Surgical treatment

Details Surgical treatment Surgical treatment

1997-03-13

1998-12-01

Buiz, Michael

Surgery

Means for introducing or removing material from body for...

Treating material introduced into or removed from body...

606185, A61M 5178

Patent

active

058430393

DESCRIPTION:

BRIEF SUMMARY
BACKGROUND OF THE INVENTION

The invention concerns a surgical instrument whose distal end region is to be introduced or inserted by a puncture into a cavity of a patient's body, the surgical instrument having an outer trocar sleeve and a trocar mandrel which can be inserted in the latter and is guided in a sliding manner, whereby, when slid into an end position, the distal tip of the trocar mandrel projects beyond the end region of the trocar sleeve, which end region is inclined relative to the longitudinal axis of the sleeve.
Surgical instruments of the type mentioned at the outset are used in minimum invasive surgery for diagnosis and surgery on the living body of a patient.
Thus to perform an intraabdominal operation, first an insufflation needle is passed through the patient's abdominal cavity. This hollow insufflation needle is connected by tubing to a gas source to enable the patient's abdominal cavity to be filled with gas and suitably dilated. After the abdominal cavity has been dilated, the surgical instrument is inserted by a puncture, practically blindly, into the body cavity, the trocar mandrel being inserted in the trocar sleeve and the trocar mandrel tip projecting beyond the distal end of the sleeve.
After the surgical instrument has been inserted by a puncture, the trocar mandrel can be removed from the trocar sleeve and replaced by optical observing instruments, grippers, thread holders, forceps or similar surgical instruments.
The trocar mandrel is usually cone-shaped at its trocar mandrel tip, so as to facilitate piercing through the layers of tissue. Trocar mandrels with polygonal trocar mandrel tips have also already been provided, these acting like a knife and practically opening the intractable peritoneum. However these usually three-edged trocar mandrel tips have the drawback of producing severe and large lacerations in the event of inadvertent injury.
To facilitate pushing the trocar sleeve further after the peritoneum has been pierced with the aid of the trocar mandrel, it is already known that the distal end of the trocar sleeve be arranged slantwise relative to the longitudinal axis of the sleeve. For the slanted sleeve opening of the trocar sleeve meets with less resistance by tissue, so that the trocar sleeve can slide better.
The so-called "tent" phenomenon during insertion of the trocar mandrel by a puncture is known, according to which the intractable peritoneum recedes inwardly to the pointed trocar mandrel and deflects in a "tent-like" fashion before the puncture wanted is established. In so doing, the trocar mandrel tip is liable to enter the vicinity of the abdominal organs, substantially increasing the risk of considerable injury to the patient.
Excessive penetration of the trocar mandrel inserted in the trocar sleeve into a cavity of the body can lead to mortal injuries to internal organs or blood vessels by the trocar mandrel tip.
A surgical instrument having a piercing means insertable in a trocar is already known from U.S. Pat. No. 5,224,951. This piercing means has an outer cutting sleeve in which a protective rod is guided in a sliding manner. The distal end of the outer cutting sleeve is disposed inclined relative to the longitudinal axis of the sleeve in such a way that the distal end edge of the sleeve tapers to a two-bladed puncturing tip situated to the fore as considered in the direction of puncture. As soon as the piercing means of the known surgical instrument meets the body tissue, the protective rod can move slightly into the interior of the sleeve so that the puncturing tip is cleared. The protective rod, which in practice is formed as a blunt plastic part, has at its distal end two slanted flanks which are to prevent the tissue from being cored by the keen edge of the outer cutting sleeve, as well to prevent cored pieces of tissue from entering the interior of the sleeve.
Since in the known surgical instrument according to U.S. Pat. No. 5,224,951 the cutting sleeve tapers slantwise at its distal end to a puncturing tip and is provided for a trocar wh

REFERENCES:
patent: 5224951 (1993-07-01), Freitas
patent: 5256147 (1993-10-01), Vidal et al.
patent: 5352206 (1994-10-01), Cushieri et al.

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