Surgery – Instruments
Patent
1995-05-08
1998-09-08
Buiz, Michael
Surgery
Instruments
606108, 606185, 604162, 604169, 604174, 604180, A61M 2900
Patent
active
058039210
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to surgical apparatus, including an access port for minimally invasive surgery, surgical instruments for use with such a port and a surgical drape for use in surgery using the access port and instruments of the invention.
Minimally invasive surgery is surgery carried out by causing the minimum amount of trauma by incision in a patient's body. The apparatus of the present invention enables laproscopic hand/instrument assisted surgery to be performed and should substantially increase the number and variety of surgical procedures which can be performed without requiring open surgery. Minimally invasive surgery almost invariably involves deliberately introducing gas into a patient's peritoneal cavity to cause pneumoperitoneum.
A sleeve for use in minimally invasive surgery forms the subject matter of a co-pending unpublished PCT Patent Application No. PCT/IE94/00045 entitled "Apparatus for use in surgery". The purpose of this prior art sleeve is to create a controlled pressurized environment within the sleeve while allowing a surgeon's arm to pass through the sleeve. For surgery, gas is pumped into the patient's body cavity where the surgery is to be performed and the purpose of the sleeve is to prevent gas escaping from the patient's body cavity while allowing the surgeon to operate using minimally invasive surgery techniques. The patent application proposes a sleeve having a flange at its distal end provided with adhesive for adhering the device to the patient's body or alternatively having a mounting ring at its distal end surrounding the incision in a patient's body.
However, the prior art device suffers from the disadvantage, inter alia, that in use, the sleeve protrudes upwardly from the patient and may interfere with the activities of the surgery team.
The prior art device also suffers from the disadvantage that the sleeve includes a sealing means to seal the sleeve against the surgeon's upper forearm, which sealing means the surgeon has to effect himself by clamping the device to his arm. The clamp must be quite tight to avoid gas leak around the area of the seal.
A further problem associated with the use of sleeves of the kind described in co-pending patent application no. PCT/IE94/00045, is that a phenomenon known as "tenting" may occur. "Tenting" means that when the sleeve is adhered the patient's skin or to sterilised wrapping material (also known and referred herein as "surgical drape" or "incise drape") which may in turn be adhered to the patient, the sleeve may have a tendency to pull away from the patient and "lift" the skin upwardly from the patient's abdomen which is inflated using gas for surgery. The sterilised wrapping material referred to above is also known as "surgical drape" or "incise drape". These latter terms will be used in the following description.
When surgery is being performed, the surgeon generally relies on a trocar and trocar sleeve to give access to the abdominal cavity while maintaining pneumoperitoneum. The trocar must be sharp to cut through and separate the muscle and facia surrounding the abdominal cavity. The trocar sleeve allows entry and exit of instruments therethrough while sealing the pneumoperitoneum. A valve is included at the entry of the trocar sleeve which opens to allow a surgical instrument such as a dissecting scissors, a stapling instrument, forceps and such like to pass through the valve and be moved through the trocar sleeve into the abdominal cavity where the instruments are manipulated by the surgeon. The valve closes when the instrument is withdrawn.
Clearly, the dimensions of the surgical instruments must be sized so that those instruments can fit through the trocar sleeve.
Known devices suffer from the disadvantage that when the surgeon wishes to use a different instrument which is larger than the internal diameter of the trocar, he must make an incision in the patient to gain access to the tissue or organ or remove the tissue or portion of say the bowel through the incision to work on it. Such an incision will lose
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Buiz Michael
Gaya Limited
Shai Daphna
Sixbey Daniel W.
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