The tip 14 may include wings to make the tip easier to grasp, as shown. In various examples, the tube 12 may be made of PVC, silicone, or a C-flex type tube, and / or any other tube having the desired biocompatibility, flexibility, and resistance to leakage or rupture even after numerous bending cycles.

[0059] In addition, the suction and perfusion system 150 may include a valve unit 18 controlled by wired, wireless, or mechanical means. In one example, the user may control the valve unit 18 using a foot pedal 22. User input via the valve unit 18 allows the valve unit 18 to access a supply of sterile saline or other perfusion fluid 24 and to actuate two valves 26 and 28 independently. The first valve 26 can control the flow of perfusion fluid from the supply source 24, while the second valve 28 can control a line 30 extending from a vacuum source such as a vacuum pump or vacuum line. As shown in Figure 1C, the system 18 may also be equipped with an internal or external power supply 51 to power an air pump 31, which inflates an inflation sleeve 25 to pressurize actuators for the perfusion fluid supply source 24 and valves 52. A busbar or terminal block 27 (see Figure 1C) can receive power from the power supply and distribute the power to various components of the valve unit 18. The system may be actuated by a switch 53.

[0060] The valve unit 18 can be positioned outside the surgical field and inside or outside the sterile field. For example, the valve unit can be spaced away from the surgical field so that it does not need to be sterile. For example, it can be placed on a table in the same room or isolated in a separate room. The valve unit 18 may include valves 26 and 28 that can be switched on / off or allow for variable flow. The valves may be solenoid pinch valves that can be used to turn the suction and perfusion functions on and off. Those skilled in the art will understand that other valves or switches, such as mechanical solenoid valves, may be used. A power switch and a printed circuit board may be provided to allow the user to turn on the valve unit 18 and switch between run mode and setup mode. The pinch valve can be controlled via a variety of mechanisms including (but not limited to) a foot pedal 22, an additional button in the robot console finger control, a button at and / or on the distal probe tip 12 (which may include wiring back to the control unit along a flexible tube), voice activation, or any other form of activation signal communication.

[0061] In addition, the valve unit perfusion fluid supply source 24 may include a pump mechanism (e.g., an air pump) that enables "electric" perfusion and / or gravity perfusion in the event of a power outage. Alternatively, such a pump may be housed in a unit separate from the unit that enables the operation of the suction and / or perfusion capacity.

[0062] As illustrated in the example in Figure 1A, the flexible tube 12 can offer several advantages compared to a non-flexible suction / irrigation probe, such as increased range of motion and improved range of movement in the surgical field. The flexible probe can be easily moved around the surgical field using a gripper operated by a human or robot. Such improved range can allow the surgeon to access the surgical target in a specific area of ​​the surgical field without requiring additional incisions or ports, thereby improving the overall safety of the surgery and reducing complexity. For example, in single-port surgery, the flexible suction / irrigation probe can facilitate improved angle adjustment and maneuverability within a narrow surgical field.

[0063] Nevertheless, rigid suction / irrigation tubes have at least three advantages. First, rigid tubes can facilitate the precise delivery of the suction / irrigation tip (e.g., tip 14) to the surgical site. Second, rigid tubes can facilitate the traction (i.e., folding) of tissue or surgical devices to access the surgical site beneath the tractioned tissue or behind the surgical device, as illustrated in the example of Figure 2. Third, the probe can be precisely controlled by hand outside the surgical field. Therefore, alternatively, there is a need for a suction and irrigation surgical system that can be made flexible or rigid at the time, depending on the needs of the surgeon and / or assistant surgeon. The systems and methods of this disclosure can address this need.

[0064] The following tests can be performed to evaluate the stiffness of conduits, rods, or other components.

[0065] Test 1: The sample of the material to be tested is fixed at one end and extends horizontally over a distance of 25 mm. A vertical force is applied downward at a point 19 mm from the anchor point. The force (Gf) required to deflect the sample vertically by 12 mm is recorded. The grades are shown in Table 1 below. [Table 1] Rigidity grade Force (grams of force) A >500 B 200-500 C 100-200 D <100 Table 1

[0066] The relative flexibility of two components can also be evaluated using the same test. For example, under Test 1, if the force required to deflect the sample by 12 mm is twice that required for component X compared to component Y, then component X is twice as stiff (or half as flexible) as component Y. If the force required to deflect component X by a distance of 12 mm is 50% greater than the force required to deflect component Y by the same 12 mm, then component X is 50% stiffer than component Y.

[0067] In various embodiments, the rigid components may have a rigidity rating 25%, 50%, 100%, or 500% higher than the rigidity rating of the flexible components of the apparatus. In a specific embodiment, the flexible conduit may have a rigidity rating of D or C. In other embodiments, the rigid components, such as rods or rigid conduits, may have a rigidity rating of A or B.

[0068] In some embodiments, a rigid conduit or rod can be reversibly bent. A reversibly bendable material can be bent into a different shape and then returned to its original (or near-original) shape without damage. A conduit or rod can be reversibly bent if a 10 cm length can be bent by hand by 90 degrees and can retain its shape when suspended in a horizontal plane by one end of the 10 cm length. It can then be bent into a rigid second shape or returned to its rigid original shape. An example of a reversibly bendable rod is one consisting of a malleable metal core with a polymer coating. The polymer coating can be flexible, but the malleable metal core retains its shape when bent by hand. Thus, a coated rod is a reversibly bendable material. A conduit can be reversibly bent if its curvature is defined by the curvature of a reversibly bendable rod or a second conduit attached to the conduit.

[0069] Figure 2 illustrates exemplary use 200 of a flexible suction and perfusion device for pulling tissue 202 during surgery, according to several embodiments of the present disclosure. In this example, the surgical target 204 is located behind tissue 202 and between tissue 202 and tissue 206. Thus, as shown, the suction / perfusion probe tip 14 is used to pull or pull back tissue 202, thereby making the target 204 accessible. As a result, the laparoscopy camera or robotic camera and / or surgeon can better visualize the target 204. Furthermore, surgical instruments 106 (e.g., scissors) can reach the target 204 (e.g., to cut or remove the target 204). Note that while being used to pull tissue, the probe 10 may simultaneously operate to suction and / or perfuse fluid.

[0070] When the suction / perfusion tube 12 is flexible, the probe 10 is manipulated by a gripper such as the gripper 104 and robotic arm 102 in the example of Figure 1A, and / or the surgical tool 16 in the example of Figure 1B. In particular, flexible tubes may be difficult to guide or manipulate manually by a surgical assistant at the patient's bedside. Furthermore, due to their flexibility, the tube may not provide the leverage that would allow the probe tip to be manually manipulated correctly and precisely. Therefore, as illustrated in Figure 1A, the surgeon(s) may manipulate the flexible suction / perfusion system by grasping the probe 10 directly with a gripper or via a robotic arm, for example, to perform tissue traction 200.

[0071] In some cases, the flexibility of the suction / perfusion tube 12 can cause difficulties in pulling large tissues or positioning the suction / perfusion probe, especially if the surgeon wants an assistant surgeon or bedside assistant to perform these activities. For example, if the surgeon (e.g., a surgeon performing robotic surgery using a console) does not want to perform tissue traction 200, the assistant surgeon or bedside assistant must grasp the flexible probe 10 at its proximal end as it exits the surgical port. Due to the length of the flexible tube 12, which is typically 30 cm to 60 cm, a bedside surgical assistant may not be able to properly and accurately control the tip of the suction / perfusion probe 14.

[0072] For example, consider a situation where significant bleeding occurs during a surgical procedure while using a suction / perfusion system. In such a case, the surgeon may not want to continue performing suction by maneuvering the suction / perfusion probe. Instead, the surgeon may want a second party to assist in performing suction so that the surgeon can more fully concentrate their attention on controlling the bleeding. However, an assistant surgeon or bedside assistant may not be able to properly or accurately control a flexible suction / perfusion probe, as outlined above.

[0073] In contrast, if the tube can be made rigid upon request (e.g., by inserting a rod or by other means disclosed below), the assistant surgeon can manage the positioning of the suction / perfusion probe and / or use it to manually pull tissue, etc., without first fixing the tip 14 with a gripper. In another example, if the surgeon (e.g., a surgeon performing robotic surgery via a console) does not wish to manipulate the suction / perfusion probe to pull tissue, converting the suction / perfusion probe to have a rigid tube allows the assistant surgeon or bedside assistant to control the suction / perfusion probe 10, the maneuvering probe 10, and use them to pull tissue 202.

[0074] Therefore, there is a need for a suction and irrigation surgical system that can be made flexible or rigid at the time, depending on the needs of the surgeon and / or assistant surgeon. In particular, there is a need for a suction and irrigation surgical system that can be made flexible or rigid while inserted into the patient, without being removed, in the surgical field. The systems and methods disclosed in the embodiments of Figures 3-6 and 7A-7B below can address these needs.

[0075] Figure 3 illustrates a perspective view of a flexible suction and perfusion surgical system 300 having a removable rod, according to several embodiments of the present disclosure. The flexible suction and perfusion surgical system 300 may include two adjacent flexible conduits or tubes 302 and 304. In some cases, the suction and perfusion surgical system 300 may be referred to as a “spine” configuration or structure.

[0076] The tube 304 can be used for suction and / or perfusion during surgery, as described in the examples in Figures 1A-1B above and in International Patent Application No. PCT / US2012 / 037516. Similar to the example in Figure 1B, the conduit 304 can be constructed from any other tubing such as PVC, silicone, C-flex type tubing, and / or flexible tubing, and may have at least one lumen. The conduit 304 can also be fluid-connected at its distal end to a suction / perfusion tip 308 (e.g., tip 14 in the example in Figure 1B), at its proximal end to a vacuum source, e.g., a vacuum pump or vacuum line, and / or a perfusion fluid supply source (e.g., fluid supply source 24 in the example in Figure 1B), or to both a perfusion source and a vacuum line. The tip can be permanently rigid, while the conduit portion can alternate between rigid and flexible.

[0077] Tube 302 may be substantially coaxial with tube 304 and through which a rod 306 can be passed for the purpose of rigidifying the flexible suction and perfusion surgical system 300. Tube 302 may be referred to as a rigidity control tube. Tube 304 may be referred to as a fluid flow tube. Rod 306 may be reversibly bendable. Rod 306 may have an elastic modulus corresponding to a rigid material; for example, rod 306 may have an elastic modulus of at least 1 megapascal (MPa), at least 10 MPa, at least 100 MPa, at least 1 gigapascal (GPa), at least 10 GPa, or at least 100 GPa. Alternatively or additionally, rod 306 may have a bending rigidity such as at least 100 Newtons per centimeter. For example, rod 306 may include steel, stainless steel, aluminum, another metal, a metal alloy, glass, or a polymer. In some cases, rod 306 may also be referred to as a “spine”. The rod can be cylindrical and may have a diameter in the range of, for example, 1–5 mm, 0.5–3 mm, or 1–3 mm. The rod can be solid or hollow and may include grooves or other concave features along its outer surface to provide passages that allow air to pass through when the rod is inserted into or removed from the closed tube 302. Alternatively, the outer surface of the rod 306 may have a different profile from the inner surface of the tube 302, allowing air to enter and exit the tube 302 when the rod 306 extends into the lumen of the tube 302 or is pulled out of the lumen.

[0078] When the rod 306 is inserted into the tube 302, the suction and perfusion surgical system 300 as a whole can be made rigid or inflexible. For example, since tubes 302 and 304 can be attached together or joined, the presence of the rod 306 in tube 302 can also, in effect, make tube 304 and / or the system 300 as a whole inflexible. It should be noted that in some embodiments, the physical properties of the fluid flow tube 304 do not change, but rather the fluid flow tube 304 is constrained to a rigid position due to its mechanical attachment to the rigidity control tube 302. Thus, when made inflexible by the insertion of the rod 306, the probe 308 of the suction and perfusion surgical system 300 can be more easily delivered for use at the surgical site or used to more easily pull tissue, as in the example of Figure 2. The insertion of the rod also provides a wider solid contact area that the surgeon can pull. The operator can more efficiently transmit lateral forces to the probe 308 due to the improved rigidity of the previously flexible tube 304. Conversely, when the rod 306 is removed from the tube 302, the suction and irrigation surgical system 300 can return to its flexible state, thereby providing, for example, an increased range of motion and / or improved range of movement in the surgical field. The probe can convert from flexible to rigid and return to flexible again, once, twice, three or more times, during a single surgical procedure. It should be noted that the rod 306 can be partially inserted at an intermediate position along the length of the conduit 302. In this way, the distal portion can provide rigidity to a portion of the probe while retaining some flexibility along, for example, 1 cm, 2 cm, or 5 cm of the distal portion measured from the distal end. The rod 306 can be moved axially by hand or mechanically.

[0079] Tubes 302 and 304 may each have a lumen, and tube 302 may have an inner diameter greater than or equal to the outer diameter of rod 306. In some examples, tube 302 may be sealed at its distal end with a seal 310 to prevent fluid from the surgical field from entering tube 302. The seal 310 may be molded as part of tube 302 or added later. In addition, the seal 310 may include a gripping tab 312 that gives the surgeon another point for grasping and maneuvering the device. In other embodiments, the gripping tab may be attached to tube 302 at another location on the tube. Tube 302 is not used for suction or irrigation and therefore does not need to be connected to a suction / irrigation tip, and therefore its distal end can be sealed to isolate rod 306 from the surgical site. In particular, conduit 304 may be in fluid communication with suction / irrigation tip 308, while conduit 302 may not be in fluid communication. Similarly, since conduit 302 does not need to extend to the suction / perfusion tip 308 or valve unit 18, conduit 302 may be shorter than conduit 304. For example, conduit 302 may be several centimeters shorter than conduit 304 and / or approximately the same length as rod 306. Alternatively, conduit 302 may be the same length as conduit 304 and is not limited by this disclosure. The proximal end of tube 304 can be attached to a vacuum source, e.g., a vacuum pump or vacuum line, and / or a perfusion fluid supply source 24, whereas the proximal end of tube 302 only needs to be open and accessible for insertion or removal of rod 306. Tube 302 does not need to be in fluid communication with the surgical site, suction / perfusion tip 308, vacuum source, or perfusion source.

[0080] In some cases, the rod 306 can be a reversibly bendable rod or tube made of aluminum coated with, for example, PTFE. In some cases, inserting a reversibly bendable rod into the conduit 302 provides rigidity while still allowing the suction and perfusion surgical system 300 to be bent to a preferred position, enabling work behind otherwise inaccessible tissue. By using a malleable material, the tube 304 can be made rigid and maneuverable while still imparting a specific shape or curve to the tube 304. The rod 306 can be withdrawn from the tube 302, its shape can be manually altered, and then it can be reinserted into the tube 302 without withdrawing the suction / perfusion tip 308 from the surgical site. Alternatively, the rod 306 can be shaped while inserted into the rigidity-controlled tube 302.

[0081] Tubes 302 and 304 can be two separate tubes joined together, or they can be formed as a single unit. For example, tubes 302 and 304 can be joined by solvent bonding or co-extruded. In one embodiment, at least a portion of tube 304 can be solvent-bonded (e.g., using PVC cement) or co-extruded with at least a portion of tube 302. For example, tubes 302 and 304 can be co-extruded using two extruders placed side by side, so that tubes 302 and 304 come into contact before water flows through the extruders, thereby joining the tubes together. Alternatively, or additionally, tubes 302 and 304 can be joined by clips, clamps, a flexible outer tube surrounding and containing both tubes 302 and 304, or other mechanical or physical means.

[0082] In some examples, the tube 302 is configured to allow the rod to pass through and / or to remove the rod while the suction / irrigation tip 308 is inserted into the patient. While the rod is being inserted or removed, the surgeon or assistant surgeon may be able to monitor the tube via a camera. For example, the surgeon or assistant surgeon may monitor the tube via a camera to prevent excessive lateral movement of the tube while the rod is being inserted. To assist in monitoring the rod 306, the tube 302 may be made of a transparent or translucent material.

[0083] It should be noted that in some cases, a separate conduit 302 holds the rod 306 outside the pathway of blood or other fluids passing through the flexible conduit 304, thereby preventing blood clotting or coagulation. For similar reasons, the conduit 302 may be sealed at its distal end to prevent the ingress of blood or other fluids and to prevent air from being expelled into the surgical field. In addition, the use of a separate conduit 302 allows for the insertion or removal of the rod 306 from the open proximal end of the conduit 302, in contrast to the proximal end of the conduit 304, which can be attached to a vacuum source and / or a perfusion fluid supply pump. The proximal end of the conduit 302 may be outside the patient for access by the surgeon or assistant and therefore less susceptible to the ingress of blood or other body fluids or surgical fluids.

[0084] In many cases, surgery may be performed under pressure, and surgical ports may be sealed by seals or valves. For example, a surgeon may inflate a patient's abdomen with gas to enlarge the surgical field and provide additional space for working. Thus, in some examples, an additional conduit 302 may be inserted into the same surgical port as the primary fluid flow conduit 304 via the use of an air seal. For example, an air seal may include a small hole or slot and utilize a high-speed gas flow across the opening to keep the port sealed. Such an air seal can allow the use of multiple irregularly shaped and / or irregularly sized surgical instruments (such as conduits 302 and 304) while maintaining a seal (e.g., pressure and / or concentration difference) across the surgical port. Alternatively, or additionally, the surgical port may utilize a “duckbill” style valve, which may include a triangular-shaped piece of plastic or another material that can be opened to allow an instrument (e.g., conduits 302 and 304) to pass through and then closed to wrap around and seal the instrument.

[0085] Figure 4 illustrates a perspective view of a suction and perfusion surgical system 400 having two coaxial conduits, including a flexible outer conduit 402 and a rigid inner conduit 406, according to some embodiments of the present disclosure. In some cases, the suction and perfusion surgical system 400 may be referred to as an “endoskeleton” configuration or structure.

[0086] In this example, the suction and perfusion surgical system 400 includes a flexible outer conduit 402 that can be used for suction and / or perfusion during surgery, as shown in the examples in Figures 1A-1B above. The outer conduit 402 can be any other conduit, such as PVC, silicone, C-flex type tubing, and / or flexible tubing, and may have at least one lumen. The outer conduit 402 may be connected at its distal end to a suction / perfusion tip 404 (e.g., tip 14 in the example in Figure 1B) and at its proximal end to a vacuum source, such as a vacuum pump or vacuum line, and / or a perfusion fluid supply source (e.g., supply source 24 in the example in Figure 1B).

[0087] The suction and perfusion surgical system 400 also includes a rigid inner conduit 406, which can be coaxial with the outer conduit 402 and have a smaller diameter to fit inside the outer conduit 402. The rigid inner conduit 406 may include steel, stainless steel, aluminum, another metal, glass, polymer, or another rigid material. The rigid inner conduit 406 may have an elastic modulus of at least 1 MPa, at least 10 MPa, at least 100 MPa, at least 1 GPa, at least 10 GPa, or at least 100 GPa, and / or a bending rigidity of at least 100 Newtons per centimeter. In some examples, the main function of the rigid inner conduit 406 may be to provide the suction and perfusion surgical system 400 with a rigid structure, i.e., to make the suction and perfusion surgical system 400 rigid when inserted. As shown in the examples in Figures 2-3 above, making the suction and irrigation surgical system 400 rigid (for example, by inserting an internal conduit 406) can facilitate the delivery of the probe tip to the surgical site and facilitate the traction of tissue. In some examples, the rigid internal conduit 406 may be referred to as an "endoskeleton."

[0088] The rigid internal conduit 406 can also be detachable from the suction and irrigation surgical system 400. Thus, similar to the suction and irrigation system 300 in the example of Figure 3 above, the suction and irrigation surgical system 400 can offer the advantages of a rigid suction and irrigation probe when the internal conduit 406 is inserted (such as facilitating probe delivery, tissue traction, and manual manipulation by a bedside assistant), and the advantages of a flexible suction and irrigation probe when the internal conduit 406 is removed (such as improved range of motion and range of movement, and improved angle adjustment and maneuverability within the surgical field).

[0089] In some cases, the suction and perfusion surgical system 400 must be removed from the patient in order to insert and / or remove the inner conduit 406. For example, since the proximal end of the flexible outer conduit 402 may be connected to a vacuum source and / or pump, the suction / perfusion probe can be removed from the patient, thereby allowing the inner conduit 406 to be inserted into or removed from the outer conduit 402 via the distal suction / perfusion tip. The suction / perfusion probe can then be reinserted into the patient.

[0090] In various embodiments, the conduit 406 may be shorter and may not extend far into the conduit 402. This allows for some degree of flexibility at the distal end of the probe. In some examples, the inner conduit 406 may be fitted, stabilized, or “locked” in place within the outer conduit 402 to prevent the inner conduit 406 from sliding outward. For example, the inner conduit 406 may be fitted or “locked” in place by a tab, groove, magnet, buckle, or harness, or by another mechanism.

[0091] Figure 5A illustrates a perspective view of a suction and perfusion surgical system having two coaxial conduits, including a flexible inner conduit 502 and a rigid outer conduit 506, according to some embodiments of the present disclosure. In some cases, the suction and perfusion surgical system 500 may be referred to as an “exoskeleton” configuration or structure.

[0092] In this example, the suction and perfusion surgical system 500 includes a flexible inner conduit 502 that can be used for suction and / or perfusion during surgery, as described above in the examples in Figures 1A and 1B. As in the example in Figure 1B, the inner conduit 502 can be any other conduit such as PVC, silicone, C-flex type tubing, and / or flexible tubing, and may have at least one lumen. The inner conduit 502 can be connected at its distal end to a suction / perfusion tip 504 (e.g., tip 14 in the example in Figure 1B) and at its proximal end to a vacuum source, e.g., a vacuum pump or vacuum line, and / or a perfusion fluid supply pump (e.g., pump 31 in the example in Figure 1B).

[0093] The suction and perfusion surgical system 500 also includes a rigid outer conduit 506, which can be coaxial with the inner conduit 502 and has a larger diameter so that the flexible inner conduit 502 can be fitted inside the rigid outer conduit 506. In various examples, the outer conduit 506 can be malleable or rigid. The outer conduit 506 may include steel, stainless steel, aluminum, another metal, glass, polymer, or another malleable or rigid material. In some examples, the outer conduit 506 may have a coating such as Teflon. In the case of a rigid outer conduit 506, the material may have an elastic modulus of at least 1 MPa, at least 10 MPa, at least 100 MPa, at least 1 GPa, at least 10 GPa, or at least 100 GPa, and / or a bending rigidity of at least 100 Newtons per centimeter. In some examples, the rigid outer conduit 506 may be referred to as an "exoskeleton".

[0094] In some examples, the primary function of a stiffer outer conduit 506 may be to give the suction and perfusion surgical system 500 a more rigid structure, i.e., to make the suction and perfusion surgical system 500 relatively rigid overall when the inner conduit 502 is inserted into the outer conduit 506. Making the suction and perfusion surgical system 500 stiffer (for example, by sliding the inner conduit 502 axially relative to the outer conduit 506) as shown in the examples in Figures 2-3 above can facilitate the delivery of the probe tip to the surgical site and facilitate the traction of tissue.

[0095] The rigid outer conduit 506 can also be retractable and detachable from the suction and perfusion surgical system 500. Thus, similar to the suction and perfusion system 300 in the example of Figure 3 above, the suction and perfusion surgical system 500 can offer the advantages of a rigid suction and perfusion probe when the inner conduit 502 is inserted into the rigid outer conduit 506 (such as facilitating probe delivery and tissue traction), as well as the advantages of a flexible suction and perfusion probe when the inner conduit 502 is not housed in the rigid outer conduit 506 (such as improved range of motion and movement, as well as improved angle adjustment and maneuverability within the surgical field).

[0096] In some cases, the suction and perfusion surgical system 500 must be removed from the patient in order to insert and / or remove the outer conduit 506. For example, since the proximal end of the flexible inner conduit 502 may be connected to a vacuum source and / or pump, the suction / perfusion probe can be removed from the patient, thereby allowing the flexible inner conduit 502 to be inserted into or removed from the more rigid outer conduit 506 via its distal suction / perfusion tip. The suction / perfusion probe can then be reinserted into the patient.

[0097] Alternatively, in some cases, the suction / perfusion probe 500 may be inserted into the patient via a trocar through a surgical port where a stiffer outer conduit 506 is already fitted around a flexible inner conduit 502. In some cases, if the surgeon or assistant wishes to remove the stiffer outer conduit 506, they can then pull (e.g., pull back) the stiffer outer conduit 506 far away from the Y connector in the flexible conduit 502 (e.g., the split 32 in the tube 12 between branches 26 and 28 in the example in Figure 1B). Thus, in such cases, the stiffer outer conduit 506 may be manually removed far enough away from the inner conduit 502 to effectively make the suction / perfusion probe flexible and / or reinserted to effectively make the probe rigid for probe delivery or tissue traction. This can be achieved without removing the probe from the surgical site. Alternatively, the inner conduit 502 may be removable at the split 32, for example by incorporating a quick-connect / disconnect inline connector (Figure 5b, 520), allowing the conduit 506 to be removed or inserted over conduit 502 without removing conduit 502 from the surgical site. The quick-disconnect 520 can be attached and detached, the over conduit 506 can be removed, and the quick-disconnect can be reattached. This can be done without removing the tip 14 from the surgical field. Furthermore, the outer conduit 506 may include a longitudinal slit along the length or part of the length of the conduit. The longitudinal slit, or incision, may allow the rigid conduit to be pried open, allowing it to be removed laterally on the flexible conduit 504 without having to slide it off the end of the tube 504.

[0098] As described above in the example in Figure 3, an additional outer conduit 506 may be inserted into the same surgical port typically used only in the primary fluid flow inner conduit 502, via the use of an air seal and / or a "duckbill" style valve. Such an air seal and / or "duckbill" valve can allow the use of multiple irregularly shaped and / or irregularly sized surgical instruments (such as the additional outer conduit 506) while maintaining a seal (e.g., pressure and / or concentration difference) across the surgical port.

[0099] Any of the embodiments described above may include an intermediate position where only a portion of the conduit near the probe is flexible, and the proximal portion of the conduit to the probe is rigid. For example, instead of full insertion, the rod can be withdrawn 1 cm, 2 cm, or 3 cm to provide some flexibility to the conduit and the distal portion of the probe while maintaining rigidity throughout the rest of the conduit at the surgical site. The amount of insertion or traction can be assisted by using a mark on the rod (or endoskeleton or exoskeleton) that can be aligned with a mark on the perfusion / suction tube, thereby indicating how far the end of the rod is from the tip of the probe.

[0100] Figure 6 is a flow chart of process 600 for using a suction and perfusion surgical system according to some embodiments of the present disclosure. Process 600 may be carried out using a suction and / or perfusion system such as the suction and perfusion surgical system 300 in the example of Figure 3 above.

[0101] In some examples, process 600 may begin with inserting a rod into a second conduit of two substantially coaxially aligned conduits (602). For example, the two conduits may have lumens and may be joined by solvent bonding or co-extrusion, as shown in the example in Figure 3. The first conduit may be connected to a suction / perfusion tip at its distal end and a vacuum source and / or perfusion fluid source at its proximal end. The second conduit may be attached to the first conduit. The second conduit may be configured to allow the rod to pass through and to have an inner diameter greater than or equal to the outer diameter of the rod. The second conduit may be sealed at its distal end and open at its proximal end and may be shorter than the first conduit. The second conduit may be configured to allow the rod to pass through while the second conduit is inserted into the patient. In some examples, the suction / perfusion tip may be used to access the surgical site and / or to pull tissue after the rod has been inserted (602).

[0102] Alternatively, process 600 may begin with removing the rod from a second conduit of two conduits substantially aligned coaxially (604). The second conduit may be configured such that the rod is removed while the second conduit remains inserted in the patient. In some examples, a suction / irrigation tip may be used to access the surgical site and / or to pull tissue before the rod is removed (604).

[0103] Next, process 600 may continue to perform suction or perfusion (606) using the first conduit of two conduits that are substantially aligned coaxially. Any step of the process can be repeated any number of times.

[0104] Next, process 600 may terminate.

[0105] Figure 7A is a flowchart of process 700 for using a suction and perfusion surgical system for pulling tissue, according to some embodiments of the present disclosure. Process 700 may be carried out using a suction and / or perfusion system such as the suction and perfusion surgical system 300 in the example of Figure 3 above, the suction and perfusion surgical system 400 in the example of Figure 4 above, and / or the suction and perfusion surgical system 500 in the example of Figure 5 above.

[0106] Process 700 may optionally begin with inserting a flexible suction / perfusion probe into the patient's surgical port (702).

[0107] Next, process 700 may optionally continue by accessing the surgical site using a flexible suction / perfusion probe (704).

[0108] Next, process 700 may continue with performing suction or perfusion using a flexible suction / perfusion probe (706). In some cases, the flexible tube of the suction / perfusion probe can provide advantages such as an increased range of motion and improved range of movement in the surgical field.

[0109] Next, process 700 may continue to stiffen the suction / perfusion probe (708) while maintaining the positioning of the suction / perfusion probe at the surgical site. For example, stiffening the suction / perfusion probe (708) may include inserting the rod into one of two substantially coaxially aligned conduits. Alternatively or additionally, stiffening the suction / perfusion probe (708) may include inserting one of two coaxial conduits, e.g., an inner conduit or an outer conduit. A quick-disconnect connector may allow the user to remove or add the rod without removing the probe from the surgical site.

[0110] Next, process 700 may involve maneuvering the rigidized suction / perfusion probe (710) to pull tissue at the surgical site. In some cases, a bedside assistant surgeon may manually manipulate the suction / perfusion probe from outside the surgical field. Alternatively or additionally, in some cases, tissue traction may be performed while the suction / perfusion probe remains flexible (710).

[0111] Next, process 700 may terminate.

[0112] Figure 7B is a flow chart of process 750 for using a suction and perfusion surgical system for pulling tissue, according to some embodiments of the present disclosure. Process 750 may be carried out using a suction and / or perfusion system such as the suction and perfusion surgical system 300 in the example of Figure 3 above, the suction and perfusion surgical system 400 in the example of Figure 4 above, and / or the suction and perfusion surgical system 500 in the example of Figure 5 above.

[0113] Process 750 may optionally begin with inserting a rigid or rigid suction / perfusion probe into the patient's surgical port (752).

[0114] Next, process 750 may optionally continue by accessing the surgical site using a rigid suction / irrigation probe (754).

[0115] Next, process 750 continues to maneuver the rigid suction / perfusion probe (756) to pull tissue at the surgical site.

[0116] Next, process 750 may continue making the suction / perfusion probe flexible (758) while maintaining the position of the suction / perfusion probe at the surgical site. For example, making the suction / perfusion probe flexible (758) may include removing the rod from one of two substantially coaxially aligned conduits. Alternatively or additionally, making the suction / perfusion probe flexible (758) may include removing one of two coaxial conduits, e.g., the inner conduit or the outer conduit. A quick-disconnect connector may allow the user to remove or add conduits without removing the probe from the surgical site.

[0117] Next, process 750 may continue with performing suction or perfusion using a flexible suction / perfusion probe (760). In some cases, the flexible tube of the suction / perfusion probe can provide advantages such as increased range of motion and improved range of movement in the surgical field. Alternatively or additionally, in some examples, suction or perfusion may be performed while the suction / perfusion probe remains rigid (760).

[0118] Next, process 750 may terminate.

[0119] The foregoing description is provided for illustrative and explanatory purposes only. It is not intended to be exhaustive or to limit the invention to the exact form disclosed. The dimensions provided are illustrative, and various alternatives are conceivable. Many modifications and variations are possible in light of this disclosure. The scope of the invention is not intended to be limited by this detailed description but rather determined by the appended claims.

Claims

1. A surgical suction and irrigation device, Rod and, Two flexible and substantially coaxially aligned first and second conduits, wherein the second conduit of the two substantially coaxially aligned conduits is sealed at its distal end and has an inner diameter configured to receive the rod, The first conduit comprises two flexible and substantially coaxially aligned first and second conduits, which are in fluid communication with a vacuum source and a perfusion source. A surgical suction and irrigation device equipped with [a specific feature].

2. The surgical suction and perfusion device according to claim 1, wherein the rod has at least twice the rigidity of the coaxially aligned conduits when tested using test 1.

3. The surgical suction and irrigation device according to claim 2, wherein the rod comprises a metal, a metal alloy, glass, or a polymer.

4. The surgical suction and irrigation device according to claim 1, wherein at least a first portion of the first conduit of the two substantially coaxially aligned conduits is joined to at least a second portion of the second conduit, or co-extruded to at least a second portion of the second conduit.

5. The surgical suction and irrigation device according to any of the prior claims, wherein, by test 1, the rod has a rigidity grade of A or B, and the coaxially aligned conduits have a rigidity grade of C or D.

6. The surgical suction and irrigation device according to claim 1, wherein the second conduit is configured to allow the rod to pass through without being removed from the patient while it is surgically inserted into the patient.

7. The surgical suction and irrigation device according to claim 1, wherein the second conduit is shorter and narrower than the first conduit.

8. The surgical suction and irrigation device according to claim 1, wherein the surgical suction and irrigation device is configured to be used for pulling the patient's tissue while the rod is inserted into the second conduit.

9. The surgical suction and irrigation device according to any of the prior claims, wherein the first conduit is configured to perform suction and irrigation during surgery.

10. The surgical suction and perfusion device according to claim 1, wherein the rod includes an air passage selected from at least one of a lumen through the rod and a concave feature on the outer surface of the rod.

11. The surgical suction and perfusion device according to claim 1, wherein the first conduit is in fluid communication with the suction / perfusion tip, and the second conduit is not in fluid communication with the suction / perfusion tip.

12. The surgical suction and irrigation device according to any of the prior claims, wherein the distal portions of the coaxially aligned conduits are reversibly bendable.

13. The surgical suction and irrigation device according to claim 1, wherein the first and second conduits do not share a common axis.

14. The surgical suction and irrigation device according to claim 1 or 2, wherein the second conduit includes a gripping tab.

15. A method of using a surgical suction and irrigation device comprising a rod and a probe having two substantially coaxially aligned flexible conduits, The insertion of the probe into the surgical field, wherein the probe exhibits a first rigidity, Insert the rod into one of the flexible conduits to increase the rigidity of the probe by at least 50%, Methods that include...

16. While the rod is inserted into the second conduit, the suction and / or perfusion is performed using the first conduit, The rod is removed from the second conduit, and while the rod is not inserted into the second conduit, suction and / or perfusion is performed using the first conduit. A method of using the surgical suction and irrigation device according to claim 15, further comprising:

17. A method of using the surgical suction and irrigation device according to claim 16, wherein the insertion and removal of the rod are performed while the surgical suction and irrigation device is surgically inserted into the surgical field during surgery.

18. The method according to any one of claims 15 to 17, wherein the rod has a rigidity grade of A or B, and the two coaxially aligned flexible conduits have a rigidity grade of C or D.

19. A method of using the surgical suction and irrigation device according to claim 15, wherein at least a first portion of the first conduit is joined to at least a second portion of the second conduit, or co-extruded to at least a second portion of the second conduit.

20. A method of using the surgical suction and irrigation device according to claim 15, wherein inserting the rod into the second conduit makes the second conduit rigid.

21. A method of using a surgical suction and irrigation device according to claim 15, further comprising using the surgical suction and irrigation device to pull on the patient's tissue while the rod is inserted into the second conduit.

22. A method using the surgical suction and irrigation device according to claim 16, comprising enabling air to be discharged from the second conduit when the rod is inserted into the second conduit.

23. A method of using the surgical suction and irrigation device according to claim 16, wherein when the rod is not inserted, the tip of the rigid probe at the distal end of the first conduit is controlled by grasping the tip of the rigid probe with a gripper in the surgical field, and when the rod is inserted, the tip of the rigid probe is controlled by controlling the movement of the rod and the rigid tip to the outside from the surgical field.

24. The method according to claim 23, wherein the device is operated by a robot when the rod is not inserted.

25. The method according to claim 23, wherein the device is operated by a human when the rod is inserted.

26. A method of using a surgical suction and irrigation device comprising a first conduit and a coaxially rigid second conduit, Inserting the aforementioned surgical suction and irrigation device into the surgical field, By sliding the second conduit axially toward the distal end of the first conduit, the rigidity of the first conduit is increased by at least 100%. By sliding the second conduit away from the distal end of the first conduit, the rigidity of the first conduit is reduced by at least 50%. Methods that include...

27. The method according to claim 26, wherein the rigid second conduit is located outside the first conduit.

28. The method according to claim 26, wherein the rigid second conduit is located inside the first conduit.

29. The method according to claim 26, further comprising maneuvering the tip at the distal end of the device by grasping a portion of the rigid second conduit located outside the surgical field.

30. The method according to claim 26, comprising manipulating the tip with the distal end of the device by grasping the tip inside the surgical field.

31. The method according to any one of claims 26 to 29, wherein the second conduit has a rigidity grade of A or B.

32. The method according to any one of claims 26 to 31, wherein the first conduit has a rigidity grade of C or D.

33. A surgical suction and irrigation device, Rigid conduit and, A flexible conduit is aligned coaxially with a rigid conduit and is slidable axially relative to the rigid conduit, Equipped with, The flexible conduit is in fluid communication with the vacuum source and the perfusion source. Surgical suction and irrigation device.

34. The surgical suction and irrigation device according to claim 33, wherein the rigid conduit is at least twice as rigid as the flexible conduit when tested using Test 1.

35. The surgical suction and perfusion device according to claim 33, wherein the rigid conduit comprises a metal, a metal alloy, glass, or a polymer.

36. The surgical suction and irrigation device according to claim 33, wherein the rigid conduit is located outside the flexible conduit.

37. The surgical suction and irrigation device according to claim 33, wherein, according to Test 1, the rigid conduit has a rigidity grade of A or B, and the flexible conduit has a rigidity grade of C or D.

38. The surgical suction and irrigation device according to claim 33, wherein the rigid conduit is configured to slide against the flexible conduit while the device is surgically inserted into the patient and without being removed from the patient.

39. The surgical suction and irrigation device according to claim 33, wherein the rigid conduit is shorter than the flexible conduit.

40. The surgical suction and irrigation device according to claim 33, wherein the rigid conduit is configured to be used for pulling patient tissue while the rigid conduit extends toward the distal end of the flexible conduit.

41. The surgical suction and perfusion device according to claim 33, wherein the flexible conduit is in fluid communication with a perfusion fluid source and a suction source.

42. The surgical suction and perfusion apparatus according to claim 41, wherein the rigid conduit is not in fluid communication with the perfusion source and the suction source.

43. A surgical suction and irrigation device according to any one of claims 33 to 42, comprising a rigid tip attached to the distal end of the flexible conduit.

44. The surgical suction and irrigation device according to any one of claims 33 to 43, wherein the rigid conduit is reversibly bendable.

45. The surgical suction and irrigation device according to any one of claims 33 to 44, wherein the rigid conduit is located inside the flexible conduit.

46. The surgical suction and irrigation device according to claim 33, wherein the outer surfaces of the two conduits include gripping tabs.

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