Visually directed trocar for laparoscopic surgical procedures and method of using same

• US 5,334,150 A
• Filed: 11/17/1992
• Issued: 08/02/1994
• Est. Priority Date: 11/17/1992
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Worldwide Optical Trocar Licensing Corporation
• Inventors: Kaali, Steven G.
• Primary Examiner(s): Apley, Richard J.
• Assistant Examiner(s): FLANAGAN, BEVERLY MEINDL
• Application Number:
  US07/978,092
• Time in Patent Office: 623 Days
• Field of Search: 128/3, 128/4, 604/164, 604/158, 604/264, 606/185, 606/15
• US Class Current: 604/164.08
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• 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 2090/373 using light, e.g. by using optical scanners

Abstract

A new and improved laparoscopic trocar and sleeve assembly in which the trocar is provided with a transparent tip and accommodates a light telescope for supplying a video console so that while the trocar is being surgically inserted through the abdominal wall and into the abdominal cavity, visualization on the video console will be possible to avoid injury to blood vessels in the abdominal cavity wall or injury to any of the internal organs located in the abdominal cavity. Once clear visualization is established, conventional laparoscopic procedures can be carried out safely.

Claims

1. A new and improved laparoscopic instrument comprising an elongated, hollow tubular member of inflexible material compatible with human flesh, and having a tipped and suitable for insertion through human flesh to form a hollow trocar, said tipped end formed essentially of light transparent material with a substantially solid piercing point, said tipped end affixed to said hollow tubular member and shaped to form a light transmission and imaging element for projecting light outwardly into an abdominal or other cavity of a patient and for imaging light images received back onto a suitable light image receptor.

2. A laparoscopic instrument according to claim 1 wherein the hollow trocar has a central passageway formed therein of sufficient diameter to accommodate passage of a miniaturized light source together with essential power supply conductors for energizing the light source and any light receptors for further accommodating fiber optic light coupling elements for deriving and providing back usable light images for supply to a video camera that excites a suitable video monitor for producing images usable for diagnostic purposes and surgical procedures even while the trocar is being surgically inserted into and is penetrating the layers of skin and wall of a patient'"'"'s abdomen.

3. A laparoscopic instrument according to claim 1 wherein the hollow trocar is provided with a blunt end and readily grasped handles extending outwardly from the blunt end of the trocar whereby the trocar more readily can be physically grasped and pressed through the navel of a patient and maneuvered to avoid injury to the blood vessels in the walls of the abdomen and internal organs in the abdominal cavity.

4. A laparoscopic instrument according to claim 2 wherein the hollow trocar is provided with a blunt end and readily grasped handles extending outwardly from the blunt end of the trocar whereby the trocar more readily can be physically grasped and pressed through the navel of a patient and maneuvered to avoid injury to blood vessels in the walls of the abdomen and any internal organs in the abdominal cavity.

5. A laparoscopic instrument according to claim 1 further including a hollow trocar tubular sleeve of relatively inflexible material compatible with human flesh physically surrounding and enclosing said trocar for a substantial portion of its length to form a combined trocar and sleeve assembly, the trocar being slidable lengthwise relative to the sleeve and removable whereby the trocar can be removed after visual surgical insertion of the trocar and sleeve assembly into the flesh of a patient at a desired location and to a desired depth, and the trocar replaced with a fiber optic light source and video imaging system of a light telescope and other remotely manipulatable surgical instruments inserted through the central opening of the trocar sleeve in a conventional known manner.

6. A laparoscopic instrument according to claim 2 further including a hollow trocar tubular sleeve of relatively inflexible material compatible with human flesh physically surrounding and enclosing said trocar for a substantial portion of its length to form a combined trocar and sleeve assembly, the trocar being slidable lengthwise relative to the sleeve and removable whereby the trocar can be removed after visual surgical insertion of the trocar and sleeve assembly into the flesh of a patient at a desired location and to a desired depth, and the trocar replaced with a fiber optic light source and video imaging system of a light telescope and other remotely manipulatable surgical instruments inserted through the central opening of the trocar sleeve in a conventional known manner.

7. A laparoscopic instrument according to claim 5 wherein the tubular trocar sleeve is provided with at least one trumpet valve subassembly, an insufflation stopcock and one or more seals and sealing caps for maintaining the trocar sleeve gastight and safely usable for laparoscopic procedures.

8. A laparoscopic instrument according to claim 6 wherein the tubular trocar sleeve is provided with at least one trumpet valve subassembly, an insufflation stopcock and one or more seals and sealing caps for maintaining the trocar sleeve gastight and safely usable for laparoscopic procedures.

9. A laparoscopic instrument according to claim 1 wherein said substantially solid piercing point is of pyramidal configuration.

10. A laparoscopic instrument according to claim 1 wherein said substantially solid piercing point is of conical configuration.

13. A new and improved laparoscopic procedure according to claim 10 wherein the tubular trocar sleeve is provided with at least one trumpet valve subassembly, an insufflation stopcock and one or more seals and sealing caps for maintaining the trocar sleeve gastight;

and wherein prior to insertion of the trocar into the abdominal cavity, an insufflation needle is inserted into the abdominal cavity and the abdominal cavity is inflated by delivering a biocompatible gas through the needle to increase the free space in the abdomen and facilitate the insertion of the trocar assembly and to provide space for surgical procedures to be carried out within the abdominal cavity.

11. A new and improved laparoscopic procedure comprising the steps of:

a) employing a novel hollow laparoscopic trocar with a tipped end formed essentially of transparent material and a substantially solid piercing point extending from said tipped end, said tipped end being designed for surgical insertion into human flesh where said tipped end is shaped to form a light transmission and receiving element;

b) mounting a miniaturized light source, suitable miniaturized light receptors, power supply conductors, and fiber optic coupling and light receptor devices of a conventional light telescope in the hollow trocar;

c) coupling the light source to an electric power source for energizing the light source;

d) coupling the output of the light receptors to a video display;

e) placing said tipped end at the point on a patient'"'"'s abdomen to be penetrated while observing such placement on the video display;

f) surgically inserting said trocar into and slowly through the layers of skin and wall of the patient'"'"'s abdomen while observing the progress of said trocar on the video display as said trocar travels into and through the navel; and

g) maneuvering said trocar to assure that said trocar does not penetrate blood vessels in the abdominal cavity wall or injure internal organs within the abdominal cavity.

12. A new and improved laparoscopic procedure according to claim 11 wherein the hollow trocar is part of an assembly further comprised by a hollow trocar sleeve physically surrounding and enclosing said trocar for a substantial portion of its length, the trocar being slidable lengthwise relative to the sleeve;

and wherein the trocar together with its light source and video display components of a light telescope are removed after placement of the trocar and sleeve assembly into the abdominal cavity at a desired and safe place and depth in a directly observed careful manner; and

the trocar is replaced with a fiber optic light source and video imaging system of another light telescope along with as well as other assorted remotely manipulatable surgical instruments, as needed, which are inserted through the central opening in the trocar sleeve in a conventional known manner.

14. A surgical penetration device comprising:

a) an inflexible elongated member having a first end,

b) light transmission and imaging means provided at the first end of said elongated member to project light and receive light images,

c) said light transmission and imaging means including means for piercing human flesh to permit surgical insertion of said light transmission and imaging means through human flesh into a body cavity,

d) said light transmission and imaging means being affixed to said first end of said inflexible elongated member and formed essentially of transparent material,

e) said piercing means having a substantially solid piercing point, and

f) said elongated member having means for containing a lighting means and a light image receiving means to cooperate with said light transmission and imaging means.

15. The surgical penetration device as claimed in claim 14 wherein said elongated member is hollow.

16. The surgical penetration device as claimed in claim 14 wherein said elongated member is a cylinder.

17. The surgical penetration device as claimed in claim 14 wherein said light transmission and imaging means has a tapered section and a nontapered section, a predetermined amount of said nontapered section being recessed in the first end of said elongated member.

18. The surgical penetration device as claimed in claim 17 wherein the nontapered section of said light transmission and imaging means is substantially circular in cross section.

19. The surgical penetration device as claimed in claim 14 wherein said light transmission and imaging means is integrally joined to said elongated member at said first end of said elongated member.

20. The surgical penetration device as claimed in claim 14 wherein said light transmission and imaging means is formed of glass.

21. The surgical penetration device as claimed in claim 14 wherein said light transmission and imaging means is formed of plastic.

22. The surgical penetration device as claimed in claim 14 wherein said elongated member has a second end opposite said first end, and a handle member being provided proximate said second end to facilitate manipulation of said elongated member.

23. A surgical penetration device according to claim 14 wherein said substantially solid piercing point is of pyramidal configuration.

24. A surgical penetration device according to claim 14 wherein said substantially solid piercing point is of conical configuration.

26. The method of claim 21 including slidably locating said hollow trocar with said light transmission and imaging member in a sleeve and fixing the position of said hollow trocar relative to the sleeve such that substantially only the light transmission and imaging member projects from one end of the sleeve to permit insertion of the sleeve with the light transmission and imaging member through the flesh into a body cavity.

25. A method of visualizing insertion of a surgical device through flesh into a body cavity comprising the steps of:

a) providing a novel hollow trocar with a tubular body and a tipped end formed essentially of transparent material, said tipped end having a substantially solid piercing point and forming a light transmission and imaging member such that said light transmission and imaging member pierces human flesh for surgical insertion through human flesh,

b) joining said light transmission and imaging member to one end of said tubular body formed of a biocompatible material,

c) locating a conventional lighting means and light image receiving means in said hollow trocar proximate said light transmission and imaging member to enable light from the lighting means to project outwardly away from said light transmission and imaging member and to permit the light image receiving means to receive light images that pass from outside said light transmission and imaging member through said light transmission and imaging member while said light transmission and imaging member is being inserted through the flesh into a body cavity, whereby said light transmission and imaging member provides a receivable image of the flesh and body cavity being entered.

27. The method of claim 25 including monitoring the light images received by the light image receiving means on a video screen while the light transmission and imaging member is being inserted through the flesh into a body cavity to obtain continuous video aided visual imaging of the internal location of the light transmission and imaging member during such insertion.

28. The method of claim 25 including the step of forming said substantially solid piercing point with a pyramidal configuration.

29. The method of claim 25 including the step of forming said substantially solid piercing point with a conical configuration.