System and method for multi-instrument surgical access using a single access port

• US 8,518,024 B2
• Filed: 05/17/2007
• Issued: 08/27/2013
• Est. Priority Date: 04/24/2006
• Status: Active Grant

• Current Assignee: Asensus Surgical US, Inc. (Asensus Surgical, Inc.)
• Original Assignee: TransEnterix, Inc.
• Inventors: Williams, Michael S., Stack, Richard S., Orth, Geoffrey A., Smith, Jeffrey A., Glenn, Richard A., Fifer, Daniel W., Athas, William L.
• Primary Examiner(s): ROANE, AARON F
• Application Number:
  US11/804,063
• Publication Number:
  US 20070299387A1
• Time in Patent Office: 2,294 Days
• Field of Search: 606/1, 606/139, 606/153, 606/205, 606/159, 606/194, 395/99, 600/102, 600/104, 600/109, 600/114, 600/117, 600/118, 600/217, 901/2, 901/3, 901/33, 901/34, 901/41, 901/44, 901/46
• US Class Current: 606/1
• CPC Class Codes: A61B 1/00052 positioned at proximal end of the endoscope body
• CPC Class Codes: A61B 1/00128 mechanical, e.g. for tubes or pipes
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/018 for receiving instruments
• 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3476 Powered trocars, e.g. electrosurgical cutting, lasers, powered knives
• CPC Class Codes: A61B 2017/00225 Systems for controlling multiple different instruments, e.g. microsurgical systems
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2906 Multiple forceps
• CPC Class Codes: A61B 2017/3407 including a base for support on the body
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3447 Linked multiple cannulas
• CPC Class Codes: A61B 2017/3486 Balloon
• CPC Class Codes: A61B 2090/372 Details of monitor hardware
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61M 2210/101 : Pleural cavity
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires

Abstract

A system for performing multi-tool minimally invasive medical procedures through a single instrument port into a body cavity includes an expandable frame that carries a pair of tool cannulas, each of which has a lumen for receiving a tool useable to perform a procedure in the body cavity. The frame is expandable to orient the tool cannulas such that they allow the tools to be used in concert to carry out a procedure at a common location in the body cavity.

Claims

1. A method of performing a minimally-invasive surgical procedure, comprising the steps of:

providing a surgical system, the surgical system including

an elongate rigid support having a distal end;

a mount on the rigid support;

first and second actuators on the mount, each actuator including a tool port;

a first tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the first actuator, and a lumen,

a second tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the second actuator, and a lumen;

forming an incision through skin of a patient into an underlying peritoneal cavity;

introducing a distal portion of the surgical system through the incision and into the peritoneal cavity by passing the distal portions of the tool cannulas and the distal end of the rigid support through the incision;

releasably attaching the surgical system to an operating room fixture and positioning the surgical system such that the mount is at least partially elevated relative to a height of the incision;

introducing an end effector of a first surgical instrument into the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the first tool cannula and into the peritoneal cavity, and further causing a proximal portion of the first surgical instrument to contact the first actuator;

introducing an end effector of a second surgical instrument into and through the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the second tool cannula and into the peritoneal cavity, and further causing a proximal portion of the second surgical instrument to contact the second actuator; and

steering the distal end of the first tool cannula by laterally moving a handle of the first instrument;

steering the distal end of the second tool cannula by laterally moving a handle of the second instrument; and

performing a surgical procedure on body tissue within the peritoneal cavity using the first and second instruments;

wherein

each actuator is provided to include a gimbal comprising

a distal member fixed to the mount and

a proximal member connected to pull cables extending through the corresponding one of the tool cannula and moveably coupled to the distal member, one of the distal and proximal members comprising a partially spherical socket member and the other of the distal and proximal members comprising a partially spherical ball member; and

steering the distal end of the first tool cannula includes laterally moving the handle of the first instrument to move the proximal member of the actuator relative to the distal member thereby activating the pull cables.

2. The method of claim 1, further including introducing a scope into a proximal opening in the elongate member.

3. The method of claim 1, wherein introducing a distal portion of the surgical system through the incision and into the peritoneal cavity includes positioning the system in an insertion position in which the distal portions of the tool cannulas extend distally from the distal end of the rigid support and are spaced apart by a first distance, passing the distal portions of the tool cannulas and the distal end of the rigid support through the incision, and then positioning the system in an expanded position in which the distal portions of the tool cannulas are spaced apart by a second distance that is greater than the first distance.

4. The method of claim 1, wherein releasably attaching the surgical system to an operating room fixture includes releasably coupling the mount to the operating room fixture.

5. The method of claim 1, wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a surgical table.

6. The method of claim 1, wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a cart.

7. The method of 1, wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a ceiling mounted support.

8. A method of performing a minimally-invasive surgical procedure, comprising the steps of:

providing a surgical system, the surgical system including

an elongate rigid support having a distal end;

a mount on the rigid support;

first and second actuators on the mount, each actuator including a tool port;

a first tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the first actuator, and a lumen,

a second tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the second actuator, and a lumen, and

a third cannula slidable relative to the elongate support, a first support member pivotally coupled between the third cannula and the distal portion of the first tool cannula, and a second support member pivotally connected between the third cannula and the distal portion of the second tool cannula, and

forming an incision through skin of a patient into an underlying peritoneal cavity;

introducing a distal portion of the surgical system through the incision and into the peritoneal cavity by passing the distal portions of the tool cannulas and the distal end of the rigid support through the incision;

releasably attaching the surgical system to an operating room fixture and positioning the surgical system such that the mount is at least partially elevated relative to a height of the incision;

introducing an end effector of a first surgical instrument into the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the first tool cannula and into the peritoneal cavity, and further causing a proximal portion of the first surgical instrument to contact the first actuator;

introducing an end effector of a second surgical instrument into and through the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the second tool cannula and into the peritoneal cavity, and further causing a proximal portion of the second surgical instrument to contact the second actuator; and

steering the distal end of the first tool cannula by laterally moving a handle of the first instrument;

steering the distal end of the second tool cannula by laterally moving a handle of the second instrument;

performing a surgical procedure on body tissue within the peritoneal cavity using the first and second instruments; and

longitudinally sliding the third cannula between first and second positions to cause the first and second support members to pivot outwardly relative to the third cannula and to thereby move the distal portions of the tool cannulas laterally outwardly relative to the third cannula.

9. The method of claim 8, wherein:

providing the surgical system includes providing the system to include a third member coupled between the elongate tube and the first tool cannula, and a fourth member coupled between the elongate tube and the distal portion of the second tool cannula, and

longitudinally sliding the third cannula between the first and second positions causes the third and fourth members to pivot relative to the elongate rigid member.

10. The method of claim 8, further including passing a distal end of a third instrument into a proximal end of the third cannula and through the third cannula into the body cavity, and using the third instrument in performing the surgical procedure.

11. The method of claim 8, wherein releasably attaching the surgical system to an operating room fixture includes releasably coupling the mount to the operating room fixture.

12. The method of claim 8, wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a surgical table.

13. The method of claim 8 wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a cart.

14. The method of claim 8, wherein releasably attaching the surgical system to an operating room fixture includes coupling the surgical system to a ceiling mounted support.

15. The method of claim 8, further including introducing a scope into a proximal opening in the elongate member.

16. A method of performing a minimally-invasive surgical procedure, comprising the steps of:

providing a surgical system, the surgical system including

an elongate rigid support having a distal end;

a mount on the rigid support;

first and second actuators on the mount, each actuator including a tool port;

a first tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the first actuator, and a lumen,

a second tool cannula having a distal portion extending distally from the distal end of the rigid support, a proximal portion coupled to the second actuator, and a lumen;

forming an incision through skin of a patient into an underlying peritoneal cavity;

positioning the system in an insertion position in which the distal portions of the tool cannulas extend distally from the distal end of the rigid support and are spaced apart by a first distance;

introducing a distal portion of the surgical system through the incision and into the peritoneal cavity by passing the distal portions of the tool cannulas and the distal end of the rigid support through the incision, and then positioning the system in an expanded position in which the distal portions of the tool cannulas are spaced apart by a second distance that is greater than the first distance

releasably attaching the surgical system to an operating room fixture and positioning the surgical system such that the mount is at least partially elevated relative to a height of the incision;

introducing an end effector of a first surgical instrument into the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the first tool cannula and into the peritoneal cavity, and further causing a proximal portion of the first surgical instrument to contact the first actuator;

introducing an end effector of a second surgical instrument into and through the tool port of the first actuator, and advancing the end effector to cause the end effector to pass into and through the lumen of the second tool cannula and into the peritoneal cavity, and further causing a proximal portion of the second surgical instrument to contact the second actuator; and

steering the distal end of the first tool cannula by laterally moving a handle of the first instrument;

steering the distal end of the second tool cannula by laterally moving a handle of the second instrument; and

performing a surgical procedure on body tissue within the peritoneal cavity using the first and second instruments;

wherein the distance between the distal end of each of the first and second tool cannulas and the distal end of the rigid support remains constant during movement of the system between the insertion position and the expanded position.