US20040158126A1 - Optical trocar - Google Patents

Abstract

The present invention relates to an optical obturator which includes a sleeve having a longitudinal bore between a proximal end and a distal end. The longitudinal bore of the sleeve is configured to receive at least a portion of an endoscope or like image transferring system. An image passing member, such as an optical window is positioned at the distal end of the sleeve and is provided to permit optical images to pass into the longitudinal bore of the sleeve and to permit illumination light to pass to the surgical site. An automatically retracting blade is positioned distal to the image passing member to facilitate penetration of body tissue.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application in a continuation-in-part of copending application Serial No. 08/120,489, filed Sep. 13, 1993.[0001]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0002]
• The present invention relates to an apparatus for penetrating and for observing penetration of body tissue. More particularly, the present invention relates to a trocar assembly having an endoscope or laparoscope inserted therethrough to provide visual observation during penetration of the peritoneum or other body tissue.[0003]
• 2. Description of the Related Art[0004]
• Endoscopic surgical procedures, that is, surgical procedures performed through tubular sleeves or cannulas, have been utilized for many years. Initially, endoscopic surgical procedures were primarily diagnostic in nature. More recently as endoscopic technology has advanced, surgeons are performing increasingly complex and innovative endoscopic surgical procedures. In endoscopic procedures, surgery is performed in any hollow viscus of the body through a small incision or through narrow endoscopic tubes (cannulas) inserted through small entrance wounds in the skin. In laparoscopic procedures surgery is performed in the interior of the abdomen.[0005]
• Laparoscopic procedures generally utilize instrumentation that is internally sealed to inhibit gases from entering or exiting th body through the laparoscopic or endoscopic incision. This is particularly true in surgical procedures in which the surgical region is insufflated. Moreover, laparoscopic and endoscopic procedures often require the surgeon to act on organs, tissues and vessels far removed from the incision, thereby requiring that any instruments to be used in such procedures be of sufficient size and length to permit remote operation. Typically, after the surgical region is insufflated, trocars are used to puncture the body cavity and include a cannula which remains in place for use during endoscopic procedures. Generally, trocars used during such procedures include a stylet having a sharp tip for penetrating the body cavity positioned coaxially within protective tubes to protect a patient or surgeon from inadvertent contact with the tip. An example of a known trocar is described in commonly assigned, U.S. Pat. No. 4,601,710 to Moll. Most currently used trocars rely on protective tubes or relative retraction of the tip to prevent inadvertent contact with tissue.[0006]
• The present invention provides a trocar assembly for observing the penetration of the peritoneum or other body portions. The trocar assembly of the present invention provides an improved window structure for passing optical images to an imaging system inserted into or formed within the trocar assembly, which provides a clear and bright image of the body tissue being penetrated. The assembly also includes a light pipe for passing illumination light to body tissue. In addition, the present invention provides an improved cutting tip for penetration of body tissue.[0007]
SUMMARY OF THE INVENTION
• The present invention relates to a trocar which includes a cannula assembly, an obturator assembly and an image passing system. The cannula assembly includes a cannula housing and a cannula sleeve extending from said cannula housing. The obturator assembly includes an obturator sleev having a proximal end, a distal end and a longitudinal bore therebetween which are configured for coaxial alignment with the cannula assembly.[0008]
• An image passing member is positioned at the distal end of the obturator sleeve and is provided to permit passage of optical images into the longitudinal bore of the sleeve and permit passage of illumination light to body tissue. A tissue penetrating member, such as a blade, is positioned adjacent the distal end of the obturator sleeve and distal to the image passing member and is preferably movable between non-deployed and deployed positions. The tissue penetrating member is configured to facilitate observation of body tissue simultaneous with penetration of body tissue.[0009]
• In the preferred embodiment, the image passing member is an optical with substantially flat surfaces for receiving optical images. Alternatively, the optical window includes at least one conical surface for receiving the optical images.[0010]
• Image transferring means, such as an endoscope, is preferably removably positioned within the longitudinal bore of the obturator sleeve and is provided to transmit illumination light through the image passing member to the surgical site and to transmit optical images from the image passing member to a proximal end of the obturator housing for subsequent viewing by the surgeon.[0011]
• The tissue penetrating blade is operatively associated with an actuating member positioned within the obturator housing. Preferably, the actuating member is configured to move th blade to a deployed position and to automatically moves the blade to a non-deployed position after the blade has been deployed.[0012]
• In th preferred embodiment, the actuating member includes a blade drive member slidably positioned within the obturator housing and operatively connected to the blade, and a trigger member which is pivotally connected to the obturator housing. An automatic release member is operatively associated with the trigger member and the blade drive member so that when the blade is moved to the deployed position, the release member actuates to facilitate movement of the blade to the non-deployed position.[0013]
BRIEF DESCRIPTION OF THE DRAWINGS
• The preferred embodiments of the invention are described hereinbelow with reference to the drawings wherein:[0014]
• FIG. 1 is a side elevational view in partial cross-section of the apparatus according to the present invention, illustrating an endoscope positioned within a trocar assembly having a movable cutting blade;[0015]
• FIG. 1A is an enlarged partial cross-sectional view of the distal end of the apparatus of FIG. 1, illustrating the cutting blade in a non-deployed position;[0016]
• FIG. 1B is an enlarged view of an alternate embodiment of the image passing member;[0017]
• FIG. 2 is an exploded perspective view of the instrument of FIG. 1 with parts separated, illustrating an actuating assembly for moving the cutting blade;[0018]
• FIG. 2A is an exploded perspective view of an image passing member and blade according to the present invention;[0019]
• FIG. 2B is a cross-sectional view of the obturator sleeve of the present invention;[0020]
• FIGS. 3 and 4 illustrate alternative embodiments for the configuration of the distal end portion of the trocar assembly according to the present invention;[0021]
• FIG. 5 is a side elevational view similar to FIG. 1, illustrating actuation of the trigger assembly to move the blade to a deployed position;[0022]
• FIG. 5A is an enlarged partial cross-sectional view of the distal end of the apparatus of FIG. 5, illustrating the cutting blade in the deployed position;[0023]
• FIGS.[0024]6-8 are side elevational views of an alternative embodiment of the blade actuation mechanism of the present invention; and
• FIG. 8A is a rear plan view of a portion of the automatic release member of the present invention.[0025]
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The apparatus of the present invention is provided to penetrate body tissue. e.g., the abdominal wall, and to provide a simultaneous forward directional view of the body tissue being penetrated. In the preferred embodiment, the apparatus includes a[0026]trocar assembly10 having anobturator assembly12 and acannula assembly14, and anendoscope16 which is positioned within the obturator assembly to provide observation of the body tissue being penetrated. The term obturator assembly as used herein refers to the tissue penetrating assembly of the trocar assembly.
• Referring to FIGS. 1 and 2,[0027]obturator assembly12 includeshousing18 and a longitudinally extendingobturator sleeve20. Preferably,obturator housing18 includesbarrel portion19 andhand grip21. The proximal end ofobturator sleeve20 is secured withinchannel22 ofbarrel portion19 so that theobturator sleeve20 extends outwardly from theobturator housing18.Hand grip21 is provided for manual gripping to facilitate penetration of the body tissue.obturator sleeve20 has alongitudinal bore24 which extends between the proximal end and distal end. Thelongitudinal bore24 is configured and dimensioned to receive theendoscopic portion26 of theendoscope16, as shown in FIG. 1.
• Referring to FIGS. 2, 3 and[0028]4, animage passing member28 is secured to the distal end ofobturator sleeve20 via retainingring30. In one embodiment, the image passing member is a transparent optical window fabricated from a variety of materials such as polystyrene, polymethylmethacrylate (PMMA), polyurethane, transparent epoxies and/or glass or other transparent materials. (When made of plastic material, the cost is reduced.) The window, as shown in FIG. 3, includes a set of four substantially flat surfaces29a,29b,29cand29d.In this embodiment the flat surfaces of the optical window permit passage of the optical image into the longitudinal bore of the obturator sleeve so as to provide a clear image. The image passing member may alternately include a set of two conical surfaces29eand29f,shown in FIG. 4, which pass an optical image into thelongitudinal bore24 ofobturator sleeve20.
• In another embodiment, the image passing member is an image directing member. In this configuration, optical images which impinge the distal end[0029]28aofimage directing member28 are directed intolongitudinal bore24 ofobturator sleeve20. The image directing member may be a lens, an optical prism, an optical mirror, or like image directing medium and is preferably configured to allow close to a 360° forward angle of view. In the preferred embodiment,image directing member28 is a prism which includes a set of four substantiallyflat surfaces28b,28c,28dand28e,as shown in FIG. 3. The corresponding inner surfaces are also preferably substantially flat. The flat surfaces direct the optical image into the longitudinal bore of the obturator sleeve so as to provide a clear image. Alternatively, the image directing member is a lens which includes a set of twoconical surfaces28fand28gwhich direct an optical image into thelongitudinal bore24 of obturator sleeve20 (see FIG. 4).
• The image passing member also allows for passage of illumination light from the[0030]obturator sleeve20 to body tissue. As shown in FIG. 1B, the passage member can be in the form oflight pipe90 having an angled surfaces92. Alternatively, the surfaces can be straight or angled other than that shown to achieve the purpose of allowing illumination light to pass therethrough. The image passing member, e.g. the window, and the light pipe can have spherical or conical surfaces and can be integral as shown. Alternatively, they can be formed as two separate parts, i.e. one channel for illumination and another for imaging. In a preferred embodiment, thelight pipe90 is cylindrical in configuration to accommodate the annular array of fiber optic elements of the endoscope described below.
• The image passing member is shown having a convex outer surface, however, other configurations can be utilized.[0031]
• Referring again to FIG. 2, the cutting[0032]portion32 ofobturator assembly12 includes acutting blade34 connected to actuating assembly36. Actuating assembly36 is provided to moveblade34 between a non-deployed position (FIG. 1A) and a deployed position (FIG. 5A) which will be described in more detail below. Thecutting blade34 is preferably centered with respect to the outer surface of the image passing member as shown. Thus, in visualization, the cutting blade is seen as a thin line through the center, i.e. bisecting, the viewing field so as not to obstruct viewing of the body.
• Actuating assembly[0033]36 includesblade pusher arms38 and40,blade drive member42,drive spring44 andtrigger46.Blade34 can be formed as an integral piece withblade drive member42 and/orblade arms38,40. Alternatelyblade34 can be connected such as by welding, to the distal end ofblade pusher arms38 and40 which extend along the longitudinal axis ofobturator sleeve20 withinslots39 and41 inobturator sleeve20, shown in FIG. 2B. The proximal end ofblade pusher arms38 and40 are secured withinslots43 and45 ofblade drive member42, as shown.Blade drive member42 and drivespring44 are positioned withinchannel22 ofobturator housing18 so thatdrive spring44 normally biasesblade drive member42 toward the proximal end ofobturator housing18, thus biasingblade34 to the proximal non-deployed position.
• [0034]Trigger46 is pivotally secured toobturator housing18 viapin47, as shown, so thatcamming surface48 oftrigger46 engages theproximal end portion42aofblade drive member42. Thus, actuation oftrigger46, i.e. movement in the direction of the arrow in FIG. 5, causescamming surface48 to engageblade drive member42 and move the drive member distally withinchannel22. Distal movement ofdrive member42 causesblade pusher arms38 and40 to move distally to moveblade34 distally to the deployed (extended) position. Release oftrigger46permits blade34 to return to the non-deployed position in response to the action ofdrive spring48 forcingblade drive member42 proximally.
• The movement of[0035]blade34 between non-deployed and deployed positions can be seen by comparing FIGS. 1 and 5. As shown in FIGS. 1 and 1A, in the non-deployed position theblade34 is at rest within recess50 (FIG. 2A) inimage directing member28. In the deployedposition blade34 is extended from recess50 beyond the distal end ofcannula assembly14, as shown in FIG. 5.
• In an alternative embodiment shown in FIGS.[0036]6-8, an automatic release member is associated withblade drive member42 andtrigger46 and is provided to automatically returnblade34 to the non-deployed position after the blade is deployed. That is, theblade34 returns to its initial undeployed position without requiring release of thetrigger46.
• [0037]Trigger46 is pivotally secured toobturator housing18 viapin47 andlever80 is pivotally secured to trigger46 vialever pin82.Spring41 biases trigger46 distally.Lever spring84 is secured to trigger46 at one end84a and is positioned aroundpin47, as shown. The biasingarm84b oflever spring84 engagescrossbar86 oflever80 and is provided to pivotlever80 clockwise a predetermined angular distance, such as 12°.Lever bushing68 is secured to the upper portion ofblade drive member42, as shown, and is provided to engagelever80. Whentrigger46 is in the armed position, i.e., trigger46 is ready for actuation,lever80 is biased upward bylever spring84 so that the upper portion oflever80 engageslever bushing88, as shown in FIG. 6.
• Referring to FIG. 7, actuation of[0038]trigger46, i.e., movement of the trigger in the proximal direction, causeslever80 to moveblade drive member42 distally to compressdrive spring44 and to advanceblade34 to the deployed position, shown in FIG. 5A.Lever80 pivots counter-clockwise with the actuation oftrigger46.
• Referring now to FIG. 8, further movement or actuation of[0039]trigger46 in the proximal direction causeslever80 to continue to pivot counter-clockwise so that the portion oflever80 engaginglever bushing88 disengages therefrom. As a result,blade drive member42 moves proximally under the action ofdrive spring44 to moveblade34 to the non-deployed position, shown in FIG. 1. Once the blade is in the non-deployed position, theimage passing member28 prohibits further proximal movement ofblade drive member42 as described above.Lever80 also prevents such proximal movement. Tore-arm lever80,trigger46 is released.Trigger46 is consequently forced clockwise byspring41 causinglever80 to pivot clockwisepast bushing88 as it is pulled slightly proximally by such clockwise movement oftrigger46. Whentrigger46 returns to the original. i.e. actuation, position of FIG. 6,lever spring84biases lever80 clockwise to a position which permits engagement withlever bushing88.
• Referring again to FIG. 2,[0040]cannula assembly14 includescannula housing52 andcannula sleeve54 secured to thecannula housing52 and extending outwardly therefrom.Obturator housing18 includesbushing56 which is configured and dimensioned to interfit with the proximal end ofcannula housing52, as shown in FIG. 1, so thatobturator sleeve20 coaxially aligns withcannula sleeve54 when the two assemblies are interfitted. Thecannula sleeve54 is adapted to remain in the body after penetration and subsequent removal of the obturator assembly12 (and endoscope10) to allow insertion of appropriate endoscopic/laparoscopic instrumentation therethrough.
• To maintain a gas tight seal within the cannula housing, a sealing member or system may be positioned therewithin which is adapted to receive the[0041]obturator assembly12 of the present invention as well as other endoscopic surgical instruments. One example of a suitable sealing system utilizes a duckbill sealing member. A more detailed description of an exemplary cannula assembly and sealing system is found in U.S. Pat. No. 5,180,373 issued Jan. 19, 1993, which is incorporated herein by reference.
• Referring to FIGS. 1A and 2,[0042]endoscope16 includesendoscopic portion26 and endoscope housing58.Endoscopic portion26 is configured to transfer illuminating light from endoscope housing58 to the distal end of the endoscopic portion to provide illuminating light to the operative site. In an exemplary configuration,endoscopic portion26 includes an outer sheath60 and an annular array of fiber optic elements62 extending betweenlight source connector64 of endoscope housing58 and the distal end of outer sheath60 to illuminate the operative site. Any known light source may be connected toconnector64 to provide the illuminating light. In addition,endoscopic portion26 includes an image transferring system66 which may include CCD's, a bundle of fiber optic elements or objective lenses which transfer an optical image to eyepiece68 for viewing. Alternatively, a video system including a monitor may be operatively connected to housing58 to provide a video image of the body tissue being penetrated. Preferably, the fiber optic elements62 are positioned adjacent the inner wall of the outer sheath so as to surround the image transferring system. In this configuration, illumination light from the endoscope is passed through the light pipe portion of image passing member and optical images which impinge on theimage passing member28 pass into the image transferring system and relayed toeyepiece68. An example of an endoscope which can be utilized is described in U.S. Pat. No. 4,964,710 incorporated herein be reference.
• In operation,[0043]endoscope16 is inserted into thetrocar assembly10, i.e. intolongitudinal bore24 ofobturator sleeve20, as shown in FIG. 1. The surgeon then positions theblade34 against the body tissue and may continuously moveblade34 between the non-deployed and deployed positions, i.e., reciprocally movingblade34, via actuatingassembly32. Pressure is applied tohand grip21 in the distal direction to penetrate the body tissue. The movement ofblade34 facilitates cutting of the body tissue, thus permitting the surgeon to apply relatively minimal pressure to handgrip21 to penetrate the body tissue.
• During penetration of the body tissue the surgeon either observes such penetration through[0044]eyepiece68, or in instances where a video system is utilized the surgeon simply observes the penetration of the body tissue via any known video monitor.
• Once the surgeon penetrates the body tissue as observed through[0045]endoscope16, the surgeon releases trigger46 to permitblade34 to return to the non-deployed position and discontinues application of pressure to handgrip21. According to the above-described alternative embodiment for the trigger arrangement, once thetrigger46 is fully actuated,blade34 automatically returns to the non-deployed position and release oftrigger46 re-arms the automatic release member.
• In operation, the surgeon may also more selectively deploy the[0046]blade34 during penetration. That is, the surgeon may insert the trocar assembly and bluntly penetrate the body tissue until reaching thicker tissue, such as muscle. At this point, the blade can be deployed to penetrate (cut through) this thick tissue, then retracted to provide blunt penetration until thick tissue is again encountered where once again the blade can be deployed.
• After penetration into the body cavity, both the[0047]endoscope16 and theobturator assembly12 are removed from thecannula assembly14, leaving thecannula assembly14 in the body for insertion of desired instrumentation therethrough.
• In an alternate embodiment, the[0048]obturator assembly12 andendoscope16 or optical components thereof can be a single unit inserted intocannula assembly14. For example, the obturator assembly can be manufactured with illumination optics and/or imaging optics positioned therein so that the obturator assembly itself can function to penetrate tissue as well as to light the surgical site and transmit images to the video monitor. In this version, th obturator would not have a longitudinal bore and it would be sealed.
• Additionally, in an alternate embodiment of the penetrating blade member, the blade member can be fixedly attached to the obturator assembly so that it remains in an exposed position. The blade or cutting member can also alternatively be movable in directions other than longitudinally as described above, such as transverse to the longitudinal axis, or the blade can vibrate.[0049]
• It will be understood that various modifications can be made to the embodiments of the present invention herein disclosed without departing from the spirit and scope thereof. For example, various diameters for the cannula assembly, the obturator assembly, as well as various diameter endoscopes are contemplated. Also, various modifications may be made in the configuration of the parts. Therefore, the above description should not be construed as limiting the invention but merely as exemplifications of preferred embodiments thereof. Those skilled in the art will envision other modifications within the scope and spirit of the present invention as defined by the claims appended hereto.[0050]

Claims (12)

1. A trocar, comprising:

a cannula;

an obturator configured for insertion into said cannula, said obturator having a proximal end, and a distal end;

a member at said distal end of said obturator, said member having a recess;

a cutting blade for penetrating body tissue positioned at said distal end of said obturator, said cutting blade being movable between a non-deployed position, in which said blade is disposed in said recess, and a deployed position, in which said blade is extended from said recess; and

an actuator operatively connected to said cutting blade, said actuator selectively movable to move the cutting blade between the non-deployed position and the deployed position.

2. The trocar ofclaim 1, wherein said blade is spring biased to the non-deployed position.

3. The trocar ofclaim 1, wherein said obturator comprises a sleeve having a longitudinal bore.

4. The trocar ofclaim 3, wherein said longitudinal bore is configured to receive an endoscope.

5. The trocar ofclaim 1, further comprising a blade drive member connected to said blade and said actuator.

6. The trocar ofclaim 5, wherein said blade drive member has a camming surface which engages said blade drive member and moves said blade drive member in response to movement of said trigger member.

7. The trocar ofclaim 5, wherein the actuating mechanism includes a trigger.

8. The trocar ofclaim 7, wherein the trigger has a camming surface arranged to engage the blade drive member.

9. The trocar ofclaim 8, wherein actuation of the trigger in the proximal direction moves the blade drive member distally.

10. The trocar ofclaim 9, wherein further actuation of the trigger disengages the trigger from the blade drive member.

11. The trocar ofclaim 10, wherein the blade is biased in the proximal direction so that when the trigger is disengaged from the blade drive member, the blade moves to the non-deployed position.

12. The trocar ofclaim 11, further comprising a lever associated with the trigger and a lever bushing associated with the blade drive member so that actuation of the trigger in the proximal direction moves the lever, moving the blade drive member distally and wherein further actuation of the trigger disengages the lever from the lever bushing.

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