Surgery – Endoscope – With guide means for body insertion
Reexamination Certificate
1998-12-29
2001-08-21
Leubecker, John P. (Department: 3739)
Surgery
Endoscope
With guide means for body insertion
C600S104000, C600S129000, C600S138000, C600S171000, C600S173000
Reexamination Certificate
active
06277064
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention pertains to an apparatus and method for endoscopic and open surgery and, more particularly, to a surgical device incorporating a rigid endoscopic instrument and methods of manipulating the endoscope.
2. Discussion of the Prior Art
Various procedures are accomplished in both open surgery and endoscopic surgery, and generally, the procedures include multiple steps and require various operating instruments. “Open surgery” refers to surgery wherein the surgeon gains access to the surgical site by a relatively large incision and “endoscopic surgery” refers to minimally invasive surgery wherein the surgeon gains access to the surgical site via one or more portals through which endoscopes are introduced to view the surgical site and through which instruments having “end effectors”, such as forceps, cutters, needle holders, cauterizers, and the like, are introduced to the surgical site.
The performance of an endoscopic procedure typically involves creation of one or more puncture sites through a wall of an anatomical cavity using a penetrating instrument including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn, leaving the sleeve in place to form a portal in the cavity wall for the introduction of instruments such an endoscopes, scissors, forceps, needle holders and the like, into the anatomical cavity.
The various end effectors at the distal end of the instrument are manipulated by the surgeon using controls disposed at the proximal end of the instrument. Of course, it is desirable to move the end effectors through various paths, depending on the step being performed. Traditionally, this was accomplished by moving the entire end of the endoscopic instrument. Recently, however, it has been proposed to provide a plurality of end effectors on a single endoscopic instrument to be passed through a single portal for minimizing the number of puncture sites and thus reducing the risk and the healing time associated with endoscopic surgery.
When a plurality of end effectors are incorporated into a single endoscopic device, it is desirable to move the end effectors individually with respect to one another without necessarily moving the entire device. Also, even in single end effector devices, it is often desirable to move the end effector through a predetermined path, such as an arc, during an operative step, without repositioning the entire endoscopic device.
Of course, it is also generally desirable to minimize the size of each puncture site. Further, in order to permit operations on a wide range of tissue sizes, it is desirable to provide a wide range of relative movement between the end effectors. The objectives, minimal number of punctures, small size punctures and wide range of relative movement, are seemingly contradictory and so conventional devices of the prior art have not achieved them.
In particular, U.S. Pat. No. 5,582,617 discloses an endoscopic instrument having an end effector movable from a position within the diameter of the barrel of the device to a position outside the diameter. However, this device must pivot about a first axis transverse to the axis of the barrel as well as a second axis coincident with the axis of the barrel and thus requires a complex movement and linkage to accomplish the disclosed functions. Accordingly, the device of the '617 patent falls short of providing an end effector for utilization over a large working span and for a wide range of applications. A surgical instrument with a rotatably mounted offset end effector, as disclosed in applicant's own U.S. patent application Ser. No. 08/847,252, discussed above, provides an important advance in permitting surgeons to perform such complex movements, over a large working span, and permitting multiple offset end effectors to be used. A problem associated with using multiple offset end effectors in a traditional endoscope having fixed point of view at the distal end of a rigid instrument is that the offset end effectors may swing into a position away from or blocking the endoscope view. This is especially troublesome in situations involving multiple end effectors used simultaneously. In such cases, the prior art endoscope provides a straight-on view from behind the end effectors and so cannot be used to directly view the entire end effector during a procedure, and so there is a need for a mechanism and method allowing visibility when using surgical instruments having rotatably mounted offset end effectors as disclosed in application Ser. No. 08/847,252.
OBJECTS AND SUMMARY OF THE INVENTION
Accordingly, it is a primary object of the present invention to overcome the above-mentioned problems and to improve surgical instruments and methods of endoscopic surgery.
It is also an object of the invention to provide an endoscopic device having a small insertion diameter and providing an oblique field of view of offset end effectors having large working spans.
Yet another object of the present invention is to minimize the number of puncture sites required for performing operative steps on anatomical tissue in an endoscopic procedure by conducting multiple procedures through a single puncture site with an instrument providing acceptable visibility to the surgeon, while moving an offset end effector through a predetermined path to operate on the anatomical tissue.
The aforesaid objects are achieved individually and in combination, and it is not intended that the present invention be construed as requiring two or more of the objects to be combined unless expressly required by the claims attached hereto.
The present invention is generally characterized in an instrument for operating on anatomical tissue including a tubular barrel, a shaft extending through the barrel and an offset endoscope mounted on the shaft. The offset endoscope viewing end is laterally offset from the longitudinal axis of the shaft by a transverse connecting member, thereby permitting the endoscope viewing end to move through an arcuate path outside the diametrical dimension of the barrel. During insertion of the surgical instrument within a portal sleeve or the like, the offset endoscope can be positioned within a diametrical dimension of the surgical instrument, either by rotating the shaft (e.g., rotating the endoscope body to angularly position the viewing end so as to lie within a circle having the outer diameter of the barrel) or by drawing the shaft and the endoscope viewing end into the barrel, in an axial manner.
The offset endoscope may be aimed to provide an oblique field of view of the procedure and may include an articulable ball joint having a solid state imaging sensor and light source; the ball joint imaging sensor aim is preferably articulable or controllable from the instrument proximal end using control members (e.g., wires) connected to handle-mounted control wheels (as disclosed in
FIG. 19
of Applicant's U.S. Pat. No. 5,437,680, the entire disclosure of which is incorporated herein by reference).
In an alternative embodiment, the offset endoscope has a fixed objective lens carried on the distal end of a rigid tubular body having a transverse connecting member. The fixed objective lens is preferably angled to aim along the transverse offset axis and generally toward the endoscopic instrument barrel central axis, to provide an oblique field of view of other surgical instruments used in other channels.
The above and still further objects, features and advantages of the present invention will become apparent upon consideration of the following detailed description of a specific embodiment thereof, particularly when taken in conjunction with the accompanying drawings, wherein like reference numerals in the various figures are utilized to designate like components.
REFERENCES:
patent: 2580964 (1952-01-01), Skaller
patent: 3918439 (1975-11-01), Zimmer
patent: 4635638 (1987-01-01), Weintraub
patent: 5222508 (1993-06-01), C
Blank Rome Comisky & McCauley LLP
Leubecker John P.
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