Surgical dissector and method for its use

• US 5,738,628 A
• Filed: 03/24/1995
• Issued: 04/14/1998
• Est. Priority Date: 03/24/1995
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Kramer, Francis J., Paul, Michel A., Freeman, Lynetta J., Sierocuk, Thomas J.
• Primary Examiner(s): FLANAGAN, BEVERLY MEINDL
• Application Number:
  US08/409,564
• Time in Patent Office: 1,117 Days
• Field of Search: 600/104, 604/49, 604/164, 604/165, 604/264, 604/170, 606/184, 606/185, 606/190
• US Class Current: 600/104
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 17/3494 with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors for the peridural space A61B17/3401
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/3456 blunt
• CPC Class Codes: A61B 2017/347 Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

A surgical method for creating an operative space during an endoscopic surgical procedure is disclosed. The method incorporates the use of an elongate instrument with an atraumatic tip for facilitating manual dissection of layers of tissues by advancing the instrument between the layers desired to be dissected. As the manual dissection is performed, the space between the dissected layers is enhanced by concurrently insufflating the dissected space as the instrument is advanced. Concurrently insufflating while dissecting eliminates the need to use a balloon dissector for creating the operative space. An improved surgical instrument particularly adapted to carry out this procedure is also disclosed. The improved surgical instrument is an optical obturator incorporating a contrasting imaging element displayed on the transparent tip of the obturator. The contrasting imaging element helps the surgeon to orient the positioning of the instrument relative to adjacent layers desired to be dissected for the creation of the operative space.

Claims

1. An improved surgical method for creating an operative space for performing a surgical procedure on a patient, the method having the steps of providing an instrument with an elongated shaft and a blunt tip at the shaft distal end, introducing the tip of the instrument adjacent to a first layer of internal bodily tissue desired to be dissected from adjacent layers of the tissue, and manually dissecting the first layer from the adjacent layers so as to create the operative space by advancing the instrument in a direction generally parallel to and between the first layer and the adjacent layers, wherein the improvement comprises:

insufflating the operative space with a pressurizing fluid concurrently with the step of manually dissecting so as to create an insufflated operative space; and

removing the instrument from the patient after the insufflated operative space has been created for performing a surgical procedure within the insufflated operative space with another surgical instrument inserted into the insufflated operative space between the first layer and the adjacent layers of tissue.

2. The method of claim 1 wherein the instrument has an outer sleeve through which the shaft is inserted and the step of insufflating is carried out through the sleeve.

3. The method of claim 2 wherein the shaft of the instrument is hollow, at least a portion of the tip is transparent, an endoscope is received in the hollow shaft and extends adjacent to the tip, and the step of manually dissecting is carried out under direct visualization using the endoscope.

4. The method of claim 3 wherein the operative space is created at the patient'"'"'s parietal peritoneum.

5. The method of claim 4 wherein the operative space is created to repair a hernia.

6. A surgical method for endoscopically dissecting internal bodily tissue so as to create an operative space remote from a point of entry for performing the surgical procedure on a patient, the method comprising:

providing a trocar assembly including a cannula having a cannula housing and an elongate cannula sleeve extending distally therefrom, and an obturator with a blunt tip slidably received into and through the cannula sleeve;

making an incision at the point of entry;

inserting the blunt tip of the trocar assembly through the incision until the tip contacts a desired layer of the internal bodily tissue;

advancing the tip in a direction generally parallel to the desired layer of the internal bodily tissue so as to dissect the layer from adjacent layers of the tissue while the cannula sleeve of the trocar assembly is likewise advanced;

insufflating at and around the dissected layer through the cannula sleeve with a pressurizing fluid while concurrently continuing to advance the blunt tip and sleeve of the trocar assembly toward a surgical site where the surgical procedure is to be performed so as to create an insufflated operative space;

removing the obturator after the insufflated operative space is created at the surgical site; and

inserting another surgical instrument into the insufflated operative space between the first layer and the adjacent layers of tissue for performing the surgical procedure.

7. The method of claim 6 when the obturator is hollow, the blunt tip is a transparent window, the trocar assembly includes an endoscope inserted into the hollow obturator and extending to adjacent the transparent window, and the advancing step is carried out under direct visualization using the endoscope.

8. The method of claim 7 wherein the point of entry is adjacent the patient'"'"'s umbilicus and the operative space created is at the patient'"'"'s parietal peritoneum.

9. The method of claim 8 wherein the operative space is created to repair a hernia.