Endoluminal and transluminal surgical methods and devices

• US 20080262302A1
• Filed: 04/17/2008
• Published: 10/23/2008
• Est. Priority Date: 04/17/2007
• Status: Active Grant

• Current Assignee: Surgiquest, Inc. (Jefferies Financial Group, Inc.)
• Original Assignee: Surgiquest, Inc. (Jefferies Financial Group, Inc.)
• Inventors: Nolan, Timothy J., Stearns, Ralph, Azarbarzin, Kurt, Jones, Daniel B.
• Granted Patent: US 9,155,557 B2
• Time in Patent Office: Days
• US Class Current: 600/114
• CPC Class Codes: A61B 1/00052 positioned at proximal end of the endoscope body
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes precedence
• 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 17/3421 Cannulas
• CPC Class Codes: A61B 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00544 pneumatically
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/40 Apparatus fixed or close to patients specially adapted for providing an aseptic surgical environment

Abstract

An access device adapted and configured to be inserted through a natural biological orifice, and related surgical methods are provided. The access device includes a body, a nozzle means and means for delivering a pressurized flow of fluid to the nozzle means. The body is configured and dimensioned to be inserted through a natural bodily orifice and has proximal and distal end portions and defines at least one lumen therethrough to accommodate passage of one or more surgical instruments. The nozzle means is operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough.

Claims

1. An access device adapted and configured to be inserted through a natural biological orifice, the access device comprising:

a) a body configured and dimensioned to be inserted through a natural bodily orifice, the body having proximal and distal end portions, the body defining at least one lumen therethrough to accommodate passage of one or more surgical instruments;

b) nozzle means operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough; and

c) means for delivering a pressurized flow of fluid to the nozzle means.

2. The access device of claim 1, wherein the body is substantially rigid.

3. The access device of claim 1, wherein the body is substantially flexible.

4. The access device of claim 1, wherein the body includes at least one rigid portion and at least one flexible portion.

5. The access device of claim 3, further comprising at least one control element for manipulation of the curvature of the access device.

6. The access device of claim 1, further comprising an image sensor arranged in the distal end portion of the access device, adapted and configured to capture images of a region distal the distal end portion of the access device.

7. The access device of claim 1, further comprising one or more working channels provided in the wall of the access device.

8. The access device of claim 7, wherein one of said working channels is configured and adapted to provide irrigation to a surgical site.

9. The access device of claim 7, wherein one of said working channels is configured and adapted to provide drainage to a surgical site.

10. The access device of claim 7, wherein one of said working channels is configured and adapted to allow a surgical instrument to pass therethrough.

11. The access device of claim 7, further comprising a light source arranged in the distal end portion of the access device, adapted and configured to illuminate a region distal the distal end portion of the access device.

12. The access device of claim 1, further comprising illumination means provided in the wall of the access device.

13. The access device of claim 1, further comprising a guide element adapted and configured to guide surgical instruments in the lumen of the access device.

14. The access device of claim 1, further comprising a pressure sense channel arranged in the wall of the access device configured and adapted to be in fluid communication with a surgical site.

15. The access device of claim 1, wherein the length of the body is between about 30 cm and about 40 cm.

16. An insertion device for the access device of claim 1, the insertion device having a tip portion to facilitate insertion of the access device through a natural orifice.

17. The insertion device of claim 16, wherein the tip tapers to a substantially blunt end.

18. The insertion device of claim 16, wherein the tip includes a dilating element.

19. The insertion device of claim 16, wherein the tip portion includes at least one transparent region.

20. The access device of claim 1, further comprising an integral image display provided in the proximal end portion thereof.

21. A method of accessing an internal region of a body comprising:

a) inserting through a natural body orifice an elongated body, the body having longitudinally opposed proximal and distal end portions, the body defining at least one lumen configured and dimensioned to accommodate passage of one or more surgical instruments, the body further including nozzle means operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough;

b) delivering pressurized fluid to the nozzle means to create said pressure differential; and

c) inserting one or more surgical instruments through the body to access the interior of the body.

22. An access device adapted and configured to be inserted through an orifice, the access device comprising:

a) a body configured and dimensioned to be inserted through an orifice, the body having proximal and distal end portions, the body defining at least one lumen therethrough to accommodate passage of one or more surgical instruments, and being flexible in at least one region;

b) nozzle means operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough;

c) means for delivering a pressurized flow of fluid to the nozzle means; and

d) at least one control element arranged within the body adapted and configured to effect a change in curvature of the at least one flexible region of the body.

23. The access device of claim 22, wherein the orifice is a natural biological orifice.

24. The access device of claim 22, wherein the orifice is formed from an incision made in a patient.

25. A method for performing a cholecystectomy comprising the steps of:

(a) inserting a first access device through the esophagus of a patient and into the stomach;

(b) penetrating the stomach wall and extending the first access device through the stomach wall;

(c) inserting a second access device through the umbilicus of the patient;

(d) inserting an endoscope through the first access device;

(e) retracting the gallbladder;

(f) exposing the cystic duct and cystic artery;

(g) applying at least two clips on each of the cystic duct and artery;

(h) transecting each of the cystic duct and artery;

(i) dissecting and removing the gallbladder from the liver bed; and

(j) removing the gallbladder.