Laparoscopic instrument system for real-time biliary exploration and stone removal

• US 6,440,061 B1
• Filed: 03/24/2000
• Issued: 08/27/2002
• Est. Priority Date: 03/24/2000
• Status: Expired due to Fees

• Current Assignee: Donald E. Wenner, George L. Scott III
• Original Assignee: Donald E. Wenner, George L. Scott III
• Inventors: Wenner, Donald E., Scott, George L. III
• Primary Examiner(s): Dvorak, Linda C. M.
• Assistant Examiner(s): RAM, JOCELYN D
• Application Number:
  US09/534,789
• Time in Patent Office: 886 Days
• Field of Search: 600/114, 600/115, 604/27, 604/43, 604/264, 604/277, 606/108
• US Class Current: 600/114
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 2017/22067 Blocking; Occlusion A61B2017/22054 takes precedence
• CPC Class Codes: A61B 2017/22068 Centering
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

A laparoscopic port adapter assembly 10 for conducting bile duct and related procedures, including a laparoscopic port 11, an introducer sheath 12 and a multiple conduit instrument guide 13. The instrument guide 13 may be inserted into a bile duct 14 to facilitate concurrent introduction of multiple instruments directly into the bile duct 14 without need for forceps manipulation of instruments through additional laparoscopic ports. The procedure may be conducted and viewed in real-time video to improve procedural efficiency and safety. Inventive related useful instruments and procedures are included to complement use and flexibility of the laparoscopic port adapter assembly 10. A preferred embodiment may include use of a three-conduit instrument guide 13 and concurrent introduction of a lithotripter 32, choledochoscope 31 and irrigative catheter 34 directly in the bile duct 14.

Claims

1. A surgical laparoscopic port adapter assembly for conducting a bile duct procedure, comprising:

a laparoscopic port having an external end extending above an external surface of the abdominal wall and an abdominal end extending below an internal surface of the abdominal wall into an abdominal cavity, the laparoscopic port including an internal through bore extending between the external end and the abdominal end to provide a conduit into the abdominal cavity;

an instrument guide received within the laparoscopic port internal through bore and having an instrument guide external end and an instrument guide abdominal end, the instrument guide external end extending above the external surface of the abdominal wall and the instrument guide abdominal end extending below the laparoscopic port abdominal end and into the bile duct, the instrument guide further including two or more through channels, each through channel conveying and deploying one of the plurality of instruments; and

the instrument guide including a curved portion in the abdominal end of the instrument guide and an angled tip on the abdominal end of the instrument guide for ease of inserting the instrument guide into a choledochotomy in the bile duct.

2. The surgical laparoscopic port adapter assembly as defined in claim 1, further comprising:

an introducer sheath received within the laparoscopic port internal through bore and having an introducer external end and an introducer abdominal end, the introducer external end extending above the external end of the laparoscopic port and the introducer abdominal end extending below the abdominal end of the laparoscopic port, the introducer sheath having an internal through bore extending from the introducer external end to the introducer abdominal end, the introducer sheath providing a conduit for introduction of the instrument guide through the introducer sheath and into the bile duct.

3. The surgical laparoscopic port adapter assembly as defined in claim 1, further comprising:

one or more seals for sealing between the laparoscopic port and the instrument guide; and

one or more valves to control insufflation of the abdominal cavity and to prevent loss of pneumoperitoneum.

4. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein at least one of the plurality of instruments is selected from a group consisting of:

a choledochoscope for real-time viewing the bile duct procedure;

an occlusion balloon catheter including an occlusion balloon to fluidly isolate a first portion of the bile duct from a second portion of the bile duct;

a stone basket to facilitate removal of physiologic calculi;

an electro-hydraulic lithotripter to destroy physiologic calculi in suit;

a laser to destroy physiologic calculi in situ;

a papillatome to cut and enlarge the ampullae of vater; and

an irrigative catheter to selectively irrigate a portion of the bile duct.

5. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein one of the plurality of instruments is an irrigative balloon catheter to selectively isolate a first portion of the bile duct from a second portion of the bile duct while selectively irrigating a portion of the bile duct.

6. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein one of the plurality of instruments is a centralizer having a plurality of selectively radially expandable and collapsible segments to concentrically centralize one or more of the plurality of instruments inside of the bile duct.

7. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein the instrument guide includes at least three through channels.

8. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein the curved portion is oriented for positioning the plurality of instruments in a first portion of the bile duct an the instrument guide includes a backdoor channel oriented to position an instrument in a second portion of the bile duct.

9. The surgical laparoscopic port adapter assembly as defined in claim 1, further comprising:

instrument guide occlusion balloon adjacent the abdominal end of the instrument guide to hydraulically seal in an annular area between the bile duct and the instrument guide.

10. The surgical laparoscopic port adapter assembly as defined in claim 1, wherein the angled tip of the instrument guide has a concave geometry to facilitate receiving a stone during removal of the stone.

11. A surgical method of performing a bile duct procedure using a plurality of instruments, comprising:

inserting an abdominal end of a laparoscopic port through an abdominal wall and into an abdominal cavity to provide a conduit into an abdominal cavity;

inserting an instrument guide through the laparoscopic port until an abdominal end of the instrument guide is within the bile duct, the instrument guide having two or more through channels;

inserting each of two or more instruments into a respective one of the two or more through channels of the instrument guide, wherein one of the two or more instruments is a choledochoscope for real-time viewing the bile duct; and

extending each of the two or more instruments beyond the abdominal end of the instrument guide and into the bile duct to perform the bile duct procedure.

12. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an abdominal end of an introducer sheath through the laparoscopic port; and

extending the abdominal end of the introducer sheath below the abdominal end of the laparoscopic port to provide a conduit for introduction of the instrument guide through the introducer sheath and into the bile duct.

13. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

introducing pneumoperitoneum through the laparoscopic port and into the abdominal cavity to insufflate the abdominal cavity; and

controlling insufflation of the abdominal cavity by the pneumoperitoneum.

14. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an occlusion balloon catheter through one of the two or more through channels of the instrument guide, the occlusion balloon catheter being one of the two or more instruments; and

inflating the occlusion balloon catheter to fluidly isolate a first portion of the bile duct from a second portion of the bile duct.

15. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting a stone basket through one of the two or more through channels of the instrument guide, the stone basket being one of the two or more instruments; and

removing physiologic calculi with the stone basket.

16. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an electro-hydraulic lithotripter through one of the two or more through channels of the instrument guide, the electro-hydraulic lithotripter being one of the two or more instruments; and

destroying physiologic calculi in situ with the electro-hydraulic lithotripter.

17. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an irrigative catheter through one of the two or more through channels of the instrument guide, the irrigative catheter being one of the two or more instruments; and

selectively irrigating a portion of the bile duct using an irrigant fluid and the irrigative catheter to remove stones and debris.

18. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an irrigative balloon catheter through one of the two or more through channels of the instrument guide, the irrigative balloon catheter being one of the two or more instruments;

inflating an irrigative balloon catheter and selectively isolating a first portion of the bile duct from a second portion of the bile duct; and

selectively irrigating a first portion of the bile duct using an irrigant fluid to remove stones and debris.

19. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting a biopsy forceps through one of the two or more through channels of the instrument guide, the biopsy forceps being one of the two or more of the plurality of instruments; and

selectively removing a biopsy sample with the biopsy forceps.

20. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting one of the two or more instruments through one of the two or more through channels of the instrument guide; and

enlarging an opening in the ampullae of vater using the one of the two or more instruments to facilitate passage of stones.

21. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

providing at least three through channels in the instrument guide for introducing a plurality of instruments through the instrument guide and into the bile duct.

22. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting an instrument into the bile duct through a backdoor channel in the instrument guide, wherein a curved portion of the instrument guide is oriented for positioning of the plurality of instruments in a first portion of the bile duct and the instrument guide includes the backdoor channel oriented to position an instrument in a second portion of the bile duct opposite the first portion with respect to the curved portion of the instrument guide.

23. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

hydraulically sealing an annular area inside of the bile duct with an instrument guide occlusion balloon between a choledochotomy in the bile duct and the tip of the instrument guide with the instrument guide occlusion balloon substantially adjacent the abdominal end of the instrument guide.

24. The surgical method of performing a bile duct procedure as defined in claim 11, further comprising:

inserting a laser through one of the two or more through channels of the instrument guide, the laser being one of the two or more instruments; and

destroying physiologic calculi in situ with the laser.

25. A surgical laparoscopic port adapter assembly for conducting a bile duct procedure, comprising:

a laparoscopic port having an external end extending above an external surface of the abdominal wall and an abdominal end extending below an internal surface of the abdominal wall into an abdominal cavity, the laparoscopic port including an internal through bore extending between the external end and the abdominal end to provide a conduit into the abdominal cavity;

an instrument guide received within the laparo,copic port internal through bore and having an instrument guide external end and an instrument guide abdominal end, the instrument guide external end extending above the external surface of the abdominal wall and the instrument guide abdominal end extending below the laparoscopic port abdominal end and into the bile duct, the instrument guide further including two or more through channels, each through channel conveying and deploying one of a plurality of instruments; and

an introducer sheath received within the laparoscopic port internal through bore and having an introducer external end and an introducer abdominal end, the introducer external end extending above the external end of the laparoscopic port and the introducer abdominal end extending below the abdominal end of the laparoscopic port, the introducer sheath having an internal through bore extending from the introducer external end to the introducer abdominal end, the introducer sheath providing a conduit for introduction of the instrument guide through the introducer sheath and into the bile duct.

26. The surgical laparoscopic port adapter assembly as defined in claim 25, further comprising:

one or more seals for sealing between the laparoscopic port and the instrument guide; and

one or more valves to control insuffiation of the abdominal cavity to prevent loss of pneumoperitoneum.

27. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein one of the plurality of instruments is an irrigative balloon catheter to selectively isolate a first portion of the bile duct from a second portion of the bile duct while selectively irrigating a portion of the bile duct.

28. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein one of the plurality of instruments is a centralizer having a plurality of selectively radially expandable and collapsible segments to concentrically centralize one or more of the plurality of instruments inside of the bile duct.

29. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein the instrument guide includes at least three through channels.

30. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein the instrument guide includes a curved portion in an abdominal end of the instrument guide and an angled tip on the abdominal end of the instrument guide for ease of inserting the instrument guide into a choledochotomy in the bile duct, and the curved portion is oriented for positioning the plurality of instruments in a first portion of the bile duct and the instrument guide includes a backdoor channel oriented to position an instrument in an second portion of the bile duct.

31. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein one of the plurality of instruments is a choledochoscope for real-time viewing of the bile duct procedure.

32. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein at least one of the plurality of instruments is selected from a group consisting of:

a choledochoscope for real-time viewing the bile duct procedure;

an occlusion balloon catheter including an occlusion balloon to fluidly isolate a first portion of the bile duct from a second portion of the bile duct;

a stone basket to facilitate removal of physiologic calculi;

an electro-hydraulic lithotripter to destroy physiologic calculi in suit;

a laser to destroy physiologic calculi in situ;

a papillatome to cut and enlarge the ampullae of vater; and

an irrigative catheter to selectively irrigate a portion of the bile duct.

33. The surgical laparoscopic port adapter assembly as defined in claim 25, wherein the instrument guide includes an angled tip on an abdominal end of the instrument guide for ease of inserting the instrument guide into a choledochotomy in the bile duct, and the angled tip has a concave geometry to facilitate receiving a stone during removal of the stone.