Surgery – Instruments
Reexamination Certificate
1999-08-10
2001-11-13
Dawson, Glenn K. (Department: 3761)
Surgery
Instruments
C604S264000, C606S205000
Reexamination Certificate
active
06315770
ABSTRACT:
BACKGROUND OF THE INVENTION
(1) Field of the Invention
The present invention pertains to an apparatus employed as an access port in minimally invasive surgery that enables the insertion of instruments or the hand through a small incision in body tissue while maintaining the insufflation pressure within a body cavity.
(2) Description of the Related Art
Minimally, invasive surgery, such as laparoscopy, despite its beneficial aspects, has some disadvantages. Surgery of this type involving the use of surgical instruments manipulated through trocars or cannula inserted through body tissue to a surgery site within a body cavity-requires a great deal of manual dexterity and hand-eye coordination of the surgeon. Many years of practice are required before the surgeon develops a comfortable level of agility in manipulating surgical instruments inserted through trocars to the surgical site while observing the movements of the instruments through a laparoscope. Until this level of familiarity with surgery techniques is developed by the surgeon, minimally invasive surgery requires significantly more of the surgeon's time than would the same operation being performed in an open incision of the body.
Additionally, the need to maintain a pneumoperitoneum or insufflation pressure within the body cavity at the surgery site while instruments are removed from and inserted through trocars during surgery increases the time required for performing an operation by minimally invasive surgery over that required for performing the same operation through an open incision in the body.
It is an object of the present invention to provide a surgical apparatus and its method of use that assist the surgeon in performing minimally invasive surgery by providing an access port through body tissue to a body cavity at the surgery site which enables insertion of surgical instruments or the surgeon's hand through the access port while maintaining the insufflation pressure or pneumoperitoneum within the body cavity.
SUMMARY OF THE INVENTION
The surgical apparatus of the present invention is basically comprised of a flexible, fluid-tight envelope having a hollow interior and first and second openings at opposite proximal and distal ends of the envelope. In the preferred embodiment, the envelope is transparent. An access port, comprised of a pair of tubular collars in one embodiment, is secured to the opening at the proximal end of the envelope. The collars have coaxial interior bores and are connected to each other for relative rotation. The collars are provided with means for securing the collars to body tissue with the interior bores of the collars adjoining an incision through the tissue.
The distal end of the envelope is provided with means for selectively closing and sealing the second opening, or for opening the second opening to enable insertion of an instrument or the surgeon's hand into the envelope interior. With an instrument or the surgeon's hand inserted through the second opening, the means for sealing the opening is then secured around the envelope distal end and the instrument or hand to prevent the escape of insufflation pressure from the body cavity through the incision and the envelope. Several means of sealing closed the second opening of the envelope are provided including a slit second opening in the resilient material of the envelope that closes the opening in its at rest condition and is opened by stretching the material of the envelope. Various types of bands including elastic cords, strips containing malleable wire, and strips of hook and loop fastener material such as Velcro® are also secured around the distal end of the envelope to close and seal the envelope second opening.
Various embodiments of the concentric collars at the envelope proximal end are also employed in sealingly securing the envelope to the body tissue adjoining the tissue incision. These embodiments include a tapered portion of one of the collars which is wedged into the tissue incision to provide the sealed connection of the envelope to the tissue. A further embodiment employs an annular rim on one of the collars which is inserted through the incision to underlie the body tissue surrounding the incision. A panel having a circular center opening is then positioned over the collar and against the exterior of the body tissue to sandwich the tissue between the collar rim and the panel and thereby provide the sealed connection of the collars to the body tissue with the collars' interior bores adjoining the tissue incision. The embodiments of the collars are constructed of flexible plastic material that enables the collars to be clamped closed by a conventional grasper or forcep, thereby sealing closed the interior bores of the collars and enabling substitution of various embodiments of the envelope on the collars. A further embodiment of the collars is provided with a removable cap that closes over the collar interior bore sealing it closed.
In additional embodiments of the access port, the access port is comprised of a closure housing having an access opening extending through the housing that provides access to the incision surrounded by the housing. A valve element is provided on the housing that is selectively opened to provide access to the incision through the housing access opening, and closed preventing access to the incision through the access opening and maintaining the insufflation pressure within the body cavity. Various embodiments of the valve element are employed in the closure housing. These embodiments include a tethered plug that seats within the access opening to seal closed the opening, a sliding gate having an inlet opening that is aligned with the access opening in one position of the gate and displaced from the access opening in a second position of the gate, a compressible, resilient annular ring that has an inlet opening that is constricted closed when the ring is compressed and resiliently opens when the compression on the ring is relieved, and an iris valve comprised of a tubular sleeve that is twisted to constrict the sleeve to its closed position blocking the access opening of the closure housing. In each of these embodiments of the closure housing, various different embodiments of the envelope are employed.
One embodiment of the envelope has a general Y-shaped configuration with three projecting arms including one proximal arm and two distal arms. The proximal arm is provided with the first opening secured to the pair of collars and the two distal arms are provided with second and third openings and means on the distal arms for closing their openings as in the previously described embodiment of the envelope.
Further embodiments of the envelope have a tubular sleeve configuration with a first end of the sleeve secured around the exterior of the access port housing. The opposite end of the envelope sleeve is provided with one or more openings for insertion of the surgeon's hand and/or a surgical instrument into the envelope. Various mechanisms are provided for securing the envelope opening around the arm of the surgeon. In a further embodiment, the envelope is formed as an inverted glove having five fingers that depend into the interior volume of the envelope. The surgeon's fingers are inserted into the fingers in order to manipulate a surgical instrument contained in the interior of the envelope. A still further embodiment of the envelope sleeve employs a suction ring that is secured to the body tissue around the access port housing.
In use of each of the embodiments of the invention, an incision is made in the body tissue and the access port is secured to the body tissue with the center bore of the access port adjoining the tissue incision. The valve element of the access port housing is closed and the second opening of the envelope is sealed closed. The body cavity at the site of the surgery to be performed is then insufflated. The sealed connection of the access port to the body adjoining the incision and the sealed closure of the envelope second opening mainta
de la Torre Roger A.
Robinson Janine C.
Scott James Stephen
Dawson Glenn K.
Fish & Richardson P.C.
General Surgical Innovations Inc.
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