Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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E:NDOSCOPIC SURGICAL INSTRUMENT
F'OR ASPIRATION AND IRRIGATION
BACKGROUND OF THE INVENTION
This application is a divisional application of
copending Canadian Application Serial No. 2,080,681 filed October
15, 1992.
1. Field of the Invention
The present invention relates to endoscopic surgical
instruments, and more particularly to endoscopic surgical
instruments for aspirating and irrigating a surgical site.
2. Discussion of the Prior Art
Surgical devices for providing irrigation fluid and
suction to a surgical site to irrigate and evacuate the tissue in
the area on which the surgical procedure is being performed are
well known in the art. Several of these devices provide a handle
member having switching means for turning on and off the flow of
the fluid stream and the suction means, and typically connect the
suction source and the fluid source to an elongated flexible
tubular member which is positioned adjacent the surgical site. In
many instances, the tube or catheter is comprised with a complex
series of passages which provide a separate channel for the
irrigation fluid and a separate channel for the suction means.
Several devices provide a pump source to provide the fluid under
pressure; however, other devices provide a source of irrigation
fluid which is operable under head pressure to gently wash the
tissue. The prior art devices typically provide a large tube or
catheter which enclose the several channels to deliver the fluid
and provide the suction during oral surgery, or invasive surgery
which allows for the positioning of the cumbersome tubing.
Several of the prior art devices provide numerous
features including electrocautery, laser dissection, and viewing
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capabilities. Typically, the handle grip includes on/off switches
in the form of trumpet valves which allow the surgeon to
selectively choose the suction or irrigation feature. Many
devices provide a pistol-type hand grip which allows the surgeon
to operate the device with the thumb-actuated valves. Other
devices provide tubular connections such as Luer-type connectors
to couple the irrigation source or the suction source to the
catheter or tube.
With the recent developments in endoscopic and
laparoscopic surgical procedures, it is necessary to provide a
device in which many of the functions provided by the more complex
and cumbersome prior art devices are included in a streamlined
construction in which many of the features are provided in a
single unit. In laparoscopic and endoscopic surgical procedures, a
small incision or puncture is made in the patient's body to
provide access for a tube or cannula device. The cannula is
inserted into the patient's body through the provision of a trocar
assembly which further includes an obturator for penetrating the
body wall. After the obturator is removed, the cannula remains in
place to maintain access to the surgical site. Once the cannula
is in place, the surgical instrument may be inserted through the
cannula to perform the procedure, while the surgical area is
viewed through an endoscope or a miniature camera inserted through
secondary cannulas to display the procedure on a video monitor.
The prior art devices are subject to several
disadvantages when considered for use in laparoscopic or
endoscopic surgical procedures. The primary focus behind such
surgical procedures is that the surgery is minimally invasive to
the patient's body, consequently reducing damage to surrounding
tissue and organs and reducing the scarring resulting from the
operation, which, as a result, greatly reduces recovery time for
the patient. The prior art devices, which typically provide a
plurality of channels in the tube or catheter portion to transport
the suction and irrigation means to the surgical site, are
generally provided for invasive type surgery which allows the
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larger diameter catheters to be manually positioned adjacent the
surgical objective thr_ough large incisions.
A further limitation to which the prior art devices are
subjected involves positioning of the device during the surgical
procedure. Many of these devic,es are provided with a pistol-type
grip which requires a particular orientation of the device in
relation to the surgeon's position during the procedure. Should
it become necessary for the device to be relocated during the
surgical procedure, it is often times uncomfortable to the'surgeon
to position the device at an angle that does not facilitate
operation of the valve members to turn the various features on and
off. As a result, the effectiveness of the device is limited, and
in many times requires a surgical assistant to operate the device
for the surgeon.
Typical suction and irrigation devices having a hand
grip in the shape of a pistol are disclosed in U.S. Patent No.
4,149,315 to Page, Jr. et al. and U.S. Patent No. 4,776,840 to
Freitas et al. Page, Jr. et al. provides a dental
suction/irrigation device which includes an elongated tube member
which transports the suction means and the irrigation means to the
tissue site. The elongated tubular member comprises a pair of
concentric tubes where the,inner tube provides the irrigation
fluid and the outer tube is provided for the suction. A pair of
trumpet valves are provided to actuate the irrigation source and
the aspiration source. Freitas et al. discloses a similar device
but includes a complex internal manual pump to provide the
irrigation fluid. A second flexible tube is provided for a vacuum
source to evacuate fluid and gases from the surgical site.
U.S. Patent: No. 4,744,360 Bath provides a surgical
device for removing cataract lenses which includes an optical
fiber for laser surgery which is surrounded by an irrigation
sleeve and a separate aspirator sleeve which provides fluid for
irrigation and suction for evacuation, respectively, of the
surgical site.
A Cabot Medical Corporation brochure (copyright 1990)
discloses a suction/irrigation probe which includes a
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hydrodissection insert which comprises a rod which passes through
the tube of the suction/irrigation probe to adjust the flow of the
irrigation fluid.
Other known devices include U.S. Patent No. 4,921,476
and U.S. Patent No. 4,493,694 to Wuchinich, and U.S. Patent No.
3,527,203 to Gravlee, which include a tube having several channels
for carrying the irrigation fluid separately from the suction
device.
The novel endoscopic surgical device for suction and
irrigation of tissue during a surgical procedure obviates the
disadvantages encountered in the prior art and provides a compact
instrument which includes many of the features necessary to
perform the surgical procedure, and which is dimensioned to fit
through a cannula for the performance of endoscopic or
laparoscopic surgical procedures. The device of the present
invention allows a surgeon to operate the suction and irrigation
device with either hand and at any orientation to the surgical
site comfortably and without assistance.
SUMALRY OF THE INVENTION
In accordance with an embodiment of the present
invention there is provided an endoscopic surgical kit comprising:
an instrument including an elongated body portion having a first
end and second end; and a handle mechanism at the first end and a
coupling mechanism at the second end; and a plurality of tool
members, each of the tool members being detachably couplable to
the coupling mechanism; wherein the tool members includes at least
two different types of interchangeable tool members selected from
the group consisting of scalpels, knives, hydrodissectors,
dissectors, blunt dissectors, spatulas, retractors, nozzles and
electro-cautery dissectors.
In accordance with another embodiment of the present
invention there is provided an endoscopic surgical kit comprising:
an instrument including an elongated body portion having a first
end and a second end; and a handle mechanism at the first end and
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a coupling mechanism at the second end; and a plurality of
interchangeable tool members, each of the interchangeable tool
members being detachably couplable to the coupling mechanism;
wherein the tool members are selected from the group consisting of
scalpels, knives, hydrodissectors, dissectors, blunt dissectors,
spatulas, retractors, nozzles and electrocautery dissectors, and
wherein the body portion includes a central passageway extending
along its length from the coupling mechanism and through the
handle mechanism.
Yet another embodiment of the present invention
provides an endoscopic surgical kit comprising: an instrument
including an elongated body portion having a first end and a
second end; and a handle mechanism at the first end and a coupling
mechanism at the second end; and a plurality of interchangeable
tool members, each of the interchangeable tool members being
detachably couplable to the coupling mechanism; wherein the tool
members are selected from the group consisting of scalpels,
knives, hydrodissectors, dissectors, blunt dissectors, spatulas,
retractors, nozzles and electrocautery dissectors, and wherein the
handle mechanism includes means for contacting the handle
mechanism to a source of irrigation and a source of suction.
A novel irrigation and aspiration device is disclosed
for performing endoscopic or laparoscopic surgical procedures
which allows the surgeon to operate the device with either hand
and at any orientation to the patient's body. The device includes
numerous features necessary for the performance of a surgical
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procedure such as dissection of tissue, or to provide suction and
irrigation to a surgical site where the procedure is performed
with additional instruments.
The suction and irrigation device may include a
variably orientable subassembly which may be incorporated into
various outer enclosures or housings dependent on the surgeon's
preference and on the type of surgical procedure in which the
surgical instrument is to be used. The subassembly essentially
comprises a connection port for a source of suction and means to
actuate the source of suction through the port, as well as a
connection point for irrigation fluid with means to actuate the
irrigation source through the port. A single lumen cannula is
provided which communicates with the actuating means for both the
suction port and the irrigation port which transports the suction
means and the irrigation fluid to the surgical site. The device
may further include a port for an optical fiber for the
performance of laser surgery which further communicates with the
single lumen cannula to locate the optical fiber through the
cannula to the surgical site. Furthermore, electrocautery means
may be provided for the performance of cauterization procedures at
the surgical site.
The single lumen cannula is provided with a connection
means at its distal end for the interchangeable connection of
various operative tips which allows the surgeon to perform various
surgical procedures. These tips include a surgical knife, blunt
dissectors, and a nozzle for high-pressure hydrodissection. The
cannula is provided with a plurality of apertures at the distal
end for communicating the interior of the cannula with the
surrounding environment at the surgical site.
A further feature of the device is the hydrodissection
capability, in which the high pressure fluid may be directed to
the tissue at high oressure to dissect the tissue. In this
regard, a concentric outer sleeve member is provided along the
length of the cannula which is longitudinally slidable to cover
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one or all of the apertures at the distal end of the cannula.
This allows the surgeon to vary the pressure and provides a visual
indication for adjusting the pressure at the distal end.
A further feature is the variably orientable valve
members which allows the surgeon to operate the device with either
hand and at any orientation in relation to the patient's body.
Preferably, the optical fiber connection port is axially aligned
with the longitudinal axis of the single lumen cannula. At least
one of the connection ports for either the aspiration means or the
suction means, or both, includes a rotatable trumpet valve to
allow the surgeon to rotate the valve at least 1800 from one
position perpendicular to the
30
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longitudinal axis of the single lumen cannula to a second position
perpendicular to the longitudinal axis of the single lumen cannula
on the opposite side of the cannula. If one connection port is
rotatable, the other n-ay be rotatable, or may extend from the
distal end of the device so that the connection port is within
substantial parallel alignment with the longitudinal axis of the
single lumen cannula and the laser optical fiber connection port.
Furthermore, the connection for the electrocautery feature
preferably includes a bayonet-type male connector which extends at
an angle to, but generally in the same direction as, the
longitudinal axis of the single lumen cannula. These features
allow the surgeon to vary the orientation of the device and
operate the device wit:h either hand by rotating the trumpet valves
so that the tubes or hoses which deliver the suction means or the
irrigation fluid are in an unobstructed position.
BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing features of the present invention will
become more readily apparent and may be understood by referring to
the following detailed description of the endoscopic surgical
aspiration and irrigation instrument, taken in conjunction with
the accompanying drawings, in which:
Figure 1 illustrates a perspective view of the
subassembly of the endoscopic surgical instrument for aspiration
and irrigation according to the present invention;
Figure 2 illustrates a perspective view of the present
invention including an external housing according to a first
embodiment;
Figure 3 illustrates a side plan view in partial cross
section of the embodiment of Figure 2;
Figure 4 illustrates a rear plan view of the device of
Figure 2;
Figure 5 illustrates a perspective view of a second
embodiment of the subassembly of the endoscopic surgical
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instrument for aspiration and irrigation according to the present
invention;
Figure 6 illustrates a top plan view of the device of
Figure 5;
Figure 7 il).ustrates.an exploded perspective view of the
valve mechanism of the: device of Figure 5;
Figure 8 illustrates a perspective view of a second
embodiment of the outer enclosure employing the device of Figure 1
according to the present invention;
Figure 9 illustrates a side plan view in partial cross
section of the device of Figure 8;
Figure 10 i:Llustrates a rear plan view of the device of
Figure 8;
Figure 11 illustrates a perspective view of the
endoscopic surgical instrument for aspiration and irrigation
according to the present invention in use during a surgical
procedure;
Figures 12a and 12b illustrate an exploded perspective
view and a perspective view, respectively, of the distal end of
the single lumen cannula having a dissector tool mechanism
attached thereto;
Figures 13a through 13c illustrate various
electrocautery dissectors for use with the device of the present
invention;
Figures 14a through 14c illustrate various blunt
dissectors and surgical knives for use with the device of the
present invention;
Figures 15a and 15b illustrate a coupling member for use
with the dissectors of Figures 13a through 13c; and
Figures 16a and 16b illustrate a coupling member for use
with the dissectors of Figures 14a through 14c.
DETAILED~ DESCR'IPTION OF THE PREFERRED EMBODIMENTS
Referring now in specific detail to the drawings, in
which like reference numerals identify similar or identical
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elements throughout the several views, Figure 1 shows the
endoscopic surgical instrument for aspiration and irrigation
according to the present invention. Instrument 10 comprises a
body portion 12 to which at least a pair of valve members 14 and
18 are attached. Preferably, at least one valve member, namely
valve member 14, includes a rotatable connection port 16 for
coupling a source of irrigation or a source of suction thereto.
The function of rotatable connection port 16 will be discussed
below. Valve member 18 may include a rotatable connection port;
however, in a preferred embodiment valve member 18 includes a
rotatably lockable actuator 18a for maintaining a source of
constant irrigation or suction. Connection port 20 is controlled
by valve member 18.
Body portion 12 essentially comprises a mixing chamber
which communicates with both connection port 16 and connection
port 20 through valve member 14 and 18, respectively. Body
portion 12 extends into coupling member 22 which couples the
mixing chamber within body portion 12 with a single lumen cannula
24. Single lumen cannula 24 provides a means for transporting the
irrigation fluid or the suction force from their respective
sources to the surgical site. Single lumen cannula 24 simplifies
the construction of device 10 and significantly reduces cost in
that a single tubular member having a reduced diameter single
channel therethrough is utilized to carry both the suction and
irrigation fluid to the surgical site.
Preferably, single lumen cannula 24 is enclosed within
outer sleeve member 26 which concentrically surrounds and contacts
single lumen cannula 24 along its length and is slidable in a
longitudinal direction by grip member 28. The purpose of the
slidable outer sleeve will be discussed below.
Device 10 niay further include a bayonet-type connector
30 for providing electrocautery capabilities to device 10.
Bayonet connector 30 is in electrical contact with single lumen
cannula 24 through the provision of bus bar 32. Bayonet connector
30 provides for cauterization at the surgical site and for
electrodissection of tissue. Device 10 may further include laser
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dissection means, which may be provided by an optical fiber
through optical fiber port 34.
Figure 2 il:lustrates the device of Figure 1 enclosed in
a working housing 36 which provides for gripping and handling of
device 10. Housing 36 may be provided with scored portion 38 in
one or several locations to facilitate gripping. As is seen in
Figure 2, single lumeri cannula 24 is enclosed by outer sleeve
member 26 which is slidable between a proximal position whereby
apertures 44 are exposed at the distal end 42, to a distal
position where outer sleeve 26 covers apertures 44. A
hydrodissection tip 40 is shown as connected to the distal end 42
of single lumen cannu:La 24. In use, device 10 may be utilized for
hydrodissection purposes. In such a case, a high pressure
irrigation fluid source is utilized and connected, preferably to
either of connection port 16 or connection port 20. As the
irrigation fluid exits the aperture 41 at the end of
hydrodissection tip 40, the pressure at which the fluid exits may
be regulated and varied by sliding outer sleeve 26 in the
direction of arrow A to cover one or more of apertures 44.
Covering apertures 44 will increase the pressure of the fluid
exiting tip 40 to provide for greater or less pressure of the
irrigation and dissection fluid.
Preferably, outer sleeve 26 is constructed of an
electrical insulating material, such as plastic, or may be
provided with an electrically insulating shrink tubing, so that
when device 10 is used for electrocautery purposes, the risk of
shock is mitigated. Figure 3 shows the electrical connection of
bayonet connector 30 with single lumen cannula 24 at connection
point 46.
Figure 4 illustrates a rear view of the device of Figure
2 which illustrates connection port 20 as being in axial alignment
with-valve members 14 and 18, while optical fiber port 34 is in
direct axial alignment with single lumen cannula 24. Optical
fiber port 34 is provided with a sealing means 48 which generally
comprises a rubber type gasket which is penetrable by the optical
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fiber and seals around the fiber to prevent loss of suction
pressure and leakage of irrigation fluid.
Figures 5 and 6 illustrate an alternate embodiment 50 of
the instrument of Figure 1. Instrument 50 comprises a pair of
rotatable trumpet valve members 52 which are secured to a body
portion 60 and are positioned directly in line with a coupling
member 62 which extends into the single lumen cannula described
above. An optical fiber port 58 is provided which is directly in
line with coupling member 62. Rotatable trumpet valve members 52
include rotatable connection ports 56 whose function will be
discussed below.
Turning to Figure 7, there is shown the rotatable
trumpet valve members 52 (as well as valve member 14 discussed
above in connection with Figure 1). Valve members 52 essentially
comprise a rotatable outer housing 64 to which connection port 56
is coupled. Outer housing 64 fits over inner housing 66, and
valve stem 70 of actuator knob 68 extends through the inner and
outer housings. Inner housing 66, is provided with an opening 72
which communicates a chamber as defined by the inner wall of outer
housing 64 and chamber wall 74 to allow for the passage of fluid
or suction pressure upon actuation of valve member 52. A pair of
gaskets 76 are provided which seal the top and bottom of the
chamber between the outer housing 64 and the inner housing 66, to
prevent leakage while maintaining the rotatable feature. A second
pair of gaskets 78 are secured to stem 70 for actuation of valve
member 52. A spring means 80 is provided, as is common in
trumpet-type valves. In addition, a locking ring 82 may be
provided to maintain the valve in the continuously on position.
The locking ring may be eliminated such as shown in Figure 1,
where a camming surface is provided on the interior surface of
actuator knob 18a which engages a cam surface on the outside of
outer housing 64.
Turning now to Figure 8, there is illustrated a further
embodiment of the surgical instrument for aspiration and
irrigation according to the present invention, in which a pistol-
type housing 86 is p:rovided. Housing 86 encloses device 10a and
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includes valve members 14 and 18, where valve member 14 includes
rotatable connection port 16. Extending from housing 86 is single
lumen cannula 24 which includes an outer sleeve member 26
longitudinally slidable in the direction of arrow A in the manner
described above. Figure 10 illustrates a rear view of the device
of Figure 8 which shows the optical fiber connection port 34a as
well as connection pDrt 20a and bayonet connector 30a.
Figure 9 illustrates surgical instrument 10a enclosed in
housing 86. Connection port 20a extends in a rearward direction
from body portion 12a and exits the device as shown. Coupling
member 22a is provided as shown which engages body portion 12a and
single lumen cannula 24, and further includes means to connect
optical fiber port 3=4a in direct axial communication with single
lumen cannula 24. Outer sleeve member 26 is slidable in a
longitudinal direction in the direction of arrow A through the
provision of grip member 28.
Figure 11 illustrates the suction and irrigation device
50 according to the present invention in use at a surgical site.
The body wall 90 of the patient is penetrated by a trocar
assembly, the cannula 88 of which remains in place after the
pointed obturator has been removed. Instrument 50 is inserted to
the surgical site through cannula 88 as shown to perform the
surgical procedure.
Figures 12a and 12b illustrate a novel means for
connecting the working tip of the device of the present invention
to the single lumen cannula. The tips may be interchangeable and
may include a plurality of tips such as that shown in Figures 12a
and 12b, as well as Figures 13a through 13c and Figures 14a
through 14c. As shown in Figures 12a and 12b, key slots 92 are
provided at the distal end 42 of single lumen cannula 24 for
accepting the key posts 96 of dissector tip 94. Tip 94 is secured
through a sealing gasket 98 to key slots 92. Dissector tip 94
includes a central passageway 100 to maintain fluid communication
with the interior of single lumen cannula 24 adjacent the working
tip 102. Tip 102 may further include a knife 104 as shown in
Figure 14c.
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An alternate means of securing detachable dissector tip
94 to distal end 42 of single lumen cannula 24 may be accomplished
through the provision of coupling members 95 and 97 as shown in
Figures 15 and 16. In this embodiment, an annular groove 106 is
provided which engages a detent on the interior of distal end 42
to snap fit coupling members 95 and 97 therein. In addition, a
threaded connection may be used.
In use, the instrument of the present invention provides
a variably orientable aspiration and irrigation device which may
also be used for dissecting tissue. The instrument is constructed
to accommodate use with either hand and at any orientation to the
patient's body during the surgical procedure through the provision
of rotatable valve members which are at least 180' rotatable so
that the connection hoses to the irrigation and aspiration sources
may be oriented on either side of the device. Furthermore, the
connection ports for at least an optical fiber for laser surgery
purposes as well as a bayonet connection member for electro-
cautery procedures are provided substantially parallel to the
longitudinal axis of the single lumen cannula which communicates
the instrument with the surgical site. In addition, one of the
rotatable valve members may be replaced by a locking valve member
and the connection port thereto extends directly from the distal
end of the device in parallel with the longitudinal axis of the
single lumen cannula.
While the invention has been particularly shown and
described with reference to the preferred embodiments, it will be
understood by those skilled in the art that various modifications
and changes in form and detail may be made therein without
departing from the scope and spirit of the invention.
Accordingly, modifications such as those suggested above, but not
limited thereto, are to be considered within the scope of the
invention.
