Surgical access apparatus and method

• US 20040143158A1
• Filed: 01/17/2003
• Published: 07/22/2004
• Est. Priority Date: 01/17/2003
• Status: Active Grant

• Current Assignee: Applied Medical Resources Corporation (Applied Medical Corporation)
• Original Assignee: Applied Medical Resources Corporation (Applied Medical Corporation)
• Inventors: Brustad, John R., Hart, Charles C.
• Granted Patent: US 6,887,194 B2
• Time in Patent Office: Days
• US Class Current: 600/114
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 2017/320044 Blunt dissectors
• CPC Class Codes: A61B 2017/349 Trocar with thread on outside
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2090/373 using light, e.g. by using optical scanners
• CPC Class Codes: A61B 90/30 Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Abstract

A laparoscopic insufflation device is provided in the configuration of a coil with a blunt tip. The device is capable of passing through the abdominal wall without cutting tissue, and exiting the abdominal wall substantially parallel to the inner surface. While rotation of the coiled device results in forward movement through the abdominal wall, a counter force can be applied to the device to create a safety space between the wall and the interior organs. With the blunt distal tip, parallel exit angle, and safety space, there is substantially no threat to the interior organs during placement of the device. Further space can be generated with the use of pressured gas to produce an abdominal cavity for the subsequent placement of trocars. By rotatably attaching the coiled insufflation device to a trocar, the advantage of a counter force can be used not only to establish the safety space but also to pull the trocar into the abdominal wall with a counterforce which resists tenting.

Claims

1. A laparoscopic insufflation needle adapted for movement across an abdominal wall of a patient to insufflate an abdominal region of the patient, the insufflation needle comprising:

an elongate tube having an inflation channel extending between a proximal end and a distal end, the elongate tube being adapted at the proximal end for connection to a source of fluid under pressure, and being adapted at the distal end to expel the fluid under pressure to insufflate the abdominal region of the patient; and

an optical element disposed at the distal end of the elongate tube to facilitate visualization of the abdominal wall and the abdominal region of the patient.

2. The laparoscopic insufflation needle recited in claim 1, wherein the optical element is a light.

3. The laparoscopic insufflation needle recited in claim 1, wherein the optical element is an endoscope.

4. The laparoscopic insufflation needle recited in claim 2, wherein the light is adapted to facilitate transillumination of the abdominal wall of the patient.

5. The laparoscopic insufflation needle recited in claim 1, wherein the distal end has a distal tip which is free of sharp edges to inhibit cutting the abdominal wall.

6. An insufflation needle adapted for movement across an abdominal wall and into an abdominal region of a patient, the Veress needle comprising:

an elongate tube having an inflation channel extending between a proximal end and a distal end, the elongate tube being adapted at the proximal end for connection to a source of fluid under pressure, and being adapted at the distal end to expel the fluid under pressure to insufflate the abdominal region; and

the tube being configured to provide a mechanical advantage when moved across the abdominal wall.

7. The insufflation needle recited in claim 6, wherein the tube has the configuration of a coil with an axis and a diameter.

8. The insufflation needle recited in claim 7, wherein the diameter is variable along the axis.

9. The insufflation needle recited in claim 8, wherein the mechanical advantage is variable along the axis.

10. The insufflation needle recited in claim 9, wherein the distal end has a distal tip free of sharp edges.

11. An insufflation needle adapted for penetrating an abdominal wall, having an inner service, defining an abdominal region containing interior organs of the patient, the needle comprising:

an elongate tube having an inflation channel extending between a proximal end and a distal end. The elongate tube being adapted at the proximal end for connection to a source of fluid under pressure, and being adapted at the distal end to expel the fluid under pressure to insufflate the abdominal region;

the elongate tube at its distal end being angled relative to the proximal end of the tube to produce an exit angle with the interior surface upon penetration of the abdominal wall; and

the exit angle being in a range of less than about 40 degrees in order to inhibit penetration of the interior organs of the patient.

12. The insufflation needle recited in claim 11, wherein the distal end of the elongate tube is curved.

13. The insufflation needle recited in claim 11, wherein the proximal end of the elongate tube produces an entry angle with the abdominal wall, and the entry angle is greater than the exit angle.

14. The insufflation needle recited in claim 12, wherein the elongate tube is formed into a coil, having at least one convolution.

15. The insufflation needle recited in claim 11, wherein the distal end of the elongate tube is substantially parallel to the inner surface of the abdominal wall upon penetration of the abdominal wall.

16. The insufflation needle recited in claim 12, wherein the distal end of the elongate tube has a distal tip which is free of cutting edges.

17. An insufflation needle adapted for penetrating an abdominal wall having an inner surface defining an abdominal region containing interior organs of a patient, the needle comprising:

an elongate tube having an inflation channel extending between a proximal end and a distal end, the elongate tube being adapted at the proximal end for connection to a source of fluid under pressure and being adapted at the distal end to expel the fluid under pressure to insufflate the abdominal regions; and

the distal end of the elongate tube having a distal tip free of sharp edges to inhibit cutting the abdominal wall during penetration of the abdominal wall and to inhibit cutting the interior organs following penetration of the abdominal wall.

18. The insufflation needle recited in claim 17, wherein the distal tip is blunt.

19. The insufflation needle recited in claim 17, wherein the distal tip is defined by a curved surface.

20. The insufflation needle recited in claim 17, wherein the distal tip is translucent.

21. The insufflation needle recited in claim 20 wherein the distal tip is transparent.

22. The insufflation needle recited in claim 20, further comprising:

a light disposed in proximity to the translucent distal tip.

23. The insufflation needle recited in claim 21, further comprising:

an endoscope disposed in the elongate tube for viewing the abdominal region upon penetration of the abdominal wall.

24. A method for accessing an abdominal region of a patient by crossing an abdominal wall of the patient, comprising the steps of:

providing a Veress needle having the configuration of a tube extending between a proximal end and a distal end; and

turning the tube to facilitate the crossing of the abdominal wall with the Veress needle.

25. The method recited in claim 24, wherein:

the providing step includes the step of forming the tube into a coil, having an axis, and

the turning step includes the step of rotating the coil to facilitate crossing the abdominal wall of the patient with the elongate tube of the Veress needle.

26. The method recited in claim 25, wherein the rotating step includes the step of rotating the coil about the axis.

27. The method recited in claim 24, wherein the forming step includes the step of:

forming the coil with at least one convolution to provide the coil with a mechanical advantage during the turning step.

28. The method recited in claim 25, wherein the rotating step includes the steps of:

rotating the coil in a first direction to advance the Veress needle into the abdominal wall; and

rotating the coil in a second direction to remove the Veress needle from the abdominal wall.

29. A method for using an access device to create an abdominal cavity in an abdominal region containing interior organs of the patient comprising the steps of:

providing an elongate shaft having an axis extending between a proximal end and a distal end;

moving the shaft across the abdominal wall to place the distal end of the shaft in the abdominal region; and

pulling on the elongate shaft to move the abdominal wall away from the interior organs and to create the abdominal cavity around the interior organs in the abdominal region of the patient.

30. The method recited in claim 29, wherein the shaft has the configuration of a tube with a lumen extending along the axis between the proximal end and the distal end.

31. The method recited in claim 30, further comprising the step of:

visualizing the abdominal cavity through the lumen of the tube.

32. The method recited in claim 29, wherein the abdominal wall has the general configuration of a plane and the pulling step includes the step of:

pulling the shaft generally perpendicular to the plane of the abdominal wall.

33. The method recited in claim 29, wherein the abdominal wall has an inner surface and the moving step includes the step of:

moving the elongate shaft through the abdominal wall with the distal end of the shaft crossing the inner surface at an exit angle generally parallel to the inner surface of the abdominal wall.

34. The method recited in claim 30, further comprising the steps of:

connecting the proximal end of the tube to a source of fluid under pressure; and

moving the fluid under pressure through the tube to insufflate the abdominal cavity of the patient.

35. The method recited in claim 34, further comprising the step of:

expelling the fluid under pressure from the tube laterally of the tube.

36. The method recited in claim 29, wherein:

the providing step includes the step of forming the shaft into the configuration of a coil having an axis and at least one convolution; and

the moving step includes the step of screwing the coil into the abdominal wall to place the distal end of the shaft into the abdominal region of the patient.

37. A surgical device adapted to provide access across an abdominal wall and into an abdominal region of a patient, comprising:

a trocar including a cannula;

a shaft having a proximal end and a distal end;

the shaft having the configuration of a coil with a coil axis, the coil facilitating rotational movement of the shaft across the abdominal wall; and

the proximal end of the shaft being coupled to the trocar so that movement by the shaft across the abdominal wall is accompanied by movement of the trocar into the abdominal wall.

39. The surgical device recited in claim 37, wherein:

the trocar has an axis; and

the trocar axis is generally coincidence with the coil access.

40. The surgical device recited in claim 39, wherein:

the trocar has a cannula with a distal tip forming a trocar exit angle with the abdominal wall;

the shaft has a distal tip forming a shaft exit angle with the abdominal wall; and

the trocar exit angle is greater than the shaft exit angle.

41. The surgical device recited in claim 40, wherein the distal tip of the cannula is generally perpendicular to the distal tip of the shaft.

42. The surgical device recited in claim 41, wherein the distal tip of the cannula is generally normal to the abdominal wall.

43. The surgical device recited in claim 37, wherein the rotation movement of the shaft across the abdominal wall provides a mechanical advantage greater than unity to facilitate movement of the shaft across the abdominal wall provides a mechanical advantage greater than unity to facilitate movement of the trocar into the abdominal wall.

44. The surgical device recited in claim 37, further comprising:

a ring rotation carried by the trocar; and

the proximal end of the shaft having a fixed relationship with the ring and a rotational relationship with the trocar.

45. The surgical device recited in claim 44, wherein the trocar has a cannula and the ring is rotational supported by the cannula.

46. The surgical device recited in claim 44, wherein the distal tip of the cannula and the distal tip of the shaft each have a blunt configuration.

38. The surgical device recited in 37, wherein the shaft is rotationally coupled to the trocar so that the coil is free to rotate relative to the trocar.

47. A method for placing a trocar across an abdominal wall of a patient, comprising the steps of:

providing a shaft in the form of a coil, the shaft having a proximal end and a distal end;

coupling the proximal end of the shaft to the trocar;

screwing the coil into the abdominal wall; and

moving the trocar with the shaft into the abdominal wall with a mechanical advantage dependent on the coil.

48. The method recited in claim 47, wherein the moving step includes the step of pulling the trocar into the abdominal wall.

49. The method recited in claim 47 wherein the moving step includes the step of lifting the coil to elevate the abdominal wall and to create an abdominal cavity.

50. The method recited in claim 48, wherein the coil has an access and the pulling step includes the step of pulling the trocar along the axis of the coil.

51. An anchor adapted for use with a trocar having a cannula and being adapted for placement in an operative position across an abdominal wall, the anchor comprising:

a structural element adapted to be coupled to the trocar and to extend outwardly of the cannula, the structural element having characteristics for engaging the abdominal wall at a location spaced from the cannula; and

the structural element having properties for inhibiting withdrawal of the cannula from the operative position of the cannula.

52. The anchor recited in claim 51, wherein the structural element comprises an elongate shaft disposed outwardly of the cannula.

53. The anchor recited in claim 52, wherein the shaft has the configuration of a coil sized and shaped for disposition around the cannula.

54. The anchor recited in claim 53, wherein the coil has a blunt distal tip.

55. The anchor recited in claim 54, wherein the coil is adapted to be rotated into the abdominal wall to produce an inwardly directed force tending to move the trocar through the abdominal wall to the operative position and to maintain the trocar in the operative position across the abdominal wall.

56. The anchor recited in claim 55, wherein:

the coil has a configuration including a diameter and a pitch; and

the inwardly directed force is variable with the configuration of the coil.

57. The anchor recited in claim 56, wherein the shaft is adapted for removal by counter rotation of the coil outwardly of the abdominal wall.