System and method for multi-instrument surgical access

• US 8,919,348 B2
• Filed: 01/17/2011
• Issued: 12/30/2014
• Est. Priority Date: 04/24/2006
• Status: Active Grant

• Current Assignee: Asensus Surgical US, Inc. (Asensus Surgical, Inc.)
• Original Assignee: TransEnterix Surgical, LLC
• Inventors: Williams, Michael S., Stack, Richard S., Orth, Geoffrey A., Smith, Jeffrey A., Glenn, Richard A., Fifer, Daniel W., Athas, William L., Pryor, Aurora
• Primary Examiner(s): ROANE, AARON F
• Application Number:
  US13/007,974
• Publication Number:
  US 20110118545A1
• Time in Patent Office: 1,443 Days
• Field of Search: 606/1, 606/139, 606/153, 606/205, 606/159, 606/194, 395/82, 395 83- 96, 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, 128/898
• US Class Current: 128/898
• 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 a rigid tube carried by a mount. Cannulas having instrument channels and steerable distal ends extend distally from the rigid tube. During a procedure using the system, the mount is supported by an operating room fixture, and instruments are advanced through the steerable instrument channels. Manipulation of the instrument handles engages actuators positioned on the mount, which steer the distal ends of the cannulas through the action of pull cables. The distal ends of the instruments may thus be steered within the body by the distal ends of the steerable cannulas.

Claims

1. A method of performing a minimally invasive medical procedure within a body cavity, comprising the steps of:

providing an access system including a mount, a rigid tube having a distal end and first and second cannulas extending from the distal end, and first and second actuators fixed to the mount;

forming a percutaneous incision;

advancing a distal end of the rigid tube through the incision to position the distal ends of the rigid tube and the cannulas within the body cavity;

attaching the mount to an operating room fixture, the mount maintaining the position of the rigid tube in the incision;

introducing a first end effector of a first instrument into a port on the first actuator, and advancing the end effector through the first cannula and out the distal end of the first cannula;

introducing a second end effector of a second instrument into a port on the second actuator, and advancing the end effector through the second cannula and out the distal end of the second cannula;

manipulating the handles of the first and second instruments, the handles engaging the actuator to deflect distal portions of the cannulas, said deflection altering the orientation of the instruments within the body cavity; and

performing a procedure in the body cavity using the end effectors.

2. The method of claim 1, wherein engaging each actuator applies tension to pull cables extending between the actuator and the distal portion of the corresponding cannula.

3. The method of claim 2, wherein each second actuators comprises a gimbal having a distal member fixed to the mount and a proximal member connected to the pull cables and moveably coupled to the distal member, and wherein engaging the actuator moves the proximal member relative to the distal member.

4. The method of claim 3, wherein one of the distal and proximal members comprises a partially spherical socket and the other of the distal and proximal members comprises a partially spherical ball, and wherein engaging the actuator cause relative articulating of the partially spherical socket and the partially spherical ball.

5. The method of claim 1, further including introducing a distal end of a scope into a proximal opening on the mount, and advancing the scope distally, wherein advancing the scope distally advances the distal end of the scope through the rigid tube.

6. The method of claim 5, further including intruding a distal end of a third instrument into a proximal opening on the mount, and advancing the distal end of the third instrument distally, wherein advancing the third instrument distally advances the distal end of the third instrument through the rigid tube.

7. The method of claim 1, further including the step of locking the first or second actuator to retain the first or second cannula in a deflected position.

8. The method of claim 7, further including the step of, with the first or second cannula retained in the deflected position, withdrawing the tool from the retained cannula and inserting a different tool into the retained cannula.

9. The method of claim 1, further including:

positioning the distal portions of the first and second cannulas in a first, side by side, arrangement prior to advancing the rigid tube through the incision, and then increasing the lateral distance between the distal portions of the first and second cannulas after the advancing step.

10. The method of claim 1, wherein first and second handles are manipulated using the right and left hands of a single user.

11. The method of claim 1, wherein the system includes a third cannula within the rigid tube and having a distal end extending from the rigid tube, and wherein the method includes introducing a distal end of a third instrument into a proximal opening on the mount, and advancing the third instrument distally to advance the distal end into and through the third cannula.

12. The method of claim 1, wherein performing a procedure includes performing a procedure selected from the group consisting of appendectomy, hysterectomy, ovary removal, cholecystectomy, prostatectomy and resection, bypass, or anastomosis of the bowel.

13. The method of claim 1, further including:

introducing a distal end of a third instrument through the mount and the rigid tube and into the body cavity;

introducing a distal end of a fourth instrument through the mount and the rigid tube and into the body cavity;

and using the distal ends of the first, second, third and fourth instruments to carry out the procedure.